Abstract: We assessed whether macrophage colony-stimulating factor (M-CSF) levels are associated with left ventricular systolic dysfunction (LVSD) in patients with acute myocardial infarction (AMI). We studied 56 patients with AMI (mean age: 67 ± 12 years) and identified those with clinical (Killip class >II) or echocardiographic signs (ejection fraction ≤45%) of LVSD. We evaluated the established cardiovascular risk factors and measured several cardiovascular biomarkers, including M-CSF. Serum M-CSF concentrations (pg/mL) were significantly increased in patients with both clinical and echocardiographic signs of LVSD (460 ± 265 vs 290 ± 210, P = .0103 and 493 ± 299 vs 287 ± 174, P = .0028, respectively). We found a significant inverse association between M-CSF and ejection fraction (r = -.351, P = .0079). Logistic regression analysis revealed that, among all evaluated clinical and biochemical parameters, the stronger predictor of LVSD was M-CSF (odds ratios 2.1, 95% confidence interval 1.1-2.9, P = .0168). This is the first study reporting plasma M-CSF levels as independent determinants of low LV ejection fraction and clinical LV dysfunction in patients with AMI.
Abstract: Plasma levels of B-type natriuretic peptide (BNP) are often increased in postcardiac surgery patients. The six-minute walking test (6MWT) is useful to assess functional capacity in postcardiac surgery patients. The aim of this study was to determine whether BNP levels are associated with exercise capacity evaluated by 6MWT in patients after cardiac surgery.
Abstract: Early diagnosis of left ventricular (LV) dysfunction represents a major challenge in asymptomatic subjects with cardiovascular (CV) risk factors. Tissue Doppler imaging (TDI) has emerged as an important tool with clinical relevance in several cardiac diseases.
Abstract: Nowadays early diagnosis of left ventricular (LV) dysfunction represents a major challenge in asymptomatic subjects with cardiovascular (CV) risk factors. Tissue Doppler imaging (TDI) recently emerged as an important tool with clinical relevance in several cardiac diseases. Aim: To evaluate the ability of TDI in detecting early longitudinal ventricular dysfunction in asymptomatic subjects, with LV ejection fraction >55%, normal diastolic function, and its relationship with CV risk factors.
Abstract: This multicenter study consisted of echocardiographic examination of subjects with stage A heart failure (HF) with cardiovascular risk factors and normal electrocardiogram and clinical examination results to (a) define whether stage A subjects with risk factors are really free of functional or structural cardiac abnormalities and (b) assess the impact of the presence of risk factors and incremental value of echocardiographic parameters in the prediction of progression of HF or in the development of cardiovascular events.
Abstract: There is an increasing need for admission of octogenarians to cardiac rehabilitation programs. The aim of this study was to evaluate if the Rivermead Mobility Index (RMI) (scale of mobility) is related to the functional capacity assessed by the 6 Minute Walking Test (6MWT).
Abstract: The aim of the study was to compare the prevalence of interventricular and intraventricular asynchrony in patients with different degrees of left ventricular (LV) dysfunction.
Abstract: The metabolic syndrome (MetS) has previously been associated with an early marker of atherosclerosis, the carotid intima-media thickness (IMT). From the ISMIR (Ispessimento Medio Intimale e Rischio cardiovascolare [media-intima thickness and cardiovascular risk]) study population of 479 asymptomatic participants, we identified 80 participants with MetS. Carotid IMT and plaques were evaluated by ultrasonography. Blood samples were obtained from all participants. Participants with MetS had a significantly higher prevalence of a carotid IMT > 0.80 mm (P = .004) and of carotid plaques (P < .001) as compared with participants without MetS. Carotid IMT was significantly correlated with fasting triglycerides and fibrinogen levels both in participants with MetS and in those without MetS (all P < .01). In contrast, IMT correlated with fasting plasma glucose, serum creatinine, and uric acid levels only in participants without MetS. Our study confirms the association between MetS and carotid atherosclerosis. In MetS, a significant correlation between carotid IMT and triglycerides and fibrinogen levels was found.
