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Objectives: This study aims to evaluate the association between prehospital intravenous therapy and clinical outcomes in the patients with acute heart failure., Methods: We conducted a prospective, multicenter observational study of consecutive AHF patients. Univariate and logistic regression analysis were performed to determine association between prehospital furosemide or nitrates administration and hospital outcome (death, length of stay)., Results: Data on a total of 1239 patients were processed. The mean age in the whole cohort was 71 ± 11.8 years with a gender distribution (M/F) of 634/605 patients. By prehospital treatment whole cohort was divided into 4 groups: F+ group with prehospital IV furosemide administration of 602 patients (48.6 %), F- group without prehospital IV furosemide administration of 637 patients (51.4 %), N+ group with prehospital IV nitrates administration of 110 patients (8.9 %) and N- group without IV nitrates administration of 1129 patients (91.1 %). Group of combined F+/N+ was not created. Ninety-four patients (7.6 %) died during the index hospitalization. Hospital mortality (p = 0.138) and length of stay (p = 0.101) did not differ in F+ vs F-. The patients with prehospital nitrates administration did not differ in mortality, but a shorter length of stay in univariate analysis (p = 0.03) was recorded. After adjusting for age, systolic BP and mode of referral to hospitalization, early IV furosemide usage nor nitrates showed no impact on hospital mortality and length of stay., Conclusions: Prehospital treatment with IV furosemide or nitrates in AHF patients seemed to have no major impact on hospital mortality or length of hospitalization after adjustment for several cofounders (Tab. 2, Ref. 16).

Background: During the COVID-19 pandemic, most of the health care systems suspended their non-urgent activities. This included the cancellation of consultations for patients with rare diseases, such as severe pulmonary hypertension (PH), resulting in potential medication shortage and loss of follow-up. Thus, the aim of the study was to evaluate PH patient health status evolution, access to health care and mental health experience during the early phase of the pandemic., Methods: We conducted an online patient survey, available in 16 languages, between 22/05/2020 and 28/06/2020. The survey included questions corresponding to demographic, COVID-19 and PH related information., Results: 1073 patients (or relatives, 27%) from 52 countries all over the world participated in the survey. Seventy-seven percent (77%) of responders reported a diagnosis of pulmonary arterial hypertension and 15% of chronic thromboembolic PH. The COVID-19 related events were few: only 1% of all responders reported a diagnosis of COVID-19. However, 8% of patients reported health deterioration possibly related to PH, and 4% hospitalization for PH. Besides, 11% of the patients reported difficulties to access their PH expert centre, and 3% interruption of treatment due to shortage of medication. Anxiety or depression was reported by 67% of the participants., Conclusion: Although COVID-19 incidence in PH patients was low, PH related problems occurred frequently as the pandemic progressed, including difficulties to have access to specialized care. The importance of primary health care was emphasized. Further studies are needed to evaluate the long-term consequences of COVID-related PH care disruption.

Aim: Patients with advanced heart failure (HF) represent a pool of candidates for heart transplantation and long-term mechanical circulatory support devices. The aim of our study was to determine simple and reliable markers of one-year mortality for selection of the most suitable patients for heart replacement therapy., Methods and Results: One thousand consecutive patients with HF (mean age 49 ± 10.9 years; 86.8% males) referred to a single tertiary centre from January 1998 to January 2010 in order to assess the indication for heart transplantation were enrolled. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. The mean follow-up was 4.3 ± 2.7 years (range 1-12 years). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%. Independent predictors of 1-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, plasma sodium <135 mmol/L, the need for intravenous treatment at hospital admission (diuretics and/or inotropes), and furosemide dose at discharge >240 mg/day., Conclusions: Short-term prognosis of HF patient can be estimated based on simple parameters. Patients with signs of poor prognosis should be referred to tertiary centres to be considered for heart replacement therapy.

Pulmonary arterial hypertension (PAH) is a disease characterised by a gradual increase in resistance of pulmonary circulation leading to right ventricular failure and death. In only 10 % of cases, there is a response to acute vasoreactivity testing with a significant reduction in mean pulmonary artery pressure (PAP), while in this group of patients, less than one half of cases benefit from long-term treatment with calcium channel blockers (CCB). This paper describes a case report of a young patient with dyspnoea and suspicion of pulmonary hypertension who was referred to a specialised centre. The complex evaluation of her clinical state led to confirmed diagnosis of idiopathic pulmonary arterial hypertension (IPAH). Because there was a positive response to vasoreactivity testing, the treatment for IPAH was initiated with a high dose of CCB. This treatment markedly improved her clinical state as well as echocardiographic and hemodynamic findings.In this study, the authors present a diagnostic algorithm in pulmonary hypertension and emphasise the role of CCB in treatment of PAH in carefully selected patients (Tab. 1, Fig. 5, Ref. 7).

