Alessandra D'Ambrosi

Levosimendan improves renal function in acute decompensated heart failure: possible underlying mechanisms.

The cardio‐renal syndrome plays a critical role in acute heart failure (HF). Levosimendan, an inodilator drug, has a positive but controversial effect on kidney. Our aim was to evaluate its effects on both renal and systemic haemodynamic parameters as well as on renal function, explaining the possible mechanisms involved.

Cost-effectiveness of levosimendan in patients with acute heart failure

Heart failure is a major public health problem because of its high prevalence and impact on mortality, morbidity, quality of life, and social costs. The aim of this analysis was to estimate the effects of the novel inodilator levosimendan versus standard inotropic therapy (ST) of dobutamine in acute heart failure. A study population of 292 patients with acute heart failure was derived from an observational registry of patients referred to our department. Of these, 147 patients received iv levosimendan (0.05–0.1 μg·kg−1·min−1 for 24 hours), and 145 patients were treated with ST. Duration of hospitalization, survival at 1 month, and the rehospitalization rate during the year after the index hospitalization were evaluated. Cost-effectiveness analysis was performed. The mean length of hospitalization was 12.08 and 13.57 days in the levosimendan and ST groups, respectively (P < 0.05). Rehospitalization rates were lower in the levosimendan group at 6 months (1.44% vs. 2.3%; P < 0.05) and 12 months (7.6% vs. 14.3%; P < 0.05). Mortality rate at 1 month was 2.1% versus 6.9% in the levosimendan and ST groups, respectively (P < 0.05). The per-capita cost of treatment with levosimendan was &U20AC;78.86 higher than that with ST during the first hospitalization but &U20AC;280.22 lower when the rehospitalization rate was considered.

TNM-Like Classification: A New Proposed Method for Heart Failure Staging

Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF.

EKG ABNORMALITIES DISTRIBUTION BETWEEN COMPETITIVE ATHLETES, NON COMPETITIVE ATHLETES AND NON ATHLETES IN A POPULATION OF 12,000 YOUNG ITALIAN STUDENTS

Introduction: The European Society of Cardiology recommends cardiovascular screening to competitive athletes. In young population the execution of 12-lead ECG screening is still controversial. Hypothesis: The aim of our study is to evaluate the distribution of ECG abnormalities between competitive athletes, non competitive athletes and non athletes. Methods: From October 2010 to October 2015, we evaluated prospectively 11916 high school students (age 17.2 ± 2.4 years old; 45.9% male): 4533 (38.04 %) non athletes (G-A), 4936 (41.42 %) non competitive athletes (G-B) and 2447 (20.54%) competitive athletes (G-C). They were screened using 12-lead ECG. The statistical difference was considered significant only for p-value l this suggest that an ECG screening is recommended also in non athletes.

A Survey of telecardiology projects in Italy

It is estimated that in Italy there are about three million people affected by chronic heart failure. Cardiology is the health care field currently getting the largest benefits from telemedicine. Transmission, using wireless devices, makes possible to achieve virtual hospitalization: it is possible to anticipate the time of discharging and the patient can be remotely controlled by the central station in the ICU of the department of Medicine. Teleconsulting (i.e. a distance consulting between physicians) is applied in telecardiology, it allows the realization of a consulting between cardiology departments and remote services in the same hospital or among far-away hospitals. In this paper some of the most significant cardiac telemonitoring projects in Italy are described. Also reported, the projects involving the applications of implantable cardiac devices which can be controlled remotely. In conclusion, we sketch out the future prospects of telecardiology research and its applications in Italy.

Telecardiology in Italy: current realizations and future prospects.

Italy has a long tradition of telemedicine experiments that may be dated back to the early Seventies and currently many different telemedicine services are implemented in the country. Cardiology is the field of health care that currently gets the greatest benefits from telemedicine and it is also a very relevant field, since it is estimated that there are about three million people affected by chronic heart failure (5% of the population). In this paper we review some of the most significant cardiac telemonitoring projects in Italy, then we show the future prospects for telecardiology and put in evidence responsibilities and legal aspects We conclude that telecardiology, by enabling a better interaction between hospital and territory by means of teleconsulting, telemonitoring, telecare and remote access to clinical information, improves the quality of the whole health system. However, it cannot and should not replace the essential home care services, but it should be integrated properly and profitably with them.