Risultati per: Incontinenza urinaria da stress o mista

Circulation, Volume 148, Issue Suppl_1, Page A14203-A14203, November 6, 2023. Background:Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A “biphasic response” in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).Methods:DSE was performed one day before CTO-PCI in consecutive 30 patients (18 female, age=71±11 years). Since 27 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 33 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems).Results:CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-15.5±2.8 at baseline v.s. -17.3±3.8, p

Circulation, Volume 148, Issue Suppl_1, Page A15399-A15399, November 6, 2023. Introduction:Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) systolic dysfunction, triggered by physical or emotional stress, and associated with increased long-term cardiovascular morbidity. Cardiac iodine-123-meta-iodobenzylguanidine (mIBG) imaging has previously demonstrated sympathetic hyperactivity in the TTS subacute state which improves at follow-up during rest imaging. Cardiac neuronal dysfunction in response to stress has not been evaluated in recovered TTS.Hypothesis:Sympathetic hyperactivity, as measured by stress mIBG, is abnormal in TTS after recovery of LV ejection fraction (LVEF).Methods:To elicit a sympathetic challenge, women with history of TTS with recovered LVEF (n=19) and asymptomatic age- and sex-matched reference controls (n=10) underwent treadmill (6 minutes) with simultaneous mental-stress testing (public speaking with anger recall). mIBG (10 mCi) was injected during exercise, and planar and SPECT imaging were performed at 15 min (early) and 240 min (late), followed by Tc-99m tetrofosmin myocardial perfusion imaging. Early and late heart-to-mediastinal ratio (HMR) and washout rate (WR) corrected for background were calculated.Results:Median time from last TTS event was 23 months (range 4-56). Overall mean age was 60± 12 years, body mass index 25 ± 4kg/m2, resting LVEF 70 ± 7%, 41% hypertension and 0% diabetes with no difference between TTS and controls. TTS had higher resting (140 ± 22 vs 123 ± 19 mmHg, p=0.049) and peak (187 ± 17 vs 171 ± 15 mmHg, p= 0.018) systolic blood pressure. While the early HMR and WR were similar, the late HMR was significantly lower in the TTS group (Figure).Conclusions:Women with a history of TTS have lower late HMR but similar WR, suggesting neuronal dysfunction in response to sympathetic challenge persists long after recovery from TTS event. Further analysis of catecholamine levels and central nervous system neural pathways will explore the mechanism of dysregulation.

Circulation, Volume 148, Issue Suppl_1, Page A14279-A14279, November 6, 2023. Background:In the clinical setting, there are various techniques for stress echocardiography, of which the 6-minute walk (6MW) test is a straightforward and utilized one. An abnormal hemodynamic response to exercise is indicated by a ΔmPAP/ΔCO slope of greater than 3 mmHg/L/min between rest and exercise. This response is associated with impaired prognosis in patients with exercise dyspnea and several cardiovascular diseases.Hypothesis:Our hypothesis was that pressure-flow relationship of the pulmonary circulation obtained by 6MW stress echocardiography would be enhanced with treatment.Aims:The aim of this study was to assess the effects of administration of Sacubitril/Valsartan on cardiac function in heart failure.Methods:We prospectively enrolled 39 patients with heart failure. The 6MW test was performed indoors in a flat, straight corridor. The peak tricuspid regurgitation jet, early diastolic transmitral flow velocity and early diastolic mitral motion were obtained by echocardiography post-6MW. We calculated the slope of ΔmPAP/ΔCO as a parameter of pulmonary hypertension. Follow-up echocardiographic studies were performed after 1 year.Results:Left ventricular diameter and volume were significantly reduced (LVDd; 59.3±7.7mm vs 56.0±8.6mm, P

