Triggers for atrial fibrillation. the role of anxiety

Atrial fibrillation (AF) is the most widely recognized arrhythmia. Systemic arterial hypertension, diabetes, obesity, heart failure, and valvular heart diseases are major risk factors for the onset and progression of AF. Various studies have emphasized the augmented anxiety rate among AF patients due to the poor quality of life; however, little information is known about the possibility of triggering atrial fibrillation by anxiety. +e present review sought to underline the possible pathophysiological association between AF and anxiety disorders and suggests that anxiety can be an independent risk factor for AF, acting as atrigger, creating an arrhythmogenic substrate, and modulating the autonomic nervous system.+e awareness of the role of anxietydisorders as a risk factor for AF may lead to the development of new clinical strategies for the management of AF

Heart Failure and Iron Deficiency

Heart failure (HF) is a major public health problem because it is one of the most common causes of morbidity and mortality in Western countries, with a prevalence of 1–2% in the adult population, rising to ≥10% in those age >70 years. In addition to the “classic” co-morbidities, such as COPD, arterial hypertension, diabetes, renal failure, etc., there are other conditions frequently found in patients with heart failure that many times are underestimated. One example are anemia and iron deficiency (ID). ID, regardless of anemia impair exercise tolerance, symptoms and quality of life, with a strong negative prognostic impact on hospitalization and mortality rate. Despite strong evidence of high prevalence of ID in these patients and current guidelines recommendations, the diagnosis of ID and its monitoring over time still have low priority for physicians in clinical practice. Consequently ID is under-treated; furthermore current therapies, in particular i.v. iron as ferric carboxymaltose, though effective, turn out to be poorly managed by clinicians. ID should be considered more in real world HF healthcare settings to improve patients’ quality of life and outcome

Diabetes mellitus and ischemic heart disease. the role of ion channels

Diabetes mellitus is one the strongest risk factors for cardiovascular disease and, in particular, for ischemic heart disease (IHD). The pathophysiology of myocardial ischemia in diabetic patients is complex and not fully understood: some diabetic patients have mainly coronary stenosis obstructing blood flow to the myocardium; others present with coronary microvascular disease with an absence of plaques in the epicardial vessels. Ion channels acting in the cross-talk between the myocardial energy state and coronary blood flow may play a role in the pathophysiology of IHD in diabetic patients. In particular, some genetic variants for ATP-dependent potassium channels seem to be involved in the determinism of IH

Aspirin-dependent effects on purinergic P2Y1 receptor express

Chronic treatment with aspirin in healthy volunteers (HVs) is associated with recovery of adenosine diphosphate (ADP)-induced platelet activation. The purinergic P2Y1 receptor exerts its effects via a Gq-protein, which is the same biochemical pathway activated by thromboxane-A2 receptor. We hypothesized that recovery of ADP-induced platelet activation could be attributed to increased P2Y1 expression induced by chronic aspirin exposure. We performed a multi-phase investigation which embraced both in vitro and in vivo experiments conducted in (1) human megakaryoblastic DAMI cells, (2) human megakaryocytic progenitor cell cultures, (3) platelets obtained from HVs treated with aspirin and (4) platelets obtained from aspirin-treated patients. DAMI cells treated with aspirin or WY14643 (PPARα agonist) had a significant up-regulation of P2Y1 mRNA, which was shown to be a PPARα-dependent process. In human megakaryocytic progenitors, in the presence of aspirin or WY14643, P2Y1 mRNA expression was higher than in mock culture. P2Y1 expression increased in platelets obtained from HVs treated with aspirin for 8 weeks. Platelets obtained from patients who were on aspirin for more than 2 months had increased P2Y1 expression and ADP-induced aggregation compared with patients on aspirin treatment for less than a month. Overall, our results suggest that aspirin induces genomic changes in megakaryocytes leading to P2Y1 up-regulation and that PPARα is the nuclear receptor involved in this regulation. Since P2Y1 is coupled to the same Gq-protein of thromboxane-A2 receptor, platelet adaptation in response to pharmacological inhibition seems not to be receptor specific, but may involve other receptors with the same biochemical pathway

Possible predicative role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients. preliminary data

