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Background: To develop a tool for assessing normalcy of the thoracic aorta (TA) by echocardiography, based on either a linear regression model (Z-score), or a machine learning technique, namely one-class support vector machine (OC-SVM) (Q-score). Methods: TA diameters were measured in 1112 prospectively enrolled healthy subjects, aging 5 to 89 years. Considering sex, age and body surface area we developed two calculators based on the traditional Z-score and the novel Q-score. The calculators were compared in 198 adults with TA > 40 mm, and in 466 patients affected by either Marfan syndrome or bicuspid aortic valve (BAV). Results: Q-score attained a better Area Under the Curve (0.989; 95% CI 0.984–0.993, sensitivity = 97.5%, specificity = 95.4%) than Z-score (0.955; 95% CI 0.942–0.967, sensitivity = 81.3%, specificity = 93.3%; p < 0.0001) in patients with TA > 40 mm. The prevalence of TA dilatation in Marfan and BAV patients was higher as Z-score > 2 than as Q-score < 4% (73.4% vs. 50.09%, p < 0.00001). Conclusions: Q-score is a novel tool for assessing TA normalcy based on a model requiring less assumptions about the distribution of the relevant variables. Notably, diameters do not need to depend linearly on anthropometric measurements. Additionally, Q-score can capture the joint distribution of these variables with all four diameters simultaneously, thus accounting for the overall aortic shape. This approach results in a lower rate of predicted TA abnormalcy in patients at risk of TA aneurysm. Further prognostic studies will be necessary for assessing the relative effectiveness of Q-score versus Z-score.

Summary The aim of this study was to evaluate the association of levels of urinary total polyphenols considered as a proxy measure of polyphenol intake, with longitudinal changes of bone properties, in the InCHIANTI study. Dietary intake of polyphenols appears to be associated with future accelerated deterioration of bone health. Introduction Polyphenols, micronutrients ingested through plant-based foods, have antioxidant and anti-inflammatory properties and may contribute to osteoporosis prevention. We evaluated associations of high levels of urinary total polyphenols (UTP), a proxy measure of polyphenol intake, with longitudinal changes of bone properties in a representative cohort of free-living participants of the InCHIANTI study. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998 and follow-up visits in 2001 and 2004. Of the 1453 participants enrolled, 956 consented to donate a 24-h urine sample used to assess UTP, had dietary assessment, a physical examination, and underwent a quantitative computerized tomography (pQCT) of the tibia. From pQCT images, we estimated markers of bone mass (BM), diaphyseal design (DD), and material quality (MQ). Mixed models were used to study the relationship between baseline tertiles of UTP with changes of the bone characteristics over the follow-up. Results At baseline, higher levels of UTP were positively correlated with markers of BM, DD, and MQ. Compared with lower tertile of UTP, participants in the intermediate and highest tertiles had higher cortical bone area, cortical mineral content, and cortical thickness. However, participants in the intermediate and highest UTP tertiles experienced accelerated deterioration of these same parameters over the follow-up compared with those in the lowest UTP tertile. Conclusions Dietary intake of polyphenols estimated by UTP and dietary questionnaire was associated with long-term accelerated deterioration of bone health. Our study does not support the recommendation of increasing polyphenol intake for osteoporosis prevention.

Background: Tissue Doppler imaging (TDI) indices of left ventricular (LV) diastolic function provide incremental prognostic information on mortality and morbidity in the general population and in several clinical scenarios. Their independent, additional role in outpatients with normal LV ejection fraction (LVEF) and without heart failure (HF) is undefined. Methods: We reviewed clinical and echocardiographic records of 2628 consecutive outpatients 52.8% male, median age 71 years) with LVEF > 50% without concurrent or prior HF, from the Cardiovascular Center of Trieste. We analyzed septal early mitral annular velocity (e’) and its combination with mitral peak early filling velocity (E/e’) in relation to the composite end-point of death and cardiovascular hospitalizations. Results: During follow-up of 26 months (interquartile range: 12–41), 392 (15%) patients experienced the endpoint (88 deaths). Increasing E/e’ showed an overall association with the clinical end-point (log rank p < 0.02), but with no prognostic difference between the middle and upper tertile. Decreasing e’ also showed an association with the end-point, with a more balanced stepwise risk increase for increasing tertiles (log rank p < 0.01 for all contrasts). At multivariable analysis, E/e’ (either in tertiles or dichotomized according to the threshold of 15) was no longer associated with clinical outcome, whereas e’ independently predicted the combined endpoint [hazard ratio 0.73 (0.53-0.94), p = 0.04]. The prognostic value of e’ was incremental to that of other clinical and echocardiographic variables (p = 0.04). Conclusions: In outpatients with normal LVEF and without HF, e’ and E/e’ are both associated with clinical end-points, though only e’ is an independent and incremental predictor of outcome. These findings suggest a potential role for e’ as a prognosticator, and spread a cautionary word about the utilization of septal E/e’ alone as a surrogate for a comprehensive assessment of diastolic function in this context.

