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Feola M.,Cardiovascular Rehabilitation Heart Failure Unit | Garnero S.,Cardiovascular Rehabilitation Heart Failure Unit | Vallauri P.,Psychology Service | Salvatico L.,Psychology Service | And 3 more authors.
Open Cardiovascular Medicine Journal | Year: 2013

Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters. Methods: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). Results: Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). Conclusions: in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness. © Feola et al.


Feola M.,Cardiovascular Rehabilitation Heart Failure Unit | Testa M.,University of Turin | Leto L.,University of Turin | Cardone M.,Laboratory Service Ospedale Mondovi | And 2 more authors.
Medicine (United States) | Year: 2016

Galectin-3 demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcome in heart failure (HF) patients. The objective of this study was to analyze the value of a predischarged determination of plasma galectin-3 alone and with plasma brain natriuretic peptide (BNP) in predicting mid-term outcome in frequent-flyers (FF) HF (≥2 hospitalization for HF/year)/dead patients discharged after an acute decompensated HF (ADHF) episode. All FF chronic HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-minute walk test, and an echocardiogram within 48 hours upon hospital discharge. Death by any cause, cardiac transplantation, and worsening HF requiring readmission to hospital were considered cardiovascular events. Eighty-three patients (67 males, age 73.2 ± 8.6 years old) were analyzed (mean follow-up 11.6 ± 5.2 months; range 4-22 months). During the follow-up 38 events (45.7%) were scheduled: (13 cardiac deaths, 35 rehospitalizations for ADHF). According to medical history, in 33 patients (39.8%) a definition of FF HF patients was performed (range 2-4 hospitalization/year). HF patients who suffered an event (FF or death) demonstrated more impaired ventricular function (P = 0.037), higher plasma BNP (P = 0.005), and Gal-3 at predischarge evaluation (P = 0.027). Choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan-Meier curves depicted the powerful stratification using BNP + Gal-3 in predicting clinical course at mid-term follow-up (log rank 5.65; P = 0.017). Adding Gal-3 to BNP, a single predischarge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Feola M.,Cardiovascular Rehabilitation Heart Failure Unit | Garrone O.,Nuclear Medicine Service | Occelli M.,Nuclear Medicine Service | Francini A.,Nuclear Medicine Service | And 4 more authors.
International Journal of Cardiology | Year: 2011

Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment. Methods: Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled. All patients underwent clinical assessment, radionuclide ventriculography, troponin I and brain natriuretic peptide (BNP) measurements at baseline and one-month (T1), one year (T2) and 2-year (T3) after chemotherapy. Reductions of LVEF ≥ 10% or an overt heart failure were considered cardiovascular events. Results: 53 patients, 52 females and 1 male, age 55.3 years were included and followed at T3. A significant reduction of LVEF was observed (from 62 ± 5.5% to 59.3 ± 8.6%, p = 0.04) at T3; BNP increased (from 33.4 ± 41.5 pg/ml to 62.7 ± 94.7 pg/ml, p = 0.005) at T1. Troponin I augmented at T1 (from 0.006 ± 0.01 ng/ml to 0.05 ± 0.04 ng/ml, p = 0.0001) but normalized at T2 (0.005 ± 0.08 ng/ml; p = 0.9). Only baseline BNP was nearly to be significantly correlated with T3 LVEF (p = 0.07 HR 0.96-1) at multivariate analysis. In 13/53 patients (32.1%) LVEF showed ≥ 10% reduction at T3 (group A); in 40/53 patients (67.9%) LVEF was unchanged (group B). Patients in group A demonstrated higher baseline plasma BNP (p = 0.02) and lower haemoglobin concentration (p = 0.007) compared to patients in group B. Conclusions: LVEF and BNP modified early after anthracycline chemotherapy and LVEF did not recover at T3. In patients who developed left ventricular systolic dysfunction, a subclinical activation of neurohormonal profile was observed. © 2009 Elsevier Ireland Ltd.


