Trend of perceived quality of life and functional capacity in outpatients with chronic heart failure and in treatment with sacubitril/valsartan: a real-life experience.

BACKGROUND: Despite the use of optimal medical therapy, heart failure and reduced left ventricular ejection fraction (HFrEF) remains a leading cause of morbidity, mortality and health care costs. The introduction of angiotensin receptor/neprilysin inhibitors (ARNIs) had a revolutionary impact on the treatment of patients with HFrEF. The aim of the study was to monitor over time the perceived quality of life, the physical performance, the trend of BNP and NT-ProBNP and the NYHA functional class in patients with HFrEF during treatment with sacubitril/valsartan. METHODS: We enrolled 37 patients (63±10 years old, 76% men) who underwent a total of one-year follow-up. All patients underwent clinical evaluation, 6MWT, blood analysis (in particular, NT-pro-BNP and BNP, renal function test); Kansas City Cardiomyopathy Questionnaire (KCCQ) and the NYHA functional class assessment were also performed, at the beginning of the study and after 3, 6 and 12 months of therapy. RESULTS: We observed at each follow-up a significant improvement of KCCQ score, 6MWT, NT-ProBNP, BNP and NYHA class. However, analyzing the ∆% of variation of each single parameter, the improvement was not uniform in time. We also observed that only 37% of patients tolerated the full recommended dose of sacubitril/valsartan (97/103 mg b.i.d.); of the remaining, 40% tolerated the intermediate dose (49/51 mg b.i.d.) and 23% the minimum (24/26 md b.i.d.). CONCLUSIONS: Sacubitril/valsartan therapy improves significantly quality of life, physical effort resistance, BNP and NT-ProBNP and NYHA functional class in patients with HFrEF. Although not all the patients tolerated the maximum recommended dose, the beneficial effects were significant even at lower doses.

Cardiovascular Risk in Psoriasis: Current State of the Art.

Psoriasis (Pso) is a chronic inflammatory immune-mediated skin disease associated with several comorbidities. Despite the growing number of studies providing evidence for the link between Pso and Cardiovascular (CV) disorders, there are still many unsolved questions, dealing with the role of the skin disease as an independent risk factor for CV events, the influence of Pso severity and duration on CV damage, the presence of Psoriatic Arthritis (PsA) as a predictor of increased CV mortality and morbidity and the detection of reliable clinical, laboratory and/or instrumental parameters to stratify CV risk in psoriatic patients. Moreover, it remains to clarify if the early treatment of the dermatosis may lower CV risk. In this paper we will try to provide answers to these queries in the light of the updated data of the literature.