Research

13 pages, 1945 KiB

Open AccessArticle

Ventricular and Atrial Remodeling after Transcatheter Edge-to-Edge Repair: A Pilot Study

by Alessandro Albini, Matteo Passiatore, Jacopo Francesco Imberti, Anna Chiara Valenti, Giulio Leo, Marco Vitolo, Francesca Coppi, Fabio Alfredo Sgura and Giuseppe Boriani

J. Pers. Med. 2022, 12(11), 1916; https://doi.org/10.3390/jpm12111916 - 16 Nov 2022

Cited by 3 | Viewed by 1370

Abstract

Background: The aim of this study was to determine the impact of transcatheter edge-to-edge repair (TEER) on left and right ventricular (LV, RV) and left and right atrial (LA, RA) remodeling according to the mechanism of mitral regurgitation (MR) and history of atrial [...] Read more.

Background: The aim of this study was to determine the impact of transcatheter edge-to-edge repair (TEER) on left and right ventricular (LV, RV) and left and right atrial (LA, RA) remodeling according to the mechanism of mitral regurgitation (MR) and history of atrial fibrillation (AF). Methods: Twenty-four patients (mean age 78.54 years ± 7.64 SD; 62.5% males) underwent TEER at our center. All the patients underwent echocardiography 1.6 ± 0.9 months before the procedure and after 5.7 ± 3.5 months; functional MR accounted for 54% of cases. Results: Compared to baseline, a statistically significant improvement in LV end-diastolic diameter (LVEDD), LV indexed mass (ILVM), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), indexed LA volume (iLAV), and morpho-functional RV parameters was recorded. LVEDD and LVEDV improved in primary MR cohort, whereas in secondary MR, a significant reduction in LVEDV and LVESV was found without a significant functional improvement. LA reverse remodeling was found in organic MR with a trend toward ameliorated function. Furthermore, a significant reduction of LA volumetry was detected only in patients without history of AF (AF baseline 51.4 mL/m² IQR 45.6–62.5 mL/m² f-u 48.9 mL/m² IQR 42.9–59.2 mL/m²; p = 0.101; no AF baseline 43.5 mL/m² IQR 34.2–60.5 mL/m² f-u 42.0 mL/m² IQR 32.0–46.2 mL/m²; p = 0.012). As regards right sections, the most relevant reverse remodeling was obtained in patients with functional MR with a baseline poorer RV function and more severe RA and RV dilation. Conclusion: TEER induces reverse remodeling involving both left and right chambers at mid-term follow-up. To deliver a tailored intervention, MR mechanism and history of AF should be considered in view of the impact on remodeling process. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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13 pages, 986 KiB

Open AccessArticle

The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study

by Maurizio Gasparini, Mauro Biffi, Maurizio Landolina, Giuseppe Cattafi, Roberto Rordorf, Giovanni Luca Botto, Giovanni Battista Forleo, Giovanni Morani, Luca Santini, Antonio Dello Russo, Antonio Rossillo, Sarah Meloni, Andrea Grammatico, Marco Vitolo and Giuseppe Boriani

J. Pers. Med. 2022, 12(9), 1512; https://doi.org/10.3390/jpm12091512 - 15 Sep 2022

Cited by 2 | Viewed by 1629

Abstract

Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV [...] Read more.

Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV reverse remodeling (>15% relative reduction in LV end-systolic volume). Methods. Among 2224 patients with CRT defibrillators, 1718 (77.2%) had a device programmed at out-of-the-box settings (sensed AV delay: 100 ms and paced AV delay: 130 ms). Results. In this cohort of 1718 patients (78.7% men, mean age 66 years, 71.6% in NYHA class III/IV, LVEF = 27 ± 6%), echocardiographic assessment at 6-month follow-up showed that LV reverse remodeling was not constant as a function of the PR interval; in detail, it occurred in 56.4% of all patients but was more frequent (76.6%) in patients with a PR interval of 160 ms. In a median follow-up of 20 months, the endpoint of death or HF hospitalizations occurred in 304/1718 (17.7%) patients; in the multivariable regression analysis it was significantly less frequent when the PR interval was between 150 and 170 ms (hazard ratio = 0.79, 95% confidence interval (CI): 0.63–0.99, p = 0.046). The same PR range was associated with higher probability of CRT response (odds ratio = 2.51, 95% CI: 1.41–4.47, p = 0.002). Conclusions. In a large population of CRT patients, with fixed AV pacing delays, specific PR intervals are associated with significant benefits in terms of LV reverse remodeling and lower morbidity. These observational data suggest the importance of optimizing pacing programming as a function of the PR interval to maximize CRT response and patient outcome. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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17 pages, 1417 KiB

Open AccessArticle

Relationship between Body Composition and Cardiac Autonomic Regulation in a Large Population of Italian Olympic Athletes

by Daniela Lucini, Antonio Spataro, Luca Giovanelli, Mara Malacarne, Raffaella Spada, Gianfranco Parati, Nadia Solaro and Massimo Pagani

J. Pers. Med. 2022, 12(9), 1508; https://doi.org/10.3390/jpm12091508 - 14 Sep 2022

Viewed by 1356

Abstract

Athletic performance is determined by many factors, such as cardiorespiratory fitness, muscular strength and psychological features, which all interact simultaneously. The large Italian National Olympic Committee database of Olympic athletes offers a unique healthy population to verify the strength of the interplay among [...] Read more.

