Exaggerated blood pressure reaction to exercise in subjects with and without systemic hypertension Cesare de Gregorio, Cesare de Gregorio Department of Clinical and Experimental Medicine, University Hospital of Messina, ItalyPost-graduate Residency School in Cardiovascular Diseases, University Hospital of Messina, Italy Corresponding author. Cesare de Gregorio, Dipartimento di Medicina Clinica e Sperimentale, UOC di Cardiologia con UTIC, Azienda Ospedaliera Universitaria di Messina, Via Consolare Valeria, 98125 Messina, Italy. Email: cdegregorio@unime.it Search for other works by this author on: Oxford Academic Google Scholar Francesco Giallauria, Francesco Giallauria Department of Translational Medical Sciences, 'Federico II' University of Naples, Italy Search for other works by this author on: Oxford Academic Google Scholar Giuseppe Lantone, Giuseppe Lantone Healthcare Public Outpatient Service, Taranto, Italy Search for other works by this author on: Oxford Academic Google Scholar Francesca Bellomo, Francesca Bellomo Post-graduate Residency School in Cardiovascular Diseases, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Mariapaola Campisi, Mariapaola Campisi Post-graduate Residency School in Cardiovascular Diseases, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Giorgio Firetto, Giorgio Firetto Post-graduate Residency School in Cardiovascular Diseases, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Paolo Mazzone, Paolo Mazzone Post-graduate Residency School in Cardiovascular Diseases, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Crescenzo Testa, Crescenzo Testa Department of Translational Medical Sciences, 'Federico II' University of Naples, Italy Search for other works by this author on: Oxford Academic Google Scholar Patrizia Grimaldi, Patrizia Grimaldi Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Matteo Casale, Matteo Casale S. Maria Misericordia Hospital, Urbino, Italy Search for other works by this author on: Oxford Academic Google Scholar ... Show more Iacopo Ciccarelli, Iacopo Ciccarelli S. Maria Misericordia Hospital, Urbino, Italy Search for other works by this author on: Oxford Academic Google Scholar Filippo Maria Sarullo, Filippo Maria Sarullo Cardiovascular Rehabilitation Unit, 'Buccheri la Ferla' Fatebenefratelli Hospital, Palermo, Italy Search for other works by this author on: Oxford Academic Google Scholar Angela Alibrandi, Angela Alibrandi Department of Economy, University of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar Alessandro Migliorato Alessandro Migliorato Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, Volume 28, Issue 10, October 2021, Pages 1152–1154, https://doi.org/10.1177/2047487320934912 Published: 03 July 2020
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
Background: The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus has resulted in significant mortality and burdening of healthcare resources. While initially noted as a pulmonary pathology, subsequent studies later identified cardiovascular involvement with high mortalities reported in specific cohorts of patients. While cardiovascular comorbidities were identified early on, the exact manifestation and etiopathology of the infection remained elusive. This systematic review aims to investigate the role of inflammatory pathways, highlighting several culprits including neutrophil extracellular traps (NETs) which have since been extensively investigated. Method: A search was conducted using three databases (MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations and EMBASE). Data from randomized controlled trials (RCT), prospective series, meta-analyses, and unmatched observational studies were considered for the processing of the algorithm and treatment of inflammatory response during SARS-CoV-2 infection. Studies without the SARS-CoV-2 Infection period and case reports were excluded. Results: A total of 47 studies were included in this study. The role of the acute inflammatory response in the propagation of the systemic inflammatory sequelae of the disease plays a major part in determining outcomes. Some of the mechanisms of activation of these pathways have been highlighted in previous studies and are highlighted. Conclusion: NETs play a pivotal role in the pathogenesis of the inflammatory response. Despite moving into the endemic phase of the disease in most countries, COVID-19 remains an entity that has not been fully understood with long-term effects remaining uncertain and requiring ongoing monitoring and research.
