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Pubblicazioni recenti - cardiorenal
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Positioning sulfonylureas in a modern treatment algorithm for patients with type 2 diabetes: expert opinion from a European Consensus Panel.
Diabetes Obes Metab2020 Jun;():. doi: 10.1111/dom.14102.
Consoli Agostino, Czupryniak Leszek, Duarte Rui, Jermendy György, Kautzky-Willer Alexandra, Mathieu Chantal, Melo Miguel, Mosenzon Ofri, Nobels Frank, Papanas Nikolaos, Roman Gabriela, Schnell Oliver, Sotiropoulos Alexis, Stehouwer Coen D A, Tack Cees J, Woo Vincent, Fadini Gian Paolo, Raz Itamar,
Abstract
The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Since newer agents offer several advantages, whether and when sulfonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The present consensus paper aims to provide additional guidance on the use of sulfonylureas in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second line treatment after metformin and often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that SGLT2-i and GLP-1RAs are associated with low hypoglycemia risk, promote weight loss, and exert a positive impact on vascular, cardiac, and renal endpoints. Thus, using SUs in place of SGLT2-i and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT2-i and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second line agents continues to be acceptable in resource-constrained settings. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Do reductions in risk of cardiorenal events with SGLT2 inhibitors in type 2 diabetes vary with baseline characteristics? A meta-analysis.
Endocrine2020 May;():. doi: 10.1007/s12020-020-02359-5.
Qiu Mei, Liu Shu-Yan, Gu Jin-Song, Li Kai-Kai, Li Ling-Lin, Ding Liang-Liang,
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nAnnexin A1 is a Potential Novel Biomarker of Congestion in Acute Heart Failure.
J Card Fail2020 May;():. doi: S1071-9164(20)30062-2.
Adel Fadi W, Rikhi Aruna, Wan Siu-Hin, Iyer Seethalakshmi R, Chakraborty Hrishikesh, McNulty Steven, Tang W H Wilson, Felker G Michael, Givertz Michael M, Chen Horng H,
Abstract
OBJECTIVES:
The study sought to identify the role of Annexin A1 as a congestion marker in acute heart failure, and to identify its putative role in predicting clinical outcomes.
BACKGROUND:
Annexin A1 (AnxA1) is a protein that inhibits inflammation following ischemia-reperfusion (I-R) injury in cardiorenal tissues. Since acute heart failure (AHF) is a state of tissue hypoperfusion, we hypothesized that plasma AnxA1 levels are altered in AHF.
METHODS:
In The Renal Optimization Strategies Evaluation (ROSE) trial, patients hospitalized for AHF with kidney injury were randomized to receive dopamine, nesiritide, or placebo for 72 hours in addition to diuresis. In a sub-analysis, plasma AnxA1 levels were measured at baseline and at 72 hours in 275 patients. Participants were divided into three tertiles based on their baseline AnxA1 levels.
RESULTS:
The prevalence of peripheral edema 2+ increased with increasing AnxA1 levels (p < 0.007). Cystatin C, blood urea nitrogen, and kidney injury molecule-1 plasma levels were higher among participants in tertile 3 vs tertiles 1 or 2 (p < 0.05). Patients with a congestion score of 4 had a mean baseline AnxA1 level 8.63 units higher than those with a congestion score of 0 (p= 0.03). Patients in tertiles 2 and 3 were twice as likely to experience creatinine elevation as patients in tertile 1 (p= 0.03). Patients in tertiles 2 and 3 were at a higher risk of 60-day all-cause mortality or heart failure hospitalization and 180-day all-cause mortality (p <0.05).
CONCLUSIONS:
Among patients hospitalized for AHF with impaired kidney function, elevated AnxA1 levels are associated with worse congestion, higher risk for further creatinine elevation, and higher rates of 60-day morbidity or all-cause mortality & 180-day all-cause mortality.
CLINICAL TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT01132846.
Copyright © 2020. Published by Elsevier Inc.
