Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology最新文献

Cardiovascular diseases are the leading cause of death for women in all countries of the world. Aging of the population and the high prevalence of risk factors among young and middle-aged women allow to hypothesize that this situation will continue in the future. Differences exist between women and men in the impact of risk factors, symptoms and therapeutic response. However, the main problem limiting prevention and control of cardiovascular diseases among women is gender inequality in health care. Myocardial infarction and stroke continue to be seen as "male" diseases and this view has deeply limited research and clinical management improvements. Furthermore, factors related to the socioeconomic environment strongly influence the development of cardiovascular diseases. For women, the ability to stop smoking, have a healthy eating and regular physical activity and live in a supportive psychosocial environment is strongly influenced by their level of income, education, role, control over their lives, culture, religion, access to health care. For the majority of women these factors represent the main barriers to cardiovascular disease prevention. The promotion of cardiovascular health among women could be accomplished only by removing all the obstacles to women's active participation in public and private life allowing them to share a full and equal role in economic, social, cultural and political decision-making processes. This strategy will not only improve women's health, but also that of children and men.

In long-term studies researchers are mainly concerned with occurrence of death during the follow-up period. This statistical note is focused on survival analysis which is the main tool to process this kind of data. Survival curve, cumulative mortality curve and hazard curve are here introduced together with an appropriate effect indicator: hazard ratio. In particular, the use of the latter is shown by resorting to the randomized controlled clinical trial TARGET.

The elderly population represents a relevant proportion of patients with non-ST-elevation acute coronary syndromes and are at increased risk because of the greater extent of coronary artery disease, a reduction in left ventricular ejection fraction, and associated comorbidities. Results from registries and post-hoc analysis of randomized clinical trials have shown that an early invasive strategy with myocardial revascularization when indicated offers a greater clinical benefit in the elderly that in younger patients despite an increased procedural risk in elderly patients.

The nutritional status and plasma concentrations of some group B vitamins, namely vitamin B6, vitamin B12 and folic acid, have recently emerged as inverse correlates of cardiovascular risk, and several experimental and clinical studies, these latter mostly retrospective and case-control studies, indicate a defect of such vitamins as capable of promoting the progression of atherosclerosis. Since all these vitamins are implicated in homocysteine metabolism, and since homocysteine has a well-recognized relationship with cardiovascular risk, the simplest hypothesis to explain the relationship of vitamin B6, vitamin B12 and folic acid on the one hand, and cardiovascular risk on the other is that this relationship is mediated by plasma levels of homocysteine. The most convincing literature data for the existence of a relationship with cardiovascular risk are for vitamin B6 and folic acid. These vitamins, however, have also a series of in vitro effects indicating a direct antiatherogenic action, and the results of several clinical studies, especially for vitamin B6, indicate an inverse relationship with cardiovascular risk at least in part independent of homocysteinemia. A further confirmation of these data is important to devise future intervention strategies in primary and secondary prophylaxis of atherosclerotic vascular disease.

Background: Since epidemiological studies on congestive heart failure (CHF) have shown somewhat contradictory results, detailed analyses of local trends may be useful in order to plan health strategies.

Methods: All patients discharged from public hospitals between 1996 and 2001 with a DRG 127 were evaluated. For patients living in the city of Turin, 1- and 12-month survival analysis was performed. Multivariate analysis was performed for both the total DRG 127 discharges and patients without acute CHF (ICD9CM 785).

Results: During the 6-year period 56292 discharges were classified as DRG 127. Hospital discharges for CHF increased until 1999, and then remained stable. Because of the progressive decrease of total number of hospital discharges, the percentage of DRG 127 increased from 1.3 to 2%. Mean age increased from 72.8 to 75.4 years in men and from 77.9 to 80.0 years in women. The average hospital stay decreased from 10.8 to 9.9 days in men, from 11.5 to 10.7 days in women. Within 12 months 17.4% of patients were re-hospitalized. The in-hospital mortality decreased from 17.3 to 14.3% in men and from 20.1 to 14.6% in women. For urban population both 1-month and 12-month mortality (from 40.5 to 35.5% in men, from 33.5 to 28.7% in women) decreased. The subgroup with acute CHF within DRG 127 decreased from 11.8 to 4.8%. At multivariate analysis in-hospital mortality is logically correlated with the age of patients and an increase of the mortality, both in women and men, is shown for patients not admitted in a cardiology department.

Conclusions: The number of CHF hospital discharges, between 1998 and 2001, remained stable, but increased with respect to total admissions. The reduction of in-hospital, 1-month, and 12-month mortality seems to be more dependent on different patient characteristics than to a real effect.

Strain/strain rate are a new echocardiographic technique able to quantify regional myocardial deformation. Since myocardial velocity, obtained by standard tissue Doppler, is affected by global heart motion, cardiac rotation and influence from velocities in other segments, strain/strain rate have been introduced to measure regional shortening fraction and shortening rate, respectively. The present review discusses the most recent developments in the application of strain/strain rate in coronary artery disease.

