Parity as predictor of early hypertension during menopausal transition

Studies regarding the effects of parity on blood pressure in later life produced conflicting results. The aim of our study is to analyse whether parity influences the prevalence of hypertension in perimenopausal and postmenopausal women. METHODS: One thousand perimenopausal and postmenopausal women (mean age 55.2\u200a\ub1\u200a5.4 years) were enrolled with a median follow-up of 63.0 months. The study sample consisted of patients who self-referred, in 1998-2009, to the BenEssere Donna Clinic, dedicated to menopause-related disorders. RESULTS: One hundred and twenty-two (12.2%) women were nulliparous and 878 (87.8%) had at least one child. Thirty-four (27.9%) women among nulliparous and 326 (37.1%) among parous were hypertensive at baseline (P\u200a=\u200a0.046) and 812 women (81.2%) were in their postmenopausal period. Univariate analysis showed that women with one or more children were at higher risk of being hypertensive [odds ratio (OR): 1.529; 95% confidence interval (CI): 1.006-2.324; P\u200a=\u200a0.047]. Likewise, multivariate analysis revealed that parity (OR: 2.907; 95% CI: 1.290-6.547; P\u200a=\u200a0.010), BMI (OR: 1.097; 95% CI: 1.048-1.149; P\u200a<\u200a0.001) and family history of hypertension (OR: 3.623; 95% CI: 2.231-5.883; P\u200a<\u200a0.001) were independently related to hypertension at baseline. In a subanalysis of 640 initially normotensive women, 109 (17.0%) patients developed hypertension after follow-up, without a statistically significant association with parity (13.6% in nulliparous versus 17.6% in parous; P\u200a=\u200a0.362). Consistently, parity showed no relationship with the incidence of hypertension during follow-up (OR: 1.350; 95% CI: 0.707-2.579; P\u200a=\u200a0.363). CONCLUSION: For the first time in a population of White perimenopausal and postmenopausal women, parity was demonstrated to be independently associated with early hypertension during menopausal transition. Conversely, postmenopausal hypertension was not related with parity

COMPARISON OF RENALGUARD SYSTEM, CONTINUOUS VENOVENOUS HEMOFILTRATION AND HYDRATION IN HIGH-RISK PATIENTS FOR CONTRAST-INDUCED NEPHROPATHY

Contrast-induced nephropathy (CIN) is a relatively frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system (RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure

Renalguard, hemofiltration and hydration in prevention of contrast induced nephropathy in patients with severe chronic kidney disease undergoing percutaneous vascular interventions

Contrast-induced nephropathy (CIN) is a frequent complication of percutaneous coronary and peripheral artery interventions and is associated with significant in-hospital and long-term morbidity and mortality. We aim to compare the impact on major events of RenalGuard system(RG), continuous veno-venous Hemofiltration (CVVH) and hydration (Hy) with sodium bicarbonate plus N-acetylcysteine in patients with severe renal failure

Remodeling classification system considering left ventricular volume in patients with aortic valve stenosis: Association with adverse cardiovascular outcomes

Background: To assess prevalence and clinical implications of left ventricular (LV) remodeling considering: LV volume, mass and relative wall thickness at the time of aortic valve stenosis diagnosis. Methods and Results: We retrospectively analyzed 343 patients (age 79.2&nbsp;±&nbsp;9.5&nbsp;years, 48.1% males) with functional aortic valve area (AVA)&nbsp;≤&nbsp;1.5&nbsp;cm 2 . LV geometric patterns and clinical outcomes (combined death, cardiac hospitalization, aortic valve replacement [AVR]) were evaluated. According to the new LV remodeling classification, 4.9% had normal geometry, 7.5% concentric remodeling, 39.3% concentric hypertrophy (LVH), 22.4% mixed LVH, 12.5% dilated LVH, 3.2% eccentric LVH and 4.3% eccentric remodeling, 5.5% had not classifiable LVH. Indexed stroke volume (SVi) was higher in patients with concentric LVH (40.3&nbsp;±&nbsp;11.9&nbsp;mL/m 2 ) and mixed LVH (41.6&nbsp;±&nbsp;13.4&nbsp;mL/m 2 ) and lower in patients with eccentric LVH (24.9&nbsp;±&nbsp;7.7&nbsp;mL/m 2 ), concentric (36.6&nbsp;±&nbsp;12.7&nbsp;mL/m 2 ) and eccentric remodeling (34.9&nbsp;±&nbsp;9.5&nbsp;mL/m 2 ), P&nbsp;=&nbsp;0.003. During a median follow-up of 2.2&nbsp;years, 260 (75.8%) had the combined end point. A significant association between the combined end point and LV dilation (P&nbsp;=&nbsp;0.010) or LV remodeling patterns (P&nbsp;=&nbsp;0.0001) was found. After multivariable adjustment for AVR, concentric remodeling (HR 3.12, IC 95% 1.14–8.55; P&nbsp;=&nbsp;0.02) and dilated LVH (HR 3.48, IC 95% 1.31–9.27; P&nbsp;=&nbsp;0.01) were strongly associated with death or cardiac hospitalizations. Conclusions: In patients with AVA&nbsp;≤&nbsp;1.5&nbsp;cm 2 , when the new LV remodeling classification system is applied, only a minority had normal geometry and less than half had “classic” concentric LVH or remodeling. LV volume dilatation is frequent and associated with adverse outcome. Concentric remodeling, eccentric remodeling, dilated LVH had the worst noninvasive hemodynamic profile and prognosis

