Search

Aims: Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction. Methods and results: We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67 years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4 years (AUC 0.764, 0.725, and 0.720, respectively). Conclusion: In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.

Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5–25 mg, n = 1431) and low dose (

Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V˙O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV˙O2 (P

Stenoptilia pelidnodactyla (Stein, 1837) (Figs. 12-13) Material examined. DISTRICT OF NEBRODI MTS.: Floresta, 1,230 m a.s.l., VC9024, 25.v.2006, 5JJ 5&female;&female;; 31.v.2005, 2 &female;&female; (GMCI). Biology. Adults: wingspan 19-24 mm. The adults fly from April to September, reaching up to 2,000 m a.s.l. In north-eastern Sicily it has been observed only in May. Our specimens were captured at dusk while flying over the grass in a field near a rocky habitat. Larval host plant: probably monophagous on Saxifraga granulata L. (Saxifragaceae). Range in Italy. Northern and central parts of the peninsula; Sicily (new record). Distribution. Siberian-Euro-Maghrebinian., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on page 203, DOI: 10.5281/zenodo.5342507

Adaina microdactyla (Hübner, 1831) (Figs. 2-3) Material examined. DISTRICT OF PELORITANI MTS.: Bottaro stream (Mongiuffi), 430 m a.s.l., WB2936, 4.viii.2004, 1&female;. DISTRICT OF NEBRODI MTS.: Pellera stream (Roccella Valdemone), 740 m a.s.l., WC0010, 6.viii.2004, 1 J (GMCI). Biology. Adults: wingspan 10-17 mm. This species flies from May to August and can fly up to 2,500 m a.s.l. in north-eastern Sicily. Our specimens were captured in August using a light trap close to a riparian habitat. Larval host plant: Eupatorium cannabinum L. (Asteraceae). Range in Italy. Throughout the peninsula; Sardinia; Sicily (new genus and species record). Distribution. Palaearctic, Oriental, and Australian regions., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on page 199, DOI: 10.5281/zenodo.5342507

Stenoptilia grisescens Schawerda, 1933 (Figs. 8-9) Material examined. DISTRICT OF MT. ETNA: Mount S. Leo (Belpasso), 1,000 m a.s.l., VB9687, 15.vi.2005, 1 &female;; 21.vi.2004, 1 &female;; 23.vi.2004, 2 JJ; 22.vii.2004, 3 JJ 2 &female;&female;; 27.vii.2005, 1 J; 17.viii.2004, 1 J 1 &female;; Piano delle Ginestre (Bronte), 1,000 m a.s.l., VB8787, 8.ix.2005, 1 &female;; Rifugio Galvarina (Biancavilla), 1,878 m a.s.l., VB9766, 28.vi.2004, 1 &female;; 19.vii.2004, 1 &female;. DISTRICT OF PELORITANI MTS.: Mouth of the Stream Agrò (S. Alessio Siculo), 1 m a.s.l., WB3918, 2.viii.2004, 1 &female;. DISTRICT OF NEBRODI MTS.: Stream Pellera (Roccella Valdemone), 740 m a.s.l., WC0010, 17.vii.2004, 1 J; 6.viii.2004, 1 &female; (GMCI). Biology. Adults: wingspan 16-20 mm. Adults fly from July to September; in north-eastern Sicily we observed adults from June to September. It flies among grass at dusk; our specimens were captured at light during the night. Larval host plant: probably monophagous on Misopates orontium (L.) Rafin. (Scrophulariaceae). Range in Italy. Piedmont, Latium; Sardinia; Sicily (new record). Distribution. Mediterranean-Macaronesian. Remark. In the Italian checklist (ARENBERGER et al. 1995), S. grisescens is indicated as a synonym of S. arida (Zeller, 1847) (type locality: Messina); the latter species is widespread in the entire peninsula and on the islands. BIGOT & PICARD (2002) considered S. grisescens as a valid species and gave a key to identify the species belonging to the grisescens group (S. grisescens, S. mariaeluisae Bigot & Picard, 2002, S. inopinata Bigot & Picard, 2002, and S. gallobritannidactyla Gibeaux, 1985); the key is based on the characters of the male uncus and the ostium bursae and post-vaginal lamella of females. However, GIELIS (2003) still indicated S. grisescens as a synonym of S. arida. ARENBERGER (2005) agreed with BIGOT & PICARD (2002) in considering S. grisescens a valid species, and confirmed its presence in Italy in Piedmont, Latium, and Sardinia. TREMATERRA et al. (2006) reported S. grisescens from Molise and considered it by mistake as a new record for Italy. ARENBERGER (2005) confirmed the presence of S. arida in Latium, Liguria and Sicily. However, most of the records of S. arida from Italy should be verified. Our data demonstrate the presence of S. grisescens in Sicily; the characters of the genitalia for both males and females are as described by NEL (2003) and ARENBERGER (2005)., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on page 202, DOI: 10.5281/zenodo.5342507, {"references":["ARENBERGER E., GAEDIKE R., SCHOLZ A. & ZANGHERI S. 1995: Lepidoptera Urodoidea, Schreckensteinioidea, Epermenioidea, Alucitoidea, Pterophoroidea, Copromorphoidea. In: MINELLI A., RUFFO S. & LA POSTA S. (eds.): Checklist delle specie della fauna italiana. Vol. 86. Calderini, Bologna, 13 pp.","ZELLER P. C. 1847: Bemerkungen uber die auf einer Reise nach Italien und Sicilien beobachteten Schmetterlingsarten. Isis von Oken 40: 895 - 910.","BIGOT L. & PICARD J. 2002: Les Stenoptilia de la section grisescens en France. Stenoptilia mariaeluisae nov. sp. et Stenoptilia inopinata nov. sp. Alexanor 21 (5) (2000): 301 - 311.","GIELIS C. 2003: Pterophoridea & Alucitoidea (Lepidoptera). In: VAN DER WOLF H. (ed.): World Catalogue of Insects. Vol. 4. Apollo Books, Stenstrup, 198 pp.","ARENBERGER E. 2005: Pterophoridae III (Platyptiliini, Stenoptilia). In: GAEDIKE R. (ed.): Microlepidoptera Palaearctica. Vol. 12. Goecke & Evers, Keltern, 191 pp.","TREMATERRA P., BIGOT L. & PICARD J. 2006: Lepidoptera Pterophoridae dell'Italia centro-meridionale e insulare. Bollettino di Zoologia Agraria e di Bachicoltura, Ser. II 38: 127 - 141.","NEL J. 2003: Atlas des Lepidopteres Pterophoridae de France. Revue de l'Association Roussillonnaise d'Entomologie 12 (Suppl.): 1 - 61."]}

