Monaldi Archives for Chest Disease最新文献

{"title":"Screening of cardiac allograft vasculopathy in heart transplant patients with coronary computed tomography angiography.","authors":"Ana Filipa Amador, Sandra Amorim, Tânia Proença, Mariana Vasconcelos, Marta Tavares Da Silva, João Rebelo, André Carvalho, José Pinheiro-Torres, Paulo Pinho, Rui Rodrigues","doi":"10.4081/monaldi.2024.2890","DOIUrl":"10.4081/monaldi.2024.2890","url":null,"abstract":"<p><p>Although coronary angiography (CA) is the gold standard for coronary allograft vasculopathy (CAV) screening, non-invasive modalities have arisen as potential alternatives, such as coronary computed tomography angiography (CCTA). CCTA also quantifies plaque burden, which may influence medical treatment. From January 2021 to April 2022, we prospectively included heart transplant recipients who performed CCTA as a first-line method for CAV detection in a single center. Clinical, CCTA, and CA data were collected. 38 patients were included, 60.5% men, aged 58±14 years. The most frequent cause of transplantation was dilated cardiomyopathy (42.1%), and the median graft duration was 10 years [interquartile range (IQR) 9]. The median left ventricle ejection fraction was 61.5% (IQR 6). The median calcium score was 17 (IQR 231) and 32 patients (84.2%) proceeded to CCTA: 7, 24, and 1 patients had a graded CAV of 0, 1, and 2, respectively. Most patients (37.5%) had both calcified and non-calcified plaques, and the median number of affected segments was 2 (IQR 3). The remaining 6 patients had extensive coronary calcification, so CA was performed: 4 had CAV1, 1 had CAV2, and 1 had CAV3. During follow-up (12.2±4.2 months), there were neither deaths nor acute coronary syndromes. After CCTA, therapeutic changes occurred in about 10 (26.3%) of patients, mainly related to anti-lipid intensification; such changes were more frequent in patients with diabetes after heart transplant. In this cohort, CCTA led to therapeutic changes in about one-quarter of patients; more studies are needed to assess how CCT may guide therapy according to plaque burden.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of patients' satisfaction with domiciliary biological treatment in severe asthma: a Portuguese survey.","authors":"Joana Lourenço, Ana Paula Vaz, Rosa Anita Fernandes, Cristina Lopes, Ana Luísa Fernandes","doi":"10.4081/monaldi.2024.2865","DOIUrl":"10.4081/monaldi.2024.2865","url":null,"abstract":"<p><p>Dear Editor, According to the Global Initiative for Asthma, severe asthma is defined as uncontrolled asthma, despite therapy adherence with an optimized high dose of inhaled corticosteroid plus long-acting β2-agonist coupled with management of modifiable factors/comorbidities, that worsens when this treatment is decreased...</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic giant ascending aortic aneurysm: a challenging surgical strategy for a silent bicuspid aortopathy.","authors":"Maria Grazia Romeo, Emanuele Pilato, Raffaele Giordano, Giuseppe Comentale, Gabriele Iannelli, Domenico Romeo, Bruna Miserrafiti, Luigi Di Tommaso","doi":"10.4081/monaldi.2024.2936","DOIUrl":"10.4081/monaldi.2024.2936","url":null,"abstract":"<p><p>We report the case of an incidental finding of a giant aneurysm of the ascending aorta with a congenital bicuspid aortic valve type 0-lateral. This severe condition was totally unknown to the patient, who was asymptomatic for cardiovascular disease. The aneurysmal mass involved the entire mediastinum, altering the normal anatomical relations, so the operative strategy was modified intraoperatively, tailoring the surgical technique to the anatomical conditions found. Despite a delayed awakening, the patient had an uncomplicated postoperative course. Therefore, this case highlights the importance of not underestimating nonspecific, seemingly harmless symptoms and signs that may reveal potentially catastrophic pathologies while also focusing on the surgical technique used. The modified Cabrol procedure, while an underutilized technique, if present in the cardiac surgeon's \"arsenal\" can represent a life-saving strategy in complex cases requiring an aortic valve and ascending aorta replacement.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring factors influencing the health-related quality of life of tuberculosis patients: a WHOQOL-BREF-based study.","authors":"Surabhi Panduranga Kodical, Rishabh Roy, Deekshitha Shetty, Nandakumar Up, Rajesh V, Sharad Chand, Reshma Kolar, Praneetha Jain","doi":"10.4081/monaldi.2024.2913","DOIUrl":"https://doi.org/10.4081/monaldi.2024.2913","url":null,"abstract":"<p><p>As a chronic illness, tuberculosis is known to negatively affect patients' day-to-day functioning. Therefore, evaluating all aspects of their health is imperative to improve their quality of life. The current study was conducted to assess the quality of life of patients receiving tuberculosis therapy and to identify the associated risk factors. A prospective, cross-sectional study of 6 months was planned and conducted in 66 Mycobacterium tuberculosis-infected patients who met the pre-defined inclusion criteria. All pertinent data about the patients were collected in a precisely created data collection form. Further, the brief version of the World Health Organization Quality of Life Questionnaire was used to evaluate the patient's quality of life. Of the 66 patients who were enrolled, 42 (63.6%) were male, and 14 (21.2%) belonged to the age group of 61-70 years. The domains of physical, psychological, social relationships, and environment had mean scores of 46.76±20.15 standard deviation (SD), 55.02±16.12 SD, 54.83±13.91 SD, and 64.92±14.59 SD, respectively. All four quality-of-life domains were found to have statistically significant associations with a variety of sociodemographic and treatment-related variables. This study gives healthcare practitioners an insight into the need to evaluate patients' health-related quality of life, particularly for individuals with chronic illnesses.