Search

Iron deficiency (ID) is recognized as an important comorbidity in patients undergoing cardiac surgery; however, it still remains under-diagnosed and under-treated in clinical practice. This study aims at comparing efficacy and the effects on exercise capacity of intravenous ferric carboxymaltose (FCM) versus ferric gluconate (FG) in patients with ID anemia (IDA) resulting from cardiac surgery. We retrospectively analyzed data from our records of in-hospital patients with IDA after cardiac surgery undergoing cardiac rehabilitation. Group I was treated with FG, group II with FCM. Efficacy measures included changes (baseline vs discharge) in hemoglobin (Hb) and in distance traveled at six-minutes walking test (6MWT). Data from 74 in-patients (mean age 67.5±10.4 years, 43% women) were analyzed. At discharge, patients treated with FCM showed higher levels of Hb (11.1±1.2g/dl vs 10.2±1.1 g/dl; p=0.001), greater distance traveled at 6MWT (279.2±108.8 meters vs 236.3±72.7 meters; p=0.048), and lower in-hospital rehabilitation length of stay (20.3±7 vs 25.3±11.7 days; p=0.043) as compared to FG group. At multivariate analysis, the most powerful predictors of Hb increase >1 g/dl at discharge were transferrin levels (p=0.019) and treatment with FCM (p100 meters) at discharge (p=0.13 and p=0.003, respectively). In patients with IDA following cardiac surgery, intravenous FCM is effective in restoring Hb levels and in improving exercise capacity after cardiac surgery.

Background Previous studies showed that troponin blood levels may increase after exercise. In this study we assessed whether, among patients admitted with suspected unstable angina, the increase in high-sensitive troponin T (hs-TnT) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and predict symptom recurrence during short term follow-up. Methods Maximal treadmill EST was performed in 69 consecutive patients admitted to the emergency room with a suspicion of unstable angina (acute chest pain but confirmed normal serum levels of cardiac troponins) was measured before and 4 hours after EST. Coronary angiography was performed in 22 patients (32.8%). Results hs-TnT increased after EST compared to baseline in the whole population (from 0.84±0.65 to 1.17±0.87 ng/dL, p

Background. Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF. Methods. We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy. Results. At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3&ndash, 14.9 months) systolic blood pressure decreased from 117 &plusmn, 14 to 101 &plusmn, 12 mmHg (p &lt, 0.0001), left ventricular ejection fraction (LVEF) increased from 27 &plusmn, 6 to 29.7 &plusmn, 7% (p &lt, 0.0001), peak oxygen consumption (VO2) improved from 14.6 &plusmn, 3.3 (% of predicted = 53.8 &plusmn, 14.1) to 17.2 &plusmn, 4.7 mL/kg/min (% of predicted = 64.7 &plusmn, 17.8) (p &lt, 0.0001), minute ventilation/carbon dioxide production relationship (VE/VCO2 Slope) decreased from 34.1 &plusmn, 6.3 to 31.7 &plusmn, 6.1 (p = 0.006), VO2 at anaerobic threshold increased from 11.3 &plusmn, 2.6 to 12.6 &plusmn, 3.5 mL/kg/min (p = 0.007), oxygen pulse increased from 11.5 &plusmn, 3.0 to 13.4 &plusmn, 4.3 mL/kg/min (p &lt, 0.0001), and ∆VO2/∆Work increased from 9.2 &plusmn, 1.5 to 10.1 &plusmn, 1.8 mL/min/watt (p = 0.0002). Conclusion. Sacubitril/valsartan improved exercise tolerance, LVEF, peak VO2, and ventilatory efficiency at 6.2 months follow-up. Further studies are necessary to better clarify underlying mechanisms of this functional improvement.

Background and aims: Use of direct acting antivirals (DAAs) has allowed to clear HCV in almost all patients even in the presence of advanced cirrhosis. Although it has been suggested that cirrhotic portal hypertension may regress after SVR, the ultimate effect of HCV clearance on the development and progression of oesophagogastric varices (OV) is still unexplored. We assessed in a prospective cohort of patients with cirrhosis the evolution of endoscopic features of portal hypertension induced by SVR obtained with DAAs. Method: 321 consecutive patients (mean age: 65.1 ± 10.5, males: 58%) with HCV Child-Pugh A cirrhosis treated with DAAs were enrolled between January 2015 and May 2016. All patients underwent esophagogastroscopy (EGS), liver ultrasound (US), liver stiffness measurement (LSM) by Transient Elastography and laboratory tests before the starting DAAs and after achieving SVR. LS * spleen diameter/platelet ratio (LSPS) was calculated as previously described [1]. Results: Forty-one patients were excluded from the analysis, 32(10%) since they had F2/F3 OV at baseline, and 9(2.8%) since they did not achieve SVR. Overall, 280 SVR patients were analysed. At baseline, 100 patients (35.7%) did not have OV and 180(64.3%) had small OV. None received beta-blockers. After a median time of 24.6 months EGS showed de novo development of OV in 24/100(24%) patients and progression from F1 to F2/F3 OV in 30/180 patients (16.7%), p = 0.68 by Kaplan–Meier. By Cox regression analysis, LSPS as continuum variable (HR: 1.06, CI95%: 1.01–1.11, p = 0.025) or at a cut off ≥ 3(HR: 3.16, CI95%: 1.64–6.09, p = 0.001) was associated with OV progression. Age (p = 0.15), gender (p = 0.93) and BMI (p = 0.07) did not correlate with progression of OV. Conclusion: Progression of clinically significant portal hypertension, as assessed by the evolution of oesophagogastric varices, is not uncommon among patients with HCV cirrhosis after HCV clearance. Non-invasive evaluation using combined data of LS, spleen diameter, and platelet count can assist in identifying patients in whom portal hypertension is likely to progress notwithstanding SVR.

Background & Aims: Studies have produced conflicting results of the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus–associated cirrhosis treated with direct-acting antivirals (DAAs). Data from clinics are needed to accurately assess the occurrence rate of HCC in patients with cirrhosis in the real world. Methods: We collected data from a large prospective study of 2,249 consecutive patients (mean age = 65.4 years, 56.9% male) with hepatitis C virus–associated cirrhosis (90.5% with Child-Pugh class A and 9.5% with Child-Pugh class B) treated with DAAs from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy. HCC occurrence was evaluated by Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with HCC development. Results: A sustained virologic response (SVR) was achieved by 2,140 patients (total = 95.2%; 95.9% with Child Pugh class A and 88.3% with Child Pugh class B; P