Women with at least one child, compared to nulliparous, have almost three-fold risk of early hypertension during menopausal transition

Women with at least one child, compared to nulliparous, have almost three-fold risk of early hypertension during menopausal transitio

Echocardiographic score to predict neonatal surgery for aortic coarctation in newborns with prenatal suspicion and patent ductus arteriosus

Introduction The evaluation of upcoming Aortic Coarctation (CoA) in new-borns with prenatal suspicion entails a close echocardiographic monitor until Arterial Duct (AD) closure, in a department with pediatric cardiological and surgical expertise. The significant number of false-positive prenatal diagnoses causes parental stress and healthcare costs. Aim The aim of this study was to elaborate an echocardiographic prediction model to be employed at birth when PDA is still present, in patients suspected of CoA during fetal life in order to foretell CoA requiring neonatal surgical intervention. Methods This retrospective monocentric study included consecutive full-term and late preterm neonates with prenatal suspicion of CoA born from 01 January 2007 to 31 December 2020. Patients were divided into two groups according to the need for aortic surgery (CoA - NoCoA). All patients underwent a comprehensive transthoracic echocardiographic exam in presence of PDA. Multivariable logistic regression was used to create a coarctation probability model (CoMOD) including isthmal (D4), transverse arch (D3) diameters, the distance between a left common carotid artery (LCA) and left subclavian artery (LSA), presence/absence of ventricular septal defect (VSD) and bicuspid aortic valve (BAV). Results We enrolled 87 neonates (49 male, 56%). 44 patients developed CoA in need of surgical repair. Our index CoMOD showed an AUC = 0.9382, high sensitivity (91%) and specificity (86%) in the prediction of CoA in neonates with prenatal suspicion. We classified neonates with CoMOD &gt; 0 to be at high risk for surgical correction of CoA, with good PPV (86.9%) and NPV (90.9%). Conclusions CoMOD &gt; 0 is highly suggestive of the need for CoA corrective surgery in newborns with prenatal suspicion

Lung ultrasound compared with bedside chest radiography in a paediatric cardiac intensive care unit

Aim: Postoperative recovery of children with heart disease is encumbered by pulmonary complications like pneumothorax (PNX), pleural effusion (PLE), interstitial oedema and pulmonary consolidation (PC). Recently, lung ultrasound (LUS) has become an important diagnostic tool for evaluation of pulmonary diseases in the paediatric context. LUS is accurate in diagnosing pleural and parenchymal diseases. The aim of this study was to evaluate the accuracy of LUS in the identification of PNX, PLE and PC in a paediatric population of patients with congenital heart disease after heart surgery. Methods: Fifty-three patients aged 0-17&nbsp;years who underwent cardiac surgery were evaluated in the postoperative period by chest X-ray (CXR) and LUS at the same time. The methods where compared for recognition of PNX, PLE and PC. Results: LUS showed a good agreement for PNX and a moderate agreement for both PLE and PC. LUS also showed a significantly superior relative sensitivity than CXR for PC and PLE and a significantly inferior relative sensitivity for PNX. Conclusion: This study confirms that LUS has a sufficient agreement rate with the current clinical standard (CXR). Non-inferiority in diagnosis together with the easiness of bedside performance makes LUS a very attractive tool for the paediatric cardiac intensive care unit

European Society of Cardiology-Proposed Diagnostic Echocardiographic Algorithm in Elective Patients with Clinical Suspicion of Infective Endocarditis: Diagnostic Yield and Prognostic Implications in Clinical Practice

Echocardiography plays a central role in diagnosing infective endocarditis (IE). Accordingly, the European Society of Cardiology (ESC) has proposed a diagnostic echocardiographic algorithm. However, new studies are still needed to evaluate the degree of implementation of these guidelines in clinical practice and their consequences on incidence and prognosis of IE

Prenatal sonography of the foramen ovale predicts urgent balloon atrial septostomy in neonates with complete transposition of the great arteries

BACKGROUND: Hypoxia caused by inadequate intracardiac mixing owing to a restrictive foramen ovale is a potentially life-threatening complication in neonates with dextro-transposition of the great arteries. An urgent balloon atrial septostomy is a procedure of choice in such cases, but dependent on the availability of a 24-hour interventional cardiology facility. The prenatal identification of predictors for an urgent balloon atrial septostomy at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage. OBJECTIVE: This study aimed to predict with prenatal echocardiography the need of urgent balloon atrial septostomy in neonates with dextro-transposition of the great arteries. STUDY DESIGN: This was a retrospective cohort study of patients with a prenatal diagnosis of transposition of the great arteries that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained at less than 3 weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of the foramen ovale, septum primum excursion (foramen ovale flap angle at the maximal excursion), diameters of the atria, and size of the ductus arteriosus. Balloon atrial septostomy was defined as urgent if performed within 12 hours from birth in neonates with restrictive foramen ovale. Neonatal follow-up was obtained through medical records analysis. RESULTS: From November 2007 to April 2019, 160 fetuses with complete transposition of the great arteries were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent balloon atrial septostomy, 11 elective balloon atrial septostomy, and 22 no balloon atrial septostomy. The size of the foramen ovale was the best predictor of an urgent balloon atrial septostomy. A measurement of &gt;6.5 mm had a sensitivity of 100% and a false positive rate of 45%. CONCLUSION: Fetal echocardiography predicts the need of an urgent balloon atrial septostomy in fetuses with dextro-transposition of the great arteries although with a limited precision. In our experience, a measurement of the foramen ovale within 3 weeks of delivery had the greatest accuracy