Available and unavailable decoys in capuchin monkeys (Sapajus spp.) decision-making.

Decision-making has been observed to be systematically affected by decoys, i.e., options that should be irrelevant, either because unavailable or because manifestly inferior to other alternatives, and yet shift preferences towards their target. Decoy effects have been extensively studied both in humans and in several other species; however, evidence in non-human primates remains scant and inconclusive. To address this gap, this study investigates how choices in capuchin monkeys (Sapajus spp.) are affected by different types of decoys: asymmetrically dominated decoys, i.e., available and unavailable options that are inferior to only one of the other alternatives, and phantom decoys, i.e., unavailable options that are superior to another available alternative. After controlling for the subjective strength of initial preferences and the distance of each decoy from its target in attribute space, results demonstrate a systematic shift in capuchins' preference towards the target of both asymmetrically dominated decoys (whether they are available or not) and phantom decoys, regardless of what options is being targeted by such decoys. This provides the most comprehensive evidence to date of decoy effects in non-human primates, with important theoretical and methodological implications for future comparative studies on context effects in decision-making.

Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem.

Hyperkalaemia is one of the most common electrolyte disorders in patients with cardiovascular disease (CVD). The true burden of hyperkalaemia in the real-world setting can be difficult to assess, but in population-based cohort studies up to 4 in 10 patients developed hyperkalaemia. In addition to drugs interfering with potassium metabolism and food intake, several conditions can cause or worsen hyperkalaemia, such as advanced age, diabetes, and chronic kidney disease. Mortality, cardiovascular morbidity, and hospitalisation are higher in patients with hyperkalaemia. Hyperkalaemia represents a major contraindication or a withholding cause for disease-modifying therapies like renin-angiotensin-aldosterone inhibitors (RAASi), mainly mineralocorticoid receptor antagonists. Hyperkalaemia can be also classified as acute and chronic, according to the onset. Acute hyperkalaemia is often a life-threatening emergency requiring immediate treatment to avoid lethal arrhythmias. Therapy goal is cell membrane stabilisation by calcium administration, cellular intake, shift of extracellular potassium to the intracellular space (insulin, beta-adrenergic agents, sodium bicarbonate), and increased elimination with diuretics or dialysis. Chronic hyperkalaemia was often managed with dietary counselling to prevent potassium-rich food intake and tapering of potassium-increasing drugs, mostly RAASi. Sodium polystyrene sulphonate, a potassium binder, was the only therapeutic option. Recently, new drugs such as patiromer and sodium zirconium cyclosilicate give new opportunities for the treatment of hyperkalaemia, as they proved to be safe, well tolerated, and effective. Aim of this review is to describe the burden of hyperkalaemia in cardiovascular patients, its direct and indirect effects, and the therapeutic options now available in the acute and chronic setting.

I want to be safe: understanding the main drivers behind vaccination choice throughout the pandemic.

BACKGROUND: Despite being a major advancement in modern medicine, vaccines face widespread hesitancy and refusal, posing challenges to immunization campaigns. The COVID-19 pandemic accentuated vaccine hesitancy, emphasizing the pivotal role of beliefs in efficacy and safety on vaccine acceptance rates. This study explores the influence of efficacy and safety perceptions on vaccine uptake in Italy during the pandemic. METHODS: We administered a 70-item questionnaire to a representative sample of 600 Italian speakers. Participants were tasked with assessing the perceived effectiveness and safety of each vaccine dose, along with providing reasons influencing their vaccination choices. Additionally, we conducted an experimental manipulation, exploring the effects of four framing messages that emphasized safety and/or efficacy on participants' willingness to receive a hypothetical fourth vaccine dose. Furthermore, participants were asked about their level of trust in the scientific community and public authorities, as well as their use of different information channels for obtaining COVID-19-related information. RESULTS: Our study reveals a dynamic shift in vaccine efficacy and safety perceptions throughout the COVID-19 pandemic, potentially influencing vaccination compliance. Initially perceived as more effective than safe, this assessment reversed by the time of the third dose. Beliefs regarding safety, rather than efficacy, played a significant role in anticipating future vaccinations (e.g., the booster dose). Safety-focused messages positively affected vaccination intent, while efficacy-focused messages showed limited impact. We also observed a changing trend in reasons for vaccination, with a decline in infection-related reasons and an increase in social related ones. Furthermore, trust dynamics evolved differently for public authorities and the scientific community. CONCLUSIONS: Vaccine perception is a dynamic process shaped by evolving factors like efficacy and safety perceptions, trust levels, and individual motivations. Our study sheds light on the complex dynamics that underlie the perception of vaccine safety and efficacy, and their impact on willingness to vaccinate. We discuss these results in light of bounded rationality, loss aversion and classic utility theory.

