Data on the prognostic role of D-dimer in patients with acute coronary syndrome (ACS) are controversial. Our aim was to summarize current evidence on the association between D-dimer levels and ...short/long-term poor prognosis of ACS patients. We also investigated the association between D-dimer and no-reflow phenomenon.
Systematic review and metanalysis of observational studies including ACS patients and reporting data on D-dimer levels. PubMed and SCOPUS databases were searched. Data were combined with hazard ratio (HR) and metanalysed. The principal endpoint was a composite of cardiovascular events (CVEs) including myocardial infarction, all-cause and cardiovascular mortality.
Overall, 32 studies included in the systematic review with 28,869 patients. Of them, 6 studies investigated in-hospital and 26 studies long-term outcomes. Overall, 23 studies showed positive association of high D-dimer levels with CVEs. D-dimer levels predicted poor prognosis in all studies reporting in-hospital outcomes. Five studies satisfied inclusion criteria and were included in the metanalysis, with a total of 8616 patients. Median follow-up was 13.2 months with 626 CVEs. The pooled HR for D-dimer levels and CVEs was 1.264 (95% CI 1.134-1.409). Five out of 7 studies (4195 STEMI patients) investigating the association between D-dimer levels and no-reflow showed a positive correlation of D-dimer levels with no-reflow.
In patients with ACS, D-dimer was associated with higher in-hospital and short/long-term complications. D-dimer was also higher in patients with no-reflow phenomenon. The use of D-dimer may help to identify patients with residual thrombotic risk after ACS.
The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233 .
Statins are extensively used to treat dyslipidemia, but, because of their low tolerability profile, they are discontinued in a significant proportion of patients. Ezetimibe and nutraceuticals have ...been introduced as alternative therapies and have proved to be effective and well tolerated. A single-blind, single-center, randomized, prospective, and parallel group trial comparing a combination of nutraceuticals (red yeast rice, policosanol, berberine, folic acid, coenzyme Q10 and astaxanthin), called Armolipid Plus, and ezetimibe for 3 months in terms of efficacy and tolerability. Patients who did not achieve their therapeutic target (low-density lipoprotein cholesterol <100 mg/dl) could add the alternative treatment on top of randomized treatment for another 12 months: 100 patients who are dyslipidemic with ischemic heart disease treated with percutaneous coronary intervention were enrolled (ezetimibe n = 50, nutraceutical n = 50). Efficacy (lipid profile) and tolerability (adverse events, transaminases, and creatine kinase) were assessed after 3 and 12 months. After 3 months, 14 patients in the nutraceutical group achieved their therapeutic target, whereas none of the patients in the ezetimibe group did. At 1-year follow-up, 58 patients (72.5%) of the combined therapy group (n = 86) and 14 (100%) of the nutraceutical group reached the therapeutic goal. No patients experienced important undesirable effects. In conclusion, nutraceuticals alone or in combination with ezetimibe are well tolerated and improve the lipid profile in statin-intolerant patients with coronary heart disease. Further studies are needed to assess long-term effects of nutraceuticals on mortality.
We pooled available data on follow-up events in patients with patent foramen ovale and cryptogenic stroke to evaluate the net clinical benefit of different therapeutic strategies (percutaneous ...closure vs antiplatelet vs anticoagulant therapy). MEDLINE/PubMed and Cochrane databases and reviewed cited references to identify relevant studies were used; 3,311 patients from 21 clinical studies, both observational and randomized, with follow-up ≥12 months were overall included. Net clinical benefit was evaluated considering the cumulative incidence of both stroke and/or transient ischemic attack and major bleeding events. Anticoagulant therapy was more effective than antiplatelet therapy in preventing recurrent stroke and/or transient ischemic attack (event rates: 7.7% vs 9.8%, respectively, p = 0.03), but at the price of more than sixfold greater risk of major bleeding (7.1% vs 1.3%; odds ratio 6.49, 95% confidence interval 3.25 to 12.99, p <0.00001). Patent foramen ovale closure was associated over the long term with significant net clinical benefit versus both antiplatelet and anticoagulant therapy; such benefit was driven by 50% relative reduction of stroke and/or transient ischemic attack versus antiplatelet therapy and by 82% relative reduction of major bleeding versus anticoagulant therapy. In conclusion, results of this large study-level meta-analysis may influence practice patterns in patients with patent foramen ovale and cryptogenic stroke; an individualized approach tailored on both the risk of recurrent cerebral events and the bleeding risk should be used to identify the best therapeutic option (percutaneous closure vs antiplatelet therapy vs anticoagulant therapy).
Research efforts are still required for modelling the seismic behaviour of infilled frames, especially for existing buildings, generally characterised by shear failures. This work discusses the ...experimental seismic behaviour and the related modelling of four conforming (compliant with modern seismic codes) and non-conforming (gravity-loads-designed) Reinforced Concrete (RC) frames with and without infills (with hollow-clay bricks). The experimental results are analysed, showing that non-conforming frames exhibited shear failures involving the infill panel and the RC columns/joints. A proposed modelling approach able to reproduce these shear failures is carried out, providing support towards more reliable numerical simulations of RC buildings.
In this study, fragility curves for Italian RC building typologies are derived, by taking advantage of post-earthquake damage data gathered after the Irpinia (1980) and L'Aquila (2009) seismic ...events. The severity of the ground shaking is characterized by extrapolating peak ground acceleration values from updated INGV ShakeMaps and a global level of damage, consistently defined with the EMS-98 and accounting for both structural and non-structural damage observed on preselected building components, is associated with each inspected building. RC buildings are allocated to twenty-four building typologies, accounting for construction age, design level and number of storeys. Statistical processing of observational damage data showed the general tendency of seismic vulnerability to increase with the number of storeys and to reduce with design level and construction age. In some cases, the reliability of the obtained results was however affected by the limited amount of damage data and/or by scarcely populated building typologies. Two alternative empirically based approaches, relying on different data processing techniques and fitting strategies, are hence developed, overcoming issues in empirical fragility assessment driven by data paucity and allowing for a robust seismic fragility model.
