Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study.

Aims: Left ventricular dysfunction (LVD) in type 2 diabetes mellitus (DM) (DYDA) study is a prospective investigation enrolling 960 with DM without overt cardiac disease. At baseline, a high prevalence of LVD was detected by analysing midwall shortening. We report here the incidence of clinical events in DYDA patients after 2-year follow-up and the frequency of LVD detected at baseline and 2-year evaluation.

Prognostic stratification by conventional echocardiography of patients with aortic stenosis: the "CAIMAN-ECHO score".

Background And Aim: Surgery is not recommended in asymptomatic patients with aortic stenosis (AS). However, prognosis of these patients is worse than retained. We built a simple score (named by the acronym "CAIMAN") for stratifying asymptomatic patients with AS according to the different risk for cardiovascular events.

Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis.

Background: Adjuvant Trastuzumab with chemotherapy is the gold standard for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (HER2+ EBC). Older patients have been largely under-represented in clinical trials, and few data on Trastuzumab cardiotoxicity have been reported in this subgroup.

Patients And Methods: Four hundred and ninety-nine consecutive HER2+ EBC patients were treated with adjuvant trastuzumab and chemotherapy (aTrastC) at 10 Italian institutions.

Left atrial systolic force and outcome in asymptomatic mild to moderate aortic stenosis.

Background And Aims: In patients with chronic pressure overload due to hypertension or aortic valve stenosis (AS), higher left atrial systolic force (LASF) is associated with a high-risk cardiovascular (CV) phenotype. We tested LASF as prognostic marker in patients with AS.

Methods: We used baseline and outcome data from 1,566 patients recruited in the Simvastatin and Ezetimibe in AS (SEAS) study evaluating the effect of placebo-controlled simvastatin and ezetimibe treatment on CV events.

Inappropriately high left-ventricular mass in asymptomatic mild-moderate aortic stenosis.

Objective: In some patients with aortic stenosis left-ventricular hypertrophy exceeds what is needed to sustain the hemodynamic load imposed by the aortic stenosis, a condition named inappropriately high left-ventricular mass (iLVM). Although iLVM is associated with increased mortality after aortic valve replacement, prevalence and covariates of iLVM in asymptomatic aortic stenosis are unknown.

Methods: We analyzed baseline data from 1614 patients (67 ± 10 years, 51% hypertensive) recruited in the Simvastatin Ezetimibe in Aortic Stenosis study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic mild-moderate aortic stenosis.

Analysis of circumferential and longitudinal left ventricular systolic function in patients with non-ischemic chronic heart failure and preserved ejection fraction (from the CARRY-IN-HFpEF study).

Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF.

Thyrocervical trunk pseudoaneurysm following central venous catheterization.

A 71-year-old female developed a painless neck mass three months following an aortic valve replacement, mitral commissurotomy, and coronary artery bypass. A cervical trunk angio revealed a pseudoaneurysm supplied from a branch of the thyrocervical trunk, which was successfully excised.

Inappropriately high left ventricular mass in patients with type 2 diabetes mellitus and no overt cardiac disease. The DYDA study.

Background: An inappropriately high left ventricular mass (iLVM) may be detected in patients with diabetes mellitus. Several hemodynamic and nonhemodynamic factors stimulating LVM growth may actively operate in these patients. In this study, we assessed prevalence and factors associated with iLVM in patients with diabetes mellitus.

Left atrial systolic force in asymptomatic aortic stenosis.

Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS).

Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method.

Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study.

Background: Individuals with diabetes mellitus (DM) have a higher risk to develop heart failure. Clinical guidelines emphasize the importance of early diagnosis of left ventricular dysfunction (LVD) and preventive interventions in these patients. In this study we assessed the prevalence of LVD, systolic or diastolic, in DM patients without known cardiac disease recruited in the 'left ventricular DYsfunction in DiAbetes (DYDA)' study.

Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for cardiovascular events.

