Cardiac biomarkers in patients with ischemic heart disease enrolled in a cardiac rehabilitation program

INTRODUZIONE: alcuni marcatori biochimici plasmatici, sia di natura lipidica che non, hanno dimostrato di avere un potere predittivo di eventi maggiori cardiovascolari, ma esistono pochi dati in letteratura sul loro ruolo e potere predittivo in prevenzione secondaria cardiovascolare. OBIETTIVO: lo scopo del nostro studio \ue8 stato quello di valutare l\u2019esistenza di una associazione tra alcuni biomarcatori (UACR, PCR alta sensibilit\ue0, Nt-proBNP, Lp (a), ApoA e ApoB) ed il rischio cardiovascolare (endpoint primario combinato di mortalit\ue0 cardiovascolare e riospedalizzazione) nel contesto di un programma di prevenzione secondaria e riabilitazione cardiologica (SPCRP). MATERIALI E METODI: 167 pazienti con sindrome coronarica acuta (ACS), 137 maschi (82%) e 30 femmine (18%), et\ue0 media 59.8 \ub1 11 anni (32.5-78.5), sono stati arruolati in un programma annuale di prevenzione secondaria e riabilitazione cardiologica basato su counseling infermieristico, visite multispecialistiche ed attivit\ue0 fisica controllata. Prelievi ematochimici specifici (livelli plasmatici di TC, HDL C, LDL C, TG, Apo A, Apo B, hs-CRP, Nt-proBNP, Lp(a), UACR) e misure antropometriche di BMI e WHR sono stati eseguiti all'arruolamento, a 6 e 12 mesi. Un follow-up telefonico [mediana di 36.2 mesi (27.7 \u2013 77.0)] ha permesso la raccolta dati a distanza. CONCLUSIONI: tra tutti i biomarcatori cardiaci considerati solo l' HDL C, Apo A e l' Nt-proBNP sono risultati predittori indipendenti di mortalit\ue0 e riospedalizzazione cardiovascolare. Ulteriori studi sono necessari per meglio definire il valore prognostico di nuovi biomarcatori in prevenzione cardiovascolare secondaria.BACKGROUND: Several plasma lipid and non-lipid biomarkers have been shown to predict major cardiovascular events in population studies, but data on novel biomarkers in secondary prevention are sparse and there exists marked heterogeneity across trials. OBJECTIVE: Aim of our study was to determine whether temporary changes of traditional lipid and new lipid and non-lipid biomarkers like UACR, hs-CRP, Nt-proBNP, Lp(a), ApoA and ApoB, observed during a Secondary Prevention and Cardiac Rehabilitation Program (SPCRP), are associated to CV risk (primary combined end-point of cardiovascular mortality and re-hospitalization). MATERIALS AND METHODS: we enrolled 167 ACS patients, 137 males (82%) and 30 females (18%); mean age of participants was 59.8 \ub1 11 years (32.5-78.5). The 12-months SPCRP was based on nurse counselling, multispecialistic visits and controlled training. Serial blood samples (plasma levels of TC, HDL C, LDL C, TG, Apo A, Apo B, hs-CRP, Nt-proBNP, Lp(a), UACR), BMI and WHR were assessed at baseline, at 6 and 12 months. A telephonic follow up [median of 36.2 months (27.7 \u2013 77.0)] was performed to collect data. CONCLUSIONS: Among all the cardiac biomarkers considered only HDL C, Apo a and Nt-proBNP resulted to be independent predictors of cardiovascular mortality and re-hospitalization. Prognostic value of novel biomarkers in secondary cardiovascular prevention needs further investigations

Gender differences and cardiometabolic risk. the importance of the risk factors

Metabolic syndrome (Mets) is a clinical condition characterized by a cluster of major risk factors for cardiovascular disease (CVD) and type 2 diabetes: proatherogenic dyslipidemia, elevated blood pressure, dysglycemia, and abdominal obesity. Each risk factor has an independent effect, but, when aggregated, they become synergistic, doubling the risk of developing cardiovascular diseases and causing a 1.5-fold increase in all-cause mortality. We will highlight gender differences in the epidemiology, etiology, pathophysiology, and clinical expression of the aforementioned Mets components. Moreover, we will discuss gender differences in new biochemical markers of metabolic syndrome and cardiovascular risk