Background:Transcatheter aortic valve replacement (TAVR) is an effective procedure capable to change the natural history of the degenerative aortic valve stenosis. Despite the TAVR, the patients with advanced valve disease and severe myocardial damage (low flow, gradient and ejection fraction)show high mortality level. Aim of this study was toevaluate the predicative power of a noninvasive and inexpensive test obtained by means of a simple standard 12-leads electrocardiogram,known as the Electrical Risk Score (ERS). Methods: ERS was composed by seven simple ECG markers: heart rate (>75 bpm); QRS duration (>110 ms), left ventricular hypertrophy (Sokolow-Lyon criteria), delayed QRS transition zone (≥ V4), frontal QRS-T angle (>90°), long QTBazett (>450 ms for men and >460 in women) or JTBazett(330 ms for men and > 340 ms for women);long T peak to T end interval (Tp-e)( >89 ms). An ERS ≥ 4was considered high risk for all-cause or cardiovascular mortality.We calculated retrospectively the pre-procedure ERS in 40 TAVR patients after one year of follow-up. Results: In the follow up the all-cause and cardiovascular mortality were respectively 25% and 15%.None of survivors reported ERS ≥ 4,moreover, the ERS was the strongest predictor of all-cause (odd ratio 3.73, 95% CI: 1.44-9.66, p<0.05) or cardiovascular (odd ratio 3.95, 95% CI: 1.09-14.27, p<0.05) mortality.ROC curves showed that ERS had the widest significant sensitivity-specificity area under the curve (auc) predicting all-cause (auc: 0.855, p<0.05) or cardiovascular mortality (auc: 0.908, p<0.05). Conclusions:In this pivotal study, ERS resulted an useful tool to stratify the risk of mortality in one-year follow-up TAVR patients. Obviously, it is necessary to confirm these data in large prospective studies

Reply to “regarding the article of ceccacci et al. (2016; 223: 54–55)” entitled “role of MIBG scintigraphy in reverse tako-tsubo cardiomyopathy. confirming a pathophysiologic hypothesis"

We agree with Nicolas Mansencal et all. and we really thanks for their comments. For brevity, we did not report some details of the descripted clinical case (1). The diagnosis of Takotsubo cardiomyopathy was performed according to Mayo Clinic criteri

Narrating the museum to promote empathy and critical thinking in medical science students and doctors through online activities: a pilot research experience

L'esperienza di ricerca "Narrare il museo per promuovere l’empatia e il pensiero critico in studenti di medicina e dottori", realizzata nell'ambito del progetto "Inclusive Memory", co-finanziato dall’Università Roma Tre, mira a promuovere l'empatia e la capacità di pensiero critico nei medici, anche in formazione, attraverso attività di educazione al patrimonio. Le caratteristiche innovative dell'esperienza di ricerca risiedono nell'utilizzo di attività online, che combinano diverse metodologie di apprendimento: Visual Thinking Strategies, Reflective Questioning, Storytelling e Object-based learning. Il contributo presenta i risultati dell'attività pilota svolta dal gruppo di ricerca del Centro di Didattica Museale, con sede presso il Dipartimento di Scienze della Formazione dell’Università Roma Tre, in collaborazione con Sapienza Università di Roma. Vengono inoltre descritte le attività didattiche, gli strumenti di apprendimento e di valutazione utilizzati durante tale esperienza, che ha coinvolto 35 partecipanti. I risultati della sperimentazione descritta evidenziano un miglioramento statisticamente significativo per quanto riguarda l’indicatore di pensiero critico “uso della lingua” e un miglioramento della dimensione empatica della sensibilità al contesto; i partecipanti dichiarano che i loro livelli di comunicazione e pensiero critico migliorano alla fine delle attività e che gli esercizi progettati stimolano la riflessione, l'osservazione e l'interpretazione.The research experience "Narrating the museum to promote empathy and critical thinking in medical science students and doctors through online activities", carried out within the "Inclusive Memory" project, co-funded by University Roma Tre, aims at promoting empathy and critical thinking skills in medical science students and doctors through heritage education activities. The innovative features of the research experience lie in the use of online activities, combining different learning methodologies: Visual Thinking Strategies, Reflective Questioning, Storytelling and Object-Based Learning. The paper presents the results of the pilot activity carried out by the Centre for Museum Studies research group, based at the Department of Education – Roma Tre, in collaboration with the Sapienza University of Rome. It also describes the teaching activities, learning and evaluation tools used during the pilot experience, which involved 35 participants. The trial results highlight a statistically significant improvement in the Critical Thinking use of language indicators and an improvement of Sensitivity to the context empathy dimension; participants state that their levels of communication and critical thinking skills improved at the end of the activities and that the exercises foreseen stimulated reflection, observation and interpretation