Circulation, Volume 148, Issue Suppl_1, Page A16689-A16689, November 6, 2023. Introduction:Immune checkpoint inhibitors (ICIs) are a form of immunotherapy widely used in the treatment of different cancers. These inhibitors function by blocking specific proteins, such as PD-1 (programmed cell death protein 1) or CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), which regulate the immune response. While ICIs have demonstrated significant benefits, they can also lead to immune-related adverse drug reactions (ADRs). Although rare, cardiac immune-related ADRs are associated with high mortality rates.Hypothesis:The aim of this study to investigate the potential association between stress cardiomyopathy and the use of immune checkpoint inhibitors.Methods:We conducted an analysis using individual case safety reports obtained from the FDA Adverse Event Reporting System (FAERS) Database. These reports encompassed the period from the marketing authorization of each specific ICIs (ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab) up until March 2023. The synthesized data was further examined based on outcome severity, age, and gender.Results:Among 9,772 individual cardiac adverse events associated with immune checkpoint inhibitors, 121 cases (1.2%) of stress cardiomyopathy were reported from 2013 to 2023. The highest occurrence of stress cardiomyopathy adverse events (57.8%) was observed in the age group of 65-85 , compared to 26.4% in the age group of 14-64. Females were more frequently affected, accounting for 55.3% of the cases, while males constituted 41.3%. The three most commonly reported ICIs associated with stress cardiomyopathy were pembrolizumab (39.6%), nivolumab (33.8%), and ipilimumab (16.5%). Among the 121 cases, 19% resulted in mortality, while 26.5% had life-threatening outcomes. Additionally, 79.3% of cases required hospitalization, 5.7% experienced disability, and 57.8% had outcomes that were not characterized.Conclusions:Immune checkpoint inhibitor-induced cardiac ADRs, specifically stress cardiomyopathy, were found to be serious and associated with unfavorable outcomes. Physicians should remain vigilant regarding cardiac symptoms in patients receiving immune checkpoint inhibitors, as early detection can improve overall outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A16873-A16873, November 6, 2023. Introduction:Stress cardiomyopathy (SCM) is usually associated with reduced systolic function on echocardiogram. However, the prevalence of systolic dysfunction between different variables of SCM has not been established.Hypothesis:Whether Takotsubo variant SCM is associated with worse systolic function compared to other SCM variants.Methods:We conducted a retrospective cohort study evaluating echocardiograms of all patients with SCM between 2010 and 2022 at Hennepin Healthcare, MN, USA. The diagnosis of SCM was made based on the International Takotsubo (InterTak) diagnostic criteria.Results:Between January 2010 and December 2022, 296 patients presented with SCM. The majority of patients (N= 173, 58.4%) had the apical (Takotsubo) variant, compared to 78 (26.3%) patients with the midventricular variant and 45 (15.2%) with the basal variant. The three groups had no significant difference in the left ventricular outflow tract and septal diameters. Patients with the apical variant had a lower ejection fraction on presentation compared to mid-ventricular and basal variants (28.1% vs. 36.8% and 35.7%, respectively, p 55%, p=0.793, mean follow-up time < 4 weeks, p=0.913).Conclusion:Takotsubo variant is associated with worse right and left ventricular systolic function compared to other SCM variants, with similar systolic function recovery at follow-up.

Circulation, Volume 148, Issue Suppl_1, Page A16706-A16706, November 6, 2023. Introduction:Coronary vascular dysfunction (CVaD) is associated with major adverse outcomes, recurrent chest pain, and can be triggered by mental stress.Hypothesis:We hypothesized that women with CVaD have heightened emotional response and attenuated recovery compared to reference control (RC) women.Methods:Women diagnosed with CVaD (cases, n=57, age: 57±1 years) by abnormal adenosine or acetylcholine response during invasive coronary function testing were enrolled in Cardiac Autonomic Nervous System Study and compared to age-matched, asymptomatic RCs women (n=25, age: 56±3 years), free of cardiac or risk factor history. All underwent two 4-minute standardized mental stress tests – anger recall and mental arithmetic – followed by 15 minutes of recovery. Emotional arousal (tension, anxious, depressed) and chest pain were assessed via self-reported Likert scale at baseline, after stress, and after recovery. The difference between post-stress or post-recovery and baseline scores was used to evaluate stress provocation and recovery. Increased differences indicate more provocation or recovery attenuation. We utilized multivariate models adjusted for anti-anginal medications, statins, and aspirin or traditional cardiovascular risk factors and chest pain to assess associations between CVaD and chest pain or emotional arousal, respectively.Results:The two groups did not differ in hemodynamic response to mental stress (p >0.05). In multivariate models, CVaD status was associated with more stress-provoked chest pain (β 1.24 [0.1, 2.4], p=0.03) and more attenuated chest pain recovery (β 1.5 [0.6, 2.3], p=0.001) than RC. Similarly, after adjustment, cases were associated with more stress-provoked anxiety (β 1.2 [0.2, 2.2], p=0.02) and tension (β 1.2 [0.001, 2.4], p=0.05) while having more attenuated recovery of anxiety (β 1.1 [0.1, 2.0], p=0.02) and tension (β 1.1 [0.2, 2.0], p=0.02) compared to RC. There were no differences in feelings of depression between the two groups.Conclusions:Response to mental stress is heightened with attenuated recovery in women with CVaD. An improved understanding of mechanisms in stress response and CVaD is needed for potential therapeutic targets that may improve angina and quality of life.

