Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population.

Background Infective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management. We aimed to define diagnosis parameters and delineate in-hospital management in patients with IE admitted in a tertiary hospital of Southern Italian. Materials and methods Fifty-six consecutive patients (42 males, 14 females; age range: 34-85 years) admitted for IE in the Infectious Diseases, Cardiac Surgery, and Cardiology units, between January 2011 and August 2017, were enrolled. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, and antimicrobial therapy were collected and analyzed. Any com…

Large left ventricular metastatis in patient with liposarcoma.

Abstract Metastasis to the heart and pericardium are rare. We present a 44-year-old male with pleural dedifferentiated liposarcoma and multiple metastases, with no previous cardiological history and/or cardiac symptoms. A transthoracic echocardiogram during the advanced stage of disease showed a lobulated, large and mobile mass, with homogeneous echogenicity, attached to the basal posterior wall of the left ventricle via a broad base and with intracavitary growth. This mass extends to inferolateral and inferoseptal wall of the left ventricle.

ATEROSCLEROSI CAROTIDEA E PERIFERICA E RESTENOSI CORONARICA DOPO ANGIOPLASTICA PERCUTANEA.

Left bundle branch block and myocardial infarction, a diagnosis not always easy: Our experience and review of literature

The occurrence of left bundle branch block (LBBB) is quite common in clinical practice. The changes in cardiac repolarization, caused by this disorder of electric conduction, may mask the presence of an acute myocardial infarction (AMI), delaying the diagnostic-therapeutic iter, with an important impact on prognosis. We describe the case of a woman of 59 years with LBBB, came to our observation for a constrictive chest pain associated with dyspnea. The diagnostic workup for suspected acute coronary syndrome (ACS), initially conducted only on the analysis of the electrocardiogram (negative TnI at entry), showed the presence of coronary arteries free of stenosis. However, the diagnostic confi…

EVALUATION OF DIASTOLIC FUNCTION BY THE TISSUE DOPPLER IN CHILDREN AFFECTED BY NON COMPACTION.

Preclinical carotid atherosclerosis enhances the global cardiovascular risk and increases the rate of cerebro- and cardiovascular events in a five-year follow-up

AIM: To evaluate if the intima-media thickening (IMT) and asymptomatic carotid plaque (ACP), as expression of carotid preclinical atherosclerosis (pre-ATS), can provide further information on the global cardiovascular risk (GCVR). METHODS: We studied 454 asymptomatic subjects, with a cluster of risk factors (RF), and evaluated the incidence of a first cardiovascular (CV) event in a five-year follow-up. The subjects at admission were subdivided in three groups of risk. RESULTS: Events occurred in 38% of subjects at high risk, in 13% and 6% of subjects at intermediate and low risk (p<0.003). Among evaluated parameters, carotid pre-ATS was a predictive marker of CV events (OR 2.7, 95% IC 1.4-5…

Cardiovascular Damage Induced by Anti-VEGF Therapy

Vascular endothelial growth factor (VEGF) plays an important role in maintaining the regular homeostasis of vascular walls. VEGF binds its receptor (VEGFR) promoting the regular survival and function of endothelial cells. Anti-VEGF and anti-VEGFR drugs inhibit the action of VEGF and VEGFR. These drugs can cause cardiovascular toxic effects such as arterial hypertension, thromboembolism, myocardial ischemia and heart failure. The monoclonal antibody bevacizumab and tyrosine kinase inhibitors (sorafenib, sunitinib, pazopanib, regorafenib, axitinib, cabozantinib, ponatinib) are the main inhibitors of VEGF, VEGFR and other tyrosine kinases. In this chapter we will illustrate the cardiovascular …

MULTIFOCAL ATHEROSCLEROSIS INFLUENCING THE OUTCOME OF PATIENTS WITH ACUTE AND CHRONIC CORONARY HEART DISEASE

MULTIFOCAL ATHEROSCLEROSIS INFLUENCING THE OUTCOME OF PATIENTS WITH ACUTE AND CHRONIC CORONARY HEART DISEASE

Behavior of patients at high risk of developing contrast induced nephropathy after coronary procedures

Patent foramen ovale (PFO): long-term impact of percutaneous treatment

Although in our center the percutaneous procedure is performed from a few years, our results are encouraging, also not understimate improve in quality of live and psychological aspects.

Therapy of ATTR Cardiac Amyloidosis: Current Indications

Transthyretin cardiac amyloidosis is a restrictive cardiomyopathy caused by extracellular deposition in the heart of amyloid fibrils derived from plasma transthyretin (ATTR), either in its hereditary (ATTRh) or acquired (ATTRwt) forms. Cardiac amyloidosis has a very poor prognosis if therapy is not started promptly. Therefore, it is very important to recognize cardiac amyloidosis early in order to immediately start a treatment capable of modifying the prognosis. Treatment of cardiac amyloidosis is not easy, often requiring a multidisciplinary team. New RNA-interfering drugs (such as patisiran) have been devised and are effective in the treatment of ATTRh amyloidosis. Tafamidis (a stabilizer…

Cardioprotection by gene therapy

Ischemic heart disease remains the leading cause of death worldwide. Ischemic pre-, post-, and remote conditionings trigger endogenous cardioprotection that renders the heart resistant to ischemic-reperfusion injury (IRI). Mimicking endogenous cardioprotection by modulating genes involved in cardioprotective signal transduction provides an opportunity to reproduce endogenous cardioprotection with better possibilities of translation into the clinical setting. Genes and signaling pathways by which conditioning maneuvers exert their effects on the heart are partially understood. This is due to the targeted approach that allowed identifying one or a few genes associated with IRI and cardioprote…

Right Ventricle Function in Patients With Anterior Myocardial Infarction: Are We Sure it Is Not Involved?

Copyright © 2022, Elsevier

Low HDL-cholesterol concentrations cause atherosclerotic disease to develop

Incidence, determinants and prognostic relevance of dyspnea at admission in patients with Takotsubo syndrome: results from the international multicenter GEIST registry

AbstractClinical presentation of Takotsubo syndrome (TTS) may range from acute chest pain to dyspnea: the prognostic role of clinical onset is still controversial. Aim of this study was therefore to investigate the prognostic relevance of dyspnea at presentation in patients with TTS. We analyzed 1,071 TTS patients (median age 72 years, 90% female) enrolled in the international multicenter GEIST registry. Patients were divided according to the presence or absence of dyspnea at hospital admission, as clinically assessed by the accepting physician. The primary endpoint was occurrence of in-hospital complications defined as a composite of pulmonary edema, cardiogenic shock and death. Overall, 3…

Relationship between endothelial dysfunction, intima media thickness, hypertension and other cardiovascular risk factors in asymptomatic subjects

The new HFA/ICOS risk assessment tool to identify patients with chronic myeloid leukaemia at high risk of cardiotoxicity

AimsTyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukaemia (CML) can cause cardiovascular adverseevents. So far, the Systematic Coronary Risk Evaluation (SCORE) charts of the European Society of Cardiology (ESC) have beenused to identify cancer patients at increased cardiovascular risk. The primary aim of our study was to evaluate the usefulnessof the new cardiovascular risk assessment model proposed by the Cardio-Oncology Study Group of the Heart Failure Associ-ation (HFA) of the ESC in collaboration with the International Cardio-Oncology Society (ICOS) to stratify the cardiovascular riskin CML patients, compared with SCORE risk charts. The secondary aim was to establish…

Troponin I/ejection fraction ratio: A new index to differentiate Takotsubo cardiomyopathy from myocardial infarction

– Transient hypokinesis, akinesis, or dyskinesis of the left ventricular mid-segments with or without apical involvement; the regional wall motion abnormalities extend beyond a single epicardial vascular distribution; a stressful trigger is often, but not always, present; – Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; – New ECG abnormalities (either ST-segment elevation and/or T wave inversion) or modest elevation in cardiac troponin; and – Absence of pheochromocytoma or myocarditis.

A possible easy way to predict response to cardiac resynchronization therapy: The role of QRS Index

Background: Some studies have evaluated the role of QRS duration (QRSd) as predictor of response to Cardiac Resynchronization Therapy (CRT). However, their results are still not entirely clear. The goal of our study was to determine the correlation between the relative change in QRS narrowing index (QI) compared to clinical outcome and prognosis in patients who underwent CRT implantation. Methods: We collected clinical and echocardiographic data of 115 patients in whome a CRT device was implanted in accordance with current guidelines. QRS duration before and after CRT implantation and QI were measured. Results: After 6 months, a signifi cant improvement in all echocardiographic parameters w…

Asymptomatic carotid lesions add to cardiovascular risk prediction.

AIM To show that subclinical atherosclerosis (subclinical-ATS) of carotid arteries [intima-media thickness (IMT) or asymptomatic carotid plaque (ACP)], may provide additional information for risk stratification, in asymptomatic patients, aged greater than 45 years, with a cluster of risk factors (RFs). METHODS AND RESULTS We studied 558 asymptomatic patients (235 males). RFs for atherosclerosis were assessed and the 10-year-risk was calculated according to the Italian risk score. Doppler ultrasound of carotid arteries identified the presence of IMT greater than 0.9 mm in 183 patients and ACP in 147 patients. One hundred and fifty-three patients developed cerebrovascular or cardiovascular (C…

Chronic pharmacological treatment in takotsubo cardiomyopathy.

Abstract Background Takotsubo cardiomyopathy is a disorder that has been appreciated only recently. In most of reported cases, this syndrome mimes an acute myocardial infarction. Till this moment no data are available from literature about the treatment in the acute phase of this disease. Aim of the study In our multicentric experience we have retrospectively looked at the benefits of a treatment with ACE-inhibitors, beta-blockers, Aspirin and calcium channels blockers, started until the early phases of the disease and continued for 30 days, in 36 patients affected by Takotsubo cardiomyopathy. We chose as endpoint of the study the efficacy of the used drug in improving left ventricular myoc…

ATHEROSCLEROSIS AND MARKERS OF INFLAMMATION IN PATIENTS WITH METABOLIC SYNDROME

RUOLO DELL’ECOCOLOR DOPPLER TISSUTALE NELLA VALUTAZIONE DELLA CARDIOTOSSICITÀ DA CHEMIOTERAPICI

Livelli plasmatici di fibrinogeno in soggetti con infarto miocardico acuto: relazione con gli eventi nel follow-up a 42 mesi

TDI and myocardial blush: good indicators of myocardial reperfusion

The TDI at follow-up confirms the reliability's value of Blush is predicting anatomical and functional recovery of the myocardium and microcirculation.

CORONARY ARTERY BYPASS GRAFT (CABG) PATENCY: ASSESSMENT WITH 40-ROW MULTISLICE COMPUTED TOMOGRAPHY (MSCT) CERSUS CORONARY ANGIOGRAPHY

IDENTIFICATION OF A HETEROZYGOUS COMPOUND INDIVIDUAL WITH AUTOSOMAL DOMINANT HYPERCHOLESTEROLEMIA HARBOURING IN THE LDL-R GENE AND IN THE PCSK9 GENE

TAKOTSUBO CARDIOMYOPATHY

Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome

ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population.MethodsThis was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secon…

Metabolic therapy in the treatment of chronic critical limbs ischemia: the L-propionyl-carnitine enhances the effects of PGE-1

Redox imbalances in ageing and metabolic alterations: Implications in cancer and cardiac diseases. An overview from the working group of cardiotoxicity and cardioprotection of the Italian society of cardiology (SIC)

Metabolic syndrome (MetS) is a well established risk factor for cardiovascular (CV) diseases. In addition, several studies indicate that MetS correlates with the increased risk of cancer in adults. The mechanisms linking MetS and cancer are not fully understood. Several risk factors involved in MetS are also cancer risk factors, such as the consumption of high calorie-food or high fat intake, low fibre intake, and sedentary lifestyle. Other common aspects of both cancer and MetS are oxidative stress and inflammation. In addition, some anticancer treatments can induce cardiotoxicity, including, for instance, left ventricular (LV) dysfunction and heart failure (HF), endothelial dysfunction an…

Role of cardiac dyssynchrony and resynchronization therapy in functional mitral regurgitation

Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR r…

Heart-type fatty acid binding protein is a sensitive biomarker for early AMI detection in troponin negative patients: a pilot study

Background: Early detecting AMI in individuals presenting to the ED with chest pain continues to be a challenge. cTn is the gold standard for AMI diagnosis but early presenters (&lt;1 hours from symptom onset) maybe cTn negative on admission. We analysed the diagnostic value of h-FABP and hs-TnI in patients presenting to ED with chest pain and no cTnI elevations. Methods: 28 AMI and 28 no-AMI individuals both presented to ED within one hour from pain onset were included. Blood donors were analysed for h-FABP cut-off identification. Among AMI patients, 55% were positive for h-FABP and 34.6% were positive for hs-TnI (p = .015), thus 21% were positive only for h-FABP. The diagnostic accuracy w…

Impact of anemia on long term prognosis of patients with STEMI treated with PCI and dual antiplatelet therapy

Anemia on admission and Hb drop % are associated with worse long term prognosis and they are independent risk factor for adverse events in patient with STEMI treated with PCI and dual antiplatelet therapy.

[Metabolic syndrome in children and in adults: is it an autonomous nosological entity?].

The term metabolic syndrome defines a cluster of risk factors for cardiovascular diseases and diabetes. This syndrome is very frequent in general population. However, despite the efforts to define the diagnostic criteria, nowadays its clinical utility is object of a lively debate.

Influence of climatic variables on acute myocardial infarction hospital admissions

BACKGROUND: Seasonal peaks in acute myocardial infarction (AMI) incidence have been widely reported. Weather has been postulated to be one of the elements at the basis of this association. The aim of our study was to determine the influence of seasonal variations and weather on AMI hospital admissions. METHODS: We correlated the daily number of AMI cases admitted to a western Sicily hospital over twelve years and weather conditions on a day-to-day basis. Information on temperature, humidity, wind force and direction, precipitation, sunny hours and atmospheric pressure was obtained from the local Birgi Air Force base. A total of 3918 consecutive patients were admitted with AMI over the perio…

Biomarkers in heart failure

Nowadays, heart failure (HF) has an increasing prevalence, particularly in the elderly, and is becoming a clinical problem of epidemic proportion in terms of morbidity and mortality. Developing biological markers, that can aid in the diagnosis of HF and in the differentiation of congestive heart failure (CHF) from other causes of dyspnoea, will reduce the cost of health care. However, an ideal biomarker has not yet been identified. Potential markers of HF include neuro-hormonal mediators, markers of myocyte injury, and indicators of systemic inflammation. Among these, the BNP and NT-pro-BNP are the most widely studied and appear to be useful in patients with dyspnoea of unknown aetiology, a…

Tissue Doppler analysis: does the false negative exist?

An unusual cause of cerebral cardioembolism in a 33-year-old man due to ventricular noncompaction

N.A.

Statin therapy in patients with aortic stenosis after the ASTRONOMER trial: is there still any space?

UTILITA’ DELLA ANGIOGRAFIA CORONARICA ESEGUITA MEDIANTE TOMOGRAFIA COMPUTERIZZATA MULTIDETETTORE NEL CONTROLLO DELLA PERVIETA’ DEL BYPASS AORTO-CORONARICO

INFLUENCE OF CAROTID AND PERIPHERAL ATHEROSCLEROSIS ON THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

Heart rate turbulence for guiding electric therapy in patients with cardiac failure

It is well-known that a reduction of the cardiac frequency variability, measurable with the Heart Rate Variability (HRV) system, is an indirect expression of the sympathetic-autonomic tone. Another index, Heart Rate Turbulence (HRT), has been recently suggested as a possible unit of measurement for the sympathetic-autonomic tone: this system allows to estimate the baro-reflex response of the carotid arteries to an early ventricular extra-systole by analysing heart rate variations induced by a premature beat.In our research we have analyzed this phenomenon in patients affected by moderate or severe cardiac failure. In particular, we divided 110 patients into two arms: subjects with or withou…

Early diagnosis, clinical management, and follow-up of cardiovascular events with ponatinib

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI an…

Impatto dell'anemia sulla prognosi dei pazienti sottoposti a PCI

A rare case of Prinzmetal angina 3 days after coronary artery stenting with a second-generation drug-eluting stent

Non previsto.