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Klotho downregulation contributes to myocardial damage of cardiorenal syndrome in sepsis.
Mol Med Rep2020 May;():. doi: 10.3892/mmr.2020.11178.
Yan Fei, Feng Yue, Chen Jin, Yan Jing,
Abstract
Klotho is a type of single?pass transmembrane protein that is important for the proper function of numerous organs. The aim of the present study was to investigate the role of Klotho in sepsis?associated myocardial damage. In the present study, reverse transcription?quantitative PCR, western blotting and ELISA were conducted to examine the expression levels of function genes, and flow cytometry was performed to detect cell apoptosis and reactive oxygen species. The present study demonstrated that Klotho expression was significantly downregulated in septic mice and that the myocardial function of septic mice improved after treatment with exogenous Klotho protein. It further demonstrated that indoxyl sulfate inhibited the expression of Klotho protein. In addition, decreased Klotho protein further led to activation of the reactive oxygen species?p38 mitogen?activated protein kinase signaling pathway, finally resulting in myocardial damage. In conclusion, Klotho protein may be a key regulator in the myocardial damage of cardiorenal syndrome in sepsis. It also has a potential to be a therapeutic target for sepsis?associated myocardial damage in the future.
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Curcumin: an inflammasome silencer.
Pharmacol Res2020 May;():104921. doi: S1043-6618(20)31229-9.
Hassanzadeh Shima, Read Morgayn I, Bland Abigail R, Majeed Muhammed, Jamialahmadi Tannaz, Sahebkar Amirhossein,
Abstract
Curcumin is the major bioactive polyphenolic ingredient of turmeric. Increasing evidence indicates that the health benefits of curcumin are mediated through its anti-inflammatory and antioxidant effects. Inflammasomes are essential components of inflammatory pathways that activate caspase-1 leading to pyroptosis and stimulate maturation and secretion of the proinflammatory cytokines, interleukin-1? (IL-1?) and interleukin-18 (IL-18) through nuclear factor kappa-B (NF-?B) signaling. The current review outlines the mechanisms of curcumin as an inflammasome modulator in inflammatory-related diseases. Regulation of NF-?B signaling and interleukins secretion is the most prominent functional mechanism of curcumin in modulating inflammasomes. More importantly, curcumin can exert its anti-inflammatory role mainly through the down-regulation of NLRP3 inflammasomes. Given the fundamental role of inflammation in diseases, such as arthritis, cancer and cardiorenal disease, curcumin may have a pivotal therapeutic role through its ability to produce beneficial anti-inflammatory effects.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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In-Hospital Mortality in Acute Myocardial Infarction According to Population Density and Primary Angioplasty Procedures Volume.
Circ J2020 May;():. doi: 10.1253/circj.CJ-19-0869.
Matsuzawa Yasushi, Konishi Masaaki, Nakai Michikazu, Saigusa Yusuke, Taguri Masataka, Gohbara Masaomi, Ebina Toshiaki, Kosuge Masami, Hibi Kiyoshi, Nishimura Kunihiro, Miyamoto Yoshihiro, Yasuda Satoshi, Ogawa Hisao, Saito Yoshihiko, Nakayama Naoki, Takeuchi Ichiro, Tamura Kouichi, Kimura Kazuo,
Abstract
BACKGROUND:
Low population density may be associated with high mortality in acute myocardial infarction (AMI) patients. The purpose of this study was to investigate the effect of population density and hospital primary percutaneous coronary intervention (PCI) volume on AMI in-hospital mortality in Japan.Methods?and?Results:This is a retrospective study of 64,414 AMI patients transported to hospital by ambulances. The main outcome measure was in-hospital mortality. The median population density was 1,147 (interquartile range, 342-5,210) persons/km. There was a significant negative relationship between population density and in-hospital mortality (OR for a quartile down in population density 1.086, 95% CI 1.042-1.132, P<0.001). Patients in less densely populated areas were more often transported to hospitals with a lower primary PCI volume, and they had a longer distance to travel. By using multivariable analysis, primary PCI volume was found to be significantly associated with in-hospital mortality, but distance to hospital was not. When divided into the low- and high-volume hospitals, using the cut-off value of 115 annual primary PCI procedures, the increase in in-hospital mortality associated with low population density was observed only in patients hospitalized in the low-volume hospitals.
