The Predictive Value of Plasma Brain Natriuretic Peptide and Galectin-3 in Elderly Patients Admitted for Heart Failure.

Galectin-3 is demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcomes in heart failure (HF) patients. The aim of this study was to analyze the value of a pre-discharged determination of galectin-3 alone and with brain natriuretic peptide (BNP) in predicting mid-term outcomes in elderly patients (>70 years old) discharged after an acute decompensated HF (ADHF) episode. METHODS: all elderly (≥70 years old) HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-min walking test (6MWT), and an echocardiogram within 48 h of hospital discharge. Cardiac death, cardiac transplantation, and worsening heart failure requiring readmission to hospital were considered cardiovascular events. RESULTS: 84 patients (63 males (75%), age 77.5 ± 5.9 years old) were analyzed (mean follow-up: 16.2 ± 12.3 months). During the follow-up, 45 events (53.6%) were scheduled (18 cardiac deaths, 27 re-hospitalizations for ADHF). HF patients who suffered an event demonstrated more impaired ventricular function (p = 0.04), higher value of BNP (p = 0.02), and Gal-3 at a pre-discharge evaluation (p = 0.05). By choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan⁻Meier curves depicted a powerful stratification using Galectin-3 > 17.6 ng/mL alone (log-rank 13.22; p = 0.0003), and by adding BNP + Gal-3, an even better result was obtained (log-rank 17.96; p < 0.00001). CONCLUSION: in an elderly population, by adding Gal-3 to BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

Role of Response-to-Diuretic in Predicting Prognosis in Discharged Heart Failure Patients After an Acute Decompensation.

BACKGROUND: The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure (ADHF) patients. The objectives of this clinical research, will aim are to: a) include diuresis in the formula for diuretic response (R-to-D); b) add to R-to-D the value of a pre-discharged determination of galectin-3 and BNP in predicting mid-term clinical outcome. METHODS: Consecutive patients discharged alive after an ADHF were enrolled. All patients underwent BNP and galectin-3, a 6 min walk test and an echocardiogram together with diuresis and body weight during diuretic administration. Death by any cause, cardiac transplantation and worsening HF requiring readmission to the hospital were considered cardiovascular events. RESULTS: 141 patients (98 males, age 73.8) were analysed (follow-up 17 months). During the follow-up 45 (31.9%) events were scheduled (19 cardiac deaths, 26 re-hospitalisation for HF). Patients who experienced CV-event had a worst renal function (p = 0.003), an higher BNP (p = 0.006) and galectin-3 (p = 0.008). At multivariate analysis, only R-to-D, galectin-3 and BNP showed a significant correlation with worst clinical prognosis (respectively p = 0.043; OR 6.01; p = 0.01; OR 8.9; p = 0.02 OR 10.38), independently of age and renal function. Kaplan-Meier curves depicted a powerful stratification using an R-to-D <1.2 kg/40 mg furosemide (log rank 10.96; p = 0.0009). Adding R-to-D<1.2 mg/40 mg furosemide to galectin-3>17.6 pg/mL and BNP>500 pg/mL the predictive value improved (log rank 23.59; p = 0.0001). CONCLUSION: Adding R-to-D to Gal-3 and BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study.

BACKGROUND: Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and their impact on reported driving mistakes. METHODS: A cross-sectional study was conducted using anonymous questionnaires. PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs (subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk driver. RESULTS: 161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84, P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001). CONCLUSIONS: Focusing prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while driving can reduce the possibility of driving errors on the road by about 5-6 times.

Seven years of workplace drug testing in Italy: A systematic review and meta-analysis.

In Italy, Workplace Drug Testing (WDT) has been compulsory by law for specific categories of workers since 2008, offering the opportunity to compare studies conducted within a single regulatory framework. The aims of this paper are to estimate the overall prevalence of WDT positivity (at screening survey) among Italian workers and evaluate the percentage of true and false positives at confirmation analysis. A systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to March 2015 was carried out, according to the MOOSE guidelines. A random effects model was utilized to calculate pooled prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis. The overall meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1-1.7%]. It was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5-1.5%), compared with a bench-top test (1.7%; 95% CI = 1.3-2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence estimate - calculated on positive cases - of 30% (95% CI = 16-44%). In Italy, the number of true positives at first-level workplace drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems advisable. Copyright © 2017 John Wiley & Sons, Ltd.