Abstract: B-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we aimed to assess the relationship between postoperative BNP levels and left ventricular filling pressures in post-cardiac surgery patients.
Abstract: Congenital heart disease is the most frequent neonatal malformation, with an estimated prevalence between 0.8% and 1%. Echocardiography is an important tool for diagnosis and follow-up in cardiology, because it is easy to use, inexpensive, and noninvasive. The study of fetal heart by means of echocardiography allows early diagnosis and treatment of fetal heart anomalies and dysfunction, and such a technique is increasingly used. This exam is often required after morphological fetal echography, when a congenital heart disease is suspected or when there is an increased risk of congenital heart disease. Fetal echocardiography allows to evaluate the cardiac anatomy and function or cardiac rhythm. The purpose of this review is to summarize the main parameters and echocardiographic techniques for the assessment of heart rhythm and function: two-dimensional echocardiography, Doppler, tissue Doppler, and two-dimensional strain.
Abstract: Carotid intima-media thickness (IMT) and aortic valve sclerosis (AVS) have recently emerged as important predictive factors for cardiovascular (CV) events. However, few data are available on their association and the respective roles of major CV risk factors in determining either condition. In this study, 479 asymptomatic subjects (mean age 58 +/- 13 years, 62% men) were assessed, without histories of CV disease, consecutively referred for comprehensive evaluations by echocardiography and carotid ultrasonography because of the presence of > or = 1 risk factor. Common carotid artery IMT and aortic valve morphology and function were analyzed. The mean IMT was 0.82 +/- 0.19 mm. The prevalence of increased carotid IMT (>0.80 mm) and AVS was 60.8% and 18.4%, respectively. The prevalence of increased IMT was 79.6% in subjects with AVS and 56.5% in those without AVS (relative risk 2.99, 95% confidence interval 1.72 to 5.21, p <0.001). On multivariate analysis, increased IMT was significantly and independently associated with hypertension, dyslipidemia, obesity, family history of CV disease, and age. Only age emerged as an independent predictor of AVS. The presence of both markers was independently associated only with hypertension and age. In conclusion, increased carotid IMT was strongly associated with AVS in a population of asymptomatic patients. IMT and AVS were differently related to individual CV risk factors, and their association seems to be correlated mainly with age and hypertension.
Abstract: We analyzed in NYHA I hypertensives the interactions between Carotid Intima-Media Thickness (IMT), Hypertension and Cardiovascular (CV) risk factors and relationships between IMT, CV risk factors and left ventricular (LV) geometric remodelling. 198 asymptomatic, never treated, essential hypertensives (age: 58.2 +/- 13) and 67 (age-gender matched) healthy subjects, were studied. Complete clinical examination, 2D Doppler echocardiography and vascular echography were performed in all study subjects. Major values of IMT are present in concentric LVH. Distribution of IMT among risk factors groups shows an higher IMT respect to increasing number of risk factors (P < 0.001). Significant correlation are present between pulse pressure and IMT (P < 0.006; r = 0.19) and IMT and LVM (P < 0.0001; r = 0.35). Altered patterns of LV geometry and carotid structural changes occur in many patients with essential hypertension. LVH or carotid remodeling are greater in elderly, in patients with higher systolic BP and with associated CV risk factors.
Abstract: We analyzed in NYHA I hypertensives the interactions between Carotid Intima-Media Thickness (IMT), Hypertension and Cardiovascular (CV) risk factors and relationships between IMT, CV risk factors and left ventricular (LV) geometric remodelling. 198 asymptomatic, never treated, essential hypertensives (age: 58.2 +/- 13) and 67 (age-gender matched) healthy subjects, were studied. Complete clinical examination, 2D Doppler echocardiography and vascular echography were performed in all study subjects. Major values of IMT are present in concentric LVH. Distribution of IMT among risk factors groups shows an higher IMT respect to increasing number of risk factors (P < 0.001). Significant correlation are present between pulse pressure and IMT (P < 0.006; r = 0.19) and IMT and LVM (P < 0.0001; r = 0.35). Altered patterns of LV geometry and carotid structural changes occur in many patients with essential hypertension. LVH or carotid remodeling are greater in elderly, in patients with higher systolic BP and with associated CV risk factors.