CONCLUSIONS:
Increased in-hospital mortality related to low population density was observed only in AMI patients who were transported to the low primary PCI volume hospitals, but not in those who were transported to high-volume hospitals.
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Need for Objective Assessment of Volume Status in Critically Ill Patients with COVID-19: The Tri-POCUS Approach.
Cardiorenal Med2020 May;():1-8. doi: 10.1159/000508544.
Koratala Abhilash, Ronco Claudio, Kazory Amir,
Abstract
As the coronavirus disease 2019 (COVID-19) continues to spread across the globe, the knowledge of its epidemiology, clinical features, and management is rapidly evolving. Nevertheless, the data on optimal fluid management strategies for those who develop critical illness remain sparse. Adding to the challenge, the fluid volume status of these patients has been found to be dynamic. Some present with several days of malaise, gastrointestinal symptoms, and consequent hypovolemia requiring aggressive fluid resuscitation, while a subset develop acute respiratory distress syndrome with renal dysfunction and lingering congestion necessitating restrictive fluid management. Accurate objective assessment of volume status allows physicians to tailor the fluid management goals throughout this wide spectrum of critical illness. Conventional point-of-care ultrasonography (POCUS) enables the reliable assessment of fluid status and reducing the staff exposure. However, due to specific characteristics of COVID-19 (e.g., rapidly expanding lung lesions), a single imaging method such as lung POCUS will have significant limitations. Herein, we suggest a Tri-POCUS approach that represents concurrent bedside assessment of the lungs, heart, and the venous system. This combinational approach is likely to overcome the limitations of the individual methods and provide a more precise evaluation of the volume status in critically ill patients with COVID-19.
© 2020 S. Karger AG, Basel.
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NT-proBNP Concentration and Early Cardiac Dysfunction in Patients Receiving Dialysis: A Prospective Cohort Study.
Cardiorenal Med2020 May;():1-10. doi: 10.1159/000507388.
Yang Wen-Ling, Hawley Carmel, Cho Yeoungjee, Johnson David W, Pascoe Elaine M, Fahim Magid, ,
Abstract
INTRODUCTION:
The significance of N-terminal pro-B type natriuretic peptide (NT-proBNP) to detect heart failure in patients with end-stage kidney diseases on dialysis is controversial.
OBJECTIVE:
To assess whether serial measurements of NT-proBNP can predict worsening cardiac function in dialysis patients.
METHODS:
In this prospective, longitudinal, observational cohort study, the relationship between changes in monthly plasma NT-proBNP concentrations and changes in echocardiographic indices (left ventricular global longitudinal strain [GLS] and ejection fraction [LVEF]) were analyzed in dialysis patients without symptoms of heart failure over 24 months using multilevel mixed effects models.
RESULTS:
The study included 40 dialysis patients who were followed for a median period of 24 months. Logarithmically transformed baseline plasma NT-proBNP levels were correlated positively with GLS (r = 0.48, p = 0.002) and negatively with LVEF (r = -0.44, p = 0.005). Time-averaged and maximum NT-proBNP values during the echocardiogram intervals were significantly correlated with GLS and LVEF over time. Every 1-unit increase in average NT-proBNP level during the echocardiogram interval was associated with a 0.99 (95% confidence interval, 0.41-1.56) higher GLS (%) and 2.90 (1.22-4.57) lower LVEF (%). Every 1-unit increase in maximum NT-proBNP level was associated with a 0.90 (0.35-1.45) higher GLS (%) and 2.67 (1.03-4.30) lower LVEF (%). This increase in GLS indicates a reduction in systolic performance.
