Association of Tricuspid Regurgitation With Outcome in Acute Heart Failure

Background: Tricuspid regurgitation (TR) is common in chronic heart failure (HF) and is associated with negative prognosis. However, evidence on prognostic implications of TR in acute HF is lacking. We sought to investigate the association between TR and mortality and the interaction with pulmonary hypertension (PH) in patients admitted for acute HF. Methods: We enrolled 1176 consecutive patients with a primary diagnosis of acute HF and with available noninvasive estimation of TR and pulmonary arterial systolic pressure. Results: Moderate-severe TR was present in 352 patients (29.9%) and was associated with older age and more comorbidities. The prevalence of PH (ie, pulmonary arterial systolic pressure >40 mm Hg), right ventricular dysfunction, and mitral regurgitation was higher in moderate-severe TR. At 1 year, 184 (15.6%) patients died. Moderate-severe TR was associated with higher 1-year mortality risk after adjustment for other echocardiographic parameters (pulmonary arterial systolic pressure, left ventricle ejection fraction, right ventricular dysfunction, mitral regurgitation, left and right atrial indexed volumes; hazard ratio, 1.718; P=0.009), and the association with outcome was maintained when clinical variables (eg, natriuretic peptides, serum creatinine and urea, systolic blood pressure, atrial fibrillation) were added to the multivariable model (hazard ratio, 1.761; P=0.024). The association between moderate-severe TR and outcome was consistent in patients with versus without PH, with versus without right ventricular dysfunction, and with versus without left ventricle ejection fraction <50%. Patients with coexistent moderate-severe TR and PH had 3-fold higher 1-year mortality risk compared with patients with no TR or PH (hazard ratio, 3.024; P<0.001). Conclusions: In patients hospitalized for acute HF, the severity of TR is associated with 1-year survival, regardless of the presence of PH. The coexistence of moderate-severe TR and estimated PH was associated with a further increase in mortality risk. Our data must be interpreted in the context of potential underestimation of pulmonary arterial systolic pressure in patients with severe TR

Electrochemical mediation of oxygen-tolerant atom transfer radical polymerization in aqueous media

reservedLa polimerizzazione radicalica per trasferimento di atomo mediata elettrochimicamente (eATRP) è un processo di polimerizzazione controllata che permette di sintetizzare polimeri di varia natura ottenendo il controllo sul peso molecolare del prodotto ed una stretta distribuzione dei pesi delle catene. Tra i problemi sperimentali che caratterizzano queste tipologie di sintesi e in generale le polimerizzazioni radicaliche vi è la presenza di ossigeno in soluzione, il quale porta alla terminazione delle specie radicaliche. In questo elaborato sarà testata la funzionalità dei complessi di CuMe6TREN nella riduzione omogenea dell’ossigeno in soluzione. Le reazioni sono state condotte in soluzione acquosa e senza degassaggio, il tutto all’interno di un sistema chiuso. È stato comprovato attraverso diversi esperimenti che è possibile polimerizzare alcune acrilamidi in soluzione acquosa riuscendo a ridurre l’ossigeno in fase omogenea prima di procedere con la polimerizzazione. Nella maggior parte degli esperimenti sono state ottenuti valori di conversione intorno al 98% in circa un’ora, il tutto con un discreto controllo sul peso molecolare ed una dispersità tra 1,1 e 1,2.Atom transfer electrochemically mediated radical polymerization (eATRP) is a controlled polymerization method that allows the synthesis of various polymers while maintaining control over the molecular weight of the product and ensuring a narrow distribution of molecular weights. Among the experimental challenges associated with these types of syntheses and radical polymerizations in general is the presence of oxygen in the solution, which leads to the termination of radical species. This work aims to evaluate the functionality of CuMe6TREN complexes in the homogeneous reduction of oxygen in solution. The reactions were conducted in aqueous solution without degassing, all within a closed system. It has been demonstrated through various experiments that it is possible to polymerize certain acrylamides in aqueous solution while reducing oxygen homogeneously before proceeding with polymerization. In most experiments, conversion values around 98% were achieved in about an hour, all with decent control over molecular weight and a dispersity between 1.1 and 1.2

The eight-shaped heart: An incidental giant left ventricular pseudoaneurysm

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ETIOLOGY.

Infective endocarditis [IE] is the final manifestation of a complex series of events ranging from the damage at the level of endocardium to the ultimaate infection of a distinct endocardial lesion by bacteria or fungi. Microorganisms infecting the endoardium may originate from distant sources of infection or through cutaneous or mucosal breaches that allow pathogens to enter and spread into bloodstream

Clinical impact of myocardial fibrosis in severe aortic stenosis

8The pressure overload due to the progressive narrowing of the valve area determines the development of the left ventricular hypertrophy which characterizes aortic stenosis (AS). The onset of myocardial fibrosis marks the inexorable decline of an initially compensatory response towards heart failure. However, myocardial fibrosis does not yet represent a key element in the prognostic and therapeutic framework of AS. In this context, cardiac magnetic resonance imaging plays a major role by highlighting both the focal irreversible fibrotic replacement, using the late gadolinium enhancement (LGE) technique, and the earlier diffuse reversible interstitial fibrosis, using the T1 mapping techniques. For this reason, the presence of myocardial fibrosis would be useful to identify a subgroup of patients at greater risk of events among the subjects with severe AS. Actually, more and more evidences seem to identify the presence of LGE as a powerful prognostic factor to be used to optimize the timing of prosthetic valve replacement. Randomized clinical trials, such as the EVoLVeD trial currently underway, will be needed to better define the importance of myocardial fibrosis assessment in the management of patients with AS.openopenCastrichini, Matteo; Vitrella, Giancarlo; De Luca, Antonio; Altinier, Alessandro; Korcova, Renata; Pagura, Linda; Radesich, Cinzia; Sinagra, GianfrancoCastrichini, Matteo; Vitrella, Giancarlo; De Luca, Antonio; Altinier, Alessandro; Korcova, Renata; Pagura, Linda; Radesich, Cinzia; Sinagra, Gianfranc

Laundry Fabric Classification in Vertical Axis Washing Machines Using Data-Driven Soft Sensors

Embedding household appliances with smart capabilities is becoming common practice among major fabric-care producers that seek competitiveness on the market by providing more efficient and easy-to-use products. In Vertical Axis Washing Machines (VA-WM), knowing the laundry composition is fundamental to setting the washing cycle properly with positive impact both on energy/water consumption and on washing performance. An indication of the load typology composition (cotton, silk, etc.) is typically provided by the user through a physical selector that, unfortunately, is often placed by the user on the most general setting due to the discomfort of manually changing configurations. An automated mechanism to determine such key information would thus provide increased user experience, better washing performance, and reduced consumption; for this reason, we present here a data-driven soft sensor that exploits physical measurements already available on board a commercial VA-WM to provide an estimate of the load typology through a machine-learning-based statistical model of the process. The proposed method is able to work in a resource-constrained environment such as the firmware of a VA-WM