HRV Spectral and Fractal Analysis in Heart Failure Patients with Different Aetiologies

Heart Rate Variability (HRV) has been widely studied both in healthy subjects and congestive heart failure (CHF) patients. Significant variations in the HRV patterns have been reported in cardiac patients and quantified both in time and spectral domain by various linear and nonlinear parameters which may be useful not only for the characterization of the autonomous nervous system but also for patients risk stratification. Nevertheless, the relationship between HRV measures and CHF aetiologies has not been completelyinvestigated yet. The purpose of this work was to evaluate the spectral and fractal properties of HRV in patients with CHF caused by either dilated cardiomyopathy or ischemic heart disease, and to compare the results with those coming from normal subjects. Results revealed that changes in some of the examined parameters may lead to a possible separation of the CHF aetiologies

Influence of Aging on Short- and Long-term Heart Rate Variability in Patients with Heart Failure

5noAlong the last years, the number of HRV studies has been widely grown. The computation of HRV linear and non-linear parameters allows the quantification of the cardiac frequency modulation and of the possible link between them and different pathologies. In the literature, significant variations of HRV linear and non-linear parameters are described, with the focus on age related changes in healthy subjects. The aim of this study is to evaluate the possible presence of age related changes in HRV parameters in congestive heart failure (CHF) patients. The RR time series extracted from 80 CHF patients, divided by age into two groups, have been accurately analyzed. The results point out a linear influence of age on characteristic parameters extracted from these patients; the behaviors of these parameters are opposite to the literature results obtained in healthy subjects. We hypothesize that this discrepancy may be due to the RR data selection and to their pre-processing phase as well as to some clinical factors as the neuro hormonal imbalance characteristic of the CHF disease that often produces a sympathetic activation.reservedmixedAccardo, A.; De Dea, F.; Cinquetti, M.; Merlo, M.; Sinagra, G.Accardo, Agostino; DE DEA, Federica; Cinquetti, Martino; Merlo, Marco; Sinagra, Gianfranc

Impact of Aging on Heart Rate Variability Properties of Healthy Subjects

Heart Rate Variability (HRV) has been studied in a variety of clinical situations in order to quantify the modulations in the heart rate associated to different pathological conditions. Nevertheless, significant changes in spectral and some nonlinear parameters of the HRV were reported also in normal subjects, depending on age and gender. The aim of this work was to quantify the age-related differences in other nonlinear parameters, particularly in the fractal dimension, of the HRV of healthy subjects and to compare the results with the changes showed by spectral measures. The RR time series extracted by the Holter monitoring of 60 healthy subjects, divided into three groups similar for both age and gender, were accurately analyzed. The results only partially revealed age-related changes both in the spectral and fractal HRV measures, underlining the need to carefully examine the RR data selection and the pre-processing phases

Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

10noAbstract BACKGROUND: Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS: We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS: PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.partially_openembargoed_20180914Sappa, Roberta*; Grillo, Maria Teresa; Cinquetti, Martino; Prati, Giulio; Spedicato, Leonardo; Nucifora, Gaetano; Perkan, Andrea; Zanuttini, Davide; Sinagra, Gianfranco; Proclemer, AlessandroSappa, Roberta; Grillo, Maria Teresa; Cinquetti, Martino; Prati, Giulio; Spedicato, Leonardo; Nucifora, Gaetano; Perkan, Andrea; Zanuttini, Davide; Sinagra, Gianfranco; Proclemer, Alessandr

ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis

11noPrimary percutaneous coronary intervention (pPCI) largely reduced the rate of left ventricular (LV) dysfunction after ST-segment elevation acute myocardial infarction (STEMI). Though LV recovery begins early following revascularization, the optimal timing for re-assessment of LV function is still unclear. We sought to assess the proportion and timing of LV recovery in STEMI patients presenting with LV dysfunction treated by pPCI and to identify possible early predictors of adverse LV remodeling. STEMI patients with LV ejection fraction (LVEF ≤40%) at presentation treated by pPCI from 2007 to 2013 were included whether they had an available 3-step LVEF assessment (35%, p<0.001). Independent predictors of 3-months LVEF ≤35% were creatinine at admission, peak troponin I and LVEF. Of note, LVEF re-assessment at discharge (median time 6days, IQR 4-9) showed an increased accuracy to predict 3-months LV dysfunction compared to LVEF at admission (AUC 0.80, 95% CI 0.72-0.88 vs AUC 0.69, 95% CI 0.58-0.79 respectively, p=0.03). In most of patients presenting with STEMI and LV dysfunction, a significant LV recovery can be observed early following pPCI. LVEF measurement at discharge indeed emerged as the best indicator of late persistence of severe LV dysfunction.reservedmixedStolfo, Davide; Cinquetti, Martino; Merlo, Marco; Santangelo, Sara; Barbati, Giulia; Alonge, Marco; Vitrella, Giancarlo; Rakar, Serena; Salvi, Alessandro; Perkan, Andrea; Sinagra, GianfrancoStolfo, Davide; Cinquetti, Martino; Merlo, Marco; Santangelo, Sara; Barbati, Giulia; Alonge, Marco; Vitrella, Giancarlo; Rakar, Serena; Salvi, Alessandro; Perkan, Andrea; Sinagra, Gianfranc

Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry.

AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. CONCLUSION: This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written