Frailty assessment in an unselected population admitted to an intensive cardiac care unit

Background

Although interest in frailty has expanded among cardiology experts over the past 2 decades, its integration, as part of cardiovascular disease management, is still lacking, above all in the acute cardiac care setting. The Clinical Frailty Scale (CFS) is a brief guided tool to assess frailty in hospital settings without specialist equipment.

Purpose

Our objective was to test the performance of the CFS in an older, unselected population, admitted to an Intensive Cardiac Care Unit (ICCU) during the year 2019.

Methods

The study sample included 431 patients ≥65 years old, admitted to an ICCU of a tertiary cardiac center in Italy. The CFS ranged from “very fit: 1” to “terminally ill: 9”, but it was considered present at a score ≥5. Our primary endpoint was defined by a combination of severe complications requiring critical care and in-hospital death. The data were collected from the hospital discharge summary and the electronic chart records.

Results

158 patients (36.7%) were frail. These individuals had greater comorbidity and higher in-hospital mortality (Table 1). After a multivariable logistic regression analysis, 4 predictors were identified: signs of congestive heart failure (OR: 8.51, 95% Confidence Interval-CI: 4.63–14.6; p<0,001), systolic blood pressure (OR per 1 mmHg increasing: 0.98, 95% CI: 0.97–0.99; p<0,001), smoking habit (OR: 0.49, 95% CI: 0.22–1.11; p=0.09) and the CFS ≥5 (OR: 1.86, 95% CI: 1.08–3.23: p=0,026).

Conclusions

The CFS is a simple guided frailty tool that may enhance outcome prediction in the acute cardiac care setting. These findings merit evaluation in larger cohorts of unselected patients.

Funding Acknowledgement

Type of funding sources: None.

412 Sacubitril/valsartan promotes cardiac reverse remodeling and preserves renal function in a real-world heart failure and reduced ejection fraction (HFrEF) population

Funding Acknowledgements

none

Aims. To evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF).

Methods and results. Prospective study enrolling consecutive patients with HFrEF treated with S/V.The primary outcome was HF rehospitalization;secondary outcomes were all-cause death, cardiac death and the composite of cardiac death and HF rehospitalization at 12 months follow up.The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy by using propensity score weighting. At 6 months follow-up, changes in symptoms, echocardiographic parameters, eGFR and furosemide dose were also evaluated. The study population consisted of 90 patients (66.1 ± 11.7 years). At 6 months FU, a significant improvement in NYHA class, LVEF (from 31.0% to 34.0%; p = 0.001), LVESV (from 115.0 to 101.0 mL; p = 0.033) and sPAP (from 31.0 to 25.0 mmHg; p = 0.024) was observed. Moreover, S/V did not affect negatively eGFR and was associated with a significantly lower dose of furosemide prescribed. The propensity score weighting adjusted regression analysis showed a significantly lower risk for HF rehospitalization (HR, 0.131; 95% CI, 0.034-0.503; p = 0.003) and the composite outcome (HR, 0.162; 95% CI, 0.053-0.492; p = 0.001) among patients treated with S/V as compared to the standard therapy group.

Conclusions

In this real-world HFrEF population, S/V reduced HF rehospitalization and cardiac death at 1 year. Moreover, S/V improved significantly NYHA class, LVEF, LVESV and sPAP at 6 months, preserving renal function and reducing the need of furosemide.

Table Study outcomes Unadjusted model HR 95% CI p-value HF rehospitalization 0.273 0.101-0.740 0.011 Cardiac death 0.443 0.137-1.440 0.176 Composite outcome 0.331 0.155-0.710 0.005 All-cause death 0.666 0.272-1.628 0.372 Adjusted model HR 95% CI p-value HF rehospitalization 0.131 0.034-0.503 0.003 Cardiac death 0.259 0.047-1.415 0.119 Composite outcome 0.162 0.053-0.492 0.001 All-cause death 0.713 0.201-2.529 0.601 Adjusted and unadjusted HR for the study outcomes.

