Risultati per: Complicanze intestinali correlate alla terapia antibiotica: prevenzione

Circulation, Volume 146, Issue Suppl_1, Page A14452-A14452, November 8, 2022. Introduction:Guidelines regarding rhythm control for atrial arrhythmias (AT/AF) are primarily based on symptom burden. Ambulatory electrocardiogram (AECG) monitoring is often performed to evaluate AT/AF burden and guide clinical decision-making. Yet, to date, little is known about the correlation of symptoms reported during AECG with recorded AT/AF.Methods:University of Utah patient AECGs with at least one AT/AF event over 7 or more days of monitoring were retrospectively reviewed – only events with symptoms or with AT/AF were included (other arrhythmias were rare and excluded). Patient triggered symptoms included reported shortness of breath, tiredness, palpitations, dizziness, or passing out. Tetrachoric correlation analysis was performed to evaluate the correlation between symptoms and AT/AF episodes.Results:We identified 742 patients with a mean age of 64 years, 50% female, 22% with chronic heart failure, overall mean CHA2DS2-VASc score of 2.5 and 67% with scores ≥2. There were 6,289 symptomatic events and 6,900 AT/AF episodes. Among these were 1,025 (16%) episodes of shortness of breath, 854 (14%) of tiredness, 2,660 (42%) of palpitations, 794 (13%) of dizziness, and 95 (2%) of passing out. Symptomatic events were less likely to predict simultaneous AT/AF compared to sinus rhythm on AECG, with a moderate inverse tetrachoric correlation of -0.66 (range -1 to 1, with 1 representing perfect positive correlation).Conclusion:Patient-triggered symptomatic events were inversely correlated with recorded AT/AF events and represented an unacceptable marker of actual arrhythmia. A more holistic approach to assessment of ATAF symptoms is needed to improve patient selection for rhythm control therapy.

Circulation, Volume 146, Issue Suppl_1, Page A14760-A14760, November 8, 2022. Introduction:Although several studies have demonstrated that elevated troponin predicts mortality in septic patients, data concerning the independent risk factors predisposing to higher chance of troponin leak are conflicting.Hypothesis:In this study we aim to identify predictors of troponinemia and lactatemia in the setting of sepsis and more specifically to clarify how hemodynamics affect these biomarkers.Methods:This is a retrospective cohort study on patients admitted to the intensive care units with severe sepsis. A total of 354 patients were included. Elevated admission troponin-T and lactate were defined as ≥0.01ng/mL and 2.5mmol/L respectively. Modified shock index defined as heart rate/mean arterial blood pressure (MSI) was used as a surrogate of hemodynamic instability. Linear regression models where generated to examine multi variate associations and Cox regression models were used for mortality outcomes. Analysis was done using STATA I/C 16.1.Results:The only independent predictor of elevated troponin in the setting of septic shock was pre-existing coronary artery disease (Coef.= 6 [1.9 – 10] p = 0.001). Troponin was not associated with mean arterial pressure (MAP) nor Modified Shock Index (Heart rate/MAP). On the other hand, elevation of lactate was significantly associated with Modified Shock index (Coef.=1.7 [CI 0.4 – 3] p= 0.001) and history of Diabetes (Coef.=1.2[0.04-2.3] p= 0.04). In a Cox regression modeling assessing for predictors of mortality in septic shock, lactate levels were strongly associated with death (OR= 1.17 [1.12-1.2] p= 0.0001) followed by male sex (OR= 1.8 [1.02-3] p=0.04) and Modified Shock Index (OR=1.5 [1.23-3.2] p=0.03) but troponin leak failed to show any correlation with mortality.Conclusions:Troponin leak is associated only with pre-existing CAD, not associated with hemodynamics and does not predict mortality.