Athletic performance is determined by many factors, such as cardiorespiratory fitness, muscular strength and psychological features, which all interact simultaneously. The large Italian National Olympic Committee database of Olympic athletes offers a unique healthy population to verify the strength of the interplay among a number of major elements of training, including autonomic nervous system (ANS) modulation, biochemical indicators and body composition, in a system medicine approach. This observational, retrospective study involved 583 individuals. As part of the yearly precompetitive examination, cardiac autonomic (heart rate variability), psychological, physical (cycloergometer stress test), biochemical and body composition (BOD POD) evaluations were performed. In subsequent analysis, we first considered the relationship between body composition and single individual variables in a simple correlation matrix, including a multitude of variables; then, Exploratory Factor Analysis (EFA) restricted the information to six latent domains, each combining congruent information in relation to body composition. Finally, we employed a multiple quantile regression model to evaluate possible relationships between ANSIs (index capable of synthetizing ANS regulation) and the latent domains indicated by EFA reflecting body composition. We observed a clear relationship between ANS and body mass composition parameters, as indicated by both bivariate correlations and the quantile regression result of ANSIs versus the latent domain aggregating mainly body composition data expressed in % (p = 0.002). In conclusion, these results suggest that specific training may elicit parallel adaptation of ANS control and body composition. The analysis of Olympic athletes’ data allowed us to obtain a better understanding of the complex, multidimensional factors involved in determining sport performance. The latter appears to be determined by the simultaneous interaction not only of cardiorespiratory fitness, muscular strength and psychological features, but also of ANS cardiovascular modulation and body composition. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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9 pages, 365 KiB

Open AccessArticle

Current Use of Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation: Results from an Italian Multicenter Prospective Study—The ISNEP Study

by Francesco De Stefano, Alberto Benassi, Alberto Maria Cappelletti, Francesco Donatelli, Damiano Regazzoli, Salvatore Tolaro, Francesca Perego, Angelo Silverio, Alessandra Scatteia, Pasquale Guarini, Santo Dellegrottaglie, Simona Mariani, Elpidio Pezzella, Gennaro Galasso, Francesco Caiazza and on behalf of ISNEP Investigators

J. Pers. Med. 2022, 12(9), 1419; https://doi.org/10.3390/jpm12091419 - 31 Aug 2022

Cited by 1 | Viewed by 1473

Abstract

Background: Atrial fibrillation (AF) is the most common heart arrhythmia, and its prevalence increases with age. Oral Anticoagulant Therapy (OAT) with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) is essential to avoid thromboembolic events in AF. However, this treatment [...] Read more.

Background: Atrial fibrillation (AF) is the most common heart arrhythmia, and its prevalence increases with age. Oral Anticoagulant Therapy (OAT) with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) is essential to avoid thromboembolic events in AF. However, this treatment is associated with a high risk of bleeding and low adherence in elderly patients. Aim: The aim was to evaluate the real-world use of OAT in a population of patients aged ≥80 years in twenty-three Italian centers and to investigate the tolerance of and patient satisfaction with this therapy. Methods: The ISNEP Study is a multicenter cross-sectional study enrolling patients with AF and aged ≥80 years and treated with either NOACs or VKAs. A written questionnaire was administered to each patient to evaluate the adherence to and patient satisfaction with this therapy. Results: The study included 641 patients with a mean age of 85 (82–87) years. The use of NOACs was reported in 93.0% of cases, with the remaining 7.0% treated with VKAs. A history of stroke events was reported in five (11.1%) and one (0.2%) patients in the VKA and NOAC groups, respectively. The rate of referred ecchymosis/epistaxis was significantly higher in the VKA group compared to the NOAC group (p < 0.001). Patients receiving NOACs reported a substantial improvement in their quality of life compared to the VKA group. Conclusions: A small, but not negligible, proportion of elderly AF patients is still treated with VKAs. Patients treated with NOAC have a higher level of satisfaction with the therapy and complete adherence. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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13 pages, 654 KiB

Open AccessArticle

Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study

by Luca Giovanelli, Carlo Palombo, Matteo Pina, Simone Facchetti, Mara Malacarne, Massimo Pagani, Monica Nannipieri, Rossana Berta and Daniela Lucini

J. Pers. Med. 2022, 12(8), 1317; https://doi.org/10.3390/jpm12081317 - 15 Aug 2022

Cited by 2 | Viewed by 1614

Abstract

Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the [...] Read more.

Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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15 pages, 1477 KiB

Open AccessArticle

Determinants of Left Atrial Compliance in the Metabolic Syndrome: Insights from the “Linosa Study”

by Paolo Barbier, Edvige Palazzo Adriano, Daniela Lucini, Massimo Pagani, Gaspare Cusumano, Beatrice De Maria and Laura Adelaide Dalla Vecchia

J. Pers. Med. 2022, 12(7), 1044; https://doi.org/10.3390/jpm12071044 - 27 Jun 2022

Cited by 2 | Viewed by 1563

Abstract

The association between left atrial (LA) impairment and cardiovascular diseases (CVD) and between dyslipidaemia and CVD are well known. The present study aims to investigate the relationships between metabolic factors and LA dimensions and compliance, as well as test the hypothesis that metabolic [...] Read more.

