Gender-Specific Aspects in the Clinical Presentation of Cardiovascular Disease

More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex-related differences

High-dose clopidogrel, prasugrel or ticagrelor: trying to unravel a skein into a ball

Antiplatelet therapy is a mainstay in the management of coronary artery disease. Indeed, optimal and rapid inhibition of platelet function is a key therapeutic goal in patients with acute coronary syndromes and those undergoing percutaneous coronary intervention. Currently, dual antiplatelet treatment with aspirin and clopidogrel is the gold standard care in patients with acute coronary syndromes or receiving coronary stents without prohibitive bleeding risk. However, recent data show that the efficacy of clopidogrel is hampered by its slow and variable platelet inhibition, with ensuing increased risk of ischemic events, including death, myocardial infarction and stent thrombosis. Novel agents such as prasugrel and ticagrelor have been developed to clopidogrel limits and thus improve cardiovascular outcomes. This article presents a comprehensive overview of the benefits and limitations of current and shortly available antiplatelet agents, providing detailed arguments in favor and against prasugrel and ticagrelor

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

Catheters for transradial coronary procedures: Pros and cons

Transradial access for coronary diagnostic and interventional procedures is a mainstay in current and future invasive cardiology, given the superior safety of this site in comparison to femoral access. However, catheter choice, manipulation and overall performance may differ strikingly when using transradial or transfemoral access. Thus, several diagnostic and guiding catheters, including sheathless guiding catheters, have been proposed to increase the efficacy of transradial access. The ultimate goal is to enable the performance of complex coronary interventions requiring large inner lumens, as well as minimizing radial trauma by employing the smallest catheters possible (e.g. 4 French). The present review provides a concise synthesis on currently available diagnostic and guiding catheters for transradial access. In particular, we explicitly state pros and cons of Judkins (e.g. Judkins Right 4 and Judkins Left 3.5), Amplatz Left 2, Sones, Tiger and Kimny catheters, among others, building upon extensive experience and thorough knowledge of the available evidence base. © 2012 Nova Science Publishers, Inc

Impact of pregnancy on natural history of systemic right ventricle in women with transposition of the great arteries

In the recent years, the pregnancy trend among women with Congenital Heart Disease (CHD) has increased; this has leaded to a growing demand for specialized care both in mother and in children. Although pregnancy is often well tolerated, maternal CHD may affect in some cases a maladaptive hemodynamic response carrying additional risks of cardiovascular events like arrhythmias, heart failure and, in rare cases, death. The impaired utero-placental perfusion due to maternal cardiac status may result in placental dysfunction, which may be associated with fetal growth restriction, preeclampsia, premature birth and perinatal morbidity. Systemic Right Ventricle (SRV) is one of the main conditions under which pregnancy is challenging. The sub-aortic position of morphological Right Ventricle (RV) is "physiologically" predisposed to fail at the adult age and may be potentially inadequate to support the hemodynamic stress of the pregnancy. Current literature about pregnancy in women with SRV consists of small retrospective series not providing conclusive evidence about the feasibility of a successful pregnancy outcomes. In addition, the long-term effects of pregnancy on SVR are not still adequately investigated and it remains unclear if maternal complications reported are due to pregnancy or to natural history of SVR. The aim of this paper is to offer a critical review of the knowledges at regard and to provide a practice update on the risk assessment and the pregnancy management in women with SRV in order to support the decision making and to optimize outcomes in these patients

Novel echocardiographic score to predict duct-dependency after percutaneous relief of critical pulmonary valve stenosis/atresia

Objectives This study aimed to identify clinical, hemodynamic, or echocardiographic predictive features of persistent duct-dependency of pulmonary circulation (PDDPC) after effective percutaneous relief of pulmonary atresia with the intact ventricular septum (PA-IVS) or critical pulmonary stenosis (CPS). Methods From 2010 to 2021, 55 neonates with PA-IVS or CPS underwent percutaneous right ventricle (RV) decompression at our Institution. After successfully relief of critical obstruction, 27 patients (group I) showed PDDPC, whereas RV was able to support the pulmonary circulation in the remaining 28 patients (group II). Clinical, hemodynamic, and echocardiographic features of these two groups were compared. Results No significant difference in clinical and hemodynamic data was found between the groups, although the group I had a lower oxygen saturation at hospital admission. However, tricuspid valve (TV) diameter <8.8 mm, TV z-score <- 2.12, tricuspid/mitral valve annular ratio <.78, pulmonary valve diameter <6.7 mm, pulmonary valve z-score <- 1.17, end-diastolic RV area <1.35 cm(2), end-systolic right atrium area >2.45 cm(2), percentage amount of interatrial right-to-left shunt >69.5%, moderate/severe tricuspid regurgitation, RV systolic pressure >42.5 mmHg, tricuspid E/E ' ratio >6.6 showed each significant predictive value of PDDPC. These parameters were used to build a composite echocardiographic score (PDDPC-score), assigning one point each above the respective cut-off value. A score >= 4.00 showed high sensitivity (100%) and specificity (86%) in predicting PDDPC. Conclusion Clinical and hemodynamic features fail to predict the short-term fate of the pulmonary circulation after successful treatment of PA-IVS/CPS. However, a simple, composite echocardiographic score is useful to predict PDDPC and could be crucial in the management of this frail subset of patients