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[Giant tricuspid annular calcification and kyphoscoliosis: is there a link?] [巨型三尖瓣环钙化与脊柱侧凸:两者之间有联系吗?]
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43044
Gabriella Bufano, Pietro Mazzeo, Maria Delia Corbo, Vincenzo Fioretti, Costantino Smaldone, Eugenio Stabile

Although mitral annular calcification is a common degenerative condition of the fibrous mitral annulus, tricuspid annular calcification, especially isolated, is rare. We report the case of a 73-year-old male, with a history of hypertension and severe kyphoscoliosis, referred to the emergency department for progressive dyspnea and leg swelling. Echocardiography revealed a dilated right heart with a homogeneous, hyperechoic, crescent shaped mass along the tricuspid annulus. Computed tomography confirmed the calcific nature of the lesion. Right heart catheterization revealed mild pre-capillary pulmonary hypertension and a mild spirometrically-defined restrictive ventilatory defect. Kyphoscoliosis has recently been associated with alterations in cardiac deformation and with an increased risk of restrictive lung disease. In our patient, we hypothesized that both these anomalies could have led to premature tricuspid annular degeneration resulting in a giant tricuspid calcification.

虽然二尖瓣环钙化是纤维性二尖瓣环的一种常见退行性病变,但三尖瓣环钙化,尤其是孤立性三尖瓣环钙化却十分罕见。我们报告了一例 73 岁男性患者的病例,他有高血压和严重脊柱侧弯病史,因进行性呼吸困难和腿部肿胀而转诊至急诊科。超声心动图显示右心扩张,沿三尖瓣环有一均匀、高回声、新月形肿块。计算机断层扫描证实了病变的钙化性质。右心导管检查发现轻度毛细血管前肺动脉高压和轻度肺活量定义的限制性通气缺陷。近来,脊柱后凸与心脏变形的改变以及限制性肺部疾病风险的增加有关。在我们的患者中,我们假设这两种异常都可能导致三尖瓣环过早变性,造成巨大的三尖瓣钙化。
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引用次数: 0
[An exotically and dangerous pattern]. [外来的危险模式]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43042
Angelo Melpignano, Michele Trichilo, Alessandro Capecchi
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引用次数: 0
[Air pollution and cardiovascular disease]. [空气污染与心血管疾病]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43041
Stefania Angela Di Fusco, Maurizio Giuseppe Abrignani, Giulia Bugani, Rita Myriam Cristina Intravaia, Marco Flori, Furio Colivicchi

Although there is substantial evidence on the harmful effects of air pollution on human health, these are scarcely considered in the general clinical practice and also in the context of cardiovascular disease prevention. In light of the numerous epidemiological and basic research studies that have demonstrated the unfavorable impact of air pollution on the cardiovascular system, this review aims to bring this aspect to the attention of clinicians. This work describes the main air polluting components that can contribute to the onset and progression of cardiovascular diseases. The pathophysiological mechanisms underlying the impact of pollutants on the cardiovascular system and the available evidence regarding their effect on cardiovascular risk factors are reported. This article also examines the evidence relating to the correlation between environmental pollutants and some specific cardiovascular diseases, including acute coronary syndromes, cerebrovascular diseases, heart failure, and arrhythmias. Finally, the possible strategies to be implemented to limit pollution-induced cardiovascular damage are analyzed.

尽管有大量证据表明空气污染对人类健康有害,但在一般临床实践和心血管疾病预防中却很少考虑到这些影响。鉴于大量流行病学和基础研究都证明了空气污染对心血管系统的不利影响,本综述旨在提请临床医生注意这方面的问题。本文介绍了可导致心血管疾病发生和发展的主要空气污染成分。文章报告了污染物对心血管系统产生影响的病理生理机制,以及污染物对心血管风险因素产生影响的现有证据。本文还研究了环境污染物与某些特定心血管疾病(包括急性冠状动脉综合征、脑血管疾病、心力衰竭和心律失常)之间相关性的证据。最后,分析了为限制污染引起的心血管损害而可能实施的策略。
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引用次数: 0
In questo numero. 本期内容
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43035
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引用次数: 0
[Percutaneous treatment of post-acute myocardial infarction mechanical complications: state of the art]. [急性心肌梗死后机械并发症的经皮治疗:最新技术]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43036
Daniele Ronco, Matteo Matteucci, Giulio Massimi, Vittoria Lodo, Sara Garis, Arianna Scarantino, Corinne Messina, Alessandra Francica, Marco Russo, Roberto Lorusso, Fabio Barili, Alessandro Parolari

