Minerva cardioangiologica最新文献

{"title":"Cardiac contractility modulation in left ventricular systolic dysfunction: trick or treat?","authors":"M. Correale, M. Iacoviello, N. Brunetti, P. Scicchitano","doi":"10.23736/S0026-4725.20.05360-8","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05360-8","url":null,"abstract":"","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73270902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential use of frontal QRS-T angle for sudden death risk stratification in athletes.","authors":"R. Scacciavillani, M. Galli","doi":"10.23736/S0026-4725.20.05402-X","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05402-X","url":null,"abstract":"","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"7 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89155941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic interpretation in athletes.","authors":"M. Abela, Sanjay Sharma","doi":"10.23736/S0026-4725.20.05331-1","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05331-1","url":null,"abstract":"Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harbouring arrhythmogenic substrates. The precise mechanism for arrhythmogenesis is likely multifactorial, however, surges in catecholamines, electrolyte shifts, acid-base disturbances, increased core temperature and demand myocardial ischaemia are potential contributors. Although most deaths occur in middle aged and older males with atherosclerotic coronary artery disease, a significant proportion also affect young athletes with inherited or congenital cardiac abnormalities. The impact of such catastrophes on society, particularly when a young high profile athlete is affected could be considered a justified reason for identifying individuals who may be at risk. Given the rarity of deaths in young athletes, only the simplest screening test, such as the 12-lead ECG may be considered to be cost effective. The ECG is effective for detecting serious electrical diseases in young athletes such as congenital electrical accessory pathways and ion channel diseases but can also identify athletes with potential life threatening structural diseases such as hypertrophic and arrhythmogenic cardiomyopathy. One of the concerns about ECG screening is that regular intensive exercise results in several physiological alterations in cardiac structure and function that are reflected on the athlete's ECG. Sinus bradycardia, first-degree atrioventricular block, incomplete right bundle branch block, minor J-point elevation and large QRS voltages are common. Conversely, some repolarisation anomalies affecting the ST segment, T waves and QT interval may overlap with patterns observed in patients with serious cardiac diseases. The situation is complicated further because age, sex and ethnicity of the athletes also influence the ECG and there is a risk that erroneous interpretation could have serious consequences. This review will describe the normal electrical patterns of the \"athlete's heart\" and provide insights into differentiation physiological electrical patterns from those observed in serious cardiac disease.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86608203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of degenerative mitral valve prolapse in the North East of China: repair characteristics, and short-term follow-up results.","authors":"Silvia Corona,&nbsp;Paolo Barbier,&nbsp;Guangyu Liu,&nbsp;Osafo A Annoh,&nbsp;Marcio Scorsin,&nbsp;Stefano Moriggia,&nbsp;Massimo Lemma","doi":"10.23736/S0026-4725.20.05248-2","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05248-2","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess the clinical and echocardiographic characteristics of patients who underwent surgery for degenerative mitral valve prolapse (MVP) in our center, and its relation to outcomes.</p><p><strong>Methods: </strong>We enrolled 117 consecutive patients from North-East China with an echocardiographic diagnosis of MVP related mitral regurgitation (MR) between April 2018 and November 2019. A complexity scoring system was used for valve anatomy, and patients were re-evaluated at 3-6 months after surgery.</p><p><strong>Results: </strong>Most patients (57.3%) were 40-59 years old. Ejection fraction was <60% in one third, and pulmonary hypertension was present in 64.3% of operated patients. Etiology was myxomatous in 58.9%, with flail as main lesion. Leaflet involvement was posterior in 59.8% patients, anterior in 32.5%, bileaflet in 6%, and commissural in 25.6%. Lesion score was intermediate in >50% of patients, and myxomatous lesions scored higher compared to fibroelastic deficiency (FED). Degree of MR left atrial volume and estimated wedge pressure were significantly higher in intermediate and complex lesions. Repair was performed in 93/101 patients (95.8% success rate). No in-hospital major adverse events, nor deaths at follow-up were reported. Residual MR was ≤ mild in 86.7% of patients at follow-up and was associated with FED etiology and complex lesions.