Abstract: BACKGROUND: Serum C-reactive protein (CRP) is involved in the acute phase reaction after surgery, even though its clinical significance remains a matter of debate. We evaluated CRP levels in cardiac surgery patients without clinical or laboratory signs of infection. METHODS: We screened 737 consecutive patients referred to our center 8+/-5 days after cardiac surgery. Patients with fever (>37.2 degrees C), elevated white blood cell count (>11,000/ml), neutrophilia (>70%), or any inflammatory, infective or malignant disease were excluded. CRP levels were measured on admission and at discharge and the values were related to the following variables: age, sex, diabetes mellitus, renal failure, type of surgery, postoperative atrial fibrillation, pericardial or pleural effusion, and length of hospital stay. Follow-up (mean: 23+/-8.5 months) was available for 175 patients (94%). RESULTS: In the 187 patients enrolled in the study, the CRP values were significantly elevated (median: 4.23 mg/dl, interquartiles range: 2.68-6.64) independent of any variable analyzed. At discharge, CRP levels were significantly reduced compared with values on admission (median: 1.55 mg/dl, interquartiles range: 0.84-2.37, P<0.001). At follow-up, 19 events (10.8%) occurred (two noncardiac deaths, 17 hospital readmissions for cardiac reasons); nonetheless, no correlation was found with CRP values either on admission or at discharge. CONCLUSION: Early after cardiac surgery, in patients without clinical or laboratory signs of acute infection, CRP levels are significantly elevated, do not correlate with clinical variables, and decrease at discharge. These findings suggest a systemic inflammatory response to surgery-related stress, which carries a favorable prognosis at follow-up.
Abstract: The assessment of arterial stiffness, a common feature of ageing, exacerbated by many common disorders such as hypertension, diabetes mellitus, or renal diseases, has become an attractive tool for identifying structural and functional abnormalities of the arteries in the preclinical stages of the atherosclerotic disease. Arterial stiffness has been recognized as an important pathophysiological determinant of systolic blood pressure and pulse pressure increases and therefore the cause of cardiovascular complications, demonstrating also an independent predictive value for cardiovascular events. Although there are many techniques and indices currently available, their large clinical application is limited by a lack of standardization, with important difficulties when one try effectively to measure, quantify, and compare. Moreover, information on the 'heart-vessel coupling disease', in which combined stiffness of both heart and arteries interact to limit cardiovascular performance and its possible implications in different clinical conditions, is still not well known. We overviewed main methods and indices used to estimate arterial stiffness and aimed to provide an insight into the knowledge of the ventricular-arterial coupling from the cardiologist's point of view.
Abstract: In advanced countries the incidence of cardiovascular diseases is constantly increasing. During the last century many resources were employed to investigate atherosclerosis in relation to the main risk factors and to modification of lifestyles. Technologies have been developed to identify atherosclerosis in the sub-clinical phase. Measurement of the carotid intima-media thickness (IMT) by B-mode ultrasound is a well-validated procedure to detect the early stages of atherosclerosis and to track progression of atherosclerosis whereas other techniques have limited utility because of their invasive nature or limited sensitivity and reproducibility. In comparison with angiography, B-mode ultrasound has greater sensitivity for detecting early atherosclerosis and plaques at risk of rupture. IMT is associated with the severity of atherosclerosis in different vascular districts and has been measured in several clinical studies in order to assess the influence of risk factors, therapies and diet. It is also validated for drug evaluation. In spite of this evidence IMT measurement is not routinely performed in patients with high and middle levels of risk for cardiovascular diseases. Scientific societies and specifically those involved in ultrasonography should promote wider recognition of the diagnostic power of ultrasonic IMT by emphasizing the low costs and low risk of use of the instruments and its major contribution to knowledge, evaluation and monitoring of the progression of atherosclerosis.