Left ventricular free wall rupture, ventricular pseudoaneurysm, papillary muscle rupture and ventricular septal rupture are life-threatening mechanical complications of acute myocardial infarction. Despite significant improvements over the last decades in overall mortality for patients with myocardial infarction, the outcome of subjects who develop post-infarction mechanical complications remains poor. Surgical treatment is considered the standard of care. However, percutaneous approaches (such as pericardial fibrin-glue injection for left ventricular free wall rupture, transcatheter edge-to-edge mitral repair for papillary muscle rupture and device closure for ventricular pseudoaneurysm or septal rupture) have been proposed in selected high-risk or inoperable patients, or in subjects with ideal characteristics for feasibility, as therapeutic alternatives to open surgery. The aim of the present review is to provide a comprehensive overview of the percutaneous strategies for the management of post-acute myocardial infarction mechanical complications.

左心室游离壁破裂、心室假性动脉瘤、乳头肌破裂和室间隔破裂是急性心肌梗死时危及生命的机械并发症。尽管过去几十年来心肌梗死患者的总死亡率有了明显改善,但心肌梗死后出现机械并发症的患者的预后仍然很差。手术治疗被认为是治疗的标准。然而,经皮方法(如心包纤维蛋白胶注射治疗左心室游离壁破裂、经导管边缘对边缘二尖瓣修复治疗乳头肌破裂、装置闭合治疗心室假性动脉瘤或室间隔破裂)已被提议用于选定的高风险或无法手术的患者,或具有理想的可行性特征的受试者,作为开放手术的替代治疗方法。本综述旨在全面概述急性心肌梗死后机械并发症的经皮治疗策略。
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引用次数: 0
[Appropriateness of requests for urgent outpatient cardiological services and impact on waiting lists: the experience of the Azienda Socio-Sanitaria Territoriale of the Province of Lodi]. [心脏科紧急门诊服务申请的适当性及对候诊名单的影响:洛迪省本土社会医疗机构的经验]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-01 DOI: 10.1714/4318.43043
Pietro Mazzarotto, Greta Ghizzardi, Giovanni Monza, Giuseppina Granata, Greta Generati, Davide Randazzo, Marta Saronio, Anca Irina Corciu

Background: The Cardiology Complex Structure of the Azienda Socio Sanitaria Territoriale (ASST) of Lodi, Italy, assists patients with clinical conditions ranging from emergency to chronicity. The model of Homogeneous Waiting Groups should guide the appropriateness of prescriptions categorized as U (urgent), B (brief), D (deferrable), and P (programmable). This study aims to describe and analyze the characteristics of prescription and delivery of clinical and instrumental cardiology outpatient services with U and B priority during the November 2023-January 2024 quarter, paying particular attention to the clinical appropriateness of prescribing.

Methods: A prospective observational study was conducted. Computerized data were anonymously extracted from the company's Management Control and provided with the authorization of the Data Protection Officer.

Results: During the observed quarter, the Cardiology Complex Structure provided 7379 services for outpatients. Out of 123 U services, 94 (76.4%) were managed through SBC (Single Booking Center) and 29 (23.6%) were managed outside the SBC. From 529 services with B priority, 504 (95%) were managed through SBC and 25 (5%) outside the SBC. Requests with U priority mainly referred to ECG (n = 50; 40.6%) and first cardiological visit (n = 46; 37.4%). Fifty percent of U and B requests were prescribed by 4% and 8% of general practitioners, respectively. The prescribed priority was correct for 13% of requests (n = 64).

Conclusions: This study shows a vastly inappropriate use of resources allocated to urgent outpatient cardiological services. Actions aimed at promoting the adherence to the Homogeneous Waiting Groups Manual and enhancing telemedicine services, currently limited to heart failure, are necessary for resource optimization in cardiology within the ASST of Lodi.

