Micro‑RNA‑21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study

Aims: Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation. miRNA-21 is a biomarker associated with MF in pressure overload. The aim of the present study was to find an integrated algorithm for detection of MF using a combined approach with both bio- and functional markers. Methods: Thirty-six patients (75.2±8 y.o.; 63% Female) with severe AVS and preserved LV ejection fraction (EF), candidate to surgical aortic valve replacement (sAVR) were enrolled. Clinical, bio-humoral evaluation (including plasmatic miRNA-21 collected using specific tubes, PAXgene, for stabilization of peripheral RNA) and a complete echocardiographic study, including GLS and septal strain, were performed before sAVR. Twenty-eight of those patients underwent sAVR and, in 23 of them, an inter-ventricular septum biopsy was performed. Tissues were fixed in formalin and embedded in paraffin. Sections were stained with Hematoxylin and Eosin for histological evaluation and with histochemical Masson trichrome for collagen fibers. The different components were calculated and expressed as micrometers2. To evaluate tissue miRNA components, sections2-μm thick were cut using a microtome blade for each slide. Regression analysis was performed to test association between dependent variable and various predictors included in the model. Results: Despite a preserved EF (66±11%), patients presented altered myocardial deformation parameters (GLS -14,02±3.8%; septal longitudinal strain, SSL -9.63±2.9%; septal longitudinal strain rate, SL-Sr -0.58±0.17 1/s; Septal Longitudinal early-diastolic strain rate, SL-SrE 0.62±0.32 1/s). The extent of MF showed an inverse association with both GLS and septal longitudinal deformation indices (GLS: R2=0.30; p=0.02; SSL: R2=0.36; p=0.01; SL-Sr: R2=0.39; p<0.001; SL-SrE: R2=0.35; p=0.001). miRNA-21 was mainly expressed in fibrous tissue (p<0.0001). A significant association between MF and plasmatic miRNA-21, alone and weighted for measures of structural (LVMi R2=0.50; p=0.0005) and functional (SSL R2=0.35; p=0.006) remodeling, was found. Conclusions: In AVS, MF is associated with alterations of regional and global strain. Plasmatic miRNA-21 is directly related to MF and associated with LV structural and functional impairment. © 2016 The Author(s)

Enoximone echocardiography: a novel test to evaluate left ventricular contractile reserve in patients with heart failure on chronic beta-blocker therapy

BACKGROUND: It has been suggested that an extensive contractile reserve identified recognised by means of dobutamine stress echocardiography may predict a better prognosis in patients with severe left ventricular dysfunction at rest. However, the clinical use of dobutamine stress echocardiography may be limited in patients with chronic heart failure by the substantial proportion of such patients treated with beta-blockers, since the inotropic response to adrenergic stimulation is known to be attenuated in patients receiving beta-adrenoceptor blockers. Enoximone is a positive inotropic agent that inhibits cyclic adenosine monophosphate-specific phosphosdiesterase. We therefore tested the hypothesis that enoximone may be an alternative to dobutamine in evaluating left ventricular contractile reserve in patients with systolic dysfunction on chronic beta-blocker therapy. METHODS: We studied 26 patients (21 males and five females) with a mean age of 58 ± 10 years: 11 were not receiving beta-blockers (noBB group); 15 were receiving carvedilol at a mean dose of 34 mg/day (BB group). Dobutamine was infused at doses of 5 and 10 micrograms/kg/min, and enoximone at a dose of 1.5 mg/kg. RESULTS: The ejection fraction in the noBB group increased by 9% with dobutamine and 8.73% with enoximone (p = 0.86); in the BB group, it increased by 6% with dobutamine and 8.94% with enoximone (p = 0.03). Regional peak systolic velocities were evaluated by means of tissue Doppler imaging in four basal and four medium level segments. In the noBB group, they increased more with dobutamine than with enoximone in three of the eight segments; no significant differences were found in the BB group. Dobutamine induced non-sustained ventricular tachycardia in three patients and supraventricular tachycardia in one, whereas enoximone did not induce any repetitive arrhythmias. CONCLUSIONS: Enoximone might be preferable to low-dose dobutamine for evaluating left ventricular contractile reserve in chronically beta-blocked heart failure patients as it is slightly more potent and has a better safety profile

Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis

BACKGROUND: People of Sub Saharan Africa (SSA) and South Asians(SA) ethnic minorities living in Europe have higher risk of stroke than native Europeans(EU). Study objective is to provide an assessment of gender specific absolute differences in office systolic(SBP) and diastolic(DBP) blood pressure(BP) levels between SSA, SA, and EU. METHODS AND FINDINGS: We performed a systematic review and meta-analysis of observational studies conducted in Europe that examined BP in non-selected adult SSA, SA and EU subjects. Medline, PubMed, Embase, Web of Science, and Scopus were searched from their inception through January 31st 2015, for relevant articles. Outcome measures were mean SBP and DBP differences between minorities and EU, using a random effects model and tested for heterogeneity. Twenty-one studies involving 9,070 SSA, 18,421 SA, and 130,380 EU were included. Compared with EU, SSA had higher values of both SBP (3.38 mmHg, 95% CI 1.28 to 5.48 mmHg; and 6.00 mmHg, 95% CI 2.22 to 9.78 in men and women respectively) and DBP (3.29 mmHg, 95% CI 1.80 to 4.78; 5.35 mmHg, 95% CI 3.04 to 7.66). SA had lower SBP than EU(-4.57 mmHg, 95% CI -6.20 to -2.93; -2.97 mmHg, 95% CI -5.45 to -0.49) but similar DBP values. Meta-analysis by subgroup showed that SA originating from countries where Islam is the main religion had lower SBP and DBP values than EU. In multivariate meta-regression analyses, SBP difference between minorities and EU populations, was influenced by panethnicity and diabetes prevalence. CONCLUSIONS: 1) The higher BP in SSA is maintained over decades, suggesting limited efficacy of prevention strategies in such group in Europe;2) The lower BP in Muslim populations suggests that yet untapped lifestyle and behavioral habits may reveal advantages towards the development of hypertension;3) The additive effect of diabetes, emphasizes the need of new strategies for the control of hypertension in groups at high prevalence of diabetes

Il Mitreo del Circo Massimo a Roma: conservare la materia, leggere la storia

Nell’ambito del progetto di ricerca dell’Università degli Studi Trieste sul Mitreo del CircoMassimo, si sono svolte una serie di indagini indirizzate alla definizione delle linee guida per il successivo intervento di conservazione e valorizzazione complessiva del sito, anche in relazione alla sua fruibilità da parte del pubblico. Tali indagini sono riconducibili a due diverse tipologie di azione. La prima è stata quella relativa alla lettura delle superfici, in particolare di quelle interessate dalla presenza di titoli incisi e graffiti, per la quale è stato previsto l’utilizzo di tecniche differenziate, sia per valutarne la consistenza fisico-materica e lo stato di conservazione che le potenzialità in relazione alle specifiche caratteristiche del sito in esame. In un secondo momento sono state realizzate delle campionature sui principali materiali presenti, finalizzate alla verifica della loro compatibilità ed efficacia, anche in conformità alle caratteristiche del microclima presente. In particolare sono state eseguite prove differenziate di pulitura e consolidamento, sia sui materiali lapidei che sulle superfici intonacate, sempre in accordo e con la supervisione della Sovrintendenza Capitolina ai Beni Culturali

Intravascular hemolysis in patients with new-generation prosthetic heart valves: A prospective study

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Repair of a giant left ventricular pseudoaneurysm with rupture of the interventricular septum

Presence of two combined mechanical complications of acute myocardial infarction is extremely rare and still associated with a high-operative mortality. We describe a 73-year-old male patient who presented with a giant left ventricular pseudoaneurysm associated with rupture of the interventricular septum. Surgical repair of both lesions was successfully accomplished