Contractile Reserve in Heart Failure with Preserved Ejection Fraction.

Background: Diastolic stress echocardiography (SE) is useful for confirming the diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) when it is uncertain. The aim of this study was to assess the value of new echocardiographic parameters during diastolic SE in patients with dyspnea and suspected HFpEF. Methods: Sixty-two patients with exertional dyspnea and inconclusive rest echocardiography for a diagnosis of HFpEF were enrolled. Exercise SE was performed in all patients. Contractile reserve (LVCR) was assessed by measuring: 1. changes in the left ventricular ejection fraction (LVEF) between rest and peak stress; 2. stress-to-rest ratio of force (force was de…

Letter: effect of HCV eradication on cardiovascular disease-Authors' reply

no abstract available

Pressure–volume relationship by pharmacological stress cardiovascular magnetic resonance

Abstract Background. The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR.Methods. One-hundred consecutive patients (24 females, 63.76±10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson’s method. Results. The ΔESPVR index showed a good inte…

Inefficiency of renin-angiotensin inhibitors to prevent the Atrial Fibrillation in patient with normal heart

Chronic stress and early recurrence of takotsubo cardiomyopathy: A clinical case

Takotsubo cardiomyopathy (TC) is characterized by transient systolic dysfunction of the apical and middle segments of the left ventricle, accompanied by electrocardiographic abnormalities and mild elevation of cardiac biomarker levels in the absence of obstructive coronary artery disease. The following case is of a woman suffering from chronic emotional stress with a very early recurrence. An acute trigger event was not detectable in both cases. It is possible to suppose that, in predisposed subjects, chronic stress by increasing sympathetic activity may be considered not only a trigger for TC, but also a negative prognostic factor for early recurrence.

Right lobar pulmonitis: a possible cause of lone atrial fibrillation

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Abstract Aims This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors. Methods and results In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack o…

Integrated non-invasive approach to atherosclerosis with cardiac CT and carotid ultrasound in patients with suspected coronary artery disease

The aim of the study was to compare the atherosclerotic disease in the coronary and carotid arteries in patients who underwent non-invasive imaging for suspected stable coronary artery disease (CAD). 107 patients (64 men, age 59 ± 12) with atypical chest pain underwent cardiac CT (CCT) and carotid ultrasound (US) on the same day. Severity (obstructive or not-obstructive disease), location, shape, and composition of atherosclerotic plaques in the two districts were evaluated. Patients presented normal coronary arteries in 36 % (n = 38), not-obstructive CAD in 36 % (n = 39), and obstructive CAD in 28 % (n = 30), while had normal carotid arteries in 53 % (n = 57), not-obstructive disease in 44…

Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review

Background Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. Objectives In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so fa…

Acidi grassi ematici e infarto miocardico

Impact of insulin resistance on cardiac and vascular function.

Background Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries. Methods We studied 32 patients (62.06 ± 11.19 years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria …

Echocardiography to estimate high filling pressure in patients with heart failure and reduced ejection fraction

Aims: Echocardiographic assessment of left ventricular filling pressures is performed using a multi-parametric algorithm. Unselected sample of patients with heart failure with reduced ejection fraction (HFrEF) patients may demonstrate an indeterminate status of diastolic indices making interpretation challenging. We sought to test improvement in the diagnostic accuracy of standard and strain echocardiography of the left ventricle and left atrium (LA) to estimate a pulmonary capillary wedge pressure (PCWP) &gt; 15 mmHg in patients with HFrEF. Methods and results: Out of 82 consecutive patients, 78 patients were included in the final analysis and right heat catheterization, and echocardiogram…

Asymptomatic carotid lesions and aging: role of hypertension and other traditional and emerging risk factors

ASYMPTOMATIC CAROTID LESIONS AND AGING: ROLE OF HYPERTENSION AND OTHER TRADITIONAL AND EMERGING RISK FACTORS BACKGROUND: We evaluated the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF). METHODS: There were 631 subjects (313 male and 318 female) aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. The following measurements were used: anamnesis, physical examination, height and sitting blood pressure. Biochemistry variables were also considered: total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, high sensitive C-reactive protein, IgG…

A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology.

The US National Cancer Institute estimates that cardiotoxicity (CTX) from target therapy refers mostly to four groups of drugs: epidermal growth factor receptor 2 inhibitors, angiogenic inhibitors, directed Abelson murine leukemia viral oncogene homolog inhibitors, and proteasome inhibitors. The main cardiotoxic side-effects related to antiepidermal growth factor receptor 2 therapy are left ventricular systolic dysfunction and heart failure. Angiogenesis inhibitors are associated with hypertension, left ventricular dysfunction/heart failure, myocardial ischemia, QT prolongation, and thrombosis. Moreover, other agents may be related to CTX induced by treatment. In this study, we review the g…

Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: Role of echocardiography

The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the last several years. The use of drugs for the treatment of cancers increased, and new molecules and protocols were developed to improve outcomes in these patients. Although, these novel approaches also produced a progressive increase in side effects, particularly myocardial dysfunction. Imaging of the heart was highly accurate in the early diagnosis of cancer therapeutics related-cardiac dysfunction. Echocardiography is the first-line method to assess ventricular function alterations, and it is required to satisfy the need for an early, easy and accurate diagnosis to stratify the risk of heart fai…

Effects of drug therapy on cardiac arrhythmias and ischemia in hypertensives with LVH.

Left ventricular hypertrophy (LVH) in hypertensive subjects is associated with an increased prevalence of ventricular arrhythmias. To evaluate the effect of antihypertensive treatment on cardiac arrhythmias (CA) and transient episodes of myocardial ischemia (TEMI), we studied 46 hypertensive patients with LVH, divided into four groups randomly treated with enalapril, hydrochlorothiazide (HCTZ), atenolol, or verapamil (SR-V) for 6 months. Office blood pressure and office heart rate values were recorded, in basal conditions, after 1 and 6 months of treatment, and all patients underwent echocardiography, electrocardiographic Holter monitoring, and stress testing. All drugs significantly lowere…

SIGNIFICATO PROGNOSTICO DELL’MMP-9 IN PAZIENTI CON SINDROME CORONARICA ACUTA

COMPORTAMENTO DEI PAZIENTI AD ALTO RISCHIO DI SVILUPPARE NEFROPATIA INDOTTA DA MEZZO DI CONTRASTO DOPO CORONAROGRAFIA/ANGIOPLASTICA PERCUTANEA

Sex differences in anthracycline-induced cardiotoxicity: the benefits of estrogens

Anthracyclines are the cornerstone for many oncologic treatments, but their cardiotoxicity has been recognized for several decades. Female subjects, especially before puberty and adolescence, or after menopause, seem to be more at increased risk, with the prognostic impact of this sex issue being less consistent compared to other cardiovascular risk factors. Several studies imply that sex differences could depend on the lack of the protective effect of sex hormones against the anthracycline-initiated damage in cardiac cells, or on differential mitochondria-related oxidative gene expression. This is also reflected by the results obtained with different diagnostic methods, such as cardiovascu…

A recommended practical approach to the management of anthracycline-based chemotherapy cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology.

Anthracyclines are the mainstay of treatment of a variety of haematological malignancies and solid tumours. Unfortunately, the clinical use of these drugs is limited by cumulative, dose-related cardiotoxicity which may ultimately lead to a severe and irreversible form of cardiomyopathy. Thus, there is an increasing need for close cooperation among cardiologists, oncologists and haemato-oncologists. As anthracyclines save lives, the logical goal of this cooperation, besides preventing or mitigating cardiotoxicity, is to promote an acceptable balance between the potential cardiac side effects and the vital benefit of anticancer treatment. This manuscript, which is specifically addressed to th…

Use of direct oral anticoagulants in very elderly patients: a case report of apixaban in an ultracentenary patient.

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Electrocardiographic abnormalities, preclinical carotid atherosclerosis and cardiovascular risk in an apparently healthy real-world population. Data from the "No Stroke, No Infarction" project of the Rotary International - district 2110 (Sicily and Malta)

Background: Cardiovascular diseases (CVDs) represent important causes of morbidity and mortality. Our study aimed to evaluate cardiovascular risk using the EuroSCORE, ECG and carotid ultrasound for prevention purpose in a population of companions aged 50-70 years, asymptomatic and without CVD. Methods: History of CVD, risk factors (RF), ECG and carotid ultrasound were evaluated. Intima-media thickness (IMT) was defined as wall thickness &gt;0.9 mm, while focal thickening ≥1.5 mm protruding into the lumen as asymptomatic carotid plaque (ACP). Results: Totally, 1860 subjects were screened. 393 (21.1%) had no RF, 780 (42%) hypertension, 571 (30.7%) hypercholesterolemia, 557 (29.9%) diabetes, 4…

Alteration of Heart Rate Variability as an Early Predictor of Cardiovascular Events: A Look at Current Evidence

Evidence suggests an association between autonomic nervous system (ANS) function and atrial fibrillation (AF) development. We sought to examine the association of baseline resting heart rate (RHR) and short-term heart rate variability (HRV) as surrogates of (ANS) with incident AF in individuals without prior cardiovascular disease. A total of 6261 participants of the Multi Ethnic Study of Atherosclerosis (MESA) who were free of AF and diagnosed cardiovascular disease were enrolled. Three standard 10-second, 12-lead electrocardiograms were used to measure RHR, the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences in RR intervals (RMSSD…

MULTIFOCAL ATHEROSCLEROSIS INFLUENCE THE OUTCOME OF PATIENTS UNDERWENT TO PRIMARY PTCA

Left ventricular hypertrophy or storage disease? the incremental value of speckle tracking strain bull's-eye

Left ventricular hypertrophy (LVH) develops in response to a variety of physical, genetic, and biochemical stimuli and represents the early stage of ventricular remodeling. In patients with LVH, subclinical left ventricular (LV) dysfunction despite normal ejection fraction (EF) may be present before the onset of symptoms, which portends a dismal prognosis. Strain measurement with two-dimensional speckle tracking echocardiography (STE) represents a highly reproducible and accurate alternative to LVEF determination. The present review focuses on current available evidence that supports the incremental value of STE in the diagnostic and prognostic workup of LVH. When assessing the components o…

Impact of Metabolic Syndrome on Coronary Microvascular Dysfunction: A Single Center Experience

Coronary microvascular dysfunction (CMD) represents a widespread condition and a prevalent cause of ischemic heart disease. Total TIMI frame count (TTFC) can be a good indicator of CMD in different populations. The aim of our study was to evaluate the incidence of CMD in different populations such as METS patients compared with diabetic and hypertensive patients. The study was carried out on patients with chest pain and/or positive stress test and angiographically undamaged coronary arteries. Our CMD population was divided into three subgroups; patients with arterial hypertension, patients with type II diabetes mellitus and patients with metabolic syndrome. TIMI Frame Count (TFC) and Myocar…

Association of elevated fibrinogen and C-reactive protein levels with carotid lesions in patients with newly diagnosed hypertension or type II diabetes.

BACKGROUND: Inflammation may be important for accelerated progression of atherosclerosis in patients with hypertension or diabetes, but few studies included subjects with early stages of atherosclerosis such as those with asymptomatic carotid lesions. METHODS: We studied 100 patients with newly diagnosed hypertension and another 100 patients with newly diagnosed type II diabetes to evaluate in such groups the association of two markers of inflammation, fibrinogen and C-reactive protein (CRP), with carotid atherosclerosis, beyond traditional cardiovascular risk factors (e.g., older age, male gender, obesity, smoking, family history of CAD, dyslipidemia). RESULTS: We found positive correlatio…

Cellular and molecular basis of the imbalance between vascular damage and repair in ageing and age-related diseases: As biomarkers and targets for new treatments

Preclinical and clinical studies suggest that specific subsets of cells isolated from the peripheral blood, play an essential role in the imbalance of damage and repair during age-associated diseases, such as metabolic syndrome, diabetes, atherosclerosis, neurodegenerative diseases, osteoporosis and cancer. Endogenous regeneration of the vessel wall involves cells of the vascular wall, inflammatory cells, circulating precursors, and mature endothelial cells, which are capable to restore the endothelium in a concerted interaction. Early detection of such imbalances with specific biomarkers may reduce age-associated diseases and subsequent cardiovascular events. Likewise, new strategies have …

Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography. This condition is present in about 5% to 25% of patients presenting with acute coronary syndromes. MINOCA is a working diagnosis. Current guidelines and consensus recommend identification of underlying causes of MINOCA in order to optimize treatment, improve prognosis, and promote prevention of recurrent myocardial infarction. An accurate evaluation of patient history, symptoms and use of invasive and non-invasive imaging should lead to identification of epicardial or microvascular causes of MINOCA an…

Reply to letter by Parodi et al. regarding article: Revised clinical diagnostic criteria for Takotsubo syndrome: The Takotsubo Italian Network proposal.

Utility of Multi-Slice Computed Tomography Coronary Angiography to Evaluate Coronary Artery Bypass Graft Patency

Subclinical atherosclerosis: independent predictor of cardiovascular events in a 20-years follow up of patients with or without metabolic syndrome

Purpose: To evaluate the influence of carotid atherosclerosis and metabolic syndrome (MetS) on the prediction of cardiovascular events during a 20-years follow-up. Methods: We studied a population of 529 asymptomatic patients, divided into 2 groups according to the results of the carotid ultrasound evaluation: one without atherosclerotic lesions (198 patients) and a second one with an increased carotid IMT or asymptomatic carotid plaque (331 patients). In each of these groups, we identified two subgroups of subjects with and without MetS. Cardiovascular endpoints were investigated in a 20-years follow-up: acute myocardial infarction, angina, transient ischemic attack, ischemic stroke, abdom…

Stress Echocardiography and Strain in Aortic Regurgitation (SESAR protocol): Left ventricular contractile reserve and myocardial work in asymptomatic patients with severe aortic regurgitation.

Objectives: To analyze left ventricular (LV) myocardial deformation and contractile reserve (CR) in asymptomatic patients with severe aortic regurgitation (AR) at rest and during exercise, and their correlation with functional capacity. Background: The natural history of chronic AR is characterized by a prolonged silent phase before onset of symptoms and overt LV dysfunction. Assessment of LV systolic function and contractile reserve has an important role in the decision-making of AR asymptomatic patients. Methods: Standard echo, lung ultrasound, and LV 2D speckle tracking strain were performed at rest and during exercise in asymptomatic patients with severe AR and in age- and sex-comparabl…

Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction

Aim: To evaluate the long-term outcome of patients with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ 35%) at presentation. Methods and results: The study population included 326 patients (mean age 69.5 ± 10.7 years, 28 male) with TTS enrolled in the Takotsubo Italian Network, divided into two groups according to LVEF (≤ 35%, n = 131; &gt; 35%, n = 195), as assessed by transthoracic echocardiography at hospital admission. In-hospital events were recorded in both groups. At long-term follow-up (median 26.5 months, interquartile range 18–33), composite major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, heart failure, and …

Gender differences in takotsubo syndrome

Background: Male sex in takotsubo syndrome (TTS) has a low incidence and it is still not well characterized. Objectives: The aim of the present study is to describe TTS sex differences. Methods: TTS patients enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry were analyzed. Comparisons between sexes were performed within the overall cohort and using an adjusted analysis with 1:1 propensity score matching for age, comorbidities, and kind of trigger. Results: In total, 286 (11%) of 2,492 TTS patients were men. Male patients were younger (age 69 ± 13 years vs 71 ± 11 years; P = 0.005), with higher prevalence of comorbid conditions (diabetes mellitus 25% …

MULTIFOCAL ATHEROSCLEROSIS INFLUENCE THE UTCOME OF PATIENTS UNDERWENT TO PRIMARY PTCA

ACCURATEZZA DIAGNOSTICA DELLA TC 40 STRATI IN PAZIENTI CON DOLORE TORACICO

[Cardiovascular health in Asian immigrants to Italy: risk factors, pathogenesis and pharmacological treatment].

