BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

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e11634 Background: Breast cancer (BC) rarely occurs in young women. Presentation, behavior and prognosis of BC in such patients (pts), when compared with older women, are unclear. It is believed that tumor is more aggressive in biologic nature in this group of pts. Objective: to describe Her2/neu status, tumor behavior and prognosis in women aged 35 and under with BC. Methods: We reviewed the records of 45 women aged 35 years or less, with diagnosis of BC between 1999 and 2007. The original Her2 status was analyzed by immunohistochemistry (IHC) with a polyclonal antibody. The results were interpreted using score 0 to 3+. Fluorescence in situ hybridization (FISH) was performed in all samples. Results: Her2/neu overexpression showed up in 8 tumors (17.7%) and all of them were confirmed by FISH. In this group of pts (FISH positive) hormone receptors were positive in 50%. Stage at diagnosis was I 2 pts and II 6 pts. 5 out of the 8 pts with Her2/neu tumors had axillary node involvement (11.1% out of the total of population), and tumor size was more than 2cm at diagnosis. All of them were invasive ductal carcinoma. Postoperative radiotherapy was given to 6pts while all pts with Her2/neu positive tumors received chemotherapy with anthracyclines, taxanes and trastuzumab. Disease free survival of 24 month was achieved in 5pts, 1pt died with bone, lung and liver metastases. 2pts had progressive disease (bone and lung metastases one of them, and local recurrence the other one). Conclusions: In our population of pts, 17.7% were Her 2/neu positive. In this small group of pts lymph node involvement was frequent and tumor size was more than 2cm. Progressive disease with distant metastases in bone, lung and liver was observed. Despite of these negative characteristics 5 out of 8 pts (62.5%) had DFS of 2 years. No significant financial relationships to disclose.

15546 Background: ENB is a rare embrionary tumor derived from neuroblasts of the olfactory sensory system. Polypoid mass with epistaxis or nasal obstruction are the most common clinical manifestations of this tumor. It’s invasive and it frequently causes regional and distant metastasis. ENB requires a multimodality therapy. The objective of this study is to describe the form of presentation, diagnosis, treatment and evolution of this tumor on a female patient (pt), as a casuistic contribution. Methods and Case Report: A 61 year old woman with a four month history of epistaxis, nasal pain and anosmia. CT shows nasal mass invading the entire nasal cavity and upper maxillary. Pt underwent nasal resection and reconstruction with frontal flaps. Anatomopathology: ENB invading the bone. Cromogranin (+), sinaptofisin (+), CK (−), NSE (−). Three months later: lesion on the right wing nasal and a mass in the soft palate. MRI: mass on the floor of the nasal fossa that involve the left maxillary sinus and the bone palate. Kadish stage C. We treated her with three cycles of chemotherapy using cisplatin 30 mg/sqM d 1–3 iv and etoposide 100 mg/sqM d 1–3 iv. After that, remission was observed in the wing nasal lesion but the the soft palate mass shows progression. MRI: mass in nasal fossa that destroys the left maxillary sinus and causes lysis of the upper maxillary and orbital floor. Pt was treated with radiotherapy (6000 cGy) showing complete remission of the nasal lession and partial response on the soft palate, verified by physical examination and RMI. Four months after the end of radiotherapy, she continues under control and maintains the response to therapy without evidence of progression. Conclusion: ENB is an unfrequent tumor without any standard treatment. In our case, the combination of surgery, CH and RT has been effective for local control of the disease with good tolerance and acceptable quality of life. No significant financial relationships to disclose.

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