</p><p><strong>Conclusions: </strong>Compared to Western countries, in our sample of Chinese population degenerative severe MR occurred in younger patients. The MVP lesion characteristics are similar, can be accurately detected by non-invasive preoperative evaluation, allowing predictable results. Advanced tailored repair techniques allow excellent immediate and short-term results regardless of the underlying complexity.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"453-468"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38573433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot topics in percutaneous coronary intervention.","authors":"Patrizia Presbitero,&nbsp;Francesco Milone","doi":"10.23736/S0026-4725.20.05201-9","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05201-9","url":null,"abstract":"","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"383-385"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37685100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latest generation stents: is it time to revive the bioresorbable scaffold?","authors":"Andrea Buono,&nbsp;Alfonso Ielasi,&nbsp;Antonio Colombo","doi":"10.23736/S0026-4725.20.05188-9","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05188-9","url":null,"abstract":"<p><p>Bioresorbable scaffolds (BRS) have been introduced in the last decade in percutaneous coronary interventions. Despite several advantages being postulated, the negative results from the mid-term follow-up of the Absorb trials have tempered enthusiasm for these innovative devices. The Absorb scaffold was associated with higher rates of target-lesion failure and scaffold thrombosis when compared to current metallic stents, and for this reason was withdrawn from the market. This failure has to be considered multifactorial, involving technical and technological aspects. Continuous engineering refinements in BRS technology, means newer-generation devices are available in clinical practice, and several more are under preclinical and clinical assessment. Thinner and smaller struts, associated with a faster resorption and reendothelialization process, are at the basis of promising preclinical results for new BRS. In this review we summarize the Absorb scaffold experience and focus on the latest evidence concerning emerging new BRS, to explore if a \"BRS revival\" is conceivable.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"415-435"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38141653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience.","authors":"Antonino G Marullo,&nbsp;Elena Cavarretta,&nbsp;Giuseppe Biondi Zoccai,&nbsp;Massimo Mancone,&nbsp;Mariangela Peruzzi,&nbsp;Fernando Piscioneri,&nbsp;Patrizio Sartini,&nbsp;Francesco Versaci,&nbsp;Andrea Morelli,&nbsp;Fabio Miraldi,&nbsp;Giacomo Frati","doi":"10.23736/S0026-4725.20.05328-1","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05328-1","url":null,"abstract":"<p><strong>Background: </strong>Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe.</p><p><strong>Methods: </strong>Freely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression were used for inferential estimates.</p><p><strong>Results: </strong>Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (P=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], P=0.004).</p><p><strong>Conclusions: </strong>ECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"368-372"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37873552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of ventricular arrhythmias after biventricular defibrillator replacement: impact on safety of downgrading from CRT-D to CRT-P.","authors":"M. Nesti, Giuseppe Riccciardi, P. Pieragnoli, S. Fumagalli, M. Padeletti, A. Paoletti Perini, E. Cavarretta, L. Sciarra","doi":"10.23736/S0026-4725.20.05352-9","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05352-9","url":null,"abstract":"BACKGROUND\u0000Cardiac resynchronization therapy (CRT) reduces mortality and hospitalizations; it is debated whether CRT alone (CRT-P) or CRT plus defibrillator (CRT-D) is preferable, and still guidelines are not exhaustive. The aim of the study was to investigate whether to implant CRT-P or CRT-D in CRT-D patients who did not experience malignant arrhythmias at moment of replacement.\u0000\u0000\u0000METHODS\u0000Out of 451 heart failure patients undergoing CRT-D according to guidelines, 103 (67±10 years, 80% men) underwent device replacement with CRT-D. Every 6 months patients underwent to clinical evaluation and device interrogation and episodes of ventricular arrhythmias (VA) stored. At baseline and before replacement echocardiogram was performed. Patients were defined responders if left ventricular (LV) end-systolic volume decreased ≥15% and super-responders if LV ejection fraction increased ≥40% or ≥50%.\u0000\u0000\u0000RESULTS\u0000Mean follow-up was 75±24 months after implantation and 26±10 months after replacement. First VAs incidence per year did not decrease over time (p=0.619). Before replacement, 27 patients (26.2%, 15 responders/12 non-responders) experienced VA. After replacement, 8 patients (7.7%, 4 responders/4 non-responders) experienced VA for the first time. Super-responder condition was not associated with lower VA incidence before (=0.499) and after (p=0.339) replacement. At multivariate analysis, age was the only independent predictor of electrical appropriate therapy after substitution (ORper year =1.17; CI 95%= 1.03- 1.34; p=0.003).