The golden hour in shock management: do a lot, do it quickly.

Cardiogenic shock can be defined as a state of inadequate organ perfusion linked primarily to cardiac pump dysfunction. The two predominant causes of this condition are acute myocardial infarction and acutely decompensated heart failure (ADHF). In recent years, a significant increase in cases of cardiogenic shock from ADHF has been described. Recent evidence has defined that the factors with the greatest impact on the prognosis in this context are the early clinical assessment, the definition of the aetiology, the timely application of pharmacological therapies, or individualized mechanical supports for the circulation. Haemodynamic monitoring can help in the phenotyping of cardiogenic shock and therefore guide therapeutic choices, especially if implemented with the aid of advanced monitoring tools such as the Swan-Ganz catheter. Finally, the presence of a dedicated shock team in the 'hub' centres is fundamental, which facilitates the choice of the best therapeutic strategy on a case-by-case basis.

Real is the new sexy: the influence of perceived realness on self-reported arousal to sexual visual stimuli.

As state-of-art technology can create artificial images that are indistinguishable from real ones, it is urgent to understand whether believing that a picture is real or not has some import over affective phenomena such as sexual arousal. Thus, in two pre-registered online studies, we tested whether 60 images depicting models in underwear elicited higher self-reported sexual arousal when believed to be (N = 57) or presented as (N = 108) real photographs as opposed to artificially generated. In both cases, Realness correlated with significantly higher scores on self-reported sexual arousal. Consistently with the literature on downregulation of emotional response to fictional works, our result indicates that sexual images that are perceived to be fake are less arousing than those believed to portray real people.

Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.

BACKGROUND: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. METHODS: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM. RESULTS: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). CONCLUSIONS: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.

Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: A dual-center experience.

INTRODUCTION: The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. We conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT). METHODS: We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n = 14) or recurrent VT (n = 7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n = 9). The associations of peak-to-peak maximum standard bipolar (BVc ) and minibipolar (PentaRay, BVp ) with microbipolar (BVµMax ) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (µBE) electrograms in sinus rhythm at sites of termination with radiofrequency energy. RESULTS: BVµMax was moderately associated with both BVc (ß = .85, p < .01) and BVp (ß = .56, p < .01). BVµMax was 0.98 (95% CI: 0.93-1.04, p < .01) mV larger than corresponding BVc , and 0.27 (95% CI: 0.16-0.37, p < .01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm2 , p < .01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm2 , p = .03) regions in microbipolar maps compared to standard bipolar maps. Late potentials areas were nonsignificantly greater in microelectrode maps, compared to standard electrode maps. At sites of VT termination (n = 14), µBE were of higher amplitude (0.9 [0.8] vs. 0.4 [0.2] mV, p < .01), longer duration (117 [66] vs. 74 [38] ms, p < .01), and with greater number of peaks (4 [2] vs. 2 [1], p < .01) in sinus rhythm compared to BE. CONCLUSION: microelectrode mapping is more sensitive than standard bipolar mapping in the identification of viable myocytes in SR, and may facilitate recognition of targets for CA.

Context-effect bias in capuchin monkeys (Sapajus spp.): exploring decoy influences in a value-based food choice task.

Decision making is known to be liable to several context effects. In particular, adding a seemingly irrelevant alternative (decoy) to a set of options can modify preferences: typically, by increasing choices towards whatever option clearly dominates the decoy (attraction effect), but occasionally also decreasing its appeal and generating a shift in the opposite direction (repulsion effect). Both types of decoy effects violate rational choice theory axioms and suggest dynamic processes of preference-formation, in which the value of each alternative is not determined a priori, but it is instead constructed by comparing options during the decision process. These effects are well documented, both in humans and in other species: e.g., amoebas, ants, honeybees, frogs, birds, cats, dogs. However, evidence of decoy effects in non-human primates remains surprisingly mixed. This study investigates decoy effects in capuchin monkeys (Sapajus spp.), manipulating time pressure across different conditions, to test whether such effects require time-consuming comparative processes among available alternatives. Whereas the time-dependent nature of decoy effects is a robust finding in the human literature, this is its first investigation in non-human animals. Our results show that capuchins exhibit an attraction effect with decoys targeting their preferred food, and that this effect disappears under time pressure; moreover, we observe preliminary evidence of a repulsion effect when decoys target instead the less-preferred food, possibly due to the larger distance between decoy and target in the attribute space. Taken together, these results provide valuable insight on the evolutionary roots of comparative decision making.

