Erythropoietin and the heart: facts and perspectives

2010 ◽  
Vol 120 (2) ◽  
pp. 51-63 ◽  
Author(s):  
Vittoria Mastromarino ◽  
Massimo Volpe ◽  
Maria B. Musumeci ◽  
Camillo Autore ◽  
Elena Conti
Keyword(s):  
Renal Failure ◽  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Clinical Applications ◽  
Compensatory Mechanism ◽  
Advanced Stages ◽  
Coronary Syndromes ◽  
Broad Variety ◽  
Potential Use ◽  
Crf Chronic Renal Failure

EPO (erythropoietin) has long been identified as a primary regulator of erythropoiesis. Subsequently, EPO has been recognized as playing a role in a broad variety of processes in cardiovascular pathophysiology. In particular, the tight interactions of EPO with the nitric oxide pathway, apoptosis, ischaemia, cell proliferation and platelet activation appear of great interest. Although enhanced EPO synthesis is viewed as an appropriate compensatory mechanism in the cardio–renal syndrome, which features CHF (congestive heart failure) and CRF (chronic renal failure), maladaptative excessive EPO synthesis in the advanced stages of these diseases appears to be predictive of higher mortality. Clinical trials based on the use of EPO in both heart and renal failure have so far produced contradictory results, whereas treatment targeted to restore low Hb levels appears rational and is supported by regulatory authorities. New areas for therapeutic use of EPO, such as acute coronary syndromes, are under investigation, and they are discussed in the present review together with other clinical applications in cardiovascular diseases. The revisited concept of a potential use of endogenous EPO levels as a predictor of CHF severity, as well as in the monitoring of responses to treatment, deserves appropriate investigation, as this may identify EPO as a useful biomarker in the clinical management of cardiovascular diseases.

scholarly journals Unpredictable Fall of Severe Emergent Cardiovascular Diseases Hospital Admissions During the COVID‐19 Pandemic: Experience of a Single Large Center in Northern Italy

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Mauro Toniolo ◽  
Francesco Negri ◽  
Marco Antonutti ◽  
Marco Masè ◽  
Domenico Facchin
Keyword(s):  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Time Frame ◽  
Northern Italy ◽  
University Hospital ◽  
Tertiary Referral Center ◽  
Coronary Syndromes ◽  
The Impact

Background Northern Italy is one of the epicenters of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV 2) pandemic in Europe. The impact of the pandemic and the consequent lockdown on medical emergencies other than those SARS‐CoV 2 pandemic related is largely unknown. The aim of this study was to analyze the epidemiologic impact of coronavirus disease 2019 pandemic on hospital admission for severe emergent cardiovascular diseases ( SECD s) in a single Northern Italy large tertiary referral center. Methods and Results We quantified SECD s admissions to the Cardiology Division of Udine University Hospital between March 1, 2020 and March 31, 2020 and compared them with those of the same time frame during 2019. Compared with March 2019, we observed a significant reduction in all SECD s admissions: −30% for ST ‐segment–elevation acute coronary syndromes, −66% for non‐ ST ‐segment–elevation acute coronary syndromes and −50% for severe bradyarrhythmia. Conclusions A significant decrease in all SECD s admissions has been observed during the SARS‐CoV 2. pandemic and was unlikely caused by a reduction in the incidence of cardiovascular diseases. Fear of contagion may have contributed to the unpredictable drop of SECD s. Social education about early recognition of symptoms of life‐threatening cardiac conditions requiring appropriate care in a timely fashion may help to reduce this counterproductive phenomenon.