Background: A new patient consent form has recently been adopted in our Institution, with a uniformly written text to be used for all medical procedures and interventions. It is accompanied by a separate information sheet, explaining both the details and the risk/benefit profile for each specific procedure/intervention. It should be given to the patient as early as possible after the procedure/intervention is planned. Testing the effectiveness of this new information policy has been included into the quality assurance goals by our nursing staff.

Methods: From mid April to mid June 2004 a questionnaire was administered to all patients who had undergone an elective cardiac interventional procedure. The timing, manner and perceived completeness of the information received by patients was investigated by 14 yes/no or multiple choice questions. A goal of <5% deviation from a 100% standard was set for all indicators.

Results: Two hundred and thirty-eight valid questionnaires were obtained out of 308 consecutive procedures. Seven patients (3%) refused the questionnaire. The response rate was >90% for each question. Seventy-eight patients (33%) had a history of cardiac interventional procedures. The information sheet had been received before the procedure in 93% of cases, and this had happened in the ward in 58% of cases; the procedure had been performed at least 1 hour after receipt of the information sheet in 83% of cases. Twenty-seven patients (13%) stated they had not read the information sheet, in most cases (92%) because they felt they already knew enough. Among patients who had read the information sheet, 99% deemed it could be easily understood. Difficulties in asking questions were reported by 6% of patients. When questions had been asked, the nursing staff was addressed in 42% of cases, and the answers were rated as clear in 98% of cases. The consent form was not read at all by 13% of patients, due to alleged lack of time, and was not read completely by another 15%; 98% of those who had read it, however, found it was fairly understandable.

Conclusions: The effectiveness of our new patient information policy seems to approach our quality goals, and is liable to further improvement. The nursing staff of the cardiac catheterization unit is involved in the patient information process, and has full competence to study this issue.

Background: The effects of omega-3 fatty acids on membrane stabilization are well known. Reduction of ventricular arrhythmias and sudden death has been reported; fewer data exist regarding the effects on atrial arrhythmias. The object of this report is to evaluate the reduction of atrial arrhythmia-fibrillation after treatment with omega-3, in patients with dual-chamber pacemakers.

Methods: We have examined 40 patients with paroxysmal atrial tachyarrhythmia recorded at the periodic pacemaker controls. At the study entry, all patients were treated with omega-3 (1 g/die); no changes in the device programmation and in the previous pharmacological therapy were allowed. The devices were interrogated after 4 months of treatment to evaluate the number of episodes and the burden of atrial tachyarrhythmia. At this time, the treatment was discontinued and the patients were reevaluated 4 months later.

Results: Two patients discontinued the treatment complaining of adverse gastroentheric effects. The episodes of atrial tachyarrhythmia in the pre-treatment period resulted 444 +/- 1161, and the burden 3.89% of time; in the treatment period resulted respectively 181 +/- 436 (-59%, p = 0.037) and 1.06% (-67%, p = 0.029). After drug withdrawal, the episodes of atrial tachyarrhythmia raised to 552 +/- 1717 (p = 0.065) and the burden to 2.69% (p = 0.003).

Conclusions: Our data suggest a powerful effect of omega-3 fatty acids in the reduction of atrial tachyarrhythmia-fibrillation in these patients, without significant adverse effects.

Cardiovascular disease is the first cause of morbidity and mortality in dialysis patients. Hyperphosphatemia and elevated serum calcium-phosphate levels have recently been investigated as inducing factors on extraskeletal calcification in this population. In vitro studies demonstrated that human aortic smooth muscle cells calcify when incubated in a high phosphate medium, where calcium and calcitriol are not changed. Furthermore, the lack of inhibitory proteins, such as fetuin and matrix Gla protein, is a possible main determinant of calcium-phosphate deposition in soft tissues. The classical treatment of hyperphosphatemia and secondary hyperparathyroidism in dialysis patients consists of calcium-based phosphate binders and calcitriol administration. Unfortunately, this "first-generation" therapy is not free of dramatic side effects. New free-calcium and -aluminum phosphate binders, new vitamin D metabolites, and calcimimetics are examples of "second-generation" therapies that may prevent vascular calcification and possibly prevent some of the burden of cardiovascular disease in uremia.

Disulfiram is a drug used since 1940 in the treatment of alcohol dependence. However, it is not a completely safe drug; there are in the literature some case reports of more severe reaction than the usual "acetaldehyde syndrome" secondary to ingestion of disulfiram and alcohol. We describe a case of a 45-year-old, chronic alcoholic man in treatment with disulfiram, who suffered an acute anterior myocardial infarction, successfully treated with thrombolysis. The possible factors precipitating acute myocardial infarction in this patient are discussed.