Intravenous Iron Replacement Therapy Improves Cardiovascular Outcomes in Hemodialysis Patients.

BACKGROUND/AIM: More than half of deaths among hemodialysis patients are due to cardiovascular disease. This study examined whether intravenous administration of ferric carboxymaltose (FCM) has an impact on cardiovascular events in iron-deficient hemodialysis patients. PATIENTS AND METHODS: We performed a retrospective study concerning patients undergoing hemodialysis in our center from September 2016 to December 2019. We identified those who began FCM therapy (FCM group) during this period and those who did not (control group). We analyzed clinical, echocardiographic and laboratory parameters at the beginning (t0) and after one year (t1), to detect differences between the two groups. RESULTS: We identified 53 patients for the FCM group and 19 for the control group. Median follow-up was 1 year±3 months for both groups. In the FCM group, we observed a reduction in the doses of erythropoiesis-stimulating agents (ESA) (p<0.001) and a significative difference in cardiovascular events (p<0.01), but no differences in echocardiographic parameters. CONCLUSION: Patients who received FCM reached satisfactory values of transferrin saturation and ferritin, presented fewer coronary artery events and cardiovascular events, and could reduce doses of ESA.

[Idiopathic massive myocardial calcification: a rare cause of heart failure]. / Calcificazione miocardica massiva idiopatica: una rara causa di insufficienza miocardica.

Massive myocardial calcification is a very rare finding usually associated with previous myocardial infarction, ventricular aneurysms, myocarditis, endomyocardial fibrosis, tuberculosis and systemic metabolic disease such as sarcoidosis and primary hyperoxaluria. Rarely, it can be associated with idiopathic mitral annular calcification or rheumatic heart disease. We report an unusual case of massive myocardial calcification without other predisposing factors and with documented disease progression.

Clinical epidemiology, management and outcome of acute coronary syndromes in the Italian network on acute coronary syndromes (IN-ACS Outcome study).

BACKGROUND: The Italian network on acute coronary syndromes outcome (IN-ACS Outcome) study is a nationwide observational, multicenter study with the aim to describe clinical epidemiology, management, 30-days and one-year outcomes of ACS in Italy. METHODS: All consecutive patients admitted for ACS to 38 hospitals, between December 2005 and February 2007, were enrolled in the study. Patient in-hospital details and follow-up data at 30-days and one-year were collected using a web-based CRF and stored in a central database. RESULTS: A total of 6045 patients (age 68 ± 13 years) were enrolled: 2313 patients (38.3%) had ST elevation myocardial infarction (STEMI) and 3732 (61.7%) patients had NSTE-ACS. Primary PCI was performed in 1085 (46.9%) STEMI patients, thrombolysis in 590 (25.5%) patients, whereas 638 (27.6%) patients were not reperfused. Among patients with NSTE-ACS, coronary angiography was performed in 2797 (75%) patients, PCI in 1797 (48.2%) patients and CABG in 213 (5.7%) patients. Thirty-days and one-year mortality rates were 5.8% and 9.8%, in STEMI patients and 3.1% and 8.6%, in NSTE-ACS patients. CONCLUSIONS: The IN-ACS Outcome study showed that the management of ACS is still suboptimal. Although 30-days mortality is low, the one-year mortality is still substantial.

[Obesity and cardiovascular disease: expected and unexpected relationship]. / Obesità e patologie cardiovascolari: relazioni attese ed inattese.

In all forms of cardiovascular disease, prevalence, incidence, morbidity and mortality are strikingly increased in obese persons, i.e. with elevated Body Mass Index or visceral adiposity. The relative excess risk for coronary events, congestive heart failure and sudden death is 1.5, 2, and 2.8 higher, respectively. Nevertheless, a paradoxical protective effect of obesity has been observed in patients with chronic heart failure, who present a better cardiovascular prognosis, i.e. lower risk of mortality, myocardial infarction, cerebrovascular events and post-PTCA bleedings. Even in patients submitted to cardiac surgery, moderate obesity is not correlated to perioperative morbidity and mortality, although sternal infections, supraventricular arrhythmias, and bleedings are more frequent. In conclusion, obese patients should undergo routine cardiac evaluation to identify those at high risk of cardiovascular events, or those with unknown coronary artery disease or asymptomatic left ventricular dysfunction. Special care should be devoted to the treatment and cardiovascular follow-up of obese patients.