The association between left atrial (LA) impairment and cardiovascular diseases (CVD) and between dyslipidaemia and CVD are well known. The present study aims to investigate the relationships between metabolic factors and LA dimensions and compliance, as well as test the hypothesis that metabolic factors influence LA function independent from hemodynamic mechanisms. Arterial blood pressure (BP), waist and hip circumference, metabolic indices, and a complete echocardiographic assessment were obtained from 148 selected inhabitants (M/F 89/59; age 20–86 years) of Linosa Island, who had no history of CVD. At enrollment, 27.7% of the subjects met the criteria for metabolic syndrome (MetS) and 15.5% for arterial hypertension (HTN). LA compliance was reduced in subjects with MetS compared to those without (53 ± 27% vs. 71 ± 29%, p = 0.04) and was even lower (32 ± 17%, p = 0.01) in those with MetS and HTN. At multiple regression analysis, the presence of MetS independently determined LA maximal area (r = 0.56, p < 0.001), whereas systolic BP and the total cholesterol/HDL cholesterol ratio determined LA compliance (r = 0.41, p < 0.001). In an apparently healthy population with a high prevalence of MetS, dyslipidaemia seems to independently influence LA compliance. At a 5-year follow-up, LA compliance was reduced in both all-cause and CVD mortality groups, and markedly impaired in those who died of CVD. These findings may contribute to understanding the prognostic role of LA function in CVD and strengthen the need for early and accurate lipid control strategies. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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11 pages, 868 KiB

Open AccessArticle

Acute Left Atrial Response to Different Eccentric Resistance Exercise Loads in Patients with Heart Failure with Middle Range Ejection Fraction: A Pilot Study

by Giuseppe Caminiti, Marco Alfonso Perrone, Ferdinando Iellamo, Valentino D’Antoni, Matteo Catena, Alessio Franchini and Maurizio Volterrani

J. Pers. Med. 2022, 12(5), 689; https://doi.org/10.3390/jpm12050689 - 26 Apr 2022

Cited by 4 | Viewed by 1750

Abstract

In this study, we aimed to assess acute changes occurring on atrial function following single bouts of eccentric resistance exercise (ECC-RE) performed at two different loads. Twenty-five patients with chronic heart failure with middle range ejection fraction (HFmrEF) participated in three experimental sessions [...] Read more.

In this study, we aimed to assess acute changes occurring on atrial function following single bouts of eccentric resistance exercise (ECC-RE) performed at two different loads. Twenty-five patients with chronic heart failure with middle range ejection fraction (HFmrEF) participated in three experimental sessions in a randomized order and on separate days: two sessions of ECC RE at 20% (ECC-20) of one-repetition maximum (1-RM) and 50% (ECC-50) 1-RM, and one session of control, without exercise. Each session lasted three minutes. Before and immediately after the sessions, patients underwent echocardiography and blood pressure and heart rate measurement. Peak atrial longitudinal strain (PALS) and peak atrial contractile strain (PACS) significantly increased after both ECC-20 (+16.3%) and ECC-50 (+18.1%) compared to control (between sessions p = 0.022). Peak atrial contractile strain (PACS) significantly increased after ECC-50 (+28.4%) compared to ECC-20 (+17.0%) and control (between sessions p = 0.034). The ratio of transmitral and annular velocities (E/E’) increased significantly after ECC-20 (+10.4%) and ECC-50 (+19.0%) compared to control (between groups p = 0.003). EF, left ventricular longitudinal strain, and stroke volume did not change after ECC-RE sessions compared to control. Cardiac output increased significantly after ECC-20 and ECC-50 compared to control, (between groups p = 0.025). In conclusion, both ECC-RE sessions were well tolerated, and LA functional reserve was properly mobilized in response to ECC-RE in patients with HFmrEF. Cardiac output increased at the cost of an increased LV filling pressure, but no detrimental changes of LV function occurred. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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14 pages, 1505 KiB

Open AccessArticle

Surgical Ventricular Restoration for Ischemic Heart Failure: A Glance at a Real-World Population

by Serenella Castelvecchio, Valentina Milani, Federico Ambrogi, Marianna Volpe, Lucia Ramputi, Giovanni Soletti, Jr. and Lorenzo Menicanti

J. Pers. Med. 2022, 12(4), 567; https://doi.org/10.3390/jpm12040567 - 02 Apr 2022

Viewed by 1765

Abstract

Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From [...] Read more.

Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m² versus 118.3 mL/m², p < 0.0001) and the end-systolic volume (70.5 mL/m² versus 81.5 mL/m², p < 0.0001) were lower in Group I. The presence of 3-vessel coronary artery disease (CAD) was higher in Group I (73.3% versus 59.2%, p < 0.0001). Thirty-day mortality (6.64%) was similar in the two groups (p = 0.4475). The Kaplan–Meier estimate for all-cause mortality for the entire population was 13% at 2 years, 19.2% at 4 years and 36.6% at 8 years, and the probability was not different between groups (Log-rank = 0.11). In a real-world ischemic HF population, SVR may be carried out with favorable results; in patients with worse LV remodeling and less extensive CAD, SVR showed a trend toward a better outcome. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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10 pages, 452 KiB

Open AccessArticle

Electrocardiogram Risk Score and Prevalence of Subclinical Atherosclerosis: A Cross-Sectional Study

by Minji Kang, Yoosoo Chang, Jeonggyu Kang, Yejin Kim and Seungho Ryu

J. Pers. Med. 2022, 12(3), 463; https://doi.org/10.3390/jpm12030463 - 14 Mar 2022

Cited by 2 | Viewed by 2735

Abstract

Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study [...] Read more.

Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study comprised 134,802 participants with no known CVD who underwent ECG and CAC computed tomography. The ECG risk score was the sum of five ECG abnormalities: heart rate of >80 beats, QRS of >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc. A multinomial regression model was used to estimate the prevalence ratios (PRs) and their 95% confidence intervals (CIs) for prevalent CAC. The prevalence of CAC progressively increased as the ECG risk score increased. After adjustment for conventional CVD risk factors and other confounders, the multivariable-adjusted PRs (95% CI) for a CAC of 1–100 in the 1, 2, and ≥3 ECG risk score groups were 1.06 (1.02–1.10), 1.12 (1.03–1.22), and 1.19 (1.00–1.42), respectively, while the corresponding PRs for a CAC of >100 were 1.03 (0.95–1.12), 1.44 (1.25–1.66), and 1.75 (1.33–2.29), respectively. Integrative ECG scoring may help identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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6 pages, 1064 KiB

Open AccessArticle

CoroFinder: A New Tool for Real Time Detection and Tracking of Coronary Arteries in Contrast-Free Cine-Angiography

by Paolo Zaffino, Maria Francesca Spadea, Ciro Indolfi and Salvatore De Rosa

J. Pers. Med. 2022, 12(3), 411; https://doi.org/10.3390/jpm12030411 - 06 Mar 2022

Cited by 1 | Viewed by 1835

Abstract

Coronary Angiography (CA) is the standard of reference to diagnose coronary artery disease. Yet, only a portion of the information it conveys is usually used. Quantitative Coronary Angiography (QCA) reliably contributes to improving the measurable assessment of CA. In this work, we developed [...] Read more.

Coronary Angiography (CA) is the standard of reference to diagnose coronary artery disease. Yet, only a portion of the information it conveys is usually used. Quantitative Coronary Angiography (QCA) reliably contributes to improving the measurable assessment of CA. In this work, we developed a new software, CoroFinder, able to automatically identify epicardial coronary arteries and to dynamically track the vessel profile in dye-free frames. The coronary tree is automatically segmented by Frangi’s filter in the angiogram’s frames where vessels are contrasted (“template frames”). Afterward, the image similarity among each template frame and the dye-free images is scored by cross-correlation. Finally, each dye-free image is associated with the most similar template frame, resulting in an estimation of vessel contour. CoroFinder allows locating the position of coronary arteries in absence of contrast dye. The developed algorithm is robust to diverse vessel curvatures, variation of vessel widths, and the presence of stenoses. This article describes the newly developed CoroFinder algorithm and the associated software and provides an overview of its potential application in research and for translation to the clinic. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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12 pages, 1021 KiB

Open AccessArticle

Evidence of Better Autonomic, Metabolic and Psychological Profile in Breast Cancer Survivors Meeting Current Physical Activity Recommendations: An Observational Study

by Daniela Lucini, Mara Malacarne, Wolfgang Gatzemeier, Eleonora Pagani, Giuseppina Bernardelli, Gianfranco Parati and Massimo Pagani

J. Pers. Med. 2022, 12(2), 273; https://doi.org/10.3390/jpm12020273 - 13 Feb 2022

Cited by 2 | Viewed by 1635

Abstract

The increased cardiometabolic risk observed in breast cancer survivors (BCS) is due to multiple mechanisms: Hormonal and immunological dysfunction are well-identified ones, while cardiac autonomic regulation (CAR) is less recognized but may play a new complementary role particularly relevant when considering conditions and [...] Read more.

The increased cardiometabolic risk observed in breast cancer survivors (BCS) is due to multiple mechanisms: Hormonal and immunological dysfunction are well-identified ones, while cardiac autonomic regulation (CAR) is less recognized but may play a new complementary role particularly relevant when considering conditions and behaviors associated with a better prognosis in BCS, such as physical training. This observational study investigated a group of consecutive (172) BCS subdivided in two groups: those who reached the physical activity goals above 600 (MET·min/week) and those who did not. We assessed CAR by autoregressive spectral analysis of cardiovascular variabilities (considering in particular the unitary autonomic nervous system index—ANSI), body mass composition, stress perception and lifestyle in order to verify possible differences due to execution of physical activity. Subjects who spontaneously met physical activity recommendations presented a better autonomic, metabolic and psychological profile compared to those who did not. Lower physical activity volume, poor metabolic parameters, increased stress and fatigue perception may cluster together, leading to worsened CAR. This control mechanism may play a complementary role in determining the increased cardiometabolic risk observed in BCS. Furthermore, it may also explain, albeit in part, the better prognosis observed in patients following interventions aiming to improve the sympathetic–parasympathetic balance, such as physical training, using a personalized medicine approach. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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16 pages, 1049 KiB

Open AccessFeature PaperArticle

Incidence and Predictors of Infections and All-Cause Death in Patients with Cardiac Implantable Electronic Devices: The Italian Nationwide RI-AIAC Registry

by Giuseppe Boriani, Marco Proietti, Matteo Bertini, Igor Diemberger, Pietro Palmisano, Stefano Baccarini, Francesco Biscione, Nicola Bottoni, Antonio Ciccaglioni, Alessandro Dal Monte, Franco Alberto Ferrari, Saverio Iacopino, Marcello Piacenti, Daniele Porcelli, Stefano Sangiorgio, Luca Santini, Michele Malagù, Giuseppe Stabile, Jacopo Francesco Imberti, Davide Caruso, Massimo Zoni-Berisso, Roberto De Ponti, Renato Pietro Ricci and on behalf of RI-AIAC Registry Investigators Show full author list Hide full author list

J. Pers. Med. 2022, 12(1), 91; https://doi.org/10.3390/jpm12010091 - 11 Jan 2022

Cited by 18 | Viewed by 1976

Abstract

Background: The incidence of infections associated with cardiac implantable electronic devices (CIEDs) and patient outcomes are not fully known. Aim: To provide a contemporary assessment of the risk of CIEDs infection and associated clinical outcomes. Methods: In Italy, 18 centres enrolled all consecutive [...] Read more.