Leto L.,University of Turin | Testa M.,University of Turin | Feola M.,Cardiovascular Rehabilitation Heart Failure Unit
International Journal of Endocrinology | Year: 2015

The determination of B-type natriuretic peptides (BNP) may have a role in the diagnosis of heart failure (HF) or guiding HF therapy. This study investigated the role of BNP determination in a cohort of elderly patients admitted to hospital with acute decompensated HF and its correlation with main demographic, clinical, and instrumental data and evaluated possible association with major outcome such as mortality or readmission after a 6-month period of follow-up. Methods. From October 2011 to May 2014 consecutive patients admitted to our unit with symptoms of acute HF or worsening of chronic HF entered the study collecting functional, echocardiographic, and hydration parameters. Correlation between BNP and main parameters was analysed, as well as the mortality/6-month readmission rate. Results. In 951 patients (mean age 71 ys; 37% females) a positive correlation was obtained between BNP and age, creatinine levels, NYHA class at admission and discharge, and levels of hydration; an inverse, negative correlation between BNP and sodium levels, LVEF, distance performed at 6MWT at admission and at discharge, and scores at MMSE at admission and discharge emerged. BNP levels at admission and at discharge were furthermore clearly associated with mortality at 6 months (Chi-square 704.38, p = 0.03) and hospital readmission (Chi-square 741.57, p < 0.01). Conclusion. In an elderly HF population, BNP is related not only with clinical, laboratory, and instrumental data but also with multidimensional scales evaluating global status; higher BNP levels are linked with a worse prognosis in terms of mortality and 6-month readmission. © 2015 Laura Leto et al.


Rinero K.,Cardiovascular Rehabilitation Heart Failure Unit | Testa M.,University of Turin | Vallauri P.,Psychology Service ASL CN1 | Garnero S.,Cardiovascular Rehabilitation Heart Failure Unit | Feola M.,Cardiovascular Rehabilitation Heart Failure Unit
Monaldi Archives for Chest Disease - Cardiac Series | Year: 2013

Object of this study was to evaluate the efficacy of multiprofessional meetings in order to improve patients' knowledge about cardiovascular diseases, risk factors and correct lifestyle in a Cardiovascular Rehabilitation Department. Methods: from November 2011 to June 2012 two MICRO-Q questionnaires were given to the Fossano Cardiovascular Rehabilitation's patients before and after the educational meetings to test their improvement after having followed educational meetings. Results: 73 patients have answered the questionnaires (57 males, mean age 68,5 ±11.73ys). From these data emerged a significant improvement of knowledge about cardiovascular risk factors (75,34% vs 91,78%; p=0,01), smoke (79,45% vs 93,15%; p=0,03), stress (76,71% vs 91,78; p=0,023), diet (84,93% vs 97,26%; p=0,02), physical activity (63,01% vs 84,93%; p=0,005) and right things to do in case of chest pain (34,25% vs 52,05%; p=0,04). Conclusions: educational meetings had an important role in improve patients' knowledge about cardiovascular risk factors, correct lifestyle and diet. Moreover MICRO-Q questionnaires demonstrated to be useful tools in order to improve the educational meetings according to the real needs of our patients.


Garnero S.,Cardiovascular Rehabilitation Heart Failure Unit | Pomero A.,Cardiovascular Rehabilitation Heart Failure Unit | Vallauri P.,Psychology Service ASL CN1 | Leto L.,University of Turin | And 2 more authors.
Minerva Cardioangiologica | Year: 2014