Wheeleria spilodactyla (Curtis, 1927) (Figs. 14-15) Material examined. DISTRICT OF MT. ETNA: Piano delle Ginestre (Bronte), 1,000 m a.s.l., VB8787, 25.vi.2004, 1 J; 18.vi.2005, 5 JJ 7 &female;&female;; 8.ix.2005, 1 J 1 &female;; 19.ix.2005, 2 JJ (GMCI). Biology. Adults: wingspan 17-24 mm. The adults fly from April to October. In north-eastern Sicily they have been collected in June and September. This species is attracted by artificial light but is easier to find at sunset on Marrubium vulgare. The pupae are very hairy with a cryptic appearance, and are thus hardly recognizable on the host plants. Larval host plants: Marrubium vulgare L. and Ballota nigra L. (Lamiaceae). Range in Italy. Trentino Alto-Adige; Molise; Sardinia; Sicily (new record). Distribution. Euro-Mediterranean. Introduced in the 1990s to Australia to control Marrubium vulgare, taken there in the early 19th century. Remarks. Male genitalia are similar to those in specimens from Spain (ARENBERGER 1995), Great Britain (GIELIS 1996), and France (NEL 2003)., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on pages 203-204, DOI: 10.5281/zenodo.5342507, {"references":["GIELIS C. 1996: Pterophoridae. In: HUEMER P., KARSHOLT O. & LYNEBORG L. (eds.): Microlepidoptera of Europe. Vol. 1. Apollo Books, Stenstrup, 222 pp.","NEL J. 2003: Atlas des Lepidopteres Pterophoridae de France. Revue de l'Association Roussillonnaise d'Entomologie 12 (Suppl.): 1 - 61."]}