Circulation, Volume 146, Issue Suppl_1, Page A9504-A9504, November 8, 2022. Introduction:The pathobiological mechanisms of coronary plaque erosion are unclear. Low endothelial shear stress (ESS) is a proinflammatory/proatherogenic stimulus associated with coronary plaque progression/destabilization. Intravascular imaging studies suggest that high ESS gradient (low ESS areas adjacent to high ESS areas), and steepness of plaque upslope/downslope correlate with plaque erosion. We investigated the relationship of local fluid hemodynamics to the inflammatory microenvironment at the culprit site of erosion in patients with an acute coronary syndrome.Hypothesis:ESS metrics associate with proinflammatory/proatherogenic cells and cytokines, and contribute to plaque erosion.Methods:We studied 30 patients with erosion from the OPTIcal-COherence Tomography in Acute Coronary Syndrome study (OPTICO-ACS). OCT images were segmented, co-registered with the angiogram to create a 3D-reconstruction of the coronary artery. ESS metrics were calculated by Computational Fluid Dynamics. Systemic and local blood samples and thrombectomy specimens were collected at the culprit lesion and analyzed by flow cytometry-based immunophenotyping and plasma cytokine and chemokine profiling, and statistically tested for correlations of continuous variables using Spearman rank correlation (r).Results:Proinflammatory cytokines (IL6, MIP-1, IL1β, IL2) and local concentration of T-cells, including subsets of T-cells (CD4+, CD8+, and NKT-cells), were significantly higher at the culprit site of erosion and correlate with local adverse ESS metrics (Min ESS, Max ESS, Plaque Topographical Slope) (Table).Conclusion:Biomechanical features likely trigger activation of the adaptive immune system, including T-lymphocytes and their cytotoxic effector molecules. These results provide novel insights into the links between fluid hemodynamics, inflammatory activation, and mechanisms involved in the pathogenesis of coronary plaque erosion.

Circulation, Volume 146, Issue Suppl_1, Page A10642-A10642, November 8, 2022. Background:Hemodynamics (HDS) after pediatric heart transplant (PHT) are understudied and may predict future outcomes. We sought to identify variables associated with normalization (NML) of HDS in the 1styear post-HT and determine association with post-HT outcomes.Methods:HDS were collected from patients who underwent HT between 2013-2020 without a history of pre-HT mechanical support and with at least 3 catheterizations in the 1st year post-HT. NML was defined as 2 consecutive catheterizations with pulmonary vascular resistance index (PVRi) < 3Wu/m2, cardiac index (CI) > 2.5L/min/m2, and pulmonary wedge pressure (PCWP)

Circulation, Volume 146, Issue Suppl_1, Page A10465-A10465, November 8, 2022. Background and Aims:Intermittent claudication (IC) in patients with peripheral artery disease (PAD) is thought to be caused by reduced lower extremity macrovascular blood flow. However, the ankle-brachial index (ABI) (a macrovascular measure) does not correlate well with patient-reported outcome measures. We aimed to study microvascular and metabolic skeletal muscle responses to exercise in patients with IC using positron emission tomography (PET).Methods:We enrolled 19 patients with IC (ABI < 0.90 and imaging/angiographic evidence of PAD) and 12 healthy controls (HCs) (normal ABI). All subjects underwent rest perfusion imaging of the legs with13N-ammonia or11C-acetate PET followed by a graded treadmill test. Subjects exercised until limited by claudication or the end of the 20-minute protocol. Subjects then underwent immediately post-exercise PET imaging of the legs. Skeletal muscle blood flow (SMBF) was quantified in each leg at rest and immediately post-exercise. Skeletal muscle oxygen utilization (SMVO2) normalized to SMBF was also quantified for patients who underwent imaging with11C-acetate. Peripheral artery questionnaire (PAQ) summary score was obtained for all subjects.Results:We found that SMBF was increased post-exercise in all subjects, and stress/rest SMBF was higher in the legs of subjects with PAD than in the legs of HCs (Figure 1A). We also found that stress SMVO2/SMBF was higher in legs of patients with PAD than in the legs of HCs (Figure 1B). There was a moderate, significant correlation between limb stress/rest SMBF and PAQ score (Figure 1C) and a strong, significant correlation between limb stress SMVO2/SMBF and PAQ score (Figure 1D).Conclusions:In conclusion, we found that SMBF increased in all subjects after treadmill exercise and paradoxically to the greatest degree in patients with IC. We also found that PET-derived markers of post-exercise microvascular perfusion and metabolism correlated with patient-reported outcomes.

65% di chi ne soffre vive in città,10 azioni per migliorare vita

Diretta Live con Claudio Mastroianni (Professore Ordinario di Malattie Infettive, Università Sapienza Roma. Presidente Società Italiana Malattie Infettive e Tropicali) e Walter Ricciardi (Professore Ordinario di Igiene e Medicina Preventiva, Università Cattolica Sacro Cuore, Roma. Consigliere scientifico del Ministro della Salute per la pandemia da coronavirus)