Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic fat accumulation after ruling out other causes of hepatic steatosis. The aim of the study is to identify the role of statin therapy in dyslipidemic patients with very high cardiovascular risk and NAFLD in achieving low density lipoprotein (LDL) cholesterol targets while also evaluating the changes in liver enzymes levels. This prospective study included 140 patients with NAFLD, hyperlipidemia and elevated cardiovascular risk. Serum lipids were assessed and liver function tests were performed at baseline and at 6 months follow up in 10 mg/ 20 mg daily atorvastatin treatment schedule. The results showed that total cholesterol, LDL cholesterol and triglycerides were significantly reduced at 6 months follow-up, while high density lipoprotein (HDL) cholesterol has not undergone important changes. Statin treatment significantly improved alanine aminotransferase serum levels, whereas aspartate aminotransferase levels were not significantly reduced between baseline and follow-up. Although statin therapy appears to be safe and effective for use in patients with NAFLD, an insufficient treatment is commonly observed in clinical practice, in order to avoid liver damage . NAFLD is not only a major cause of liver related morbidity and mortality, but also an independent cardiovascular risk factor, with cardiovascular mortality being the most important cause of death. Therefore, detecting and modifying risk factors without impairing liver function is desirable.
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.
Resistant hypertension still represents a major health problem, incompletely resolved by the current therapeutic interventions. Based on the interference of sympathetic over activity in resistant hypertension, novel invasive strategies such as sympathetic renal denervation and carotid baroreceptor stimulation have recently emerged. Despite the promising results and their good tolerability profile, the optimal role of these non-pharmacologic therapies relative to conventional medical regimens, remains unknown. Further investigation is also necessary to establish their real long-term efficacy and safety in clinical practice.
Obesity is a major cause of adipose tissue (AT) inflammation. Ghrelin (GHRL), through its growth hormone secretagogue receptor (GHS-R) present on adipose tissue macrophages (ATMs), could modulate AT inflammation.
Cardiac amyloidosis may occur in any type of systemic amyloidosis. The clinical picture is often characterized by restrictive cardiomyopathy. We report the case of a 41-year-old female patient admitted to the Department of Cardiology with clinical signs of right heart failure: congested jugular veins, hepatomegaly, peripheral edema, ascites associated with atrial fibrillation, low values of arterial blood pressure and oliguria. Echocardiographic findings were helpful for the diagnosis of cardiac amyloidosis: enlarged atrial cavities, normal size ventricles, thickened ventricular septum and posterior left ventricle wall with normal left ventricular ejection fraction, mitral and tricuspid regurgitation. Two-dimensional echocardiography revealed additional features: thickened papillary muscles and a specific "granular sparkling" appearance of the thickened cardiac walls - probably due to the amyloid deposit. Gingival biopsy showing amorphous eosinophilic material located in the vessel walls and the specific dichroism and "apple-green" birefringence under polarized light on Congo red stained slides completed the diagnosis of systemic amyloidosis. We recommend cardiologists to take into account a possible cardiac amyloidosis in a patient with unexplained refractory heart failure and a typical pattern of restrictive cardiomyopathy revealed by echocardiographic examination. We also emphasize the fact that the complete diagnosis cannot be set without a biopsy that should reveal the presence of amyloid. Although endomyocardial biopsy, completed with histochemical and immunohistochemical stains, is a valuable diagnostic method, in cases with advanced cardiac failure, the best site for this biopsy may be the gingiva.
Heart-type Fatty Acid-Binding Protein (H-FABP), compared with classical biomarkers, proved to have high sensitivity for myocardial damage size in patients undergoing cardiac surgery. High H-FABP levels are strongly associated in case of death, post-operatively acute kidney injury and atrial fibrillation. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 110 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the H-FABP, the mean value in the Phase I was 67.40 � 9.81 ng/mL, while the mean value in Phase III was 4.80 � 2.30 ng/mL. The difference registered between the plasma H-FABP value in the first 24 h after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. The reduction of plasma H-FABP values were registered between the first phase (the first 24 h) after cardiac surgery and the third phase of the cardiac rehabilitation program. H-FABP protein had a higher sensitivity and specificity when compared to other enzymes of myocardial cytolysis.
Coronary artery disease (CAD) is one of the major predictors of future cardiovascular events (CVEs). In addition, biomarkers such as high-sensitivity C-Reactive Protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) correlate well with a future CVE. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 120 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the Framingham cardiovascular risk score, the mean value in the Phase I was 16.5, while the mean value in Phase III was 10.6. The difference registered after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. By comparing the Phase I and Phase III results, we observed that the median 10-year Framingham cardiovascular risk score was approximately 6% lower (p [0.05), reflecting the survival benefit gained by patients under the intensive cardiovascular recovery program.
Although initially considered a strictly respiratory pathology, the novel coronavirus disease-19 (COVID-19) has emerged as a significant prothrombotic trigger, inducing hypercoagulable status and increased risk of thrombotic events.This is due to a plethora of mechanisms, either from inflammation-induced endothelial dysfunction, overexpression of procoagulant molecules doubled by down-regulation of physiological antithrombotic pathways, or from an exagerated response to otherwise normal procoagulant stimuli.This complex association of factors define the concept of immunothrombosis, which can be influenced by several antithrombotic medications.Despite the lack of an "universal" guideline, the general consensus is to recommend antithrombotic treatment in COVID-19 patients, but its administration should take into account the patient's clinical status, comorbidities or the other previous indications for antithrombotic treatment.This precaution is due to the multiple drug interactions with antivirals or other molecules used in COVID-19.Concerning anticoagulant treatment, heparins are the optimal choice, compared to antivitamins K and direct oral anticoagulants (DOACs), because they exhibit the most protective effects doubled by the least interactions with other substances.Hospitalized patients should receive prophylactic doses of anticoagulation, but not for the prevention of arterial thrombosis, unless they have a previous indication such as atrial fibrillation or prosthetic valve.It is generally recommended that patients on chronic anticoagulant or antiplatelet therapy for other conditions will continue their prescribed medication, here including special categories such as pregnant women.However, non-hospitalized patients with mild forms of the disease should not be initiated anticoagulant and antiplatelet therapy unless they have other indication.Continuation of prophylaxis after discharge is a matter of debate, the existing data suggesting it may be considered in those patients at high risk for venous thromboembolism (VTE) and/or who had a moderate-severe form of the disease, always assessing the bleeding risk.Further data from extensive studies are required in order to standardize the antithrombotic approach in COVID-19 patients.
Treatment of patients with immune thrombocytopenic purpura (ITP) associated with recurrent venous and arterial thrombosis can represent a major challenge. We present the rare case of a 56-year-old female who was first diagnosed with severe ITP at the age of 36. She required corticosteroid therapy and splenectomy in evolution. However, in the last three years she had several episodes of recurrent venous thromboembolism for which she required different anticoagulant therapies despite severe thrombocythemia. The patient also developed acute myocardial infarction treated by primary percutaneous coronary intervention that was complicated with acute intrastent thrombosis. Thus, maximal antiplatelet therapy was mandatory. For ITP, the patient received intravenous steroids, platelet transfusion as well as eltrombopag. Moreover, the patient also suffered from a haemorrhagic uterine fibroma that required surgery. Thus, a close multidisciplinary approach was needed for the successful treatment of this patient.
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