Among the older patients' cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. ...Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient's history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.
Although sex differences in cardiovascular diseases are recognised, including differences in incidence, clinical presentation, response to treatments, and outcomes, most of the practice guidelines ...are not sex-specific. Heart failure (HF) is a major public health challenge, with high health care expenditures, high prevalence, and poor clinical outcomes. The objective was to analyse the sex-specific association of socio-demographics, life-style factors and health characteristics with the prevalence of HF and diastolic left ventricular dysfunction (DLVD) in a cross-sectional population-based study.
A random sample of 2001 65-84 year-olds underwent physical examination, laboratory measurements, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiography, and echocardiography. We selected the subjects with no missing values in covariates and echocardiographic parameters and performed a complete case analysis. Sex-specific multivariable logistic regression models were used to identify the factors associated with the prevalence of the diseases, multinomial logistic regression was used to investigate the factors associated to asymptomatic and symptomatic LVD, and spline curves to display the relationship between the conditions and both age and NT-proBNP.
In 857 men included, there were 66 cases of HF and 408 cases of DLVD (77% not reporting symptoms). In 819 women, there were 51 cases of HF and 382 of DLVD (79% not reporting symptoms). In men, the factors associated with prevalence of HF were age, ischemic heart disease (IHD), and suffering from three or more comorbid conditions. In women, the factors associated with HF were age, lifestyles (smoking and alcohol), BMI, hypertension, and atrial fibrillation. Age and diabetes were associated to asymptomatic DLVD in both genders. NT-proBNP levels were more strongly associated with HF in men than in women.
There were sex differences in the factors associated with HF. The results suggest that prevention policies should consider the sex-specific impact on cardiac function of modifiable cardiovascular risk factors.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Age‐ and sex‐specific differences exist in the treatment and outcome of ST‐elevation myocardial infarction (STEMI). We sought to describe age‐ and sex‐matched contemporary trends of ...in‐hospital management and outcome of patients with STEMI.
Methods and Results
We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age‐ and sex‐matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in‐hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07–1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07–1.93, P=0.009) were found to be significantly associated with in‐hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61).
Conclusions
Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in‐hospital mortality than men, irrespective of age.
In the 24th and 25thof June 2016, 80 national experts were invited to Rome from The Italian Society of Geriatric Cardiology and the Italian Association of Cardiovascular Prevention and Rehabilitation ...to revise the current knowledge on the perioperative risk in the elderly. Cardiologists, geriatricians, heart and general surgeons and anesthesiologists discussed the topic with the objective of reaching a consensus and to launch observational research and registries in the field of perioperative risk evaluation in the elderly. The introduction of objective measures of frailty on top of traditional cardiac evaluation in the different surgical contexts could allow for a more precise definition of "surgical risk", appropriate perioperative management and postoperative outcome.
Background:Galectin-3 (Gal-3) is involved in collagen deposition and inflammation and is a prognostic biomarker in heart failure (HF).Methods and Results:Gal-3 and other markers of fibrosis or ...cardiac stress were measured serially in 413 patients with mild HF randomized to the mineralocorticoid receptor antagonist canrenone or placebo to evaluate treatment effect and association with clinical outcome. Gal-3 increased slightly over 6 months in both arms of the study and was associated with clinical endpoints.Conclusions:Although Gal-3 showed prognostic value, the effect of canrenone on clinical outcomes was unaffected by baseline concentrations of biomarkers of fibrosis or cardiac stress.
La classificazione dello scompenso cardiaco (SC) secondo i livelli di frazione di eiezione (FE) non è sufficiente per un corretto inquadramento clinico e per le scelte terapeutiche. Nonostante ...questo, la suddivisione nelle diverse fasce di FE (FE ridotta, moderatamente ridotta, preservata – HFrEF, HFmrEF, HfpEF) è utile per un iniziale inquadramento fisiopatologico e in quanto le scelte terapeutiche dettate dalle Linee Guida sono nate dai trial basati su questo tipo di classificazione. Un migliore orientamento alle scelte terapeutiche si ottiene associando al valore di FE la stadiazione clinica e la sua evoluzione, nonché la considerazione della eziologia e fisiopatologia del caso individuale e delle comorbosità. È opportuno associare alla suddivisione in tre categorie quella della FE modificata dalla terapia o dalla storia naturale (FE migliorata o peggiorata), per considerare la necessità di adattare le cure alle condizioni variate nel tempo. Per quanto riguarda HFrEF le Linee Guida europee, canadesi e americane, pur riconoscendo in modo unanime le quattro categorie di farmaci essenziali (ARNI, BB, MRA, SGLT2i) differiscono leggermente sui tempi e modalità di titolazione alle dosi indicate come efficaci. La categoria più complessa, ed in aumento epidemiologico, è quella con FE preservata, nella quale confluiscono situazioni cliniche molto eterogenee, da individuare con attenzione per personalizzare la cura. La categoria dei farmaci SGLT2i si è dimostrata efficace in tutte le categorie di FE, per cui oggi è sufficiente la diagnosi di SC, indipendentemente dal valore di FE, per dover utilizzare questa terapia.
