Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with ...peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.
Background
Sarcopenia is a prevalent condition in elderly patients and has been associated with adverse outcomes following transcatheter aortic valve replacement (TAVR). The present study aimed to ...determine the predictive value of serum creatinine‐cystatin C ratio, that is, “Sarcopenia Index” (SI) as a surrogate marker of sarcopenia, and investigate its association with clinical outcomes after TAVR.
Methods
We conducted a retrospective observational study of patients undergoing TAVR between January, 2016 and December, 2018 at Hospital Italiano de Buenos Aires, Argentina. Patients were excluded if <65‐years old, presented previous surgical aortic valve replacement, severe chronic kidney disease, or hemodialysis requirement. The SI was obtained at baseline before TAVR. All‐cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint.
Results
In total 100 patients met inclusion criteria for the purpose of the study. Sarcopenia Index was significantly correlated with Timed Up and Go (r = −0.272, p = .010) and Gait Speed (r = −0.278, p = .005). During follow‐up, 5/100 patients died within 30 days and a total of 10/100 patients died at 1‐year follow‐up. Moreover, survival curves were significantly worse (Log‐rank test = p = .02) and CHF readmissions were more prevalent in the lowest SI tertile (Log‐rank test = p = .01). In multivariate Cox regression analysis, we identified low SI (cutoff ≤66) as an independent predictor of long‐term adverse outcomes (HR = 4.01, 95% CI = 1.31–12.27, p = .015) at 1‐year follow‐up.
Conclusion
Sarcopenia Index, surrogate for the degree of skeletal muscle mass (SMM), could be used as a predictor of adverse outcomes in patients undergoing TAVR.
Background
To evaluate the additive prognostic value of myocardial, inflammatory, and renal biomarkers according to frailty status in patients undergoing transcatheter aortic valve replacement (TAVR) ...for aortic stenosis (AS).
Methods
A total of 111 subjects who underwent TAVR at Hospital Italiano de Buenos Aires, Argentina between January 2016 and December 2018 were retrospectively reviewed. Plasma levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), high sensitivity troponin T (hs‐cTnT), C‐reactive protein (CRP), cystatin‐c (Cys‐C) and carbohydrate antigen‐125 (CA‐125) were assessed prior to TAVR. Frailty status was assessed according to the fried physical frailty phenotype (FPFP). The primary endpoint was defined as all‐cause death and/or readmission for worsening congestive heart failure (CHF) within the first year after TAVR.
Results
Of the 111 patients included, 48/111 (43%) were considered to be “frail” according to the FPFP. Among biomarkers, we found CA‐125 to be strongly associated with the primary endpoint (p = .006). CA‐125 ≥ 18.2 U/ml was present in 41% and was associated with a higher rate of the primary endpoint (31% vs. 9%; p = .003). After multivariable adjustment, CA‐125 ≥ 18.2 U/ml (hazard ratio HR 3.17; p = .024) was the only independent predictor of the primary endpoint. Finally, the inclusion of CA‐125 to frailty significantly improved C‐index (0.68–0.74; p < .05), and provided a Net Reclassification Improvement (NRI) of 0.34 (95% CI 0.19–0.49, p = .031), largely through reductions in risk estimates among pre‐frail and frail patients.
Conclusions
CA‐125, a tumor biomarker, outperformed frailty for predicting the primary endpoint within the first year after TAVR.
Management of Acute and Recurrent Pericarditis Chiabrando, Juan Guido; Bonaventura, Aldo; Vecchié, Alessandra ...
Journal of the American College of Cardiology,
01/2020, Letnik:
75, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with ...peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.
Display omitted
•Pericarditis is the most common disease of the pericardium. Generally self-limiting, pericarditis can be fraught by a significant risk of acute complications and of recurrences.•Prompt diagnosis and appropriate treatment of acute pericarditis may reduce the risk of acute complications and recurrences.•New therapies, such as IL-1 blockers, show promising results in patients with recurrent/refractory pericarditis.•Future studies are needed to deepen the knowledge about pericarditis pathophysiology and provide targeted therapies.
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated ...with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
Stress Cardiomyopathy Diagnosis and Treatment Medina de Chazal, Horacio; Del Buono, Marco Giuseppe; Keyser-Marcus, Lori ...
Journal of the American College of Cardiology,
10/2018, Letnik:
72, Številka:
16
Journal Article
Recenzirano
Odprti dostop
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated ...with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
Display omitted
Stress Cardiomyopathy Diagnosis and Treatment de Chazal, Horacio Medina; Del Buono, Marco Giuseppe; Keyser-Marcus, Lori ...
Journal of the American College of Cardiology,
10/2018, Letnik:
72, Številka:
16
Journal Article
Recenzirano
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated ...with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15–30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
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