Background: The hemodynamic alterations induced by the impairment of renal function explain only in part the development of left ventricular hypertrophy in patients with chronic kidney disease (CKD), who are theoretically exposed to an inappropriate high growth of left ventricular mass (iLVM) due to the activation of neuro-hormonal stressors. Few data are available on the relations between iLVM and renal function.

Study Design And Measurements: Three hundred and forty individuals at increased risk for cardiovascular events underwent assessment of renal function by the estimation of glomerular filtration rate (eGFR) and echocardiography: 227 patients had stages 1-2 CKD (eGFR ≥60 ml/min per 1.

Left atrial size and force in patients with systolic chronic heart failure: Comparison with healthy controls and different cardiac diseases.

Background: Left atrial (LA) systolic force (LASF) is significantly increased in chronic heart failure (CHF), arterial hypertension (HT) and aortic stenosis (AS). The increase is proportional to the degree of left ventricular hypertrophy and diastolic dysfunction.

Objectives: To assess the magnitude of changes in maximal LA volume (LAV(max)) and LASF in systolic CHF compared with other cardiac diseases, and to assess whether the left atrium remodels differently and works in response to specific conditions affecting diastolic function and to individual factors associated with LA alterations.

Analysis of left ventricular systolic function by midwall mechanics in patients with obstructive sleep apnoea.

Aims: midwall mechanics reveal systolic dysfunction in obese and hypertensive patients with concentric left ventricular (LV) geometry, which is frequently detected in subjects with obstructive sleep apnoea (OSA). Midwall mechanics have never been studied in these patients, who frequently experience heart failure (HF).

Methods And Results: we analysed midwall stress-shortening relations by echocardiography in 150 controls and 200 patients with OSA (age 62 ± 13 years) without known cardiac disease.

Prognostic effect of inappropriately high left ventricular mass in asymptomatic severe aortic stenosis.

Objectives: In patients with aortic stenosis (AS) left ventricular (LV) myocardial growth may exceed individual needs to compensate LV haemodynamic load leading to inappropriately high LV mass (iLVM), a condition at high risk of adverse cardiovascular events. The prognostic impact of iLVM was determined in 218 patients with asymptomatic severe AS.

Methods: iLVM was recognised when the measured LV mass exceeded 10% of the expected value predicted from height, sex and stroke work (prognostic cut-off assessed by a specific ROC analysis).

Severe obstructive sleep apnea elicits concentric left ventricular geometry.

Background: Obstructive sleep apnea (OSA) has several negative effects on the heart including increase in myocardial end-systolic stress, venous return and sympathetic activity, all potential stimuli of left ventricular (LV) hypertrophy. The impact of the severity of OSA on LV geometry is unknown. We hypothesized that OSA is related to concentric LV geometry.

Influence of age on the relationship between left atrial performance and left ventricular systolic and diastolic function in systemic arterial hypertension.

Background: Changes in left ventricular (LV) systolic and diastolic properties may generate variations in left atrial (LA) size and function in many pathophysiological models of LV overload. Besides these states, increasing age may independently influence and magnify LA changes.

Objective: To investigate the relation of LA size and function to increasing age in hypertensive patients, and to evaluate whether this relationship is influenced by LV function.

Left atrial systolic force: comparison between two methods for the noninvasive assessment of left atrial systolic function.

Background: Left atrial systolic force (LASF) is a measure of atrial systolic function applied both in patients with systemic arterial hypertension and aortic valve disease.

Design And Methods: The method used for assessing LASF was described by Manning in 1993. It assumes a constant circular area for estimating the mitral orifice and measures peak atrial velocity of transmitral flow.

Prevalence, predictors and prognostic value of acute impairment in renal function during intensive unloading therapy in a community population hospitalized for decompensated heart failure.

