U-shaped relationship between vitamin D levels and long-term outcome in large cohort of survivors of acute myocardial infarction

Background: Previous studies in the setting of patients with acute myocardial infarction (AMI) have demonstrated that hypovitaminosis D is associated with increased mortality risk during a follow-up whose median did not exceed two years. Objective: To evaluate the impact of vitamin D levels on long-term mortality in patients with AMI. Results: In our study 477 patients with AMI were included. During a median follow-up period of 57 (IQR 53\u201364) months, 93 patients (20%) died. A non-linear U-shaped relationship between 25(OH)D levels and long-term mortality was observed; patients with vitamin D b 10 ng/mL and N30 ng/mL had higher mortality rate than those with intermediate values. After adjustment for differences in baseline features and treatment, it was con- firmed that extreme values of vitamin D (b10 or N30 ng/mL) are independent predictors of mortality with HR of 3.02 (95% CI 1.78\u20135.11). Other independent predictors of outcome were age, NYHA class at discharge, treatment with ACE inhibitors and statins. The estimated time-dependent ROC curve of the multivariable model including vitamin D showed an AUC significantly higher than the model without vitamin D: AUC 0.82 (95% CI 0.76\u20130.87) vs. 0.77 (95% CI 0.71\u20130.83), p = 0.005. Addition of vitamin D to the model that included all significant factors for mortality improved the prognostic accuracy as showed by the metrics of reclassification (NRI 0.34 (95% CI 0.14\u20130.48), p = 0.003 and IDI 0.06 (95% CI 0.01\u20130.12, p = 0.005 p = 0.03). Conclusions: We report a U-shaped relationship between vitamin D levels and long-term outcome of patients surviving AMI

Interleukin-1β levels predict long-term mortality and need for heart transplantation in ambulatory patients affected by idiopathic dilated cardiomyopathy

The prognostic stratification of patients with Idiopathic Dilated Cardiomyopathy (iDCM) is a difficult task. Here, we assessed the additive value of the evaluation of biomarkers of inflammasome activation and systemic inflammation for the long-term risk stratification of iDCM patients

Is it time to calculate renal function in non valvular atrial fibrillation patients to stratify the risk of future events?

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Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study

Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area

Obesity and high waist circumference are associated with low circulating pentraxin-3 in acute coronary syndrome

BACKGROUND: Long pentraxin 3 (PTX3) is a component of the pentraxin superfamily and a potential marker of vascular damage and inflammation, associated with negative outcome in patients with acute coronary syndromes (ACS). Obesity is a risk factor for cardiovascular disease and PTX3 production is reported in abdominal adipose tissue. Low PTX3 is however reported in the obese population, and obesity per se may be associated with less negative ACS outcome. METHODS: We investigated the potential impact of obesity and high waist circumference (reflecting abdominal fat accumulation) on plasma PTX3 concentration in ACS patients (n\u2009=\u200972, 20 obese) compared to age-, sex- and BMI-matched non-ACS individuals. RESULTS: Both obese and non-obese ACS patients had higher PTX3 than matched non-ACS counterparts, but PTX3 was lower in obese than non-obese individuals in both groups (all P\u2009<\u20090.05). PTX3 was also lower in ACS subjects with high than in those with normal waist circumference (WC). Plasma PTX3 was accordingly associated negatively with BMI and WC, independently of age and plasma creatinine. No associations were observed between PTX3 and plasma insulin, glucose or the short pentraxin and validated inflammation marker C-reactive protein, that was higher in ACS than in non-ACS individuals independently of BMI or WC. CONCLUSIONS: Obesity is associated with low circulating PTX3 in ACS. This association is also observed in the presence of abdominal fat accumulation as reflected by elevated waist circumference. Low PTX3 is a novel potential modulator of tissue damage and outcome in obese ACS patients

Evidence of a double anaerobic threshold in healthy subjects

The anaerobic threshold (AT) is an important cardiopulmonary exercise test (CPET) parameter both in healthy and in patients. It is normally determined with three approaches: V-slope method, ventilatory equivalent method, and end-tidal method. The finding of different AT values with these methods is only anecdotic. We defined the presence of a double threshold (DT) when a \u394VO2 > 15\u2009mL/min was observed between the V-slope method (met AT) and the other two methods (vent AT). The aim was to identify whether there is a DT in healthy subjects

Left ventricular function and exercise performance in idiopathic dilated cardiomyopathy: Role of tissue Doppler imaging

BACKGROUND: To examine the relationship between left ventricular (LV) function evaluated at echocardiography and exercise performance in idiopathic dilated cardiomyopathy (IDCM) patients. METHODS AND RESULTS: We enrolled 76 consecutive IDCM patients in sinus rhythm, undergoing cardiopulmonary exercise testing and echocardiography [49\u200a\ub1\u200a13 years old; LV ejection fraction 31\u200a\ub1\u200a7%, LV end-diastolic volume 96\u200a\ub1\u200a31\u200aml/m; peak oxygen consumption (peak VO2/kg) 18\u200a\ub1\u200a5.6\u200aml/kg/min]. Linear regression analysis revealed that peak systolic velocity (S') (r\u200a=\u200a0.46; P\u200a<\u200a0.001) and E/E' (r\u200a=\u200a-0.43; P\u200a<\u200a0.001), two tissue Doppler imaging derived parameters, were related to peak VO2/kg, whereas ejection fraction and mitral inflow variables were not. Considering the 69 patients (90%) without diastolic restrictive pattern (a well known index of severe diastolic dysfunction), multivariate regression analysis showed that age, E/E' and S' were the only independent variables related to peak VO2/kg. Similarly, age and E/E' were confirmed as independent parameters for the prediction of ventilation/carbon dioxide production slope in the whole population. CONCLUSION: In IDCM patients, cardiopulmonary exercise performance variables were strongly related to E/E' and S'

