Diagnostic value of the head-up tilt test and the R-test in patients with syncope

The diagnostic value of the head-up tilt test (HUTT) in discovering vasovagal syndrome depends on the pre-test probability. An accurate anamnesis and clinical examination screens the patients indicated for the HUTT. In patients with unexplained syncope, the R-test is an alternative procedure to discover its cause. In our study, we evaluated the diagnostic significance of the HUTT in a group of 211 patients and of the R-test in a subgroup of 45 patients with negative HUTT results and with negative traditional Holter ECG monitoring (24 hr)

Erythropoietin: a new perspective in cardiovascular therapy

Erythropoietin is a hormone produced by the kidney, which regulates proliferation, differentiation and maturation of red cells. Recombinant human EPO (rH-EPO) is well known to correct anaemia in patients with chronic renal failure in terminal stage. However, recent studies showed the existence of several not haematopoietic effects of erythropoietin. EPO receptors have been found to be expressed in several tissues, included the cardiovascular system. An increase in cardiac systolic function has been observed in patients with chronic heart failure treated with EPO. Other beneficial effects appear to be related to the pro-angiogenic properties on endothelial cells and could be useful for treatment of ischemic heart disease. These findings suggest that EPO could provide potential therapeutic benefits in the management of cardiovascular diseases beyond anaemia correction. This review focuses its attention on the pleiotropic effects of EPO and its future promising applications in cardiovascular pathology

[Indications for statin therapy in patients with acute coronary syndrome of ischemic origin]

Recent evidence has increasingly demonstrated that statins, besides reducing cholesterol levels, are as effective as other therapeutic approaches in the treatment of patients with acute coronary syndromes. Appropriate control of cardiovascular risk factors accounts for 44% of the overall reduction in mortality. The decrease in plasma cholesterol concentrations, however, remains the most effective therapeutic target, leading to a -24% reduction of total mortality. Statins have proved to be effective within the first few weeks after an acute coronary event. As a consequence, their use is recommended by current guidelines (class IB) in patients with non-ST-elevation myocardial infarction. Data from recent trials suggest that early statin therapy is a reasonable option for patients with ST-elevation myocardial infarction (class IA recommendation)

Nitric oxide and cardiovascular risk factors

The endothelium is a dynamic organ with many properties that takes part in the regulation of the principal mechanisms of vascular physiology. Its principal functions include the control of blood-tissue exchange and permeability, the vascular tonus, and the modulation of inflammatory or coagulatory mechanisms. Many vasoactive molecules, produced by the endothelium, are involved in the control of these functions. The most important is nitric oxide (NO), a gaseous molecule electrically neutral with an odd number of electrons that gives the molecule chemically reactive radical properties. Already known in the twentieth century, NO, sometimes considered as a dangerous molecule, recently valued as an important endogenous vasodilator factor. Recently, it was discovered that it is involved in several physiological mechanisms of endothelial protection (Tab. I). In 1992, Science elected it as “molecule of the year”; 6 yrs later three American researchers (Louis Ignarro, Robert Furchgott and Fried Murad) obtained a Nobel Prize for Medicine and Physiology “for their discoveries about NO as signal in the cardiovascular system”