ObjectivePulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.MethodsIn this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.ResultsA total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.ConclusionsLUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.

Percutaneous coronary intervention (PCI) for coronary bifurcation lesions (CBL) represents one of the most challenging procedures in interventional cardiology because of lower angiographic success rate and increased risk of procedural complications (1).Currently, the single stent strategy has been considered as the default approach for the treatment of CBL (2); however, the optimal therapy for Medina type 0,1,0 or 0,0,1 left main stem (LMS) bifurcation lesions remains unclear. For these lesions, precise ostial stent placement and crossover stenting technique have been proposed. Nevertheless, precise stent placement is known to be challenging, and there is no established technique for perfect ostial stent deployment despite the fact that different strategies and/or devices have been tested (3). Several studies have shown that the cross-over stenting approach is superior to the ostial stenting with a lower rate of major adverse cardiovascular event (MACE) rate during longterm clinical follow-up (4, 5). However, data indicates that this procedure may be complicated by a significant stenosis of the other major branch of the LMS even if ABSTRACT Objective: To investigate the safety and efficacy of a percutaneous revascularization strategy that is based on the use of drug-coated balloon (DCB) for the treatment of patients with acute coronary syndrome (ACS) and de novo Medina type 0,1,0 or 0,0,1 left main stem (LMS) bifurcation lesions. Methods:In this multicenter, prospective, proof-of-concept study, patients fulfilling the above criteria were enrolled and received treatment with DCB combined with provisional drug-eluting stent (DES) implantation in the proximal major branches of the LMS. Patients who declined this revascularization approach were treated with DES implantation 1-2 mm distally to the LAD or LCx ostium followed by DCB therapy for the ostial disease. The primary endpoint of the study was percent diameter stenosis (%DS) on quantitative coronary angiography post procedure as well as event rate at 8 months follow-up.Results: Thirty patients were enrolled in the study with mean age of 60.3±7.8 years, of whom 22 (73.3%) were male. Twenty-two patients were treated only with DCB and provisional DES implantation, and 8 had DES implantation followed by DCB therapy of the ostium of the LMS major branch. All the procedures were successful with no immediate complications. Lesion %DS decreased significantly post-procedure from 62.9±14.6 to 13.3±7.5, p<0.001. During the follow-up period, no major adverse cardiac events were reported. Conclusion:This proof-of-concept study indicates that ostial DCB therapy of the LMS major branches is safe and effective. Larger clinical data and longer follow-up is needed before advocating its regular use in clinical practice.

The combination of significant FTR and right ventricular dysfunction, but not FTR and right ventricular dysfunction alone, is independently associated with renal dysfunction. The presence of significant FTR is related to an excess event rate of heart failure and has significant impact on outcome.