Background: The incidence of infections associated with cardiac implantable electronic devices (CIEDs) and patient outcomes are not fully known. Aim: To provide a contemporary assessment of the risk of CIEDs infection and associated clinical outcomes. Methods: In Italy, 18 centres enrolled all consecutive patients undergoing a CIED procedure and entered a 12-months follow-up. CIED infections, as well as a composite clinical event of infection or all-cause death were recorded. Results: A total of 2675 patients (64.3% male, age 78 (70–84)) were enrolled. During follow up 28 (1.1%) CIED infections and 132 (5%) deaths, with 152 (5.7%) composite clinical events were observed. At a multivariate analysis, the type of procedure (revision/upgrading/reimplantation) (OR: 4.08, 95% CI: 1.38–12.08) and diabetes (OR: 2.22, 95% CI: 1.02–4.84) were found as main clinical factors associated to CIED infection. Both the PADIT score and the RI-AIAC Infection score were significantly associated with CIED infections, with the RI-AIAC infection score showing the strongest association (OR: 2.38, 95% CI: 1.60–3.55 for each point), with a c-index = 0.64 (0.52–0.75), p = 0.015. Regarding the occurrence of composite clinical events, the Kolek score, the Shariff score and the RI-AIAC Event score all predicted the outcome, with an AUC for the RI-AIAC Event score equal to 0.67 (0.63−0.71) p < 0.001. Conclusions: In this Italian nationwide cohort of patients, while the incidence of CIED infections was substantially low, the rate of the composite clinical outcome of infection or all-cause death was quite high and associated with several clinical factors depicting a more impaired clinical status. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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14 pages, 1880 KiB

Open AccessArticle

Assessment of Biventricular Myocardial Function with 2-Dimensional Strain and Conventional Echocardiographic Parameters: A Comparative Analysis in Healthy Infants and Patients with Severe and Critical Pulmonary Stenosis

by Liliana Gozar, Mihaela Iancu, Horea Gozar, Anca Sglimbea, Andreea Cerghit Paler, Dorottya Gabor-Miklosi, Rodica Toganel, Amalia Făgărășan, Diana Ramona Iurian and Daniela Toma

J. Pers. Med. 2022, 12(1), 57; https://doi.org/10.3390/jpm12010057 - 06 Jan 2022

Cited by 2 | Viewed by 1109

Abstract

Our aim was to compare the global longitudinal and regional biventricular strain between infants with severe and critical pulmonary stenosis (PS), and controls; to compare pre- and post-procedural strain values in infants with severe and critical PS; and to assess the correlations between [...] Read more.

Our aim was to compare the global longitudinal and regional biventricular strain between infants with severe and critical pulmonary stenosis (PS), and controls; to compare pre- and post-procedural strain values in infants with severe and critical PS; and to assess the correlations between echocardiographic strain and conventional parameters. We conducted a retrospective single-center study. The comparisons of echocardiographic variables were performed using separate linear mixed models. The overall mean right ventricle (RV) regional strains measured before intervention in PS patients was significantly different when compared to the control group (p = 0.0324). We found a significant change in the left ventricle, RV, and inter-ventricular septum strain (IVS) values from basal to apical location (p < 0.05). IVS strain values showed a higher decrease in mean strain values from basal to apical in PS patients. There was no significant difference in means of baseline and post-interventional strain values in PS patients (p > 0.05). Following the strain analysis in patients with PS, we obtained statistically significant changes in the RV global-4-chamber longitudinal strain (RV4C). The RV4C, which quantifies the longitudinal strain to the entire RV, can be used in current clinical practice for the evaluation of RV function in infants with severe and critical PS. The longitudinal and segmental strain capture the pathological changes in the IVS, modifications that cannot be highlighted through a classical echocardiographic evaluation. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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10 pages, 264 KiB

Open AccessArticle

Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care

by Alessandra Gorini, Federica Galli, Mattia Giuliani, Antonia Pierobon, José Pablo Werba, Edvige Palazzo Adriano and Daniela Trabattoni

J. Pers. Med. 2022, 12(1), 38; https://doi.org/10.3390/jpm12010038 - 04 Jan 2022

Cited by 3 | Viewed by 1571

Abstract

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was [...] Read more.

