Heart valve calcification and cardiac hemodynamics.

PURPOSE: Heart valve calcification (VC) is associated with increased cardiovascular risk, but the hemodynamic and functional profile of patients affected by VC has not been fully explored. METHODS: The study population was formed by consecutive unselected patients included in seven echocardiographic laboratories in a 2-week period. A comprehensive echocardiographic examination was performed. VC was defined by the presence of calcification on at least one valve. RESULTS: Population was formed of 1098 patients (mean age 65 ± 15 years; 47% female). VC was present in 31% of the overall population. Compared with subjects without VC, VC patients were older (60 ± 14 vs 75 ± 9; P < .0001), had more hypertension (40% vs 57%; P = .0005), diabetes (11% vs 18%; P = .002), coronary artery disease (22% vs 38%; P = .04), and chronic kidney disease (4% vs 8%; P = .007). Furthermore, VC patients had lower ejection fraction (55 ± 14 vs 53 ± 25; P < .0001), worse diastolic function (E/e' 8.5 ± 4.6 vs 13.0 ± 7.1; P < .0001) and higher pulmonary artery pressure (29 ± 9 vs 37 ± 12; P < .0001). The association between VC and EF was not independent of etiology (p for VC 0.13), whereas the association with E/e' and PASP was independent in a full multivariate model (P < .0001 and P = .0002, respectively). CONCLUSION: Heart valve calcification patients were characterized by a worse functional and hemodynamic profile compared to patients with normal valve. The association between VC and diastolic function and PASP were independent in comprehensive multivariate models.

Lipid Lowering Treatment and Eligibility for PCSK9 Inhibition in Post-Myocardial Infarction Patients in Italy: Insights from Two Contemporary Nationwide Registries.

INTRODUCTION: The current use of lipid lowering therapies and the eligibility for proprotein convertase subtilisin/kexin-9 (PCSK9) inhibitors of patients surviving a myocardial infarction (MI) is poorly known. METHODS: Using the data from two contemporary, nationwide, prospective, real-world registries of patients with stable coronary artery disease, we sought to describe the lipid lowering therapies prescribed by cardiologists in patients with a prior MI and the resulting eligibility for PCSK9 inhibitors according to the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) and the Italian regulatory agency (Agenzia Italiana del Farmaco; AIFA) criteria. The study cohort was stratified according to the following low-density lipoprotein cholesterol (LDL-C) levels at the time of enrolment: <70 mg/dl; 70-99 mg/dl and ≥100 mg/dl. RESULTS: Among the 3074 post-MI patients with LDL-C levels available, a target level of LDL-C < 70 mg/dl was present in 1186 (38.6%), while 1150 (37.4%) had LDL-C levels ranging from 70 to 99 mg/dl and the remaining 738 (24.0%) an LDL-C ≥ 100 mg/dl. A statin was prescribed more frequently in post-MI patients with LDL-C levels <70 mg/dl (97.1%) compared to the other LDL-C groups (p < 0.0001). A low dose of statin was prescribed in 9.3%, while a high dose in 61.4% of patients. Statin plus ezetimibe association therapy was used in less than 18% of cases. In the overall cohort, 293 (9.8%) and 450 (22.2%) resulted eligible for PCSK9 inhibitors, according to ESC/EAS and AIFA criteria, respectively. CONCLUSIONS: Post-MI patients are undertreated with conventional lipid lowering therapies. A minority of post-MI patients would be eligible to PCSK9 inhibitors according to ESC/EAS guidelines and Italian regulatory agency criteria.

A retrospective multicenter study on long-term prevalence of chronic pain after cardiac surgery.

BACKGROUND: There are limited data on sternotomy as a cause of chronic postsurgical pain, mainly restricted to 1 year after surgery. AIMS: To assess the prevalence of chronic post-sternotomy pain and its interference on daily living. METHODS: In three groups of patients, a standardized telephone interview was obtained at 3 months (n = 313), 1 year (n = 313), and 3 years (n = 319) following the rehabilitation program after cardiac surgery, in 11 rehabilitation centers. Presence, site, and the severity and interference of pain on selected daily living items were assessed. RESULTS: The prevalence of pain after cardiac surgery was 35.3% in the 3-month group, 26.8% in the 1-year group, and 19.8% in the 3-year group (P < 0.0001). Pain in the 3-year group was rated as moderate to severe in one-third of the patients. In patients aged above 75 years, the prevalence of pain in the 3-month and the 3-year group was nonsignificantly different [34.2 and 29.3%, respectively (NS)]. In the 3-month group, pain was more frequent in the female (51.4%) than in the male patients (31.3%; P < 0.01); in the remaining groups, a comparable prevalence was documented. CONCLUSION: Results form this large, retrospective, multicenter survey indicated that one out of five patients still complain pain at 3 years after cardiac surgery; persistence of pain was more common in the older patients. The approach to management of chronic pain by cardiologists and cardiac surgeons should be improved.