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the western world has occurred due to several factors, such as economic crisis, political instabilities, persecutions and wars. It is well established that South Asians (SA) have a higher prevalence of coronary artery disease (CAD) and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both SA residing in their birth country and in those residing abroad, but it may also be due to the new spatial environment in which they live. We have found a higher prevalence of traditional cardiovascular risk fa…

Role of the HIPPO pathway as potential key player in the cross talk between oncology and cardiology.

The HIPPO pathway (HP) is a highly conserved kinase cascade that affects organ size by regulating proliferation, cell survival and differentiation. Discovered in Drosophila melanogaster to early 2000, it immediately opened wide frontiers in the field of research. Over the last years the field of knowledge on HP is quickly expanding and it is thought will offer many answers on complex pathologies. Here, we summarized the results of several studies that have investigated HP signaling both in oncology than in cardiology field, with an overview on future perspectives in cardiology research.

Cardiotoxicity mechanisms of the combination of BRAF-inhibitors and MEK-inhibitors.

Many new drugs have appeared in last years in the oncological treatment scenario. Each drug carries an important set of adverse events, not less, cardiovascular adverse events. This aspect is even more important considering the increasing use of combination therapies with two drugs, or three drugs as in some ongoing clinical trials. Besides it represents a growing problem for Cardiologists, that face it in every day clinical practice and that will face it probably more and more in the coming years. This work reviews the mechanism of action of BRAF-inhibitors and MEK-inhibitors used together, the pathophysiological mechanisms that lead to cardiovascular toxicity. Particularly, it focuses on …

PREVALENZA DELLE LESIONI CAROTIDEE IN UNA POPOLAZIONE MEDITERRANEA DI IPERTESI

Peripheral atherosclerosis is associated with the occurrence of restenosis after percutaneous coronary intervention

INTRODUCTION: The aim of our study was to evaluate, in patients with proven coronary artery disease (CAD) and treated with elective percutaneous coronary intervention (PCI), whether the coexistence of asymptomatic carotid and femoral atherosclerotic lesions would provide prognostic information in terms of occurrence of restenosis. METHODS: We studied 104 patients with CAD (M/F=77/27), mean age 60.5+/-9 years. All patients were treated with elective PCI. After PCI the suspicion of restenosis was confirmed by coronary angiography. All patients underwent ultrasound duplex scan of carotid and femoral-popliteal-tibial axis to detect atherosclerotic lesions. According to ultrasound results, patie…

NOVEL NONSENSE MUTATION IN THE CETP GENE IN ITALIAN HYPERALPHALIPOPROTEINEMIC SUBJECTS

PREVALENZA DELLA SINDROME METABOLICA IN PAZIENTI CON CARDIOPATIA ICSHEMICA CRONICA Ital. Heart J. 2005; 6 (Suppl. 8): 170S

Giant unruptured circumflex coronary artery aneurysms presenting as acute coronary syndrome

STUDIO ADVANCE: QUALI RISPOSTE PER LA NOSTRA PRATICA CLINICA?

Dual guidewire balloon antegrade fenestration and re‐entrytechnique for coronary chronic total occlusions percutaneouscoronary interventions

Objectives:To describe the experience of coronary chronic total occlusions (CTOs)percutaneous coronary interventions (PCI) using antegrade fenestration and re‐entry(AFR) technique with a dedicated dual guidewire balloon (DGB).Background:Antegrade dissection and re‐entry (ADR) techniques has beenemphasized in recent worldwide CTO consensus documents. We investigated thefeasibility and safety of DGB as a dedicated device to perform guidewire‐based AFR.Methods and Results:Fourteen consecutive patients with complex CTO (J‐CTOscore: 3.1 ± 0.9) underwent DGB‐AFR in the years 2020–2021. DGB‐AFR consists inadvancing the DGB over a guidewire that reached the vessel distal to the CTO in anextra plaqu…

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

CAROTID AND PERIPHERAL ATHEROSCLEROSIS IN PATIENTS UNDERWENT TO PRIMARY PCI AND OUTCOME ASSOCIATED WITH MULTIFOCAL ATHEROSCLEROSIS

INFLUENZA DELL’ATEROSCLEROSI MULTIFOCALE NELL’OUTCOME DI PAZIENTI CHE HANNO EFFETTUATO PTCA PRIMARIA

Association of carotid atherosclerosis with coronary artery disease: comparison between carotid ultrasonography and coronary angiography in patients with chest pain].

Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography.

Cardiac surgical techniques and circulatory supports have strongly evolved in the last years. Right ventricular (RV) function during the post-operatory period is still subject of study, although its relevant prognostic impact has been variably described in different papers. RV post-surgical dysfunction’s underlying mechanisms are still not clear and include a different hypothesis. Echocardiography, with both first and second level parameters, offers the possibility to accurately analyze the right ventricle and optimize these patients’ management. This paper describes the pathophysiology of the right ventricle, the most used echo indexes of RV function, whether they alter after surgery, the …

COLESTEROLO HDL E PROGRESSIONE DELLA MALATTIA ATEROSCLEROTICA

Usefulness of Stress Echocardiography in the Management of Patients Treated with Anticancer Drugs.

In recent years, the survival of patients with cancer has improved thanks to advances in antineoplastic therapeutic protocols. This has led to an increasing burden of cardiovascular complications related to cancer treatment. Therefore, a new branch of cardiology has been created, ``cardio-oncology,'' with the aims of preventing cardiovascular complications related to antineoplastic treatment, achieving early diagnosis and treatment of any complications, and allowing completion of the expected antineoplastic treatment. Stress echocardiography has a pivotal role in achieving a timely diagnosis of coronary artery disease and thus is the best management approach in this clinical setting. Athero…

Growth hormone deficiency and increased coronary risk.

RUOLO DELLA SINDROME METABOLICA NELLA FIBRILLAZIONE ATRIALE

268Prognostic value of dipyridamole stress CMR in patients with known or suspected coronary artery disease: a long term follow-up study

METABOLIC SYNDROME IN CHILDHOOD AND CARDIOVASCULAR RISK

Prediction of vascular events in subjects with subclinical atherosclerosis and the metabolic syndrome: the role of markers of inflammation.

Mediterranean diet impact on cardiovascular diseases: a narrative review

Cardiovascular disease (CVD) accounts for more than 17 million deaths per year worldwide. It has been estimated that the influence of lifestyle on CVD mortality amounts to 13.7% for smoking, 13.2% for poor diet, and 12% for inactive lifestyle. These results deeply impact both the healthy status of individuals and their skills in working. The impact of CVD on productivity loss accounts for the 24% in total costs for CVD management. Mediterranean diet (MedD) can positively impact on natural history of CVD. It is characterized by a relatively high consumption of inexpensive and genuine food such as cereals, vegetables, legumes, nuts, fish, fresh fruits, and olive oil as the principal source of…

In-hospital complications of acute myocardial infarction in hypertensive subjects

Recent studies have shown a worse in-hospital outcome in hypertensive than in normotensive patients with acute myocardial infarction (AMI), which has been attributed to more frequent complications. The aim of this study was to investigate clinical patterns, risk factors, and in-hospital complications in hypertensive and normotensive patients with AMI.Of 4994 consecutive patients with AMI admitted to the intensive care unit, hypertensive patients with first infarction (n = 915; mean age 68.8 +/- 11.4 years) and 915 gender- and age-matched normotensive subjects were retrospectively studied.In the univariate analysis, hypertensive subjects presented more frequently non-Q-wave infarction and ST…

Management of a patient with multiple device replacements and extractions: When the leadless pacemaker is a viable solution

Leadless pacemaker (LPs) is a safe device and the implantation rates of this device is increasing. The device extraction and replacement are today a challenging procedures especially in case of infections, fragile and older patients or in unfavorable venous anatomy; LPs can be a valid alternative strategy in these cases. We report a case of management of a patient with multiple previous device replacements and extractions, with malfunction of transvenous pacemaker and with a fibrous membrane between the walls of the ventricular lead and the superior vena cava (SVC), who underwent a successful LP implantation.

An update on the role of markers of inflammation in atherosclerosis

In recent years, several studies have used the measurement of carotid intima-media thickness (IMT) as a marker of early atherosclerosis: IMT has been shown to correlate significantly with the presence of coronary artery disease (CAD) and to predict fatal and not fatal cerebro- and cardio-vascular events. These findings highlight the importance of recognizing and managing early stages of atherosclerosis for effective cardiovascular prevention. Beyond traditional established cardiovascular risk factors, inflammation has been shown to be crucial throughout atherosclerosis from endothelial dysfunction to plaque rupture and thrombosis. Several studies have shown the existence of a strong relatio…

Incidence and Clinical Impact of Recurrent Takotsubo Syndrome: Results From the GEIST Registry

Background Current literature only reports variable information from single‐center studies on the recurrence rate, the complications, and the outcome of patients with Takotsubo syndrome ( TTS) experiencing recurrent TTS . Therefore, a detailed description of clinical characteristics, predictors, and the prognostic impact of patients with TTS and recurrences in a multicenter registry is needed. Methods and Results We analyzed 749 patients with TTS from 9 European centers being part of the international, multicenter GEIST (German Italian Stress Cardiomyopathy) Registry. Patients were divided into the recurrence group and the nonrecurrence group. The recurrence rate at a median follow‐up of 8…

Fetuin-A is Associated to Serum Calcium and AHSG T256S Genotype but Not to Coronary Artery Calcification

Vascular calcification has been recently associated to an increased cardiovascular risk and mortality. In few studies, Fetuin-A showed an association to coronary artery calcification (CAC), although the physiopathological mechanism underlying this association has not been fully established yet. Seventy-four patients with one or more cardiovascular risk factor and asymptomatic for coronary vasculopathy were included in the study. CAC was evaluated by Agatston score. Serum Fetuin-A levels were determined by ELISA. Molecular analysis of AHSG T256S gene variant (rs4918) was performed by PCR-RFLP. Serum Fetuin-A was correlated to serum calcium (r = 0,321; P = 0,018), but not to serum phosphorous…

Three-dimensional transesophageal echocardiography in the guide of cardiac mass biopsy

Cardiac tumors are rare. Cardiovascular imaging is more important in the differential diagnosis of cardiac masses but no current noninvasive diagnostic tool has the ability to absolutely diagnose cardiac tumors. In effect cardiac biopsy remains the gold standard in the differential diagnosis. In our case we show the advantages of three-dimensional (3D) transesophageal echocardiography as a guide for cardiac biopsy. We believe that 3D TEE is ready to be used in the guide of cardiac mass biopsy. Once interventionalists become confident with 3D imaging, this technique should be used routinely during these procedures.

Segmental dyskinesia in Wolff-Parkinson-White syndrome: A possible cause of dilatative cardiomyopathy.

Wolff-Parkinson-White (WPW) is a syndrome characterized by the presence of an accessory pathway that skipping A-V node may lead the electrical stimulus from the atrium directly to the ventricle. Some studies reported the finding of myocardial dyskinesia in the segments precociously activated by the accessory pathway, at echocardiogram and at nuclear cardiac study. Soria et al. reported, in 1985, an increased incidence of dilative cardiomyopathy in patients with WPW. The pathophysiological pathway that leads to ventricular dilation may be due to the increase of end-diastolic pressure secondary to a tachycardia-induced cardiomyopathy. Tachycardia-induced cardiomyopathy is usually secondary to…

P776 Stress ecocardiography and speckle tracking analysis in patients with heart failure and preserved ejection fraction

Abstract BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is characterized by heart failure symptoms despite preserved LV systolic function together with at least one among left ventricle hypertrophy/left atrial enlargement plus diastolic dysfunction (DD) and increased brain natriuretic peptide levels. Rest echocardiography could still be normal despite patients experience HF symptoms. Speckle tracking analysis (STE) analyzes myocardial deformation and is able to identify subtle left ventricular dysfunction. PURPOSE to analyze the added value of stress echocardiography to improve diagnostic accuracy in patients with normal ejection fraction and unexplained dyspnoea by evalu…

Speckle tracking analysis in intensive care unit: A toy or a tool?

The use of conventional echocardiography in the intensive care unit (ICU) is today established to assess left and right ventricular systolic function, for preload determination and procedural guidance. Next step in ICU echocardiography could be the use of novel ultrasound techniques such as strain echocardiography to assist in the management of patients with acute coronary syndrome, heart failure, or pulmonary embolism. This review has gathered the available evidence supporting the incremental value of strain in the diagnostic workup of cardiac diseases treated in ICU.

LA TERAPIA MEDICA NELLA TASC II

CARDIOVASCULAR MAGNETIC RESONANCE IN CHILDREN WITH IDIOPATHIC MONOMORPHIC VENTRICULAR TACHYCARDIA OR COMPLEX VENTRICULAR EXTRASYSTOLES

FIBRILLAZIONE ATRIALE E DETERIORAMENTO COGNITIVO CEREBRALE

LOW EF: THE BEST MARKER OF POOR PROGNOSIS IN PATIENTS AFFECTED BY NON COMPACTION.

N.A.

PREVALENCE OF METABOLIC SYNDROME IN CHRONIC ISCHEMIC HEART DISEASE

PREVALENCE OF METABOLIC SYNDROME IN CHRONIC ISCHEMIC HEART DISEASE

Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy characterized by extracellular deposition of mis-folded proteins called amyloid. Cardiac complications of CA are several: heart failure, aortic valve stenosis, thromboembolism, conduction disorders, atrial fibrillation, and ventricular arrhythmias. Atrial dysfunction is common in CA patients. Several evidences suggest to anticoagulated patients with CA in atrial fibrillation independently from CHA2DS2VaSC score. Considering the high thromboembolic risk in CA patients, anticoagulant therapy should be considered also in CA patients in sinus rhythm, when the atria are enlarged and dysfunctional, and the bleeding risk is low. Unfortunat…

Climatic variables in Takotsubo cardiomyopathy: role of temperature

Background Recent studies documented a seasonal (summer) and circadian (morning) temporal distribution of takotsubo cardiomyopathy (TTC). Aim The aim of our study was to investigate whether there is a relationship among season, temperature and the occurrence of TTC. A second aim of our study was the comparison of climatic variables in Takotsubo cardiomyopathy versus acute myocardial infarction (AMI). Methods We enrolled consecutive patients with TTC in three Italian centres and, for comparison consecutive patients with AMI. The frequency of TTC and AMI patients according to month, season and quartiles of temperature (I quartile: 9.8–15-, II quartile: 15–19-, III quartile: 19–25- and IV quar…

Low levels of testosterone levels increase the risk of major cardiovascular events in a follow-up to 5 years

Materials and Methods. We evaluated a series of 802 patients with intermediate cardiovascular risk according to the Framingham Risk Score (FRS). The endothelial function through flow-mediated vasodilatation (FMD), the erectile function (EF), and the total serum testosterone levels were assessed. Patients were followed for up to 5 years and the prevalence and predictors of MACEs were evaluated. Results. The levels of serum testosterone are related with both endothelial function (FMD) (t=9,4080, 95% CI= 0,9318 to 1,4234, p<0,0001) and erectile function (FMD) (t=8,9584, 95% CI= 0,7642 to 1,1932, p<0,0001). Analysis of variance (ANOVA) of serum testosterone levels are related with the MACEs (F-…

RUOLO DELLA SINDROME METABOLICA NELLE SINDROMI CORONARICHE ACUTE

RISK FACTORS AND MULTIFOCAL ATHEROSCLEROSIS INFLUENCE THE RATE OF RESTENOSIS POST-PTCA

MYOCARDIAL ISCHEMIA IN THE HYPERTENSIVE PATIENT: THE ROLE OF CORONARY MICROCIRCULATION

What links BRAF to the heart function? new insights from the cardiotoxicity of BRAF inhibitors in cancer treatment

