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No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case–control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e′ ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (− 22.6 ± 3.3% vs − 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = − 0.87 and − 0.82, respectively) but not in controls (r = − 0.29 and − 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.

An association between C-reactive protein (CRP) levels and carotid plaque has never been investigated in idiopathic pulmonary fibrosis (IPF). The aim of this study was to evaluate the extent of carotid atherosclerosis in mild-to-moderate IPF and to assess its relationship to serum CRP. This observational retrospective case–control study included 60 consecutive IPF patients (73.8 ± 6.6 years, 45 males) and 60 matched controls, examined between Sep 2017 and Jan 2019. All patients underwent CRP assessment and a carotid Doppler ultrasonography. CRP levels were significantly higher in IPF patients than controls (0.2 ± 0.09 mg/dl vs 0.09 ± 0.04 mg/dl, p

Background: Two pharmaceutical agents have been approved for treatment of idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Objectives: We investigated the need of dose reduction in consecutive patients treated with nintedanib in relation to gender and body max index, comparing the population over and under 80 years of age. Methods: We retrospectively reviewed the data of all consecutive IPF patients treated with nintedanib for at least 3 months. Data on age, gender, body max index, side effects, and duration of therapy after enrolment were recorded. Results: A total of 82 patients has been evaluated. All dose reductions were related to side effects and/or toxicities. The need for a dose reduction was significantly more frequent in patients aged 80 years or older (50 vs. 26.8%, p = 0.039), independently from their body mass index. A total of 52% of males >80 years and only 16% of males p = 0.002). Conclusions: Male gender and not body mass index in IPF patients aged ≥80 years treated with nintedanib seems to influence dose reduction.

Introduction: In severe COPD two classes of anti-inflammatory agents can be associated to a bronchodilator: inhibitors of phosphodiesterase-4 (PDE-4) and inhaled corticosteroids (ICS). It has been demonstrated a different effect on inflammation when a LAMA is associated to a PDE-4 inhibitor or to an ICS. Objective: This prospective interventional phase III pilot study aims to investigate whether RFL+Gly provides a greater bronchodilation vs to CLS+Gly in severe COPD. Secondary endpoint was to evaluate which combination between RFL+Gly or CLS+Gly had a greater effect on exercise capacity (endurance time and IC). Methods: 10 severe COPD patients performed PFTs, and Endurance Shuttle Walk Test (ESWT) (at 85% of an Incremental SWT) at time 0 (v1) after 2 weeks of gly (v2) and after 4 weeks (v3) of either RFL+Gly (5 subjects) or CLS+Gly (5 subjects). ICs were measured at rest and at the end of each ESWT. Lung volumes and distance were evaluated. Results: The RFL+Gly walked a longer distance at the ESWT than CLS+Gly ( Δ DistanceV2_V3: 56m ±82 vs –58m ±69, p Δ FEV1_V2_V3: 0,15L ±0,08 vs – 0,14L ±0,19, p Δ IC_V2_V3 at rest: 0,16L ±0,13 vs – 0,21L ±0,30, p Δ IC_V2_V3 at peak: 0,18L ±0,24 vs – 0,03L ±0,24, p=0,2). Conclusion: This is the first study to show that the choice of an anti-inflammatory agent (PDE4 inhibitor/ICS) associated to a LAMA may have different effects on lung volume and exercise tolerance; suggesting that RFL have a synergic interaction with Gly.

Roberto Lipsi,1 Paola Rogliani,1 Luigino Calzetta,2 Andrea Segreti,1Mario Cazzola1 1Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; 2Department of Pulmonary Rehabilitation, San Raffaele Pisana Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy Abstract: Regenerative or stem cell therapy is an emerging field of treatment based on stimulation of endogenous resident stem cells or administration of exogenous stem cells to treat diseases or injury and to replace malfunctioning or damaged tissues. Current evidence suggests that in the lung, these cells may participate in tissue homeostasis and regeneration after injury. Animal and human studies have demonstrated that tissue-specific stem cells and bone marrow-derived cells contribute to lung tissue regeneration and protection, and thus administration of exogenous stem/progenitor cells or humoral factors responsible for the activation of endogenous stem/progenitor cells may be a potent next-generation therapy for chronic obstructive pulmonary disease. The use of bone marrow-derived stem cells could allow repairing and regenerate the damaged tissue present in chronic obstructive pulmonary disease by means of their engraftment into the lung. Another approach could be the stimulation of resident stem cells by means of humoral factors or photobiostimulation. Keywords: chronic obstructive pulmonary disease, stem cells, regenerative therapy, all-trans retinoic acid, photobiostimulation