Progression of aortic valve sclerosis to aortic stenosis.
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Aged↗
Biomedical subjects
Pompilio Faggiano
Publications and source records attributed to Pompilio Faggiano.
Absence of inferior vena cava as a rare cause of deep venous thrombosis complicated by liver and lung embolism.
Congenital anomalies of the inferior vena cava such as absence or atresia are uncommon vascular defects and result from aberrant development during embryogenesis. We report a case of a young female patient affected by proximal deep venous thrombosis (DVT) complicated by liver and pulmonary embolism; subsequent extensive evaluation revealed the congenital absence of infrarenal inferior vena cava, with emboli probably occurring through collateral veins. Accordingly, in young patients with idiopathic DVT of the lower extremities and pelvic veins, the presence of inferior vena cava abnormalities should always be considered and investigated, together with classic coagulation factors, as a factor predisposing to thromboembolic complications.
Adult↗
Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment.
BACKGROUND: Diuretics are the cornerstone of treatment for the congestive symptoms of heart failure (HF). Despite their widespread use, diuretic prescription data in clinical practice are scarce. In this study we evaluated the prescription pattern of diuretics in a large population of HF outpatients, enrolled by a national network of hospital-based cardiologists. METHODS AND RESULTS: Among 11070 HF outpatients (mean age 64 +/- 12 years, 72.9% men, 29.8% New York Heart Association [NYHA] class III-IV, mean left ventricular ejection fraction [LVEF] 35+/-12%), 9247 took a diuretic, the most frequently prescribed therapeutic agent (83.5%). Loop diuretics were prescribed alone (65.5%) or combined with other diuretics in 91.6% of patients. By multivariate analysis, the strongest independent predictors of diuretic use were a previous hospital admission for HF (odds ratio [OR] 2.55, 95% confidence interval [CI] 2.28-2.86), NYHA class III-IV (OR 2.52, 95% CI 2.14-2.96), LVEF < 30% (OR 1.87, 95% CI 1.57-2.24). Aldosterone antagonists were prescribed to 2142 patients (23.1%); independent predictors of their use overlapped with those of diuretics and moreover included treatment with loop diuretics (OR 3.52, 95% CI 2.66-4.66) and digoxin (OR 1.45, 95% CI 1.29-1.64). CONCLUSIONS: In this wide series of stable HF outpatients, cardiologists prescribed diuretics in accordance with published guidelines. Evolving prescription patterns of aldosterone-receptor blockers need to be further evaluated.
Diuretics↗
[Coronary artery calcium identified by multislice TC as marker of early coronary artery disease].
Approximately one-half of acute myocardial infarctions occur in patients with no history of coronary artery disease (CAD), and nearly two-third are due to thrombosis occurred on mild to moderate coronary stenosis. So, early noninvasive identification of CAD is mandatory for identifying patient at high risk of coronary events. The extension of coronary artery calcium (CAC), strictly associated with mural atheromatous plaque, is a novel tool for identifying subjects with early CAD and correlates with overall magnitude of atherosclerosis plaque burden. CAC strongly correlates with the risk of future coronary events. Electron-beam tomography (EBT) was the first noninvasive tool for detecting and quantifying CAC; more recently, multislice spiral CT faster x-ray tube rotation time, allow the use of CAC detection also in the clinical setting, out of specialized, research centers. CAC scanning affords the opportunity of accurate and noninvasive detection of patients with early CAD, with high probability of coronary events. Moreover, CAC scoring is repeatable and allows the monitoring of plaque burden during the follow-up and the effects of the treatment. Finally, there is not yet a consensus about the use of CAC scoring in the clinical setting and, at present, CAC may not be considered alternative to stress testing or angiography to diagnose CAD. The purpose of this review is to provide a background information regarding CAC scanning and its current and future applications.
Calcinosis↗
[Diastolic heart failure:a disease in search of his own identity].
Epidemiological surveys on congestive heart failure (CHF) in the community settings reveal that 30-70% of CHF patients presents a normal (> 50%) or only mildly depressed left ventricular ejection fraction. Usually it is tought that these patients suffer of "diastolic" heart failure (DHF). However, some authors contest the "real" existence of isolated DHF. This is a consequence of known difficulty to evaluate the diastolic function with available tests, the lack of a "simple" and unequivocal marker of diastolic dysfunction, the frequent co-existence of associated chronic diseases that may act as confounding factors. Accordingly, an integrated approach to patients with suspected DHF by means of an accurate clinical evaluation, combined with a Doppler-echocardiographic examination, brain natriuretic peptide (BNP) dosage and functional capacity tests (cardiopulmonary exercise test, 6-minute walk test) may represent a strategy in order to overcome such diagnostic difficulties.
Diastole↗
One biologic marker (carbohydrate antigen-CA 125), two different diseases (ovarian cancer and congestive heart failure): practical implications of monitoring CA 125 serum levels. A case report.