The dilemma of ischemia testing with different methods

A 52-year-old man presented after one episode of effort angina, normal treadmill-ECG and clearly positive adenosine cardiac magnetic resonance (aCMR) for reversible perfusion defects in the left anterior descending coronary artery (LAD) territory. Contrast high-dose dipyridamole (0.84mg/kg/6min) stress-echocardiography (cSE) demonstrated normal myocardial perfusion and wall motion at rest, while perfusion defects were shown in the lateral and apical segments after dipyridamole. Wall motion at stress was completely normal and stress/rest Doppler diastolic velocity ratio on the LAD demonstrated reduced flow reserve. In this case cSE was the provocative test detecting both the LAD and circumflex obstructive lesions, thanks to myocardial perfusion analysis, while wall motion assessment was negative, not differently from treadmill-ECG, and aCMR highlighted only the LAD disease

Les anti-agrégants plaquettaires dans les syndromes coronaires aigus : rapport bénéfice/risque

Antithrombotic medications, particularly antiplatelet agents, are crucial in the management of patients with acute coronary syndromes. Their potential to increase the risk of bleeding, however, represents the downside of their remarkable efficacy in terms of prevention of ischaemic events. Careful assessment of the benefit/risk ratio of the medications that are currently available is therefore essential

Anomalous origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA): a rare presentation in late adulthood

We report a case of ALCAPA seen in one of the oldest patients ever reported

Salute della donna & esercizio fisico

Secondo l\u2019Organizzazione Mondiale della Sanit\ue0, la sedentariet\ue0 provoca 1,9 milioni di morti annue. La costante pratica di esercizio fisico, al contrario, gioca un ben noto ruolo nel diminuire la morbilit\ue0 e la mortalit\ue0 in quasi tutti i tipi di malattie croniche. In questa disamina della letteratura si possono rintracciare contenuti sugli effetti dell\u2019esercizio in diversi contesti fisiologici, con un\u2019attenzione particolare al genere femminile, dovuta alle specifiche risposte della donna rispetto all\u2019insorgenza e alla progressione delle patologie cardiovascolari, con un approfondimento sui livelli di attivit\ue0 fisica tra le donne italiane in relazione alle diverse fasi della loro vita.Alla luce di questa analisi, la scelta di un approccio clinico-preventivo legato al genere risulta essenziale per poter organizzare piani pi\uf9 dettagliati per la prevenzione, la cura e il mantenimento dei livelli di salute della donna

023 - National observational study of diagnostic and interventional cardiac catheterization by the French Society of Cardiology (ONACI): results according to administrates regions (northern vs. southern)

Descrizione dei dati osservazionali del registro nazionale ONACI. Differenze epidemiologiche regioni francesi nord - sud

019 - National observational study of diagnostic and interventional cardiac catheterization by the French Society of Cardiology (ONACI): study design and baseline characteristics

Studi osservazionale nazionale francese di cardiologia interventistica, disegno dello studio e caratteristiche di base della popolazione

Study design and baseline characteristics of the national observational study of diagnostic and interventional cardiac catheterization by the French Society of Cardiology.

The national observational study of diagnostic and interventional cardiac catheterization (ONACI) is a prospective multicenter registry of the French Society of Cardiology including all interventional cardiology procedures performed from 2004. We aimed to evaluate "real-world" management of patients with coronary artery disease in France from this registry. The present study was focused on data collected from 2004 to 2008. Patient demographics and co-morbidities, invasive parameters, treatment options, and procedural techniques were prospectively collected. Patients were recruited from 99 hospitals (55% of patients were hospitalized in private clinics and 45% in public institutions). During a 5-year period, a total of 298,105 patients underwent coronary angiography and 176,166 patients underwent percutaneous coronary intervention. Diagnosis was acute coronary syndrome in 22%, stable angina or silent ischemia in 23%, and atypical chest pain in 9% of cases. Normal coronary arteries or nonsignificant coronary narrowing were found in 26% of patients. Radial access was increasingly used over the years regardless of the indication. The average number of percutaneous coronary interventions per procedure was 1.5 ± 0.7 (range, 1.3 ± 0.7 to 1.5 ± 0.7) and that of stents per procedure was 1.5 ± 0.8 (range, 1.5 ± 0.8 to 1.6 ± 0.8). Drug-eluting stents were used in 45% (range, 34% to 62%), increasing from 2004 to 2006, and then decreasing after the 2006 controversy. In conclusion, ONACI is one of the largest catheterization registries during this period, providing a detailed and comprehensive global description of the spectrum and management of patients with suspected coronary artery disease undergoing cardiac catheterization