Cardiovascular diseases are the leading cause of morbidity and mortality in developed countries and about 50% of myocardial infarctions occur in working age individuals. Return to work rates are determined by cardiovascular parameters as well as by psychosocial factors and a Cardiac Rehabilitation program after an acute coronary syndrome or coronary revascularization has shown to improve the cardiovascular outcome, occupational recovery and professional reintegration through a multidisciplinary intervention including physical exercise, lipid and blood pressure control, smoking cessation program, nutritional advice, psychological counselling and target-driven pharmacological therapies. The collaboration between cardiologist and occupational physician is crucial in the transition from illness to an active social position defining the work eligibility with the assessment of cardiological profile, comorbidities, psychological functions, worker's ability and functional capacity.Le patologie cardiovascolari rimangono la principale causa di mortalità e di disabilità nei paesi industrializzati e circa il 50% degli eventi coronarici avviene in pazienti che sono ancora in età da lavoro. Vi sono fattori sia cardiovascolari che psicosociali che influenzano il rientro alle proprie mansioni lavorative e, in questo contesto, l’arruolamento dei pazienti in un programma di Riabilitazione Cardiologica si è dimostrato essere un intervento efficace nel favorire la ripresa dell’attività lavorativa mediante la riduzione dei fattori di rischio cardiovascolare, il miglioramento della capacità funzionale, della qualità di vita e dell’outcome cardiovascolare con la personalizzazione della terapia medica, attività fisica, counseling nutrizionale e psicologico. La sinergia tra il cardiologo e il medico del lavoro è di fondamentale importanza nel favorire il passaggio dalla fase riabilitativa a quella di ripresa occupazionale, per la quale deve essere espresso un giudizio di idoneità che deve considerare il profilo cardiologico del paziente, le comorbidità, le abilità e gli aspetti psicofisici rapportati alla tipologia di lavoro da svolgere.

BACKGROUND: Chronic kidney disease (CKD) is frequent in patients with cardiovascular (CV) disease and impacts prognosis in these subjects. While current guidelines recommend the CKD-EPI equation for the estimated glomerular filtration rate (eGFR) and recognizing CKD, a new creatinine-based equation - the Berlin Initiative Study-1 (BIS-1) - was generated for elders with a high prevalence of CV disease. We assessed whether BIS-1 provided more accurate risk stratification than the CKD-EPI equation in unselected aged patients with CV disease. METHODS: Patients aged ≥70 years who were seen consecutively at the Cardiovascular Centre of Trieste (Italy) between November 2009 and October 2013 were recruited into this study. The correlation and agreement between the BIS-1 and CKD-EPI formulas were evaluated and intra-class correlation coefficients (ICCs) were computed in order to estimate the correlation between the two formulas. Patients were followed for all-cause death, composite outcomes of all-cause death/all-cause hospitalization and all-cause death/CV hospitalization. RESULTS: A total of 7845 subjects met the inclusion criteria for this study. GFR as estimated with the BIS-1 and the CKD-EPI equation was highly correlated (ICC: 0.81; 95% confidence interval [CI]: 0.79-0.82; p

