In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition.
Background: Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas -recently defined as possible autonomous cortisol secretion (pACS) -has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. Subjects and methods: Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. Results: According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 nonfunctioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMI BSA ) was increased in pACS compared to NFA (P = 0.006) and mildly correlated to the post-DST cortisol level (rho = 0.347; P = 0.004). The post-DST cortisol levels explained up to 13.7% of LVMI BSA variance (P = 0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P = 0.001) and worse arterial stiffness assessed by pulse wave velocity (P = 0.033). Conclusions: In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition.
Aeromonas hydrophila has been infrequently reported as a cause of infection in humans. It has been associated with a variety of clinical syndromes but Aeromonas-related endocarditis is extremely rare. We present the case of a 76-year-old diabetic patient who was admitted to our hospital due to severe lumbar pain resistant to nonsteroidal anti-inflammatory drugs accompanied by fever (up to 38.5°C). The vital signs were normal and the physical examination was unremarkable except for tenderness over right flank. Laboratory investigation showed a mild leukocytosis (white blood cell count of 11,360×106/L) with elevation of inflammatory markers. Cardiac ultrasound showed a large vegetation on the mitral valve. Abdominal computed tomogrpahy revealed a ruptured aneurysm of the right renal artery. Multiple sets of blood culture grew A. hydrophila.
BackgroundCardiac involvement in Systemic Sclerosis (SSc) is rather common and it can be considered a bad prognostic feature.ObjectivesIn this study we aimed to evaluate this involvement performing electrocardiogram (ECG) and echocardiogram in a group of SSc patients, comparing their data with those of healthy volunteers (NC).MethodsSeventy-one consecutive SSc patients (Group A) were compared to 60 NC (Group B), matched for age and sex. Both patients and NC were evaluated by anamnesis, physical examination, ECG and trans-thoracic echocardiogram, with Doppler and tissue-wave Doppler.ResultsTen SSc patients and 3 NC were excluded (Group A: 4 patients for increased basal heart rate, 2 for TAPSE <17 mm, 3 for valvular disease and 1 patient for severe pulmonary hypertension. Group B: 3 subjects for high basal heart rate). Among SSc patients 22 (36.1%) had a diffuse cutaneous form (dcSSc), and 39 (73.9%) had a limited cutaneous form (lcSSc). In table 1 clinical-demographic and laboratory features of patients are described. QT dispersion (QTd) and QTc dispersion (QTcd) were significantly higher in Group A respect to Group B (QTd 49.83 vs 27.85 msec, p<0.0001; QTcd: 51.39 vs 29.73 msec, p<0.0001). Patients with dcSSc showed longer QTc values than controls (440.58±18.23 vs 427.64±23.12 msec, p=0.02). Left ventricular mass index (LVMI) mean values were significantly increased while left ventricular ejection fraction (LVEF) mean values were significantly reduced in Group A compared with Group B respectively (LVMI: 80.5 vs 61.54 g/m2, p<0.0001; LVEF: 63.55 vs 68.42%, p=0.0001). No patient with LVEF<55% was found. In addition left atrial volume index for body surface (LAVI) mean values were higher in Group A (27.67 vs 18.78 ml/m2, p<0.0001). The percentage of patients with left ventricular diastolic dysfunction (LVDD) was higher in Group A (70.5 vs 21.8%, p=0.0001). In Group A QTc prolungation, increased levels of QTcd and P wave duration were associated with LVDD. An increase of P-wave duration was also associated with higher values of LAVI (p=0.04).Table 1.Main clinical-demographic and laboratory features of 61 SSc patientsFeaturesAge (years)(median, 25°p–75°p)66.5 (55–74.5)Sex (F/M)57/4Disease duration (years)(median, 25°p–75°p)5.5 (4–12)lcSSc/dcSSc39/22Modified Rodnan Skin score (median, 25°p–75°p)8.5 (4.75–14.25)Active digital ulcers (n/%)8/13Interstitial lung disease (n/%)26/42.6Anti-nuclear antibodies positivity (n/%)58/95Anti-centromere antibodies positivity (n/%)23/37.7Anti-topoisomerase I antibodies positivity (n/%)22/36ConclusionsSignificant cardiological differences can be found in SSc, even in asymptomatic patients, respect to NC, thus confirming how ECG and echocardiogram are relevant instruments able to detect morpho-functional abnormalities suggestive of an early myocardial involvement in this disease.Disclosure of InterestNone declared
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