Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Nov 2018
[Tips and tricks: how to do a good coronary angioplasty? Instructions for use].
Percutaneous coronary angioplasty celebrated its 40th anniversary and gained an established role thanks to its remarkable results. The progressive development of techniques and materials together with a better understanding about the pharmacological treatment of patients with coronary artery disease contributed to this success. Nowadays percutaneous treatments have become a valid alternative to coronary artery bypass graft surgery in many patients. In this article we will highlight practical "tips and tricks" to improve the performance and the results of percutaneous coronary interventions.
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G Ital Cardiol (Rome) · Nov 2018
Editorial Historical Article[70th Anniversary of the Framingham Heart Study. Cardiovascular epidemiology from the past to the future].
Abstract
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G Ital Cardiol (Rome) · Oct 2018
[ANMCO position paper on sacubitril/valsartan in the management of patients with heart failure].
Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is the first medication to demonstrate a mortality benefit in patients with chronic heart failure and reduced ejection fraction (HFrEF) since the early 2000s. Sacubitril/valsartan simultaneously suppresses renin-angiotensin-aldosterone system activation through blockade of angiotensin II type 1 receptors and enhances the activity of vasoactive peptides including natriuretic peptides, through inhibition of neprilysin, the enzyme responsible for their degradation. In the landmark PARADIGM-HF trial, patients with HFrEF treated with sacubitril/valsartan had a 20% reduction in the primary composite endpoint of cardiovascular death or heart failure hospitalization, a 20% lower risk of cardiovascular death, a 21% to 20% lower risk of a first heart failure hospitalization, and a 16% to 20% lower risk of death from any cause, compared with subjects allocated to enalapril (all p<0.001). ⋯ In this position paper, we discuss the current role of sacubitril/valsartan in the management of chronic HFrEF, treatment eligibility and the modulating role of patients' characteristics. Moreover, we address concerns elicited by the PARADIGM-HF study and shortcomings of this novel drug, to clarify the place of this new therapy in the context of global care of heart failure in Italy. Our aim is to provide clinical cardiologists with a concise and practical guidance on when and how to use sacubitril/valsartan, to assist clinicians in closing the gap between scientific innovation and real-world experience.
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G Ital Cardiol (Rome) · Oct 2018
Review[Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome].
Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome is a difficult challenge because of the need of taking into consideration three different issues: the cardiac ischemic risk related to coronary artery disease and its treatment with angioplasty and stenting; the thromboembolic risk associated with atrial fibrillation; and the hemorrhagic risk related to the combined use of antiplatelet therapy (with one or two agents) and oral anticoagulant therapy. Data from many trials and meta-analyses currently support a combination therapy with oral anticoagulants (vitamin K antagonists or direct oral anticoagulants) and antiplatelet agents (aspirin and clopidogrel in dual or single antiplatelet therapy). Recently completed and ongoing trials aim to tackle the still controversial issues of this therapy: the choice of the anticoagulant agent and its dosage; the choice of the antiplatelet agent; the use of single or dual antiplatelet therapy and its duration.
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Cardiac tamponade is a pericardial syndrome characterized by diastolic impairment due to the accumulation of pericardial fluid under pressure. It may be an acute life-threatening condition if not recognized and treated (e.g. cardiac tamponade by hemopericardium), or may present as a subacute condition allowing in some cases a delayed treatment. The causes of cardiac tamponade are the same as for pericardial effusion, primarily cancer in one third of cases (being lung cancer the most common type of cancer), bacterial infections (25% of cases), iatrogenic factors (15% of cases), and acute aortic disease with aortic dissection. ⋯ Cardiac tamponade is a clinical diagnosis that is confirmed by echocardiography. The risk of recurrent cardiac tamponade is around 10% at 10-year follow-up and is mainly determined by the underlying etiology, with cancer patients showing the highest mortality. In this focused review, we will try to provide answers to the most common questions on the causes, presentation, diagnosis, treatment, and outcomes of cardiac tamponade.