CONCLUSIONS:
Our cohort study demonstrated that serial plasma NT-proBNP concentrations may be useful for early identification of individuals with worsening cardiac function over time.
© 2020 S. Karger AG, Basel.
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Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome.
Nutr Metab Cardiovasc Dis2020 Mar;():. doi: S0939-4753(20)30099-5.
Okada Kozo, Hibi Kiyoshi, Honda Yasuhiro, Fitzgerald Peter J, Tamura Kouichi, Kimura Kazuo,
Abstract
BACKGROUND AND AIMS:
This study aimed to assess possible association of detailed abdominal fat profiles with coronary plaque characteristics in patients with acute coronary syndrome (ACS).
METHODS AND RESULTS:
In 60 patients with ACS, culprit arteries were evaluated at 1-mm intervals (length analyzed: 66 ± 28 mm) by grayscale and integrated backscatter intravascular ultrasound (IB-IVUS) before percutaneous coronary intervention. Standard IVUS indexes (as a volume index: volume/length), plaque components (as percent tissue volume) and fibrous cap thickness (FCT) were assessed by IB-IVUS. Plain abdominal computed tomography was performed to evaluate subcutaneous adipose tissue (SAT) area, visceral adipose tissue (VAT) area, and VAT/SAT ratio. While SAT area only correlated with vessel volume (r = 0.27, p = 0.04), VAT area correlated positively with vessel (r = 0.30, p = 0.02) and plaque (r = 0.33, p = 0.01) volumes and negatively with FCT (r = -0.26, p = 0.049), but not with percent plaque volume and plaque tissue components. In contrast, higher VAT/SAT ratio significantly correlated with higher percent lipid (r = 0.34, p = 0.008) and lower percent fibrous (r = -0.34, p = 0.007) volumes with a trend toward larger percent plaque volume (r = 0.19, p = 0.15), as well as thinner FCT (r = -0.53, p < 0.0001). In the multiple regression analysis, higher VAT/SAT ratio was independently associated with higher percent lipid with lower percent fibrous volumes (p = 0.03 for both) and thinner fibrous cap thickness (p = 0.0001).
CONCLUSION:
Coronary plaque vulnerability, defined as increased lipid content with thinner fibrous cap thickness, appears to be more related to abnormal abdominal fat distribution, or so-called hidden obesity, compared with visceral or subcutaneous fat amount alone in patients with ACS.
Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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[Renin-angiotensin system blockers and COVID-19 infection].
Hipertens Riesgo Vasc2020 Apr;():. doi: S1889-1837(20)30034-9.
Ruilope L M, Garcia Donaire J A, de la Sierra A,
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Treatment Options for Poor Responders to Bariatric Surgery.
Curr Obes Rep2020 May;():. doi: 10.1007/s13679-020-00381-2.
Lee Phong Ching, Dixon John B, Sim Pei Yin, Lim Chin Hong,
Abstract
PURPOSE OF REVIEW:
This review aims to evaluate the latest evidence on the treatment options for perceived poor responders to bariatric surgery and provide practitioners with a guide on when to consider revisional surgery and when to consider alternatives.
RECENT FINDINGS:
The use of adjuvant pharmacotherapy has been increasingly described in the literature as an adjunct to primary bariatric surgery, in order to attain more weight loss or better control of obesity-related complications. The newer anti-obesity and anti-diabetes drugs also have cardiorenal benefits, which are shown in recent cardiovascular outcome trials. Revisional bariatric surgery has emerged as a distinctive entity and can be broadly organized into three categories: corrective, conversion, and reversal surgeries. Careful patient selection and preoperative optimization are needed to ensure long-term favorable outcomes. Newer treatment modalities involving the use of anti-obesity medications and endoscopic bariatric interventions provide patients and healthcare providers with more options, when faced with the challenge of poor response after bariatric surgery.
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Effects of Linagliptin on Cardiovascular and Kidney Outcomes in People With Normal and Reduced Kidney Function: Secondary Analysis of the CARMELINA Randomized Trial.
