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Clinical characteristics and course of patients entering cardiac rehabilitation withchronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation(ISYDE)
No full textPurpose: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide
insight into the characteristics and clinical course of patients with chronic kidney disease
(CKD) admitted to Cardiac Rehabilitation (CR) programs.
Methods: Data from 165 CR units were collected online from January 28th to February 10th,
2008.
Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 200 (71.312.2 yrs,
66% male) CKD patients and 2081 (66.311.6 yrs, 74% male) non-CKD patients. Compared
to non-CKD, CKD patients were older and their admission diagnosis of acute myocardial
infarction, myocardial revascularization or heart failure was more frequent. They also showed
more cardiac and non cardiac comorbidities, mostly diabetes, chronic obstructive lung disease
and cognitive impairment. During the course of CR, CKD patients had reduced access to
exercise functional evaluation, more complications (particularly atrial fibrillation, worsening
of chronic kidney disease and anaemia) requiring more intense medical treatment, and longer
length of in-hospital stay. CKD patients were less likely discharged at home (88% versus 91%,
p1⁄40.05), were more likely transferred to the intensive care units (8% versus 4%, p1⁄40.005),
and had higher death rate during CR programs (2.0% versus 0.5%, p1⁄40.02). After adjusting
for age, ejection fraction, comorbidities (acute myocardial infarction, percutaneous coronary
intervention, cardiac surgery, carotid artery critical lesions, peripheral artery disease, respiratory
insufficiency, heart failure, diabetes, stroke and cognitive impairment), and complications
during CR program (atrial fibrillation and severe ventricular arrhythmias), multivariate logistic
analysis showed that heart failure (OR 1.6, 95% CI, 1.1 to 2.4, p1⁄40.04), respiratory
insufficiency (OR 2.4, 95% CI, 1.4 to 4.0, p1⁄40.0007), and cognitive impairment (OR 4.5,
95% CI, 2.5 to 8.1, p < 0.0001) were significant predictors of death during the CR program in
CKD patients.
Conclusions: This subanalysis of the ISYDE-2008 survey provided a detailed snapshot of the
clinical characteristics, complexity and more severe clinical course of patients admitted to CR
presenting with CKD
Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis.
No full textEcho-derived pulmonary arterial systolic pressure (PASP) and right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE; from the end of diastole to end-systole) are of basic relevance in the clinical follow-up of heart failure (HF) patients, carrying two- to threefold increase in cardiac risk when increased and reduced, respectively. We hypothesized that the relationship between TAPSE (longitudinal RV fiber shortening) and PASP (force generated by the RV) provides an index of in vivo RV length-force relationship, with their ratio better disclosing prognosis. Two hundred ninety-three HF patients with reduced (HFrEF, n = 247) or with preserved left ventricular (LV) ejection fraction (HFpEF, n = 46) underwent echo-Doppler studies and N-terminal pro-brain-type natriuretic peptide assessment and were tracked for adverse events. The median follow-up duration was 20.8 mo. TAPSE vs. PASP relationship showed a downward regression line shift in nonsurvivors who were more frequently presenting with higher PASP and lower TAPSE. HFrEF and HFpEF patients exhibited a similar distribution along the regression line. Given the TAPSE, PASP, and TAPSE-to-PASP ratio (TAPSE/PASP) collinearity, separate Cox regression and Kaplan-Meier analyses were performed: one with TAPSE and PASP as individual measures, and the other combining them in ratio form. Hazard ratios for variables retained in the multivariate regression were as follows: TAPSE/PASP </≥ 0.36 mm/mmHg [hazard ratio (HR): 10.4, P < 0.001]; TAPSE </≥ 16 mm (HR: 5.1, P < 0.01); New York Heart Association functional class </≥ 3 (HR: 4.4, P < 0.001); E/e' (HR: 4.1, P < 0.001). This study shows that the TAPSE vs. PASP relationship is shifted downward in nonsurvivors with a similar distribution in HFrEF and HFpEF, and their ratio improves prognostic resolution. The TAPSE vs. PASP relationship as a possible index of the length-force relationship may be a step forward for a more efficient RV function evaluation and is not affected by the quality of LV dysfunction
Cardiac rehabilitation in chronic heart failure patients: data from the italian survey on cardiac rehabilitation (ISYDE)
No full textBackground: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide
insight into the level of implementation of Cardiac Rehabilitation (CR) in patients with
chronic heart failure (CHF).
