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Background Heart failure (HF) continues to be an important medical and social problem, with high morbidity and mortality. Data on the trends in hospitalizations, hospital readmissions and mortality is of great importance both from the epidemiological and clinical points of view. Methods and results We analyzed the secular trends in first-time hospital admissions for heart failure between 2010 and 2016, derived from SILCARD database, covering a population of 3.8 million adults. Patient characteristics as well as data on in-hospital and 12-month outcomes were recorded for each year. The total number of first-time hospitalizations for HF as the primary diagnosis showed a downward trend during the study period (reduction by 12%, p = 0.07), with a constant patient age (mean 74.3 ± 11.3 years). The length of hospital stay shortened from 10.9 to 9.6 days (p = 0.003). Crude in-hospital mortality remained constant at around 14% (p = 0.55), but after adjustment for sex and age, mortality rates tended to decrease from 17.2% in 2010 to 11.5% in 2016 (p = 0.007). All-cause hospital readmission rates in 12-month follow-up increased which was due to non-CV hospitalizations, since both CV- and HF-related readmissions were constant throughout the years. Crude 12-month mortality was constant, but after adjustment for age and sex absolute reduction by about 10% was found (p = 0.02). Conclusions Despite the decreasing duration of hospital stay, significant improvement in both in-hospital and long-term survival was observed, with constant rates of hospital readmissions related to HF.

Background The clinical results of abciximab administration during rescue angioplasty (PCI) are poorly investigated. Methods We evaluated the outcome of 406 consecutive patients undergoing rescue PCI treated with ( n =218) or without ( n =188) abciximab and a clopidogrel loading dose of 300mg. The end point was the incidence of major cardiac adverse events (MACE) defined as death, recurrent acute myocardial infarction (AMI) and target vessel revascularization at 30days and 1year. The predictors of MACE were also investigated. Results No differences were found in MACE between the groups treated with or without abciximab at 30days (15 and 20, p =0.67) and 1year (23 and 29, p =0.85). Stepwise logistic regression analysis identified: cardiogenic shock (Odds Ratio [OR]=17.8, 95% confidence interval [CI] 5–99, p =0.0001), age (OR=1.099, 95% CI 1.04–1.15, p =0.0001), TIMI flow 0–1 after procedure (OR=5.51, 95% CI 1.72–17.6, p =0.004) as independent predictors of MACE at 30days. Cox proportional hazards model identified: cardiogenic shock (adjusted hazard ratio [HR]=3.83, 95% confidence interval [CI] 1.76–8.35, p =0.01), age (HR=3.7, 95% CI 1.75–8.3, p =0.01), TIMI flow 0–1 after procedure (HR=1.04, 95% CI 1.01–1.07, p =0.001 as predictors of MACE at 1year). After propensity score adjustments the predictors of MACE did not change. Conclusion There were no differences in MACE at 30days and 1year in patients treated with or without abciximab during rescue PCI after a clopidogrel loading dose of 300mg. Cardiogenic shock, age and TIMI flow 0 and 1 after PCI were predictors of MACE.

