The ACEF score: a simple but powerful predictor of short-term mortality in patients with ST-elevation myocardial infarction

Background: several clinical risk scores are available for the risk stratification of patients with ST-elevation myocardial infarction (STEMI), such as the CADILLAC, GRACE, PAMI, TIMI, and Zwolle, but all are complex to use and there is uncertainty on the best one. The age-creatinine-ejection fraction (ACEF) score, has been recently proven effective and proficient as a risk score in cardiac surgery despite its user-friendliness. We thus aimed to compare the performance of the ACEF score in comparison to the other available risk scores in patient with STEMI. Methods: subjects with STEMI undergoing primary percutaneous coronary intervention at our Institution from 2001 to 2009 were enrolled. The primary end-point was in-hospital all-cause death, whereas long-term all-cause death, long-term cardiac death were appraised as secondary outcomes. ACEF, CADILLAC, GRACE, PAMI, TIMI, and Zwolle risk scores were compared with receiver-operating characteristics (ROC) curves with areas under the curve (AUC), and binary multivariable logistic regression analysis with odds ratios (OR), plus 95% confidence intervals

PICKING THE BEST NOVEL ORAL ANTICOAGULANT FOR ATRIAL FIBRILLATION: EVIDENCE FROM A WARFARIN-CONTROLLED NETWORK META-ANALYSIS

Warfarin is a mainstay atrial ibrillation (AF) treatment, yet it has a narrow therapeutic window. Novel agents have been successfully tested against warfarin, yet no direct comparison among them is available. We thus performed a pair-wise and warfarin-adjusted network metaanalyses of novel oral anticoagulants for AF

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

Indexed left atrial volume, C-reactive protein and erythrocyte sedimentation rate as predictors of recurrence of non-valvular atrial fibrillation after successful cardioversion

Indexed left atrial volume, C-reactive protein and erythrocyte sedimentation rate as predictors of recurrence of non-valvular atrial fibrillation after successful cardioversio

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

PREVALENCE OF 'BORDERLINE' VALUES OF CARDIOVASCULAR RISK FACTORS IN THE CLINICAL PRACTICE OF GENERAL MEDICINE IN ITALY: RESULTS OF THE BORDERLINE STUDY.

INTRODUCTION: The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy. AIM: The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy. METHODS: Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90 mmHg; total cholesterol 180-200 mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150 mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40 mg/dL in males and 40-50 mg/dL in females; triglycerides 130-150 mg/dL and fasting glucose 100-110 mg/dL. RESULTS: Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9 ± 13.2 years, body mass index 26.6 ± 5.0 kg/m2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters. CONCLUSIONS: Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy

Extragenital Müllerian adenosarcoma with pouch of Douglas location

Background: Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Mullerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.Case Presentation: A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Mullerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.Conclusions: The case of Mullerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst

Endothelial dysfunction, carotid artery plaque burden, and conventional exercise-induced myocardial ischemia as predictors of coronary artery disease prognosis

<p>Abstract</p> <p>Background</p> <p>While both flow-mediated vasodilation (FMD) in the brachial artery (BA), which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT) in the carotid artery are correlated with the prognosis of coronary artery disease (CAD), it is not clear which modality is a better predictor of CAD. Furthermore, it has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG) as a predictor. Thus, the goal of the present study was to compare the predictive value of FMD, IMT, and stress ECG for CAD prognosis.</p> <p>Methods and Results</p> <p>A total of 103 consecutive patients (62 ± 9 years old, 79 men) with clinically suspected CAD had FMD and nitroglycerin-induced dilation (NTG-D) in the BA, carotid artery IMT measurement using high-resolution ultrasound, and exercise treadmill testing. The 73 CAD patients and 30 normal coronary patients were followed for 50 ± 15 months. Fifteen patients had coronary events during this period (1 cardiac death, 2 non-fatal myocardial infarctions, 3 acute heart failures, and 9 unstable anginas). On Kaplan-Meier analysis, only FMD and stress ECG were significant predictors for cardiac events.</p> <p>Conclusion</p> <p>Brachial endothelial function as reflected by FMD and conventional exercise stress testing has comparable prognostic value, whereas carotid artery plaque burden appears to be less powerful for predicting future cardiac events.</p

Antihypertensive Treatment Differentially Affects Vascular Sphingolipid Biology in Spontaneously Hypertensive Rats

We have previously shown that essential hypertension in humans and spontaneously hypertensive rats (SHR), is associated with increased levels of ceramide and marked alterations in sphingolipid biology. Pharmacological elevation of ceramide in isolated carotid arteries of SHR leads to vasoconstriction via a calcium-independent phospholipase A2, cyclooxygenase-1 and thromboxane synthase-dependent release of thromboxane A2. This phenomenon is almost absent in vessels from normotensive Wistar Kyoto (WKY) rats. Here we investigated whether lowering of blood pressure can reverse elevated ceramide levels and reduce ceramide-mediated contractions in SHR. Methods and Findings For this purpose SHR were treated for 4 weeks with the angiotensin II type 1 receptor antagonist losartan or the vasodilator hydralazine. Both drugs decreased blood pressure equally (SBP untreated SHR: 191±7 mmHg, losartan: 125±5 mmHg and hydralazine: 113±14 mmHg). The blood pressure lowering was associated with a 20–25% reduction in vascular ceramide levels and improved endothelial function of isolated carotid arteries in both groups. Interestingly, losartan, but not hydralazine treatment, markedly reduced sphingomyelinase-induced contractions. While both drugs lowered cyclooxygenase-1 expression, only losartan and not hydralazine, reduced the endothelial expression of calcium-independent phospholipase A2. The latter finding may explain the effect of losartan treatment on sphingomyelinase-induced vascular contraction. Conclusion In summary, this study corroborates the importance of sphingolipid biology in blood pressure control and specifically shows that blood pressure lowering reduces vascular ceramide levels in SHR and that losartan treatment, but not blood pressure lowering per se, reduces ceramide-mediated arterial contractions