Acute heart failure: differential diagnosis and treatment.

Acute heart failure is a heterogeneous clinical syndrome and is the first cause of unplanned hospitalization in people >65 years. Patients with heart failure may have different clinical presentations according to clinical history, pre-existing heart disease, and pattern of intravascular congestion. A comprehensive assessment of clinical, echocardiographic, and laboratory data should aid in clinical decision-making and treatment. In some cases, a more accurate evaluation of patient haemodynamics via a pulmonary artery catheter may be necessary to undertake and guide escalation and de-escalation of therapy, especially when clinical, echo, and laboratory data are inconclusive or in the presence of right ventricular dysfunction. Similarly, a pulmonary artery catheter may be useful in patients with cardiogenic shock undergoing mechanical circulatory support. With the subsequent de-escalation of therapy and haemodynamic stabilization, the implementation of guideline-directed medical therapy should be pursued to reduce the risk of subsequent heart failure hospitalization and death, paying particular attention to the recognition and treatment of residual congestion.

A Novel Transformer-Based IMU Self-Calibration Approach through On-Board RGB Camera for UAV Flight Stabilization.

During flight, unmanned aerial vehicles (UAVs) need several sensors to follow a predefined path and reach a specific destination. To this aim, they generally exploit an inertial measurement unit (IMU) for pose estimation. Usually, in the UAV context, an IMU entails a three-axis accelerometer and a three-axis gyroscope. However, as happens for many physical devices, they can present some misalignment between the real value and the registered one. These systematic or occasional errors can derive from different sources and could be related to the sensor itself or to external noise due to the place where it is located. Hardware calibration requires special equipment, which is not always available. In any case, even if possible, it can be used to solve the physical problem and sometimes requires removing the sensor from its location, which is not always feasible. At the same time, solving the problem of external noise usually requires software procedures. Moreover, as reported in the literature, even two IMUs from the same brand and the same production chain could produce different measurements under identical conditions. This paper proposes a soft calibration procedure to reduce the misalignment created by systematic errors and noise based on the grayscale or RGB camera built-in on the drone. Based on the transformer neural network architecture trained in a supervised learning fashion on pairs of short videos shot by the UAV's camera and the correspondent UAV measurements, the strategy does not require any special equipment. It is easily reproducible and could be used to increase the trajectory accuracy of the UAV during the flight.

Facial impression of trustworthiness biases statement credibility unless suppressed by facemask.

The impression of trustworthiness based on someone's facial appearance biases our subsequent behavior toward that subject in a variety of contexts. In this study, we investigated whether facial trustworthiness also biases the credibility of utterances associated with that face (H1). We explored whether this bias is mitigated by utterances eliciting reasoning, i.e. explanations (as opposed to factual statements; H2). Moreover, we hypothesized that overimposing facemasks on those faces could enhance/reduce utterance credibility due to social value of mask-wearing (H3), and that facemasks could counter the putative credibility bias introduced by facial trustworthiness (H4). If so, this may be either because facemasks remove the visual information necessary for trustworthiness impression (H4a), or because information is less salient, although it can be retrieved under different circumstances (H4b). An online study (N = 159) was conducted to test these hypotheses. In the first task, subjects saw 48 facial pictures coupled with one utterance and judged the truthfulness/falsity of this utterance. In the second task, they saw again 16 of the faces from the previous tasks and were asked to recall whether the associated utterance was true or false. Findings from the first task support H1 and H4, but not H2 and H3. However, in the second task, where the face is the only available cue, the credibility-mitigation bias exerted by facemask disappears, supporting H4b over H4a. Our results confirm the pervasivity of facial trustworthiness impressions in social cognition, and suggest that facemask can mitigate them, or at least their salience. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-022-03277-7.

ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock.

