Monaldi Archives for Chest Disease最新文献

Globally, acute myocardial infarction (AMI) is a predominant cause of morbidity and mortality. Identifying reliable biomarkers to enhance risk prediction models remains a priority. This study assesses the role of growth differentiation factor-15 (GDF-15) as a predictor of AMI and its incremental value in refining current risk assessment models. A case-control study was established involving 45 AMI cases and 45 controls. Demographic, clinical, and biochemical parameters were evaluated. Logistic regression models were developed to assess the relationship between GDF-15 and AMI, adjusting for conventional risk factors and biomarkers. The prediction ability of models with and without GDF-15 was compared using the area under the curve (AUC). GDF-15 values were markedly elevated in AMI patients relative to controls. Incorporating GDF-15 into predictive models substantially improved their discriminative ability, demonstrating that GDF-15 was a robust independent predictor of AMI, enhancing diagnostic sensitivity and specificity across multiple models. Adjusting for demographic, lifestyle, and clinical risk factors, inclusion of GDF-15 led to notable AUC enhancements in Model 2 (32.88%) and Model 3 (19.66%). Models 4 and 5, which included additional biomarkers, demonstrated modest AUC improvements (2.57% and 0.61%, respectively), highlighting GDF-15's incremental value, even in models already incorporating a wide range of established biomarkers. In conclusion, GDF-15 is a robust and independent predictor of AMI, consistently improving the diagnostic performance of multivariable models. Its incorporation enhanced sensitivity, specificity, predictive values, and AUC (up to 0.999), underlining its effectiveness in risk stratification and early diagnosis of AMI.

Tuberculosis has remained an intractable challenge for mankind. The Cascade of Care approach is adopted, emphasizing early detection of latent tuberculosis infections through screening and primordial prevention of disease holistically. Currently available tests include the tuberculin skin test (TST) and interferon-γ release assays (IGRA). Our study aims at identifying the adequacy of prevailing operational knowledge about these tests amongst the interns and postgraduates who form the future medical fraternity. We conducted a prospective questionnaire-based study among interns and postgraduates. Further data compilation was done using Microsoft Excel. Comparison between groups was done using appropriate statistical tests. In our study conducted on 196 participants, we found that 53.41% of the total questions were answered rightly. The correct responses for the questions on TST were 65.29%, while for IGRA, they were 33.45%. Our study discloses the problem of a significant gap in operational knowledge about the screening tests, silently delaying the achievement of the vision, mission, and goals of the National Tuberculosis Elimination Program. India is both committed and concerned: as a solution, there is an urgent need to address this through continued medical education and periodic training workshops by utilizing the existing resources and allocations.

Despite considerable improvements in therapeutic opportunities, infective endocarditis (IE) still suffers from a high morbidity and mortality rate, with septic embolism from valvular vegetations being one of its most dreadful complications. In complicated cases, early cardiac surgery can represent the greatest opportunity to improve the patient's prognosis, yet it encounters many issues that limit its indication. Herein, we present a case of an 80-year-old woman with native valve IE causing embolic ischemic stroke, delaying early cardiac surgery, and requiring complex multidisciplinary management. The case summarizes the pros and cons of the delayed surgery approach, which may allow a longer duration of antibiotic therapy and reduced risks of neurologic worsening but may enhance the risk of valve destruction, heart block, embolic complications, and death. This case reveals many critical aspects indicating early intervention despite very high surgical risk, providing insights into knowledge gaps and clinical needs for future research on this topic.

The relationship between increased pericardial fat volume (PFV) and coronary plaque characteristics in patients with metabolic syndrome (MetS) is unclear. We aimed to assess PFV and coronary plaque characteristics, including type, stenosis severity, and presence of multiple plaques, among patients with MetS being evaluated for suspected coronary artery disease (CAD). This retrospective study included patients with suspected CAD who underwent computed tomography coronary angiography to exclude the presence of occlusive CAD. MetS diagnosis was based on the American Association of Clinical Endocrinologists criteria. The study included 811 individuals with suspected CAD who underwent MDCT examinations: 127 were in the MetS group, 71 were in the diabetes mellitus (DM) group, and 613 were in the control group (neither DM nor MetS). PFV was higher in the MetS group compared to the DM and the control groups (p=0.003). The MetS group had a higher prevalence of multiple (p<0.001) and mixed coronary plaques (p<0.001) compared to other groups. Increased age [odds ratio (OR) confidence interval (CI)=1.1(1-1.2), p=0.039] and PFV [OR (CI)=1 (1-1.2), p=0.027] showed an independent association with multiple plaque presence, while PFV was an independent predictor of mixed plaque presence [OR (CI)=1.1 (1-1.2), p=0.008]. In conclusion, patients with MetS had larger PFV and a higher prevalence of mixed and multiple coronary plaques than patients without MetS. PFV showed an independent and significant association with mixed and multiple coronary plaques among patients with MetS.

