P2613Initial combination therapy with ambrisentan and tadalafil for pulmonary arterial hypertension: clinical effect and haemodynamic changes. A multicenter retrospective analysis

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Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS

Aim: To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS). Methods: Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results: The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01–0.579; p: 0.019) and PaO2/FIO2 (HR: 0.988; 95%CI 0.988–0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively. Conclusions: COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Background. Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E’ and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. Methods. EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Results. Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusion. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

La politicità dell’interpretazione alle origini del positivismo giuridico. Esperienze di diritto vivente nel Codice Napoleone

Il lavoro svolto tende ad analizzare l'aspetto fattuale, o se si vuole dinamico, della tripartizione rigida dei poteri dello Stato, guardando in particolare al ruolo del giudice quale mero applicatore di una legge rigida, chiara e semplice – il Codice – considerata garanzia della certezza del diritto. Si è scelto, a tal fine, di analizzare l’operato della Corte di cassazione francese nei primi anni di vigenza del codice napoleone, presumendo che quel periodo fosse particolarmente significante per verificare l’efficacia del nuovo sistema. L’analisi è stata svolta innanzitutto sul piano tecnico-giuridico, scegliendo istituti che più di altri erano espressivi del nuovo assetto, segnato in particolare dal binomio proprietà-contratto, quale traduzione giuridica del principio individualistico. L’approccio tecnico ad uno studio suscettibile evidentemente di molteplici approfondimenti, ha consentito l’emersione della strutturale politicità del diritto, e segnatamente del diritto applicato, che è poi la sua essenza. Già dalle proprie origini, sebbene inconsce, il positivismo mostra le sue debolezze, la scelta tutta ideologica di inscrivere il fenomeno giuridico alla legge dello stato e, quindi, la necessità di adattare quella legge alle esigenze della realtà. L’attività del giudice, segnatamente di quello di legittimità, esprime bene in questa fase tutta la sua valenza di mediazione, riuscendo a creare quel tratto d’unione tra disegno politico ed evoluzione della società, che è un ruolo che avrà modo di delinearsi come organico all’ordine giudiziario dello stato liberale, svolto grazie all’aspetto più tecnico, e meno neutrale, del diritto, ovvero la sua interpretazione

Il giudice: bouche de la loi?

Nel saggio emerge una certa discontinuità tra il piano codicistico e la sua applicazione; ciò che assume un preciso rilievo storico trattandosi del piano normativo imposto dal Code Napoléon. In tema di diritti reali si coglie in maniera netta la contrapposizione tra il disegno valoriale inaugurato dalla codificazione – di matrice antifeudale – e la sua proiezione nel mondo dell'appartenenza; diventando a tal fine decisiva l'analisi dei casi concreti sottoposti alla magistratura