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Possible role of VEGF/Akt transduction pathway after beta-2 adrenergic receptors overexpression-promoted angiogenesis.

Exercise upregulates beta-adrenergic receptor expression and this, in turn, stimulates angiogenesis.

Angiogenesis in the failing heart is stimulated beta-1 AR blockade and cardiac beta-2 AR overexpression.

Thoracic aortic emergencies (TAE) - fixured thoracic aortic aneurysms (TAA), acute type b dissection - are associated with high risk of mortality and morbility. Endovasular surgery (ES) of TAE has been considered as an alternative procedure. From March 2001 to July 2003, 26 patients with TAE were admitted to our department and submitted to ES: 8 pts (30.7%) for fixured TAA, 18 pts (69.3%) for acute type b dissection evolving to rupture. AngioCT scan was diagnostic in all pts. A stented-graft was placed by femoral arteriotomy. TAA and type B pts were submitted to a multiple stent-graft procedure to cover the entire descending thoracic aorta (2.2 ± 1.2 grafts/pt). There were no perioperative deaths and open surgical conversions. The intraoperative angiography and Ctscan at the discharge showed no significant endoleaks and good seating of the aortic dissection. Average ICU and hospital stay was 1.7 ± 0.8 and 5.9 ± 3.0 days. Follow up ranged between 4 and 23 months, included clinical examination and serial CT scan at 3, 6 and 12 months, and every 6 months successively. An 84 years old TAA pt died of septic shock from pneumonia 78 days after endovascular surgery. Endovascular surgery is a safe technique for treating TAE with encouraging early and mid-term results. This therapeutic approach seem to be particulary efficacious in high risk subsets, as those represented by elderly patients.

La disfunzione età-correlata dei βARs a livello cardiaco e vascolare rappresenta un fenomeno reversibile e che interventi sia di natura farmacologica che non farmacologica, come i β-bloccanti e l’esercizio fisico, possono indurre un significativo miglioramento del signaling a livello recettoriale e post-recettoriale. Ciò aggiunge nuove informazioni sui meccanismi molecolari attraverso i quali queste due strategie d’intervento esercitano i loro effetti favorevoli nel trattamento delle patologie cardiovascolari nella popolazione geriatrica. L’invecchiamento si associa alla disregolazione di molti sistemi ormonali e il RAAS non fa eccezione a questo comportamento. Tuttavia, esistono ancora numerose lacune tra le conoscenze attualmente disponibili sulle specifiche interazioni tra RAAS sistemico e RAAS tissutali e sul significato della depressione del sistema ormonale circolante e sull’attivazione, invece, dei sistemi tissutali cardiaco e renale tubulo-interstiziale. Tali contraddizioni si accentuano ulteriormente laddove si consideri che la somministrazione di farmaci bloccanti il RAAS sia in grado anche nell’anziano ed in presenza di un RAAS sistemico depresso, di rallentare il danno d’organo renale e determinare un reverse-remodeling ventricolare sinistro.

Aim Stents reduce angiographic restenosis in comparison with balloon angioplasty. The rate of in-stent restenosis (ISR), although less frequent than post-angioplasty restenosis, is becoming increasingly prevalent due to the recent exponential increase in the use of intracoronary stents. The aim of this study is to evaluate angiographic and clinical outcomes of PTCA in combination with the use of excimer laser coronary angioplasty (ELCA) and drug-eluting balloon (DEB) in treatment of in-stent restenosis (ISR). Methods and results This multi-centric case-control study evaluated angiographic and clinical outcomes of PTCA with excimer laser coronary angioplasty (ELCA) and drug-eluting balloon (DEB) in 80 patients with in-stent restenosis (ISR). All patients underwent nine months of clinical and a coronary angiography follow-up. This study showed clinical and angiographic long-term success in the 91% of the patients. The incidence of myocardial infarctions and deaths was lower than the rate after plain balloon angioplasty within the stent. Conclusions This study showed that excimer laser coronary angioplasty (ELCA) and drug-eluting balloon (DEB) may be an alternative treatment for in-stent restenosis (ISR).

Heart failure achieves particular relevance and different characteristics in the elderly population, especially for the clinical complexity related to the presence of comorbidity and chronicity, which are common conditions in these patients. Despite recent advances in clinical approach, diagnosis and therapeutic management of heart failure, the incidence and prevalence of this syndrome are still increasing, owing to the better control of the disease, and, largely, to the aging of the population. Epidemiologic data indicate that heart failure represents a crucial problem in the elderly population in terms of social, economic, and health burden. Despite their importance in the worsening of heart failure and prevention of the progression of this syndrome, the risks of hospital readmission and the causes of exacerbation have not been systematically evaluated in controlled trials. This explains why the precipitating factors of heart failure remain unknown in more than 40% of cases. For these reasons, prospective studies are needed in order to assess and clearly define the risk of hospital readmission and the causes related to heart failure exacerbation in the elderly population.