Deprescribing: a challenge for clinical cardiologists.

Deprescribing is a holistic process to identify medications that can be ceased, substituted or reduced. This process can improve the health of older patients and also enhance their compliance to the prescribed medications which are actually beneficial. Recommendations and guidelines have been elaborated for extensively prescribed drugs.

[Medication adherence in cardiovascular diseases.].

Nonadherence to medications is common in cardiovascular diseases because of their long duration, the patient age and the complexity of therapy. Its prevalence depends on the population, the types of drugs and the disease under study. Adherence decreases from the initial prescription and it is usually under 80%, a value defined as satisfactory.

[Cardiovascular complications of cancer chemotherapy. The need for cardio-oncology.].

Traditional chemotherapic agents as antraciclines and radiumtherapy are known to be the cause of cardiovascular complications from many years. Nevertheless also recent drugs, which were initially considered effective only on cancer cells are now recognized to exert negative effects also on the cardiovascular system. The frequency and the entity of the effects are variable for each drug and depend from the clinical status of the patient.

Improving survival rates of patients with idiopathic dilated cardiomyopathy in Tuscany over 3 decades: impact of evidence-based management.

Background: Contemporary therapeutic options have led to substantial improvement in survival of patients with heart failure. However, limited evidence is available specifically on idiopathic dilated cardiomyopathy. We thus examined changes in prognosis of a large idiopathic dilated cardiomyopathy cohort systematically followed during the past 30 years.

Endomyocardial biopsy (1962-2012) celebrates 50 years. 'Adelante Pedro, si puedes'.

A brief history of endomyocardial biopsy as seen through the personal experience is herein reported. After 60 years from its introduction in clinical practice, the procedure still maintains its value as a tool for diagnosis and research, provided it is performed in qualified centers.

Short-term versus long-term outcomes after catheter ablation for atrial fibrillation: impact on clinical practice.

A review of recent articles dealing with long-term outcomes of catheter ablation in patients with atrial fibrillation has confirmed the success rates obtained in the short period. Repetition of the ablation procedure was necessary often in a high percentage of patients. Repeat ablation as well as continued vigilance for atrial fibrillation recurrence must be considered by clinicians when discussing the pros and cons of the ablation procedure with patients.

Ultrasonographic backscatter of the carotid artery wall in patients with HIV infection: a pilot study.

Aims: The aim of our study was to measure carotid intima-media thickness (cIMT) and risk factors associated with its development and progression, and to evaluate arterial wall characteristics through integrated backscatter analysis (IBS) in HIV patients.

Methods: Perspective cohort study enrolling 44 HIV patients treated with antiretroviral drugs who underwent standard B Mode cIMT measurement and tissue characterization of carotid wall by means of dedicated software by acoustic densitometry, at time 0 and 2 years later.

Major Findings: Cross-sectional evaluation performed at baseline found that cIMT value correlated significantly with age (r = 0.

Controversies in the therapy of isolated congenital complete heart block.

Controversies in the therapy of congenital complete heart block are reviewed in terms of the timing of pacemaker implantation, the type and complications of pacing and its role in the presence of myocardial dysfunction. Drug treatment may be useful in selected cases in the presence of pleural effusions, ascites and hydrops of the fetus, but have no effect on complete heart block. Administration of fluorinated steroids in anti-Ro antibody-positive mothers with the aim of preventing complete heart block has given controversial results.

CD4 cell-guided scheduled treatment interruptions in HIV-infected patients with sustained immunologic response to HAART.

Objective: To compare continuous HAART with a CD4 cell-driven scheduled treatment interruption (STI) strategy.

Methods: LOng Term Treatment Interruption study is a randomized, controlled, prospective trial. Patients with CD4 cell counts more than 700 cells/microl were eligible, and the immunologic threshold to resume HAART was 350 cells/microl.

The decline of cardiac auscultation: 'the ball of the match point is poised on the net'.

A brief review of the history of cardiac auscultation confirms its decline. The intervention of healthcare institutions may avoid loss of medical culture and increased costs by adequate training of medical staff.

Acute cardiac failure following pacing in an adult patient with congenital complete heart block.