Role of galectin-3 and plasma B type-natriuretic peptide in predicting prognosis in discharged chronic heart failure patients.

Galectin-3 demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcome in heart failure (HF) patients. The objective of this study was to analyze the value of a predischarged determination of plasma galectin-3 alone and with plasma brain natriuretic peptide (BNP) in predicting mid-term outcome in frequent-flyers (FF) HF (≥2 hospitalization for HF/year)/dead patients discharged after an acute decompensated HF (ADHF) episode.All FF chronic HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-minute walk test, and an echocardiogram within 48 hours upon hospital discharge. Death by any cause, cardiac transplantation, and worsening HF requiring readmission to hospital were considered cardiovascular events.Eighty-three patients (67 males, age 73.2 ±â€Š8.6 years old) were analyzed (mean follow-up 11.6 ±â€Š5.2 months; range 4-22 months). During the follow-up 38 events (45.7%) were scheduled: (13 cardiac deaths, 35 rehospitalizations for ADHF). According to medical history, in 33 patients (39.8%) a definition of FF HF patients was performed (range 2-4 hospitalization/year). HF patients who suffered an event (FF or death) demonstrated more impaired ventricular function (P = 0.037), higher plasma BNP (P = 0.005), and Gal-3 at predischarge evaluation (P = 0.027). Choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan-Meier curves depicted the powerful stratification using BNP + Gal-3 in predicting clinical course at mid-term follow-up (log rank 5.65; P = 0.017).Adding Gal-3 to BNP, a single predischarge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

Poor weight control, alcoholic beverage consumption and sudden sleep onset at the wheel among Italian truck drivers: A preliminary pilot study.

OBJECTIVES: The aim of this study was to investigate the prevalence of obesity, alcoholic beverage consumption, unhealthy alcohol use and sudden sleep onset at the wheel among Italian truck drivers. In addition to prevalence rates, this study also aimed at investigating potential predictors for sudden-onset sleepiness and obesity. MATERIAL AND METHODS: A sample of truck drivers was extracted from the database of the High Risk Professional Driver Study. Data concerning demographics, anthropometry, medical information and working conditions were collected using anonymous questionnaires. Logistic regression analyses were performed to assess the association of the reported body mass index (BMI), alcohol consumption and sudden sleep onset with working conditions and general lifestyle factors. RESULTS: Three hundred and thirty-five questionnaires were collected. According to their BMI, 45% of the participants were overweight and 21.4% of them were obese. Twenty-four point two percent declared they drank alcoholic beverages during working hours or work breaks and 21.3% of the drivers had an Alcohol Use Disorders Identification Test Consumption (AUDIT C) score ≥ 5 (the threshold value for unhealthy alcohol use). Forty-one point six percent of the interviewees experienced one episode of sudden sleep onset at the wheel per month (5.5% per week and 0.9% daily). Predictive factors for obesity were: length of service (odds ratio (OR) = 1.09, confidence interval (95% CI): 1.04-1.15, p < 0.001) and the AUDIT C total score (OR = 1.34, 95% CI: 1.08-1.66, p = 0.008). Predictive factors for sudden-onset sleepiness at the wheel were: age > 55 years old (OR = 5.22, 95% CI: 1.29-21.1, p = 0.020), driving more than 50 000 km per year (OR = 2.89, 95% CI: 1.37-6.11, p = 0.006) and the Chalder Fatigue Questionnaire (CFQ) score > 11 (adjusted OR = 2.97, 95% CI: 1.22-7.21, p = 0.016). CONCLUSIONS: This study strongly emphasizes the need for intervention in order to reduce and prevent important risk factors for the sake of road safety and truck drivers' health.

