Silvio Nocco

Cardiopulmonary and endothelial effects of metformin treatment in an insulin resistant population

Insulin resistance(IR) is considereda primaryetiologic factor in thedevelopment of cardiac dysfunction. A high prevalence of IR has beenfound in the non-ischemic heart failure population. It predates thedevelopment of the disease, and independently defines a worseprognosis[1].Severalstudieshaveshownthatareductioninendothelialfunction [2] may represent the link between IR and decline incardiovascular performance. Treatment with metformin has beenreported to prevent the above-mentioned cardiac abnormalities [3]and the evolution of IR diabetes [4]. However, metformin has also beenshown to slightly but significantly reduce oxygen consumption in apopulation of healthy individuals [5].The present study investigated a population of individuals affectedby IR without known cardiovascular disease. The aim was to examinethe possible effects of early metformin treatment on exercise oxygenconsumption and vasodilatory function, measured as endothelial flowreserve (EFR).Twenty consecutive individuals (7 women and 13 men; meanage 46±11 years) with a recent diagnosis of IR calculated accordingto the homeostatic model assessment (HOMA) index ([insulin (μU/mL)×glycaemia (mmol/L)]/22); (HOMA 5±3.5) were enrolled in thestudy. Exclusion criteria were an echocardiographic LVEF of ≤55%,hypertension with cardiac hypertrophy, a previous treatment withinsulin sensitizers.At enrolment, patients underwent ECG and bi-dimensional Dopplerechocardiogram with tissue Doppler imaging (TDI). EFR measurementwasassessedbymeansofaperipheralarterialtone(PAT)device [6,7].Anintegrated maximal cardiopulmonaryexercise test was performed on anelectricallybrakedcycleergometer.Arampprotocolwasapplied.Breath-by-breath VO

Echocardiographic accidental finding of asymptomatic cardiac and pulmonary embolism caused by cement leakage after percutaneous vertebroplasty

Percutaneous vertebroplasty (PVP) is a therapeutic, interventional radiological procedure involving bone cement injection into a vertebral body. Although PVP is considered a minimally invasive procedure, cement leakage into the perivertebral venous system can occur with its migration towards the right heart and the pulmonary circulation. We report a case of accidental finding of asymptomatic cardiac and pulmonary embolism caused by cement leakage after PVP.

Cardiovascular modulation during vagus nerve stimulation therapy in patients with refractory epilepsy.

To evaluate the effects of permanent vagal stimulation on cardiovascular system, 10 patients, affected by drug-resistant epilepsy with no primitive cardiovascular pathologies, were assessed prior to VNS surgery. A complete echocardiographic study [conventional and tissue Doppler imaging (TDI)], 24-h blood pressure (BP) monitoring and HRV evaluation were performed. The above mentioned parameters were investigated without any substantial changes to drug treatment during a check-up subsequent to VNS activation [mean: 7.7 months]. The results obtained show that while the anthropometrical data and both conventional and TDI echocardiography were unvaried compared to baseline, BP showed a significant increase of both systodiastolic values. Moreover, a close scrutiny of the most affected period of the BP increase (zenith between 16:31 and 17:30 pm) (systolic BP 114.7 mmHg vs 95.3 mmHg, P < 0.0001; diastolic BP 70.9 mmHg vs 56.9 mmHg, P < 0.001) showed a significant increase of the high frequencies components (HF) (28.4 ± 2.7 vs 36 ± 5.3, P < 0.05) and a significant reduction in low frequency/HF ratio (2.3 ± 0.3 vs 1.7 ± 0.3, P < 0.0001). The present study confirms the intrinsic cardiovascular safety and reliability of VNS procedures on both BP and HF and LF profiles and suggests that a primitive VNS-mediated central impingement on vagal efferents, independently by the antiepileptic mechanism, correlated to an moderate increase of parasympathetic activity, which in turn might play a protective role in seizure-triggered alterations of cardiovascular dynamic.

Effects of an Aquatic-Based Exercise Program to Improve Cardiometabolic Profile, Quality of Life, and Physical Activity Levels in Men With Type 2 Diabetes Mellitus

The role of structured exercise in improving cardiometabolic profile and quality of life in patients with type 2 diabetes mellitus (2DM) has been widely demonstrated. Little is known about the effects of an aquatic‐based exercise program in patients with 2DM.

Effects of Metformin Treatment on Myocardial and Endothelial Function in Insulin Resistance Patients: A Metabolomic Study

Introduction: Insulin resistance (IR) adversely affects cardiac performance and peripheral vasodilation reserve. Metformin, prescribed to prevent the progression of IR resistance into diabetes, has been shown to improve myocardial performance and endothelial function in insulin resistant individuals. Metabolomics in the study of the metabolite profile of a biological organism proved its efficacy in detecting metabolites changes as a result of a therapeutic intervention and, so, predicting the response. Aim: To evaluate myocardial and endothelium-dependent vasodilatory functions in an IR population subsequent to treatment with metformin and to determine the metabolic changes associated. Methods: Twenty consecutive patients recently diagnosed with IR were studied. All subjects underwent echocardiography with Speckle Tracking technique, peripheral arterial tonometry to measure the endothelial flow reserve (EFR) and metabolomic analysis by 1H Nuclear Magnetic Resonance (NMR) spectroscopy and multivariate analysis at baseline and after metformin treatment. Results: Inter-test comparison performed at baseline and after 3 months of metformin showed a significant reduction in weight (79 ± 15.4 vs 80.9 ± 16.2, P<0.05) and BMI (29.7 ± 5.3 vs 30.8 ± 5.2, p<0.05). Moreover we evidenced a significant increase in EFR (2.1 ± 0.43 vs 1.88 ± 0.47, p<0.05), and of the Global Longitudinal Strain (20.2 ± 4.21% vs 15.4 ± 3.06%, p<0.001). PLS-DA analysis of the metabolic profile detected by NMR identified two groups significantly different (cross validation p-value=0.005). More significant discriminating metabolites were: lactate, lipids, N.acetyl glycoproteins, valine, choline, betaine,creatine. Conclusions: The data obtained show that in IR subjects metformin improves myocardial and endothelial function. This effect was associated to significant metabolic changes characterized by means of a metabolomic approach.

Inverted Takotsubo Cardiomyopathy Induced by Dobutamine Stress Echocardiography with Atypical Presentation

A 48-year-old woman was scheduled by our lab to perform a standard dobutamine/atropine stress echocardiogram. During the test, the patient referred to a slight chest discomfort and developed a progressive left ventricle akinesia of all midbasal LV segments, thus mimicking a midbasal ballooning. ECG persisted without significant abnormalities and with no raise of Troponin I. Coronary angiography showed normal coronary arteries and ventriculography a severe EF reduction and apical hypercontractility. Echocardiography showed a progressive improvement with a complete recovery 48 hours later. This is a rare case of inverted takotsubo syndrome induced by dobutamine stress echocardiography that occurred with atypical presentation.