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Anthracyclines, taxanes and trastuzumab are used for therapy in early breast cancer (EBC) overexpressing Human Epidermal Growth Factor 2 (HER2+). These drugs, considered alone, do not present potential nephrotoxicity. However, renal dysfunction (RD) may increase the myocardial sensibility to the insult of these chemotherapies used in combination. The aim of the study is to assess the role of RD on the development of cardiotoxicity associated with trastuzumab-based adjuvant therapy (aTrastC) for EBC. Clinical and echocardiographic data of 499 women with ERB2+ EBC were analyzed. At 12-month evaluation, any symptoms of heart failure or decrease in left ventricular ejection fraction (LVEF) were recorded. Patients who had cardiotoxicity (n = 130, 26 %) were older (57 ± 11 vs. 55 ± 11 years; p = 0.03), had lower glomerular filtration rate (GFR) (76 ± 15 vs. 83 ± 19 ml/min/1.73 m(2); p = 0.003), higher LVEF (69 ± 6 vs. 63 ± 5 %; p < 0.001) and received more frequent doses of doxorubicin (18 vs. 9 %; p = 0.01) than those who did not. In patients with GFR 60-90 and <60 ml/min/1.73 m(2), the 1-year event rate of cardiotoxicity was 25 and 38 %, respectively. ROC analysis showed that the best cut-off point of GFR for predicting cardiotoxicity was 78 ml/min/1.73 m(2) (AUC = 0.66, [95 % CI 0.57-0.74]). Multiple logistic regression revealed that GRF <78 ml/min/1.73 m(2) was the strongest predictor of cardiotoxicity (OR 3.32 [CI = 1.30-8.65]), independent of doxorubicin treatment and left ventricular ejection fraction. A reduced renal function represents a condition of higher risk of developing cardiotoxicity at 12-month follow-up in patients with HER2 + EBC treated with aTrastC. [ABSTRACT FROM AUTHOR]

Aims: Tissue Doppler imaging (TDI) systolic velocities have been used to detect impaired systolic function in patients with heart failure and normal ejection fraction (HFnEF). However, many patients do not show alterations by this technique, and furthermore, myocardial systolic velocities can be affected by tethering, translation, and loading conditions. Thus, uncertainties remain about the detection of abnormal systolic function in HFnEF patients. The aim of this study was, therefore, to compare systolic velocities vs. TDI-derived deformation indices for detection of possible abnormalities of systolic function in HFnEF patients, taking into account loading conditions. Methods and Results: We studied 40 patients with systolic heart failure (SHF: EF ≤ 40%), 47 HFnEF patients, and 50 controls (C). Systolic velocities of the mitral annulus (pulsed-wave TDI) were measured at four sites and averaged; concomitantly, peak negative TDI-derived strain and strain rate of the four walls were measured in apical, four-, and two-chamber views. Ejection fraction was 65 ± 6% in C, 62 ± 7% in HFnEF, and 29 ± 7% in SHF (P< 0.001 vs. both). In HFnEF patients, systolic velocities and peak negative global longitudinal strain rate and strain were higher than in SHF (P< 0.0001 for all), but lower than in C (P< 0.0001 for all). After controlling for age, left ventricular mass index, end-diastolic volume index, and circumferential end-systolic stress, differences between groups remained significant for deformation indices but not for TDI velocities. By velocity/strain-stress relationship analysis, peak global longitudinal strain was more sensitive than peak systolic motion in detecting systolic dysfunction in HFnEF patients (64 vs. 40%, P< 0.05). Conclusion: In patients with HFnEF, TDI-derived deformation indices may more accurately detect abnormal systolic function than myocardial velocities. [ABSTRACT FROM AUTHOR]

Normal esophageal motor parameters and nuteracker esophagus have never been well characterized in Italy. For this reason, we investigated 33 patients with nutcracker esophagus and compared them with 34 age- and sex-matched volunteers. Esophageal manometry revealed that lower esophageal sphincter pressure and contraction amplitude at 3, 8, 13, and 18 cm above the lower esophageal sphincter were significantly higher in patients ( p<0.05). In addition, bi- and tripeaked waves were significantly increased in the patients at all esophageal recording levels. No significant differences were found between the 9 patients and 17 controls who were also evaluated for upper esophageal sphincter pressure. [ABSTRACT FROM AUTHOR]

An abstract of the article "Feasibility and burden of multidimensional assessement of heart failure elderly in clinical practice: data from the IMAGE-HF Study," by D. Del Sindaco and colleagues is presented.

An abstract of the article "Reversibility of Restrictive Filling During Low-Dose Dobutamine Echocardiography Predicts Reverse LV Remodeling After Revascularization in Ischemic Cardiomyopathy," by E. Carluccio and colleagues is presented.

An abstract of the study "Integrated Care Pathways for Heart Failure (HF) Patients: A National Consensus Initiative," by A. Di Lenarda et al. is presented.

An abstract of the study "Improving Pharmacological Treatment of Heart Failure (HF) Through Networking: Drug Prescription Patterns in a National Cardiologist Network vs Community," by A. Di Lenarda and colleagues is presented.