Stenoptilia mariaeluisae Bigot & Picard, 2002 (Figs. 10-11) Material examined. DISTRICT OF MT. ETNA: Catania city, 30 m a.s.l., WB0572, 26.vi.2006, 1 &female;; Mount S. Leo (Belpasso), 1,000 m a.s.l., VB9687, 21.vi.2004, 1 J 3 &female;&female;; 22.vii.2004, 1 J 1 &female;; 27.vii.2005, 1 J 3 &female;&female;; 17.viii.2004, 1 &female;. DISTRICT OF NEBRODI MTS.: Stream Pellera (Roccella Valdemone), 740 m a.s.l., WC0010, 13.ix.2004, 1 &female;; Floresta, 1,230 m a.s.l., VC9024, 25.v.2006, 1 &female; (GMCI). Biology. Adults: wingspan 18-19 mm. In north-eastern Sicily the species flies from June to September and can be observed up to ca. 1,200 m a.s.l. It flies at dusk, together with S. grisescens, hiding in grass if disturbed; some specimens were collected at a light trap. Larval host plant: probably monophagous on Kickxia spuria (L.) Dumort. (Scrophulariaceae). Range in Italy. Friuli Venezia Giulia; Latium; Sicily (new record). Distribution. Holo-Mediterranean. Remark. NEL (2003) and ARENBERGER (2005) considered S. mariaeluisae a valid species and ARENBERGER (2005) found it in Friuli Venezia Giulia and Latium. On the other hand, GIELIS (2003) considers it a synonym of S. arida. As stated above, all records of S. arida from Italy should be checked. Our findings confirm the presence of S. mariaeluisae in Sicily; the characters of male and female genitalia are identical to those described by BIGOT & PICARD (2002) for the holotype and the allotype; see also NEL (2003) and ARENBERGER (2005)., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on page 203, DOI: 10.5281/zenodo.5342507, {"references":["BIGOT L. & PICARD J. 2002: Les Stenoptilia de la section grisescens en France. Stenoptilia mariaeluisae nov. sp. et Stenoptilia inopinata nov. sp. Alexanor 21 (5) (2000): 301 - 311.","NEL J. 2003: Atlas des Lepidopteres Pterophoridae de France. Revue de l'Association Roussillonnaise d'Entomologie 12 (Suppl.): 1 - 61.","ARENBERGER E. 2005: Pterophoridae III (Platyptiliini, Stenoptilia). In: GAEDIKE R. (ed.): Microlepidoptera Palaearctica. Vol. 12. Goecke & Evers, Keltern, 191 pp.","GIELIS C. 2003: Pterophoridea & Alucitoidea (Lepidoptera). In: VAN DER WOLF H. (ed.): World Catalogue of Insects. Vol. 4. Apollo Books, Stenstrup, 198 pp."]}

