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.

The Role of Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy.

Until recently, the only imaging technique for the diagnosis and management of hypertrophic cardiomyopathy (HCM) was two-dimensional echocardiography, and the use of cardiac magnetic resonance imaging (cMRI) was limited to patients with poor acoustic windows. Now, cMRI has gained an essential role in the diagnosis of HCM, providing superior visualization of myocardial hypertrophy-even in remote zones of the left ventricle-and visualization of subtle changes in thickness and contractility over time. The morphologic accuracy of cMRI allows for the differentiation of HCM from other pathologic conditions with hypertrophic phenotype. Moreover, cMRI sheds light on the in vivo fibrotic changes in cardiac ultrastructure, offering an important advantage in the understanding of pathologic mechanisms of the disease, allowing early identification, risk stratification, and timely therapeutic management.

Long-term follow-up of Tako-Tsubo-like syndrome: a retrospective study of 22 cases.

OBJECTIVES: To assess the late outcome of the Tako-Tsubo like syndrome in a community hospital in northern Italy. METHODS AND RESULTS: We reviewed 2233 patients who were admitted from 2001 to 2006 with diagnosis of acute coronary syndrome. Twenty-two patients (1%) presenting clinical and instrumental characteristics of Tako-Tsubo like syndrome were included in the study and prospectively underwent clinical and echocardiographic follow-up. All patients were women; aged 76 +/- 7 years; 82% experienced a stress before the acute episode; 50% reported chest pain and dyspnoea also days before. Mean troponin peak value was 3.6 +/- 3.3 microg/l. Mean acute echocardiographic ejection fraction was 40 +/- 7%. Eighteen percent of them presented major in-hospital complications. At a mean follow-up time of 27 +/- 19 months, 2 patients (9%) died because of ischemic stroke and renal failure, respectively, 14 (63%) were asymptomatic, 1 (5%) declared a paroxysmal episode of atrial fibrillation, and 5 (23%) still lamented dyspnoea or atypical chest pain. In all patients, typical apical ballooning disappeared and an increase in mean ejection fraction to 60 +/- 4% was observed. CONCLUSION: After complications are promptly recognized and treated in the acute phase, prognosis of Tako-Tsubo like syndrome appears to be good at long-term follow-up, with a complete recovery of normal left ventricular function.

Maximization of recombinant Helicobacter pylori neutrophil activating protein production in Escherichia coli: improvement of a chemically defined medium using response surface methodology.

Medium optimization for the production of constitutive recombinant Helicobacter pylori neutrophil activating protein (NAP) in Escherichia coli was investigated by using response surface methodology. Carbon to nitrogen ratio, concentrations of sodium polyphosphate and magnesium sulfate were considered as independent variables. The optimized medium was a chemically defined medium with a carbon to nitrogen ratio of 14.4 and with concentrations of sodium polyphosphate and magnesium sulfate about 7.1 g l(-1) and 3.04 g l(-1) respectively. The maximum recombinant NAP production level (1184.6 mg l(-1)) was 29.96% higher than that in control medium.