Objective: To assess serum levels of carbohydrate antigen 125 (CA125) in patients with chronic congestive heart failure (CHF) and to assess any correlation with clinical symptoms and echocardiographic indices. Patients and methods: We enrolled 77 male patients (mean age: 73F10 years) admitted to the Cardiology Emergency Department (ED) with cardiac symptoms requiring hospitalization. Diagnosis of CHF was based upon medical history or initial echocardiographic evaluation on current admission. Serum CA125 was measured by an enzyme immunoradiometric assay, on admission and before discharge. Results: The median overall CA125 value was 22.4 (11.5-48.9) U/ml. Serum CA125 levels were related to the severity of CHF [New York Heart Association (NYHA) class I: 19.2 (7.2-31) U/ml, NYHA class II: 17.6 (10-23) U/ml, NYHA class III: 32 (25-77) U/ml and NYHA class IV: 34.3 (18.6-77) U/ml ( pb0.04)]. Patients in NYHA classes III and IV had significantly higher mean values of CA125, than patients in class II ( pb0.005 and pb0.05, respectively). Moreover, patients with fluid congestion (pulmonary congestion, ankle edema) had higher levels of serum CA125 than patients without congestion ( p=0.002 and pb0.03, respectively). Finally, levels of serum CA125 correlated weakly with right ventricular systolic pressure (RVSP) and renal function, while no significant correlation was found between CA125 and E wave deceleration time on Doppler echocardiography, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), liver function and the medical treatment prescribed. Conclusion: Serum CA125 is associated with the clinical severity of CHF and the symptoms and signs of fluid congestion and therefore may be a useful additional tool for the evaluation and clinical staging of these patients.
Objective: The aim of this study was to describe sleep quality and associated daytime consequences in idiopathic pulmonary fibrosis (IPF). Subjects and Methods: Fifteen patients with IPF and 15 control subjects matched on age and anthropometric variables were included in the study. Sleep quality and its daytime consequences were assessed by clinical interview, the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale and attended all-night polysomnography. Results: Polysomnography revealed a decrease in sleep efficiency and slow wave sleep, and an increase in stage 1 sleep and arousal index in IPF patients compared to controls. Daytime tachypnea persisted during sleep. Oxygen saturation below 90% was observed during 34.3 ± 37.3% of the total sleep time (TST). Quality of sleep and daytime function were moderately to significantly impaired based on the PSQI and FOSQ. The total FOSQ score was negatively correlated with TST with oxygen saturation below 90% (p = 0.01, r = –0.62). FSS scores were correlated with TST at oxygen saturation below 90% and mean oxygen saturation during sleep (p = 0.002, r = 0.74, and p = 0.007, r = –0.66, respectively). Conclusions: Our data suggest significant sleep disruption and consequent impairment of physical and social functioning in patients with IPF. In the absence of effective treatments for IPF, the improvement of sleep quality should be a primary therapeutic goal.
Cardio-oncology is a new field of interest in cardiology that focuses on the detection, monitoring, and treatment of cardiovascular disease occurring as a side effect of chemotherapy and radiotherapy. Both cancer treatment modalities can cause cardiac dysfunction, a major cause of morbidity and mortality in the oncologic population. It is necessary to periodically monitor cancer patients under treatment, especially those receiving anthracyclines and trastuzumab (monoclonal antibody), using mainly 3D echocardiography to calculate left ventricular ejection fraction and to estimate myocardial deformation. Additionally, measuring various biomarkers, such as natriuretic peptides, could facilitate early identification and appropriate response to potential cardiotoxicity. In this regard, cardiological assessment before starting cancer treatment is essential and should be continued throughout, since cardiac dysfunction can occur at any time, even several years after therapy onset. High-risk individuals, in particular, should receive a detailed management plan designed in collaboration between an oncology and a cardiology specialist. If heart failure develops, even in the absence of overt clinical symptoms, standard heart treatment is to be followed and causal agent discontinued if possible. One important question is whether and when to stop cardiac medication in case of heart dysfunction reversal, after completion of cancer treatment. Further cardio-oncology evolution can lead to a deeper understanding of the adverse mechanisms and effects causing heart failure, as well as the development of personalized treatment regimens in order to limit cardiotoxicity.
MVr in pts with non-ischemic MR and preoperative LV dysfunction achieves better preservation of LV systolic indices than MVR, probably due to preservation of the subvalvular apparatus and LV geometry.
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