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was to investigate if post-recovery TTS and ACS patients present different psychological profiles. We also investigated whether the occurrence of acute psychological stressful episodes that had occurred prior to the cardiac event could be found in either syndrome. Twenty TTS and twenty ACS female patients were recruited. All patients completed self-report questionnaires about anxiety and depressive symptoms, perceived stress, type-D personality and post-traumatic symptoms. Results showed that only three subscales of health anxiety (i.e., Fear of Death/Diseases, Interference and Reassurance) significantly differed between the two groups, while no differences were found in the other psychological measurements. Moreover, personality traits seem to not be associated with the impact of the cardiac traumatic event. Finally, only TTS patients reported the presence of a significant emotional trigger preceding the acute cardiac event. In conclusion, post-recovery TTS patients differ from ACS patients in their level of concern about their health and in their need of reassurance and information only, probably as a result of the different clinical characteristics of the two illnesses. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

7 pages, 623 KiB

Open AccessCommunication

Phenotyping Type 2 Diabetes in Terms of Myocardial Insulin Resistance and Its Potential Cardiovascular Consequences: A New Strategy Based on ¹⁸F-FDG PET/CT

by José Raul Herance, Rafael Simó, Mayra Alejandra Velasquez, Bruno Paun, Daniel García-Leon, Carolina Aparicio, Roso Marés, Olga Simó-Servat, Joan Castell-Conesa, Cristina Hernández and Santiago Aguadé-Bruix

J. Pers. Med. 2022, 12(1), 30; https://doi.org/10.3390/jpm12010030 - 02 Jan 2022

Cited by 2 | Viewed by 1624

Abstract

Background: Systemic insulin resistance is generally postulated as an independent risk factor of cardiovascular events in type 2 diabetes (T2D). However, the role of myocardial insulin resistance (mIR) remains to be clarified. Methods: Two ¹⁸F-FDG PET/CT scans were performed on forty-three T2D [...] Read more.

Background: Systemic insulin resistance is generally postulated as an independent risk factor of cardiovascular events in type 2 diabetes (T2D). However, the role of myocardial insulin resistance (mIR) remains to be clarified. Methods: Two ¹⁸F-FDG PET/CT scans were performed on forty-three T2D patients at baseline and after hyperinsulinemic–euglycemic clamp (HEC). Myocardial insulin sensitivity (mIS) was determined by measuring the increment in myocardial ¹⁸F-FDG uptake after HEC. Coronary artery calcium scoring (CACs) and myocardial radiodensity (mRD) were assessed by CT. Results: After HEC, seventeen patients exhibited a strikingly enhancement of myocardial ¹⁸F-FDG uptake and twenty-six a marginal increase, thus revealing mIS and mIR, respectively. Patients with mIR showed higher mRD (HU: 38.95 [33.81–44.06] vs. 30.82 [21.48–38.02]; p = 0.03) and CACs > 400 (AU: 52% vs. 29%; p = 0.002) than patients with mIS. In addition, HOMA-IR and mIS only showed a correlation in those patients with mIR. Conclusions: ¹⁸F-FDG PET combined with HEC is a reliable method for identifying patients with mIR. This subgroup of patients was found to be specifically at high risk of developing cardiovascular events and showed myocardial structural changes. Moreover, the gold-standard HOMA-IR index was only associated with mIR in this subgroup of patients. Our results open up a new avenue for stratifying patients with cardiovascular risk in T2D. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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15 pages, 1640 KiB

Open AccessFeature PaperArticle

A First Step towards a Comprehensive Approach to Harmonic Analysis of Synchronous Peripheral Volume Pulses: A Proof-of-Concept Study

by Hsien-Tsai Wu, Bagus Haryadi and Jian-Jung Chen

J. Pers. Med. 2021, 11(12), 1263; https://doi.org/10.3390/jpm11121263 - 01 Dec 2021

Cited by 3 | Viewed by 2137

Abstract

The harmonic analysis (HA) of arterial radial pulses in humans has been widely investigated in recent years for clinical applications of traditional Chinese medicine. This study aimed at establishing the validity of carrying out HA on synchronous peripheral volume pulses for predicting diabetes-induced [...] Read more.

The harmonic analysis (HA) of arterial radial pulses in humans has been widely investigated in recent years for clinical applications of traditional Chinese medicine. This study aimed at establishing the validity of carrying out HA on synchronous peripheral volume pulses for predicting diabetes-induced subtle changes in heart energy. In this study, 141 subjects (Group 1: 63 healthy elderly subjects; Group 2: 78 diabetic subjects) were enrolled at the same hospital. After routine blood sampling, all synchronous electrocardiogram (ECG) and photoplethysmography (PPG) measurements (i.e., at the six locations) were acquired in the morning. HA of synchronous peripheral volume pulses and radial pulse waves was performed and analyzed after a short period of an ensemble averaging process based on the R-wave peak location. This study utilized HA for the peripheral volume pulses and found that the averaged total pulse energy (i.e., the C₀ of the DTFS) was identical in the same subject. A logistic regression model with C₀ and a waist circumference variable showed a graded association with the risk of developing type 2 diabetes. The adjusted odds ratio for C₀ and the waist circumference were 0.986 (95% confidence interval: 0.977, 0.994) and 1.130 (95% confidence interval: 1.045, 1.222), respectively. C₀ also showed significant negative correlations with risk factors for type 2 diabetes mellitus, including glycosylated hemoglobin and fasting plasma glucose (r = −0.438, p < 0.001; r = −0.358, p < 0.001, respectively). This study established a new application of harmonic analysis in synchronous peripheral volume pulses for clinical applications. The findings showed that the C₀ could be used as a prognostic indicator of a protective factor for predicting type 2 diabetes. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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9 pages, 588 KiB

Open AccessFeature PaperArticle

The Cardio-Hepatic Relation in STEMI

by Lian Bannon, Ilan Merdler, Nir Bar, Lior Lupu, Shmuel Banai, Giris Jacob and Yacov Shacham

J. Pers. Med. 2021, 11(12), 1241; https://doi.org/10.3390/jpm11121241 - 23 Nov 2021

Cited by 6 | Viewed by 2012

Abstract

Background: Hepatic injury secondary to congestive heart failure is well described, however, only limited data exist about the possible impact of acute cardiac dysfunction on the liver. We aimed to explore the possible cardio-hepatic interaction in patients with myocardial infarction. Material and methods: [...] Read more.

