Alessandro Sestu

Cardiac and non-cardiac co-morbidities are highly prevalent in patients with heart failure (HF). The aim of the present study was to describe their selective impact on in-hospital outcomes (length of hospitalization and mortality) of HF patients hospitalized in an Internal Medicine Unit, Methods Between January 2017 and December 2022, 12435 (6146 F, 6289 M) inpatient were hospitalized in our Internal Medicine Unit. HF was defined according to the International Statistical Classification of Diseases and Related Health Problems (ICD) version 9 codes 428, 402.01, 402.11, 402.91, 404.11, 404.13, 404.91, 404.93. Patients were classified by burden of overall, cardiac, and of non-cardiac comorbidities (0, 1, 2, 3+). Multivariable regression models were used to assess associations between comorbidity burden and length of stay (linear regression) or in-hospital mortality (logistic regression). Results HF patients (1481, or 11.9% of all hospitalization during observation period) had on average 1.6 comorbidity number. Increasing number of comorbidities was associated with longer duration of hospitalization and mortality. Non-cardiac, but not cardiac, comorbidities were associated with significantly higher length of stay (beta coefficient 2.86 ±0.27) and in-hospital mortality (OR 1.90, 95% confidence interval (CI) 1.60–2.23; p <0.0001). Conclusions Cardiac and non-cardiac comorbidities differentially impact on in-hospital outcomes of older HF patients hospitalized in Internal Medicine unit. Their more precise management will allow a reduction of avoidable hospitalization in HF patients.

Background: Thrombotic adverse events and disease progression are crucial in Polycythemia Vera (PV), as it stands as the leading cause of mortality. The pulse wave velocity (PWV) is a valuable indicator of arterial aging and often plays a significant independent role in contributing to cardiovascular adverse events (CV-AEs). The aim of this study was to examine the relationship between PWV and critical vascular function parameters, with the goal of identifying new predictive factors of vascular damage and exploring a potential connection with disease progression. Methods: Non-invasive aortic stiffness was assessed through carotid–femoral PWV measurement. PWV was measured using the SphygmoCor device. History of arterial or venous thrombosis (TAEs) or other CV-AEs was collected at baseline. PWV measurements were repeated at baseline, at 6 and at 12 months. Results: The study involved 28 PV patients aged 27 to 77 years, with 57.1% being male. Fourteen patients (50%) reported a high-risk thrombotic score at diagnosis, and 60.7% had at least one comorbidity. Multivariable regression models showed that hemoglobin levels were independently associated with PWV (β: 0.68, SE 0.24, p < 0.01). During the follow-up period (median duration 21.3 months, range 6–33), a total of 13 events were documented. Specifically, two patients exhibited a loss of response to treatment, four patients presented an increase in spleen diameters, three patients displayed an escalation of systemic symptoms, and three patients had a clear progression to secondary myelofibrosis. PWV (per 1 m/s: OR 1.70, 95% CI 1.00–2.91, p = 0.047) and leukocyte count (per 1 × 10³/μL: OR 1.47, 95% CI: 1.04–2.09, p = 0.043) were significant predictors of events, independently of waist circumference, blood pressure, treatment, and hematocrit. Conclusions: PWV has demonstrated its potential as an effective tool for monitoring PV patients. It stands as a clinical parameter that can predict the risk of progression in PV patients. Further investigation is essential to fully explore this potential. If successful, it could offer clinicians a valuable resource for effectively managing PV patients.

Background and Aims: Heart rate variability (HRV), i.e., the beat-by-beat fluctuations in heart rate (HR) reflecting the autonomic nervous system balance, is altered in patients with diabetes. This has been associated with arterial aging (stiffer arteries) and differs in men and women. The present study hypothesized that the impact of HRV on arterial aging, indexed as carotid–femoral pulse wave velocity (PWV), differs in a gender-specific manner and is affected by diabetes mellitus. Method: A total of 422 outpatients (187 women and 235 men) were studied. PWV was measured using the validated SphygmoCor device (AtCor Medical). Time-domain and frequency-domain parameters were measured to assess HRV. Results: The prevalence of diabetes was 30.8% with a slight, but nonsignificant, greater prevalence in men. Both age and SBP were independent determinants of PWV in each of the four groups (men and women with or without diabetes). Low-frequency activity was inversely correlated with PWV. It was greater in women without diabetes, but it was not significant in men regardless of the presence of diabetes. Conclusions: Beyond age, blood pressure, and diabetes, impaired cardiac autonomic function assessed by determination of HRV was significantly associated with arterial aging. The association between lower sympathetic and parasympathetic activity and stiffer arteries was significant in women, but not in men.