Early interventricular septum rupture after systemic thrombolysis in a patient with STEMI

Intraventricular septal rupture (ISR) is one of the most dreadful complications during AMI, requiring early diagnosis and urgent surgery. However, medical (90%) and surgical (50%) mortality remain elevated. We report a case of a 59 years old patient with inferoposterior AMI complicated by ISR after thrombolysis. Despite early recognition of this complication by trans-thoracic echocardiography at bedside and prompt surgical intervention the patient died on the second post-surgical day

Optimal anticoagulation in patients with atrial fibrillation and bioprosthetic heart valves

The antithrombotic management of patients after surgical or transcatheter bioprosthetic heart valves (BHVs) replacement is still challenging. Our review aims to describe the current evidence on the best antithrombotic strategy among patients undergoing BHVs replacement (surgical or transcatheter) and/or valve repair, with particular attention to those with atrial fibrillation

The glacial traces in the «parco Nazionale d 'A bruzzo » area (Central Apennines): Preliminary note

In the mountainous area of the «Parco Nazionale d' Abruzzo », characterized by several massifs with maximum altitudes frequently above the 2 000 m, a large number of glacial traces can be observed. The examination of new evidence discovered and the re -examination of those already known has permitted to reconstruct several distinct glacial events. In the studied area the cirques are the most frequent forms due to glacial modelling, even though other glacial remains like troughs and moraine deposits are found in association with them. In a number of places the existence of several episods of glaciation is provided by the occurence of a cirque stairway observed on the same slope. Starting from the more complete and best preserved local sequence an attempt was made to put into order all the other glacial traces. Correlations have been based on relative position and morphology of the cirques and the snow limits. As a result, it seemed likely to refer the observed evidence to four distinct events of glaciation. The first glacial event (pre -wiirmian glaciation, probably Riss) is characterized by a snow limit situated about 1 340 meters a.s.l, and evidenced by few glacial forms in the massifs of Toppe del Tesoro, S. Nicola and the Meta Mountains. They consist of large badly preserved cirque-like depressions situated about 1 300-1 400 meters a.s.l., and moraine deposits whose position and distribution largely contrasts with the actual orographic configuration. During a new glacial advance (maximum wiirrnian expansion) the snow limit rised to 1 560 m. Numerous are the traces relative to this ad vance, consisting in a large number of erosional forms , like cirques and glacial troughs, and morainic deposits which frequently preserve their ori ginal morphology forming lateral and frontal moraines. The third event (first late Wiirmian stage = first apenninic stage of FEDERICI, 1979) is characterized by a further rise of the snow limit now situated about 1 760 m. The evidences rel ative to this minor expansion consist only of erosional forms except one morainic deposit rico gnized on the eastern side of the Meta Mountains. Effects relative to the fourth event (second late Wiirmian stage = second apenninic sta ge of FEDERICI, 1979) can be observed only in the reliefs situated North of the Sangro Valley and in the Meta Mountains, while in the other reliefs the snow limit, situated about 1 970 m, had already reached or passed the altitude of their highest peaks. A summary examination of the distribution and the morphological features of the glacial traces studied shows that the area South of the Sangro valley seems to have developed greater glaciers that the part of the studied area situated at the North of the same valley.Published121-1331TR. GeorisorseJCR Journa

Atrial Fibrillation and Malignancy: The Clinical Performance of Non-Vitamin K Oral Anticoagulants-A Systematic Review

Atrial fibrillation (AF) is commonly diagnosed in the setting of active cancer. Because of an increased risk of either thromboembolic events or bleeding, the decision to initiate therapeutic anticoagulation in patients with active cancer can be challenging. Moreover, little is still known about the optimal anticoagulation therapy in the setting of AF and cancer, and no guidelines are as yet available. Considering that nonvitamin K antagonist oral anticoagulants (NOACs) are recommended as alternatives to vitamin K antagonists for stroke prevention in AF patients with CHA2DS2-VASc score ≥2, the authors performed a systematic review of the current literature to describe the efficacy and safety of NOACs in AF patients with malignancy

