AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic enceph...AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.展开更多
Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of eithe...Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of either condition can‘cause’the development of the other,creating a new patient group that demands different management strategies to that if they occur in isolation.Regardless of the temproral association of the two conditions,their presence is linked with adverse cardi-ovascular outcomes,increased rate of hospitalizations,and increased economic burden on healthcare systems.The use of low-cost,easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and HF.Both AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic information.These will then guide patient centred therapeutic management.The current biomarkers that offer potential for guiding therapy,focus on the physiological pathways of miRNA,myocardial stretch and injury,oxidative stress,inflammation,fibrosis,coagulation and renal impairment.Each of these has different utility in current clinincal practice.展开更多
The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echoc...The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.展开更多
Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midra...Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds differently.Betablocker constitute an important component of our pharmacological regimen for chronic HF.Betablocker administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and survival.The beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality reduction.The presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and mortality.But more question is the use of betablocker in HF patients irrespective of EF and concomitant AF.There are many conflicting data and publications,regarding the beta blocker benefit in this population.Generally,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.展开更多
The management of heart failure(HF)and atrial fibrillation(AF)in realworld practice remains a debating issue,while the number of HF patients with AF increase dramatically.While it is unclear if rhythm or rate control ...The management of heart failure(HF)and atrial fibrillation(AF)in realworld practice remains a debating issue,while the number of HF patients with AF increase dramatically.While it is unclear if rhythm or rate control therapy is more beneficial and under which circumstances,anticoagulation therapy is the cornerstone of the AFHF patients’approach.VitaminK antagonists were the goldstandard during the past,but currently their usage is limited in specific conditions.Nonvitamin K oral anticoagulants(NOACs)have gained ground during the last ten years and considered as goldstandard of a wide spectrum of HF phenotypes.The current manuscript aims to review the current literature regarding the indications and the optimal choice and usage of NOACs in HF patients with AF.展开更多
Heart failure(HF)and atrial fibrillation(AF)demonstrate a constantly increasing prevalence during the 21st century worldwide,as a result of the aging population and the successful interventions of the clinical practic...Heart failure(HF)and atrial fibrillation(AF)demonstrate a constantly increasing prevalence during the 21st century worldwide,as a result of the aging population and the successful interventions of the clinical practice in the deterioration of adverse cardiovascular outcomes.HF and AF share common risk factors and pathophysiological mechanisms,creating the base of a constant interrelation.AF impairs systolic and diastolic function,resulting in the increasing incidence of HF,whereas the structural and neurohormonal changes in HF with preserved or reduced ejection fraction increase the possibility of the AF development.The temporal relationship of the development of either condition affects the diagnostic algorithms,the prognosis and the ideal therapeutic strategy that leads to euvolaemia,management of noncardiovascular comorbidities,control of heart rate or restoration of sinus rate,ventricular synchronization,prevention of sudden death,stroke,embolism,or major bleeding and maintenance of a sustainable quality of life.The indicated treatment for the concomitant HF and AF includes rate or/and rhythm control as well as thromboembolism prophylaxis,while the progress in the understanding of their pathophysiological interdependence and the introduction of the genetic profiling,create new paths in the diagnosis,the prognosis and the prevention of these diseases.展开更多
1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular m...1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,展开更多
As the population ages,conditions like heart failure(HF),atrial fibrillation(AF)and cognitive impairment(CI)demonstrate higher prevalence.HF is a very common clinical syndrome affecting many people worldwide.It is est...As the population ages,conditions like heart failure(HF),atrial fibrillation(AF)and cognitive impairment(CI)demonstrate higher prevalence.HF is a very common clinical syndrome affecting many people worldwide.It is estimated that in the developed countries approximately 1%-2%of the adult population suffers from HF,whereas in adults>70 years old the incidence rises to≥10%.展开更多
An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compat...An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compatible with class NYHA Ⅲ-Ⅳ heart failure, bilateral peripheral oedema, increased NT-proBNP （9198 pg/mL）, mildly elevated Troponin （TnT 64 pg/mL）, interstitial pulmonary oedema and bilateral pleural effusions in chest X ray.展开更多
文摘AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.
文摘Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of either condition can‘cause’the development of the other,creating a new patient group that demands different management strategies to that if they occur in isolation.Regardless of the temproral association of the two conditions,their presence is linked with adverse cardi-ovascular outcomes,increased rate of hospitalizations,and increased economic burden on healthcare systems.The use of low-cost,easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and HF.Both AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic information.These will then guide patient centred therapeutic management.The current biomarkers that offer potential for guiding therapy,focus on the physiological pathways of miRNA,myocardial stretch and injury,oxidative stress,inflammation,fibrosis,coagulation and renal impairment.Each of these has different utility in current clinincal practice.
文摘The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.
文摘Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently coexist.The classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds differently.Betablocker constitute an important component of our pharmacological regimen for chronic HF.Betablocker administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and survival.The beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality reduction.The presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and mortality.But more question is the use of betablocker in HF patients irrespective of EF and concomitant AF.There are many conflicting data and publications,regarding the beta blocker benefit in this population.Generally,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.
文摘The management of heart failure(HF)and atrial fibrillation(AF)in realworld practice remains a debating issue,while the number of HF patients with AF increase dramatically.While it is unclear if rhythm or rate control therapy is more beneficial and under which circumstances,anticoagulation therapy is the cornerstone of the AFHF patients’approach.VitaminK antagonists were the goldstandard during the past,but currently their usage is limited in specific conditions.Nonvitamin K oral anticoagulants(NOACs)have gained ground during the last ten years and considered as goldstandard of a wide spectrum of HF phenotypes.The current manuscript aims to review the current literature regarding the indications and the optimal choice and usage of NOACs in HF patients with AF.
文摘Heart failure(HF)and atrial fibrillation(AF)demonstrate a constantly increasing prevalence during the 21st century worldwide,as a result of the aging population and the successful interventions of the clinical practice in the deterioration of adverse cardiovascular outcomes.HF and AF share common risk factors and pathophysiological mechanisms,creating the base of a constant interrelation.AF impairs systolic and diastolic function,resulting in the increasing incidence of HF,whereas the structural and neurohormonal changes in HF with preserved or reduced ejection fraction increase the possibility of the AF development.The temporal relationship of the development of either condition affects the diagnostic algorithms,the prognosis and the ideal therapeutic strategy that leads to euvolaemia,management of noncardiovascular comorbidities,control of heart rate or restoration of sinus rate,ventricular synchronization,prevention of sudden death,stroke,embolism,or major bleeding and maintenance of a sustainable quality of life.The indicated treatment for the concomitant HF and AF includes rate or/and rhythm control as well as thromboembolism prophylaxis,while the progress in the understanding of their pathophysiological interdependence and the introduction of the genetic profiling,create new paths in the diagnosis,the prognosis and the prevention of these diseases.
文摘1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,
文摘As the population ages,conditions like heart failure(HF),atrial fibrillation(AF)and cognitive impairment(CI)demonstrate higher prevalence.HF is a very common clinical syndrome affecting many people worldwide.It is estimated that in the developed countries approximately 1%-2%of the adult population suffers from HF,whereas in adults>70 years old the incidence rises to≥10%.
文摘An 86-year-old male patient was admitted in our cardiology ward with signs of congestive biventricular heart failure. The patient presented with deteriorating dyspnea on mild exertion and at rest the last days, compatible with class NYHA Ⅲ-Ⅳ heart failure, bilateral peripheral oedema, increased NT-proBNP （9198 pg/mL）, mildly elevated Troponin （TnT 64 pg/mL）, interstitial pulmonary oedema and bilateral pleural effusions in chest X ray.
