Age-related changes in clinical characteristics and outcomes of chronic heart failure outpatients in a cardiology setting. A report from the Italian Network on Heart Failure.

AIMS: Ageing and comorbidities are increasing frailty/complexity of heart failure (HF) patients globally. We assessed evolving trends over two decades according to patients' age and time of recruitment in a nationwide cardiology setting in Italy. METHODS AND RESULTS: Chronic HF outpatients recruited between 1999 and 2018 (N = 14,823) were divided into 3 cohorts: 1999-2005 (N = 5404); 2006-2011 (N = 3971); 2012-2018 (N = 5448). We analyzed temporal changes in clinical characteristics, therapies, and outcome (1-year all-cause mortality/cardiovascular hospitalization), overall and by age group: <65 (n = 5465); 65-79 (n = 6838); ≥80 (n = 2520) years old. Across enrolment epochs, comorbidities (atrial fibrillation, hypertension, obesity) increased by both epoch/age groups (p < 0.001), whereas the prevalence of ischemic etiology declined among patients ≥65 years (p = 0.05). Accordingly, the preserved LVEF phenotype (HFpEF) increased in all age categories (p < 0.001) over time. Moreover, the use of betablockers, mineralocorticoid-receptor antagonists and loop-diuretics rose by enrolment epoch in all age groups (p < 0.05). In parallel with these epidemiologic/treatment changes, age-adjusted survival free from cardiovascular hospitalization improved over time (p < 0.0001). However, divergent trends in the end-point components were apparent according to age groups: mortality decreased in patients<80 years, although hospitalizations remained stable in the youngest group, while subjects ≥65 years were less likely to be admitted for cardiovascular causes (all p < 0.005). CONCLUSIONS: Over two decades in a cardiology outpatient setting, the prevalence of comorbid HFpEF increased in all age categories. Mortality improved among patients<80 years and cardiovascular hospitalizations decreased in patients≥65 years. These findings point to the value of cardiologist' input in the management of adult chronic HF patients at all ages.

[New etiologies responsible for infective endocarditis with negative blood cultures]. / Etiologie emergenti responsabili di endocarditi infettive con emocolture negative.

The prevalence of infective endocarditis with negative blood cultures varies in the different series from 5 to 25%. There are certain explanations of negative blood culture endocarditis: previous incorrect antibiotic therapy before obtaining blood samples (antibiotic treatment inhibits the growth of germs, and therefore bacteremia, without sterilizing the vegetations); infective endocarditis due to fastidious microorganism, that is of difficult cultivation and identification; infective endocarditis due to cell-dependent organism (e.g. Coxiella burnetii); infective endocarditis due to fungi; non-infectious involvement of the endocardium (at times with vegetations) during the course of certain disease. We underline three etiologies (Coxiella burnetii, Bartonella species and Whipple's disease bacterium) because their study have constituted the stimulus for the introduction into clinical evaluation of patients with suspected infective endocarditis of different diagnostic approaches, based on a correct sequential application of blood cultures, serodiagnosis and molecular microbiology.

Echocardiographic Diagnosis of Subacute Ventricular Wall Rupture Complicating Acute Myocardial Infarction.

Rupture of ventricular wall is one of the most threatening complications of acute myocardial infarction. As a rule, it is rapidly lethal, and a precise diagnosis is seldom possible. On the contrary, in the so-called subacute ruptures (about one third of all cases), patients can survive for several hours, allowing time for diagnosis and immediate surgical intervention. We report here the case of one patient with subacute cardiac rupture who was diagnosed with echocardiography and successfully treated with pericardiocentesis and surgery.