The RAS-related signalling cascade has a fundamental role in cell. It activates differentiation and survival. It is particularly important one of its molecules, B-RAF. B-RAF has been a central point for research, especially in melanoma. Indeed, it lacked effective therapeutic weapons since the early years of its study. Molecules targeting B-RAF have been developed. Nowadays, two classes of molecules are approved by FDA. Multi-target molecules, such as Sorafenib and Regorafenib, and selective molecules, such as Vemurafenib and Dabrafenib. Many other molecules are still under investigation. Most of them are studied in phase 1 trials. Clinical studies correlate B-RAF inhibitors and QT prolonga…

Catheter-based closure of a large atrial septal defect with inferior rim deficiency using pulmonary vein slide-out assisted implantation technique: a case report

Abstract Background Transcatheter approach for large and complex atrial septal defects may represent a therapeutic challenge, particularly when the postero-inferior rim is deficient and floppy. Case summary Here, we describe a successful catheter-based closure of a large (&amp;gt;30 mm) secundum atrial septal defect associated with postero-inferior rim deficiency in a 35-year-old female with congestive heart failure using pulmonary vein slide-out assisted implantation technique. Discussion Inferior–posterior rim deficiency is a well-known risk factor for device instability or embolization. Transcatheter closure may represent a safe and effective alternative to the traditional surgical appro…

Cytokine Polymorphism in Takotsubo Cardiomyopathy

IMIN11. Cytokine Polymorphism in Takotsubo Cardiomyopathy P. Di Gangi1, L. Scola1, S. Giambanco1, M. Bova1, G. Santini1, L. Vaccarino1, C. R. Balistreri1, D. Lio1, P. Assennato1, S. Novo1, G. Novo1 1University of Palermo, Palermo, Italy Background: Takotsubo (TT) cardiomyopathy is characterised by an acute left ventricular dysfunction triggered by emotional or physical stresses. Clinically, the syndrome is characterised by acute symptoms mimicking acute infarction without relevant electrocardiographic and biochemical markers of myocardial damage changes. Stressful events inducing an excess catecholamine release and myocardial β-adrenergic receptors (β-AR) seem to play a major role in TT. Ac…

Lipid ratios as predictors of subclinical atherosclerosis

Iatrogenic pulmonary artery dissection in patient with ostium secundum interatrial septum defect

Pulmonary artery dissection is a rare and lethal condition. Few cases are reported in the literature, and most are derived from autopsies. In most cases, pulmonary artery dissection is a complication of chronic pulmonary hypertension leading to pulmonary artery aneurysm but there are other causes. We describe a case of iatrogenic pulmonary artery dissection in an elderly patient with ostium secundum defect. In particular, we describe the role of cardiac magnetic resonance in making this diagnosis and guiding future therapeutic decisions.

The percutaneous treatment of Patent Foramen Ovale, an effective and safe therapeutic choice

Introduction: The aim of our study is to evaluate the feasibility, safety and efficacy of the percutaneous closure of PFO (abnormal communication between the right and left atrium). Methods: Between July 2009 and October 2012 percutaneous closure was performed in 37 patients. The presence of PFO was diagnosed through the use of ultrasound techniques: transcranial doppler with contrast (cTCD), transthoracic echocardiography(TTE) and transesophageal echocardiography (TEE). Follow-up was composed consisted of a Holter ECG 7 days after the closure with a 24 hour heart rhythm monitoring, to evaluate eventual arrhythmia cases and programmed controls which included a TTE at 1-3 months, TTE+ cTCD a…

Two cases of tako-tsubo cardiomyophaty in Caucasians

Tako-tsubo cardiomyopathy is a recently described disease characterized by chest pain, transient left ventricular dysfunction and specific electrocardiographic changes. The disease takes its name from the typical left apical ballooning observed at left ventriculogram. Tako-tsubo cardiomyopathy was first described by Sato in 1990. Since then sporadic cases were reported by Japanese authors, and only a few European publications are available. We describe 2 cases of patients affected by this syndrome.

UTILITA’ DELL’ANGIOGRAFIA CORONARICA ESEGUITA MEDIANTE TOMOGRAFIA COMPUTERIZZATA MULTISTRATO NEL CONTROLLO DELLA PERVIETA’ DEL BYPASS AORTO-CORONARICO

The predictive role of C-reactive protein in patients with hypertension and subclinical atherosclerosis.

Recent guidelines published by the joint European Society of Hypertension/European Society of Cardiology have suggested the inclusion of C-reactive protein (CRP) in the standard assessment of cardiovascular risk in hypertensive patients, but little data is available on the role of CRP in patients with carotid lesions. We studied in 472 subjects, 236 with and 236 without hypertension, gender- and age-matched, with and without early stages of atherosclerosis (e.g. those with asymptomatic intima-media thickness >0.9 mm), the influence of all the other traditional cardiovascular risk factors (e.g. older age, male gender, obesity, diabetes, smoking habit, family history of coronary artery diseas…

LIVELLI PLASMATICI DI MCSF IN PAZIENTI CON SINDROMI CORONARICHE ACUTE.

Impact of anemia on long-term prognosis of patients with NSTEMI treated with PCI and dual antiplatelet therapy

Anemia; NSTEMI;

Marker of inlammation and prevalance of vascular disease in patients with metabolic syndrome

[Diagnosis of coronary microvascualar dysfunction in diabetic patients with cardiac syndrome X: comparison by current methods].

The study population included 208 patients with chest pain and uninjured coronary arteries that we split into two populations: diabetics (72 patients) and non-diabetics (136 patients). We split patients with chest pain and uninjured coronary arteries that had a myocardial scintigraphy into two populations: patients with positive scintigraphy and negative. We calculated, on angiographic images of each patient, stored on suitable digital supports, Timi Frame Count (TFC), Myocardial Blush Grade (MBG) and Total Myocardial Blush Score (TMBS) using the protocol described by Gibson and Yusuf. On the basis of Yusuf's experience we imagined a new index: the Total Timi Frame Count as the sum of the t…

Chemotherapy-induced cardiotoxicity: role of the tissue Doppler in the early diagnosis of left ventricular dysfunction.

Cardiotoxicity is a common complication of chemotherapy. The aim of this study was to assess the cardiotoxicity of anticancer drugs using tissue Doppler imaging. A prospective study was carried out using patients with early breast cancer (72 women, median age: 57 ± 12 year) and other inclusion and exclusion criteria. Inclusion criteria were treatment with epirubicin, trastuzumab, fluorouracil, cyclophosphamide, taxotere, and taxolo; left ventricular ejection fraction (LVEF) of more than 50%; and absence of important pathologies. Exclusion criteria were presence of known heart disease, earlier exposure to mediastinal irradiation, and earlier chemotherapy. On the basis of treatment, patients …

Atherosclerosis, inflammation and Chlamydia pneumoniae

Coronary heart disease is the single most common cause of illness and death in the developed world. Coronary atherosclerosis is by far the most frequent cause of ischemic heart disease, and plaque disruption with superimposed thrombosis is the main cause of the acute coronary syndromes of unstable angina, myocardial infarction, and sudden death. Atherosclerosis is the result of a complex interaction between blood elements, disturbed flow, and vessel wall abnormality, involving several pathological processes: inflammation, with increased endothelial permeability, endothelial activation, and monocyte recruitment; growth, with smooth muscle cell proliferation, migration, and matrix synthesis; …

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION?

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION? Aim. Atrial fibrillation (AF), in addition to macroembolic complications, may also produce multiple cerebral ischemic areas due to microembolic phenomena and transient hypoperfusion, eventually leading to a progressive cognitive impairment and even to acclaimed vascular dementia. The aim of this study was to evaluate the prevalence of cognitive impairment in patients with AF. The reported results concern data obtained at the moment of recruitment. Methods. The authors studied 42 patients with a history of non valvular AF (paroxysmal, persistent, recurrent or permanent) and 40 homogenous controls in sinus rhythm without pre…

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROME

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROME

Cardiac involvement in patients with cirrhosis: a focus on clinical features and diagnosis

Cirrhotic heart has been traditionally considered protected from cardiovascular disease, even if a large amount of literature has recently shown that patients affected by chronic liver disease are exposed to cardiovascular events, as well. Since the first recognition of cardiac involvement in cirrhosis, all published studies explain that decompensated cirrhotic patients suffer from haemodynamic changes, currently known as hyperdynamic syndrome, which finally lead to cirrhotic cardiomyopathy. This is defined by the presence of a subclinical systolic dysfunction unmasked under stress conditions, impaired diastolic function and electrophysiological abnormalities, in the absence of any known ca…

Neuromuscolar disorders and non compaction reply

Anomalous Origin and Course of the Right Coronary Artery

Coronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery.1–4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes …

Higher Incidence of Cancer Therapy-Related Cardiac Dysfunction in the COVID-19 Era: A Single Cardio-Oncology Center Experience

Aim: COVID-19 pandemic had a big impact on our life, it has revolutionized the practice of cardiology and the organization of hospital and outpatient activities. Thus the aim of our study was to assess the impact of the COVID-19 pandemic on the development of cancer therapy-related cardiac dysfunction (CTRCD). Methods and results: A single center retrospective study was carried out evaluating 96 cancer patients treated with anthracyclines and admitted to our Cardio-Oncology unit from June to August 2019 and 60 patients from June to August 2021. The incidence of CTRCD was assessed performing an echocardiogram at the time of the enrollment. We found a significantly higher incidence of CTRCD i…

Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Abstract Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P &amp;lt; 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P …

Selective pacing sites

The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All t…

PERIPHERAL ATEROSCLEROSIS AND RESTENOSIS AFTER PCI

L'ecocardiografia speckle tracking: Roadmap per la misurazione e l'utilizzo clinico

Speckle tracking echocardiography (STE) has recently emerged as a quantitative technique to accurately estimate myocardial function. By the analysis of the motion of speckles in the two-dimensional ultrasonic image, this technique allows a non-Doppler angle-independent objective analysis of myocardial deformation, with the possibility to quantify thickening, shortening and rotation dynamics of cardiac function. Since this technique does not require Doppler imaging, the analysis is relatively angle-independent and is marginally affected by cardiac in-plane motion artifacts. Data regarding feasibility, reproducibility and diagnostic accuracy appear to be optimal in several clinical contexts. …

An update on the conquests and perspectives of cardio-oncology in the field of tumor angiogenesis-targeting TKI-based therapy.

Introduction: The angiogenesis mechanism is considered a crucial point in neoplastic development. A growing number of multi-targeted tyrosine kinase inhibitors (TKI) has been developed and approved for cancer treatment during the last few years. Cardiac side effects still remain an issue to manage nowadays. These drugs mechanisms and toxicities have already been discussed, hence the authors will report updates on these already available drugs. Area covered: This manuscript provides an updated review on the new mechanisms involved in angiogenesis and cardiotoxicity that are TKI-related. Here is reported an overview of the already available and the most recent TKIs under investigation in the …

Angiographic Evaluation of Coronary Microvascular Dysfunction in Patients with Heart Failure and Preserved Ejection Fraction

Background The aim of this study was to evaluate myocardial perfusion and coronary blood flow through validated angiography indices to assess whether there is greater MVD in patients with microvascular angina and HFPEF compared to those who do not have. Methods Our study was performed on a population of 286 patients with stable angina that underwent coronary angiography and echocardiography. They showed epicardial coronary arteries free from stenosis. We divided the sample into two categories: patients with HFPEF and those without. We calculated indices for each patient based on angiographic images, including TFC, MBG, and TMBS. Results Our sample compared two groups: HFPEF (n = 155) and no…

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients.

Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kan…

Clinical outcomes of aortic valve repair in asymptomatic patients with chronic severe aortic valve regurgitation.

Early subclinical ventricular dysfunction in patients with insulin resistance

AIMS: The aim of our study was to evaluate the relationship between insulin resistance and the detection of precocious echocardiographic signs of heart failure in patients with cardiovascular risk factors. METHODS: We enrolled 34 consecutive patients with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, and laboratory tests. Exclusion criteria were diabetes (fasting glucose greater than 126 mg/dl or treatment with insulin or oral hypoglycemic agents), coronary artery disease, creatinine above 1.5 mg/dl, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%, atrial fibrillation, or other severe arrhythmia. The presence of…

Real-world use of ticagrelor and prasugrel in patients with NSTEMI undergoing percutaneous coronary intervention.

Usefulness of longitudinal systolic strain and delayed enhancement cardiac magnetic resonance in depicting risk of supraventricular arrythmias in patients with acute myocarditis and preserved left ventricular function

Background: Myocarditis have variable clinical presentation, evolution and prognosis. Aim of our study was to evaluate the value of speckle tracking echocardiography and cardiac magnetic resonance (CMR) in the short-term prediction of supraventricular arrhythmias (SVA) in patients with acute myocarditis. Methods: Seventy patients (mean age 31±14 years old) with acute myocarditis and preserved left ventricular ejection fraction (LVEF) were enrolled. Longitudinal systolic strain (LS) of the left ventricle (LV), mechanical dispersion (MD) and CMR with quantitative measurement of delayed enhancement (DE) were performed in a subset of 43 patients. Logistic regression and ROC analysis were used t…

Long-term parameters of heart rate variability in patients with insulin-resistance.

Heart rate variability (HRV) is defined as the oscillation in both the interval between consecutive heartbeats (considered RR intervals) and consecutives measures of instantaneous heart rates.1 HRV measures the cardiac autonomic function noninvasively1,2 and its reduction is an independent risk factor for cardiovascular events.3 Insulin-resistance is a pathological condition, in which the body’s cells become resistant to insulin effects.4 The aim of our study was to evaluate the relationship between insulin-resistance and the reduction of HRV parameters.

Prevalence, management, and outcome of adverse rhythm disorders in takotsubo syndrome: insights from the international multicenter GEIST registry

One important complication related to takotsubo syndrome (TTS) is adverse rhythm disorders. Our study was conducted to determine the incidence and management of adverse rhythm disorders in TTS and its long-term prognostic impact. We analyzed 906 TTS patients from 9 European centers. Patients were divided into the adverse rhythm disorders group (encompassing ventricular tachycardia, ventricular fibrillation, torsade de pointes, and asystole or complete atrioventricular block) and non-adverse rhythm disorders group. In our study cohort, we identified 67 (7.4%) patients with presence of adverse rhythm disorders. TTS patients were followed up over a period of 2.8 years. In the adverse rhythm di…

Ventricular arrhythmias in children : the usefulness of MRI

FIBRILLAZIONE ATRIALE E MILD COGNITIVE IMPAIRMENT: QUALE RELAZIONE.

Short-term Changes in Gal 3 Circulating Levels After Acute Myocardial Infarction.

