Nitrates in Congestive Heart Failure

Organic nitrates remain among the oldest and most commonly employed drugs in cardiology. Although, in most cases, their use in acute and chronic heart failure is based on clinical practice, only a few clinical trials have been conducted to evaluate their use in acute and chronic heart failure, most of which compare them with other drugs to evaluate differing endpoints. The purpose of this review is to examine the various trials that have evaluated the use of nitrates in acute and chronic heart failure

Spontaneous pneumomediastinum in COVID-19 pneumonia.

Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes

Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO 2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO 2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life

Echocardiographic elastic properties of ascending aorta and their relationship with exercise capacity in patients with non-ischemic dilated cardiomyopathy

AbstractBackground: Aortic stiffness, an independent predictor of mortality and cardiovascular events, is common among patients affected by non-ischemic dilated cardiomyopathy (NIDC) and heart failure (HF).Methods: A total of 55 patients with diagnosis of NIDC (aged 60 ± 11 years, mean ejection fraction (EF) 35.2% ± 7.7%) admitted consecutively to our department for mild to moderate HF (NYHA class II–III) underwent an echocardiographic study and cardiopulmonary exercise test (CPX). We evaluated elastic properties of ascending aorta, i.e. aortic stiffness and aortic distensibility (mm Hg− 1), derived from ascending aorta systolic and diastolic diameter (mm/m2) measured 3 cm above the valvular plane through 2D-guided M-mode echocardiography.Results: Mean aortic stiffness was 15.63 ± 14.53 and aortic distensibility was 2.61 ± 2.39 mm Hg− 1. Collected parameters at CPX were peak oxygen consumption (pVO2) (ml/kg/min), anaerobic threshold (AT) and the slope of the relation between minute ventilation (VE) and carbon dioxide production (VCO2). Mean pVO2 was 15.4 ± 3.9 ml/kg/min, VE/VCO2 ratio at AT was 36.1 ± 6.1. Functional capacity measured through peak VO2 was found to be directly correlated with aortic distensibility (r = 0.47, p = − 0.0002) and negatively correlated to aortic stiffness index (r = − 0.51, p = − 0.0001). These results were the same at multivariate analysis, corrected by age, hypertension, diabetes mellitus and ejection fraction (respectively r = 0.27, p = 0.008 and r = − 1.75, p = 0.0002).Conclusions: HF patients due to NIDC elastic properties of ascending aorta, evaluated by echocardiography, are correlated with a reduced functional capacity

Self-expanding transcatheter aortic valve implantation for degenerated small Mitroflow bioprosthesis: Early and midterm outcomes

The aim of this study was to report clinical outcomes of self-expanding transcatheter aortic valve implantation (TAVI) for failed small Mitroflow (MF) bioprostheses