Abstract 412 Figure.

Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer)

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.

The safety of dose-dense liposomal-encapsulated doxorubicin in association with docetaxel (MyTax) in breast cancer

Abstract #2157

Background: Liposomal-Encapsulated Doxorubicin (LED) shows equivalent efficacy, better cardiac tolerability at higher cumulative dose than conventional anthracyclines in breast cancer treatment.
 Methods: Sixteen pts were enrolled in a dose-finding study of LED (TLC-D99 Myocet ®) associated to Docetaxel (TXT). Twelve pts were treated with a fixed TXT dose (50 mg/m2) and TLC-D99 at three dose levels, 40-45-50 mg/m2, days 1 and 15 every 2 weeks using an intra- and inter-patient approach; four pts wrere treated at the TLC-D99 recommended dose (50 mg/m2). Cardiac monitoring of LVEF was performed every two cycles; Precursor Brain Natriuretic Peptide (proBNP) and cardiac Troponin (c-TnI) before and after 24 h chemotherapy was evaluated.
 Results: Breast cancer (BC) disease extension: metastatic (MBC), 8; locally advanced BC, 5; T2-T3 BC, 3. Previous chemotherapy: untreated, 11 pts; adjuvant, 5 pts. Enrolled pts for each dose-level: I, 7; II, 9; III, 14. Newly treated pts: I dose-level, 7; II dose-level, 3; III dose-level, 6. Valuable cycles for each dose-level in a total 77 cycles: I, 14; II, 21; III, 42. DLTs were observed in 3 pts, 21%, and 3 cycles, 4%: 2 cardiac, characterized by a 19% LVEF decrease and a symptomatic arrhythmia; one G4 hematologic resistant to G-CSF. DLTs for each dose-level by pts and cycles, respectively: I, 14% (1/7 pts) and 7% (1/14 cycles); II, no DLT in 9 pts and 21 cycles; III, 14% (2/14 pts) and 5% (2/42 cycles). Cumulative G3-4 toxicities by pts and cycles, respectively: cardiac arrhythmia 6% and 1,3%, cardiac general (symptomatic LVEF decrease), 6% and 1,3%; alopecia 81% and 65%; neutropenia resistant to G-CSF, 6% and 1,3%. Cardiac DLTs were observed in 2 elderly pts (>65 y). The 2 cardiac DLTs were observed in 2 out of 3 pts with pre-existing diastolic dysfunction. No pathologic increase of c-TnI levels was detected. Seven pts showed increased pro-BNP after chemotherapy; 1 of these with increased pro-BNP after chemotherapy, persistent the day 1 of each subsequent chemotherapy showed a DLT;
 G2 toxicities by patients and cycles, respectively: asthenia 37% and 18%, stomatitis/mucositis 12% and 5%, nausea 31% and 12%. Median rDI of TLC-D99 was 25 mg/m2/w and TXT 25 mg/m2/w for pts, respectively. Preliminary efficacy in 16 assessable pts: LA-BC and MBC, 1 CR (pCR) 7 PR (OR 62%), 4 SD and 1 PD; T2-T3 BC, 2 PR and 1 SD.
 Conclusion: dose-dense TLC-D99/Docetaxel association can be safely recommended at the dose of 50 mg/m2 for each drug. Docetaxel intensification is ongoing.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2157.

Psychological aspects in orthognathic surgery. Body image and quality of life in postsurgical assessment. Body image and quality of life in postsurgical assessment

AIM

The aim of this study is to evaluate the psychological assessment of 20 patients after orthognathic surgery. Body image, anxiety levels, depression, somatic symptoms, aggressiveness and quality of life have been evaluated using 3 different questionnaires (BDDE, SQ, Q-LES-Q) during the postsurgical period. Analysis of the questionnaire has shown that the patients undergo orthognathic surgery mainly for esthetical reasons and, even if they could be considered normal, psychological evaluation followed by a proper support is a must. The present study has mainly developed and outlined this aspect.