\u0000\u0000\u0000CONCLUSIONS\u0000Freedom from VA before device replacement does not correlate with freedom from VA after replacement, so downgrade from CRT-D to CRT-P is not feasible at replacement, in particular in the elderlies, independently of responder and super-responder condition.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88904502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous coronary intervention in women: is sex still an issue?","authors":"Stéphane Manzo-Silberman","doi":"10.23736/S0026-4725.20.05203-2","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05203-2","url":null,"abstract":"<p><p>Coronary artery disease among women presents differences in terms of clinical presentation and pathophysiology. To date, women present worse prognoses with more events and higher mortality rate. One the one hand, they are less likely addressed for invasive therapy. One the other hand, revascularization procedures, whether by bypass or by percutaneous coronary intervention, are associated with higher rates of complications and poorer prognosis. Despite higher risk factor burden and comorbidity, women are less affected by obstructive disease and plaque characteristics are more favorable than among men. Abnormalities of endothelial function and micro vascular flow reserve could explain part of the high prevalence of symptoms of angina observed among women. Due to the worse prognosis of microvascular dysfunction, particularly in women, proper diagnosis is mandatory and deserve invasive management. Outcome following ST elevation myocardial infarction is still more severe among women with higher in-hospital mortality, but sex discrepancies are observed even in elective percutaneous coronary intervention. However, improvement of techniques, drugs and devices benefited to both men and women and tend to decrease gender gap. Especially, changes in the design of newer-generation drug-eluting stents (DES) may be particularly important for women. Female sex remains a potent predictor of higher risk of bleeding and vascular complication; thus important efforts should be promoted to develop bleeding avoidance strategies. Sex-based differences still deserve dedicated investigations in terms of physiopathology, particular hormonal impacts, and specific responses to drugs and devices.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"393-404"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37865338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative neurological dysfunctions: what is their meaning in patients presenting with acute type A aortic dissection?","authors":"Ilaria Giambuzzi,&nbsp;Giorgio Mastroiacovo,&nbsp;Maurizio Roberto,&nbsp;Sergio Pirola,&nbsp;Francesco Alamanni,&nbsp;Laura Cavallotti,&nbsp;Giorgia Bonalumi","doi":"10.23736/S0026-4725.20.05230-5","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05230-5","url":null,"abstract":"<p><strong>Introduction: </strong>Type A aortic dissection (AAD) is a life-threatening disease with very high mortality. The gold standard treatment is surgical, as medical treatment has been proven to be ineffective. It is still unclear the role of preoperative neurological dysfunction in the prognosis of the patient. Therefore, the choice of performing surgery in patients with neurological symptoms is still left to the surgeon at the time of the diagnosis. The aim of this study is to make a narrative review of the current literature about the management of patients with neurological symptoms in AAD patients.</p><p><strong>Evidence acquisition: </strong>A bibliographical research was performed on PubMed, looking for papers containing the words: \"((preoperative neurological symptoms in type a aortic dissection) OR brain injury type A aortic dissection) AND (\"2010\"[Date - Publication]: \"3000\"[Date - Publication])\". A total of 35 papers were found.</p><p><strong>Evidence synthesis: </strong>A total of 6 papers were chosen to be reviewed. All of them concluded that even patients with severe neurological symptoms (up to comatose state) had a good chance to recover neurological functions after surgery if treated in the first hours from the onset of symptoms. Interestingly, a hemorrhagic stroke was rarely found.</p><p><strong>Conclusions: </strong>Preoperative neurological dysfunction have been long considered a contraindication to surgery. Nevertheless, several authors show neurological and survival good results in patients with preoperative neurological dysfunction. They also stress the importance of surgical timing finding in 5 to 10 hours the surgical time limit to improve neurological dysfunction. A preoperative neurological dysfunction could be considered a strong advice towards surgical intervention. It is time to change and consider prompt surgery not only for survival but also for cerebral protection.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"68 5","pages":"511-517"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38032967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}