Carbohydrate antigen (CA) 125 is a glycoprotein produced by the serous epithelium, found to be increased in ovarian cancer and currently used in the follow-up of patients with this malignancy and to evaluate the response to therapy. However, an increase in the blood levels of this tumor marker has been recently reported even in patients with congestive heart failure. We report a case of a woman in whom previously high levels of CA 125 were related to the presence of an ovarian cancer; after bilateral oophorectomy and chemotherapy, the CA 125 levels remained within the normal range for several years, until a new increase was recently detected, raising the suspicion of a cancer recurrence. Clinical evaluation, together with comprehensive laboratory assessment, allowed us to exclude a malignancy and to identify the presence of congestive heart failure due to left ventricular systolic dysfunction as being responsible for the abnormal CA 125 levels. The patient's clinical improvement following medical therapy was associated with a reduction in the serum levels of CA 125 to normal values. The clinical relevance of this finding is discussed.
Biomarkers, Tumor↗
Hypertensive crisis and acute, reversible, left ventricular systolic dysfunction: a case report.
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Acute Disease↗
Reliability of new and old Doppler echocardiographic indexes of the severity of aortic stenosis in patients with a low cardiac output.
BACKGROUND: In addition to the conventional "flow-corrected" parameters (continuity equation and aortic valve resistance), new and simpler Doppler echocardiographic indexes of the severity of aortic stenosis have recently been introduced. These measures can be classified as "function-corrected" indexes (fractional shortening-velocity ratio and ejection fraction-velocity ratio) and "pressure-corrected" indexes (percent stroke work loss). Little information however is available about the diagnostic accuracy of each of these parameters in identifying patients with severe aortic stenosis in low-flow states, in which the diagnosis and clinical decision-making are more difficult and challenging. METHODS: We analyzed 161 patients with aortic stenosis (96 males, 65 females, mean age 68 +/- 9 years) and a low cardiac output (thermodilution cardiac index < or = 2.5 l/min/m2). All patients underwent both cardiac catheterization and echocardiography within 48 hours one of the other. The invasive Gorlin valve area was used as gold standard (severe aortic stenosis = Gorlin < or = 0.8 cm2). Echocardiographic indexes were assessed by an investigator who was unaware of the hemodynamic findings. RESULTS: The mean Gorlin aortic valve area was 0.7 +/- 0.3 cm2; cardiac catheterization allowed the identification of 129 patients with severe aortic stenosis and of 32 with mild-to-moderate aortic stenosis. The diagnostic accuracy of the Doppler gradient alone was low (sensitivity 55%). The best linear correlation with the Gorlin value was found using the "function-corrected" ejection fraction-velocity ratio (r = 0.85). Similarly, the best combination of sensitivity and specificity in identifying patients with severe aortic stenosis, as assessed by cardiac catheterization, was observed using the ejection fraction-velocity ratio (sensitivity 87%, specificity 88%). CONCLUSIONS: In patients with aortic stenosis and a low cardiac output, the "function-corrected" ejection fraction-velocity ratio offers the better diagnostic accuracy, as compared with the cardiac catheterization valve area calculation.
Aged↗
Clinical features and prognosis associated with a preserved left ventricular systolic function in a large cohort of congestive heart failure outpatients managed by cardiologists. Data from the Italian Network on Congestive Heart Failure.
BACKGROUND: The aim of this study was to evaluate the clinical characteristics, 1-year prognosis and therapeutic approach of heart failure with a preserved left ventricular systolic function in a large multicenter registry of patients referred to specialized heart failure clinics. METHODS: The study population consisted of 5164 outpatients (mean age 62 +/- 12 years, 78.8% male, 28.1% in NYHA functional class III-IV) with an available left ventricular ejection fraction (LVEF) measurement at the initial evaluation for enrollment in the Italian Network on Congestive Heart Failure. A 1-year follow-up was available for 2390 patients. RESULTS: 2859 out of 5164 patients (55.4%) had an LVEF < 35%, 1618 (31.3%) had an LVEF between 35 and 45%, and 687 patients (13.3%) had an LVEF > 45%. Patients with an LVEF > 45% were significantly older, more often female and presented a significantly higher prevalence of a hypertensive etiology, obesity and atrial fibrillation. The severity of the clinical picture, as indicated by a lower prevalence of NYHA class III-IV (17.2 vs 35.6%, p = 0.001) and a third heart sound (14.8 vs 33.5%, p = 0.001), was less in patients with an LVEF > 45%. The therapeutic approach differed significantly, with a larger use of calcium antagonists and beta-blockers in patients with an LVEF > 45%, while ACE-inhibitors, diuretics and digoxin were more often prescribed to those with an impaired LVEF. The 1-year mortality and morbidity (all cause and congestive heart failure worsening hospitalizations) were significantly lower in patients with a preserved left ventricular systolic function compared to those with left ventricular systolic dysfunction (8.9 vs 18.8% for mortality, p = 0.001, and 8.3 vs 16.5% for hospital readmissions due to worsening congestive heart failure, p = 0.001, respectively). CONCLUSIONS: Patients with congestive heart failure and a preserved left ventricular systolic function seem to constitute a distinct population not infrequently presenting even in the clinical setting of specialized heart failure clinics. Further studies are needed to establish a definitive and standardized diagnosis and the most appropriate therapy for congestive heart failure with a normal LVEF.
Aged↗