Diabetes Care2020 May;():. doi: dc200279.
Perkovic Vlado, Toto Robert, Cooper Mark E, Mann Johannes F E, Rosenstock Julio, McGuire Darren K, Kahn Steven E, Marx Nikolaus, Alexander John H, Zinman Bernard, Pfarr Egon, Schnaidt Sven, Meinicke Thomas, von Eynatten Maximillian, George Jyothis T, Johansen Odd Erik, Wanner Christoph, ,
Abstract
OBJECTIVE:
Type 2 diabetes is a leading cause of kidney failure, but few outcome trials proactively enrolled individuals with chronic kidney disease (CKD). We performed secondary analyses of cardiovascular (CV) and kidney outcomes across baseline estimated glomerular filtration rate (eGFR) categories (?60, 45 to <60, 30 to <45, and <30 mL/min/1.73 m) in Cardiovascular and Renal Microvascular Outcome Study With Linagliptin (CARMELINA), a cardiorenal placebo-controlled outcome trial of the dipeptidyl peptidase 4 inhibitor linagliptin (NCT01897532).
RESEARCH DESIGN AND METHODS:
Participants with CV disease and/or CKD were included. The primary outcome was time to first occurrence of CV death, nonfatal myocardial infarction, or nonfatal stroke (three-point major adverse CV event [3P-MACE]), with a secondary outcome of renal death, end-stage kidney disease, or sustained ?40% decrease in eGFR from baseline. Other end points included progression of albuminuria, change in HbA, and adverse events (AEs) including hypoglycemia.
RESULTS:
A total of 6,979 subjects (mean age 65.9 years; eGFR 54.6 mL/min/1.73 m; 80.1% albuminuria) were followed for 2.2 years. Across eGFR categories, linagliptin as compared with placebo did not affect the risk for 3P-MACE (hazard ratio 1.02 [95% CI 0.89, 1.17]) or the secondary kidney outcome (1.04 [0.89, 1.22]) (interaction values >0.05). Regardless of eGFR, albuminuria progression was reduced with linagliptin, as was HbA, without increasing risk for hypoglycemia. AEs were balanced among groups overall and across eGFR categories.
CONCLUSIONS:
Across all GFR categories, in participants with type 2 diabetes and CKD and/or CV disease, there was no difference in risk for linagliptin versus placebo on CV and kidney events. Significant reductions in risk for albuminuria progression and HbA and no difference in AEs were observed.
© 2020 by the American Diabetes Association.
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A new potential mode of cardiorenal protection of KLOTHO gene variability in type 1 diabetic adolescents.
J Mol Med (Berl)2020 May;():. doi: 10.1007/s00109-020-01918-7.
S?omi?ski Bartosz, Ryba-Stanis?awowska Monika, Skrzypkowska Maria, Gabig-Cimi?ska Magdalena, My?liwiec Ma?gorzata,
Abstract
As the KL-VS haplotype alters secretion and activity of KLOTHO and uric acid (UA) is associated with endothelial dysfunction and inflammation, their mutual links may contribute to microalbuminuria (MA) in patients with type 1 diabetes (T1D). Therefore, we hypothesize that KL-VS polymorphism could be associated with the prevalence of MA in T1D patients, and KL-VS polymorphism could modify physiological functions and pathogenic potential of UA. We have examined 350 patients with T1D. The analysis concerned KL-VS polymorphism along with the concentrations of serum inflammatory markers, indicators of renal function, blood pressure, and lipid profile. The incidence of KL-VS genotype was lower in a group with MA in comparison to patients without this condition. Moreover, KL-VS carriers had improved indicators of renal function, lower concentrations of pro-inflammatory cytokines, and higher levels of anti-inflammatory markers. Simultaneously, among KL-VS carriers serum UA was negatively correlated with HbA1c, albumin excretion rate, ACR, CRP, TNF-?, total cholesterol, LDL-C and triglycerides, and positively correlated with HDL-C. Moreover, among wild-type KLOTHO carriers serum, UA was in positive correlation with creatinine, blood pressure, IL-12 and MCP-1, and in negative correlation with IL-10 and eGFR. Findings of our study suggest that the functional KL-VS polymorphism is independently associated with MA and the KL-VS genotype protects from the development of MA, and KL-VS polymorphism may modify physiological functions and pathogenic potential of UA by altering the levels of HbA1c, inflammatory biomarkers, indicators of renal function, blood pressure, and lipid profile. KEY MESSAGES: ? We analyzed the KL-VS polymorphism and the UA serum level in patients with T1D. ? The KL-VS polymorphism is independently associated with microalbuminuria. ? The KL-VS alleles protect from the development of microalbuminuria. ? KL-VS polymorphism may modify physiological functions and pathogenic potential of uric acid.