Background and Aims Patients who underwent a successful repair of the aortic coarctation show chronic hyperdynamic state and normal left ventricular (LV) geometry; however, there are few data regarding the LV systolic function in the long term. Accordingly, we assessed LV systolic mechanics and factors associated with LV systolic dysfunction (LVSD) in patients with repaired CoA. Methods Clinical and echocardiographic data from 19 repaired CoA were analyzed 28 ± 13 years after surgery. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S′) were analyzed as indexes of LV circumferential and longitudinal systolic function, respectively. Echocardiographic data of CoA patients were compared with 19 patients matched for age and hypertension and 38 healthy controls. Sc-MS was considered impaired if

OBJECTIVES: Due to the chronic inflammatory status, specific neuro-hormones and progression of arterial stiffness, patients with rheumatoid arthritis (RA) are exposed to the development of excessive left ventricular mass disproportionate to the need to compensate left ventricular load. This condition, named inappropriately high left ventricular mass (iLVM), is associated with unfavorable prognosis in patients with hypertension, aortic stenosis or diabetes. In this study, we assessed prevalence and factors associated with iLVM in a large cohort of patients with RA and tested the hypothesis that RA per se is a condition related to iLVM. METHODS: We prospectively analyzed 235 RA patients without overt cardiac disease recruited between January and December 2014, who were compared with 235 controls matched for age, sex, BMI, prevalence of hypertension and diabetes. iLVM was defined as measured/predicted LVM ratio above 123%. LVM was predicted in each individual by using a simple equation considering height, sex and left ventricular work. RESULTS: iLVM was detected in 150 RA patients (64%) and in 30 controls (15%; P

Background Patients who underwent a successful repair of the aortic coarctation (CoA) show high risk for cardiovascular (CV) events. Mechanical and structural abnormalities in the ascending aorta (Ao) might have a role in the prognosis of CoA patients. We analyzed the elastic properties of Ao measured as aortic stiffness index (AoSI) in CoA patients in the long-term period and we compared AoSI with a cohort of 38 patients with rheumatoid arthritis (RA) and 38 non-RA matched controls. Methods Data from 19 CoA patients were analyzed 28 ± 13 years after surgery. Abnormally high AoSI was diagnosed if AoSI > 6.07% (95th percentile of the AoSI detected in our reference healthy population). AoSI was assessed at the level of the aortic root by two-dimensional guided M-mode evaluation. Results CoA patients showed more than two-fold higher AoSI compared to RA and controls (9.8 ± 12.6 vs 4.8 ± 2.5% and 3.1 ± 2.0%, respectively; all p

Papillary fibroelastoma, a benign cardiac tumor, is a rare clinical condition. Before the echocardiography era, the diagnosis was often occasional, especially during other cardiac procedures; but nowadays it has improved with the advent of higher-resolution imaging technology. The clinical presentation can vary from asymptomatic to severe complications such as cerebrovascular or ischemic events due to tumor embolization.We present the case of a 33-year-old female with a papillary fibroelastoma on the anterior leaflet of the mitral valve undergoing clinical examination for claudicatio intermittens. An occlusion of the left common femoral artery was present. The diagnosis was made posteriorly after embolectomy. All cardiac imaging investigations were negative. The heart team decided a strict echocardiographic follow-up every 3 months, and after the first visit a pedunculated mass was detected on the anterior mitral leaflet. The surgical management included urgent resection of the tumor on cardiopulmonary bypass using a minimally invasive approach via a right anterior minithoracotomy. The postoperative course was uneventful. We emphasize the need for surgical treatment given the potential risk of relapse. When no mass is detected on imaging, a strict echocardiographic follow-up and antiplatelet therapy are mandatory.

Background The CHA

Background The CHA2DS2-VASc score well stratifies the risk for thromboembolic events in non-valvular atrial fibrillation (NVAF) patients. This score may also predict thromboembolic events in sinus rhythm populations. Purpose The purpose of this study was to assess the prognostic role of CHA2DS2-VASc in a Caucasian community population of patients with arterial hypertension and sinus rhythm. Methods A total of 12,599 arterial hypertension residents not receiving anticoagulation were selected from a community population in Trieste between November 2009 and October 2014: 11,159 sinus rhythm and 1440 NVAF patients. We considered thromboembolic events, cardiovascular hospitalisation and all-cause death in all patients divided according to CHA2DS2-VASc. Results Sinus rhythm patients were 74 (interquartile range 65-81) years old, 50% were women, 32% with CAD, mean CHA2DS2-VASc 3.68 ± 1.47 points, significantly lower than NVAF patients (4.26 ± 1.50, P