The incidence and prevalence of cardiovascular disease are increasing progressively in the general population and workers due to higher mean age and improved prognosis and survival as a result of new therapeutic and diagnostic options. The assessment of cardiovascular risk in the workplace is complex due to the fact that it is not a specific work risk and because of the absence of a specific assessment methodology, leading to numerous limitations in the formulation of the job fitness certification, the protection of workers' expertise and health, and the applicability of regulations. The tools used in cardiology and, particularly, in cardio-rehabilitation can provide important information to both estimate the residual functional capacity and the cardiovascular load during work activity. A multidisciplinary approach and collaboration between occupational physicians, cardiologists, cardio-rehabilitators, and general practitioners are essential for managing critical cases.

Anti-inflammatory therapy, particularly colchicine, has emerged as a potential secondary prevention strategy post-acute coronary syndrome (ACS). This meta-analysis assessed the impact of long-term colchicine therapy (≥12 months) compared to standard care on cardiovascular events in post-ACS patients. A systematic search of PubMed, Cochrane, Scopus, and Web of Science was conducted on December 22, 2024, for randomized controlled trials (RCTs) comparing long-term (≥12 months) treatment with colchicine to standard care in ACS patients. Outcomes assessed included all-cause mortality, cardiovascular death, myocardial infarction (MI), ischemia-driven revascularization, and stroke. Three RCTs (COLCOT, COPS, and CLEAR SYNERGY) with 12,602 patients were included. Colchicine did not significantly reduce all-cause mortality [hazard ratio (HR) 1.01, 95% confidence interval (CI): 0.67-1.53; I2=54%], cardiovascular death (HR 1.01, 95% CI: 0.80-1.29; I2=0%), or MI (HR 0.86, 95% CI: 0.71-1.05; I2=0%). Ischemia-driven revascularization (HR 0.61, 95% CI: 0.30-1.21; I2=81%) and stroke (HR 0.55, 95% CI: 0.18-1.64; I2=75%) showed non-significant reductions with high heterogeneity. The composite outcome of cardiovascular death, MI, revascularization, or stroke was not significantly reduced (HR 0.80, 95% CI: 0.59-1.07; I2=73%). These findings suggest that long-term colchicine therapy did not confer a consistent reduction in major cardiovascular outcomes after ACS. The pooled results indicate an overall null effect; however, the substantial heterogeneity across trials limits the certainty of this conclusion. This analysis may prompt a reassessment of colchicine's preventive role in ACS. Future studies should aim to reduce heterogeneity through standardized protocols and follow-up reporting and to explore whether subgroups, such as patients with elevated inflammatory markers, may derive benefit.

Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular complications such as atrial fibrillation (AF), heart failure, and myocardial infarction. AF is highly prevalent in COPD, yet the mechanisms linking them remain unclear. This study investigates the role of atrial electromechanical delay (AEMD) in predicting cardiovascular outcomes in COPD patients. This prospective cohort study included 60 COPD patients (forced expiratory volume in 1 second/forced vital capacity <0.7) from August 2022 to March 2024. Patients with pre-existing heart disease and other major comorbidities were excluded. Participants underwent spirometry, electrocardiogram (ECG), echocardiography, and N-terminal pro b-type natriuretic peptide (NT-proBNP) testing. AEMD was measured at the lateral and medial mitral annuli and tricuspid annulus. Primary endpoints included AF incidence, heart failure, stroke, and COPD exacerbations, while secondary endpoints were hospitalization and mortality. AEMD values were significantly higher in patients with AF (75.4±5.9 ms vs. 70.4±4.1 ms, p=0.004), heart failure, and COPD exacerbations, particularly at the lateral and medial mitral annuli. AEMD at the tricuspid annulus was strongly associated with mortality (p=0.04). P wave dispersion (41.2±6.4 ms vs. 36.1±4.2 ms, p=0.001) and QT dispersion (49.3±8.9 ms vs. 42.1±6.8 ms, p=0.002) were significantly elevated in patients with adverse outcomes. Elevated NT-proBNP levels (>1000 pg/mL) correlated with prolonged AEMD, suggesting cardiac stress. AEMD, particularly at the mitral and tricuspid annuli, is a strong predictor of AF, heart failure, and COPD exacerbations. P wave and QT dispersion are associated with increased hospitalization and mortality, highlighting their role in risk stratification. These findings support the use of AEMD and ECG parameters as early markers for cardiovascular complications in COPD. Further validation in larger cohorts is needed.