The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

Optimising Speaker-Dependent Feature Extraction Parameters to Improve Automatic Speech Recognition Performance for People with Dysarthria.

Within the field of Automatic Speech Recognition (ASR) systems, facing impaired speech is a big challenge because standard approaches are ineffective in the presence of dysarthria. The first aim of our work is to confirm the effectiveness of a new speech analysis technique for speakers with dysarthria. This new approach exploits the fine-tuning of the size and shift parameters of the spectral analysis window used to compute the initial short-time Fourier transform, to improve the performance of a speaker-dependent ASR system. The second aim is to define if there exists a correlation among the speaker's voice features and the optimal window and shift parameters that minimises the error of an ASR system, for that specific speaker. For our experiments, we used both impaired and unimpaired Italian speech. Specifically, we used 30 speakers with dysarthria from the IDEA database and 10 professional speakers from the CLIPS database. Both databases are freely available. The results confirm that, if a standard ASR system performs poorly with a speaker with dysarthria, it can be improved by using the new speech analysis. Otherwise, the new approach is ineffective in cases of unimpaired and low impaired speech. Furthermore, there exists a correlation between some speaker's voice features and their optimal parameters.

An Easily Integrable Industrial System for Gamma Spectroscopic Analysis and Traceability of Stones and Building Materials.

In the building material and stones market, lots of restrictions are coming in different world zones. In Europe, a recent regulatory set up the maximum level of radiological emissions for materials intended for use in public and private building structures. For this reason, companies need to have a very efficient radiological measurements system in their production chain, in order to respect all the rules and to be competitive in the world market. This article describes CORSAIR, a Cloud-Oriented Measurement System for Radiological Investigation and Traceability of Stones. Our cyber-physical system consists of sensing nodes network connected to a data collection gateway through LoRaWAN protocol, and interfaces with a centralized cloud application. CORSAIR introduces a fast, repeatable, real-time and non-destructive method to measure radiological emissions and other parameters of each single building material item, uniquely identified by an applied RFID tag. The validity of this system is confirmed by in-situ measurement campaign compared with high-precision laboratory analysis. The results demonstrate the accuracy of the CORSAIR sensor and the possibility to easily integrate it in the company production chain without any change.

An interactive and low-cost full body rehabilitation framework based on 3D immersive serious games.

Strokes, surgeries, or degenerative diseases can impair motor abilities and balance. Long-term rehabilitation is often the only way to recover, as completely as possible, these lost skills. To be effective, this type of rehabilitation should follow three main rules. First, rehabilitation exercises should be able to keep patient's motivation high. Second, each exercise should be customizable depending on patient's needs. Third, patient's performance should be evaluated objectively, i.e., by measuring patient's movements with respect to an optimal reference model. To meet the just reported requirements, in this paper, an interactive and low-cost full body rehabilitation framework for the generation of 3D immersive serious games is proposed. The framework combines two Natural User Interfaces (NUIs), for hand and body modeling, respectively, and a Head Mounted Display (HMD) to provide the patient with an interactive and highly defined Virtual Environment (VE) for playing with stimulating rehabilitation exercises. The paper presents the overall architecture of the framework, including the environment for the generation of the pilot serious games and the main features of the used hand and body models. The effectiveness of the proposed system is shown on a group of ninety-two patients. In a first stage, a pool of seven rehabilitation therapists has evaluated the results of the patients on the basis of three reference rehabilitation exercises, confirming a significant gradual recovery of the patients' skills. Moreover, the feedbacks received by the therapists and patients, who have used the system, have pointed out remarkable results in terms of motivation, usability, and customization. In a second stage, by comparing the current state-of-the-art in rehabilitation area with the proposed system, we have observed that the latter can be considered a concrete contribution in terms of versatility, immersivity, and novelty. In a final stage, by training a Gated Recurrent Unit Recurrent Neural Network (GRU-RNN) with healthy subjects (i.e., baseline), we have also provided a reference model to objectively evaluate the degree of the patients' performance. To estimate the effectiveness of this last aspect of the proposed approach, we have used the NTU RGB + D Action Recognition dataset obtaining comparable results with the current literature in action recognition.

ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care.

Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment. In conclusion, This guidance document details roles and interactions of cardiology specialists, so as to best exploit the added value of their input in the care of HF patients and is intended to promote a more efficient and effective organization of HF services.