Investigating obesity among professional drivers: the high risk professional driver study.

OBJECTIVE: The aim of this study is to detect the main individual and transportation factors associated with obesity and its prevalence among Italian professional drivers (PDs). METHODS: We performed a cross-sectional questionnaire survey. Data from PDs (n = 497) were used for analyses. RESULTS: Sixty-one percent of participants were either overweight or obese according to their body mass index. Predictive factors for obesity were traveling more than 40,000 miles per year (odds ratio [OR] 4.20, confidence interval [CI] 1.41-12.56) and hours spent behind the wheel per day (OR 1.27, CI 1.02-1.58). Bus drivers had half the risk of being obese compared to truck drivers (OR 0.45, CI 0.23-0.87). An inverse association was detected between educational attainment and obesity (OR 0.32, CI 0.11-0.90). CONCLUSIONS: PDs with high number of driving hours per day, miles driven per year, and low educational level should be subject to special educational programs to reduce and prevent obesity.

[CO detector: a tool for the early diagnosis of carbon monoxide intoxication and a personal protective equipment. The experience of the Emergency Medical Sevice (118) in the Province of Cuneo]. / Il Rilevatore di Monossido di Carbonio: uno strumento di sorveglianza ambientale e di protezione individuale nel soccorso pre-ospedaliero. L'esperienza del Servizio di Emergenza Sanitaria Territoriale (118) della Provincia di Cuneo.

BACKGROUND: Many people are poisoned by carbon monoxide (CO) each year, either intentionally (e.g. suicide attempts) or by accident. In the prehospital care the early diagnosis is primary for a correct treatment with high flow of oxygen and for the appropriate hospitalization of the patient. The aim of this study is to detect the main factors associated with CO poisoning in our area and to evaluate the role of CO detector in the prehospital setting. METHODS: From 1 January 2012 to 1 May 2013, all cases of carbon monoxide poisoning, recorded by the Emergency Medical Service (118) in the Province of Cuneo, were analyzed. RESULTS: Seventy clinical cases were collected, 68.5% of poisonings occurred in the months of December, January and February. Boilers were found to be the main source of indoor CO poisoning (average CO concentration of 66.78 versus 32.92 ppm generated by other heating systems, p = 0.004). CO detector was used in 77.4% of cases. The prehospital diagnosis was properly made in 96% (48/50) of cases in which CO detector was used, versus 70% (14/20) of correct clinical assessment without its use (p = 0.005). CONCLUSIONS: The CO detector is not only a personal protective equipment for Emergency Medical Service operators, but it contributes significantly to increase prehospital diagnosis of CO poisoning, thus suggesting its use in all emergency services in the national territory.

Falling asleep at the wheel among Italian professional drivers (PDs): results from the HiRis PD study.

OBJECTIVES: A high percentage of professional drivers (PDs) often report feeling fatigue during their work, and falling asleep at the wheel (FAW) is a major contributing factor to the occurrence of near-miss or actual accidents. The aim of this study is to evaluate the prevalence of FAW among Italian PDs and the effect of fatigue on this occurrence (corrected for the main predictive factors already known). MATERIAL AND METHODS: We performed a cross-sectional questionnaire survey. Data from PDs (N = 497) were used for analyses. Logistic regression analyses were performed to assess the association of reported sudden-onset sleep at the wheel with working conditions and general lifestyle factors. RESULTS: Forty-one percent of the interviewees experienced at least 1 episode per month of sudden-onset sleep at the wheel (4.7% per week). Predictive factors of self-reported FAW were: age > 55 years old (odds ratio (OR) = 4.91, confidence interval (CI): 1.79-13.50, p < 0.01), traveling more than 40 thousand miles per year (OR = 1.86, 95% CI: 1.08-3.22, p < 0.05), body mass index ≥ 30 (OR = 2.16, 95% CI: 1.01-4.64, p < 0.05) and Chalder Fatigue Questionnaire score > 22 (OR = 3.93, 95% CI: 1.90-8.14, p < 0.01). CONCLUSIONS: There are different work and human factors underlying FAW among PDs. The Chalder Fatigue Questionnaire might be useful in measuring fatigue in this group and in detecting PDs at high risk of experiencing FAW.

