Frailty is an issue of paramount importance for cardiologists,because of the aging of patients admitted to hospital for acute coronary syndrome(ACS)and the straight relationship between aging and frailty.Several tools...Frailty is an issue of paramount importance for cardiologists,because of the aging of patients admitted to hospital for acute coronary syndrome(ACS)and the straight relationship between aging and frailty.Several tools have been provided in this setting,in order to objectively assess frailty status,but important questions are still unsolved.There are conflicting data about a unique definition of frailty in subjects with cardiovascular diseases,the timing to perform a frailty evaluation in the context of an acute myocardial infarction,the mean to assess frailty in these patients and the usefulness of the information derived from the frailty assessment.Frailty results from the analysis of several items and a multidomain evaluation including laboratory values,clinical data and physical performance assessment is required for a comprehensive frailty assessment.However,regardless of the frailty tool,the prevalence of frailty in older ACS patients is high and it could add important information to the decision-making process about invasive strategy,the multivessel disease management,dual antiplatelet therapy and secondary prevention programs.The present overview tries to summarize the current knowledge about the definition and prevalence of frailty in older adults admitted to hospital for ACS,suggesting how frailty assessment may improve the management of older ACS patients.展开更多
Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of pro...Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy(CRT) and to select patients for implantable cardioverter defibrillators(ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated singlephoton emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.展开更多
PURPOSE Syringomyelia is a misleading disease since the problem always lies elsewhere.Arachnoiditis,because it is radiographically difficult to discern,is an especially insidious cause.To better guide selection from a...PURPOSE Syringomyelia is a misleading disease since the problem always lies elsewhere.Arachnoiditis,because it is radiographically difficult to discern,is an especially insidious cause.To better guide selection from among surgical treatment options for syringomyelia,we reviewed our case series of patients without Chiari malformation or spinal injury.METHODS Excluding syringomyelia due to Chiari malformation,spinal cord injury,and tumors,32 patients(mean age 44 years)were operated on between 1995 and 2013and followed up for a mean of 53.8 months.Presumed causes at diagnosis,clinical and radiological findings,type of operation,clinical and radiological outcome were reviewed.RESULTS Duration of clinical history varied widely(range 6-164 months).Clinical assessment was based on the McC ormick classification(15 independent,17 dependent).Causes included birth trauma,pyogenic meningitis,tuberculous meningitis,postoperative scarring,dysraphism,and basilar impression.Treatment was local decompression with arachnoid lysis and shunts.Hindbrain-related syringomyelia was differentiated from non hindbrain-related syringomyelia.Hindbrain arachnoiditis was significantly associated with radiological findings at the foramen magnum(P=0.01)and craniocervical decompression(P<0.03),with good clinical and radiological outcome at 6 months and later follow-up controls(P=0.02),whereas uneven results were observed in cases of non-hindbrain arachnoiditis.CONCLUSIONS To remove the cause of syringomyelia,surgical planning will rely on thorough clinical history and accurate imaging to determine the site of cerebrospinal fluid obstruction.Craniocervical decompression to dissect basal arachnoiditis in the posterior fossa can be recommended in hindbrain syringomyelia.Treatment of non-hindbrain arachnoiditis is more controversial,probably owing to uncertainties about the extent of adhesions.展开更多
文摘Frailty is an issue of paramount importance for cardiologists,because of the aging of patients admitted to hospital for acute coronary syndrome(ACS)and the straight relationship between aging and frailty.Several tools have been provided in this setting,in order to objectively assess frailty status,but important questions are still unsolved.There are conflicting data about a unique definition of frailty in subjects with cardiovascular diseases,the timing to perform a frailty evaluation in the context of an acute myocardial infarction,the mean to assess frailty in these patients and the usefulness of the information derived from the frailty assessment.Frailty results from the analysis of several items and a multidomain evaluation including laboratory values,clinical data and physical performance assessment is required for a comprehensive frailty assessment.However,regardless of the frailty tool,the prevalence of frailty in older ACS patients is high and it could add important information to the decision-making process about invasive strategy,the multivessel disease management,dual antiplatelet therapy and secondary prevention programs.The present overview tries to summarize the current knowledge about the definition and prevalence of frailty in older adults admitted to hospital for ACS,suggesting how frailty assessment may improve the management of older ACS patients.
文摘Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy(CRT) and to select patients for implantable cardioverter defibrillators(ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated singlephoton emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.
文摘PURPOSE Syringomyelia is a misleading disease since the problem always lies elsewhere.Arachnoiditis,because it is radiographically difficult to discern,is an especially insidious cause.To better guide selection from among surgical treatment options for syringomyelia,we reviewed our case series of patients without Chiari malformation or spinal injury.METHODS Excluding syringomyelia due to Chiari malformation,spinal cord injury,and tumors,32 patients(mean age 44 years)were operated on between 1995 and 2013and followed up for a mean of 53.8 months.Presumed causes at diagnosis,clinical and radiological findings,type of operation,clinical and radiological outcome were reviewed.RESULTS Duration of clinical history varied widely(range 6-164 months).Clinical assessment was based on the McC ormick classification(15 independent,17 dependent).Causes included birth trauma,pyogenic meningitis,tuberculous meningitis,postoperative scarring,dysraphism,and basilar impression.Treatment was local decompression with arachnoid lysis and shunts.Hindbrain-related syringomyelia was differentiated from non hindbrain-related syringomyelia.Hindbrain arachnoiditis was significantly associated with radiological findings at the foramen magnum(P=0.01)and craniocervical decompression(P<0.03),with good clinical and radiological outcome at 6 months and later follow-up controls(P=0.02),whereas uneven results were observed in cases of non-hindbrain arachnoiditis.CONCLUSIONS To remove the cause of syringomyelia,surgical planning will rely on thorough clinical history and accurate imaging to determine the site of cerebrospinal fluid obstruction.Craniocervical decompression to dissect basal arachnoiditis in the posterior fossa can be recommended in hindbrain syringomyelia.Treatment of non-hindbrain arachnoiditis is more controversial,probably owing to uncertainties about the extent of adhesions.