Urso, Marchese, Giovanni, Nel, Jacques (2008): A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records. Acta Entomologica Musei Nationalis Pragae 48 (1): 197-208, DOI: http://doi.org/10.5281/zenodo.5342507, {"references":["ADAMCZEWSKI S. 1951: On the systematics and origin of the generic group Oxyptilus Zeller (Lep., Alucitidae). Bulletin of the British Museum Natural History (Entomology) 1(5): 301-388.","ARENBERGER E., GAEDIKE R., SCHOLZ A. & ZANGHERI S. 1995:Lepidoptera Urodoidea,Schreckensteinioidea, Epermenioidea,Alucitoidea, Pterophoroidea, Copromorphoidea. In: MINELLI A., RUFFO S. & LA POSTA S. (eds.): Checklist delle specie della fauna italiana. Vol. 86. Calderini, Bologna, 13 pp.","ARENBERGER E. 1995: Pterophoridae I (Pterophorinae, Ochyroticinae,Agdistinae). In:AMSEL H. G., GREGOR F. & REISSER H. (eds.): Microlepidoptera Palaearctica. Vol. 9. Verlag G. Braun GmbH, Karlsruhe, 284 + 296 pp.","ARENBERGER E. 2002: Pterophoridae II (Deuterocopinae, Platyptiliinae: Trichoptilini, Oxyptilini, Tetraschalini). In: GAEDIKE R. (ed.): Microlepidoptera Palaearctica. Vol. 11. Goecke & Evers, Keltern, 287 pp.","ARENBERGER E. 2005: Pterophoridae III (Platyptiliini, Stenoptilia). In: GAEDIKE R. (ed.): Microlepidoptera Palaearctica. Vol. 12. Goecke & Evers, Keltern, 191 pp.","BELLA S. 2007:Contribution to the knowledge of the Pterophoridae from Pantano Longarini (South-Eastern Sicily) (Lepidoptera). Naturalista Siciliano, Ser. IV 31: 49-55.","BELLA S. & FERRAUTO G. 2005: Presence of Megalorhipida leucodactyla (Lepidoptera Pterophoridae) in Sicily: new report for the Italian fauna and notes on the diffusion of its host plant Boerhavia repens L. ssp. viscosa (Choisy) Maire (Nyctaginaceae). Biological Invasions 7: 577-587.","BELLA S. & MARCHESE G. 2007: Prima segnalazione di Lantanophaga pusillidactylus per la fauna italiana (Lepidoptera Pterophoridae). Bollettino di Zoologia Agraria e di Bachicoltura, Ser. II 39: 71-74.","BIGOT L. & PICARD J. 2002: Les Stenoptilia de la section grisescens en France. Stenoptilia mariaeluisae nov. sp. et Stenoptilia inopinata nov. sp. Alexanor 21(5) (2000): 301-311.","GIBEAUX C. & NEL J. 1991: Revision des especes francaises du complexe bipunctidactyla (Scopoli, 1963) dans le genre Stenoptilia Hubner, 1825. Alexanor 17(2): 103-119.","GIELIS C. 1996: Pterophoridae. In: HUEMER P., KARSHOLT O. & LYNEBORG L. (eds.): Microlepidoptera of Europe. Vol. 1. Apollo Books, Stenstrup, 222 pp.","GIELIS C. 2003: Pterophoridea & Alucitoidea (Lepidoptera). In: VAN DER WOLF H. (ed.): World Catalogue of Insects. Vol. 4. Apollo Books, Stenstrup, 198 pp.","GHILIANI F. 1842: Insetti della Sicilia. Atti dell'Accademia Gioenia di Scienze Naturali, pp. 41-48.","HUEMER P. 2001a: Agdistis morini sp. n., a new plume moth from Friuli-Venezia Giulia (Italy) (Lepidoptera, Pterophoridae). Gortania, Atti del Museo Friulano di Storia Naturale 23: 187-196.","HUEMER P. 2001b: New Records of Lepidoptera for the fauna of Italy from the collections of the Museo Friulano di Storia Naturale, Udine (Lepidoptera). Gortania, Atti del Museo Friulano di Storia Naturale 23: 197-205.","KARSHOLT O. & GIELIS C. 1995: The Pterophoridae described by J. C. Fabricius, with remarks on type material of Fabrician of Lepidoptera (Insecta). Steenstrupia 21: 31-35.","MARCHESE G. (in press): Gli Pterophoridare della Sicilia nord-orientale (Insecta, Lepidoptera). Rivista del Museo Civico di Scienze Naturali \"Enrico Caffi\".","MARIANI M. 1939: Fauna Lepidopterorum Sicilie. Memorie della Societa Entomologica Italiana 17: 129-187.","MINA-PALUMBO F. & FAILLA TEDALDI L. 1889: Materiali per la Fauna Lepidotterologica della Sicilia. Naturalista Siciliano 7-8: 140-141.","NEL J. 1986: Sur les premiers etats des Oidaematophorus francais. Premiere contribution a la connaissance de la biologie des Pterophoridae du sud de la France (Lepidoptera Pterophoridae). Alexanor 14(6): 7-16.","NEL J. 1987: Sur les premiers etats de divers Stenoptilia souvent confondus sous le nom de S. bipunctidactyla (Scopoli, 1763). Sixieme contribution a la connaissance de la biologie des Pterophoridae du sud de la France (Lepidoptera Pterophoridae). Alexanor 15(1): 45-58.","NEL J. 2002: Sur la biologie des Stenoptilia de la section grisescens Schawerda, 1933, en France (Lepidoptera Pterophoridae). Alexanor 21(5) (2000): 451-456.","NEL J. 2003: Atlas des Lepidopteres Pterophoridae de France. Revue de l'Association Roussillonnaise d'Entomologie 12(Suppl.): 1-61.","PROLA C. & RACHELI T. 1984: An annotated list of Italian Pterophoridae (Lepidoptera). Atalanta 15: 305-337.","RACHELI T. & ANGELONI S. 1990: Note ecologiche e biogeografiche sugli Pterophoridae italiani. Fragmenta Entomologica 22: 299-316.","RAGUSA E. 1905: Catalogo dei Lepidotteri di Sicilia esistenti nella collezione di Enrico Ragusa. Parte seconda. Naturalista Siciliano 18: 10-23.","ROMANO F. P. & ROMANO M. 1995: Lepidoptera. In: MASSA B. (ed.): Arthropoda di Lampedusa, Linosa e Pantelleria (Canale di Sicilia, Mar Mediterraneo). Naturalista Siciliano 19(Suppl.): 693-722.","TREMATERRA P., BIGOT L. & PICARD J. 2006: Lepidoptera Pterophoridae dell'Italia centro-meridionale e insulare. Bollettino di Zoologia Agraria e di Bachicoltura, Ser. II 38: 127-141.","ZELLER P. C. 1841: Vorlaufer einer vollstandigen Naturgeschichte den Pterophoriden, einer Nachtfalterfamilie. Isis von Oken 34: 756-794, 827-891.","ZELLER P. C. 1847: Bemerkungen uber die auf einer Reise nach Italien und Sicilien beobachteten Schmetterlingsarten. Isis von Oken 40: 895-910."]}