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":"95 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular magnetic resonance in muscular dystrophies: looking ahead.","authors":"Ana Filipa Amador, Teresa Pinho, Catarina Martins da Costa, António José Madureira, Elisabete Martins","doi":"10.4081/monaldi.2024.2851","DOIUrl":"10.4081/monaldi.2024.2851","url":null,"abstract":"<p><p>Cardiac magnetic resonance (CMR) is an established tool for risk stratification in several cardiomyopathies, and its role in muscular dystrophies (MuD) looks promising. We sought to assess how CMR performs in predicting cardiac events in a real cohort of MuD patients. This is a prospective single-center study with the enrollment of consecutive adult MuD patients referred to cardiac screening from 2012 to 2018 with the collection of clinical and CMR data. During follow-up (FUP), major adverse cardiac events such as a composite of device implantation, ventricular tachycardia (VT), hospitalization due to heart failure, and death, were considered. Sixty-five patients were included (mean age of 32±16, 51% female); the majority had myotonic dystrophy (34; 52.3%); most were asymptomatic (60; 92.3%) and at sinus rhythm (64; 98.5%). CMR was abnormal in 23 (43.3%) patients: left ventricle ejection fraction (LVEF) <55% was found in 7 patients, and late gadolinium enhancement (LGE) was present in 23 patients, mainly intra-myocardial or subepicardial (10 and 8 patients, respectively). During a median FUP of 77 months (interquartile range: 33), there were 7 deaths, 8 implanted devices, and one sustained VT. LVEF<55% and the presence of LGE were associated with the occurrence of all events (log-rank test, p=0.002 and p=0.045, respectively). LVEF<55% was associated with a 6-fold higher risk of events (crude hazard ratio of 6.15; 95% confidence interval of 1.65-22.93), which remained significant after adjusting for LGE presence (adjusted hazard ratio of 4.81, 95% confidence interval of 1.07-15.9). In our cohort, CMR LVEF<55% and the presence of LGE were significantly associated with adverse events during FUP, reinforcing the role of this technique on risk stratification of MuD populations.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-day discharge after elective percutaneous closure of patent foramen ovale.","authors":"Catarina Martins da Costa, Ana Filipa Amador, Roberto Pinto, Bruno Bragança, Inês Oliveira, João Carlos Silva, Carla Sousa, Rui André Rodrigues","doi":"10.4081/monaldi.2024.2833","DOIUrl":"10.4081/monaldi.2024.2833","url":null,"abstract":"<p><p>Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. A total of 49 (40%) patients had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this SDD strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From clues to clarity: multimodality imaging uncovers ruptured sinus of Valsalva aneurysm masquerading as tricuspid valve endocarditis.","authors":"Jaikrit Bhutani, Prateek Jain, Reeva Bathla, Divya Mangal","doi":"10.4081/monaldi.2025.3310","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3310","url":null,"abstract":"<p><p>Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare but life-threatening condition that may be misdiagnosed due to nonspecific symptoms. We report the case of a 24-year-old postpartum female who presented with acute right heart failure and was initially misdiagnosed with tricuspid valve infective endocarditis. Detailed evaluation revealed RSOVA originating from the right coronary sinus with left-to-right shunting into the right ventricle. This case highlights the importance of clinical suspicion and multimodal imaging for accurate diagnosis in postpartum females presenting with dyspnea, chest pain, and a continuous murmur. Early diagnosis and timely intervention are crucial to improving outcomes.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic role of blood eosinophils in acute exacerbations of chronic obstructive pulmonary disease: systematic review and meta-analysis.","authors":"Ombretta Para, Giuliano Cassataro, Chiara Fantoni, Lorenza Bertù, Claudia Tieri, Lorenzo Caruso, Sara Rotunno, Francesco Dentali","doi":"10.4081/monaldi.2025.3298","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3298","url":null,"abstract":"<p><p>Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major cause of hospitalization and mortality worldwide. While blood eosinophils have been suggested as a prognostic biomarker of COPD, their predictive value in AECOPD remains uncertain. This meta-analysis aims to evaluate the prognostic role of blood eosinophil counts in predicting mortality and hospital readmission in these patients. A systematic review and meta-analysis were conducted according to PRISMA guidelines. We included studies that evaluated the prognostic role of blood eosinophils in AECOPD, with predefined cut-offs. Data on mortality and