3 research outputs found
Myocardial inotropic reserve: An old twist that constitutes a reliable index in the modern era of heart failure
Current national and international guidelines, including those of the European Society of Cardiology, recognize that the assessment of prognosis should be a part of the standard management for patients with chronic heart failure (CHF). However, these same guidelines recognize the inherent difficulty of this process. A variety of factors contribute to this difficulty, including the varying etiology, frequent co-morbidity and, perhaps most importantly, huge inter-individual variability in the disease progression and outcome. Although CHF is chronic, it is also a condition in which significant proportions of patients experience apparently ‘sudden’ death, which almost certainly contributes to our difficulty in assessing individual patient prognosis. A useful tool for the risk stratification of heart failure patients is dobutamine stress echocardiography (DSE), which determines the myocardial viability in ischemic cardiomyopathy and myocardial contractile reserve in idiopathic cardiomyopathy
Blood-brain barrier dysfunction: the undervalued frontier of hypertension
The blood-brain barrier (BBB) constitutes the complex anatomic and
physiologic interface between the intravascular compartment and the
central nervous system, and its integrity is paramount for the
maintenance of the very sensitive homeostasis of the central nervous
system. Arterial hypertension is a leading cause of morbidity and
mortality. The BBB has been shown to be disrupted in essential
hypertension. BBB integrity is important for central autonomic control
and this may be implicated in the pathophysiology of hypertension. On
the other hand, evidence from experimental studies indicates that BBB
disruption can be present in both hypertensive disease and dementia
syndromes, suggesting a possibly key position of loss of BBB integrity
in the pathophysiological pathways linking arterial hypertension with
cognitive decline. Although much still remains to be elucidated with
respect to the exact underlying mechanisms, the discovery of novel
pathological pathways has changed our understanding of adult dementia
and central nervous system disease overall, pointing out-in parallel-new
potential therapeutic targets. The aim of this review is to summarize
current scientific knowledge relevant to the pathophysiologic pathways
that are involved in the disruption of the BBB function and potentially
mediate hypertension-induced cognitive impairment. In parallel, we
underline the differential cognition-preserving effect of several
antihypertensive agents of similar blood pressure-lowering capacity,
highlighting the presence of previously under-recognized BBB-protective
actions of these drugs
Antiplatelet and Antithrombotic Therapy in Type I Diabetes Mellitus: Update on Current Data.
Diabetes mellitus type 1 (T1DM) is an autoimmune disease characterized by a markedly elevated cardiovascular (CV) risk due to premature atherosclerosis. Previous studies have shown that intense glycemic control reduces the incidence of CV disease. Antiplatelet therapy is considered to be a very important therapy for secondary prevention of recurrent atherothrombotic events in patients with DM, while it may be considered for primary prevention in individuals with T1DM with additional CV risk factors.The aim of the present review is to summarize existing literature data regarding the thrombotic risk in T1DM patients and discuss current treatment strategies