Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity in Western Countries. Coronary artery disease is the etiology underlying the most prevalent clinical manifestations of CVD. Atherosclerosis is often diagnosed only at late stages, when it manifests in clinically overt forms. Coronary angiography often does not show critical stenoses. We recently showed that the latency of flow mediated dilation (FMD) correlates with the presence of carotid atherosclerosis and the individual cardiovascular risk. Hence, we aimed at evaluating whether the latency of the vasodilator response at the brachial artery could predict the presence of critical coronary stenoses. We evaluated FMD in 74 consecutive patients, before performing coronary angiography for clinical indication at our hospital. Patients were classified in early (ED), late (LD) and no dilators (ND), based on the latency of the vasodilator response. Briefly, ED showed maximal dilation at 60s after ischemic stimulus, and LD over 60s. Very interestingly, lost of early vasodilator response showed a much better diagnostic performance than maximal FMD for the prediction of critical (>70%) coronary stenoses. In fact, classification match of loss of early vasodilator response with coronary angiography was twice as good as with FMD max (72% vs 39%, p=0.002). Using this approach, the number of false negative results was quite low at 4/74 (0.5%), yielding a 89% specificity. Furthermore, ischemia extension - measured by means of the Gensini score - was progressively larger with longer latency (4.5±13.5 in ED, 17.5±27.1 in LD, 39.7±55.0 in ND; p<0.02). In conclusion, using the lost of early vasodilator response as a diagnostic cutpoint allowed to confidently rule out the presence of critical coronary stenoses be means of a simple non-invasive examination. In our cohort, this could have avoided a useless exposition of patients to the potential complications of an invasive coronary angiography in 42% of cases. Once confirmed in larger studies, measurement of latency in vasodilator response could largely improve the selection of patients to refer for coronary angiography, reducing useless patients’ exposition to a potentially harmful diagnostic procedure and healthcare costs.
Background: The differentiated state of SMCs plays a key role in the pathogenesis of several major human diseases, including atherosclerosis and restenosis after vascular injury. Several miRNAs hav...
Cardiovascular diseases represent, to date, the major cause of mortality worldwide. Diagnosis of the most frequent of such disease, acute myocardial infarction (AMI), requires the evaluation of time-series measurement of specific cardiac biomarkers concentration. The aim of this paper is to provide the clinicians with a quantitative tool to analyze such time-series, with the final goal of enhancing the diagnostic and prognostic procedures. The proposed approach is based on a novel dynamical model, which synthetically describes the basic mechanisms underlying cardiac troponin (cTnT) release into the plasma after the onset of AMI. Leveraging tools of system identification and a data set of AMI patients treated at our University Hospital, the model has been assessed as an effective tool to quantify the characteristic release curves observed under different conditions. Furthermore, it has been shown how the devised approach is also suitable in those cases where only partial measurements are available to the clinician to recover important clinical information. Finally, an optimal experimental design analysis has been performed in order to gain insights on how to optimize the experimental data collection phase with potentially relevant implications on both the quality and cost of the diagnosis procedure.
The present work proposes a novel model of the release in the blood of cardiac troponin T (cTnT), a biomarker of acute myocardial infarction. Starting from the underpinning mechanisms at the molecular and cellular level, and leveraging a clinical experimental dataset, we have devised a mathematical model that is able to capture the characteristic features of the release curve of cTnT. The model aims at providing the clinicians with an effective tool to evaluate the type and extent of cardiac damage and specific clinical parameters that can be used to improve the diagnosis and treatment planning phases.
Abstract Background Crohn's disease (CD) is a leading cause of short bowel syndrome (SBS) in adults, which can result in intestinal failure (IF) when intravenous nutritional or electrolyte supplementation is required. SBS is frequently associated with sarcopenia, characterized by loss of muscle mass and function, which adversely impacts quality of life and increases the risk of complications. This study aimed to evaluate differences in body composition and muscle strength among CD patients at varying risk levels for SBS. Methods We conducted a cross-sectional study involving consecutive CD outpatients. The participants were divided into two groups. Group A consisted of CD patients diagnosed with SBS and patients who had undergone two or more bowel resections, or a resection of more than 50 cm. Group B included patients who had never undergone surgery or those who had undergone a resection of less than 50 cm. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured via hand grip testing with a dynamometer, recording the best result of three attempts with the dominant hand. We administered food frequency questionnaire (FFQ) to assess eating habits. Statistical analyses, including t-tests or Mann-Whitney tests, were used as appropriate, with a significance threshold of p < 0.05. Results The study cohort included 150 patients (mean age 53 years [±19,2]; 24% female). Group A showed an average BMI of 23,7±4 kg/m2, whereas group B showed an average BMI of 24.6±5 kg/m2. Muscle strength measured between groups was reduced in group A showing significant differences in hand grip test compared to group B (p-value<0.001). However, no significant differences were observed in BIA parameters, including muscle mass, or in eating habits across the groups. Conclusion Our study revealed that SBS patients and CD patients resected two or more times or with a resection greater than 50 cm had reduced muscle strength without a corresponding reduction in muscle mass, indicating impaired muscle function. Further research is needed to better understand the relationship between Crohn's disease-related resections and their impact on both muscle quality and quantity. Funded by:2.1 "Rafforzamento e potenziamento della ricerca biomedica del SSN",finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project "Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets"code:PNRR-MAD-2022-12376791