Abstract: BACKGROUND: We evaluated the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF). METHODS: There were 631 subjects (313 male and 318 female) aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. The following measurements were used: anamnesis, physical examination, height and sitting blood pressure. Biochemistry variables were also considered: total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, high sensitive C-reactive protein, IgG antibodies for Helicobacter pylori (HP), cytotoxic HP, cytomegalovirus and Chlamydia pneumoniae. Finally, an echo color Doppler examination of the carotid arteries was performed. We subdivided the population studied in normotensive and hypertensive subjects and evaluated in each group the frequency of IMT and ACP in relation to age. RESULTS: We showed that IMT + ACP was significantly more frequent in patients >65 years in comparison with those <65 years (80.6 vs. 52.1%, p < 0.005) and in hypertensive patients in comparison to normotensive, independent of coexistence of other cardiovascular risk factors (71 vs. 48%, p < 0.005). Another interesting result of our study is a significant presence of IMT and ACP in subjects with emerging but without traditional RF than in subjects with traditional but without emerging RF. CONCLUSIONS: IMT and ACP of carotid arteries are significantly more frequent in patients >65 years vs. those <65 years and in hypertensive patients in comparison to controls. Finally, we have found that the seropositivity of infection and the presence of higher levels of marker of inflammation were correlated with carotid lesion.
Abstract: BACKGROUND: Diagnosis of heart failure (HF) is based on clinical signs, instrumental findings and response to treatment. The recent classification of the European Society of Cardiology identifies early stages of ventricular dysfunction not associated with symptoms of HF (Stage A-B). However, only few data are available on the prevalence and prognostic value of asymptomatic left ventricular dysfunction. METHODS: The SIEC (Società Italiana di Ecografia Cardiovascolare - Italian Society of Cardiovascular Echography) has planned a national multicenter observational study aimed to assess: (1) the prevalence of left ventricular (LV) systolic and diastolic dysfunction in asymptomatic subjects without a history of HF (transversal phase); (2) the relationship between cardiovascular risk factors and LV asymptomatic dysfunction; (3) the relationship between comorbidities and LV asymptomatic dysfunction; and (4) the incidence of cardiac events at follow-up (longitudinal phase). Data from 75 echocardiographic laboratories were recorded, merged, and analyzed using a dedicated software. CURRENT STATUS: Recruitment started in June 2003 and closed in February 2004. Overall, 16 099 patients (men, 8496; women, 7603; male: female ratio, 1.11) have been screened and 6679 (men, 3504; women, 3175; male: female ratio, 1.10) were enrolled. The follow-up is currently ongoing.
Abstract: Progression of sclerosis and stenosis is substantially unpredictable in the individual patient: in some cases it is very slow, in others it is accelerated. In addition, different patterns of progression (linear and non-linear) are possible. It has been suggested that the aortic valve lesion can be considered a form within the spectrum of the same atherosclerotic disease. In this context it seemed reasonable to hypothesize that targeted medical therapy could retard the progression of the disease. In particular HMG-CoA reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have been tested. The first experimental and clinical studies are now available, even though they are not conclusive to date. Large, prospective, randomized trials are ideally needed, but they are quite difficult, if not even impossible, to realize in practice. The ASSIST study (Asymptomatic aortic Sclerosis/Stenosis: Influence of STatins) of the Italian Society of Cardiovascular Echography aims to create a large, prospective, observational investigation, involving many centers of echocardiography and thousands of patients, in order to provide from the real clinical world at least some of the answers to this unsolved question.
Abstract: The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery.
