Search

Highlights • Congestive heart failure is a major cause of morbidity and mortality worldwide. • Sacubitril/valsartan improved left ventricular remodeling and ejection fraction in a real-world setting, mostly within 12 months. • Female gender and primitive cardiomyopathy were predictors of favorable remodeling. • Sacubitril/valsartan should be initiated early to maximize its beneficial effects., Background Compared to angiotensin inhibition, angiotensin-neprilysin “blockade” improves mortality and reduces hospitalizations in patients with heart failure (HF) with reduced ejection fraction (EF). Sacubitril/valsartan is known to influence left ventricular (LV) reverse remodeling with systolic function improvement, although underlying mechanisms remain partially unclear. Our objectives were to evaluate whether sacubitril/valsartan promotes LV remodeling and improves LV ejection fraction (LVEF) (above the 35% threshold by echocardiographic evaluation) and to identify predictors of reverse remodeling in a real-world setting. Methods New York Heart Association (NYHA) class II–III patients with EF ≤ 35% were consecutively enrolled. All patients were on optimal medical therapy on the initiation of sacubitril/valsartan therapy. Full clinical and multi-parametric echocardiographic evaluation, electrocardiogram, and laboratory tests were performed at baseline and after 3, 6, 12, and 24 months. Results In total, 69 patients were recruited from July 2016 to August 2018. Reverse remodeling was observed in 57.7% (30/52) of patients, occurring within 3, 6, 12, and 24 months in 2, 11, 13, and 4 patients, respectively. Twenty-four (46%) patients showed LVEF improvement above the threshold of 35% during follow-up, occurring in 1, 10, 9, and 4 patients within 3, 6, 12, and 24 months, respectively. Primitive dilated cardiomyopathy and female gender were identified as significant predictors of reverse remodeling. NYHA class was improved in both remodeling and non-remodeling patients. Conclusion Sacubitril/valsartan promotes favorable cardiac remodeling and significantly improves LVEF in a significant proportion of HF patients within 24 months, both in NYHA class II and III patients with HF.

Background The effectiveness of implantable cardioverter-defibrillator (ICD) in the elderly is uncertain, given their competing risk of nonarrhythmic death. Guidelines state that an ICD should be implanted if the expectation of survival is at least 1 year. However, survival is not easy to predict in elderly patients with severe cardiac disease. Aim To assess 12-month survival after ICD implantation in patients aged ≥75 years, to identify predictors of 12-month mortality, and to evaluate the incidence of ICD therapy during follow-up. Methods We retrospectively analyzed all clinical, instrumental, and survival data of patients ≥75 years old who received an ICD in our center from 2000 to 2013. Results We included 127 patients (mean age 78 years). ICD was implanted for primary prevention in 61%. The 12-month survival rate was 87.4%. At both univariate and multivariate analyses, left ventricular ejection fraction (EF) ≤ 25%, and moderate to severe impaired renal function (IRF) independently predicted 12-month mortality that was as high as 45.5% in patients with both risk factors. During a median follow-up of 38 months, 30 patients (23.6%) received ≥1 appropriate ICD interventions, but only 3.1% of shocks occurred during the first year, and none in the subgroup of patients with EF ≤ 25% and IRF. Conclusion Twelve-month survival in elderly patients after ICD implantation is good and the indication for ICD should not be based on age alone. However, the subgroup with EF ≤ 25% and IRF showed a high 12-month nonarrhythmic mortality and did not benefit from ICD implantation.

Axillary vein puncture is an effective method for pacemaker lead insertion with less complications compared with subclavian vein puncture; however, there are limited data on implantable cardioverter defibrillator (ICD) implantation with this technique. We reported our experience with a blind axillary vein puncture using fluoroscopic landmarks consisting of the outer edge of the first rib and the body surface of the second rib for ICD lead implantation. The study population included 103 consecutive patients (mean age 59 ± 9 years) referred for ICD implantation using axillary vein puncture without contrast venography. An 18-gauge needle was advanced toward the outer edge of the fist rib below the clavicle or the body surface of the second rib. If the vein was not entered, the needle was withdrawn and the puncture was repeated with slight variations of needle direction for a maximum of four times, then contrast-guided vein puncture was performed. The total implanted leads were 152 including 103 right ventricular leads, 35 right atrial leads, and 14 left ventricular epicardial leads. Blind axillary vein puncture was successful obtained in 96 (93.2 %) patients. The rate of success was higher using the body surface of the second rib compared with the outer edge of the first rib (88.7 vs. 100 %; p = 0.04).Contrast venography was required in seven (6.8 %) patients because of vein course abnormality (n = 5) or vasospasm (n = 2). No acute complications or device-related complications were recorded during a mean follow-up of 12 ± 5 months. Axillary vein access using fluoroscopic landmarks, especially the body surface of the second rib, is an effective approach for ICD implantation and offers the potential to avoid complications usually observed with traditional subclavian vein approach

It is well recognized that the majority of patients with heart failure (HF) are admitted to General Medicine Departments (GMDs), and that the recommendations of the international guidelines for the treatment of HF are often incorrectly applied in hospital practice. We evaluated the treatment of patients with HF discharged from a single hospital over a period of 10 years. The study population comprised two series of patients who were discharged from six GMDs of a single hospital with the diagnosis of HF in the first 2 months of 1998 and 2008. The patients were also divided in two groups on the basis of the type of HF, systolic or diastolic. In 10 years, the number of patients who were discharged with the diagnosis of HF increased, the median age rose from 79 to 82 years and diastolic has become the more common type of HF. The prevalence of comorbidities rose significantly. There was an increased use of ACE-inhibitors and betablockers, and a reduction of digoxin and nitrates. The mortality decreased from 16.7% in 1998 to 9.6% in 2008 (p < 0.02) and hospitalizations became shorter (p < 0.05) considering patients with systolic HF (EF ≤ 45%) the median age rose from 74 to 79 years old (p < 0.01). We recorded an increasing use of betablockers, a reduction in the prescription of digoxin. The percentage of Diastolic HF rose from 55.7% in 1998 to 65.0% in 2008 (p < 0.001). The median age of these patients changed from 79 to 82 years old (p < 0.05). In 10 years, the clinical characteristics and management of HF patients who are hospitalized have changed. Pharmacological treatment has improved, but it still remains far from being adequately compliant with guideline recommendations.