背景:意大利洛迪 Azienda Socio Sanitaria Territoriale (ASST) 心脏病综合医院为临床症状从急诊到慢性病的患者提供帮助。同质候诊组模式应指导处方的合理性,处方可分为 U(紧急)、B(简短)、D(可推迟)和 P(可编程)四类。本研究旨在描述和分析 2023 年 11 月至 2024 年 1 月期间 U 和 B 优先级临床和器械心脏病学门诊服务的处方和交付特点,尤其关注处方的临床适宜性:进行了一项前瞻性观察研究。计算机数据以匿名方式从公司的管理控制中提取,并在数据保护官的授权下提供:在观察季度内,心脏科综合机构为门诊患者提供了 7379 次服务。在 123 项 U 级服务中,94 项(76.4%)通过 SBC(单一预约中心)管理,29 项(23.6%)在 SBC 之外管理。在 529 项 B 优先级服务中,504 项(95%)通过 SBC 管理,25 项(5%)在 SBC 以外管理。优先级为 U 的请求主要涉及心电图(50 人;40.6%)和首次心脏科就诊(46 人;37.4%)。50%的 U 级和 B 级请求分别由 4% 和 8% 的全科医生开具处方。13%的申请(64 人)的处方优先级是正确的:这项研究表明,分配给心脏科急诊门诊服务的资源使用极为不当。为了优化洛迪 ASST 的心脏病学资源,有必要采取旨在促进遵守《同质候诊群体手册》和加强远程医疗服务(目前仅限于心力衰竭)的行动。
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引用次数: 0
[Diffuse large B-cell lymphoma with heart involvement: the relevance of the multidisciplinary and multiparameter approach]. [心脏受累的弥漫大 B 细胞淋巴瘤:多学科和多参数方法的意义]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1714/4282.42640
Andrea Pennacchioni, Maria Elena Nizzoli, Massimo Roncali, Alberto Bavieri, Durmo Rexhep, Alessandro Navazio, Stefano Luminari, Luigi Tarantini

Lymphoma patients are at high risk of cardiovascular events due to anthracycline cardiotoxicity and, in rare cases, related to heart infiltration. The presence of cardiac masses adds further complexity to the management of lymphoma patients beyond myocardial chemotherapy-related toxicity, given possible unpredictable acute complications such as arrhythmias, atrioventricular block, myocardial ischemia, pericardial effusion and cardiac tamponade. Here we describe the clinical presentation and successful multidisciplinary management of diffuse large B-cell lymphoma with multifocal cardiac involvement identified by total body 18FDG positron emission tomography performed at disease staging.

由于蒽环类药物的心脏毒性,以及在极少数情况下与心脏浸润有关,淋巴瘤患者发生心血管事件的风险很高。除了与心肌化疗相关的毒性外,心脏肿块的存在还可能导致心律失常、房室传导阻滞、心肌缺血、心包积液和心脏填塞等不可预知的急性并发症,这进一步增加了淋巴瘤患者治疗的复杂性。在此,我们描述了弥漫大B细胞淋巴瘤的临床表现和多学科治疗的成功案例,该淋巴瘤在疾病分期时通过全身18FDG正电子发射断层扫描发现多灶性心脏受累。
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引用次数: 0
[Right bundle branch block or ventricular preexcitation? Sometimes the solution lies in the middle]. [右束支传导阻滞还是室性期前收缩?有时解决方案就在中间]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-01 DOI: 10.1714/4282.42633
Matteo Arzenton, Renè Tezze, Alberto Sarti, Francesco Vitali
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引用次数: 0
[Ten questions about cardiopulmonary exercise testing: all that the cardiologist dares or dares not to ask]. [关于心肺运动测试的十个问题:心脏病医生敢问或不敢问的所有问题]。
IF 0.5 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4269.42464
Ailia Giubertoni, Luca Cumitini, Simone Fodra, Andrea Giordano, Davide Avenoso, Giuseppe Patti

In patients with cardiovascular, pulmonary, muscular and neurological diseases, cardiopulmonary exercise testing (CPET) is a valuable tool providing clinically-relevant diagnostic and prognostic information by evaluation of exercise response. CPET requires to be performed in dedicated centers able to correctly carry out the examination and to carefully evaluate the results. CPET analyzes functional capacity revealing both symptomatic and asymptomatic intolerance to exercise. One of the most important advantages for clinicians derived by the use of CPET, beyond standard exercise electrocardiography testing, is the capability not only to grade the severity of the disease, but also to distinguish between different causes of dyspnea and exercise impairment. Indications for CPET use in clinical practice are increasing in the last decades, evolving beyond the routine use as a training tool in athletes. In fact, CPET represents an important step in the management of patients with heart failure or pulmonary hypertension, as suggested by international guidelines. CPET role in helping for the selection of patients candidate to heart transplantation is also well known. Beyond its clinical usefulness, scientific interest in CPET is constantly expanding, mainly due to the safety of the exam and to the huge size of the pathophysiological information that it offers. The aim of this paper is to simply explain everyday applications and potential further purposes of CPET in clinical practice. Our review is intended both for physicians approaching CPET for the first time and for clinicians with an interest in expanding their knowledge in this field.