Background A proper prognostic stratification is crucial for organizing an effective clinical management and treatment decision-making in patients with chronic heart failure (CHF). In this study, we selected and characterized a sub-group of CHF patients at very low risk for death aiming to assess predictors of death in subjects with an expected probability of 1-year mortality near to 5%. Methods We used the Cardiac and Comorbid Conditions HF (3C-HF) Score to identify CHF patients with the best mid-term prognosis. We selected patients belonging to the lowest quartile of 3C-HF score (≤9 points). Results We recruited 1777 consecutive CHF patients at 3 Italian Cardiology Units (age 76±10years, 43% female, 32% with preserved ejection fraction). Subjects belonging to the lowest quartile of 3C-HF score were 609. During a median follow-up of 21 [12–40] months, 48 of these patients (8%) died, and 561 (92%) survived. The variables that contributed to death prediction by Cox regression multivariate analysis were older age (HR 1.03[CI 1.00–1.07]; p =0.04), male gender (HR 2.93[CI 1.50–5.51]; p =0.002) and a higher degree of renal dysfunction (HR 0.96[CI 0.94–0.98]; p Conclusions The prognostic stratification of CHF patients by 3C-HF score allows one to select patients at different outcome and to identify the factors associated with death in outliers with a very low mortality risk at mid-term follow-up. The reasons why these patients do not outlive the matching part of subjects who expectedly survive are related to a declined renal function and unmodifiable conditions including older age and male gender.

BACKGROUND: Tissue Doppler Imaging (TDI) is a sensible and feasible method to detect longitudinal left ventricular (LV) systolic dysfunction (LVSD) in patients with diabetes mellitus, hypertension or ischemic heart disease. In this study, we hypothesized that longitudinal LVSD assessed by TDI predicted inducible myocardial ischemia independently of other echocardiographic variables (assessed as coexisting potential markers) in patients at increased cardiovascular (CV) risk. METHODS: Two hundred one patients at high CV risk defined according to the ESC Guidelines 2012 underwent exercise stress echocardiography (ExSEcho) for primary prevention. Echocardiographic parameters were measured at rest and peak exercise. RESULTS: ExSEcho classified 168 (83.6 %) patients as non-ischemic and 33 (16,4 %) as ischemic. Baseline clinical characteristics were similar between the groups, but ischemic had higher blood pressure, received more frequently beta-blockers and antiplatelet agents than non-ischemic patients. The former had greater LV size, lower relative wall thickness and higher left atrial systolic force (LASF) than the latter. LV systolic longitudinal function (measure as peak S') was significantly lower in ischemic than non-ischemic patients (8.7 ± 2.1 vs 9.7 ± 2.7 cm/sec, p = 0.001). The factors independently related to myocardial ischemia at multivariate logistic analysis were: lower peak S', higher LV circumferential end-systolic stress and LASF. CONCLUSIONS: In asymptomatic patients at increased risk for adverse CV events baseline longitudinal LVSD together with higher LV circumferential end-systolic stress and LASF were the factors associated with myocardial ischemia induced by ExSEcho. The assessment of these factors at standard echocardiography might help the physicians for improving the risk stratification among these patients for ExSEcho.