readmission rates were extracted, and statistical analyses were performed to assess sensitivity, specificity, and likelihood ratios. A total of 14 studies with 23,625 patients were included. High blood eosinophil counts during AECOPD hospitalization had low sensitivity (28.1%) and specificity (66.2%) in predicting 12-month mortality and readmission. Positive and negative likelihood ratios were also suboptimal, with values of 0.8 and 1.1, respectively. Sensitivity analyses, including only high-quality studies, confirmed these findings. The results suggest that blood eosinophil counts have limited prognostic value in predicting mortality and readmission in AECOPD patients. The variability in eosinophil cut-offs and lack of consistent data across studies contribute to this limitation. Further large-scale prospective studies are needed to clarify the role of eosinophils as a prognostic marker in AECOPD. Consequently, routine measurement of blood eosinophils during acute exacerbations may not be warranted for prognostic purposes.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of pleural fluid and serum C-reactive protein/albumin ratio in exudate/transudate, infectious/non-infectious pleural fluid discrimination.","authors":"Ayshan Mammadova, Zuleyha Galata, Zeynep Yaylçınkaya, Nilgun Yılmaz Demirci","doi":"10.4081/monaldi.2025.3060","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3060","url":null,"abstract":"<p><p>As a new parameter, the C-reactive protein (CRP)/albumin ratio (CAR) has been shown to be more accurate than CRP and albumin alone in predicting the diagnosis and overall prognosis in cancer, sepsis, and vascular and non-vascular conditions. In this direction, we aimed to investigate the role of CAR in the differentiation of transudate/exudate and infectious/non-infectious in our study. A total of 160 patients who were examined for pleural fluid between August 2020 and February 2021 were included in our single-center prospective observational study. The study did not include those who could not undergo diagnostic thoracentesis and those under the age of 18. The presence of pleural effusion was determined by physical and radiological examinations [chest radiograph, thorax computed tomography, thoracic ultrasonography (US)]. Diagnostic thoracentesis was performed under the guidance of thoracic US after the patients who met the inclusion criteria signed an informed consent form. A total of 160 patients, 117 (73.1%) male and 43 (26.9%) female, were included in the study. While exudate was detected in 101 (63.1%) cases and transudate was detected in 59 (36.9%) cases, 47 (29.4%) of these were due to infectious and 113 (70.6%) non-infectious causes. The mean pleural fluid CAR (46.38) and serum CAR (72.43) in the infectious group were found to be significantly higher than those in the non-infectious group (13.17 and 19.48, respectively) (p<0.001). The pleural fluid and serum CAR (31.79 and 49.68) were found to be significantly higher in the exudate-qualified group compared to the transudate-qualified group (7.76 and 9.97) (p<0.001). When the threshold value for the pleural fluid CAR is >15.65, it is 80.9% sensitive and 73.5% specific in predicting infectious fluid; when the threshold value was >9.48, it was found to be 71.3% sensitive and 71.2% specific in exudate-transudate discrimination. In conclusion, in our study, we see that the pleural fluid and serum CAR are promising parameters in the differentiation of infectious/non-infectious pleural effusions and in the differentiation of exudate/transudate.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic computed tomography in the diagnosis of tracheomalacia in asthmatic patients.","authors":"Nessma Ali Gouda, Waleed El Sorougi, Marwa Romeih, Fatmaalzahraa Saad Abdalrazik","doi":"10.4081/monaldi.2025.3245","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3245","url":null,"abstract":"<p><p>Dynamic computed tomography (CT) offers a non-invasive approach to diagnosing tracheomalacia, especially in asthmatic patients with varying severities of airway obstruction. This study aimed to assess the incidence of tracheomalacia in asthmatic patients using dynamic CT and its relation to asthma severity. A total of 60 asthmatic individuals, diagnosed based on the Global Initiative for Asthma 2021 criteria, participated in this cross-sectional study. Participants were split into three separate groups (mild, moderate, and severe) based on pre-bronchodilator forced expiratory volume levels. All patients underwent dynamic CT to evaluate tracheal collapsibility, and spirometry was performed to assess pulmonary function. Tracheomalacia was detected in 5 participants (8.3%). The groups showed a significant disparity in pre- and post-forced expiratory volume % (p<0.001) and the forced expiratory volume/forced vital capacity ratio (p<0.001). Additionally, the bifurcation cross-sectional area % expiration/inspiration was significantly lower in the tracheomalacia group (p<0.001), and the aorta cross-sectional area % expiration/inspiration also reported a significant reduction (p<0.001). Dynamic CT is a valuable diagnostic tool for identifying tracheomalacia in asthmatic patients. Although tracheomalacia was not directly related to asthma severity, further studies are needed to explore its potential causes, including airway remodeling and gastroesophageal reflux disease.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}