Aortic valve sclerosis: a marker of significant obstructive coronary artery disease in patients with chest pain?

Background: Previous reports suggested a relationship between coronary artery disease (CAD) and aortic valve sclerosis (AVS). However, whether AVS can be used as a marker of obstructive CAD (obCAD) in patients with chest pain is unknown. We hypothesized that AVS is a predictive marker for obCAD in patients hospitalized for chest pain.

Statin use and survival in patients with chronic heart failure--results from two observational studies with 5200 patients.

Background: There is minimal evidence that HMG-CoA reductase inhibitors (statins) are beneficial in patients with chronic heart failure (CHF). Treatment with statins may lead to a lower mortality in CHF, independent of cholesterol levels, CHF etiology and clinical status.

Methods: In a first study, we included 3132 patients with CHF from the ELITE 2 study in whom information on body mass index (BMI) and statin use at baseline were available.

Aortic stiffness correlates with an increased extracellular matrix turnover in patients with dilated cardiomyopathy.

Background: An increased extracellular matrix (ECM) turnover has been associated with poor survival in patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM). However, the influence of the accelerated collagen turnover on the progressive large artery stiffening process characterizing CHF has not been clarified. This is relevant because aortic stiffening imposes an additional systolic load and impairs exercise tolerance in CHF patients.

Safety of percutaneous left heart catheterization directly performed by cardiology fellows: a cohort analysis.

Background: No previous study has analyzed the possible responsibility of fellows-in-training in terms of the risk of complications during cardiac catheterization. Thus, we sought to identify possible risk factors for access site complications following cardiac catheterization procedures, with particular attention to the role of cardiology fellows.

Methods: A total of 1,288 left heart catheterization procedures (both diagnostic and interventional), performed over a 1-year period at a university hospital, were retrospectively evaluated to determine the incidence of local complications (pseudoaneurysm, arterio-venous fistula, major hematoma or bleeding, vascular dissection).

Impact of body mass index on short-term outcome after acute myocardial infarction: does excess body weight have a paradoxical protective role?

Background: Obesity is a risk factor for acute myocardial infarction (AMI), due in part to obesity-related conditions. However, the relation between BMI (body mass index) and outcome in patients with AMI has not been completely clarified. The aim of our study was to assess the impact of BMI on short-term outcome after AMI.

Safety and efficacy of the percutaneous radial artery approach for coronary angiography and angioplasty in the elderly.

Background: The transradial approach to coronary interventions has been accepted as a safe and effective alternative to the femoral approach due to fewer access site complications and improved patient comfort. In the present study we aimed to investigate the safety and efficacy of transradial procedure in the elderly.

Methods: We analyzed 850 patients who underwent transradial coronary angiography and/or angioplasty.

Carotid atherosclerotic plaque instability in patients with acute myocardial infarction.

Unlabelled: The instability of atherosclerotic plaque is partly determined by local factors, but systemic factors such as infection, inflammation, autoimmunity or genes might also be important. We aimed to analyze whether patients with acute myocardial infarction (AMI) might have a higher proportion of unstable plaques in the carotid arteries compared with patients who had had no acute coronary events.

Methods: Sixty-nine consecutive patients with AMI (Group 1) and 95 patients without acute coronary events (Group 2) had carotid artery duplex ultrasounds.

Chronic heart failure with preserved left ventricular ejection fraction: diagnostic and prognostic value of left atrial size.

Background: Almost 40% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (EF) and prognosis similar to those with reduced EF. Data on prognostic markers in such patients are limited. We analyzed the prevalence and prognostic value of left atrial (LA) size in this condition.

Ischemic etiology of heart failure identifies patients with more severely impaired exercise capacity.

Background: Peak oxygen uptake (peak VO2) and the regression slope of ventilation against CO2 production during exercise (VE/VCO2 slope) are powerful prognostic indicators in patients with chronic heart failure (CHF). Our purpose was to evaluate the influence of CHF etiology on peak VO2 and VE/VCO2 slope, independently of demographic, clinical, Doppler-echocardiographic and neurohormonal factors.

Methods: Data were collected from 239 CHF patients referred for a cardiopulmonary exercise test as part of their clinical evaluation.

Plasma levels of oxidized-low-density lipoproteins are higher in patients with unstable angina and correlated with angiographic coronary complex plaques.

Objectives: To measure circulating levels of oxidized-low-density lipoproteins (ox-LDL) in patients with stable and unstable angina and controls, and to investigate their correlation with the extent of coronary artery disease (CAD) and the presence of complex plaques at coronary angiography.

Methods And Results: Circulating ox-LDL were assessed, using ELISA, in patients with unstable angina (UA, n=26), stable angina (SA, n=29) and in controls (C, n=27). All patients underwent coronary angiography.

Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials.

Aims: To compare, by meta-analytical techniques, the clinical impact of bare-metal stenting vs. balloon angioplasty for the treatment of lesions in small coronary arteries.

Methods And Results: We included trials with random allocation and prospective comparison of angioplasty vs.

Prediction of mortality in chronic heart failure from peak oxygen consumption adjusted for either body weight or lean tissue.

Background: Peak oxygen consumption (pVO2) reflects oxygen extraction from the skeletal muscles, but is routinely corrected for body weight. We hypothesized that correcting pVO2 for lean tissue rather than total body weight would improve the prediction of prognosis in patients with chronic heart failure (CHF).

Methods And Results: A total of 272 CHF outpatients (mean age 61 +/- 12 years, New York Heart Association [NYHA] class 2.

Independent and additional prognostic value of aminoterminal propeptide of type III procollagen circulating levels in patients with chronic heart failure.