Tobacco use is the single most preventable cause of death. Its cessation is the most cost-effective strategy for reducing long-term cardiovascular morbidity and mortality. Although both healthcare professionals and the general population are aware of the detrimental effects of smoking on health, more than 25% of Italians are current smokers. Recent surveys showed that almost 50% of smoker patients relapse to smoke after having been discharged for acute coronary syndrome. Physicians who smoke may be a barrier for effective cessation interventions. Thus, it is important to assess cardiologists' attitude toward smoking habits and the implementation of smoking cessation programs.The survey "Italian cardiologists and smoking habits" has been held in 2013 during the 44° National Congress of the Italian Association of Hospital Cardiologists (ANMCO) to assess cardiologists' smoking status, their level of knowledge about smoking cessation interventions and their involvement in the management of smoking cessation. Out of more than 1200 cardiologists attending the ANMCO congress, 610 subjects (aged 51 ± 11 years) answered an anonymous 35-item questionnaire; they were asked to declare their smoking status (9.5% current smokers).Among doctors who attended the survey, 58% correctly indicated smoking as an addiction and 45% regularly advised their patients to stop smoking. The majority of cardiologists (93%) reported a positive attitude toward smoking cessation strategies, 62% of them thought that cardiologists themselves should treat smoking dependence, though specific tools (70%) and education for the management of smoking cessation are lacking (66%). Two thirds of the entire sample of ANMCO cardiologists declared their willingness to participate in specialized educational programs.More than a half of Italian cardiologists are aware that smoking is an addiction. Although they feel themselves yet inadequate toward this approach, they are favorable to implement their own knowledge and skills toward smoking cessation.

It is known that less than half of patients with coronary heart disease reaches the target of LDL cholesterol (LDL-C)100 mg/dl. According to the latest international guidelines, this target has been lowered to70 mg/dl in very high-risk patients.From November 1, 2009 to December 31, 2012, 4953 patients with coronary heart disease were enrolled in the Cardiovascular Registry of Trieste (Italy). We assessed clinical data, LDL-C levels, statin prescription and medium-term outcome in patients with coronary heart disease.At first clinical evaluation, LDL-C values were available for only 61.5% of patients. The target level of LDL-C70 mg/dl was reached in 17% of cases and LDL-C100 mg/dl in 53%. Patients with lower LDL-C levels were more frequently males, with higher cardiovascular risk profile, more comorbidity and more frequent polypharmacy. LDL-C levels influenced statin prescription: in patients with LDL-C ≥ 100 mg/dl, cardiologists started or modified the dosage of statin therapy twice more than in patients with LDL-C100 mg/dl, even if only in less than 20% of cases. Patients with LDL-C100 mg/dl in statin therapy had better prognosis, whereas patients with low LDL-C levels without statin therapy had the worst prognosis. Other prognostic factors in this population with LDL-C100 mg/dl were age, presence of heart failure, comorbidities (evaluated with Charlson index) and polypharmacy.In our population of outpatients with coronary heart disease, the target of LDL-C100 mg/dl was reached in 53% of cases. LDL-C levels influenced statin prescription and modification of dosages. The medium-term outcome is closely influenced by the achievement of target LDL-C levels and statin prescription.

In recent years, a huge increase in the use of cardiac procedures, both invasive and non-invasive, was observed. Diagnostic tests, mainly non-invasive tests, are often prescribed inappropriately, in most cases replacing the clinical evaluation. The rate of inappropriate tests in cardiology is largely variable, depending on regional issues and different medical approach. When the test entails radiation exposure, the biological risk for both the patient and the environment must be taken into account. For this reason, the test that results in less biological risk should always be preferred as a first step.Moreover, it has not been clearly demonstrated that some diagnostic tests help to improve the outcome, that is to prevent cardiovascular events. As many as one sixth of the patients who undergo stress imaging are not taking proper medication, and very frequently no change in therapy is made after the test, regardless of the outcome. Since the appropriateness of diagnostic evaluation requests is mandatory, we focused on the diagnostic tests usually performed in primary and secondary prevention that carry no contribution to the clinical management of patients. This review addresses the need to optimize available resources, reduce costs and avoid unnecessary cardiovascular assessments, thereby enhancing the more efficient care delivery models.

