Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Conservative determinization of translated automata by embedded subset construction

A translated finite automaton (TFA) results from a translation of a deterministic finite automaton (DFA). A translation is based on a mapping from the alphabet of the DFA to a new alphabet, where each symbol in the original alphabet is substituted with a symbol in the new alphabet. When this substitution generates a nondeterministic automaton, the TFA may need to be determinized into an equivalent DFA. Determinization of TFAs may be useful in a variety of domains, specifically in model-based diagnosis of discrete-event systems, where large TFAs constructed by model-based reasoning are processed to perform knowledge compilation. Since, in computation time, the classical Subset Construction determinization algorithm may be less than optimal when applied to large TFAs, a conservative algorithm is proposed, called Embedded Subset Construction. This alternative algorithm updates the TFA based on the mapping of the alphabet rather than building a new DFA from scratch. This way, in contrast with Subset Construction, which performs an exhaustive processing of the TFA to be determinized, the portion of the TFA that does not require determinization is not processed. Embedded Subset Construction is sound and complete, thereby yielding a DFA that is identical to the DFA generated by Subset Construction. The benefit of using Embedded Subset Construction largely depends on the portion of the TFA that actually requires determinization. Experimental results indicate the viability of Embedded Subset Construction, especially so when large TFAs are affected by small portions of nondeterminism

Anestesia TIVA in chirurgia Maxillo-facciale: ipotensione versus normotensione e sue correlazioni con la profondit\uf2 del piano di narcosi e l\u2019entit\ue0 del sanguinamento intraoperatorio

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A high throughput approach to rotating-disk sorptive extraction (RDSE) using laminar cork for the simultaneous determination of multiclass organic micro-pollutants in aqueous sample by GC-MS

In this study, a high throughput approach to rotating-disk sorptive extraction (RDSE) using laminar cork as extraction phase is demonstrated for the first time in the determination of 20 multiclass organic micro-pollutants including pesticides, PAHs and UV filters compounds from aqueous samples with gas chromatography mass spectrometry (GC-MS). The influencing parameters (desorption solvent, volume and time, extraction time and sample pH and ionic strength) were carefully optimized using multivariate designs. The optimal conditions were 10 min for extraction using 35 mL of water samples and a liquid desorption using 1 mL of MeOH:AcOEt (50:50% v/v) for 20 min. A low-cost apparatus that allows six extractions simultaneously, providing a high throughput of 5 min per sample turnaround times, considering the sample preparation step was used for the first time in this modified RDSE methodology. Satisfactory analytical performance was achieved with limits of detection (LOD) between 0.08 and 1.5 mu g L-1 and limits of quantification (LOQ) between 0.3 and 4.8 mu g L-1. The relative recoveries for the analytes were determined using river and lake water samples spiked at different concentrations and ranging from 80% to 119% for all analytes, with relative standard deviations (RSD) lower than 20%. The extraction efficiency obtained for the proposed configuration with laminar cork was significantly superior to powdered cork, demonstrating an interesting new configuration for new applications.National Council for Scientific and Technological Development (CNPq). CAPES