Aim. Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). The aim was to analyse the prevalence of cognitive impairment and anxiety-depression in an inhospital CHF population before discharge attempting to correlate with the presence of an implantable cardioverter defibrillator (ICD). Methods. All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), hospital anxiety and depression scale test (HADS). Results. Three-hundred and eighteen CHF patients (age 71.6 years, 195 males) were analysed. The mean New York Heart Association class (NYHA) was 2.9±0.8, left ventricular ejection fraction (LVEF) was 43.4+15.8%; brain natriuretic peptide (BNP) plasma level was 579.8±688.4 pg/mL. In 9-6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. An ICD was implanted in 43 (14.2%) CHF patients for primary prevention of cardiac sudden death. Patients in ICD group demonstrated a higher prevalence of renal impairment (creatinine 1.7±0.7 vs. 1.2±0.8 mg/dL; P=0.0001), lower LVEF (24.9±8.9 vs. 46.2±14.6% P=0.0001) and higher BNP (717.1+538 vs. 345.4±448.6 pg/ml; P=0.0001) but similar 6-minute walking test (338.6±81.3 vs. 345.3±114.9 m; P=0.8). An ICD intervention was registered in 9 (20.9%) patients. Although clinical parameters seemed to describe a sicker population in ICD implanted patients, from neuropsy-chological tests did not emerge any significant differences (P=NS for MMSE, GDS and HADS). Conclusion. ICD-implanted CHF patients for primary prevention did not reveal a worsening in anxiety and depression of mood demonstrating a similar cognitive performance in comparison with non-ICD implanted.


PubMed | Cardiovascular Rehabilitation Heart Failure Unit, University of Turin and Psychology Service ASL CN1
Type: Journal Article | Journal: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace | Year: 2014

Object of this study was to evaluate the efficacy of multiprofessional meetings in order to improve patients knowledge about cardiovascular diseases, risk factors and correct lifestyle in a Cardiovascular Rehabilitation Department.from November 2011 to June 2012 two MICRO-Q questionnaires were given to the Fossano Cardiovascular Rehabilitations patients before and after the educational meetings to test their improvement after having followed educational meetings.73 patients have answered the questionnaires (57 males, mean age 68,5 +/-11.73ys). From these data emerged a significant improvement of knowledge about cardiovascular risk factors (75,34% vs 91,78%; p=0,01), smoke (79,45% vs 93,15%; p=0,03), stress (76,71% vs 91,78; p=0,023), diet (84,93% vs 97,26%; p=0,02), physical activity (63,01% vs 84,93%; p=0,005) and right things to do in case of chest pain (34,25% vs 52,05%; p=0,04).educational meetings had an important role in improve patients knowledge about cardiovascular risk factors, correct lifestyle and diet. Moreover MICRO-Q questionnaires demonstrated to be useful tools in order to improve the educational meetings according to the real needs of our patients.


Feola M.,Cardiovascular Rehabilitation Heart Failure Unit | Valeri L.,Ss Annunziata Hospital | Menditto E.,Cardiovascular Rehabilitation Heart Failure Unit | Nervo E.,Cardiovascular Rehabilitation Heart Failure Unit | And 4 more authors.
Journal of Endocrinological Investigation | Year: 2010

This study compared two different methods, namely the immunoradiometric (IRMA) and fluorimetric (FIA), in order to determine plasma brain natriuretic peptide (BNP) in congestive heart failure (CHF) patients. Methods: CHF in-patients underwent echocardiography and plasma BNP determination using both two methods. The echocardiograms analysed left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes and systolic dysfunction [left ventricular ejection fraction (LVEF) <50%]. Results: Seventy-three (71% males, age 67±9.6 yr) patients were enrolled, 31.5% affected by valvular heart disease. The mean LVEF was 39.8±14.1%; in 26 (35%) a hypertensive etiology emerged. The immunoradiometric assay (IRMA) BNP was found to be significantly lower than the FIA determination 116.5±149 pg/ml vs 267.3±285.6 pg/ml; p=0.0001) and the two methods were closely correlated (r=0.89; p=0.00001). Logistic regression demonstrated a significant correlation between BNP, LVEF, and LVESV/LVEDV (r=-0.45, p=0.0003; r=-0.48, p=0.00001; r=0.22 p=0.003; r=0.34 p=0.0001; r=0.13 p=0.02; r=0.28 p=0.001 IRMA and FIA, respectively). IRMA BNP and FIA BNP significantly increased according to the worsening functional class [from 34.3±60.2 pg/ml in NYHA (New York Heart Association) I to 555.5±273.1 pg/ml in NYHA IV; from 86.1±162.1 pg/ml in NYHA I to 1070±42.2 pg/ml in NYHA IV, respectively]. In severe systolic dysfunction (LVEF<30%), receiver operating characteristic analysis revealed a satisfactorily sensitivity and specificity using a cut-off point of 50.6 pg/ml with IRMA and 243 pg/ml with FIA. In mild systolic dysfunction (LVEF<50%), a good sensitivity and specificity using a cut-off point of 42 pg/ml with IRMA and 182 pg/ml with FIA emerged. Conclusions: In CHF patients both BNP methods correlated with NYHA class, LVEF, and ventricular volumes. ©2010, Editrice Kurtis.


