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2.
J Heart Lung Transplant ; 43(4): 554-562, 2024 Apr.
Article in English | MEDLINE | ID: mdl-37972826

ABSTRACT

BACKGROUND: The changing demographic of heart failure (HF) increases the exposure to non-cardiovascular (non-CV) events. We investigated the distribution of non-CV mortality/morbidity and the characteristics associated with higher risk of non-CV events in patients with advanced HF. METHODS: Patients from the HELP-HF registry were stratified according to the number of 2018 HFA-ESC criteria for advanced HF. Endpoints were non-CV mortality and non-CV hospitalization. Competing risk analyses were performed assessing the association between HFA-ESC criteria and study outcomes and the additional predictors of non-CV endpoints. RESULTS: One thousand one hundred and forty-nine patients were included (median age 77 years-IQR 69-83). At 6, 12, 18 and 22 months, cumulative incidence of CV vs non-CV mortality was 13% vs 5%, 17% vs 8%, 20% vs 12%, 23% vs 12%, and of CV vs non-CV hospitalization was 26% vs 11%, 38% vs 17%, 45% vs 20%, 50% vs 21%. HFA-ESC criteria were associated with increasing adjusted risk of CV death, whereas no association was observed for CV hospitalization, non-CV death and non-CV hospitalization. Predictors of non-CV death were age, chronic obstructive pulmonary disease, dementia, preserved ejection fraction, >1 HF hospitalization and hemoglobin. CONCLUSIONS: Patients with advanced HF are exposed to high, even though not predominant, burden of non-CV outcomes. HFA-ESC criteria aid to stratify the risk of CV death, but are not associated with lower competing risk of non-CV outcomes. Alternative factors can be useful to define the patients with advanced HF at risk of non-CV events in order to better select patients for treatments specifically reducing CV risk.


Subject(s)
Heart Failure , Humans , Aged , Stroke Volume , Risk Factors , Heart Failure/therapy , Morbidity , Risk Assessment , Hospitalization , Prognosis
3.
ESC Heart Fail ; 11(1): 136-146, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37845829

ABSTRACT

AIMS: Patients with heart failure (HF) with reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF) may all progress to advanced HF, but the impact of EF in the advanced setting is not well established. Our aim was to assess the prognostic impact of EF in patients with at least one 'I NEED HELP' marker for advanced HF. METHODS AND RESULTS: Patients with HF and at least one high-risk 'I NEED HELP' criterion from four centres were included in this analysis. Outcomes were assessed in patients with HFrEF (EF ≤ 40%), HFmrEF (EF 41-49%), and HFpEF (EF ≥ 50%) and with EF analysed as a continuous variable. The prognostic impact of medical therapy for HF in patients with EF < 50% and EF > 50% was also evaluated. All-cause death was the primary endpoint, and cardiovascular death was a secondary endpoint. Among 1149 patients enrolled [mean age 75.1 ± 11.5 years, 67.3% males, 67.6% hospitalized, median follow-up 260 days (inter-quartile range 105-390 days)], HFrEF, HFmrEF, and HFpEF were observed in 699 (60.8%), 122 (10.6%), and 328 (28.6%) patients, and 1 year mortality was 28.3%, 26.2%, and 20.1, respectively (log-rank P = 0.036). As compared with HFrEF patients, HFpEF patients had a lower risk of all-cause death [adjusted hazard ratio (HRadj ) 0.67, 95% confidence interval (CI) 0.48-0.94, P = 0.022], whereas no difference was noted for HFmrEF patients. After multivariable adjustment, a lower risk of all-cause death (HRadj for 5% increase 0.94, 95% CI 0.89-0.99, P = 0.017) and cardiovascular death (HRadj for 5% increase 0.94, 95% CI 0.88-1.00, P = 0.049) was observed at higher EF values. Beta-blockers and renin-angiotensin system inhibitors or sacubitril/valsartan were associated with lower mortality in both EF < 50% and EF ≥ 50% groups. CONCLUSIONS: Among patients with HF and at least one 'I NEED HELP' marker for advanced HF, left ventricular EF is still of prognostic value.