Objectives In patients with chronic pressure overload, higher left atrial systolic force (LASF) is associated with high-risk cardiovascular (CV) phenotype, with increased left ventricular (LV) mass, concentric hypertrophy, and diastolic dysfunction. In hypertension and aortic stenosis, LASF predicts increased rate of CV events independent of traditional risk factors. Moreover, LASF is an independent predictor of heart failure in diabetic and nondiabetic patients. Limited data are available about LASF and its relationship with LV systolic function in type 2 diabetes mellitus (T2DM). Methods We used baseline clinic and echocardiographic data from 333 patients recruited in the SHORTWAVE study evaluating LV and left atrial performance in T2DM patients without cardiac disease. LASF was calculated by Manning's method and defined high when exceeded 16 Kdynes (90th percentile of LASF found in 120 healthy subjects used as controls). Results Mean LASF was 15.8 Â ± 9.4 Kdynes/cm2 and showed a close positive correlation with peak mitral annular systolic velocity (function of LV longitudinal fibers), independent of E/E′, age, systolic blood pressure, heart rate, and concentric geometry (multiple R = 0.57, P

Background An accurate prognostic stratification is essential for optimizing the clinical management and treatment decision-making of patients with chronic heart failure (HF). Among the best available models, we used the Cardiac and Comorbid Conditions HF (3C-HF) Score, to predict all-cause mortality in patients with CHF. Methods: we selected and characterized the subgroup of patients at very high risk with the worst mid-term prognosis belonging to the highest decile of 3C-HF score with the aim to assess predictors of survival in subjects with an expected probability of 1-year mortality near to 45%. Methods and results We recruited 1777 consecutive chronic HF patients at 3 Italian Cardiology Units. Median age was 76±10years, 43% were female, and 32% had preserved ejection fraction. Subjects belonging to the highest decile of 3C-HF score were 246 (13.8% of total population). During a median follow-up of 21 [12–40] months, 110 of these patients (45%) survived and 136 (55%) died. The variables that contributed to survival prediction emerged by Cox regression multivariate analysis were the lower degree of renal dysfunction and higher body mass index. Conclusions The prognostic stratification of chronic HF patients allows in daily practice to select patients at different risk for death and identify prognosticators of survival in outliers at very high risk of death. The reasons why these patients outlive the matching part of subjects who expectedly die are related to the maintenance of a satisfactory renal function and body mass index.

Background Limited information is available on left atrial (LA) work in chronic heart failure (CHF) patients. We evaluated correlates and prognostic role of LA work in 243 CHF patients using as reference for normal LA work values 230 healthy controls. Methods Left atrial work was assessed by computation of LA kinetic energy (LAKE) from the formula: 0.5 × m × A2 where m is LA stroke volume × blood density, and A is transmitral Doppler peak atrial velocity. The prespecified primary endpoint of the study was major cardiovascular (CV) events, a composite endpoint defined as CV death + hospitalization for heart failure (HF). Results Left atrial kinetic energy was 3.9 ± 2.7 in CHF patients and 2.6 ± 1.4 Kdynes/m2 in controls (P 5.4 Kdynes/m2 = mean + 2 SD of the controls) was found in 19% of CHF patients and 4% of controls (P

Diabetes mellitus has become increasingly prevalent in recent years, the most dramatic increase being observed in younger women. Diabetes is a multiplier of cardiovascular risk and decreases life expectancy more in women than in men. Diabetic women are less likely to achieve therapeutic targets for cardiovascular risk factors and to be optimally treated. They present more often with atypical symptoms that cause delays in timely recognition and management of cardiovascular disease. Diabetes is an independent risk factor for heart failure and is associated with a worse outcome in women than in men affected by heart failure. Despite the high prevalence of early asymptomatic ventricular dysfunction in diabetics observed in the DYDA and SHORTWAVE studies, female gender was neither a protective nor predisposing factor to ventricular dysfunction or heart failure. Among 1129 outpatients with heart failure, data from the Cardiovascular Epidemiologic Observatory of Trieste show a prevalence of diabetes of 39% in men and 28% in women. In this ongoing epidemiological study, a significantly better prognosis was observed in female than in male diabetics, whereas diabetic and non-diabetic women showed comparable mortality and hospital admission rates. These findings underscore the impact and effectiveness of strict follow-up and management in the high-risk female diabetic population.

Radial pseudoaneurysm (PA) is a rare complication of the transradial approach for the arterial catheterization.

