Hypertrophic-phenotype cardiopathy… the great simulator

We describe the case of an incidental finding of left ventricular hypertrophy and high blood pressure values in a patient with irrelevant medical history, who was hospitalized for a vehicle accident. After discharge, he was sent to our center, where the etiological diagnosis was pursued. After achieving blood pressure control, left ventricle reverse remodeling is observed at a 6-month follow-up

Integrated Care for Heart Failure in Primary Care

Chronic heart failure (CHF or simply HF) is a complex clinical syndrome that involves more than 2% of the general population and over 10% of the older people. For people with reduced ventricular function (the classical HFrEF phenotype), the guideline-directed medical therapy (GDMT) (e.g., Ace-inhibitors, beta-blockers, diuretics, rehabilitation or implantable ventricular devices) demonstrated to be efficacious in reducing hospitalisations and prolonging survival. Vice-versa, the HF with preserved ejection fraction (diastolic HF or HFpEF phenotype) is a much more complex syndrome, in which co-morbidities (such as COPD, depression, anemia, and diabetes, CAD) play a significant role in the decompensation episodes

Evidence of reverse remodeling after long-term biventricular stimulation for resynchronization in patients with wide QRS selected on the basis of echocardiographic electromechanical delays

Background. There is increasing evidence that cardiac resynchronization therapy (CRT) may trigger an inverse remodeling process leading to decreased left ventricular (LV) volumes in patients with heart failure and wide QRS. However, it is still important to simplify patient selection and achieve a widely applicable parameter to better stratify patients who are candidates for CRT. Methods. Eighteen patients (13 males, 5 females, mean age 67.5 ± 7.2 years) with advanced heart failure due to ischemic (n = 12) or idiopathic dilated cardiomyopathy (n = 6) and complete left bundle branch block received biventricular pacing. The patients were considered eligible in the presence of echocardiographic evidence of intra- and interventricular asynchrony, defined on the basis of LV electromechanical delay. Investigations were performed before pacemaker implantation (at baseline), the day after, and 3 and 6 months later. Results. Two patients died before the first outpatient examination. There were 15 (83%) responders to reverse remodeling among the remainder. In the overall population, there was a significant and progressive improvement in LV sphericity indexes, ejection fraction, mitral regurgitation area and LV volumes (p < 0.001). The improvement in the interventricular mechanical delay after CRT was significantly correlated with the decrease in LV end-systolic volume (r2= 0.2558, p = 0.04). Conclusions. CRT reduces LV volumes in patients with advanced heart failure, complete left bundle branch block and detailed documentation of ventricular asynchrony prior to therapeutic pacing. Broadly applicable Doppler echocardiographic measures may increase the specificity of the longterm response to CRT in terms of LV performance. © 2004 CEPI Srl

Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: A long-term outcome study

AimsTo examine the independent prognostic role of functional mitral regurgitation (FMR) and its impact across the severity of chronic heart failure (CHF) in a large population of outpatients with systolic CHF followed at two multidisciplinary clinics.Methods and resultsEchocardiography was performed upon enrolment in 469 CHF patients. Follow-up for death and heart transplant was updated on January 2007. Five-year transplant-free survival was 82.7 in patients with no or Grade I FMR, 64.4 in Grade II, 58.5 in Grade III, and 46.5 in Grade IV (P < 0.0001). There was a strong graded association between FMR and the long-term risk of death and heart transplant, which remained significant after multivariable adjustment (P = 0.0003). The association between FMR and events was strong and independent in patients with less severe symptoms and in those at lower overall risk based on a propensity score analysis, while it was not significant in patients with more advanced CHF or in the high-risk subgroup (P < 0.0001 for interactions).ConclusionThis study clarifies previous apparently discrepant results by demonstrating that FMR is an independent determinant of death and heart transplantation only in less severe CHF and in patients with a lower risk profile. This finding indicates that FMR plays a major role in the early phase of CHF, suggesting that this should be the focus of strategies attempting to reduce it. \uc2\ua9 The Author 2010

Attività sportiva e COVID-19: cosa c'è di nuovo?

Growing evidence about COVID-19 and its possible cardiopulmonary complications have raised concerns about a potential subclinical heart damage even in asymptomatic patients. Many countries worldwide provided recommendations for a safe return to play and sports activity for athletes with previous COVID-19 disease. Italy was among the first nations to deal with the problem of protecting athletes’ health. In this regard, after an initial version released on April 2020, on December 11, 2020 the Italian Sports Medicine Federation (FMSI) updated the recommendations for the return play of non-professional athletes. The purpose of this article is to analyze and deepen the contents of the new FMSI recommendations, integrating and comparing them with the previous ones. Further updates may occur if new scientific and epidemiological evidence will rise regarding COVID-19.Growing evidence about COVID-19 and its possible cardiopulmonary complications have raised concerns about a potential subclinical heart damage even in asymptomatic patients. Many countries worldwide provided recommendations for a safe return to play and sports activity for athletes with previous COVID-19 disease. Italy was among the first nations to deal with the problem of protecting athletes’ health. In this regard, after an initial version released on April 2020, on December 11, 2020 the Italian Sports Medicine Federation (FMSI) updated the recommendations for the return play of non-professional athletes. The purpose of this article is to analyze and deepen the contents of the new FMSI recommendations, integrating and comparing them with the previous ones. Further updates may occur if new scientific and epidemiological evidence will rise regarding COVID-19