A case of an adult patient with congenital complete heart block is reported in whom acute heart failure followed pacemaker implantation. It is uncertain whether the associated cardiomyopathy was present since birth, although right ventricular pacing was probably responsible for further deterioration of myocardial function. Synchronous pacing of both ventricles might be recommended in these patients.

Avoiding haste in clinical cardiology.

This paper examines, from a thorough review of the literature, the negative effects of haste (excessive eagerness to act) in clinical cardiology such as early discharge from the hospital, premature timing in surgery, too much enthusiasm for new technologies, exaggerated emphasis on tests or pharmacological measures for prevention and inaccurate transfer of results of trials to daily clinical practice. Avoiding haste allows doctors and nurses to provide their patients with the best traditional diagnostic and therapeutic procedures, to guide them wisely to the new ones and to have time enough for an accurate evaluation of all their personal, familial and social problems.

Therapeutic implications of contractile reserve elicited by dobutamine echocardiography in symptomatic, low-gradient aortic stenosis.

Background: In patients with heart failure, poor ejection fraction and estimated severe aortic stenosis because of a reduced aortic valve area (AVA) and low gradients, dobutamine echocardiography (DE) was proposed to distinguish afterload mismatch from primary left ventricular dysfunction. In this setting the feasibility and safety of DE and the outcome following management based on DE results were investigated.

Methods: Forty-eight patients (mean age 73 +/- 9 years; 79% males; AVA 0.

[Invitation to "slow medicine"].

In clinical practice, hyperactivity is often unnecessary. Adopting a strategy of "slow medicine" may be more rewarding in many situations. Such an approach would allow health professionals and particularly doctors and nurses, to have a sufficiently long time to evaluate the personal, familial and social problems of patients extensively, to reduce anxiety whilst waiting for non urgent diagnostic and therapeutic procedures, to evaluate new methods and technologies carefully, to prevent premature dismissals from hospital and finally to offer an adequate emotional support to the terminal patients and their families.

Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy.

Background: Clinical impact of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is largely unresolved. Thus, we analyzed the prognostic implications of AF in a large, community-based HCM population assembled from Italian and US cohorts.

Methods And Results: Occurrence of AF and outcome were assessed in 480 consecutive HCM patients (age at diagnosis, 45+/-20 years; 61% male) who were followed up for 9.

Increased glutamate in CSF and plasma of patients with HIV dementia.

Background: Experimental evidence suggests that excitotoxicity might play a major role in HIV-induced neurodegeneration. However, few studies have investigated the role of endogenous glutamate in patients with HIV dementia.

Objective: To analyze CSF and plasma glutamate levels in 30 patients with AIDS with different dementia severity compared with 10 patients with other neurologic disorders, 11 healthy control subjects, and 10 patients with Alzheimer-type dementia.

Cardiac contusion in blunt chest trauma: a combined study of transesophageal echocardiography and cardiac troponin I determination.

Background: The role of cardiac troponin I (cTnI) is well established in acute myocardial ischemia. However, its role in myocardial contusion remains to be clarified. Since transesophageal echocardiography (TEE) appears, at present, to be the best method for the diagnosis of myocardial contusion, the aim of this study was to measure the concentration of cTnI in patients with blunt chest trauma studied using TEE.

"Natural histories" of mitral valve prolapse. Influence of patient selection on cardiovascular event rates.

Background: In previous studies the reported incidence of cardiovascular events among mitral valve prolapse patients has differed more than 10 fold. We endeavored to determine the relation between the clinical features and mode of ascertainment of mitral valve prolapse and the resulting event rate.

Methods: Between January 1979 and August 1996, 275 patients (129-47% men, 146-53% women, mean age 43 +/- 19 years), were followed for a mean of 98 months after evaluation in a referral center for valvular heart disease.

[Should the patient with an interatrial defect recognized in adulthood always be operated on?].

Background: Atrial septal defect (ASD) can be recognized in adult age, mostly in asymptomatic or scarcely symptomatic patients. These patients differ from patients in "historical" clinical series, in whom diagnosis was done on the basis of clinical evidence, and their natural history is probably different.

Aim Of The Study: Our aim was to verify retrospectively results of surgery versus medical follow-up in an adult population with ASD with age at first diagnosis > or = 30 years.