Given that in patients with cardiac amyloidosis (CA), deposition of amyloid protein is not restricted to the left ventricular (LV) myocardium, it can be hypothesized that the diagnostic value of ...deformation mechanics would be enhanced by considering right ventricular (RV) strain measures. The aim of the present study was to examine the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiograph (3DSTE) to diagnose cardiac amyloidosis and differentiate this disease from other forms of myocardial hypertrophy.
Twenty-three patients with biopsy-proven light-chain (AL) amyloidosis, 23 patients with systemic arterial hypertension (HTN), 23 patients with hypertrophic cardiomyopathy (HCM), 23 athletes and 23 normal controls were prospectively studied by conventional echocardiography and 3DSTE. LV longitudinal strain (LV LS), LV circumferential strain (LV CS), RV global longitudinal strain and RV free-wall longitudinal strain (RV FW LS) were obtained by 3DSTE, as well as LV rotation and rotational velocities.
LV and RV longitudinal strains were reduced in cardiac amyloidosis (CA) patients compared to controls. By multivariate analysis, LV basal LS (p = 0.002), LV peak basal rotation (p = 0.003), and RV basal FW LS (p = 0.014) were independently associated with CA in the overall population. A significant improvement in global χ2 value was noted with RV 3D-strain parameters over only LV-3DSTE + conventional indices for detection of CA (p < 0.001). Comparison of ROC curves showed that the AUC using combined LV basal LS, LV basal rotation and RV basal FW LS had a higher discriminative value than the other echocardiographic parameters used for detecting CA (AUC 0.93, 95%CI 0.81–0.97).
Three-dimensional speckle tracking echocardiography reveals regional and global biventricular dysfunction in CA. Assessment of RV ventricular dysfunction has an additive value in differentiating CA from other causes of myocardial wall thickening.
•We examined the potential utility of three-dimensional speckle-tracking echocardiography in cardiac amyloidosis (CA).•Three-dimensional speckle tracking echocardiography revealed regional and global biventricular dysfunction in CA.•Right ventricular dysfunction assessment had an additive value in differentiating CA from other myocardial hypertrophies.
The simplified mechanical method POST (PushOver on Shear Type models) for seismic vulnerability assessment of RC buildings is used in this study to derive damage scenarios for a database of 7597 RC ...buildings subjected to the 2009 L’Aquila earthquake. POST allows the evaluation of fragility curves through the determination of the non-linear static response of RC buildings in closed form, assuming the hypothesis of shear type behaviour, and considering the influence of infill panels both in the derivation of structural response and in assessment of building damage, which is defined according to the European Macroseismic Scale EMS-98. The aim of the present study is to provide a much more significant and reliable validation of the methodology, thanks to a much wider database compared to previous studies, and based on a different application of the methodology, i.e. at building class-level instead of single building-level. To this aim, the main geometrical-typological characteristics of the analysed buildings (number of storeys, age of construction, building area) have been statistically characterized based on data collected from post-earthquake AeDES survey forms, considering both the variability of each single parameter and the correlation that exists between one parameter and the other. This also allows to analyse the effectiveness of the adopted analytical procedure in predicting the general trends of observed damage with these parameters, showing a good agreement between observed and predicted trends. The overall predicted damage scenarios are compared with the corresponding observed ones, collected from AeDES survey forms, highlighting, again, a good agreement. Finally, the assumed mechanical interpretation of damage classification of EMS-98 is validated through the comparison between the distributions of damage to vertical structures and infill panels and the corresponding observed post-earthquake damage data.
Background Glutathione is a water-soluble tripeptide with a potent oxidant scavenging activity. We hypothesized that glutathione administration immediately before and after primary angioplasty ...(primary percutaneous coronary intervention) could be effective in modulating immune cell activation, thereby preventing infarct expansion. Methods and Results One hundred consecutive patients with ST-segment-elevation myocardial infarction, scheduled to undergo primary percutaneous coronary intervention were randomly assigned before the intervention to receive an infusion of glutathione (2500 mg/25 mL over 10 minutes), followed by drug administration at the same doses at 24, 48, and 72 hours elapsing time or placebo. Total leukocytes, NOX2 (nicotinamide adenine dinucleotide phosphate oxidase 2) activation, NO bioavailability, cTpT (serum cardiac troponin T), hsCRP (high-sensitivity C-reactive protein), and TNF-α (tumor necrosis factor α) levels were measured. Left ventricular size and function were assessed within 120 minutes, 5 days, and 6 months from percutaneous coronary intervention. Following reperfusion, a significant reduction of neutrophil to lymphocyte ratio (
<0.0001), hsCRP generation (
<0.0001), NOX2 activation (
<0.0001), TNF-α levels (
<0.001), and cTpT release (
<0.0001) were found in the glutathione group compared with placebo. In treated patients, blunted inflammatory response was linked to better left ventricular size and function at follow-up (
=0.78,
<0.005). Conclusions Early and prolonged glutathione infusion seems able to protect vital myocardial components and endothelial cell function against harmful pro-oxidant and inflammatory environments, thus preventing maladaptive cardiac repair and left ventricular adverse remodeling. Registration URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2014-004486-25.
PDF
