Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

AimsTo analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.Methods and resultsPatients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6-12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.ConclusionIn 'real world' clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available

Spontaneous low CSF pressure headache in Marfan syndrome. A case report

Neurol Sci 25 (Suppl) Abstracts del XXXV Congresso della Società Italiana di Neurologi

Synthesis and functionalization of meso-aryl-substituted corroles

The Rothemund condensation reaction of pyrrole and aldehydes is an extensively used route to meso-tetraarylporphyrins, but simple modifications of the reaction conditions allow the formation of different macrocycles other than the expected porphyrin. In the presence of an excess of pyrrole, this modified Rothemund approach leads to the synthesis of meso-triaryl-substituted corroles. This methodology allows the preparation of a wide range of substituted corroles starting from commercially available products. Higher yields have been obtained in the case of benzaldehydes bearing electron-withdrawing substituents, while the reaction fails in the presence of 2,6-disubstituted benzaldehydes. Although if not isolated, some experimental evidences indicate that the linear 5,10,15-triphenylbilane 4 is the precursor of the final corrole ring. Reaction of 5,10,15-triphenylcorrole 2 with an excess of NBS leads to the complete bromination of the macrocycle. Spectroscopic characterization seems to indicate the formation of the porphodimethene-like structure 5, where the macrocyclic aromatic conjugation is interrupted at the 10 position. Metalation of this compound with cobalt acetate and PPhB affords the corresponding complex. The X-ray crystal structure of triphenylphosphine [2,3,7,8,12,13,17,18-octabromo-5,10,15-tris(4-nitrophenyl)corrolato]cobalt(III) 8 confirms the ability of corrole ring to retain an almost planar conformation when fully substituted at the peripheral positions

Septic encephalopathy: clinical and EEG features of a case

Neurol Sci 25 (Suppl), Abstracts del XXXV Congresso della Società Italiana di Neurologi

Bis-vinylogous corrole: The first expanded corrole

A dimeric structure that is held together by hydrogen bonds and is stable in solution is adopted by the hydrochloride salt of the expanded corrole shown. The synthesis, X-ray structure, and NMR and electronic absorption spectra of the new species all confirm the structural assignment in solution and in the solid state

When water hurts

Deglutition syncope refers to an uncommon cause of neurally mediated syncope induced by swallowing. We briefly review a case of a 66-year-old man who experienced recurrent syncope episodes during ingestion of beverages, mainly water. Our investigations documented several short asymptomatic episodes of asystole and one prolonged complete atrioventricular block of around 15 seconds associated with the syncopal events, during swallowing. Barium x-ray and manometry evaluations revealed only a nonspecific esophageal dysmotility. An underlying sick-sinus syndrome was found on electrophysiologic study. A DDD pacemaker implantation was performed leading to total disappearance of patient's symptoms

5,10,15-Triphenylcorrole: a product from a modified Rothemund reaction

One-pot synthesis of 5,10,15-triphenylcorrole has been achieved by reaction of benzaldehyde with an excess of pyrrole; the triphenylphosphinocobalt complex of 5,10,15-triphenylcorrole has been structurally characterized using X-ray crystallography