Background And Methods: Chronic heart failure (CHF) is often associated with impaired renal function. Diuretics and vasodilators may lead to aggravated renal dysfunction (ARD), particularly among patients with decompensated CHF. Although the prevalence of ARD has been evaluated in patients awaiting heart transplantation, little is known about ARD in the community sample of CHF patients.

Changes in plasma N-terminal proBNP levels and ventricular filling pressures during intensive unloading therapy in elderly with decompensated congestive heart failure and preserved left ventricular systolic function.

Background: Plasma B-type natriuretic peptide (BNP) levels depend on left ventricular (LV) filling pressures and correlate with the state of neurohormonal modulation in patients with congestive heart failure (CHF). In these subjects, therapy of decompensated CHF can determine acute changes in BNP levels.

Methods And Results: We defined the sequential pattern of N-terminal (T) proBNP in elderly with decompensated CHF and preserved LV systolic function undergoing intensive unloading therapy, assessed the prevalence of patients who significantly reduced NTproBNP at the end of treatment, and verified the relations between changes in NTproBNP and ventricular filling pressures.

Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia.

Background And Aim: Pulmonary hypertension (PH) determines various adaptive changes in right ventricular (RV) geometry which may progressively lead to hypertrophy, mechanical dysfunction and dilatation with pump failure. Right atrium (RA) is theoretically involved in this physiopathological process, but its role has never been investigated. We hypothesized that RA increases volume and function to assist RV during the chronic pressure overload exposition due to PH.

Does atrial fibrillation in very elderly patients with chronic systolic heart failure limit the use of carvedilol?

Background And Aims: It is well known that beta-blockers are useful in patients with chronic heart failure (CHF). These favourable effects have recently been observed even in elderly CHF patients. Objectives of the present study were to evaluate the feasibility, tolerability and safety of carvedilol therapy in a cohort of patients > 70 years of age with CHF and left ventricular ejection fraction < 40% with chronic atrial fibrillation.

Pharmacological left ventricular reverse remodeling in elderly patients receiving optimal therapy for chronic heart failure.

Background And Aims: In recent years, reversal of established left ventricular (LV) dilatation has been increasingly recognized in middle-aged patients with dilated cardiomyopathy receiving angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers. We performed this prospective study to evaluate whether optimized therapy for heart failure also induces LV reverse remodeling in older patients.

Methods: One hundred and twenty-four patients aged >70 years with LV ejection fraction <40% underwent clinical and echocardiographic evaluation at baseline and after 1 year.

Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure.

Background And Aim: Mitral regurgitation (MR) has been demonstrated to be a powerful predictor of adverse outcome in middle-aged patients with chronic heart failure (CHF). In this study, we sought to define the prognostic impact of functional mitral regurgitation in a population of elderly patients with systolic CHF.

Methods: One hundred seventy-five outpatients aged >70 years with validated CHF and left ventricular ejection fraction <40% underwent clinical and echocardiographic evaluations at baseline.

Dilated versus nondilated cardiomyopathy in the elderly population treated with guideline-based medical therapy for systolic chronic heart failure.

Background: Although the process by which the left ventricular (LV) remodels in response to an injury generally leads to dilatation, in patients with heart failure (HF) the recognition of a small or mildly dilated left ventricle is not uncommon. We investigated the prevalence and the characteristics of elderly patients with traditional dilated and nondilated cardiomyopathy (CMP). We also assessed the response to the guideline-based medical therapy and the prognosis based on LV dilatation in this population.

Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension.

Background: Arterial hypertension determines distinct adaptive left ventricular geometric responses, which may differently affect left ventricular function and left atrial performance.

Objectives: In this study, the effect of left ventricular geometry on left atrial size and function, and the relationship between left atrial size and left ventricular mass were assessed in 336 patients with systemic arterial hypertension who had undergone Doppler echocardiography.

Methods And Results: Patients were classified into concentric (110 patients with concentric left ventricular geometry defined as relative wall thickness > or = 0.