Bicuspid aortic valve (BAV) is the most common congenital cardiac diseasewith an estimated incidence in the North American population of 1–2% [1]. Patients with BAV have a lifetime risk of 22–25% of surgery due to aortic valve disease and/or ascending aorta dilatation [1]. This has encouraged cardiac surgeons to be more aggressive in considering replacement of the ascending aorta at a lower diameter (50 mm) than in tricuspid aortic valve (TAV) patients (55 mm) [2]. Recent studies have questioned this kind of “paradigm” [3,4]. First-degree relatives (FDR) of BAV individuals are at an increased risk of inheriting a BAV (9%), or any congenital cardiac disease (31%) [5]. Recently, Biner et al. have shown that 32% of FDRs of BAV patients have dilated aorta [6]. Based on these data, guidelines recommend as class IC, echocardiographic evaluation of all FDR of patients with BAV in search of aortic dilatation and/or BAV [2]. In Biner et al.'s study, BAV patients from whom FDRs were contacted had normal and pathological aorta. We hypothesized that FDRs of BAV patients with normal aortic diameter share a similar risk of aortic dilatation as FDRs of TAV patients. Patients with BAV and TAV who underwent isolated aortic valve replacement and had normal aortic dimensions were identified from the database. FDRs of these patients were contacted by phone to participate in this study. The study complies with the Declaration of Helsinki. Informed consent was obtained and the ethical review board approved the study. Echocardiographic evaluation was done entirely at the echocardiography laboratory of the Department of Cardiology of the University Hospital (Hospital de Clinicas). A single observer supervised by an expert blinded to anthropometric and clinical data of participants performed the measurements. Aortic dimensions (annulus, root, sino-tubular junction, ascending aorta) were obtained during end systole and indexed to body surface area of patients. In order to calculate the sample size needed to find differences between both groups, we used published data obtained from a sample of North American individuals [6]. Based on these data our sample size calculation estimated a total of 20 individuals per group. Continuous data were presented as mean ± standard deviation (SD) and categorical variables as percentage. Continuous variables were compared using independent t test. For comparison of categorical data among the study groups, the Fisher exact test was used. Analysis was performed using the statistical software program SPSS version 18. The significance level was set at p b 0.05. Body surface area was significantly greater in FDR of TAV patients than in BAV patients (p = 0.006). This was mainly due to a higher weight (p = 0.006) (Table 1). All evaluated patients had a normal functioning tricuspid aortic valve. No differences were found at either of the aortic segments between both groups (Fig. 1). There is no evidence regarding the risk of aortopathy in tricuspid FDR of BAV individuals with normal aortic dimensions. The only published report in the matter, documents that aortic root dilation is highly prevalent (32%) in tricuspid FDRs of BAV patients [6]. In this study [6], FDRs were derived from BAV patients in whom 53% had a dilated aorta. Our results show that FDRs of BAV and TAV patients with

Optimal management of patients with PFO and paradoxical embolic events is still debated. Moreover, data from long-term studies on large patient populations are lacking. Aim of the study is to assess immediate and long-term clinical outcome of patients with PFO and paradoxical thrombo-embolic events submitted to transcatheter PFO closure.Only patients with PFO-related transient ischemic attack or stroke underwent PFO closure. Patients were evaluated clinically and echocardiographically at 1, 6 and 12 months after the procedure and yearly thereafter. Primary endpoints were death, recurrent stroke or TIA. Residual right-to left shunt (RLS) was monitored by transthoracic echocardiography (TTE) or transcranial Doppler (TCD) at 6 months'follow-up.202 consecutive patients underwent percutaneous PFO closure for secondary prevention of TE. Device migration was observed in one patient 24 h after the procedure. No cases of procedure-related death or stroke occurred during a median follow-up of 3+/-1.3 years. Three recurrent TIAs were observed within the first 6 months of follow-up. The cumulative estimated probability of recurrent TE-free survival rate after PFO closure was 99% in patientsor=55 years, 84% in patients55 years (p0.05) and 94% and 100% in patients with PFO, with or without atrial septal aneurysm (ASA), respectively (p0.05). Of the 188 (93%) patients submitted to TTE or TCD at 6 months' follow-up, 8 (4%) presented a small RLS.Transcatheter PFO closure is associated with low incidence of in-hospital complications and low frequency of recurrent TE at long-term follow-up.

There is limited evidence on the medium-term prognosis of patients with chronic total occlusion successfully treated with drug-eluting stent (DES) implantation.We compared the medium-term outcome of 111 patients with chronic total occlusion (CTO) successfully treated with implantation of sirolimus-or paclitaxel-eluting stents versus 112 patients treated with bare metal stents.During an overall follow-up period of 18 months, the composite endpoint of death, myocardial infarction or target lesion revascularization was significantly lower in the drug-eluting stent than in the bare metal stent group: 8.1% vs. 21.6%, respectively (p=0.005). The difference was due to the reduction of target lesion revascularization with DES compared to bare metal stents: 3.6% vs. 18.9%, respectively (p0.001). The Cox proportional hazards model identified DES as an independent predictor of adverse cardiac events (adjusted hazard ratio, 0.16; 95% confidence interval 0.05 to 0.52, p=0.002).During medium-term follow-up use of DES is associated with improved outcome compared to use of bare metal stents in patients with CTO.