Background: Hepatic injury secondary to congestive heart failure is well described, however, only limited data exist about the possible impact of acute cardiac dysfunction on the liver. We aimed to explore the possible cardio-hepatic interaction in patients with myocardial infarction. Material and methods: A single-center retrospective cohort study of 1339 ST elevation myocardial infarction (STEMI) patients who underwent primary coronary intervention between June 2012 to June 2019. Echocardiographic examinations were performed to assess left ventricular ejection fraction (LVEF) and central venous pressure (CVP). Patients were stratified into four groups by their LVEF and CVP levels: LVEF ≥ 45%, and CVP ≤ 10 mm/Hg (n = 853), LVEF < 45% with CVP ≤ 10 mm/Hg (n = 364), EF ≥ 45%, with CVP > 10 mm/Hg (n = 61), and LVEF < 45% with CVP > 10 mm/Hg (n = 61). Patients were evaluated for baseline and peak liver enzymes including alanine transaminase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and bilirubin. Results: Greater severity of cardiac dysfunction was associated with worse elevation of liver enzymes. We found a graded increase in mean levels of maximal ALT, first and maximal ALP, and first and maximal GGT values. Using propensity score matching to estimate the impact of cardiac dysfunction on liver injury, we chose patients with the worst cardiac function parameters: (LVEF < 45% and CVP >10 mm/Hg; n = 61) and compared them to matched patients with better cardiac function (n = 45). We found a significantly higher level of maximal ALT, first and maximal ALP, and GGT values in the group with the worst cardiac function parameters (p < 0.05). Conclusions: Among patients with STEMI, the combination of decreased LVEF and venous congestion was associated with liver enzymes elevation suggesting a possible cardio-hepatic syndrome. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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12 pages, 1554 KiB

Open AccessArticle

Effects of Algorithmic Music on the Cardiovascular Neural Control

by Alfredo Raglio, Beatrice De Maria, Francesca Perego, Gianluigi Galizia, Matteo Gallotta, Chiara Imbriani, Alberto Porta and Laura Adelaide Dalla Vecchia

J. Pers. Med. 2021, 11(11), 1084; https://doi.org/10.3390/jpm11111084 - 25 Oct 2021

Cited by 4 | Viewed by 1704

Abstract

Music influences many physiological parameters, including some cardiovascular (CV) control indices. The complexity and heterogeneity of musical stimuli, the integrated response within the brain and the limited availability of quantitative methods for non-invasive assessment of the autonomic function are the main reasons for [...] Read more.

Music influences many physiological parameters, including some cardiovascular (CV) control indices. The complexity and heterogeneity of musical stimuli, the integrated response within the brain and the limited availability of quantitative methods for non-invasive assessment of the autonomic function are the main reasons for the scarcity of studies about the impact of music on CV control. This study aims to investigate the effects of listening to algorithmic music on the CV regulation of healthy subjects by means of the spectral analysis of heart period, approximated as the time distance between two consecutive R-wave peaks (RR), and systolic arterial pressure (SAP) variability. We studied 10 healthy volunteers (age 39 ± 6 years, 5 females) both while supine (REST) and during passive orthostatism (TILT). Activating and relaxing algorithmic music tracks were used to produce possible contrasting effects. At baseline, the group featured normal indices of CV sympathovagal modulation both at REST and during TILT. Compared to baseline, at REST, listening to both musical stimuli did not affect time and frequency domain markers of both SAP and RR, except for a significant increase in mean RR. A physiological TILT response was maintained while listening to both musical tracks in terms of time and frequency domain markers, compared to baseline, an increase in mean RR was again observed. In healthy subjects featuring a normal CV neural profile at baseline, algorithmic music reduced the heart rate, a potentially favorable effect. The innovative music approach of this study encourages further research, as in the presence of several diseases, such as ischemic heart disease, hypertension, and heart failure, a standardized musical stimulation could play a therapeutic role. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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14 pages, 2385 KiB

Open AccessFeature PaperArticle

High Skin Sympathetic Nerve Activity in Patients with Recurrent Syncope

by Tien-Chi Huang, Nai-Yu Chi, Chih-Sung Lan, Chang-Jen Chen, Shih-Jie Jhuo, Tsung-Han Lin, Yi-Hsueh Liu, Li-Fang Chou, Chien-Wei Chang, Wei-Sheng Liao, Pei-Heng Kao, Po-Chao Hsu, Chee-Siong Lee, Yi-Hsiung Lin, Hsiang-Chun Lee, Ye-Hsu Lu, Hsueh-Wei Yen, Tsung-Hsien Lin, Ho-Ming Su, Wen-Ter Lai, Wei-Chung Tsai, Shien-Fong Lin and Chien-Hung Lee Show full author list Hide full author list

J. Pers. Med. 2021, 11(11), 1053; https://doi.org/10.3390/jpm11111053 - 21 Oct 2021

Cited by 5 | Viewed by 1735

Abstract

(1) Background: The autonomic imbalance plays a role in vasovagal syncope (VVS) diagnosed by head-up tilting test (HUT). neuECG is a new method of recording skin electrical signals to simultaneously analyze skin sympathetic nerve activity (SKNA) and electrocardiogram. We hypothesize that SKNA is [...] Read more.