Background: In chronic heart failure (CHF), changes in the extracellular space contribute to cardiac dysfunction. We aimed to determine whether aminoterminal-propeptide of type III procollagen (PIIINP), a marker of extracellular matrix turnover, might provide prognostic information in CHF patients.

Methods And Results: A total of 101 consecutive CHF patients (mean age 61.

Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.

Objectives: We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes.

Background: The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results.

Effects of ACE gene insertion/deletion polymorphism on response to spironolactone in patients with chronic heart failure.

Background: Angiotensin-converting enzyme (ACE) is involved in the pathophysiology of chronic heart failure, and its activity is determined in part by a polymorphism of the ACE gene. We hypothesized that the benefits of spironolactone, which inhibits downstream elements of ACE-mediated abnormalities, may depend on ACE genotype.

Methods: We randomly assigned 93 chronic heart failure patients to treatment with spironolactone (n = 47) or to a control group (n = 46) and followed them for 12 months.

The role of angiotensin-converting enzyme polymorphism in congestive heart failure.

Angiotensin-converting enzyme (ACE) is a zinc metallopeptidase, with primary known functions of converting angiotensin I into the vasoactive and aldosterone-stimulating peptide angiotensin II and inactivating bradykinin. There is high variability among individuals in ACE concentrations, mainly due to the presence of a genetic polymorphism. The ACE gene has, in fact, insertion/deletion polymorphism in intron 16, consisting of a 287-base pair Alu repeat sequence, with three genotypes: insertion polymorphism, insertion/deletion polymorphism, and deletion polymorphism.

Association of aortic valve sclerosis and coronary artery disease in patients with severe nonischemic mitral regurgitation.

Background: The presence of aortic valve sclerosis accounts for a higher rate of ischemic events and increased cardiovascular mortality. It may reflect coronary artery disease (CAD) because of a shared pathologic background.

Hypothesis: We aimed to analyze whether the presence of aortic valve sclerosis might help in identifying patients with coronary atherosclerosis among those with severe nonischemic mitral regurgitation (MR), who undergo coronary angiography before surgery for screening, and not because of suspected ischemic heart disease.

Selection of endpoints for heart failure clinical trials.

In assessing the efficacy and the safety of a new drug, randomized clinical trials represent the standard scientific method. The selection of the best response variables in a clinical trial of a treatment in congestive heart failure patients is often not straightforward; the primary end point of a trial should be clinically relevant, directly related to the primary goal of the trial, and with favorable distributional properties. All-cause mortality is undoubtedly the most unbiased endpoint, but there is interest both in assessing cause-specific mortality and hospitalization rate and in evaluating 'soft' endpoints (functional status, exercise tolerance); the latter, in fact, are clinically relevant and potentially more useful in mild heart failure patients.

Feasibility and safety of transeophageal atrial pacing stress echocardiography in patients with known or suspected coronary artery disease.

To investigate the feasibility and safety of the transesophageal atrial pacing stress test combined with echocardiography (TAPSE) 1,727 TAPSE tests were performed on 1,641 patients consecutively referred to our echocardiographic laboratory for nonexercise stress testing (1,319 men; mean age 60 +/- 9 years; 34% of whom were outpatients). Wall motion abnormalities were present at baseline echocardiography in 975 cases (56%). TAPSE was feasible in 1,648 cases (95.

Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis.

Vasopressin is currently recommended in the management of patients with cardiac arrest, but its efficacy is still incompletely established. We systematically reviewed randomized trials comparing vasopressin to control treatment in the management of cardiac arrest in humans and animals. Two human and 33 animal studies were retrieved.

Skeletal muscle abnormalities in chronic heart failure patients: relation to exercise capacity and therapeutic implications.

Recent studies suggest that changes in the periphery, like those occurring in the skeletal muscles of patients with chronic heart failure, might play an important role in the origin of symptoms and exercise intolerance in this condition. Biochemical and histologic changes in the skeletal muscles of chronic heart failure patients relate with the degree of exercise intolerance better than hemodynamics parameters. A reduction in skeletal muscle mass represents another important determinant of exercise intolerance in chronic heart failure patients.

Stenting versus surgical bypass grafting for coronary artery disease: systematic overview and meta-analysis of randomized trials.

Background: Coronary angioplasty and coronary artery bypass grafting (CABG) are both major techniques for the management of coronary artery disease, but CABG is associated with a lower incidence of repeat revascularization. Recent studies comparing angioplasty with stenting vs CABG have yielded conflicting results, with some suggesting improved survival with stenting, and others the opposite. We thus undertook a systematic overview of the randomized trials comparing stenting vs CABG in coronary artery disease.

Aortic distensibility independently affects exercise tolerance in patients with dilated cardiomyopathy.

Background: Peak exercise oxygen consumption (VO2) is crucial for the prognostic stratification of patients with congestive heart failure, but its hemodynamic determinants are still not completely understood. Aortic wall elasticity modulates left ventricular function and coronary blood flow. Whether an increased aortic pulse-wave velocity (PWV), a known marker of arterial stiffness, may predict peak VO2 in patients with dilated cardiomyopathy (DCM) has to be clarified.

Myocardial viability independently influences left ventricular diastolic function in the early phase after acute myocardial infarction.

Background: After acute myocardial infarction, a broad range of left ventricular (LV) end-diastolic pressure (LVEDP) is expected because of chamber remodeling. However, intrinsic characteristics of the infarcted tissue (necrosis or viability) may also play a role. We aimed to evaluate whether myocardial viability (Mviab) has an influence on LVEDP.

Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy.

Objectives: We aimed to investigate the determinants of left atrial (LA) volume and its prognostic value in patients with dilated cardiomyopathy (DCM).

Background: Enlargement of the LA is a marker of mortality in the general population. Patients with DCM are characterized by a wide range of LA sizes, but the clinical role of this observation has been played down.