METHODS

BDDE has been utilised to evaluate body image, self-estimation and social relationship. It was evident that the psychological impact after surgery represents a "revolution" for the patient. The "new face" may generate psychological problems for the patients. The SQ test has been used to evaluate the emotional profile. We also considered it essential for our study to evaluate several aspects of the quality of life of our sample group. The body image, particularly when others find it pleasing or displeasing may affect everyday life behaviour.

RESULTS

The study reports positive results in the psycho-emotional profiles and in several aspects of the quality of life, while the results of the self-perception of the body image could be considered average.

CONCLUSION

Reported data show that the corrections following orthognathic surgery have a positive impact on the assessment of the patients and on the personal and social attitude and behaviour, however suggesting, a long term psychological support to assure a satisfactory postoperative recovery.

Two gamma-interferon-activation sites (GAS) on the promoter of the human intercellular adhesion molecule (ICAM-1) gene are required for induction of transcription by IFN-gamma

We describe the molecular features of the interferon (IFN)-gamma-mediated transcription of the human intercellular adhesion molecule (ICAM-1) gene. We identified putative IFN-gamma-activated sites (GAS) distributed throughout a large segment of the ICAM-1 promoter (4.0 kb region). Using computer-assisted search, these sequences were similar to potential IFN-gamma responsive elements that have a core sequence 5'-TTNCNNNAA-3'. In this report we show that in the ICAM-1 promoter a GAS site is located at -115 from the translation initiation site, and binds with strong affinity to IFN-gamma-activated Signal Transducers and Activators of Transcription (STAT1) homodimers. The same sequence is responsible for the IFN-gamma-mediated transcription of the ICAM-1 gene. Moreover, we present evidence that a more distal GAS element that maps at -2787 from the translation initiation site, binds IFN-gamma-activated STAT1 dimers with lower affinity. Multimeric copies of such GAS sequence inserted into a tkCAT minimal promoter can drive transcription, demonstrating that the -2787 bp GAS element has an independent functional activity upon binding of IFN-gamma-activated STAT1 proteins as documented by in vitro binding assays. Furthermore, using recombinant ICAM-CAT mutants, we show that, in vivo, the -2787 GAS, but not a mutagenized -2787 GAS site, when coupled to the more proximal -115 GAS element, has an additive effect in enhancing the IFN-gamma-mediated transcription of ICAM-1 promoter. Nevertheless, using a recombinant construct bearing the wild type -2787 GAS element and a mutagenized -115 GAS element, we could not detect any transcription after transfection of U937 recipient cells, suggesting that the -2787 bp GAS element is not sufficient as such for gene activation, but can cooperate with its cognate proximal sequence to give full function to the ICAM-1 promoter during the IFN-gamma response. Taken together these data provide evidence that two GAS sites are required for the full potential activity in the mechanism of ICAM-1 gene activation by IFN-gamma.

Anthropometric or ultrasonic measurements in assessment of visceral fat? A comparative study

The main aim of the study (study 1) was to compare the accuracy of anthropometric and ultrasonic measurements in assessing the amount of visceral adipose tissue. An additional aim (study 2) was to verify ultrasound technique precision. Study 1: using computed tomography (CT) L4-L5 adipose tissue area as a gold standard we compared the accuracy of waist/hip circumference ratio, sagittal diameter and ultrasonic measurements of intra-abdominal depth in assessing the amount of visceral adipose tissue. Study 2: ultrasonic measurements of the intra-abdominal muscle-vertebra distance were made in triplicate by three different operators. In study 1, 24 volunteers were used; body mass index (BMI): 19-43. In study 2, 22 volunteers were used; BMI 20-42. In study 1, ultrasonic measurements of the abdominal depth correlated best with CT visceral adipose tissue area (r = 0.89 - 0.91). In study 2, inter-operator and intra-operator mean variation coefficients were about 7% and 5% respectively. We concluded that using a well standardized technique and properly trained operators, ultrasonic measurement of intra-abdominal depth is a valid method in assessing the amount of visceral adipose tissue.