(1) Background: The autonomic imbalance plays a role in vasovagal syncope (VVS) diagnosed by head-up tilting test (HUT). neuECG is a new method of recording skin electrical signals to simultaneously analyze skin sympathetic nerve activity (SKNA) and electrocardiogram. We hypothesize that SKNA is higher in subjects with tilt-positive than tilt-negative and the SKNA surges before syncope. (2) Methods: We recorded neuECG in 41 subjects who received HUT (according to the “Italian protocol”), including rest, tilt-up, provocation and recovery phases. Data were analyzed to determine the average SKNA (aSKNA, μV) per digitized sample. Electrocardiogram was used to calculate standard deviation of normal-to-normal beat intervals (SDNN). The “SKNA-SDNN index” was calculated by rest aSKNA multiplied by the ratio of tilt-up to rest SDNN. (3) Results: 16 of 41 (39%) subjects developed syncope. The aSKNA at rest phase is significantly higher in the tilt-positive (1.21 ± 0.27 µV) than tilt-negative subjects (1.02 ± 0.29 µV) (p = 0.034). There are significant surges and withdraw of aSKNA 30 s before and after syncope (both p ≤ 0.006). SKNA-SDNN index is able to predict syncope (p < 0.001). (4) Conclusion: Higher SKNA at rest phase is associated with positive HUT. The SKNA-SDNN index is a novel marker to predict syncope during HUT. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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Review

Jump to: Research, Other

15 pages, 1380 KiB

Open AccessFeature PaperReview

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

by Isabella Canavero, Nicola Rifino, Maurizio Bussotti, Tatiana Carrozzini, Antonella Potenza, Gemma Gorla, Giuliana Pollaci, Benedetta Storti, Eugenio Agostino Parati, Laura Gatti and Anna Bersano

J. Pers. Med. 2022, 12(8), 1244; https://doi.org/10.3390/jpm12081244 - 29 Jul 2022

Cited by 2 | Viewed by 4127

Abstract

Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both [...] Read more.

Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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13 pages, 3216 KiB

Open AccessReview

Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

by Alessandra Scatteia, Angelo Silverio, Roberto Padalino, Francesco De Stefano, Raffaella America, Alberto Maria Cappelletti, Laura Adelaide Dalla Vecchia, Pasquale Guarini, Francesco Donatelli, Francesco Caiazza and Santo Dellegrottaglie

J. Pers. Med. 2021, 11(11), 1153; https://doi.org/10.3390/jpm11111153 - 05 Nov 2021

Cited by 7 | Viewed by 3624

Abstract

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently [...] Read more.

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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Other

Jump to: Research, Review

5 pages, 185 KiB

Open AccessCommentary

Direct Oral Anticoagulants in Old and Frail Patients with Atrial Fibrillation: The Advantages of an Anticoagulation Service

by Maria Cristina Vedovati and Giancarlo Agnelli

J. Pers. Med. 2022, 12(8), 1339; https://doi.org/10.3390/jpm12081339 - 20 Aug 2022

Viewed by 1179

Abstract

Despite the recent advancements, oral anticoagulation is still challenging in some patients and this is the case for old and frail patients. The large majority of frail patients with atrial fibrillation should receive anticoagulation since the associated benefits outweigh the risk of bleeding. [...] Read more.

Despite the recent advancements, oral anticoagulation is still challenging in some patients and this is the case for old and frail patients. The large majority of frail patients with atrial fibrillation should receive anticoagulation since the associated benefits outweigh the risk of bleeding. A multidisciplinary consensus document on the use and prescription of direct oral anticoagulants (DOACs) in older and frail patients with atrial fibrillation has been recently published. In this manuscript we provide a comment on this document and add insights into the management of these patients. The new DOAC age had imposed a paradigm shift in the management of patients with the need for clinically-oriented services rather than laboratory-oriented services. In this paper we provide tools for a structured patient-oriented DOACs treatment service supported by a multidisciplinary approach. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

9 pages, 267 KiB

Open AccessViewpoint

Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document

by Marco Proietti, Marina Camera, Maurizio Gallieni, Luigi Gianturco, Antonio Gidaro, Carlo Piemontese, Giuseppe Pizzetti, Franco Redaelli, Barbara Scimeca, Carlo Sebastiano Tadeo, Matteo Cesari, Giuseppe Bellelli and Laura Adelaide Dalla Vecchia

J. Pers. Med. 2022, 12(3), 469; https://doi.org/10.3390/jpm12030469 - 15 Mar 2022

Cited by 9 | Viewed by 2690

Abstract

In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct [...] Read more.

In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct oral anticoagulants, such as the oldest and/or frailest individuals. Frailty is clinical syndrome characterized by a reduction of functions and physiological reserves which results in individuals having higher vulnerability. While current evidence underlines a relationship between atrial fibrillation and frailty, particularly in determining a higher risk of adverse outcomes, data regarding effectiveness and safety of direct oral anticoagulants in frailty atrial fibrillation patients are still lacking, leaving uncertainty about how to guide prescription in this specific subgroup. On these premises, this multidisciplinary consensus document explains why it would be useful to integrate the clinical evaluation performed through comprehensive geriatric assessment to gather further elements to guide prescription of direct oral anticoagulants in such a high-risk group of patients. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Disease)

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