Background and Aims Galectin 3 (Gal 3) is a β-galactoside-binding lectin known to play a part in inflammation, adverse remodeling and fibrosis. Gal 3 seems to be linked to atherogenesis and Coronary Artery Disease (CAD), but less is known about the relationship between Gal 3 and acute myocardial infarction (AMI). The aim of the present study is to assess circulating levels of Gal 3 after AMI and to evaluate short-term changes of the biomarker within 5 days from the acute event. Methods Two hundred fifteen confirmed AMI patients (125 STEMI, M/F = 2.8; mean age: 65.4 ± 13.8 years) were enrolled in the present study; two blood samples were collected from each patient: first, within 1 h from ad…

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

Purpose: It is well known that anticancer drugs used for treating breast cancer can cause cardiac toxicity, and less is known about vascular toxicity. The aim of this study was to assess subclinical vascular effects of anthracyclines and trastuzumab (TRZ) in women treated for breast cancer.Methods: We enrolled 133 female patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel) + TRZ. Patients underwent a standard echocardiography including measurement of left ventricular ejection fraction and global longitudinal strain at baseline and at follow-up. Vascular toxicity was evaluated by measuring brachial…

Usefulness of regional right ventricular and right atrial strain for prediction of early and late right ventricular failure following a left ventricular assist device implant: A machine learning approach

Background: Identifying candidates for left ventricular assist device surgery at risk of right ventricular failure remains difficult. The aim was to identify the most accurate predictors of right ventricular failure among clinical, biological, and imaging markers, assessed by agreement of different supervised machine learning algorithms. Methods: Seventy-four patients, referred to HeartWare left ventricular assist device since 2010 in two Italian centers, were recruited. Biomarkers, right ventricular standard, and strain echocardiography, as well as cath-lab measures, were compared among patients who did not develop right ventricular failure (N = 56), those with acute–right ventricular fail…

1177 The additive prognostic value of end-systolic pressure-volume relation by CMR in patients with with known or suspected coronary artery disease

Abstract Background The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. This index is easily obtained during routine stress echocardiography but can be derived also during a stress cardiovascular magnetic resonance (CMR) exam, that is the gold standard for the quantification of biventricular volumes. Purpose The aim of this study was to assess for the first time the prognostic value ofdelta rest-stress ESPVR (DESPVR) by dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD). Methods One hundred and sixty-six consecutive patients (37 females, main age 61.96 ± 1…

Atrial fibrillation and cognitive disorders: An overview on possible correlation

Atrial Fibrillation is the most common cardiac arrhythmia affecting people of all ages, principally the elderly. Cognitive decline and dementia are also prevalent diseases in elderly. The scientific community always showed interest in the possible association between these two pathological entities, both implicating social and economic burden. This has been confirmed by several longitudinal population-based studies. Some studies also revealed that the association between atrial fibrillation and dementia may be not related to history of stroke. Therefore, other pathophysiological mechanisms are likely implicated, so far unclear or undefined. The aim of the present review is to analyse the po…

EECP IN PATIENTS WITH REFRACTORY ANGINA

The PFO anatomy evaluation as possible tool to stratify the associated risks and the benefits arising from the closure

Aims According to the current guidelines, the patent foramen ovale (PFO) is still considered a qualitative factor and, as a consequence, its closure is recommended just on the basis of its ‘presence’. Methods and results In the year 2008, we evaluated 25 patients (mean age 62.7) with acute cerebrovascular event and 92 patients (mean age 27.3) suffering from migraine with aura. No PFO was reported in 79 patients. A venous-to-arterial circulation shunt had been shown in 38 patients (29 subjects with migraine and 9 subjects with prior stroke). According to the number of microbubbles arrived during the Valsava manoeuvre, we found: 25 small PFO, 6 moderate PFO, and 6 severe PFO. In the baseline …

Cardiovascular Issues in Tyrosine Kinase Inhibitors Treatments for Chronic Myeloid Leukemia: A Review

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by a fusion gene, encoding for the chimeric protein BCR-ABL, with constitutive tyrosine kinase activity. The use of tyrosine kinase inhibitors (TKIs) has drastically improved survival, but there are significant concerns about cardiovascular toxicity. Cardiovascular risk can be lowered with appropriate baseline evaluation, accurate choice of TKI therapy, improvement of modifiable cardiovascular risk factors through lifestyle modifications, and prescription of drugs for primary or secondary prevention. Which examinations are necessary, and when do they have to be scheduled? How often should a TKI-treated patient undergo wh…

Role of cardiac computed tomography in the evaluation of coronary artery stenosis in patients with ascending aorta aneurysm detected at transthoracic echocardiography

OBJECTIVE The aim of our study was to evaluate the diagnostic performance of cardiac computed tomography (CCT) in the evaluation of coronary artery stenosis in patients with ascending aorta aneurysm detected at transthoracic echocardiography. METHODS We conducted a retrospective analysis of patients with an aneurysm 45 mm or greater at transthoracic echocardiography who underwent CCT from 2012 to 2014 in our hospital. We calculated the sensitivity, specificity, and positive and negative predictive values of CCT for the assessment of coronary artery stenosis (<50% or ≥50% stenosis) in patients who underwent conventional coronary angiography. RESULTS We included 104 patients (73 men, aged 64 …

Medical therapy or revascularization for patients with chronic total occlusion? A dilemma almost solved

Chronic total occlusion (CTO) of the coronary arteries are relatively common, observed in approximatively 15-25% of patients with coronary artery disease undergoing coronary angiography. The right coronary artery represents the most common CTO vessel, which represents about half of the CTO cases.The CTO prevalence is much higher ( 90%) among patients with prior coronary artery bypass graft (CABG), while a CTO is found in only one tenth of patients referred for ST-elevation myocardial infarction (STEMI)

Chest pain due to late huge coronary pseudoaneurysm following stent implantation

A 50-year-old man was referred to our hospital because of persistent atypical chest pain. His past medical history was remarkable for a non ST elevation myocardial infarction, treated five months previously with PCI on the right coronary artery. Two months later, for chest pain, he underwent coronary angiography that showed a right coronary artery with slight ectasia near the stent. Five months later for the persistence of atypical chest pain he came to our clinic. Chest CT showed a 31.5 mm hematoma of the right coronary artery. Coronary angiography revealed a giant aneurysm, proximal to the stent. In the light of rapid growth of aneurysm, the risk of rupture and symptoms, we decided to tre…

DIAGNOSTIC ACCURACY OF MDCT 40 SLICES IN PATIENTS WITH CHEST PAIN

Cardiovascular magnetic resonance characterization of a hamartoma in an asymptomatic child

5037Drug treatment with beta-blockers and long-term outcome in patients with takotsubo syndrome: results from the takotsubo Italian network

Abstract Background Although generally considered a benign disease, Takotsubo syndrome (TTS) has recently been associated to a substantially comparable long-term outcome than acute coronary syndrome (ACS). The use of beta-blockers (BB) has been advocated in these patients for secondary prevention after the index event, considering the presumed role of catecholamine in TTS pathophysiology. However, the effect of BB on long-term outcome remains controversial due to the paucity of data and the lack of evidence from randomized studies. Purpose To investigate the impact of BB therapy on long-term outcome in patients with TTS. Methods The study included all TTS patients enrolled in the Takotsubo …

Scrotal swelling in a patient with paroxysmal supraventricular tachycardia

We present a case of a patient with paroxysmal supraventricular tachycardia and a history of chronic ischemic disease evolved into dilated cardiomyopathy. During hospitalization, the occurrence of arrhythmic crisis, our patient felt sporadic palpitations associated with dyspnea, distended jugular veins and scrotal swelling, quite unexpected clinical sign that caught our attention. Echocardiography showed dilated left ventricle, severely reduced systolic function, dilated right-sided, dilated inferior vena cava with reduced respiratory excursions. Echography of both testicles showed bilateral expansion of pampiniform plexus with reflux to the functional maneuvers, such as varicocele of grade…

Impact of dual antiplatelet therapy with proton pump inhibitors on the outcome of patients with acute coronary syndrome undergoing drug-eluting stent implantation.

This study aimed to assess if proton pump inhibitors (PPIs) may reduce the effectiveness of clopidogrel, than H2 antagonist (anti-H2) in order to determine rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death. This case-control study included 176 patients with ACS undergoing angioplasty (PCI) with drug-eluting stent implantation. The population was divided into two groups: PPI group (n=121) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group (n=55), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS e…

The spectrum of risk factors for contrast induced nephropathy in patients undergoing coronary angiography or intervention

Abstract Introduction Contrast induced nephropathy is an unfavorable acute event which can complicate the clinical course of patients undergoing coronary angiography. Clinical characteristics predisposing to its occurrence are still rather obscure. Methods We enrolled 591 patients (mean age 64.2 ± 10.98; 449 male and 142 female) who underwent emergency or elective Coronary angiography/Angioplastic in our Cardiologic Division between 10/2006 and 06/2008, paying attention to their Cardiovascular risk factors, dose and type of contrast medium, type and number of affected coronary arteries, pharmacological therapies, baseline renal function and extracoronary atherosclerosis. We performed a univ…

ASSOCIATION OF PARAOXONASE-1 Q192R PLYMORPHISM WITH CORONARY ARTERY DISEASE IN AMI PATIENTS, NON AMI CAD PATIENTS AND HEALTHY CONTROLS

Il ruolo del microcircolo nell’eziopatogenesi della Cardiopatia di Takotsubo

RUOLO DELL’ANGIOGRAFIA CORONARICA IN TOMOGRAFIA

Fatal heart failure induced by pazopanib in a sarcoma patient previously treated with gemcitabine

Gemcitabine is commonly used for various solid organ malignancies with rarely reported cardiac side effects such as cardiomyopathy. Pazopanib usually can cause arterial hypertension but cases of heart failure have recently been re-ported. We describe a case of fatal heart failure after treatment with gemcitabine and pazopanib in a 55-year-old female with sarcoma. Patient developed left ventricular dysfunction after gemcitabine treatment and acute heart failure after 22 days of pazopanib treatment which led to death. Physicians should be aware of the cardiotoxicity risk when managing the use of pazopanib especially in patients previously treated with other cardiotoxic drugs.

BIOMARKERS OF CORONARY MICROVASCULAR DYSFUNCTION IN PATIENTS WITH MICROVASCULAR ANGINA: A NARRATIVE REVIEW

The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have i…

METABOLIC THERAPY IN THE TREATMENT OF CHRONIC CRITICAL LIMBS ISCHEMIA OF THE LOWER LIMBS. THE L-PROPIONYL-CARNITINE ENHANCES THE EFFECTS OF PGE-1

Cardiovascular Toxicity in Cancer Patients Treated with Tyrosine Kinase Inhibitors: A Real-World Single-Center Experience

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Target therapy can cause various cardiovascular complications. The aim of this study was to evaluate the burden of cardiovascular complications related to treatment with anti-BCR-ABL tyrosine kinase inhibitors (TKIs) and to determine if there are differences between the latest- and first-generation TKIs. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A retrospective observational study was carried out on 55 patients (39 men, 16 women; mean age ± SD: 58 ± 11 years) treated with TKIs targeting Bcr-Abl for a median period of 3.5 years. Patients were divided in two groups according to the type of treatment. Group A included patients treated with…

Aterosclerosi Preclinica e Rischio Cardiovascolare Globale

PePERCUTANEOUS ANGIOPLASTY AND STENTING OF LEFT SUBCLAVIAN ARTERY LESIONS FOR THE TREATMENT OF PATIENTS WITH SIMULTANEOUS VERTEBRAL AND CORONARY SUBCLAVIAN STEAL SYNDROMES

ASSOCIATION OF THE PARAOXONASE-1 Q192R POLYMORPHISM WITH CORONARY ARTERY DISEASE IN AMI PATIENTS, NON AMI CAD AND HEALTHY CONTROLS.

CLINICAL APPROPRIATENESS OF CORONARY ANGIOGRAPHY EXAMINATION IN PATIENTS OBSERVED IN A DIVISION OF CARDIOLOGY

Large Mediastinal mass in pregnancy: utility of echocardiography and cardiac MRI. A case report

PREVALENCE OF CAROTID LESIONS IN A MEDITERRANEAN POPULTION OF HYPERTENSIVES

P1687Microvascular function detected by timi frame count (TFC) and myocardial blush grade (MBG) in patients with takostubo syndrome

Anthracyclines and regional myocardial damage in breast cancer patients. A multicentre study from the Working Group on Drug Cardiotoxicity and Cardioprotection, Italian Society of Cardiology (SIC)

Abstract Aims In breast cancer (BC) patients treated with anthracyclines-based therapies, we aim at assessing whether adjuvant drugs impact cardiac function differently and whether their cardiotoxicity has a regional pattern. Methods and results In a multicentre study, 146 BC patients (56 ± 11 years) were prospectively enrolled and divided into three groups according to the received treatments: AC/EC-Group (doxorubicin or epirubicin + cyclophosphamide), AC/EC/Tax-Group (AC/EC + taxanes), FEC/Tax-Group (fluorouracil + EC + taxanes). Fifty-six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated …

A case of Takotsubo syndrome

Management of Direct Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Cardioversion

Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real “epidemic phenomenon”. Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. This, whether obtained with synchronized shock or with drugs, involves a periprocedural risk of stroke and systemic embolism which is reduced by adequate anticoagulant therapy in the weeks before or by the exclusion of left atrial thrombi. Direct oral anticoagulants are safe, manageable, and provide rapid onset of oral anticoagulation; they are an important alternative to heparin/warfarin from all points of view, with a considerable reduction in b…

INIBITORI DEL SISTEMA RENINA-ANGIOTENSINA E FIBRILLAZIONE ATRIALE: UNO STUDIO RETROSPETTIVO SU 187 PAZIENTI

INFLUENZA DELL’ATEROSCLEROSI CAROTIDEA PRECLINICA SUGLI EVENTI CEREBRO- E CARDIOVASCOLARI IN 5 ANNI DI FOLLOW-UP. INFLUENCE OF PRECLINICAL CAROTID ATHEROSCLEROSIS ON CEREBRO- AND CARDIOVASCULAR EVENTS IN A FIVE YEARS FOLLOW-UP

Introduzione: numerosi studi hanno utilizzato la valutazione dello spessore intima-media carotideo (IMT) come marker di aterosclerosi (ATS) preclinica ed è stato ampiamente dimostrato che l’IMT correla con la presenza di ATS coronarica ed è predittivo di eventi sia cardio- che cerebrovascolari. Scopo dello studio: valutare se in soggetti asintomatici la presenza di ATS carotidea preclinica, ispessimento medio intimale carotideo (IMT) e placca carotidea asintomatica (PCA), aggiunga ulteriori informazioni nella stratificazione del rischio permettendo di individuare soggetti che potrebbero beneficiare di un trattamento più aggressivo, anche farmacologico, dei fattori di rischio presenti. Mater…

4G/5G polymorphism on the promoter of the plasminogen activator inhibitor-1 gene and post-surgical calf vein thrombosis

P5285Pressure-volume relationship by cardiovascular magnetic resonance: feasibility and clinical implications

Abstract Background The variation between rest and peak stress end-systolic pressure-volume relation (ESPVR; the Suga index) is easily obtained during routine stress echocardiography and has been established as a reasonably load-independent index of myocardial contractile performance that provides prognostic information above and beyond regional wall motion. Purpose This is the first study assessing the delta rest-stress ESPVR (DESPVR) by stress Cardiovascular Magnetic Resonance (CMR). Methods Eighty-five consecutive patients (19 females, main age 62.99±9.26 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. The ESPVR was evaluated at rest and peak…

Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry

Aims: Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. Methods and results: Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-…

Quantitative criteria for the diagnosis of the congenital absence of pericardium by cardiac magnetic resonance

Congenital absence of the left ventricular pericardium (LCAP) is a rare and poorly known cardiac malformation. Cardiac Magnetic Resonance (CMR) is generally used for the diagnosis of LCAP because of its high soft tissue contrast, multiplanarity and cine capability, but the diagnosis is usually made by only qualitative criteria. The aim of the present study was to establish quantitative criteria for the accurate diagnosis of LCAP on CMR.We enrolled nine consecutive patients affected by LCAP (mean age 26±8years, 7 males), 13 healthy controls, 13 patients with dilated cardiomyopathy (DCM), 12 patients with hypertrophic cardiomyopathy (HCM) and 13 patients with right ventricular overload (RVO).…

Heart Failure and Left Ventricular Dysfunction

Heart failure (HF) and left ventricular (LV) dysfunction are the most concerning and serious cardiovascular complications of cancer therapies and cause an increase in morbidity and mortality. Some cancer treatments induce left ventricular dysfunction that appears early after exposure and therefore may adversely affect oncological therapy, while others generate cardiac injuries resulting in clinical problems only years later.

Effects of SGLT2 inhibitors on cardiac structure and function.