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Fifty Shades of Central Venous Pressure in the Cardiorenal Syndrome.
J Transl Int Med2020 Mar;8(1):1-2. doi: 10.2478/jtim-2020-0001.
Redant Sebastien, Honoré Patrick M, Bels David De,
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Management of acute kidney injury in COVID-19.
Cleve Clin J Med2020 May;():. doi: 10.3949/ccjm.87a.ccc034.
Hassanein Mohamed, Thomas George, Taliercio Jonathan,
Abstract
Acute kidney injury has been reported in as many as 29% of COVID-19 patients. Reported risk factors include elevated baseline serum creatinine, elevated blood urea nitrogen, acute kidney injury, proteinuria, and hematuria. Suspected causes include sepsis and acute tubular necrosis resulting from renal hypoperfusion, cytokine release syndrome, direct viral invasion, renal medullary hypoxia secondary to alveolar damage, rhabdomyolysis, and cardiorenal syndrome due to viral myocarditis.
Copyright © 2020 The Cleveland Clinic Foundation. All Rights Reserved.
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A Prospective, Randomized, Open-Label Trial of Atorvastatin versus Rosuvastatin in the Prevention of Contrast-Induced Acute Kidney Injury, Worsened Renal Function at 30 Days, and Clinical Events After Acute Coronary Angiography: the PRATO-ACS-2 Study.
Cardiorenal Med2020 May;():1-14. doi: 10.1159/000506857.
Toso Anna, Leoncini Mario, Maioli Mauro, Tropeano Francesco, Villani Simona, Bellandi Francesco,
Abstract
BACKGROUND/AIMS:
Both high-dose atorvastatin and rosuvastatin have been shown to reduce contrast-induced acute kidney injury (AKI) occurrence and improve clinical outcomes in high-risk coronary patients undergoing angiographic procedures. However, there is a lack of head-to-head comparative studies on the effects of atorvastatin or rosuvastatin administered upon hospital admission in statin-naive patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).
METHODS:
In this open-label, noninferiority study, we compared changes in renal function in 709 NSTE-ACS patients randomized to atorvastatin (80 mg upon admission followed by 40 mg/day) or rosuvastatin (40 mg upon admission followed by 20 mg/day). The primary end point was AKI (increase in serum creatinine ?0.5 mg/dL or ?25% above baseline within 72 h). Worsening renal function (WRF) (decrease of ?25% in the glomerular filtration rate from baseline to 30 days), 30-day major adverse cardiovascular events, and 12-month myocardial infarction (MI) or death were also evaluated.
RESULTS:
The AKI incidence was similar in the 2 groups (i.e., 8.2% with rosuvastatin and 7.6% with atorvastatin; absolute risk difference = 0.54; 90% CI -3.9 to 2.8), satisfying the noninferiority criteria. WRF occurred in 53 (7.5%) patients, 19 (34%) of whom had developed AKI. The rates of WRF and adverse events at 30 days and at 12 months did not differ significantly between the 2 groups. Both AKI and WRF were found to be closely associated with the 12-month cardiovascular outcome irrespectively of statin choice.
