Additional Prognostic Value of EAS index in predicting the occurrence of rehospitalizations in chronic heart failure: data from the Daunia Heart Failure Registry.

BACKGROUND: Tissue Doppler imaging (TDI) may be useful in identifying subjects at higher risk among patients with chronic heart failure (CHF). The clinical role of newly developed TDI parameters, however, still needs to be documented. METHODS: A total of 287 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and were followed prospectively for a median 255 (204-316) days. Conventional echocardiography and TDI parameters were calculated. We also quantified by TDI a combined index (EAS index) of diastolic and systolic performance E'/(A'xS') and assessed its possible additional prognostic role in combination with 'traditional' parameters such as left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). RESULTS: Subjects readmitted for worsening HF were characterized by higher levels of EAS index (median 0·14 (95% C.I. 0·12-0·21) vs. 0·11 (0·10-0·12, P < 0·05)). Increased rates of rehospitalization were found in subjects with EAS index >median (0·115) (21% vs. 10%, P < 0·05); higher EAS index values predicted the incidence of readmissions for worsening HF during follow-up, even at multivariable analysis. The assessment of EAS index in addition to LVEF and MPI showed an adjunctive prognostic value (log-rank P < 0·001 and P < 0·05, respectively). CONCLUSIONS: EAS index assessed by TDI may be helpful in predicting the risk of rehospitalizations in subjects with CHF. EAS index may represent an independent adjunctive tool for the risk stratification of patients with CHF in addition to 'traditional' tools such as LVEF or MPI.

Tissue Doppler Imaging predicts central sleep apnea in patients with chronic heart failure: data from the Daunia Registry.

BACKGROUND: Tissue Doppler imaging (TDI) is used to improve risk stratification in patients with chronic heart failure (CHF). So far, few studies have used this method to investigate the characteristics of subjects with CHF and Cheyne-Stokes breathing (CSB). The aim of this study was therefore to evaluate whether TDI assessment may predict the presence of CSB in patients with CHF. MATERIALS AND METHODS: A total of 41 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and nocturnal polygraphy to evaluate the presence of sleep apnea and CSB. Conventional echocardiography and TDI parameters were calculated. We have also quantified by TDI a combined index (EAS index) of diastolic and systolic performance: E'/(A' × S'). RESULTS: Subjects with evidence of CSB (N = 8) were characterized by lower values of A' (5·03 ± 2·64 vs. 7·88 ± 2·64 cm/s, P < 0·01). A' and EAS index values were related to Cheyne-Stokes episode rates (r = -0·49 and 0·52, P < 0·05 and <0·01 respectively), EAS index values also with the number of episodes of central apnea (r = 0·39, P < 0·05). A' values predicted the presence of CSB at poly-somnography examination with an OR 0·62 (95% CI 0·40-0·96, P < 0·05) even after correction for age and gender. CONCLUSIONS: Tissue Doppler imaging values (A') are associated with the presence of sleep apnea at nocturnal polygraphy.

Peak myocardial acceleration during isovolumic relaxation time predicts the occurrence of rehospitalization in chronic heart failure: data from the Daunia heart failure registry.

BACKGROUND: Tissue Doppler imaging (TDI) may be useful in identifying subjects at higher risk among patients with chronic heart failure (CHF). The clinical role of new developed TDI parameters, however, still needs to be documented. METHODS: A total of 113 consecutive patients with CHF enrolled in the Daunia heart failure registry underwent echocardiography assessment and were followed prospectively for 234 ± 262 days. Conventional echocardiography and TDI parameters were calculated. We also calculated peak myocardial acceleration during isovolumic relaxation time (pIVA[r]) derived from TDI (pIVV(r)/AT). RESULTS: Subjects readmitted for worsening HF were characterized by lower levels of pIVA(r) (0.8 ± 0.3 vs. 1.3 ± 0.5 m/s(2) , P < 0.001). pIVA(r) levels predicted the incidence of readmission for worsening HF during follow-up (HR 0.78, 95% confidence interval 0.64-0.96, P < 0.05), even after multivariable analysis. The assessment of pIVA(r) in addition to left ventricular ejection fraction (LVEF) and E/E' provided additional prognostic value (Log Rank P < 0.05). The presence of abnormal pIVA(r), LVEF, and E/E' levels identified subjects with a higher risk of hospitalization for worsening dyspnea during follow-up than those with 2 abnormal marker levels or 0-1 (Log Rank P < 0.05). CONCLUSIONS: Peak myocardial acceleration during isovolumic relaxation time may represent an independent adjunctive tool for the risk stratification of patients with CHF.

Bioresorbable coronary stent for the treatment of complex coronary lesions: Data from an all-comer registry.

BACKGROUND: The study aimed to report the results from an all-comers registry of patients undergoing coronary angioplasty and treated with bioresorbable vascular scaffold (BVS). METHODS: Fifty-five consecutive patients with type B/C coronary lesions according to the AHA classification and treated with BVS were enrolled in the study. The clinical and procedural characteristics of enrolled patients were recorded. Fifty-five consecutive subjects with coronary lesions type B/C treated with everolimus eluting stent (EES) were used as control group. RESULTS: The incidence of adverse events was not statistically significant comparing subjects treated with BVS with those treated with EES. Non significant differences were also found in the follow-up considering the presence of diabetes, multivessel disease, use of more than one stent at the same time, diagnosis (STEMI vs UA/NSTEMI), use of coronary stents in overlapping. The differences were significant considering the type of lesion (Log-Rank p<0.05), stenoses treated in correspondence of a coronary bifurcation (p<0.05), the SYNTAX score (cut off 22) (p<0.001); after multivariable correction for age and gender, however, differences remained significant only for SYNTAX score. CONCLUSIONS: The use of BVS in an all-comers registry of patients undergoing coronary angioplasty on complex coronary lesions is associated with a safety profile comparable to that obtained with EES; the use of BVS in particular conditions, such as very high SYNTAX score, should be further assessed.

Transient apical ballooning accompanying respiratory infection.

We report the case of a 75-year-old man, referred for worsening dyspnea and fever. The electrocardiography (ECG) showed mild ST-elevation in anterior leads, while cardiac echography severe left ventricular (LV) systolic dysfunction with apical ballooning. Later on, ECG showed negative T-waves and QT-prolongation in the same anterior leads and T-waves positivization during fever peak. Ten days later, LV ejection fraction completely recovered, apical ballooning and fever disappeared. We, therefore, hypothesize that transient apical ballooning found in our patient may have been induced by a respiratory infection, not detectable at seriate blood cultures.