Workplace drug testing and alcohol policy in Italy; there is still a long way to go.

The effectiveness of workplace drug testing (WDT) in Italy has recently been questioned, while very little is known about the real consumption of alcoholic beverages among workers performing hazardous jobs, such as professional drivers (PDs). The aim of this study is to investigate the modality and frequency of WDT execution and of alcohol consumption in the above category. Anonymous questionnaires were used to collect information. Four hundred and ninety-seven questionnaires were collected; 50.1% declared that they know well in advance when they will be subjected to screening tests for drugs, while 19.5% claimed they have never been subjected to such a test. The greater the number of employees in a company, the greater the likelihood that the tests are performed with a genuinely surprise effect [odds ratio (OR) 2.41, 5.39 and 9.07, respectively, for businesses with 5-14 employees, 15-50 and more than 50, compared with companies with less than 5 employees, p < 0.01]. Twenty-one point four percent declared they drink alcoholic beverages during working hours or work breaks. This attitude is positively correlated with driver seniority [OR 1.07, 95% confidence interval (CI) 1.03-1.11 p < 0.01] and is more common in those who operate on mainly international routes (OR 3.34 CI 1.30-8.59 p < 0.01) and only occasionally consume meals in restaurants (OR 4.27, CI 1.19-15.42 p < 0.05). Fifteen percent of the participants have an AUDIT C score ≥ 5. In conclusion WDT is largely ineffective, particularly in small businesses. The high percentage of PDs who claim to drink during working hours and who are hazardous drinkers requires a further strengthening of prevention strategies in this area.

Oxygen pulse as a predictor of cardiopulmonary events in lung resection.

Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.8 +/-8.1 years who underwent lung resection after a cardiopulmonary exercise test. During basal spirometry, the mean predicted forced expiratory volume in the first second was 69.9% +/-18.6%, and predicted carbon monoxide diffusing capacity was 71.6% +/-20.5%. Peak oxygen consumption was 11.1 +/-3.2 mL.kg(-1).min(-1), oxygen pulse was 9 +/-2.8 mL.beat(-1), and minute ventilation/CO(2) output was 45.2 +/- 7.7. Mean hospital stay was 10.4 days, and intensive care unit stay was 0.3 days. Postoperative complications occurred in 20 (20%) patients. On multivariate analysis, body mass index, a high level of exercise achieved during the cardiopulmonary exercise test, lower heart rate at peak exercise, and oxygen pulse correlated significantly with better postoperative outcome. Cardiopulmonary exercise tests are helpful for stratifying patients undergoing thoracic surgery. Perioperative complications seem to be strongly related to left ventricular function and physical performance.

Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure.

To date, the role of CPET (cardiopulmonary exercise testing) for risk stratification in elderly patients with HF (heart failure) with depressed or preserved ventricular function has not been evaluated. In the present study, we analysed whether CPET is useful in predicting outcome in this population. A total of 220 NYHA (New York Heart Association) class I-III patients with HF > or =70 years of age [median age, 75 years; 23% had NYHA class III; and 59% had preserved ventricular systolic function (left ventricular ejection fraction > or =40%)] performed maximal CPET (peak expiratory exchange ratio >1.00). Median peak oxygen uptake was 11.9 ml.kg(-1) of body weight.min(-1), median VE/VCO(2) slope (slope of the minute ventilation/carbon dioxide production ratio) was 33.2 and 45% had an EVR (enhanced ventilatory response) to exercise (VE/VCO(2) slope > or =34). During 19 months of follow-up, 94 patients (43%) met the combined end point of death and hospital admission for worsening HF, arrhythmias or acute coronary syndromes. By Cox multivariable analysis, a creatinine clearance of <50 ml/min {HR (hazard ratio), 1.657 [95% CI (confidence interval), 1.055-2.602]} and EVR [HR, 1.965 (95% CI, 1.195-3.231)] were the best predictors of outcome, while ventricular function had no influence on prognosis. In conclusion, in elderly patients with HF, a steeper VE/VCO(2) slope provides additional information for risk stratification across the spectrum of ventricular function and identifies a high-risk population, commonly not considered in exercise testing guidelines.

Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study.

BACKGROUND: The precise etiology of takotsubo cardiomyopathy remains unclear. The study of myocardial blood flow (MBF) and coronary flow reserve (CFR) by use of positron emission tomography might help in understanding this syndrome. METHODS AND RESULTS: Three postmenopausal women underwent adenosine/rest perfusion with nitrogen 13 ammonia and metabolism with fluorine 18 fluorodeoxyglucose positron emission tomography, coronary angiography, cardiac magnetic resonance, and echocardiography in the acute phase of takotsubo cardiomyopathy and at 3 months' follow-up, after normalization of left ventricular function. PET study was performed in 2 parts: the perfusion analysis with nitrogen ammonia and the metabolism of the heart using FDG. MBF and CFR were analyzed quantitatively in the acute phase and at follow-up. The images highlighted the impairment of tissue metabolism in the dysfunctioning left ventricular segments in the acute phase, mainly in the apical segments and progressively less in the medium segments. At the same time, a clear inverse metabolic/perfusion mismatch emerged, which normalized 3 months later. The quantitative analysis of MBF showed a reduction in the acute phase in apical segments in comparison to basal segments without differences between midventricular and basal segments. In the acute phase CFR proved to be reduced in apical versus basal segments. CFR impairment of apical segments recovered completely after 3 months. CONCLUSION: The acute phase of takotsubo cardiomyopathy is characterized by an inverse perfusion/metabolism mismatch with a reduction in CFR in the apical segments. However, the impairment of CFR and the reduction of metabolism in the apical segments recovered completely after 3 months.

Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report.

INTRODUCTION: Delayed-enhancement magnetic resonance imaging (DE-MRI) has been recently proposed as an alternative tool in identifying myocardial viability and transmural distribution of necrosis in the myocardium. CASE PRESENTATION: We describe a case of a 71-year-old man admitted for ischemic-like chest pain in which DE-MRI and post-nitrate 99mTc-tetrofosmin myocardial scintigraphy equally contributed to the diagnosis of previous lateral myocardial infarction. CONCLUSION: In this patient with coronary artery disease, the absence of uptake of tracer at myocardial scintigraphy appeared to be closely correlated to DE-MRI data. Cardiologists can use SPECT or DE-MRI to obtain similar information about myocardial viability.

Correlation between cognitive impairment and prognostic parameters in patients with congestive heart failure.

BACKGROUND: Cognitive impairment has been observed in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients with neuropsychological tests attempting to correlate the results with prognostic parameters. METHODS: All subjects underwent a mini-mental state examination (MMSE), memory and learning tests (Corsi Block-tapping test, Verbal Span test, Prose Memory test, Visual Search), anxiety and depression scale test. New York Hospital Association (NYHA) class, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were evaluated. RESULTS: Sixty patients (mean age 65.5 years) were analyzed. NYHA class was 2.9 +/- 0.9, LVEF was 32.9 +/- 13.7%, BNP plasma level 683.3 +/- 864.3 pg/mL. In 23.3% of cases a pathological MMSE score emerged; memory and learning test results were abnormal in 3.4-37%. A positive correlation between MMSE and age (r = 0.18, p = 0.01), BNP (r = 0.25, p = 0.02) was observed but not between MMSE and years of education, NYHA class and LVEF. The Corsi Block-tapping test was related to educational duration (r = 0.12, p = 0.02) with a positive trend for BNP (r = 0.2, p = 0.07). The Prose Memory test and Visual Search were influenced by the patients' educational level (r = 0.36, p = 0.0001; r = 0.27, p = 0.0001). CONCLUSIONS: CHF patients manifest an impairment of MMSE and memory and learning test performance. In our population MMSE correlates to plasma BNP and advanced age.