Recovery problems

2009 ◽  
pp. 313-352
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Residual Neuromuscular Blockade ◽  
Coronary Syndromes ◽  
Postoperative Hypertension

Chest pain 314 Acute coronary syndromes (ACS) 318 Acute heart failure (AHF) 322 Postoperative hypertension 326 Postoperative hypotension 328 Respiratory depression/failure 330 Hypoxia 332 Confusion 334 The unrousable patient 336 Stroke 338 Residual neuromuscular blockade 340 Oliguria/acute renal failure (ARF) 342 Severe postoperative nausea and vomiting (PONV) ...

scholarly journals Machine learning for subtype definition and risk prediction in heart failure, acute coronary syndromes and atrial fibrillation: systematic review of validity and clinical utility

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Amitava Banerjee ◽  
Suliang Chen ◽  
Ghazaleh Fatemifar ◽  
Mohamad Zeina ◽  
R. Thomas Lumbers ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cardiovascular Diseases ◽  
Risk Prediction ◽  
Clinical Setting ◽  
Acute Coronary Syndromes ◽  
Clinical Utility ◽  
Coronary Syndromes

Abstract Background Machine learning (ML) is increasingly used in research for subtype definition and risk prediction, particularly in cardiovascular diseases. No existing ML models are routinely used for cardiovascular disease management, and their phase of clinical utility is unknown, partly due to a lack of clear criteria. We evaluated ML for subtype definition and risk prediction in heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation (AF). Methods For ML studies of subtype definition and risk prediction, we conducted a systematic review in HF, ACS and AF, using PubMed, MEDLINE and Web of Science from January 2000 until December 2019. By adapting published criteria for diagnostic and prognostic studies, we developed a seven-domain, ML-specific checklist. Results Of 5918 studies identified, 97 were included. Across studies for subtype definition (n = 40) and risk prediction (n = 57), there was variation in data source, population size (median 606 and median 6769), clinical setting (outpatient, inpatient, different departments), number of covariates (median 19 and median 48) and ML methods. All studies were single disease, most were North American (n = 61/97) and only 14 studies combined definition and risk prediction. Subtype definition and risk prediction studies respectively had limitations in development (e.g. 15.0% and 78.9% of studies related to patient benefit; 15.0% and 15.8% had low patient selection bias), validation (12.5% and 5.3% externally validated) and impact (32.5% and 91.2% improved outcome prediction; no effectiveness or cost-effectiveness evaluations). Conclusions Studies of ML in HF, ACS and AF are limited by number and type of included covariates, ML methods, population size, country, clinical setting and focus on single diseases, not overlap or multimorbidity. Clinical utility and implementation rely on improvements in development, validation and impact, facilitated by simple checklists. We provide clear steps prior to safe implementation of machine learning in clinical practice for cardiovascular diseases and other disease areas.

scholarly journals Perspectives on targeting cardio-vascular diseases through reorientation of activities

2020 ◽  
Author(s):  
Atul Agarwal
Keyword(s):  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Vascular Diseases ◽  
Peripheral Vascular ◽  
Primary And Secondary Prevention ◽  
Coronary Syndromes ◽  
New Perspective ◽  
Cardio Vascular ◽  
Underlying Pathology

Cardiovascular diseases include coronary artery, cerebrovascular, renovascular, and peripheral vascular diseases. These vascular diseases are known to present with many serious conditions―which include angina and acute coronary syndromes, strokes, cognitive impairment and dementia, epilepsy, parkinsonism, claudication, erectile dysfunction, renal failure, and hypertension. The underlying pathology for these ailments is atherosclerosis. Since 1950s, we have become increasingly focused on causation and management of cardiovascular diseases, which have strong behavioral components. Primary and secondary prevention remains our long-term goal. This paper discusses a new perspective on targeting cardiovascular diseases through reorientation of activities.

scholarly journals Human neutrophil peptides: a novel potential mediator of inflammatory cardiovascular diseases