对于患有心血管、肺部、肌肉和神经系统疾病的患者来说,心肺运动测试(CPET)是一项非常有价值的工具,可通过评估运动反应提供与临床相关的诊断和预后信息。CPET 需要在能够正确进行检查和仔细评估结果的专门中心进行。CPET 可分析功能能力,揭示有症状和无症状的运动不耐受情况。对临床医生来说,使用 CPET 所带来的最重要的优势之一是,它不仅能对疾病的严重程度进行分级,还能区分呼吸困难和运动障碍的不同原因。在过去的几十年中,CPET 在临床实践中的使用指征不断增加,已经超出了作为运动员训练工具的常规使用范围。事实上,根据国际指南的建议,CPET 是治疗心衰或肺动脉高压患者的一个重要步骤。CPET 在帮助选择心脏移植候选患者方面的作用也是众所周知的。除了其临床用途外,科学界对 CPET 的兴趣也在不断扩大,这主要是由于该检查的安全性以及其提供的病理生理学信息量巨大。本文旨在简单介绍 CPET 在临床实践中的日常应用和潜在的进一步用途。我们的综述既适用于首次接触 CPET 的医生,也适用于有兴趣扩展该领域知识的临床医生。
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引用次数: 0
[The Italian law 219/2017: informed consent and advance directives. When the patient-doctor communication time is law, but it is forgotten]. [意大利第 219/2017 号法律:知情同意和预先指示。当医患沟通时间成为法律,却被遗忘]。
IF 0.5 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4269.42461
Massimo Romanò

The Italian law 217/2019 on "Informed consent and advance directives" is an important step forward in the redefinition of patient-doctor relationships. The law points out the principles of the decisional autonomy and freedom of the patient to choose the treatment options. However, it is underestimated and largely unapplied by the Italian cardiologists. The main elements of patient-doctor communication are present in the law. The most important is the time devoted to the patient-doctor relationship, necessary to ease the disease awareness. This time is clearly emphasized in the law, but the healthcare institutions did not arrange for the appropriate organizational procedures. Through the advance directives (ADs) the patients may express their own wishes about healthcare treatments, as well as their consent or refusal regarding the diagnostic or therapeutical doctors' suggestions, allowing their respect in case they become incompetent. This right is supported by the patients' designation of a healthcare proxy, who can interact for them with the healthcare team. However, after 6 years since the law enactment, only 0.4% of the Italian citizens signed ADs, due to insufficient information and organization by the healthcare authorities. In the Law, the advance care planning is closely related to ADs. In this process, the adults can understand and share their personal values, life goals and preferences, in order to define the potential future medical care and to discuss all the issues with family and physicians. These processes can be integrated in a broader shared decision-making, a strong tool of the patient-doctor alliance.

意大利关于 "知情同意和预先指示 "的第 217/2019 号法律是在重新定义医患关系方面迈出的重要一步。该法律指出了患者自主决定和自由选择治疗方案的原则。然而,意大利心脏病专家却低估了这一原则,而且在很大程度上没有加以应用。法律规定了医患沟通的主要内容。其中最重要的是专门用于医患关系的时间,这对于提高患者对疾病的认识十分必要。法律明确强调了这一时间,但医疗机构并未安排适当的组织程序。通过预嘱(ADs),病人可以表达自己对医疗保健治疗的意愿,以及对医生的诊断或治疗建议的同意或拒绝,从而在他们丧失能力时得到尊重。病人可以指定一名医疗保健代理来支持自己的这一权利,该代理可以代表他们与医疗保健团队进行交流。然而,在法律颁布 6 年后,只有 0.4% 的意大利公民签署了预先护理计划,原因是医疗机构提供的信息和组织不够充分。在该法律中,预先护理计划与预嘱密切相关。在这一过程中,成年人可以了解并分享他们的个人价值观、生活目标和偏好,以确定未来可能的医疗护理,并与家人和医生讨论所有问题。这些过程可以整合到更广泛的共同决策中,是医患联盟的有力工具。
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Giornale italiano di cardiologia
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