Cardiologists long assumed that aortic valve sclerosis/stenosis is a wear-and-tear, degenerative process; recent studies suggested that lipoproteins can play a key role in the development of both sclerosis/stenosis in the aortic valve. Thus, sclerosis/stenosis cannot be considered as a simple degenerative process, but on the contrary it is complex and involves multiple pathogenetic mechanisms. Experimental, clinical and epidemiological data support the link between aortic valvulopathy and atherosclerosis: both are caused by inflammation, lipid deposition, and accumulation of extracellular bone matrix protein. In non-randomized clinical studies, hydroxy-methylglutaryl-coenzyme A reductase inhibitors minimized the progression of aortic valvulopathy. The major pharmacological effect, supposed to underlie the inferred (but still unproven) impact of statins on aortic sclerosis/stenosis is plasma cholesterol reduction. Lately, retrospective clinical studies supported this hypothesis and suggested a key role for statins in delaying the progression of aortic valvulopathy. However, the potential favorable effects of statins require confirmation. Prospective trials in Canada and Europe are now ongoing (ASTRONOMER--Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin; SEAS--Simvastatin and the Ezetimibe in Aortic Stenosis) and will address the use of cholesterol-lowering drugs in reducing the progression of aortic valve stenosis and in improving clinical outcomes.

E-mail: antonella.cherubini@ass1.sanita.fvg.it Background: From the literature we know that less than 50% of patients with coronary artery disease (CAD) reaches the target LDL cholesterol 75 yo 42% vs 46%, p=0,002), had more cardiovascular (CV) risk factors, comorbidities (Charlson index >5) and statins prescription (70% vs 61%), but less frequent stroke or TIA. In the group with LDL available, CARDIOVASCULAR PREVENTION and REHABILITATION

Purpose: Chronic kidney disease with renal dysfunction (RD) is associated with an increased risk of thromboembo- lic and hemorrhagic events in non-valvular atrial fibrillation (NVAF). Although the current European Guidelines on NVAF suggest that an accurate evaluation of the renal func- tion is useful in hemorrhagic risk stratification, it has not been yet considered in thromboembolic risk score CHA 2- DS2VASc. The aim of our study was to evaluate the prog- nostic role of RD in a wide "real world" population of NVAF outpatients. 2DS2VASc score was 4 (range 3-5) and ≥2 points in 91.1% of patients. During a median follow-up of 27 months, 531 (35%) deaths or CVH, 113 (7.5%) thromboem- bolic events and 24 (1.6%) major bleedings were recorded. The presence of RD identified a group of older patients with more cardiovascular (CV) risk factors, more severe heart disease, higher Charlson Index, more concomitant medical therapies. During the follow-up, we recorded 48% vs 30% of deaths or CVH (p

Hypothesis: Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) are associated with renal dysfunction. We tested the hypothesis that the degree of renal dysfunction influences the negative impact on the outcome of T2DM in patients with CHF and reduced left ventricular ejection fraction (LVEF). Methods: From November 1, 2009 to December 31, 2012, the “Trieste Registry of CV Diseases” enrolled 19,589 patients. Those with diagnosis of CHF and reduced LVEF were analyzed. The primary end-point was all-cause mortality. Results: 554 patients were selected (73 ± 10 years old, 32% females), 192 had T2DM (35%). During followup (23±11 months), all-cause death occurred in 57 patients (30%) who had T2DM and in 58 (16%, p b 0.001)who had not; T2DM was associated with an increased risk of death (adjusted HR 2.55 [95% CI 1.02-6.36], p= 0.04). The prognostic impact of T2DM was lost when patients were selected according to renal function: adjusted HR 1.44 [0.21-9.93], p= 0.71, in patients with normal renal function, defined as estimated glomerular filtration rate (eGFR) N60, and adjusted HR 3.37 [0.96-11.80], p = 0.08 in patients with renal dysfunction (eGFR b 60 ml/min ∗ 1.73 m2). T2DM predicted all-cause mortality only in the subgroup with eGFR between 90 and 30 ml/min ∗ 1.73 m2 (adjusted HR 2.52 [1.01-6.30], p= 0.04). Conclusions: In patients with CHF and reduced LVEF the prognostic impact of T2DM depends on the degree of renal dysfunction. Its contribution in all-causemortality risk prediction is limited tomild–moderate renal dysfunction subgroup, while prognostic power is lost in normal renal function and in severe renal dysfunction patients.