2008 ◽  
Vol 295 (5) ◽  
pp. H1817-H1824 ◽  
Author(s):  
Kieran Quinn ◽  
Melanie Henriques ◽  
Tom Parker ◽  
Arthur S. Slutsky ◽  
Haibo Zhang
Keyword(s):  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Human Neutrophil ◽  
Acute Coronary Syndromes ◽  
Biological Marker ◽  
Polymorphonuclear Neutrophil ◽  
Current Evidence ◽  
Coronary Artery Diseases ◽  
Lipid Metabolism Disorder ◽  
Coronary Syndromes

The traditional view of atherosclerosis has recently been expanded from a predominantly lipid retentive disease to a coupling of inflammatory mechanisms and dyslipidemia. Studies have suggested a novel role for polymorphonuclear neutrophil (PMN)-dominant inflammation in the development of atherosclerosis. Human neutrophil peptides (HNPs), also known as α-defensins, are secreted and released from PMN granules upon activation and are conventionally involved in microbial killing. Current evidence suggests an important immunomodulative role for these peptides. HNP levels are markedly increased in inflammatory diseases including sepsis and acute coronary syndromes. They have been found within the intima of human atherosclerotic arteries, and their deposition in the skin correlates with the severity of coronary artery diseases. HNPs form complexes with LDL in solution and increase LDL binding to the endothelial surface. HNPs have also been shown to contribute to endothelial dysfunction, lipid metabolism disorder, and the inhibition of fibrinolysis. Given the emerging relationship between PMN-dominant inflammation and atherosclerosis, HNPs may serve as a link between them and as a biological marker and potential therapeutic target in cardiovascular diseases including coronary artery diseases and acute coronary syndromes.

Epidemiology of acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1213-1218
Author(s):  
Héctor Bueno
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Case Fatality ◽  
Risk Scores ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Coronary Events

Cardiovascular diseases cause approximately one-third of all deaths in the world, of which 7.5 million deaths are estimated to be due to ischaemic heart disease (IHD). Acute coronary syndromes (ACS) and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year. The incidence of IHD in general, and of ACS, increases with age although, on average, this occurs 7–10 years earlier in men compared with women. ACS occurs far more often in men than in women below the age of 60 years but women represent the majority of patients over 75 years of age. The risk of acute coronary events in life is related to the exposure to traditional cardiovascular risk factors. This can be estimated using risk scores, such as the European Society of Cardiology SCORE system. Huge differences within European and world regions can be found in the incidence and prevalence of IHD and ACS as well as in case fatality rates. However, information on the incidence of ACS is still limited for Europe. While the incidence of non ST-segment elevation ACS has remained relatively stable, the incidence of ST-segment elevation myocardial infarction has suffered a significant decrease in recent years. Furthermore, the majority of European countries experienced substantial decreases in age-standardized death rates for cardiovascular diseases and IHD in the last decades, particularly for myocardial infarction. This is the consequence of the improvement in cardiovascular prevention and ACS treatment but this trend may be reverting due to population ageing and the increase in some risk factors.

The direct thrombin inhibitor hirudin

2008 ◽  
Vol 99 (11) ◽  
pp. 819-829 ◽  
Author(s):  
Theodore Warkentin ◽  
Andreas Greinacher
Keyword(s):  
Side Effects ◽  
Acute Coronary Syndromes ◽  
Clinical Applications ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Heparin Induced Thrombocytopenia ◽  
Package Inserts ◽  
The Third ◽  
Preventative Measures ◽  
Coronary Syndromes

SummaryThis review discusses the pharmacology and clinical applications of hirudin, a bivalent direct thrombin inhibitor (DTI). Besides the current major indication for hirudin – anticoagulation of patients with heparin-induced thrombocytopenia (HIT) – the experience with hirudin in other indications, especially acute coronary syndromes, are briefly presented. Hirudins have been formally studied prior to their regulatory approval; however, important information on their side effects and relevant preventative measures only became available later. Therefore, current recommendations and dosing schedules for hirudin differ considerably from the information given in the package inserts. Drawbacks of hirudin and important precautions for avoiding potential adverse effects are discussed in detail in the third part of this review.

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