Projected changes in intense precipitation over Europe at the daily and subdaily time scales.

Abstract Heavy precipitation is a major hazard over Europe. It is well established that climate model projections indicate a tendency toward more extreme daily rainfall events. It is still uncertain, however, how this changing intensity translates at the subdaily time scales. The main goal of the present study is to examine possible differences in projected changes in intense precipitation events over Europe at the daily and subdaily (3-hourly) time scales using a state-of-the-science climate model. The focus will be on one representative concentration pathway (RCP8.5), considered as illustrative of a high rate of increase in greenhouse gas concentrations over this century. There are statistically significant differences in intense precipitation projections (up to 40%) when comparing the results at the daily and subdaily time scales. Over northeastern Europe, projected precipitation intensification at the 3-hourly scale is lower than at the daily scale. On the other hand, Spain and the western seaboard exhibit an opposite behavior, with stronger intensification at the 3-hourly scale rather than the daily scale. While the mean properties of the precipitation distributions are independent of the analyzed frequency, projected precipitation intensification exhibits regional differences. This finding has implications for the extrapolation of impacts of intense precipitation events, given the daily time scale at which the analyses are usually performed

Malformazioni

La patologia malformativa vascolare encefalica comprende, secondo lo schema di Russel e Rubinstein, quattro entità principali: - Malformazioni arterovenose; - angiomi cavernosi; - anomalie di sviluppo venoso; - teleangectasi

Incidence and risk factors for pacemaker implantation in light-chain and transthyretin cardiac amyloidosis

The incidence and risk factors of pacemaker (PM) implantation in patients with cardiac amyloidosis (CA) are largely unexplored. We sought to characterize the trends in the incidence of permanent PM and to identify baseline predictors of future PM implantation in light-chain (AL) and transthyretin (ATTR) CA

Current patterns of beta-blocker prescription in cardiac amyloidosis: an Italian nationwide survey

Aims The use of beta-blocker therapy in cardiac amyloidosis (CA) is debated. We aimed at describing patterns of beta-blocker prescription through a nationwide survey.Methods and results From 11 referral centres, we retrospectively collected data of CA patients with a first evaluation after 2016 (n = 642). Clinical characteristics at first and last evaluation were collected, with a focus on medical therapy. For patients in whom beta-blocker therapy was started, stopped, or continued between first and last evaluation, the main reason for beta-blocker management was requested. Median age of study population was 77 years; 81% were men. Arterial hypertension was found in 58% of patients, atrial fibrillation (AF) in 57%, and coronary artery disease in 16%. Left ventricular ejection fraction was preserved in 62% of cases, and 74% of patients had advanced diastolic dysfunction. Out of the 250 CA patients on beta-blockers at last evaluation, 215 (33%) were already taking this therapy at first evaluation, while 35 (5%) were started it, in both cases primarily because of high-rate AF. One-hundred-nineteen patients (19%) who were on beta-blocker at first evaluation had this therapy withdrawn, mainly because of intolerance in the presence of heart failure with advanced diastolic dysfunction. The remaining 273 patients (43%) had never received beta-blocker therapy. Beta-blockers usage was similar between CA aetiologies. Patients taking vs. not taking beta-blockers differed only for a greater prevalence of arterial hypertension, coronary artery disease, AF, and non-restrictive filling pattern (P < 0.01 for all) in the former group.Conclusions Beta-blockers prescription is not infrequent in CA. Such therapy may be tolerated in the presence of co-morbidities for which beta-blockers are routinely used and in the absence of advanced diastolic dysfunction

Diagnostic pathways to wild-type transthyretin amyloid cardiomyopathy: a multicentre network study

Aim Epidemiology of wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) remains poorly defined. A better characterization of pathways leading to ATTRwt-CA diagnosis is of key importance, and potentially informative of disease course and prognosis. The aim of this study was to describe the characteristics of contemporary pathways leading to ATTRwt-CA diagnosis, and their potential association with survival.Methods and results This was a retrospective study of patients diagnosed with ATTRwt-CA at 17 Italian referral centres for CA. Patients were categorized into different 'pathways' according to the medical reason that triggered the diagnosis of ATTRwt-CA (hypertrophic cardiomyopathy [HCM] pathway, heart failure [HF] pathway, incidental imaging or incidental clinical pathway). Prognosis was investigated with all-cause mortality as endpoint. Overall, 1281 ATTRwt-CA patients were included in the study. The diagnostic pathway leading to ATTRwt-CA diagnosis was HCM in 7% of patients, HF in 51%, incidental imaging in 23%, incidental clinical in 19%. Patients in the HF pathway, as compared to the others, were older and had a greater prevalence of New York Heart Association (NYHA) class III-IV and chronic kidney disease. Survival was significantly worse in the HF versus other pathways, but similar among the three others. In multivariate model, older age at diagnosis, NYHA class III-IV and some comorbidities but not the HF pathway were independently associated with worse survival.Conclusions Half of contemporary ATTRwt-CA diagnoses occur in a HF setting. These patients had worse clinical profile and outcome than those diagnosed either due to suspected HCM or incidentally, although prognosis remained primarily related to age, NYHA functional class and comorbidities rather than the diagnostic pathway itself