Abstract
Pathology affecting the atria have a significant impact on the occurrence of arrhythmias and the risk of stroke. The causal relationship between atrial fibrillation (AF) and ischaemic stroke ...has been challenged by the recent uncovering of the lack of temporal association between thrombo-embolic cerebral events and paroxysmal AF or tachycardia. General conditions, such as the one considered in the definition of the CHA2DS2-VASc score, or specific atrial pathology (also independently occurring), could predispose to cerebral embolism.
L’aumento dell’età media della popolazione a cui si è assistito negli ultimi 40 anni ha reso epidemiologicamente rilevanti le valvulopatie degenerative, tra cui la Stenosi Valvolare Aortica (SAV). La ...diagnosi precoce di questa condizione può consentire di allungare anche non di poco la vita dei pazienti e sicuramente migliorarne la qualità. Una causa possibile della sottodiagnosi della SAV è la scarsa consapevolezza del peso epidemiologico della malattia. La prevalenza della SAV moderata-severa nella popolazione generale tra i 70 e i 75 anni è di circa il 2%, crescente con l’età. La sclerosi valvolare aortica, premessa per lo sviluppo nel tempo di SAV, è presente nel 34% della popolazione oltre i 65 anni. Nei pazienti asintomatici con SAV moderata-severa, durante un periodo di follow up medio di 2 anni circa, il 39,4% sviluppa sintomi tali da giustificare la sostituzione valvolare. Circa il 50% dei pazienti con SAV da moderata a severa non riferisce sintomi. In letteratura, il rischio di morte improvvisa nella fase silente della SAV varia dallo 0,25% al 1,7% per anno. È molto frequente che i pazienti con SAV riferiscano con ritardo i propri sintomi. Se si considera una mortalità annua del 30% in presenza di sintomi, il loro riconoscimento precoce e il tempestivo avvio a sostituzione protesica sono fondamentali Da queste considerazioni emerge la necessità di una diagnosi precoce e possibilmente ad uno stadio di minore gravità, attraverso campagne di screening istituzionale.
Abstract
Background
Little is known about the clinical value of Insulin-like growth factor-binding protein-7 (IGFBP7), a cellular senescence marker, in an elderly general population with multiple ...co-morbidities and high prevalence of asymptomatic cardiovascular ventricular dysfunction. Inflammation and fibrosis are hallmarks of cardiac aging and remodelling. Therefore, we assessed the clinical performance of IGFBP7 and two other biomarkers reflecting these pathogenic pathways, the growth differentiation factor-15 (GFD-15) and amino-terminal propeptide of type I procollagen (P1NP), for their association with cardiac phenotypes and outcomes in the PREDICTOR study.
Methods
2001 community-dwelling subjects aged 65–84 years who had undergone centrally-read echocardiography, were selected through administrative registries. Atrial fibrillation (AF) and 4 echocardiographic patterns were assessed: E/e’ (> 8), enlarged left atrial area, left ventricular hypertrophy (LVH) and reduced midwall circumference shortening (MFS). All-cause and cardiovascular mortality and hospitalization were recorded over a median follow-up of 10.6 years.
Results
IGFBP7 and GDF-15, but not P1NP, were independently associated with prevalent AF and echocardiographic variables after adjusting for age and sex. After adjustment for clinical risk factors and cardiac patterns or NT-proBNP and hsTnT, both IGFBP7 and GDF-15 independently predicted all-cause mortality, hazard ratios 2.131.08–4.22 and 2.031.62–2.56 per unit increase of Ln-transformed markers, respectively.
Conclusions
In a community-based elderly cohort
,
IGFBP7 and GDF-15 appear associated to cardiac alterations as well as to 10-year risk of all-cause mortality.
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