SGLT2 inhibitors reduce cardiovascular death or hospitalization for heart failure, regardless of the presence or absence of diabetes in patients at high cardiovascular risk and in those with heart failure and reduced ejection fraction (HFrEF). In patients with HF and preserved EF, empagliflozin also showed favorable effects mainly related to the reduction of hospitalization for heart failure. These favorable effects are beyond the reduction of glycemic levels and mainly related to beneficial hemodynamic and anti-inflammatory effects of these drugs and improved cardiac energy metabolism. In this review, we aimed to evaluate the effects of SGLT2 inhibitor on cardiac remodeling and function, w…

Relationship between metabolic syndrome and aortic stiffness in untreated hypertensive patients

The relationship between endothlial ABD erectile dysfunction, levels of testosterone and cardiovascular events in the follow-up

Background: Clinical and experimental evidence suggest that testosterone levels play a role in cardiac and vascular pathology. A long history of observational studies investigating serum testosterone level and cardiovascular risks, specifically mortality, reveals important associations between low testosterone and mortality, while higher serum testosterone level appear to be predictive in the majority of studies. On the other hand, it is well documented and accepted that endothelial dysfunction is expression of preclinical atherosclerosis and it is associated with an increased amount of CV events in the follow-up. Erectile dysfunction is also an early manifestation of arteriosclerosis assoc…

401Prognostic role of late gadolinium enhancement in patients with low-intermediate 5 year HCM SCD risk score: a multicenter study

Role of biomarkers in monitoring antiblastic cardiotoxicity

Early detection of anticancer drug-induced cardiotoxicity (CTX) has been evaluated by most international scientific cardiology and oncology societies. High expectations have been placed on the use of specific biomarkers. In recent years, conventional biomarkers and molecules of more recent interest have been tested and compared in the context of anticancer drug-related CTX. Encouraging results were obtained from studies on molecules of myocardial damage, such as troponin and markers of myocardial wall stress, including circulating natriuretic peptides, as well as from the assessment of the products of inflammation or circulating levels of free radicals. However, clear guidelines on their se…

Metabolic syndrome (MetS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study.

BACKGROUND AND PURPOSE: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, considered as emerging and promoting atherosclerosis. This study aimed at the evaluation of the influence of MetS on the prediction of cerebro and cardiovascular events during a 20 years follow-up period in an asymptomatic population of middle-aged subjects. METHODS: We evaluated 529 asymptomatic persons through a prospective study. Study population was divided into two subgroups: patients with and without MetS. Echo-color-Doppler was used in order to assess the presence of subclinical atherosclerosis. A 20 years follow-up study was carried out in order to estimate the incidence of cerebro and car…

RIGHT LOBAR PULMONITIS A POSSIBLE CAUSE OF LONE ATRIAL FIBRILLATION

RIGHT LOBAR PULMONITIS A POSSIBLE CAUSE OF LONE ATRIAL FIBRILLATION

Use of myocardial work for multiparametric detection of subclinical anthracycline cardiotoxicity in breast cancer patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC). Methods We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel).  Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global wor…

INCREASED MACROPHAGE COLONY STIMULATING FACTOR CONCENTRATIONS ARE ASSOCIATED WITH LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROMES

INCREASED MACROPHAGE COLONY STIMULATING FACTOR CONCENTRATIONS ARE ASSOCIATED WITH LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROMES

Risk Stratification Using the CHA(2)DS(2)-VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

Background The CHA 2 DS 2 ‐VASc score predicts stroke in patients with atrial fibrillation and has been reported to have a prognostic role even in acute coronary syndrome patients. The Takotsubo syndrome is a condition that mimics acute coronary syndrome and may present several complications including stroke. We sought to assess the ability of CHA 2 DS 2 ‐VASc score to predict adverse events in Takotsubo syndrome patients. Methods and Results Overall, 371 Takotsubo syndrome patients were enrolled in a prospective registry. Patients were divided into 3 groups according to the CHA 2 DS 2 ‐VASc score: Group A (≤1), B (2–3), and C (≥4). The median CHA 2 DS 2 ‐VASc score was 3 (interquartile ra…

Left ventricular noncompaction presenting like a double-chambered left ventricle

Approccio diagnostico non invasivo con tomografia computerizzata multidetettore a 40 strati per lo studio della malattia aterosclerotica coronarica

Background. Multidetector computed tomography coronary angiography (MDCT-CA) is a non-invasive technique that clearly shows coronary anatomy and correctly identifies plaque location and morphology. In this study we assessed diagnostic accuracy of MDCT-CA in detectiong significant stenosis in patients with clinically relevant coronary tree disease. Methods. Fifty patients (38 males, 12 females, mean age 60.9 ± 9.2 years) with atypical chest pain, stable or unstable angina pectoris, or non-ST-elevation myocardial infarction underwent MDCT-CA (Brilliance 40, Philips Medical Systems, Cleveland, OH, USA) within 3 days before diagnostic conventional coronary angiography. Inclusion criteria were s…

Longitudinal Strain Analysis and Correlation with TIMI Frame Count in Patients with Ischemia with No Obstructive Coronary Artery (INOCA) and Microvascular Angina (MVA)

Background: The aim of the study is to evaluate the subclinical alterations of cardiac mechanics detected using speckle-tracking echocardiography and compare these data with the coronary angiography indices used during coronary angiography in a population of patients diagnosed with ischemia with no obstructive coronary artery (INOCA) and microvascular angina (MVA). Methods: The study included 85 patients admitted to our center between November 2019 and January 2022 who were diagnosed with INOCA compared with a control group of 70 healthy patients. A collection of anamnestic data and a complete cardiovascular physical examination, and echocardiogram at rest with longitudinal strain were perf…

Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry

OBJECTIVE In view of low prevalence rates, diabetes is discussed as a protective factor for the occurrence of Takotsubo syndrome (TTS). Furthermore, it was associated with improved outcome in a small single-center analysis. Therefore, this study assessed the prevalence and prognostic relevance of concomitant diabetes in TTS. RESEARCH DESIGN AND METHODS A total of 826 patients with TTS were enrolled in an international, multicenter, registry-based study (eight centers in Italy and Germany). All-cause mortality was compared between patients with diabetes and patients without diabetes, and the independent predictive value of diabetes was evaluated in multivariate regression analysis. RESULTS …

Prediction of cardio- and cerebro-vascular events in patients with subclinical carotid atherosclerosis and the metabolic syndrome.

CHLAMIDYA PNEUMONIAE AND VULNERABLE PLAQUE: DOES EXIST A CORRELATION?

PREVALENCE OF A MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH ATRIAL FIBRILLATION

ELEVATED C-REACTIVE PROTEIN LEVELS ARE A STRONG PREDICTOR OF CLINICAL EVENTS IN HYPERTENSIVE PATIENTS WITH EARLY STAGE OF ATHEROSCLEROSIS

IVABRADINE VERSUS BISOPROLOL

IVABRADINE VERSUS BISOPROLOL

Cardiovascular Damage Induced by Radiotherapy

Radiotherapy is a fundamental therapeutic aid that in recent years has contributed significantly to improve the prognosis of cancer patients. Despite its great effectiveness, it can cause a wide spectrum of toxic effects. Among these, cardiovascular toxicity is very relevant, and it can occur even many years after the termination of treatment. The concomitant use of radiotherapy with other antineoplastic drugs, including new-generation tyrosine-kinase inhibitors or immunotherapy, can enhance its cardiotoxic effects. It is fundamental to know the cardiovascular toxic effects that are potentially linked to radiotherapy (RIHD: radiation-induced heart damage), to monitor patients who underwent …

Cardiovascular Damage Induced by Anti-BCR-ABL TKIs

Anti-BCR-ABL TKIs (tyrosine kinase inhibitors) are drugs that inhibit BCR ABL tyrosine. They are used especially in the treatment of hematological cancer and gastrointestinal stromal tumors (GIST). Anti-BCR-ABL TKIs include first (imatinib), second (nilotinib, dasatinib, bosutinib) and third-generation drugs (ponatinib). Especially second- and third-generation drugs can cause cardiovascular complications such as arterial thrombosis, myocardial ischemia, peripheral arterial diseases, QTc prolongation, and pulmonary hypertension. Nilotinib and ponatinib can cause thrombotic arterial events with various mechanisms. Particularly dasatinib can cause pulmonary hypertension. Compared to convention…

Anticancer therapy-induced vascular toxicity: VEGF inhibition and beyond

Cardiotoxicity induced by chemotherapeutic agents and radiotherapy is a growing problem. In recent years, an increasing number of new drugs with targeted action have been designed. These molecules, such as monoclonal antibodies and tyrosine kinase inhibitors, can cause different type of toxicities compared to traditional chemotherapy. However, they can also cause cardiac complications such as heart failure, arterial hypertension, QT interval prolongation and arrhythmias. Currently, a field of intense research is the vascular toxicity induced by new biologic drugs, particularly those which inhibit vascular endothelial growth factor (VEGF) and its receptor (VEGF-R) and other tyrosine kinases.…

Prevalence and prognostic impact of nonischemic late gadolinium enhancement in stress cardiac magnetic resonance

Aim To assess the prevalence and prognostic significance of NI-LGE in patients undergoing stress-CMR. Methods Stress-CMR with either dipyridamole or adenosine was performed in 283 patients (228 men, 81%) including perfusion imaging, wall motion evaluation and LGE. Follow-up was completed in all enrolled patients (median time: 1850 days; interquartile range: 1225-2705 days). Composite endpoint included cardiac death, ventricular tachycardia, myocardial infarction, stroke, hospitalization for cardiac cause and coronary revascularization performed beyond 90 days from stress-CMR scans. Results One hundred and twelve patients (40%) had negative LGE (no-LGE), 140 patients (49%) I-LGE and 31 patie…

Circulating transforming growth factor-beta1 levels in asymptomatic carotid plaques

Channel Tracking Guidewire and Technique for Retrograde Approach

Evaluation of the collateral circulation is critical for determining the feasibility of the retrograde approach. When assessing collateral channels it is of paramount importance to take time and review the previous angiogram carefully, for multiple potential collateral pathways, as the predominant collateral may change over time prior to the procedure. Careful review of collaterals prior to the procedure can reduce contrast and radiation dose as well as the duration of the procedure.Retrograde access to the distal vessel can be achieved via septal collaterals, epicardial collaterals (atrial channel), or (patent or occluded) coronary bypass grafts. Generally septals are used more often 65–70…

Left atrial strain and left atrial stiffness for early detection of cardiotoxicity in cancer patients

Abstract Background Anti-cancer drugs can cause cardiovascular complications. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are usually used to identify clinical and subclinical cardiotoxicity. Purpose The aim of our study was to assess the addictional role of left atrial reservoir strain (LAS-S) and left atrial stiffness (LASI – the ratio of E/e' to LAS-S) in identifying patients at higher risk of cardiotoxicity. Methods 102 breast cancer patients (median age 53±9.5 years), without cardiovascular diseases, were enrolled before starting chemotherapy. Electrocardiogram and transthoracic echocardiogram (conventional measurements based on EACVI recommendations;…

Coronary Artery Disease in South Asian Patients: Cardiovascular Risk Factors, Pathogenesis and Treatments.

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the Western World has occurred for social, economic and geopolitical reasons. The aim of this review is to describe cardiovascular risk factors, pathogenesis and treatments of coronary artery disease in South Asian patients. It is well established that South Asian populations have a higher prevalence of coronary artery disease and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both South Asian patients residing in their birth country and in those residing abroad, but it may also be due to the …

Novo, S. et al. Aliskiren: Just a New Drug for Few Selected Patients or an Innovative Molecule Predestinated to Replace Arbs and Ace-Inhibitors? Pharmaceuticals 2009, 2, 118-124

The renin-angiotensin-aldosterone system (RAAS) plays a dominant role in the pathophysiology of hypertension, diabetes mellitus, chronic kidney disease and chronic heart failure. Therefore, drugs that block key components of the RAAS such as ACE inhibitors (ACEI) and angiotensin receptor blockers (ARBs) have gained wide clinical use for these indications. Despite progress, the morbidity and mortality of patients treated with ACEI or ARBs remain high. Aliskiren (Tekturna, Rasilez) is the first orally active inhibitor of renin approved for clinical use as an antihypertensive agent. The development program has established that at the licensed doses of 150 mg and 300 mg. Aliskiren is effective …

Relazione tra disfunzione erettile, livelli di testosterone e funzione endoteliale in pazienti a rischio cardiovascolare intermedio secondo le stime della Carta di Framingham” – P259

Scopo del lavoro Il ruolo dei livelli di testosterone plasmatico e della disfunzione erettile come marcatori precoci di disfunzione endoteliale non è ben definito. Pertanto, abbiamo cercato di analizzare la relazione tra testosterone plasmatico e disfunzione erettile, in rapporto alla funzione endoteliale. Materiali e metodi Abbiamo quindi arruolato 802 pazienti in prevenzione primaria, con una stima di rischio cardiovascolare (CV) intermedio secondo la carta del rischio di Framingham, di età compresa fra 40 e 80 anni, che si sono sottoposti all’esame ecografico della dilatazione flusso mediata dell’arteria brachiale destra, alla valutazione della disfunzione erettile attraverso il question…

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROMES

PROGNOSTIC IMPACT OF HYPERTENSION AND CAROTIID LESIONS N A FIVE YEARS FOLLOW UP

Incidence and Clinical Impact of Right Ventricular Involvement (Biventricular Ballooning) in Takotsubo Syndrome

Background The short- and long-term prognosis of Takotsubo syndrome (TTS) presenting with right ventricular (RV) involvement remains poorly understood. Research Question What is the incidence and clinical outcome of RV involvement in TTS? Study Design and Methods This study analyzed 839 consecutive patients with TTS (758 female subjects and 81 male subjects) in a multicenter registry. RV involvement was defined as wall motion abnormality of the RV free wall, with or without apical involvement. The median long-term follow-up was 2.1 years (interquartile range, 0.3-4.5 years). The primary outcome was in-hospital and out-of-hospital all-cause mortality. The secondary end point was a composite …

Thrombus-like small apical fibroma in patient with left ventricular dysfunction and thrombophilia: an unusual presentation.

Cardioprotection by gene therapy: A review paper on behalf of the Working Group on Drug Cardiotoxicity and Cardioprotection of the Italian Society of Cardiology

Ischemic heart disease remains the leading cause of death worldwide. Ischemic pre-, post-, and remote conditionings trigger endogenous cardioprotection that renders the heart resistant to ischemic-reperfusion injury (IRI). Mimicking endogenous cardioprotection by modulating genes involved in cardioprotective signal transduction provides an opportunity to reproduce endogenous cardioprotection with better possibilities of translation into the clinical setting. Genes and signaling pathways by which conditioning maneuvers exert their effects on the heart are partially understood. This is due to the targeted approach that allowed identifying one or a few genes associated with IRI and cardioprote…

Prognostic value of LDL/HDL cholesterol ratio in patients undergoing coronary stenting

P1319 Speckle tracking echocardiography in patients with acute coronary syndrome: the added value

Abstract Background Speckle tracking echocardiography with assessment of left ventricular global longitudinal strain (GLS) allows to identify early signs of cardiac dysfunction. The superiority of GLS in the prediction of all-cause mortality in the general population compared with LVEF is well known; in addiction GLS improves risk stratification and recognize early left ventricular dysfunction in several clinical setting. Purpose the aim of this study was to assess the diagnostic and prognostic role of global and segmental strain in the early identification of cardiac dysfunction in patients with myocardial infarction without persistent ST segment elevation (NSTEMI) and without obvious wall…

Cardiotoxic Effects of Anti-VEGFR Tyrosine Kinase Inhibitors

Angiogenesis is a key moment in tumor development and proliferation. Until recently oncologists did not know the mechanisms that were behind this phenomenon, but following the discoveries of Folkman and coworkers, they have gradually created and developed a series of drugs that act against angiogenesis by interacting with molecules belonging to the vascular endothelial growth factor (VEGFs) class and its receptors (VEGFRs) giving rise to anticancer effects. Tyrosine kinase inhibitors (TKIs) are a major class of these new anticancer agents, demonstrating high antitumor activity in a variety of "orphan" neoplasms (such as hepatocellular carcinoma, kidney cancer, sarcomas, etc.). The mechanism…

Endothelial dysfunction and carotid lesions are strong predictors of clinical events in patients with early stages of atherosclerosis: a 24 months follow-up study.

ASSOCIATION OF ELEVATED FIBRINOGEN AND C-REACTIVE PROTEIN LEVELS WITH CAROTID LESIONS IN PATIENTS WITH EARLY ONSET OF HYPERTENSION OR TYPE II DIABETES.