We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
Abstract Aims The aim of this multicentre registry was to verify the association between an exaggerated blood pressure response (EBPR) to exercise stress test (EST) and evidence of previous myocardial and/or brain ischaemic events in the general population. Methods and results All subjects who underwent EST for screening of ischaemic heart disease and/or follow-up and re-evaluation of heart disease were included in the registry. Patients who discontinued EST due to early muscle exhaustion, younger individuals (<18 years), patients with potentially dangerous channelopathies or ventricular arrhythmias, as well as those with disabling chronic diseases or experiencing cardiovascular events in the 3 months prior to TE. Everyone performed EST on a treadmill or cycle ergometer using similar protocols in the various centres. Based on some study in the literature, we identified the EBPR to exercise for a systolic BP rise >60 mmHg (men) or > 50 mmHg (women) compared to pre-exercise baseline measurement, but also an absolute value >210 or > 190 mmHg, respectively. Retrospectively, we verified the presence of non-disabling ischaemic cardiac and cerebrovascular events over the past 10 years. Five hundred and three subjects of mean age 61 ± 11 years were included in the registry. EST was performed on a treadmill in 65% of subjects and maximal workload was achieved by 75% of them. Subjects with EBPR were 170 (34%) vs. 333 (66%) who had normal response (controls). EBPR group included most male subjects, often overweight and with a higher prevalence of diabetes (31% vs. 20% in the control group, P < 0.01), and with already diagnosed arterial hypertension in a half of cases. Previous ischaemic myocardial events were found in 35% of EBPR subjects vs. 36% of controls (P = NS), while cerebrovascular disease in 20% vs. 10%, respectively (P < 0.005). Conclusion Albeit retrospectively performed, this multicentre registry highlighted an association between EBPR to exercise (present in more than one-third of the subjects examined, especially males) and history of cerebrovascular ischaemic events within 10 years prior to enrolment. In line with previous studies, present data confirmed a clinical impact of EBPR on exercise. However, the precise pathophysiological mechanism(s) need to be clarified yet, also in terms of therapies against such exaggerated functional response and its possible prognostic impact over time.
The Ross procedure has long been seen as an optimal operation for a select few. The detractors of it highlight the issue of an additional harvesting of the pulmonary artery, subjecting the native PA to systemic pressures and the need for reintervention as reasons to avoid it. However, the PA is a living tissue and capable of adapting and remodeling to growth. We therefore review the current evidence available to discuss the indications, contraindications, harvesting techniques, and modifications in a state-of-the-art narrative review of the PA as an aortic conduit. Due to the lack of substantial well-designed randomized controlled trials (RCTs), we also highlight the areas of need to reiterate the importance of the Ross procedure as part of the surgical armamentarium.
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: “aortic valve stenosis,” “aortic valve operation,” and “transcatheter aortic valve therapy.” Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.
Nontreated severe symptomatic tricuspid valve regurgitation is associated with significant morbidity and mortality. When a surgical correction is not feasible due to high operative risk, transcatheter treatment of the tricuspid valve has been suggested as an interesting valuable option. Caval valve implantation has been proposed to overcome the tricuspid valve regurgitation mechanism reducing the effect of insufficiency on the splanchnic systems. Given the technical simplicity of the caval valve implantation technique when compared with other transcatheter devices, it is a suitable option for a wide variety of patients. Eligibility criteria and patient selection are still matter of debate. We hereby describe the case of a patient successfully treated with bicaval implants with regard to preoperative assessment.
Neutrophil extracellular traps (NETs) recently emerged as a newly recognized contributor to venous and arterial thrombosis. These strands of DNA, extruded by activated or dying neutrophils, decorated with various protein mediators, become solid-state reactors that can localize at the critical interface of blood with the intimal surface of diseased arteries alongside propagating and amplifying the regional injury. NETs thus furnish a previously unsuspected link between inflammation, innate immunity, thrombosis, oxidative stress, and cardiovascular diseases. In response to disease-relevant stimuli, neutrophils undergo a specialized series of reactions that culminate in NET formation. DNA derived from either nuclei or mitochondria can contribute to NET formation. The DNA liberated from neutrophils forms a reticular mesh that resembles morphologically a net, rendering the acronym NETs particularly appropriate. The DNA backbone of NETs not only presents intrinsic neutrophil proteins (e.g., MPO (myeloperoxidase) and various proteinases) but can congregate other proteins found in blood (e.g., tissue factor procoagulant). This systematic review discusses the current hypothesis of neutrophil biology, focusing on the triggers and mechanisms of NET formation. Furthermore, the contribution of NETs to atherosclerosis and thrombosis is extensively addressed. Again, the use of NET markers in clinical trials was considered. Ultimately, given the vast body of the published literature, we aim to integrate the experimental evidence with the growing body of clinical information relating to NET critically.
