Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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Although the incidence of sudden cardiac death (SCD) is greater in men than in women, it represents an important mode of death also in the female gender. Sex-related differences have been identified not only in the prevalence of the phenomenon, but also in risk factors and etiology of SCD. The peripartum period represents a peculiar trigger of SCD in women with underlying cardiovascular substrates. ⋯ While the incidence of SCD increases progressively with age in adult elderly women to reach a 1:1 male:female ratio after the age of 80 years, mostly due to the increasing incidence of atherosclerotic disease in the postmenopausal period, SCD in young women is a rare event and usually associated with non-atherosclerotic disease, such as mitral valve prolapse, spontaneous coronary dissection, myocarditis, inherited cardiomyopathies and congenital heart diseases. The heart can be found structurally normal and inherited ion channel diseases are often implicated. Gender differences in the risk of SCD deserve further attention, since they affect the evaluation of interventions designed to reduce the rate of female SCD.
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G Ital Cardiol (Rome) · May 2012
[Heart failure in women treated with adjuvant trastuzumab for breast cancer].
The amplification of the HER receptor system is present in approximately 20% of breast cancers and confers a marked malignancy and a poor prognosis. Trastuzumab, a monoclonal antibody directed against the HER2 receptor, has dramatically improved the prognosis of patients with HER2+ metastatic and early breast cancer. However, the use of trastuzumab is associated with the possible development of myocardial dysfunction and heart failure. ⋯ For this reason, careful monitoring of cardiac function, an aggressive treatment of hypertension and possibly the use of non-anthracycline-containing chemotherapy protocols are required during trastuzumab treatment. Owing to the selection of patients enrolled in major randomized trials, the safety profile of trastuzumab is currently unclear in elderly women, in patients at high cardiovascular risk and in those with structural heart disease on optimal treatment. Further studies are therefore needed to determine whether this highly effective therapy in breast cancer survival can be extended to such categories of patients.
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G Ital Cardiol (Rome) · Apr 2012
Review[Continuous infusion versus bolus injection of loop diuretics in acute heart failure: a literature review].
Intravenous loop diuretics are increasingly used to treat symptoms and signs of fluid overload in acute heart failure, a clinical condition associated with high morbidity and mortality rates. Although diuretic therapy is widely used and strongly recommended by most recent clinical guidelines, prospective studies and randomized clinical trials are lacking and hence there is no reliable evidence regarding the best therapy in terms of doses, ways and methods of administration. With heart failure progression, the efficacy of loop diuretics is impaired by diuretic resistance characterized by a decreased diuretic and natriuretic effect of drugs. ⋯ Several available studies comparing bolus injection to continuous infusion of loop diuretics proved the latter to be an effective and safe method of administration. Continuous infusion seems to produce a constant plasma drug concentration with a more uniform daily diuretic and natriuretic effect and a greater safety profile (fewer adverse events such as worsening renal failure, electrolyte imbalance, ototoxicity). In addition, the analysis of available literature data did not provide conclusive evidence about the effects on clinical outcomes (mortality, rehospitalization rates, adverse events).
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G Ital Cardiol (Rome) · Apr 2012
[Conflict of interest policies and disclosure requirements among European Society of Cardiology National Cardiovascular Journals].
Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. ⋯ This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed.
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G Ital Cardiol (Rome) · Apr 2012
Review[Physiological versus pathological left ventricular remodeling in athletes].
Intense and chronic athletic training is associated with left ventricular remodeling, including an increase in wall thickness, cavity size and mass. The extent of morphological cardiac changes depends on a variety of factors, namely body size, gender, type of sport, ethnicity and, likely, genetic factors. ⋯ A common clinical challenge in sports cardiology is the differential diagnosis between physiological left ventricular hypertrophy (i.e., "athlete's heart") and hypertrophic cardiomyopathy, which is one of the most common causes of sudden cardiac death in young athletes. This review describes the physiological determinants, characteristics and upper limits of left ventricular hypertrophy in athletes, and analyzes the criteria that can be useful in the differential diagnosis between "athlete's heart" and hypertrophic cardiomyopathy.