Methods: Data from 165 CR units were collected online from January 28th to February 10th,
2008.
Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 285 (71.312.2 yrs,
66% male) CHF patients and 1996 (66.311.6 yrs, 74% male) non-CHF patients. Compared
to non-CHF, CHF patients were older, showed more comorbidity, and had a lower left
ventricular ejection fraction (EF). During the course of CR, CHF patients had reduced
access to functional evaluation, underwent more complications, and had less secondary prevention
information and a longer length of in-hospital stay. CHF patients were also more
likely transferred to intensive care units (9% versus 3%, p < 0.0001), and less likely discharged
at home (85% versus 92%, p < 0.0001), respectively, compared to non-CHF patients.
Discharge medications were significantly different in CHF as compared to non-CHF patients.
Finally, CHF patients had higher death rate during CR programs (1.7% versus 0.5%,
p1⁄40.01). After adjusting for age, ejection fraction, comorbidity and complications during
CR program, multivariate logistic analysis showed that respiratory insufficiency (OR 2.3, 95%
CI, 1.3-4.1, p1⁄40.002), acute kidney insufficiency or worsening chronic kidney disease (OR
2.9, 95% CI, 1.5-5.6, p1⁄40.001) and cognitive impairment (OR 3.7, 95% CI, 2.0-6.7,
p < 0.001) were significant predictors of death in CHF patients.
Conclusions: The ISYDE-2008 survey provided a detailed snapshot of CR in CHF patients,
and confirmed the complexity and the differences in clinical presentation and course of CHF
patients entering CR programs
Doppler echocardiography for the assessment of left ventricular diastolic function: methodology, clinical and prognostic value
No full textHypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study
Full text linkBackground: This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting.
Methods: A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020, followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate (eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG levels (vHTG) (respectively <150 mg/dL, 150-500 mg/dL and >500 mg/dL) were comparatively evaluated.
Results: Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ± 66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 person-years, in normal-TG, HTG and vHTG subjects, respectively (P<0.01). The incidence of ESKD was 0.7 and 0.9 per 1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P<0.01). Univariate and multivariate analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint) increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300-1.696; P<0.001). Moreover, each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%CI 1.039-1.086 P<0.001) and ESKD (OR:1.174, 95%CI 1.070-1.289, P = 0.001).
Conclusions: This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of long-term kidney function deterioration
Obesity paradox in patients with aortic valve stenosis. Protective effect of body mass index independently of age, disease severity, treatment modality and non-cardiac comorbidities.
No full textAn increased body mass index (BMI) is considered a risk factor for cardiovascular (CV) disease and mortality in the general population. However, after the onset of established disease the association between BMI and outcome is paradoxically inverted [2]. In patients with aortic stenosis (AS) contrasting results have been reported. A recent study denied the BMI paradox in AS, but the enrolled population was asymptomatic and relatively young. Notably, in other conditions this phenomenon has been described only in elderly patients with more advanced disease stage. We aimed to assess the prognostic value of BMI in a large population of severe AS patients and to verify its independency from cardiac and non-CV confounding variables
Reversible abnormal right ventricular function at follow-up is associated with better survival in patients with chronic systolic heart failure
No full textReversible abnormal right ventricular function at follow-up is associated with better survival in patients with chronic systolic heart failur
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure.
No full textReduced pulmonary arterial compliance is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that pulmonary arterial Ca could be a predictor of outcome in patients with chronic heart failure (CHF).METHODS: We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right-sided heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end point was cardiovascular death; secondary end point was the composite of cardiovascular death, urgent heart transplantation, and appropriately detected and treated episode of ventricular fibrillation. RESULTS: An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 s. In patients with pulmonary capillary wedge pressure (PCWP) 2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high (P = .003) and in patients with normal pulmonary vascular resistance (P = .005). CONCLUSIONS: Pulmonary arterial Ca is a strong prognostic indicator in patients with CHF with sLVD. Most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance
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