Images in cardiovascular medicine. Anomalous origin and course of the right coronary artery.

Coronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery.1–4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes of death and revealed an underlying congenital heart disease, which was characterized by a congenital bicuspid aortic valve and an anomalous origin of the right coronary artery just above the median raphe of the anterior cusp

When, why, and how to perform wire-based antegrade dissection and reentry technique

Antegrade dissection and reentry (ADR) refers to an attempt to cross a coronary chronic total occlusion (CTO) lesion through wire and/or equipment passage in the subintimal space followed by reentry to the distal true lumen. From the original subintimal tracking and reentry (STAR) technique description by Colombo in 2005, refinement of the technique, improved characteristics of the microcatheters and wires, and better understanding of subadventitial vessel trauma have led to higher success rates, lower complications rates, and improved long-term outcomes. In this chapter, we discuss the technique, its outcomes, and limitations.

Reverse remodeling and arrhythmic burden reduction in a patient with an implantable cardioverter defibrillator treated with sacubitril/valsartan: Case report

Abstract Sacubitril/valsartan has been shown to reduce cardiovascular mortality and hospitalizations in patients with HFrEF when compared to enalapril. There are also some evidences of its potential antiarrhythmic effects. We present a report where we found a relation between reverse ventricular remodeling and arrhythmic reduction in a patient treated with sacubitril/valsartan.

How to Write a Research Protocol: Tips and Tricks

There is a need to reassess the most appropriate indications for stress echocardiography in the current era, in patients with suspect or known coronary artery disease (CAD), and also the most helpful additional parameters that can be easily calculated in clinical practice to increase the known suboptimal sensitivity for obstructive CAD of this test. The current review tries to clarify what is and what should be the proper role for functional testing in general, but specifically regarding modern stress echocardiography in the current practice, for suspected CAD and/or atypical chest pain. Few candidate additional parameters beyond wall motion assessment are here suggested to improve diagnost…

Markers of inflammation are strong predictors of subclinical and clinical atherosclerosis in women with hypertension

XStrain 4D analysis predicts left ventricular remodeling in patients with recent non-ST-segment elevation myocardial infarction

Intrahospital complications of acute myocardial infarction in hypertensive patients. A retrospective case-control study

Do the current guidelines for heart failure diagnosis and treatment fit with clinical complexity?

Heart failure (HF) is a clinical syndrome defined by specific symptoms and signs due to structural and/or functional heart abnormalities, which lead to inadequate cardiac output and/or increased intraventricular filling pressure. Importantly, HF becomes progressively a multisystemic disease. However, in August 2021, the European Society of Cardiology published the new Guidelines for the diagnosis and treatment of acute and chronic HF, according to which the left ventricular ejection fraction (LVEF) continues to represent the pivotal parameter for HF patients’ evaluation, risk stratification and therapeutic management despite its limitations are well known. Indeed, HF has a complex pathophys…

The prognostic role of CMR using global planimetric criteria in patients with excessive left ventricular trabeculation.

Objectives: Although cardiovascular magnetic resonance (CMR) is widely used in the assessment of left ventricular non-compaction (LVNC), there are no universally accepted diagnostic criteria and limited data regarding their prognostic value. We assessed the long-term prognostic role of the planimetric global Grothoff’s criteria and of the CMR findings in predicting adverse cardiovascular events (CE). Methods: We prospectively enrolled 78 patients (46.7 ± 18.7 years, 33.3% females) with documented positive Jenni’s echocardiographic criteria for LVNC. Cine images were used to quantify function parameters and to assess for the presence of all four quantitative Grothoff’s criteria (global Groth…

Early detection of myocardial damage: A multimodality approach

Cardiovascular diseases are possible complications of antineoplastic treatment and may lead to premature morbidity and mortality among cancer survivors. A symptom-based follow-up is ineffective, and there are growing evidences that early detection of myocardial damage in patients treated with antineoplastic drugs is the key point to prevent the occurrence of damage and improve the prognosis of these patients. Different techniques have been proposed to monitor cardiac function in oncologic patients such as cardiac imaging (echocardiography, nuclear imaging, and cardiac magnetic resonance) and biomarkers (troponin and natriuretic peptides). The European Association of Cardiovascular Imaging/A…

Cardiovascular Damage in Clinical Trials

The Cardio-oncology field has grown considerably in the last two decades. The remarkable increase in the number of molecules used in oncology has brought with it a huge set of cardiovascular adverse events. For this reason, it is necessary to intervene on the early stages of drug development. This is what the Food and Drug Administration aims to do. This purpose can be achieved through a more careful analysis of the adverse event, development of guidelines, and identification of objective parameters that could guide the researcher in defining precisely the adverse event. It is also necessary to use additional methods not yet used in clinical trials that can allow an early detection of adver…

Correlation between longitudinal strain analysis and coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Objective: The aim of this study was to evaluate in patients with microvascular angina and heart failure with preserved ejection fraction, the speckle-tracking echocardiography, and longitudinal myocardial strain to evaluate the possible presence of alterations in heart failure with preserved ejection fraction patients compared with a control population. We also investigated the correlation between the longitudinal strain analysis and the TIMI frame count after coronary angiography. Methods: Our study was performed on a population 41 patients with microvascular angina that underwent coronary angiography and speckle-tracking echocardiography. We divided the sample into two categories: patien…

Bempedoic acid as adjunct for traditional lipid-lowering therapy in patients with hyperlipidaemia

Statin therapy has been the cornerstone for the reduction of cholesterol and circulating low-density lipoprotein (LDL) in patients with cardiovascular diseases. However, statin monotherapy has disadvantages attributable to myopathies and to the insufficient cholesterol reduction observed in some patients. There is a need for new well-tolerated therapies for lowering LDL. This review will focus on bempedoic acid in combination with traditional statin therapy or other lipid-lowering agents and its emerging role in LDL-C lowering. Bempedoic acid is also a viable alternative for reducing LDL cholesterol in the treatment of some patients suffering from heterozygous familial hypercholesterolemia.

Ischemia in patients with no obstructive coronary artery disease: classification, diagnosis and treatment of coronary microvascular dysfunction

Patients with coronary microvascular dysfunction represent a widespread population, and despite the good prognosis, many of them, because of the angina symptoms, have a poor quality of life with strong limitations in their daily activities. In 2017, a new classification of microvascular dysfunction as well as a new definition of ischemia in patients with no obstructive coronary artery disease became available. This new definition improves Kemp's initial work, where cardiac X syndrome was initially described. This work summarizes the last updates on the subject with particular attention to the new classification of microvascular dysfunction, with particular attention to microvascular and vas…

Antineoplastic Drug-Induced Cardiotoxicity: A Redox Perspective

Antineoplastic drugs can be associated with several side effects, including cardiovascular toxicity (CTX). Biochemical studies have identified multiple mechanisms of CTX. Chemoterapeutic agents can alter redox homeostasis by increasing the production of reactive oxygen species (ROS) and reactive nitrogen species RNS. Cellular sources of ROS/RNS are cardiomyocytes, endothelial cells, stromal and inflammatory cells in the heart. Mitochondria, peroxisomes and other subcellular components are central hubs that control redox homeostasis. Mitochondria are central targets for antineoplastic drug-induced CTX. Understanding the mechanisms of CTX is fundamental for effective cardioprotection, without…

Multiplane two-dimensional versus real time three-dimensional transesophageal echocardiography in ischemic mitral regurgitation

OBJECTIVES: Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has been suggested to be a valuable technique for the evaluation of the mechanisms of ischemic mitral regurgitation (IMR). Studies comparing multiplane two-dimensional (2D) with 3D TEE reconstruction of the mitral valve using the new mitral valve quantification (MVQ) software are lacking. We undertook a prospective comparison between multiplane 2D and 3D TEE for the assessment of IMR. METHODS: We evaluated echocardiographically 45 patients with IMR who underwent mitral valve surgery in our institution. 2D and 3D TEE examinations followed by a 3D offline assessment of the mitral valve apparatus were perf…

1232 Acute myocarditis: prognostic role of speckle tracking echocardiography and cardiac magnetic resonance

Abstract Background Myocarditis is an inflammatory disease of the myocardium predominantly caused by infection with subsequent immunological response. Cardiac magnetic resonance (CMR) is the currently best imaging modality to confirm a suspected diagnosis of myocarditis. Conventional echocardiography can detect regional or global wall motion abnormalities but it could also be negative. Speckle tracking echocardiography can help to identify subtle systolic dysfunction, in patients with myocardits and apparently negative echocardiogram. Purpose the aim of this study was to identify cardiac imaging parameters predictive of cardiovascular events in patients with acute myocarditis. Methods a pro…

Role of ARBs in the blood hypertension therapy and prevention of cardiovascular events

Hypertension has a worldwide high incidence in the general population and undoubtedly it is the most important risk factor for cardiovascular morbidity and mortality, in industrialized countries. In this Review we investigated the role of angiotensin II receptor antagonists (ARBs) therapy in the treatment of essential hypertension. We selected in the PubMed and in a list of selected sources the most significant clinical trials and meta-analysis carried out from 1999 to now, to assess, in adult patients populations, ARBs efficacy, safety and tolerability profile, in comparison with the efficacy of the other common antihypertensive drugs, with particular regard to both the prevention of disab…

ASSOCIATION OF ELEVATED FIBRINOGEN AND C-REACTIVE PROTEIN LEVELS WITH CAROTID LESIONS IN PATIENTS WITH EARLY ONSET OF HYPERTENSION OR TYPE-II DIABETES

Optimal duration of treatment in surgical patients with calf venous thrombosis localized only in one or two leg.

OBJECTIVE: This retrospective study was planned for a good risk assessment of asymptomatic patients affected by ventricular pre-excitation. METHODS: From 1985 to 2007, 124 patients with an atrioventricular pathway (electrocardiographic signs of ventricular pre-excitation) were admitted to our cardiology division. The average age was 7 years (range 1 month to 18 years). The mean follow-up period in the whole population of patients was 4.2 years (range 1-13 years). Four patients were lost during the follow-up. During this period, all patients remained in good health. In all of them, we performed a Holter evaluation every year. An intermittent pathway was detected in 18 patients (15%), and fou…

Chronic inflammation: A key role in degeneration of bicuspid aortic valve.

Abstract Introduction Bicuspid aortic valve (BAV) is the most common congenital valvular heart defect resulting from abnormal aortic cusp formation during heart development, where two of the three normal and equal sized cusps fuse into a single large cusp resulting in a two cusps aortic valve. Over the past years, much interest has been given in understanding the pathogenesis of BAV and its complications. In this review, we focused on the role of inflammation, involved in the degeneration of BAV and the development of its complications. Role of inflammation From a pathophysiological point of view, BAV may rapidly progress into aortic stenosis (AS) and is related to aortopathy. Several histo…

Early Effects of Sacubitril/Valsartan on Exercise Tolerance in Patients with Heart Failure with Reduced Ejection Fraction.

Background. Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF. Methods. We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy. Results. At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3&ndash

ELEVATED C-REATIVE PROTEIN LEVELS ARE STRONG PREDICTOR OF CLINICAL EVENTS IN HYPERTENSIVE PATIENTS WITH EARLY STAGES OF ATHEROSCLEROSIS

P1462 Additive value of global longitudinal strain measurement in patients with known or suspected ischaemic heart disease undergoing stress echo

Abstract BACKGROUND Speckle-tracking echocardiography (STE) can be applied in a large variety of clinical conditions. Global longitudinal strain (GLS) shows high diagnostic accuracy for the detection of myocardial ischemia as it reflects changes in subendocardial fibers deformation that are more exposed to ischemic damage, even before alterations in segmental kinetics are revealed. PURPOSE Aim of our study was to assess whether the measurement of global longitudinal strain during stress-echo can provide additional information compared to the assessment of conventional parameters such as left ventricular ejection fraction (LVEF) and wall motion abnormalities. We also evaluated the added valu…

Evaluation of remnant cholesterol levels and Monocyte-to-HDL-cholesterol ratio in South Asian patients with acute coronary syndrome.

Abstract Background and aims In the present study, we aimed to compare the clinical and coronary angiography features between South Asian and Caucasian patients with Acute Coronary Syndrome (ACS). In particular, we focused our analysis on the evaluation of recent cardiovascular risk markers, such as remnant cholesterol, corresponding to all plasma cholesterol minus HDL-C (high-density lipoprotein cholesterol) and LDL-C (low-density lipoprotein cholesterol), and the Monocyte-to-HDL-cholesterol ratio. We also compared values of several lipoprotein ratios and the Platelet-to-lymphocyte ratio, accurate predictors of coronary events and coronary artery disease. Methods and results We recruited 4…

Testosterone levels are directly related with erectile function and endothelial function in men with intermediate risk according to the Framingham score

Background. The value of testosterone levels and erectile dysfunction (ED) as early markers of atherosclerosis is not well understood. Objectives. To analyze the relationship between plasma testosterone levels in men with both endothelial function (F) and ED. Methods. We enrolled 802 asymptomatic, intermediate cardiovascular risk patients, according to the Framingham Risk Score, aged 40 to 80 years, who underwent the study of EF, evaluation of ED and dosage of plasma testosterone. Results. At linear regression, EF (t=9.40; 95% CI from 0.9318 to 1.4234; p<0.0001) and erectile function (t=8.96; 95% CI from 0.7642 to 1.1932; p<0.0001) statistically increased with increasing levels of testoster…

Impact of preclinical carotid atherosclerosis on global cardiovascular risk stratification and events in a 10-year follow-up: comparison between the algorithms of the Framingham Heart Study, the European SCORE and the Italian 'Progetto Cuore'

Background The aim of the study was to compare three widely used algorithms for stratification of the global cardiovascular risk (GCVR): the Framingham Heart Study (FHS) score, the European systemic coronary risk estimation (SCORE) and the Italian 'Progetto Cuore' (heart project) score. It was also investigated how preclinical carotid atherosclerosis (pre-ATS) might influence the incidence and improve the risk prediction of cerebrovascular and cardiovascular events. Methods Subjects (n = 358) without previous history of cardiovascular disease (CVD) were recruited and the GCVR was calculated for each patient. An ultrasound evaluation of the carotid arteries was also performed. Results Accord…

Effects of four different anti-hypertensive treatments on cardiac arrhythmias and transient episodes of myocardial ischemia in hypertensives with left ventricular hypertrophy

Subclinical Cardiotoxicity: The Emerging Role of Myocardial Work and Other Imaging Techniques.

In recent years, the cancer survival of patients has improved thanks to advances in the pharmacological field. In many guidelines, cardiotoxicity induced by anticancer drugs was defined as a reduction from baseline in the left ventricular ejection fraction (LVEF) assessed by echocardiography. It is known that LVEF is not a sensible parameter in the detection of cardiotoxicity. Therefore, a decrease from baseline in the global longitudinal strain (GLS) or troponins elevation is used to detect subclinical cardiotoxicity. LVEF and GLS as well as the increase in some biomarkers are influenced by loading conditions that are frequent during chemotherapy. Other parameters not influenced by loading…

Early Detection of Cardiac Damage

Early detection and quantification of cardiac damage in cancer patients are essential to readily intervene with cardioprotective strategies and avoid the need of the discontinuation of antineoplastic treatment.

