Community-acquired pneumonia (CAP) is complicated by cardiac events in the early phase of the disease. Aim of this study was to assess if these intrahospital cardiac complications may account for ...overall mortality and cardiovascular events occurring during a long-term follow-up. Three hundred one consecutive patients admitted to the University-Hospital, Policlinico Umberto I, with community-acquired pneumonia were prospectively recruited and followed up for a median of 17.4 months. Primary end point was the occurrence of death for any cause, and secondary end point was the occurrence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction MI, and stroke). During the intrahospital stay, 55 patients (18%) experienced a cardiac complication. Of these, 32 had an MI (29 non–ST-elevation MI and 3 ST-elevation MI) and 30 had a new episode of atrial fibrillation (7 nonmutually exclusive events). During the follow-up, 89 patients died (51% of patients with an intrahospital cardiac complication and 26% of patients without, p <0.001) and 73 experienced a cardiovascular event (47% of patients with and 19% of patients without an intrahospital cardiac complication, p <0.001). A Cox regression analysis showed that intrahospital cardiac complications, age, and Pneumonia Severity Index were significantly associated with overall mortality, whereas intrahospital cardiac complications, age, hypertension, and diabetes were significantly associated with cardiovascular events during the follow-up. In conclusion, this prospective study shows that intrahospital cardiac complications in the early phase of pneumonia are associated with an enhanced risk of death and cardiovascular events during long-term follow-up.
Abstract Background Troponins may be elevated in patients with pneumonia, but associations with myocardial infarction (MI) and with platelet activation are still undefined. Objectives The aim of this ...study was to investigate the relationship between troponin elevation and in vivo markers of platelet activation in the early phase of hospitalization of patients affected by community-acquired pneumonia. Methods A total of 278 consecutive patients hospitalized for community-acquired pneumonia, who were followed up until discharge, were included. At admission, platelet activation markers such as plasma soluble P-selectin, soluble CD40 ligand, and serum thromboxane B2 (TxB2 ) were measured. Serum high-sensitivity cardiac troponin T levels and electrocardiograms were obtained every 12 and 24 h, respectively. Results Among 144 patients with elevated high-sensitivity cardiac troponin T, 31 had signs of MI and 113 did not. Baseline plasma levels of soluble P-selectin and soluble CD40 ligand and serum TxB2 were significantly higher in patients who developed signs of MI. Logistic regression analysis showed plasma soluble CD40 ligand (p < 0.001) and soluble P-selectin (p < 0.001), serum TxB2 (p = 0.030), mean platelet volume (p = 0.037), Pneumonia Severity Index score (p = 0.030), and ejection fraction (p = 0.001) to be independent predictors of MI. There were no significant differences in MI rate between the 123 patients (45%) taking aspirin (100 mg/day) and those who were not aspirin treated (12% vs. 10%; p = 0.649). Aspirin-treated patients with MIs had higher serum TxB2 compared with those without MIs (p = 0.005). Conclusions MI is an early complication of pneumonia and is associated with in vivo platelet activation and serum TxB2 overproduction; aspirin 100 mg/day seems insufficient to inhibit thromboxane biosynthesis. (MACCE in Hospitalized Patients With Community-acquired Pneumonia; NCT01773863 )
Myocardial fibrosis derives from a direct glucocorticoid stimulation of fibroblast activity, likely through Smad and the transforming growth factor beta-1 pathway, and was reduced in our CS ...population from 11.5% to 3.1% after adrenalectomy, confirming the data obtained by speckle tracking echocardiography (3). ...CS cardiomyopathy is a reversible entity induced by high levels of glucocorticoids, characterized by cell hypertrophy, myofibrillolysis, and myocardial fibrosis that revert after adrenalectomy.
Reply Violi, Francesco, MD; Calvieri, Camilla, MD; Falcone, Marco, MD ...
Journal of the American College of Cardiology,
2015, Letnik:
65, Številka:
14
Journal Article
Reply Violi, Francesco, MD; Calvieri, Camilla, MD; Falcone, Marco, MD ...
Journal of the American College of Cardiology,
2015, Letnik:
65, Številka:
14
Journal Article
Reply Violi, Francesco, MD; Calvieri, Camilla, MD; Falcone, Marco, MD ...
Journal of the American College of Cardiology,
2015, Letnik:
65, Številka:
14
Journal Article
Prednisone at a daily dose of 25 mg (0.3 mg/kg d) and atorvastatin at a daily dose of 80 mg were started in addition to aspirin, clopidogrel, losartan, and amlodipine that the patient assumed at ...home. ...narcotic therapy with tramadol chlorhydrate was added to relieve severe leg pain of which the patient had complained. Despite the progress of radiology and vascular surgery with their possible complications, CCE is still underdiagnosed; and its treatment is not codified. ...it is very important that clinicians be aware of the risks of CCE after vascular procedure. The benefit of HBO are explained by hyperoxygenation of the hypoperfused tissue that induces significant positive changes in the repair process by enhancing fibroblastic replication, collagen synthesis, and neovascularization 19. ...hyperoxia has an anti-inflammatory effect in the vascular bed, reducing rolling and adhesion of polymorphonuclear cells in the microcirculation 20.
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