Spatio-Temporal Image-Based Encoded Atlases for EEG Emotion Recognition.

Emotion recognition plays an essential role in human-human interaction since it is a key to understanding the emotional states and reactions of human beings when they are subject to events and engagements in everyday life. Moving towards human-computer interaction, the study of emotions becomes fundamental because it is at the basis of the design of advanced systems to support a broad spectrum of application areas, including forensic, rehabilitative, educational, and many others. An effective method for discriminating emotions is based on ElectroEncephaloGraphy (EEG) data analysis, which is used as input for classification systems. Collecting brain signals on several channels and for a wide range of emotions produces cumbersome datasets that are hard to manage, transmit, and use in varied applications. In this context, the paper introduces the Empátheia system, which explores a different EEG representation by encoding EEG signals into images prior to their classification. In particular, the proposed system extracts spatio-temporal image encodings, or atlases, from EEG data through the Processing and transfeR of Interaction States and Mappings through Image-based eNcoding (PRISMIN) framework, thus obtaining a compact representation of the input signals. The atlases are then classified through the Empátheia architecture, which comprises branches based on convolutional, recurrent, and transformer models designed and tuned to capture the spatial and temporal aspects of emotions. Extensive experiments were conducted on the Shanghai Jiao Tong University (SJTU) Emotion EEG Dataset (SEED) public dataset, where the proposed system significantly reduced its size while retaining high performance. The results obtained highlight the effectiveness of the proposed approach and suggest new avenues for data representation in emotion recognition from EEG signals.

Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction.

Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging and it could require different tests, some of which are affected by limited availability. Nowadays, considering that new therapies are available for HFpEF and related conditions, a prompt and correct diagnosis is relevant. However, the diagnostic role of biomarker level, imaging tools, score-based algorithms and invasive evaluation, should be based on the strengths and weaknesses of each test. The aim of this review is to help the clinician in diagnosing HFpEF, overcoming the diagnostic uncertainty and disentangling among the different underlying causes, in order to properly treat this kind of patient.

Safety and Efficacy of Dapagliflozin in Patients with Heart Failure with Reduced Ejection Fraction: Multicentre Retrospective Study on Echocardiographic Parameters and Biomarkers of Heart Congestion.

Objectives: Dapagliflozin has shown efficacy in clinical trials in patients with heart failure and reduced ejection fraction (HFrEF). However, real-world data on its use and outcomes in routine clinical practice are limited. We aimed to evaluate the utilisation and safety profile of dapagliflozin in a real-world population of HFrEF patients within the Marche region. Methods: Nine cardiology departments within the Marche region retrospectively included HFrEF patients who were initiated on dapagliflozin therapy in an outpatient setting. Data on medical history, comorbidities, echocardiographic parameters, and laboratory tests were collected at baseline and after 6 months. Telephone follow-up interviews were conducted at 1 and 3 months to assess adverse events. We defined the composite endpoint score as meeting at least 50% of four objective measures of improvement among: weight loss, NYHA decrease, ≥50% Natriuretic peptides (NP) decrease, and guideline/directed medical therapy (GDMT) up titration. Results: We included 95 HFrEF patients aged 66 ± 12 years, 82% were men, 48% had ischemic heart disease, and 20% had diabetes. At six months, glomerular filtration rate declined (p = 0.03) and natriuretic peptides levels decreased, on average, by 23% (p < 0.001). Echocardiographic measurements revealed a decrease in pulmonary artery pressure (p < 0.001) and E/e' (p < 0.001). In terms of drug therapy, furosemide dosage decreased (p = 0.001), and the percentage of the target dose achieved for angiotensin receptor-neprilysin inhibitors increased (p = 0.003). By multivariable Cox regression, after adjustment for age, sex, the presence of diabetes/prediabetes, and HF duration, higher baseline Hb concentrations (HR 1.347, 95% CI 1.038-1.746, p = 0.025), and eGFR levels (HR 1.016, 95% CI 1.000-1.033, p = 0.46). Conclusions: In a real-life HFrEF population, dapagliflozin therapy is safe and well-tolerated, improves echocardiographic parameters and biomarkers of congestion, and can also facilitate the titration of drugs with a prognostic impact.

Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center.

Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a "shock team" consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61-80) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1-8.8) mmol/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed ≥ 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years.