Garrone O.,S Croce General Hospital | Crosetto N.,Massachusetts Institute of Technology | Nigro C.L.,S Croce General Hospital | Catzeddu T.,S Croce General Hospital | And 4 more authors.
Cardiovascular Toxicology | Year: 2012

Anthracyclines are active drugs against breast cancer, but can exert cardiotoxic effects. We analyzed the association between the kinetics of various biomarkers during chemotherapy, and the risk of subsequent cardiac toxicity. 50 patients (49 women) with early breast cancer surgically treated and eligible to anthracycline-based adjuvant chemotherapy were analyzed. The left ventricular ejection fraction (LVEF) together with the plasma concentration of several blood markers was measured at the beginning of anthracycline chemotherapy (t 0), 5 months (t1), 16 months (t2), 28 months (t3), and 40 months later (t4). A single measured LVEF value less than 50% or a clinically overt congestive heart failure (CHF) was considered cardiotoxic effects. We tested whether the kinetics of LVEF and blood biomarkers measured during chemotherapy was predictive of subsequent cardiotoxicity and overall cardiac fitness. The left ventricular ejection fraction measured at the end of treatment as well as the rate of change of hemoglobin concentration during anthracycline-based chemotherapy predicted cardiotoxicity in a 3-year follow-up period. When LVEF at the end of chemotherapy was lower than 53% or hemoglobin blood concentration declined more than 0.33 g/dL/month during chemotherapy, the odds ratio of subsequent cardiotoxicity was 37.3 and 18, respectively. The specificity of these two tests was 93.3% and 80%, whereas the sensitivity was 90.9 and 81.2%, respectively. Testing the rate of change of hemoglobin concentration during anthracycline-based chemotherapy, as well as the left ventricular ejection fraction at the end of treatment, seems a powerful method to assess the effects of anthracyclines on cardiac fitness and identify patients at high risk of CHF. Further validation of these tests on a large cohort of patients and cost-benefit analysis should be encouraged. © 2011 Springer Science+Business Media, LLC.


PubMed | Cardiovascular Rehabilitation Heart Failure Unit
Type: Journal Article | Journal: Minerva cardioangiologica | Year: 2016

Natriuretic peptides (NPs) have demonstrated their value to support clinical diagnosis of heart failure (HF); furthermore they are also studied for their prognostic role using them to guide appropriate management strategies. The present review gathers available evidence on prognostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF).We searched Medline for English-language studies with the sequent key-words: acute heart failure/acute decompensated heart failure, NT-proBNP/N-terminal pro-B type natriuretic peptide and prognosis/mortality/readmission.Almost 30 studies were included. NT-proBNP plasma levels at admission are strongly associated with all-cause short-term mortality (2-3 months), mid-term (6-11 months) or long- term mortality (more than one year) of follow-up. Regarding the prognostic power on cardiac death fewer data are available with uncertain results. NT-proBNP at discharge demonstrated its prognostic role for all-cause mortality at mid and long-term follow-up. The relation between NT-proBNP at discharge and cardiovascular mortality or composite end-point is under investigation. A decrease in NT-proBNP values during hospitalization provided prognostic prospects mainly for cardiovascular mortality and HF readmission. A 30% variation in NT-proBNP levels during in-hospital stay seemed to be an optimal cut-off for prognostic role.SNT-proBNP plasma levels proved to have a strong correlation with all-cause mortality, cardiovascular mortality, morbidity and composite outcomes in patients discharged after an ADHF. A better definition of the correct time of serial measurements and the cut-off values might be the challenge for the future investigations.

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