CONCLUSIONS:
High-dose rosuvastatin or atorvastatin started upon hospital admission led to similar rates of AKI, 30-day renal function changes, and 12-month death or MI in NSTE-ACS patients who underwent an early invasive strategy (clinical trial registration: https://www.clinicaltrials.gov; unique identifier: NCT01870804).
© 2020 S. Karger AG, Basel.
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Neutrophil gelatinase-associated lipocalin does not predict acute kidney injury in heart failure.
World J Clin Cases2020 May;8(9):1600-1607. doi: 10.12998/wjcc.v8.i9.1600.
Ferrari Fiorenza, Scalzotto Elisa, Esposito Pasquale, Samoni Sara, Mistrorigo Flavio, Rizo Topete Lilia Maria, De Cal Massimo, Virzì Grazia Maria, Corradi Valentina, Torregrossa Rossella, Valle Roberto, Bianzina Stefania, Aspromonte Nadia, Floris Matteo, Fontanelli Alessandro, Brendolan Alessandra, Ronco Claudio,
Abstract
BACKGROUND:
Acute cardiorenal syndrome type 1 (CRS-1) is defined by a rapid cardiac dysfunction leading to acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) is expressed on the surface of human neutrophils and epithelial cells, such as renal tubule cells, and its serum (sNGAL) and urinary have been used to predict AKI in different clinical settings.
AIM:
To characterize CRS-1 in a cohort of patients with acute heart diseases, evaluating the potentiality of sNGAL as an early marker of CRS-1.
METHODS:
We performed a retrospective cohort, multi-centre study. From January 2010 to December 2011, we recruited 202 adult patients admitted to the coronary intensive care unit (CICU) with a diagnosis of acute heart failure or acute coronary syndrome. We monitored the renal function to evaluate CRS-1 development and measured sNGAL levels within 24 h and after 72 h of CICU admission.
RESULTS:
Overall, enrolled patients were hemodynamically stable with a mean arterial pressure of 92 (82-107) mmHg, 55/202 (27.2%) of the patients developed CRS-1, but none of them required dialysis. Neither the NGAL delta value (AUC 0.40, 95%CI: 0.25-0.55) nor the NGAL peak (AUC 0.45, 95%CI: 0.36-0.54) or NGAL cut-off (? 140 ng/mL) values were statistically significant between the two groups (CRS-1 no-CRS1 patients). The area under the ROC curve for the prediction of CRS-1 was 0.40 (95%CI: 0.25-0.55) for the delta NGAL value and 0.45 (95%CI: 0.36-0.54) for the NGAL peak value. Finally, in multivariate analysis, the risk of developing CRS-1 was correlated with age > 60 years, urea nitrogen at admission and 24 h-urine output (AUC 0.83, SE = 60.5% SP = 93%), while sNGAL was not significantly correlated.
CONCLUSION:
In our population, sNGAL does not predict CRS-1, probably as a consequence of the mild renal injury and the low severity of heart disease. So, these data might suggest that patient selection should be taken into account when considering the utility of NGAL measurement as a biomarker of kidney damage.
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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Hypertrophic cardiomyopathy incidentally detected by 99mTc-HAS-D scintigraphy.
J Nucl Cardiol2020 May;():. doi: 10.1007/s12350-020-02189-y.
Norikane Takashi, Yamamoto Yuka, Kengo Fujimoto, Takami Yasukage, Mitamura Katsuya, Noma Takahisa, Nishiyama Yoshihiro,
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Cardiac overload resolved by resection of a large plexiform neurofibroma on both the buttocks and upper posterior thighs in a patient with neurofibromatosis type I: a case report.
BMC Surg2020 May;20(1):106. doi: 10.1186/s12893-020-00761-4.
