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

Cardiology of the future: xenotransplantation with porcine heart

The reduced availability of human donor hearts compared with the needs of patients with advanced heart failure refractory to medical therapy has promoted the search for therapeutic alternatives to cardiac allografts. Porcine heart xenotransplantation represents one of the most promising frontiers in this field today. From the first researches in the 1960s to today, the numerous advances achieved in the field of surgical techniques, genetic engineering and immunosuppression have made it possible at the beginning of 2022 to carry out the first swine-to-human heart transplant, attaining a survival of 2 months after surgery. The main intellectual and experimental stages that have marked the history of xenotransplantation, the latest acquisitions in terms of genetic editing, as well as the improvement of immunosuppressive therapy are discussed analytically in this article in order to illustrate the underlying complexity of this therapeutic model

Analysis of the physical processes responsible for the degradation of deep-ultraviolet light emitting diodes

This paper reports an extensive analysis of the degradation of deep-ultraviolet light-emitting diodes submitted to dc stress test. The study was carried out by means of combined electrical and optical characterization techniques. Results described in the paper indicate that the following: i stress can induce a significant decrease in the optical power emitted by the devices; ii optical power decrease is more prominent at low measuring current levels, thus suggesting that degradation is related to an increase in the concentration of defects; iii stress induces a significant increase in the green-yellow parasitic emission of the devices; and iv stress causes a localized increase in the apparent charge distribution profiles in the active region of the devices. Experimental evidence collected within this work suggest that degradation is due to an increase in the defectiveness in the active layer of the devices, with subsequent worsening of their radiative efficiency

Participatory meeting: a new educational program based on bottom-up learning approach

A substantial part of the training program for cardiology residents includes several hours per week of face-to-face teaching. Since the beginning of the pandemic, most of these activities in universities have been conducted virtually using one of the available secure and reliable video platforms

Defect-related degradation of Deep-UV-LEDs

With this paper we describe an extensive analysis of the electro-optical degradation of deep ultraviolet Light-Emitting Diodes emitting at 310 nm, submitted to accelerated stress test. The results obtained within this study indicate that: (i) high current stress can induce a significant decrease in the optical power emitted by the LEDs; (ii) optical power decrease is more prominent at low measuring current levels, indicating that degradation is related to an increase in the concentration of defects, with subsequent decrease in the radiative efficiency of the active layer; (iii) stress can induce a significant increase in the operating voltage of the LEDs, due to the increase in the resistivity of the ohmic contacts or p-type semiconductor; and (iv) after stress, LEDs show a significantly increased green parasitic emission. This result suggest that stress induced an increase in the defectiveness of the active layer. Information on the location of the degraded region is achieved by the analysis of the Apparent Charge Distribution curves obtained by capacitance\u2013voltage measurements

ESD characterization of multi-chip RGB LEDs

In this paper we present an extensive analysis of the failure mechanisms of RGB (multi-chip) LEDs submitted to ESD testing: the tests have been carried out on several commercially available LEDs of three different suppliers. In order to better understand the failure mechanisms, we have submitted LEDs to ESD tests under reverse and forward bias condition separately, by means of a Transmission Line Pulser (TLP). The experimental results indicate that: (i) red LEDs (based on AlInGaP) have an higher ESD robustness with respect to green and blue samples (based on InGaN), both under reverse and under forward bias test; (ii) TLP negative pulses with a current smaller than the failure threshold can induce a decrease of the leakage current in GaN-based LEDs, due to a partial annihilation of defective paths responsible for reverse conduction; (iii) typical failure mechanism of devices is represented by a catastrophic event, with short-circuiting of the junction. Moreover, some of the analyzed red LEDs had shown "soft" failure, with gradual increase of the leakage current and corresponding decrease of the optical power, even without a catastrophic damage. \ua9 2013 Elsevier Ltd. All rights reserved

Grey zones in the supportive treatments of cardiac amyloidosis

Recent advances in the diagnosis and treatment of cardiac amyloidosis (CA) have translated into a longer life expectancy of patients and more challenging clinical scenarios. Compared to the past, patients with CA and heart failure (HF) currently encountered in clinical practice are a more heterogeneous population and require tailored strategies. The perception of CA as a treatable disease has opened new possibilities for the management of these patients, but many grey areas remain to be explored. The aim of this review is to provide practical suggestions for daily clinical activity in the management of challenging scenarios in CA, including the effectiveness and tolerability of evidence-based HF medication; rate vs. rhythm control in atrial fibrillation, thromboembolic risk, and anticoagulation therapies; replacement of severe aortic valve stenosis; the impact of implantable cardioverter defibrillator on survival; and the usefulness of cardiac resynchronization therapy

End-of-life decision-making and quality of ICU performance: an observational study in 84 Italian units

Purpose: To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. Design: Prospective, multicenter, observational study, lasting 12 months. Setting: Eighty-four Italian, adult ICUs. Patients: Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005. Measurements: Data collection included patient description, treatment limitation and decision-makers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit. Results: Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-not-resuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio <0.77) showed higher overall standardized mortality ratio (1.08; 95% confidence interval: 1.04-1.12). Limitations: The voluntary nature of participation, with self-selected ICUs from a self-selected independent network. Conclusions: Treatment limitation is common in ICU and still principally a physician's responsibility. Units with below-average inclination to limit treatments have worse performance in terms of overall mortality, showing that limitation is not against the patient's interests. On the contrary, the inclination to limit treatments at the end of life can be taken as an indication of quality in the unit. © 2010 Copyright jointly held by Springer and ESICM