Mitochondrial Dynamics as Potential Modulators of Hormonal Therapy Effectiveness in Males

Worldwide the incidence of andrological diseases is rising every year and, together with it, also the interest in them is increasing due to their strict association with disorders of the reproductive system, including impairment of male fertility, alterations of male hormones production, and/or sexual function. Prevention and early diagnosis of andrological dysfunctions have long been neglected, with the consequent increase in the incidence and prevalence of diseases otherwise easy to prevent and treat if diagnosed early. In this review, we report the latest evidence of the effect of andrological alterations on fertility potential in both young and adult patients, with a focus on the link between gonadotropins' mechanism of action and mitochondria. Indeed, mitochondria are highly dynamic cellular organelles that undergo rapid morphological adaptations, conditioning a multitude of aspects, including their size, shape, number, transport, cellular distribution, and, consequently, their function. Since the first step of steroidogenesis takes place in these organelles, we consider that mitochondria dynamics might have a possible role in a plethora of signaling cascades, including testosterone production. In addition, we also hypothesize a central role of mitochondria fission boost on the decreased response to the commonly administrated hormonal therapy used to treat urological disease in pediatric and adolescent patients as well as infertile adults

Assessment of Myocardial Fibrosis Using Advanced Echocardiography in Patients With Systemic Lupus Erythematosus: a Pilot Study

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, which is characterized by a multi-organ involvement and increased mortality, mainly due to cardiovascular complications. Myocardial fibrosis (MF) is common in SLE, affecting up to 30% of these patients. Cardiac magnetic resonance imaging allows an accurate assessment of myocardial tissue in SLE patients, but it is costly, time consuming, and unfit for patients with coexisting chronic kidney disease. Recent advanced echocardiographic techniques allow an accurate assessment of MF. In particular, speckle tracking echocardiography (STE) is a reproducible technique that provides information about MF by detecting abnormalities in myocardial active deformation. Scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) is another novel technique that has been validated for detecting ischemic myocardial scars in patients with prior acute myocardial infarction. Aim: To examine whether STE and eSCAR may detect the presence of subclinical myocardial involvement in patients with SLE. Methods: We consecutively recruited 29 patients (M/F=3/26; age 45\ub111 years) with established SLE, who had a disease duration of 15\ub110 years. Their median SLE Disease Activity Index (SLEDAI) score was 2 (0-6). Patients with current cardiac symptoms or prior history of any heart disease were excluded from the study. We also recruited a sample of 32 control individuals, who were comparable for age, sex and traditional cardiovascular risk factors to the cases. All participants underwent a complete echocardiography examination, using both STE and eSCAR. Results: Global longitudinal strain (GLS) was significantly impaired in most myocardial segments in SLE patients than in control subjects, except for the myocardial apical region that was comparable between the two groups. Higher SLEDAI was associated with an impaired GLS-4 chamber (r=0.470, p=0.01) and GLS infero-septal wall (r=0.464, p=0.01). A higher daily dosage of prednisone was also associated with an impaired GLS in the infero-septal myocardial segment (r=0.414, p=0.02). Myocardial scar by eSCAR was observed in 5 (17%) out of 29 SLE patients, mainly in the infero-septal myocardial segment. A significant association was found between the infero-septal GLS and the presence of scar by eSCAR technique (r=0.569, p<0.001). Conclusions: Advanced echocardiography techniques detected the presence of subclinical myocardial dysfunction in SLE patients with no history of cardiac disease compared to controls. An \u2018apical sparing\u2019 GLS pattern was also observed in SLE patients, with possible important diagnostic implications. In about one fifth of SLE patients a myocardial scar by eSCAR technique was identified, mainly in the infero-septal segments. Larger prospective studies are certainly needed to confirm these findings and to better elucidate the diagnostic and prognostic significance of advanced echocardiography techniques (including GLS and eSCAR) in patients with SLE

A New Method to Evaluate Atrial Hemodynamic and Quantify Mitral Regurgitation using Cardiovascular Magnetic Resonance: The Pulmonary Venous Flow Approach

Pulmonary venous flow (PVF) provides incremental information on left ventricular (LV) diastolic function, and can support the diagnosis of severe mitral regurgitation (MR). The suggestion has been made to combine the left atrial filling volume (LA Fill) and PVF for estimating the mitral regurgitant volume, but echocardiographic PVF evaluation is known to have many limitations. The present case report includes an example of how to assess PVF using cardiovascular magnetic resonance, and a new method is proposed for quantification of the mitral regurgitant volume

Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression

Objective: The authors evaluated the outcome of patients >= 80 years undergoing mitral valve (MV) surgery.Design: Systematic review of the literature and meta-analysis.Setting: None.Participants: None.Interventions: None.Main Results: Twenty-four studies reporting on 5,572 patients 80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% Cl 2.6-5.2), and dialysis was 2.7% (95% Cl 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other than isolated MV surgery (p = 0.010), MV surgery associated with coronary artery surgery (p = 0.029), aortic cross-clamping time (p < 0.001), and cardiopulmonary bypass time (p < 0.001) were associated significantly with increased operative mortality. MV repair had lower operative mortality compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% Cl 0.342-0.962). Random-effects metaregression showed that prolonged aortic cross-clamping time (p = 0.005) was the only determinant of increased operative mortality, even when adjusted (p < 0.001) for date of study (p = 0.004). Operative mortality was significantly higher in studies reporting a mean cross-clamp time >90 minutes (17.0% v 7.4%, p < 0.001). Survival rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively.Conclusions: MV surgery in patients >= 80 years of age is associated with operative mortality, which has decreased significantly during recent years. Prolonged aortic cross-clamp time is a major determinant of operative mortality. MV repair may achieve better results than MV replacement in the very elderly. Five-year survival of these patients is good and justifies surgical treatment of MV diseases in octogenarians. (C) 2013 Elsevier Inc. All rights reserved

Optimizing the role of transthoracic echocardiography to improve the cardiovascular risk stratification: the dream of subclinical coronary artery disease detection

Detecting coronary artery disease at a subclinical level has always been a challenging task for cardiologists. Various non-invasive echocardiographic approaches such as measurements of left ventricular hypertrophy, diastolic function, left atrial enlargement, valve sclerosis and calcification, epicardial fat thickness, and pulse wave velocity have been proposed to integrate the available risk-charts. The present review is a collection of evidence that supports the role of the above mentioned features in cardiac risk stratification, summarizing the state of the art in non-invasive echocardiographic coronary risk assessment. Each parameter is presented with its strengths and weaknesses, aiming to trace the future directions for the development of a reliable non-invasive approach

Midventricular Takotsubo cardiomyopathy complicated by a ventricular septal rupture: a surgical management

Takotsubo cardiomyopathy, also known as 'Broken Heart Syndrome', is a form of acute heart failure, featured by a reversible impairment in cardiac contractility. About 20% of patients during hospitalization experience complications including cardiogenic shock, stroke, left ventricular thrombosis or death. Ventricular rupture has already been reported in Takotsubo cardiomyopathy in patients with typical apical ballooning pattern. We report one of the first cases of a midventricular ballooning Takotsubo cardiomyopathy in a 57-year-old woman complicated by ventricular septal rupture, successfully repaired with a surgical interrupted suture technique. \ua9 2019 Wolters Kluwer Health, Inc. All rights reserved

Drug eluting balloon for the treatment of patients with coronary artery disease: Current perspectives

Despite the improvement of outcomes after the introduction of bare metal and drug eluting stents for the treatment of CAD, certain type of patients have still an increased risk of stent failure. An alternative is represented by drug-eluting balloons (DEB). This innovation could give potential benefits in particular for the in-stent restenosis (ISR) and the de-novo lesions. In the first setting DEB have shown results superior to those with plain-balloon angioplasty and similar to those with first generation DES. Their performance seems to be more evident in BMS-ISR than in DES-ISR, showing a reliable effectiveness in those cases of recalcitrant ISR or when dual antiplatelet therapy is not indicated. In the context of de-novo lesions the use of DEB as unique strategy results more safe and feasible than a strategy with combined BMS implantation. The results are comparable to DES in lesions limited to small coronary vessels. Other particular scenarios, like bifurcations, acute myocardial infarction and diffuse disease, have been approached with DEB resulting in very heterogeneous outcomes. At present, given the high efficacy of last generation DESs, DEBs should be considered where clinical and angiographic conditions require the avoidance of stent implantation

Left atrial volume in patients with HER2-positive breast cancer: One step further to predict trastuzumab-related cardiotoxicity

Background: Trastuzumab (TZ) therapy requires careful monitoring of left ventricular (LV) ejection fraction (LVEF) because it can be potentially cardiotoxic. However, LVEF is an imperfect parameter and there is a need to find other variables to predict cardiac dysfunction early. Left atrium (LA) enlargement has proven to be a powerful predictor of adverse outcomes in several disease entities. Hypothesis: Baseline LA volume enlargement might predict TZ-related LV dysfunction. Methods: HER2-positive breast cancer patients receiving TZ and undergoing transthoracic echocardiography at baseline and at follow-up every 3 months were retrospectively recruited. One-hundred sixty-two patients formed the study population. Results: Baseline LAVI was dilated in 14 patients (8.6%). Mean follow-up was 14 ± 4 months. Cardiotoxicity occurred in 24 patients (14.8%). LAVI was an independent predictor of TZ-induced LV dysfunction in a clinical model, after adjustment for age and hypertension (odds ratio per 5-mL/m2 LAVI increase: 1.34, 95% confidence interval: 1.03-1.82, P = 0.03); and in a hemodynamic model, including ventricular sizes and systolic blood pressure level (odds ratio per 5-mL/m2 LAVI increase: 1.34, 95% confidence interval: 1.01-1.81, P = 0.04). The predicted probability of developing cardiotoxicity increased progressively, in parallel with LAVI values. Conclusions: Baseline LA dilatation emerges as a condition associated with the development of cardiotoxicity in HER2-positive breast cancer patients treated with TZ