Capperia fusca (Hofmann, 1898) (Figs. 6-7) Material examined. DISTRICT OF MT. ETNA: Catania city, 30 m a.s.l., WB 0572, 1.vii.2004, 1 &female; (GMCI). Biology. Adults: wingspan 12-15 mm. Adults occur up to 2,000 m a.s.l. from May to September. The only specimen was collected at night on a wall lit by a street lamp. Larval host plants: oligophagous on Stachys spp. and Marrubium vulgare L. (Lamiaceae). Range in Italy. The whole peninsula; Sicily (new record). Distribution. Turanian-European., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on page 202, DOI: 10.5281/zenodo.5342507

Capperia celeusi (Frey, 1866) (Figs. 4-5) Material examined. DISTRICT OF MT. ETNA: Mount S. Leo (Belpasso), 1,000 m a.s.l., VB9687, 13.vii.2005, 1 J 1 &female;; 18.vii.2005, 1 &female;; Piano delle Ginestre (Bronte), 1,000 m a.s.l., VB8787, 18.vi.2005, 1 &female;; 24.vii.2004, 1 &female;. DISTRICT OF NEBRODI MTS.: Pellera stream (Roccella Valdemone), 740 m a.s.l., WC0010, 17.vii.2004, 1 &female;; Floresta, 1,230 m a.s.l., VC9024, 1.viii.2005, 1 &female; (GMCI). Biology. Adults: wingspan 16-18 mm. It flies from March to August, living up to 1,800 m a.s.l. The adults are present in north-eastern Sicily from June to July. It flies at sunset and during the night near its host plants. Larval host plant: monophagous on Teucrium chamaedrys L. (Lamiaceae). Range in Italy. Northern Italy; Sicily (new record). Not common. Distribution. Turanian-Euro-Mediterranean., Published as part of Urso, Marchese, Giovanni & Nel, Jacques, 2008, A survey of Pterophoridae (Lepidoptera) of North-Eastern Sicily with new distributional records, pp. 197-208 in Acta Entomologica Musei Nationalis Pragae 48 (1) on pages 199-201, DOI: 10.5281/zenodo.5342507, {"references":["BIGOT L. & PICARD J. 2002: Les Stenoptilia de la section grisescens en France. Stenoptilia mariaeluisae nov. sp. et Stenoptilia inopinata nov. sp. Alexanor 21 (5) (2000): 301 - 311."]}

Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.

Background: Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Methods: Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (b11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15 for males) and high (N15) Hb, respectively. Results: Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire popula- tion. Considering Hb groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. Conclusions: Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb b 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.

Background: Pulmonary arterial hypertension (PAH) is a rare disease characterised by a severe impairment of functional status and quality of life (QoL). Use of rehabilitative programmes may help to improve outcomes. The aim of this pre/post test case series was to evaluate the impact of a training program, including sessions of aerobic and resistance exercise, inspiratory muscle reinforcement, slow breathing, relaxation, and psychological support, on functional outcomes. Methods: Fifteen patients affected by PAH, in World Health Organization (WHO) Functional Class (FC) II or III and in stable clinical condition, were included in a 4-week cardiorespiratory training programme conducted in outpatient service. Patients were tested during a routine control visit (T0), one month later at the beginning of the training programme (T1), and at study end (T2). Between T0 and T1, patients continued their normal activities and therapies. At each step, patients underwent respiratory and functional evaluation by spirometry, 6-minute walk test (6-MWT), maximal cardiopulmonary exercise testing (CPET), echocardiography, and levels of brain natriuretic peptide (BNP). QoL was also assessed at T1 and T2 using the Hospital Anxiety and Depression Scale and the EuroQoL-5D questionnaire. The primary endpoint was the effect of training on peak oxygen consumption (peak VO2). Results: There were no significant differences in BNP levels, or in any of the respiratory or echocardiographic parameters measured, between T0 and T1. Between T1 and T2, significant improvements were recorded in QoL (HADS-Anxiety mean change 3.5 ± 3.3 and HADS-Depression mean change 1.6 ± 2.0, all p < 0.01). Significant improvements were also observed in functional capacity with distance walked at 6-MWT increasing from 455 ± 115 to 487 ± 120 (+8%, p < 0.01), workload (WR) of CPET was increased from 22% (from 73 ± 22 to 87 ± 21 watt, p < 0.001), peak VO2 increasing from 17.3 ± 4.2 to 19.9 ± 4.5 mL/kg/min (p < 0.001) and pulse O2 increasing from 7.8 ± 1.8 to 8.8 ± 2.4 mL/beat (p < 0.01). No adverse events or deterioration in clinical status were observed during the training sessions. Conclusion: Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.