Advances in intensive care have increased survival rates among critically ill patients but revealed a new challenge: post-intensive care syndrome (PICS). This syndrome, affecting patients' physical, cognitive, and psychological well-being, also impacts their quality of life (QoL). Recognized in the early 21st century, PICS is now a research and clinical priority, particularly in specialized units like intermediate respiratory care units (IRCUs). This review aims to examine the evolution, clinical impact, and management strategies of PICS. A narrative review approach was utilized. A systematic search was conducted in biomedical databases (PubMed, Scopus, and Google Scholar), identifying relevant studies on PICS, its manifestations, risk factors, and therapeutic strategies. The review included original articles and clinical guidelines published between 2010 and 2024. The findings are organized into emerging themes: clinical manifestations, risk factors, diagnostic tools, management strategies, and the role of IRCUs. Each theme was analyzed to identify recurring patterns and gaps in the current knowledge base. IRCUs offer an ideal setting to address PICS-related sequelae, improving patients' QoL and facilitating their social reintegration. However, ongoing research is essential to optimize therapeutic strategies and develop more effective care models.

Chronic obstructive pulmonary disease (COPD) can arise from smoking and non-smoking causes. Spirometry with flow-volume loop (FVL) analysis is a simple and essential test not only for diagnosing COPD but also for detecting upper airway obstruction (UAO). Identifying the coexistence of UAO in COPD has important clinical implications. The present study was an independent analysis of spirometry data from COPD patients (ECARP/2022/124) over 2 years at a tertiary care center. Various spirometry parameters and FVL patterns were assessed, including visual loop flattening, forced expiratory flow at 50% of vital capacity, forced inspiratory flow at 50% of vital capacity ratio (FEF50/FIF50), FIF50, and Empey's index. Patients meeting ≥3 of 4 standard UAO criteria were classified as having UAO. A total of 193 COPD patients were included (mean age 56.3 years). Visual loop flattening was observed in 27% (7% inspiratory, 20% expiratory). The FEF50/FIF50 ratio was >1 in 17% and <0.3 in 44%, suggesting variable intrathoracic obstruction as the most common type of UAO. FIF50 <100 L/min was noted at 27.3%. Overall, 7.21% of patients met ≥3 of 4 diagnostic criteria for UAO. Thus, a significant subset of COPD patients demonstrated features of coexisting UAO. Routine spirometry with FVL analysis provides a valuable, noninvasive tool to identify this overlap, which may influence diagnosis, management, and patient outcomes.

Lung cancer is a complex and heterogeneous disease with significant morbidity and mortality worldwide. Over the years, several inflammation markers have been studied, such as molecules, cells, genes, etc., that are implicated in the extremely complex interactions taking place in the inflammatory process implicated in cancer development. This narrative review aims to present the most commonly studied inflammation markers in lung cancer, including C-reactive protein, tumor necrosis factor family members, and prostaglandin E synthase enzyme 3, as well as the significant number of scores and indexes that have been developed to improve the prognostic and predictive potential for non-small cell lung cancer and small cell lung cancer patients of different stages and treatment approaches. Scores and indexes originating from a combination of variables used in everyday clinical practice are emphasized due to their simplicity and cost-effectiveness. Studies addressing the prognostic and predictive value of the most important and recently studied markers, indexes, and scores in lung cancer are summarized, revealing their potential as indicators of overall survival, therapeutic response, and tumor immune characteristics. Limitations in utilizing inflammation markers as predictive biomarkers are discussed, including assay standardization, the complexity of the inflammatory response, confounding factors, and the dynamic nature of marker assessment. The progress of biotechnology, along with the combination of routine clinical practice insights, could result in the development of inflammation markers with improved prognostic and predictive value guiding treatment decisions for lung cancer patients in the context of precision medicine.