Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

Background: The use of cardiac resynchronization therapy (CRT) and implantable cardioverter- defibrillator (ICD) for advanced heart failure (HF) is increasing. Renal dysfunction is a common condition in HF which is associated with a worse survival. The study aims at identifying in patients with advanced HF treated with CRT the effect of baseline glomerular filtration rate (GFR), GFR improvement and left ventricular ejection fraction (LVEF) change, after 6-months of CRT implant, on survival. Methods: The study population consisted of 375 advanced HF patients who received a CRT between 1999 and 2009, of these 277 received also an ICD implant. Clinical characteristics (New York Heart Association [NYHA] functional class, ischemic vs. non-ischemic etiology, atrial fibrillation, diabetes, hypertension, LVEF, QRS duration and GFR were recorded. The use of common used drugs was evaluated. Cox proportional hazards analysis was calculated in order to evaluate variables associated to mortality. Results: During a median follow-up of 43.0 months, 93 (24.8%) patients died. Patients deceased during the study had at baseline higher NYHA class and lower LVEF and GFR. In Cox regression analysis, GFR predicts long-term mortality (hazard ratio [HR] 0.983; 95% confidence interval [CI] 0.969–0.998; p = 0.023) independently from the effect of others covariates. In addition, a positive GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality (for each 10 mL/min of GFR improvement HR 0.86; 95% CI 0.75–0.99; p = 0.038). Conclusions: GFR is a significant predictor of mortality in advanced HF patients who received CRT. A GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality.

the novel role of epigenetics in primary prevention of cardiovascular diseases

A great deal of evidences indicate that impaired fetal growth and in utero exposure to risk factors, especially maternal hypercholesterolemia, may be relevant for human pathophysiological signs of atherosclerosis and subsequent development of cardiovascular disease (CVD) during different life stages. Despite the underlying mechanisms of fetal programming are still unknown, epigenetics has been suggested as one of the possible explanations for the associations between intrauterine risk factors and CVD development. Indeed, a lot of translational studies support the hypothesis that epigenetic changes are related to increased CVD risk although it is still not possible to establish a direct causality in humans. Notably, epigenetic modifications can be reversible through therapeutic approaches employing histone deacetylase inhibitors, histone acetyltransferase inhibitors and commonly used drugs like statins. Thus, the whole comprehension of these mechanisms will provide in the next future the rationale for the development of novel tools to be used in the primary prevention and therapy of CVD

Cambiamenti ambientali indotti dalle variazioni climatiche oloceniche e dall’uomo nell’area dell’abitato antico di Pontecagnano

L’abitato antico di Pontecagnano (vii-iii a.C.), sorge su un alto morfologico di natura travertinosa, che in antico emergeva di pochi metri dal settore NO della pianura alluvionale costiera del Fiume Sele. I lavori per l’ampliamento dell’autostrada A3 SA-RC hanno intercettato livelli archeologici rappresentativi di ampie porzioni del territorio urbano e periurbano dell’abitato antico e messo in evidenza un record archeostratigrafico che va dal Pleistocene Superiore ad oggi. Lo studio geomorfologico ed archeo-tephro-stratigrafico di dettaglio, corredato da analisi paleoambientali, ha consentito di delineare gli aspetti salienti dell’evoluzione del paesaggio e degli ambienti nel corso dell’Olocene. Le modifiche dell’ambiente e del paesaggio sono state prevalentemente indotte da condizionamenti antropici sul sistema idraulico e forestale e sull’organizzazione del territorio soprattutto per il periodo di vita dell’abitato, dove si coglie un importante bonifica. Nei periodi precedenti e successivi alla vita dell’abitato i cambiamenti ambientali sono stati indotti da variazioni climatiche e dai prodotti delle eruzioni dei vulcani napoletani.The ancient settlement of Pontecagnano (7th-3rd centuries B.C.) was built up on the travertine plateau overlooking the Sele river on the NW sector of the alluvial-coastal plain. Motorway construction works brought to light archaeological remains of an ancient urban and suburban settlement. Archaeostratigraphical records dated between the late Pleistocene and today have been elucidated. The geomorphological and archaeo-tephro-stratigraphical study, coupled with palaeoenvironmental analysis, allowed us to outline the evolution of the environment during the Holocene. The environmental changes have been mainly induced by human activities, during the 7th -3rd centuries B.C., by land reclamation. During other periods of the Holocene the environmental changes can be attributed to climatic variations and, secondly, to the impact of the distal products of Neapolitan volcanic eruptions on geomorphic systems

Detection and Characterization of Meteotsunamis in the Gulf of Genoa

A long-term time series of high-frequency sampled sea-level data collected in the port of Genoa were analyzed to detect the occurrence of meteotsunami events and to characterize them. Time-frequency analysis showed well-developed energy peaks on a 26–30 minute band, which are an almost permanent feature in the analyzed signal. The amplitude of these waves is generally few centimeters but, in some cases, they can reach values comparable or even greater than the local tidal elevation. In the perspective of sea-level rise, their assessment can be relevant for sound coastal work planning and port management. Events having the highest energy were selected for detailed analysis and the main features were identified and characterized by means of wavelet transform. The most important one occurred on 14 October 2016, when the oscillations, generated by an abrupt jump in the atmospheric pressure, achieved a maximum wave height of 50 cm and lasted for about three hours

Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy

BACKGROUND: The use of cardiac resynchronization therapy (CRT) and implantable cardioverter- defibrillator (ICD) for advanced heart failure (HF) is increasing. Renal dysfunction is a common condition in HF which is associated with a worse survival. The study aims at identifying in patients with advanced HF treated with CRT the effect of baseline glomerular filtration rate (GFR), GFR improvement and left ventricular ejection fraction (LVEF) change, after 6-months of CRT implant, on survival. METHODS: The study population consisted of 375 advanced HF patients who received a CRT between 1999 and 2009, of these 277 received also an ICD implant. Clinical characteristics (New York Heart Association [NYHA] functional class, ischemic vs. non-ischemic etiology, atrial fibrillation, diabetes, hypertension, LVEF, QRS duration and GFR were recorded. The use of common used drugs was evaluated. Cox proportional hazards analysis was calculated in order to evaluate variables associated to mortality. RESULTS: During a median follow-up of 43.0 months, 93 (24.8%) patients died. Patients deceased during the study had at baseline higher NYHA class and lower LVEF and GFR. In Cox regression analysis, GFR predicts long-term mortality (hazard ratio [HR] 0.983; 95% confidence interval [CI] 0.969-0.998; p = 0.023) independently from the effect of others covariates. In addition, a positive GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality (for each 10 mL/min of GFR improvement HR 0.86; 95% CI 0.75-0.99; p = 0.038). CONCLUSIONS: GFR is a significant predictor of mortality in advanced HF patients who received CRT. A GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality

Impact of an anti-infective screening and monitoring protocol together with infectious disease consultation in preventing infective adverse events in patients treated with anti-CD20/CD52 agents for multiple sclerosis

Monoclonal antibodies have been a milestone in the treatment of multiple sclerosis (MS). Infective complications have been observed in patients on agents targeting lymphoid cells' surface antigens, namely anti-CD52 (alemtuzumab) and anti-CD20 agents (ocrelizumab and rituximab). Despite increasing emerging data, there is no standardized consensus regarding pre-treatment testing, vaccinations, and patient education before and during MS therapy or optimal infection-control strategies