La fibrillazione atriale non valvolare: dati dall\u2019Osservatorio delle Malattie Cardiovascolari della provincia di Trieste [Nonvalvular atrial fibrillation: data from the Observatory of Cardiovascular Diseases in the province of Trieste (Italy)]

Razionale. La fibrillazione atriale non valvolare (FANV) \ue8 la pi\uf9 frequente aritmia nei pazienti ambulatoriali e si associa ad un incremento della mortalit\ue0 e degli eventi tromboembolici ed emorragici. Numerosi studi ne hanno analizzato l\u2019impatto prognostico nel mondo reale, ma non sono disponibili dati epidemiologici su ampie popolazioni valutate in Italia. Il nostro obiettivo \ue8 definire prevalenza, comorbilit\ue0, terapia ed outcome in una vasta popolazione italiana \u201creal-life\u201d di pazienti ambulatoriali con FANV. Materiali e metodi. Dal 2009 al 2013 abbiamo arruolato 21 282 pazienti consecutivi afferenti al Centro Cardiovascolare di Trieste. La FANV era definita in assenza di valvulopatie moderato-severe, interventi valvolari, cardiopatia reumatica. Gli eventi valutati nel follow-up sono stati: mortalit\ue0, ospedalizzazioni, tromboembolismi ed emorragie. Dati clinici ed eventi sono stati estratti dalla cartella elettronica cardiologica regionale e dai codici ICD-9 di dimissione ospedaliera. Risultati. 3379 pazienti (15.8%) presentavano FANV (35.6% parossistica, 34.5% persistente, 29.9% permanente); rispetto alla popolazione senza fibrillazione atriale questi pazienti erano pi\uf9 anziani, prevalentemente uomini, ipertesi, diabetici, con storia di ictus/attacco ischemico transitorio e scompenso cardiaco. La terapia anticoagulante orale era prescritta nel 54% dei casi, soprattutto nelle forme persistenti o permanenti, all\u2019aumentare del CHA2DS2-VASc e al diminuire dell\u2019et\ue0. Il tasso di mortalit\ue0 globale, ospedalizzazioni cardiovascolari, eventi tromboembolici ed emorragici nel follow-up era pi\uf9 elevato nei pazienti con FANV rispetto alla popolazione senza fibrillazione atriale. Il ricorso alla terapia anticoagulante orale riduceva l\u2019incidenza di eventi tromboembolici. Il CHA2DS2-VASc score emergeva come predittore di rischio tromboembolico nei tre diversi tipi di FANV con un incremento del rischio di eventi del 35% nella forma parossistica, del 40% nella forma persistente e del 34% nella forma permanente rispetto ai soggetti senza fibrillazione atriale. Conclusioni. In un\u2019ampia popolazione italiana di pazienti \u201creal-life\u201d ambulatoriali la FANV si associa ad et\ue0 pi\uf9 avanzata, maggiori comorbilit\ue0 ed incremento degli eventi cardiovascolari. Gli score CHA2DS2-VASc e HAS-BLED predicono accuratamente il rischio di eventi tromboembolici ed emorragici. La terapia anticoagulante orale riduce gli eventi tromboembolici, sebbene il suo utilizzo \ue8 limitato a circa la met\ue0 dei soggetti esaminati

The double anaerobic threshold in heart failure: MECKI score database overview

Abstract Aims In heart failure (HF), anaerobic threshold (AT) may be indeterminable but its value held a relevant prognostic role. AT is evaluated joining three methods: V‐slope, ventilatory equivalent, and end‐tidal methods. The possible non‐concordance between the V‐slope (met AT) and the other two methods (vent AT) has been highlighted in healthy individuals and named double threshold (DT). Methods and results We reanalysed 1075 cardiopulmonary exercise tests of HF patients recruited in the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score database. We identified DT in 43% of cases. Met AT precedes vent AT being met–ventΔVO2 221 (interquartile range: 129–319) mL/min. Peak VO2, 1307 ± 485 vs. 1343 ± 446 mL/min (63 ± 17 vs. 63 ± 17 percentage of predicted), was similar between DT+ and DT− patients. Differently, DT+ showed a lower ventilatory vs. carbon dioxide production (VE/VCO2) slope (29.6 ± 6.1 vs. 31.0 ± 6.3), a lower peak exercise end‐tidal oxygen tension (PetO2) 115.3 (111.5–118.9) vs. 116.4 (112.4–120.2) mmHg, and a higher carbon dioxide tension (PetCO2) 34.2 (30.9–37.1) vs. 32.4 (28.7–35.5) mmHg. Vent AT showed a significant higher VO2, 957 ± 318 vs. 719 ± 252 mL/min, VCO2, 939 ± 319 vs. 627 ± 226 mL/min, ventilation, 31.0 ± 8.3 vs. 22.5 ± 6.3 L/min, respiratory exchange ratio, 0.98 ± 0.08 vs. 0.87 ± 0.07, PetO2, 108 (104–112) vs. 105 (101–109) mmHg, PetCO2, 37 (34–40) vs. 36 (33–39) mmHg, and VE/VO2 ratio, 33.5 ± 6.7 vs. 32.6 ± 6.9, but lower VE/VCO2 ratio, 33 (30–37) vs. 36 (32–41), compared with met AT. At 2 year survival by Kaplan–Meier analysis, even adjusted for confounders, DT resulted not associated with survival. Conclusions Double threshold is frequently observed in HF patients. DT+ is associated to a decreased ventilatory response during exercise