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

Abstract Aims Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting. Methods and results In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P …

P1450Effect of overweight and obesity on left ventricular longitudinal multi-layer strain: a speckle tracking two-dimensional echocardiographic study

Coronary embolism in a young patient with nonbacterial thrombotic endocarditis related to antiphospholipid syndrome

myocardial infarction

Acute troponin i increase in absence of obstructive coronary disease: A case of takotsubo syndrome

A 66-year-old woman was admitted to the Emergency Department of Policlinico P. Giaccone, in Palermo, for non-radiating chest pain that occurred after an emotional stress. Her medical history included a positive family history for cardiovascular disease, arterial hypertension, gastro-esophageal reflux disease, and anxiety-depressive syndrome. Upon admission, the electrocardiogram showed diffuse ST-T abnormalities with an elevation of the ST segment; Troponin I was 3790 ng/L, creatine phosphokinase was 374 U/L, which became normal within 48 hours. No evidence of significant coronary artery stenosis was detected on the angiography. The echocardiogram showed apical akinesia and hyperkinesia of …

Ankle-Brachial Index as a Predictor of Cardiovascular Risk in Atrial Fibrillation

Objectives: Atrial Fibrillation (AF), the most frequent sustained arrhythmia, is associated with a high rate of morbidity and mortality. The clinical course of AF is often complicated by cardiovascular and cerebrovascular adverse events that usually have a dual origin: cardio embolic and atherothrombotic. The aim of our study is to demonstrate the existence of a relationship between Systemic Atherosclerosis and AF. More specifically, we have analysed the prevalence of lower limb Peripheral Artery Disease (PAD) in a population of fibrillating patients, and we have assessed whether the coexistence of AF and PAD might result in increased cardiovascular risks. Methods: The study has been conduc…

324Prognostic role of late gadolinium enhancement in patients with low or intermediate HCM SCD risk score: a multicenter study

Characteristics of coronary microcirculatory function in patients with Takotsubo syndrome.

Background: Takotsubo syndrome (TS) is a recently described cardiac syndrome whose pathogenesis is still unclear. We investigated the characteristics of coronary microcirculatory function in patients with TS through the analysis of the TIMI frame count (TFC) compared to normal subjects and with to subjects with microvascular angina (MA). Methods: We enrolled 71 TS patients (F:M =69:2, mean age of 65.27±9.53 years), 70 controls (F:M =34:36, mean age of 56.63±13.5 years) and 71 patients with MA, (F:M =69:2, mean age of 65.9±9.2 years). The assessment of the microcirculation was carried out through the TFC. Results: microcirculation was significantly altered in patients with TS compared with h…

Pathophysiology of anthracycline cardiotoxicity.

Anthracyclines (ANTs) are powerful drugs that have reduced the mortality of cancer patients. However, their use is limited by the development of cardiotoxicity (CTX), which is dose dependent and may lead to left ventricular dysfunction and heart failure. Although various strategies have been suggested to reduce the negative effects of ANTs, CTX is still an important unresolved clinical issue. This may be due at least partly to the incomplete characterization of the molecular and cellular mechanisms of ANT-induced CTX. In addition, although various forms of cardiac damage have been demonstrated with the use of these drugs in experimental studies, it is not yet clear how these translate to th…

INFLUENZA PROGNOSTICA DELL’ATEROSCLEROSI CAROTIDEA O PERIFERICA IN PAZIENTI CON SINDROMI CORONARICHE ACUTE.

THE ASSOCIATION BETWEEN PROGRESSION OF POST-SURGICAL CALF VEIN THROMBOSIS AND 4G/5G POLYMORPHSM IN THE PROMOTER OF THE PLASMINOGEN ACTIVATOR INHIBITOR

A case of neurogenic heart disease: is there a elationship between heart and brain?

Letters to the Editor

Prognostic Role of Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy and Low-to-Intermediate Sudden Cardiac Death Risk Score

Sudden cardiac death (SCD) is the most life-threating complication of hypertrophic cardiomyopathy. Guidelines of the European Society of Cardiology (ESC) suggest the implantation of an implantable cardioverter defibrillator in primary prevention according to a 5-year risk SCD score &gt;= 6%. The aim of the study is to evaluate the prognostic role of late gadolinium enhancement (LGE) in patients with a 5-year risk SCD score &lt;6%. In this multicenter study, we performed cardiac magnetic resonance in 354 consecutive hypertrophic cardiomy-opathy patients (257 males, range of age 54 +/- 17) with a risk SCD score &lt;6% (302 with &lt;4% and 52 with &gt;= 4 and &lt;6% risk). Hard cardiac events,…

DYSLIPIDEMIA AND CARDIOVASCULAR RISK: FOCUS ON THE ROLE OF LOW HDL-CHOLESTEROL CONCENTRATIONS IN DEVELOPING ATHEROSCLEROTIC DISEASE AND IN ACCELERATING ITS PROGRESSION FROM SUBCLINICAL LESIONS TO CLINICAL EVENTS. EVIDENCES AND THERAPEUTICAL IMPLICATIONS.

Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome.

IMPORTANCE Takotsubo syndrome (TTS) is an acute, reversible heart failure syndrome featured by significant rates of in-hospital complications. There is a lack of data for risk stratification during hospitalization. OBJECTIVE To derive a simple clinical score for risk prediction of in-hospital complications among patients with TTS. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, 1007 consecutive patients were enrolled in the German and Italian Stress Cardiomyopathy (GEIST) registry from July 1, 2007, through December 31, 2017, and identified as the derivation cohort; 946 patients were enrolled in the Spanish Registry for Takotsubo Cardiomyopathy (RETAKO) as the external score val…

Coronary microvascular dysfunction

Patients with coronary microvascular dysfunction (CMVD) represent a widespread population and despite the good prognosis, many of them have a poor quality of life with strong limitations in their daily activities because of the angina symptoms. This article summarizes the most frequent clinical presentation pictures like stable and unstable microvascular angina. Main risk factors are discussed, followed by the latest updates on the subject about different pathogenic hypotheses, diagnosis and treatment. Not very well understood microvascular alterations, like slow flow phenomenon and no reflow are discussed and both prognosis and the impact of the disease in the quality of life are analyzed.

Multimodality imaging approach to paradoxical embolism: a cauliflower mass on the Eustachian valve

The Eustachian valve was first described by Bartolomeo Eustachio (Italian anatomist) at 1552. It is an embryological remnant of the inferior vena cava valve that prenatally directs the oxygenated blood from inferior vena cava across the patent foramen ovale (PFO) into systemic circulation. Generally, following birth, after the closure of the foramen ovale it gradually regresses and not have a specific function, but it may persist in some patients as a floating membrane in the right atrium (RA), a nonpathological functionless structure.1 The prevalence of Eustachian valve in the normal population is unknown. Generally, it is an incidental finding without any significant pathophysiological co…

ATHEROSCLEROSIS ACUTE CORONARY SYNDROMES AND HEART TRANSPLANTATION

Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: A single-centre experience.

Aims Recent advancements in echocardiographic technology allow to analyse myocardial strain in multiple layers. Little is known about the impact of age on layer-specific longitudinal strain in healthy subjects. The aim of this study was to analyse the influence of age on multilayer longitudinal strain and establish normal reference values of layer-specific strain according to age decades in a healthy population referring to our echo laboratory using 2D speckle-tracking echocardiography with layer-specific software. Methods and results Two-hundred sixty-six healthy, consecutive subjects (mean age = 39.2 ± 17.5 years, women/men = 137/129), free of cardiovascular risk factors, were enrolled. S…

Subclinical atherosclerosis inflammation and events

Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology

Chemotherapy-induced cardiotoxicity (CTX) is a determining factor for the quality of life and mortality of patients administered potentially cardiotoxic drugs and in long-term cancer survivors. Therefore, prevention and early detection of CTX are highly desirable, as is the exploration of alternative therapeutic strategies and/or the proposal of potentially cardioprotective treatments. In recent years, cardiovascular imaging has acquired a pivotal role in this setting. Although echocardiography remains the diagnostic method most used to monitor cancer patients, the need for more reliable, reproducible and accurate detection of early chemotherapy-induced CTX has encouraged the introduction o…

CONTROLLO DELLA PERVIETA’ DEI VASI CORONARICI IN PAZIENTI CON CARDIOPATIA ISCHEMICA MEDIANTE TAC MULTISTRATO

CLINICAL FEATURES OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT OR WITH DIABETES MELLITUS

Aortic stenosis: insights on pathogenesis and clinical implications

Aortic stenosis (AS) is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active "atherosclerosis-like" pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces (such as mechanical stress, genetic factors and interaction between inflammation and calcification). The improved understanding presents potentially new thera…

[Cardiovascular risk profile of patients with psoriasis].

The aim of this study was to assess the cardiovascular risk profile of patients with psoriasis compared to patients without psoriasis. A case-control assay was performed using 143 cases (psoriasis patients) and 104 controls (patients without psoriasis). We assessed the presence of hypertension, lipid profile (HDL, triglycerides), diabetes, and body mass index in both cases and controls. Psoriasis patients showed an unfavorable cardiovascular risk profile and a higher risk of cardiovascular events and metabolic syndrome than patients without psoriasis.

P3691Intra-aortic balloon counterpulsation in takotsubo syndrome complicated by cardiogenic shock: short- and long-term results from a cohort of 2250 patients of the German-Italian-Spanish registry

Abstract Background Takotsubo syndrome (TTS) is featured by an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock. Intra-aortic balloon pumping (IABP) use in this setting is controversial, and few data are available from large populations. Aim of this study was therefore to evaluate short- and long-term impact of IABP on mortality in TTS complicated by cardiogenic shock. Methods The GEIST registry is a multicenter, international registry on TTS involving 38 centers from Germany, Italy and Spain. Between 2006 and 2017, 2250 consecutive patients with TTS were enrolled. Results Of the 2250 patients, 211 (9%) experienced cardiogenic shock during hospit…

The association between coronary microvascular dysfunction and carotid intima media thickness in patients with cardiac syndrome X

Abstract Objective The aim of this study was to evaluate in patients with cardiac syndrome X (CSX), using validated angiography indices, coronary blood flow and myocardial perfusion of the microcirculation to assess whether there is greater microvascular dysfunction in patients with increase of carotid intima media thickness (C-IMT), compared to those who do not have. Methods Our study was performed on a population 124 patients with CSX that underwent coronary angiography and carotid ultrasound. We divided the sample into two categories: patients with increase of C-IMT and those without increase. We calculated Gibson and Yusuf indices for each patient based on angiographic images, including…

Influence of carotid peripheral atherosclerosis on the outcome of patients with acute coronary syndrome

ARTERIOSCLEROSI

From molecular mechanisms to clinical management of antineoplastic drug-induced cardiovascular toxicity: A translational overview

Significance: Antineoplastic therapies have significantly improved the prognosis of oncology patients. However, these treatments can bring to a higher incidence of side-effects, including the worrying cardiovascular toxicity (CTX). Recent Advances: Substantial evidence indicates multiple mechanisms of CTX, with redox mechanisms playing a key role. Recent data singled out mitochondria as key targets for antineoplastic drug-induced CTX; understanding the underlying mechanisms is, therefore, crucial for effective cardioprotection, without compromising the efficacy of anti-cancer treatments. Critical Issues: CTX can occur within a few days or many years after treatment. Type I CTX is associated…

IN-HOSPITAL COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION IN HYPERTENSIVE SUBJECTS

BACKGROUND: Recent studies have shown a worse in-hospital outcome in hypertensive than in normotensive patients with acute myocardial infarction (AMI), which has been attributed to more frequent complications. The aim of this study was to investigate clinical patterns, risk factors, and in-hospital complications in hypertensive and normotensive patients with AMI. METHODS: Of 4994 consecutive patients with AMI admitted to the intensive care unit, hypertensive patients with first infarction (n = 915; mean age 68.8 +/- 11.4 years) and 915 gender- and age-matched normotensive subjects were retrospectively studied. RESULTS: In the univariate analysis, hypertensive subjects presented more frequen…

40 Slices MDCT Non-Invasive Diagnostic Approach to Coronary Artery Disease

Relationship between epicardial fat and diastolic dysfunction in obese subjects: an echocardiographic study

The planimetric Grothoff's criteria by cardiac magnetic resonance can improve the specificity of left ventricular non-compaction diagnosis in thalassemia intermedia

We differentiated the left ventricle non-compaction (LVNC) from hypertrabeculated myocardium due to a negative remodeling in thalassemia intermedia (TI) patients applying linear and planimetric criteria and comparing the cardiovascular magnetic resonance (CMR) findings. CMR images were analyzed in 181 TI patients enrolled in the Myocardial Iron Overload in Thalassemia Network and 27 patients with proved LVNC diagnosis. The CMR diagnostic criteria applied in TI patients were: a modified linear CMR Petersen’s criterion based on a more restrictive ratio of diastolic NC/C &gt; 2.5 at segmental level and the combination of planimetric Grothoff’s criteria (percentage of trabeculated LV myocardial…

Usefulness of coronary angiography with multidetector computed tomography in the evaluation of aorto-coronary bypass patency

Angioplastica percutanea con stent in pazienti con concomitante sindrome da fdurto vertebro-succlaveare e coronario-succlaveare

Angioplastica percutanea e stent nel trattamento delle lesioni steno-obliteranti della succlavia sinistra in sogetti conm furto coronarop e vertebro-succlaveare.

[Forty-slice multidetector computed tomography for non-invasive diagnostic approach to coronary artery disease]

IL MIOCARDIO NON COMPATTATO: UNA SERIE DI 177 CASI DEL REGISTRO ITALIANO DELLA SOCIETA’ ITALIANA DI ECOGRAFIA CARDIOVASCOLARE

Prognostic impact of hypertension and carotid lesions in a five years follow-up

Bicuspid aortic valve and unruptured sinus of Valsalva aneurysm, a rare association

Bicuspid aortic valve (BAV) is one of the most common forms of congenital heart defect and is associated with other congenital vascular and cardiac defects. The most common comorbidity is dilation of thoracic aorta and clinical manifestations are usually related to function of the aortic valve and to other cardiovascular acquired complications. Sinus of Valsalva aneurysm (SVA) is an uncommon congenital cardiovascular anomaly and the combination of these two anomalies is very rare. Common complications are rupture and obstruction of the termination chamber due to space-occupying effect of large unruptured aneurysms. Early cardiac imaging can help limiting morbidity and mortality in these pat…

ASSOCIAZIONE TRA ATEROSCLEROSI CAROTIDEA E MALATTIA CORONARICA: ECO-COLORDOPPLER DEI TRONCHI SOVRAORTICI E CORONAROGRAFIA A CONFRONTO IN PAZIENTI CON DOLORE TORACICO

Significato clinico e prognostico dell'aterosclerosi carotidea nella valutazione del rischio cardiovascolare globale

TRIAL FIBRILLATION AND COGNITIVE IMPAIRMENT

DO MARKERS OF PRECLINICAL ATHEROSCLEROSIS INFLUENCE GLOBAL CARDIOVASCULAR RISK?

DO MARKERS OF PRECLINICAL ATHEROSCLEROSIS INFLUENCE GLOBAL CARDIOVASCULAR RISK?

Management of Ponatinib in Patients with Chronic Myeloid Leukemia with Cardiovascular Risk Factors

Cardiovascular (CV) adverse events are considered common complications of ponatinib treatment. Recently, it has been demonstrated that ponatinib dose reductions in definite settings can obtain optimal responses and lower ponatinib-related CV events. In this study, we describe the management of 5 patients with chronic myeloid leukemia treated with ponatinib, from second to fourth line of tyrosine kinase inhibitor therapy, carrying high pre-ponatinib CV risk, who obtained optimal molecular response and developed no CV adverse event during follow-up. Among these 5 patients, 2 had diagnosis of ischemic heart disease and underwent percutaneous angioplasty, 2 had type 2 diabetes and arterial hype…

Prognosis in patients with microvascular angina: A clinical follow-up

IDIOPHATIC MONOMORPHIC VENTRICULAR TACHYCARDIA AND SYMPATHETIC IMBALANCE

IDIOPHATIC MONOMORPHIC VENTRICULAR TACHYCARDIA AND SYMPATHETIC IMBALANCE

MANAGEMENT OF CHILDREN AFFECTED BY ATRIOVENTRICULAR NODAL RE-ENTRANT TACHICARDIA

MANAGEMENT OF CHILDREN AFFECTED BY ATRIOVENTRICULAR NODAL RE-ENTRANT TACHICARDIA

TASC II - DOCUMENTO DI CONSENSO INTERSOCIETARIO TRANSATLANTICO PER IL TRATTAMENTO DELLA MALATTIA VASCOLARE PERIFERICA