Subject(s)
Heart Failure , Male , Humans , Infant , Female , Stroke Volume , Cause of Death , Risk Factors , Registries
4.
Eur J Intern Med ; 122: 102-108, 2024 Apr.
Article in English | MEDLINE | ID: mdl-37980233

ABSTRACT

AIM: The impact of mitral regurgitation (MR) in patients with advanced heart failure (HF) is poorly known. We aimed to evaluate the impact of MR on clinical outcomes of a real-world, contemporary, multicentre population with advanced HF. METHODS: The HELP-HF registry enrolled patients with HF and at least one "I NEED HELP" criterion, at four Italian centres between January 2020 and November 2021. The population was stratified by none/mild MR vs. moderate MR vs. severe MR. Outcomes of interest were all-cause, cardiovascular (CV) death, the composite of all-cause death or first HF hospitalization, first HF hospitalization and recurrent HF hospitalizations. RESULTS: Among 1079 patients, 429 (39.8%) had none/mild MR, 443 (41.1%) had moderate MR and 207 (19.2%) had severe MR. Patients with severe MR were most likely to be inpatients, present with cardiogenic shock, need intravenous loop diuretics and inotropes/vasopressors, have lower ejection fraction and higher natriuretic peptides. Estimated rates of all-cause death, CV death, and the composite of all-cause death or first HF hospitalization at 1 year increased with increasing MR severity. Compared with no/mild MR, severe MR was independently associated with an increased risk of CV death (adjusted HR 1.61, 95% CI 1.04-2.51, p = 0.033) and recurrent HF hospitalizations (adjusted HR 1.49, 95% CI 1.08-2.06, p = 0.015), but not with and increased risk of all-cause death, first HF hospitalization and composite outcome. CONCLUSIONS: In unselected patients with advanced HF, severe MR was common and independently associated with an increased risk of CV death and of recurrent HF hospitalizations.


Subject(s)
Heart Failure , Mitral Valve Insufficiency , Humans , Prognosis , Mitral Valve Insufficiency/epidemiology , Mitral Valve Insufficiency/complications , Hospitalization , Heart Failure/complications , Inpatients , Stroke Volume
5.
Catheter Cardiovasc Interv ; 102(1): 138-144, 2023 07.
Article in English | MEDLINE | ID: mdl-37161909

ABSTRACT

Papillary muscle rupture (PMR) is a rare complication of acute myocardial infarction (AMI) associated with high mortality and morbidity. Surgery is the gold-standard treatment for these patients, but it is burdened by a high perioperative risk due to hemodynamic instability. Mitral transcatheter edge-to-edge repair (M-TEER) was reported to be safe and effective in unstable patients with significant mitral regurgitation. However, data in patients with post-AMI PMR are limited to a few case reports. In this review, we summarized all data available regarding percutaneous treatment of post-AMI PMR. These results show that M-TEER is safe and effective in this setting with low in-hospital mortality and complications and high rate of significant mitral regurgitation reduction.


Subject(s)
Heart Failure , Heart Rupture, Post-Infarction , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Myocardial Infarction , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Papillary Muscles/diagnostic imaging , Papillary Muscles/surgery , Heart Rupture, Post-Infarction/diagnostic imaging , Heart Rupture, Post-Infarction/etiology , Treatment Outcome , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/surgery , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Heart Failure/surgery
6.
Int Angiol ; 39(5): 405-410, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32401472

ABSTRACT

BACKGROUND: Endovascular repair of abdominal aortic aneurysm (EVAR) presents an increasing role in treatment of abdominal aortic aneurysms in patients at high and mid risk for conventional surgery. Most Vascular Surgery Units need to identify a single device as workhorse in AAA treatment. Objective of this study is to analyze midterm results of consecutive unselected patients treated with the same device in a single center series. METHODS: A retrospective analysis of a prospective database of all consecutive patients treated between January 2016 and June 2019 with the TREO device in our center. Primary outcomes of the study were AAA related mortality rate, migration rate and type 1 endoleak at 1-year follow-up. RESULTS: During the study period 71 consecutive patients (96% male) were treated with TREO device. Technical success was achieved in all patients. Mean follow-up was 19.6 months (range: 1-42 months). Procedure related mortality was 1.4% (N.=1), No AAA related mortality, migration or type 1b endoleak were recorded during follow-up. Two cases of late type 1a endoleak were recorded, both resolved with aortic cuffing. Median shrinkage of the residual sac was 10% and 18.5% at 6 and 18 months, respectively. CONCLUSIONS: EVAR using TREO device seems to be safe and effective treatment for unselected patients suffering AAA. Particularly this device seems to be suitable as workhorse device in a single center with skillness between open and endovascular techniques.


Subject(s)
Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Female , Humans , Male , Prosthesis Design , Retrospective Studies , Stents , Treatment Outcome
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