Objectives: Distinguishing pulmonary arterial hypertension (PAH) and pulmonary hypertension due to left ventricular diastolic dysfunction (PHLDD) is essential for the correct disease management. We compared the importance of electrocardiographic (ECG) signs of right ventricular hypertrophy (RVH) in patients with similar degree PAH and PHLDD., Methods: ECG analysis was retrospectively performed in 17 PHLDD and in 17 PAH patients with catheterization-confirmed moderate pulmonary hypertension. Sensitivity, specificity, and positive and negative predictive values for individual RVH signs were calculated., Results: The PAH group showed a higher prevalence of the following: R/S ratio > 1 in V1 (p < 0.001), R in V1 + S in V6 > 1.05 mV (p < 0.01), R wave peak time > 0.035 s (p < 0.05), right ventricular strain (p < 0.001), and A+R-PL parameter (i. e. R(V1) + S1 - S(V1)) = 0.07 mV (p < 0.05). The sensitivity and negative predictive value (NPV) of RVH signs for distinguishing PAH and PHLDD were low for all signs except right ventricular strain (sensitivity 71%, NPV 77%). The specificity and positive predictive value (PPV) of all six parameters were both 100%., Conclusions: In patients with pulmonary hypertension detected using echocardiography, ECG presence of RVH/overload may exclude LV diastolic dysfunction as a cause of PH and suggests the diagnosis of PAH (Tab. 3, Ref. 19).

Aim: The goal of the study was to describe the changes of the portal vein (PV) flow in patients with an exacerbation of advanced chronic congestion heart failure (CHF) in relation to central hemodynamics and biochemical indicators of liver lesion., Patients and Methods: 90 pts (76 males) aged 49.2 +/- 11.2 years admitted for an acute exacerbation of chronic heart failure based on severe left ventricular systolic dysfunction (LVEF 20 +/- 4.3%) were evaluated. The PV flow was sampled from the main portal vein using the intercostal approach. Systolic and diastolic flow velocities were measured and the the pulsatility index (PI, max - min/max PV flow velocity) was calculated., Results: The median of PI in all patients was 0.82 (0-2.0). PI > or = 0.5 was found in 77 (86%) of patients. There was a significant linear correlation of PI and right atrium pressure (RAP), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) (p <0.01, r = 0.68, 0.51 and 0.49 resp). Out of 75 patients with RAP > or =8 mmHg, 67 (89%) had the pulsatility index > or = 0.5. The mean RAP was 7.2 +/- 3.1 mmHg in patients with continuous flow, 14.9 +/- 5.9 mmHg in the group with pulsatile flow pattern, and 20.1 +/- 6.3 and 21.1 +/- 6.5 mmHg in intermittent and alternating flow, respectively (p < 0.01)., Conclusion: The flow pulsatility increases with increasing right ventricular filling pressure so that an analysis of the PV flow can detect the elevation of right atrial pressure and allow a quantitative estimation of RAP. The finding of flat portal vein flow wave patterns in HF patients with signs of congestion draws the attention to concurrent primary liver disease. This information could be important in the risk stratification as well as in the therapeutic decision (Tab. 1, Fig. 6, Ref. 19).

Introduction: Metabolic syndrome (MS) is a cardiovascular risk predictor. Prevalence of MS after heart transplantation (HTx) is high. Recent data suggest a positive metabolic effect of telmisartan., Aim: To describe the influence of telmisartan on lipid and glycide metabolism in MS after HTx., Methods: Fifteen patients aged 55+/-12 yr, 88+/-25 months after HTx with MS receiving statins were followed. The reason for telmisartan administration was arterial hypertension with either drug intolerance or poor control. Body mass index (BMI), waist circumference, total cholesterol, low density lipoprotein LDL-cholesterol, high density lipoprotein-cholesterol, triglycerides, C-reactive protein (CRP), fasting glucose, immunoreactive insulin (IRI), C-peptide and the homeostasis model assessment (HOMA) index were determined. Ambulatory blood pressure monitoring was performed. After initial evaluation, telmisartan 80 mg was started. After 20 +/- 5 wk follow-up, identical parameters were measured. Statistical significance was evaluated using Student's t-test., Results: BMI, waist circumference, systolic and diastolic blood pressures, serum lipids and CRP remained unchanged after telmisartan. Significant reduction in fasting glucose (6.7 vs. 5.6 mmol/L, p < 0.02), IRI (8.8 vs. 8.5 U/mL p = 0.05), HOMA (7.3 vs. 5.8 mmol/L x muU/mL, p < 0.05) and C-peptide (4.0 vs. 3.3 ng/mL, p < 0.02) was found., Conclusions: Telmisartan had a positive impact on insulin sensitivity parameters (fasting glucose, IRI, C-peptide and HOMA) in this population. No effect on obesity, serum lipids and systemic inflammation was observed.