Mikami Taro, Honma-Koretsune Yuki, Tsunoda Yui, Kagimoto Shintaro, Yabuki Yuichiro, Maegawa Jiro, Terauchi Takashi, Nawata Shintaro, Kamide Hiroyuki, Ishiwata Yoshinobu, Kino Tabito, Sugano Teruyasu,
Abstract
BACKGROUND:
A large plexiform neurofibroma in patients with neurofibromatosis type I can be life threatening due to possible massive bleeding within the lesion. Although the literature includes many reports that describe the plexiform neurofibroma size and weight or strategies for their surgical treatment, few have discussed their possible physical or mental benefits, such as reducing cardiac stress. In addition, resection of these large tumors can result in impaired wound healing, partly due to massive blood loss during surgery.
CASE PRESENTATION:
A 24-year-old man was diagnosed with neurofibromatosis type I and burdened with a large plexiform neurofibroma on the buttocks and upper posterior thighs. The patient was 159 cm in height and 70.0 kg in weight at the first visit. Cardiac overload was indicated by an echocardiography before surgery. His cardiac output was 5.2 L/min with mild tricuspid regurgitation. After embolism of the arteries feeding the tumor, the patient underwent surgery to remove the neurofibroma, followed by skin grafting. Follow-up echocardiography, performed 6 months after the final surgery, indicated a decreased cardiac output (3.6 L/min) with improvement of tricuspid regurgitation. Because the blood loss during the first surgery was over 3.8 L, malnutrition with albuminemia was induced and half of the skin graft did not attach. Nutritional support to improve the albuminemia produced better results following a second surgery to repair the skin wound.
CONCLUSION:
Cardiac overload may be latent in patients with neurofibromatosis type I with large plexiform neurofibromas. As in pregnancy, the body may compensate for this burden. In these patients, one stage total excision may improve quality of life and reduce cardiac overload. In addition, nutritional support is likely needed following a major surgery that results in either an extensive skin wound or excessive blood loss during treatment.
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Combination of extracellular volume fraction by cardiac magnetic resonance imaging and QRS duration for the risk stratification for patients with non-ischemic dilated cardiomyopathy.
Heart Vessels2020 May;():. doi: 10.1007/s00380-020-01618-9.
Kodama Sho, Kato Shingo, Hayakawa Keigo, Azuma Mai, Kagimoto Minako, Iguchi Kohei, Fukuoka Masahiro, Fukui Kazuki, Iwasawa Tae, Utsunomiya Daisuke, Kosuge Masami, Kimura Kazuo, Tamura Kouichi,
Abstract
The extracellular volume fraction (ECV) by T1 mapping can quantify diffuse myocardial fibrosis, and useful as a non-invasive marker for risk stratification for patients with non-ischemic dilated cardiomyopathy (NIDCM). Prolonged QRS interval on electrocardiogram is related to worse clinical outcome for heart failure patients. The purpose of this study was to evaluate the prognostic value of the combination of ECV and QRS duration for NIDCM patients. A total of 60 NIDCM patients (mean age 61?±?12 years, mean left ventricular ejection fraction 37?±?10%, mean QRS duration 110?±?19 ms) were enrolled. Using a 1.5-T MR scanner and 32-channel cardiac coils, the mean ECV value of six myocardial segments at the mid-ventricular level was measured by the modified look-locker inversion recovery method. Adverse events were defined as follows: cardiac death; recurrent hospitalization due to heart failure. Patients were allocated into three groups based on ECV value and QRS duration (group 1: ECV ? 0.30 and QRS ? 120 ms; group 2: ECV?>?0.30 or QRS?>?120 ms; group 3: ECV?>?0.30 and QRS?>?120 ms). During a median follow-up duration of 370 days, 7 of 60 (12%) NIDCM patients experienced adverse events. NIDCM patients with events had longer QRS duration (134?±?31 ms vs. 106?±?14 ms, p?=?0.01) and higher ECV (0.34?±?0.07 vs 0.29?±?0.05, p?=?0.026) compared with those without events. On Kaplan-Meier curve analysis, significant difference was found between group 1 and group 3 (p?
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