Circulation, Volume 148, Issue Suppl_1, Page A12477-A12477, November 6, 2023. Introduction:Renovascular hypertension poses a significant risk for cardiovascular diseases, with endoplasmic reticulum (ER) stress playing a critical role in their development. However, the specific impact of ER stress-induced C/EBP homologous protein (CHOP) expression in endothelial cells on renovascular hypertension-induced cardiovascular complications remains unexplored. This study investigates the effects of disrupting ER stress CHOP in endothelial cells on microvascular dysfunction associated with renovascular hypertension.Hypothesis:We hypothesize that deleting ER stress CHOP in endothelial cells (EC) can mitigate renovascular hypertension-induced vascular endothelial dysfunction.Methods:Eight-week-old male and female mice (CHOPflx/flxand ECCHOP-/-) were divided into eight groups: control groups undergoing a sham operation for 4 weeks and renovascular hypertension groups subjected to 2-kidney-1-clip (2K1C) surgery for 4 weeks. Body weight, blood pressure, running performance, cardiac hypertrophy and fibrosis, lung edema, inflammation, vascular endothelial function, and signaling were assessed.Results:Male and female CHOPflx/flxmice subjected to 2K1C for four weeks exhibited hypertension, cardiac hypertrophy and fibrosis, lung edema, impaired running performance, and endothelium-dependent vascular relaxation dysfunction. In contrast, male and female ECCHOP-/-mice subjected to 2K1C for four weeks were protected against the pathogenesis of renovascular hypertension. Furthermore, mesenteric resistance arteries from CHOPflx/flxmice displayed reduced endothelial nitric oxide synthase (eNOS) phosphorylation, while ECHOP-/-mice showed no such effect.Conclusions:These findings emphasize the significance of targeting ER stress CHOP in endothelial cells of male and female mice to protect against the development and pathogenesis of renovascular hypertension.

Circulation, Volume 148, Issue Suppl_1, Page A15544-A15544, November 6, 2023. Introduction:Human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) hold great promise for myocardial infarction (MI) treatment. Although O2-releasing engineering approaches have been developed to enhance stem cell engraftment, a significant gap persists in knowledge regarding the oxidative stress controlling viability and functionality of hPSC-CMs.Hypothesis:Preconditioning hPSC-CMs with appropriate oxidative levels will enhance their adaptation and engraftment in the infarcted heart.Aims:To develop a novel system that produces a controlled release of O2to supply engineered heart tissue for regenerative therapies.Methods:An O2-releasing hydrogel system (ORHS) was engineered using peroxides (sodium percarbonate) and antioxidants (β-carotene) encapsulated in PLGA-based particles. The effect of ORHS on hPSC-CMs was evaluated through oxidative stress assays, cell viability assessments, and contractility measurements. RNA-seq profiling was performed to analyze the gene expression of hPSC-CMs in response to ORHS. After implantation of ORHS-hPSC-CMs in infarcted hearts of immunodeficient mice, heart functions were monitored with echocardiography. Implanted cell engraftment was assessed using in vivo imaging systems and immunostaining.Results:The dissolved O2levels were increased in ORHS for 7 days, while the oxidative stress was minimized by β-carotene. The optimal ORHS significantly enhanced the viability and mitigated cell death of hPSC-CMs under hypoxic stress conditions. ORHS also enhanced cell contractility and improved calcium signaling in hPSC-CMs. Genes related to maturation and functionality (such as TNNT2, TNNI3, GJA1, and RYR2) were upregulated by ORHS in hPSC-CMs. Implantation of ORHS-hPSC-CMs for 4 weeks resulted in improved ejection fraction, reduced ventricular remodeling, alleviated infarct size, and scar formation. Furthermore, the engraftment and survival of hPSC-CMs were significantly increased by ORHS compared to control hydrogels, as demonstrated by luciferase reporter assays and troponin immunostaining with TUNEL.Conclusion:The development of ORHS offers a promising approach for inducing oxidative preconditioning and achieving enhanced regenerative outcomes of hPSC-CMs.

Circulation, Volume 148, Issue Suppl_1, Page A16692-A16692, November 6, 2023. Introduction:Adverse childhood experiences, particularly early life stress (ELS), are associated with cardiovascular disease later in life but the underlying mechanisms remain elusive. Parental life experiences can have effects that are transmitted to the offspring suggesting a possible trans-generational transmission of ELS phenotypic traits.Hypothesis:ELS can impair cardiac function in exposed parents and their offspring.Methods:We used an ELS mouse model based on unpredictable separation of mouse pups (F1) from their mother (F0) each day for 3 hours from postnatal day 1 (PND1) to PND14 combined with dams exposure to an additional unpredictable stressor (forced swim in 18°C water for 5 minutes or 20-minute physical restraint in a tube) during separation. Control litters were raised normally. Echocardiography (Vevo 3100, Visualsonics) was performed at 6, 12 and 18 months in exposed animals (F0), their unexposed offspring (F1) and grand-offspring (F2). Both male and female mice were studied. Heart weight/tibia length was used to assess cardiac mass while Masson’s Trichrome was employed to detect fibrosis. Lung congestion was assessed as lung wet/dry weight ratio. Single-cell RNA sequencing (scRNAseq) was performed in MSUS and control hearts. A 6-week environmental enrichment (EE) program (cages containing running wheels, maze) was employed to test the possible rescue of ELS effects in adult males and their offspring.Results:Male and female MSUS mice (F1) displayed a time-dependent deterioration (from 6 to 18 months) of LV hypertrophy, diastolic function, myocardial fibrosis and lung congestion when compared to controls. ScRNAseq revealed dysregulation of genes controlling inflammation and metabolism (Cav1, Fabp4) in cardiomyocyte and endothelial cell clusters. MSUS F1 and F2 females and males had diastolic dysfunction and lung congestion at 12 and 18 months (no change at 6 months). Notably, EE improved diastolic function and lung congestion in MSUS mice.Conclusions:ELS induces heritable cardiac alterations which can be rescued by EE in fathers. These results shed light on the causal role of ELS on heart failure development and potential mitigation strategies.

Circulation, Volume 148, Issue Suppl_1, Page A17343-A17343, November 6, 2023. Background:As a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that seems more prevalent among male than female physicians.Aim:This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events.Methods:Thirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on measures of coronary microvascular function in the same model while adjusting for age and body mass index.Results:Burnout and job stress had significant and independent effects on endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow (MBF) response, and hyperemic MBF (r partial: 0.29 to 0.35; p-value: 0.008 to 0.027). Effort-reward ratio (r partial: -0.32 to -0.34; p-value: 0.009 to 0.017) and overcommitment (r partial: -0.29 to -0.35; p-value: 0.008 to 0.027) showed inverse associations with these measures.Conclusions:In male physicians, burnout and high job stress showed opposite effects on coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications. Future studies should include burnout and job stress for a more nuanced understanding of their potential impact on cardiovascular health.

Le donne di mezza età a rischio maggiore aterosclerosi carotidea

This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.

Various forms of psychological intervention have proven to be powerful in the treatment of posttraumatic stress disorder (PTSD). Two of the best-studied interventions, prolonged exposure (PE) and cognitive processing therapy (CPT), have strong support for their efficacy and have been extensively disseminated by Veterans Affairs, while a third intervention, eye movement desensitization and reprocessing, also is efficacious and widely practiced. Each of these treatments requires considerable therapist training, typically involves numerous sessions over several months, and is variably tolerated by patients. These limitations of extant psychotherapies for PTSD have hastened the demand for therapies that might provide alternatives that are less burdensome for therapists and patients.

Introduction
Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.
Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).
Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection.

Methods and analysis
The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).
The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique.

Ethics and dissemination
Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.
Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022.

Trial registration number
NCT05364203.

Giorlandino, ‘obesità dopo il parto è una sfida clinica e di salute pubblica’

Objectives
The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

Design
A longitudinal study with follow-ups from 42 days to 6 months after delivery.

Settings and participants
A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

Methods
Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

Results
Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p