TAKOTSUBO CARDIOMYOPATHY AS EPIPHENOMENON OF CARDIOTOXICITY IN CANCER PATIENTS: A META SUMMARY OF CASE REPORTS

Many antitumoral drugs have been linked to takotsubo cardiomyopathy, with no clear pathogenetic mechanisms. Data about this condition are lacking in literature. The aim of this meta-summary is to summarize the characteristics of patients with anti-tumoral drug-induced takotsubo cardiomyopathy, described in case reports available in literature.We searched for published case reports in PubMed, Google Scholar, EMBASE, and Scopus from 2009 about stress cardiomyopathy and antiblastic drugs. We selected 41 case reports.All cases underwent chemotherapy/immunotherapy for different types of cancer. Median age was 58 years old, 61% of them were women. The most common comorbidities were hypertension (12,2%) and dyslipidemia (4,9%), but most of the population had no past cardiological clinical history. Takotsubo cardiomyopathy is associated to the 5-fluorouracil (36,5%), Capecitabine (9,7%), Trastuzumab (9,7%) and ICIs (9,7%) treatment. The median time of onset was 2 days (1-150). Cardiogenic shock was the first manifestation in 11 patients (26,8%). Left ventricle ejection fraction recovery was showed in 33 patients (89%) with mean EF 57,7±7 %, after a median of 30 days (4-300) follow-up.Cancer patients experienced takotsubo cardiomyopathy within few days from the beginning of therapy and the most of them normalized the heart function in few weeks. Cardiogenic shock showed high prevalence in this setting of patients. Larger studies are needed to better understand the pathological mechanisms of antiblastic drugs-induced stress cardiomyopathy, to find risk factors associated and preventive strategies for limit this type of cardiotoxicities

TAKOTSUBO CARDIOMYOPATHY AS EPIPHENOMENON OF CARDIOTOXICITY IN CANCER PATIENTS

Many antitumoral drugs have been linked to takotsubo cardiomyopathy, with no clear pathogenetic mechanisms. Data about this condition are lacking in literature. The aim of this meta-summary is to summarize the characteristics of patients with anti-tumoral drug-induced takotsubo cardiomyopathy, described in case reports available in literature.We searched for published case reports in PubMed, Google Scholar, EMBASE, and Scopus from 2009 about stress cardiomyopathy and antiblastic drugs. We selected 41 case reports.All cases underwent chemotherapy/immunotherapy for different types of cancer. Median age was 58 years old, 61% of them were women. The most common comorbidities were hypertension (12,2%) and dyslipidemia (4,9%), but most of the population had no past cardiological clinical history. Takotsubo cardiomyopathy is associated to the 5-fluorouracil (36,5%), Capecitabine (9,7%), Trastuzumab (9,7%) and ICIs (9,7%) treatment. The median time of onset was 2 days (1-150). Cardiogenic shock was the first manifestation in 11 patients (26,8%). Left ventricle ejection fraction recovery was showed in 33 patients (89%) with mean EF 57,7±7 %, after a median of 30 days (4-300) follow-up.Cancer patients experienced takotsubo cardiomyopathy within few days from the beginning of therapy and the most of them normalized the heart function in few weeks. Cardiogenic shock showed high prevalence in this setting of patients. Larger studies are needed to better understand the pathological mechanisms of antiblastic drugs-induced stress cardiomyopathy, to find risk factors associated and preventive strategies for limit this type of cardiotoxicities

Edoxaban (LIXIANA®) in the treatment of venous thromboembolism

Standard therapy for venous thromboembolism (VTE) includes the use of heparins and vitamin K antagonists. Randomized clinical trials have shown that non-vitamin K oral anticoagulants are as effective and safe as standard therapy in VTE treatment, with an improved pharmacological profile. Edoxaban, a direct inhibitor of factor Xa, has demonstrated noninferiority to standard therapy for the treatment of VTE, preserving a high safety profile even in long-term therapy, in frail patients and in severe clinical presentations. The present paper focuses on the role of edoxaban in VTE treatment, from general population to cancer patients, presenting the available data from randomized clinical trials and real world, to discuss edoxaban use in clinical practice.Lay abstractAnticoagulants are the main treatment for venous thromboembolism (VTE), a condition in which a blood clot forms in the deep veins of the body, in areas such as the leg. Currently, direct oral anticoagulants are available as an alternative to warfarin, a drug that is sensitive to changes in the diet and requires constant monitoring. Direct-oral anticoagulants have been shown in large-scale studies to be as effective and safe as warfarin in the treatment of this disease, with the advantage of not being affected by the food the patient eats. Among these, edoxaban only needs to be taken once a day and has obtained many favorable results in high-risk populations (such as the elderly, patients with cancer, those receiving prolonged treatment or those with severe VTE). In this review we discuss the role of edoxaban for the treatment of VTE in several scenarios and review its role in clinical practice.Tweetable abstractEdoxaban is effective and safe for the treatment of venous thromboembolism (VTE) even in special population. Caution is needed in some patients to avoid major bleeding events. Favorable results are also shown in the ETNA VTE study, a real-world data prospective registry. #edoxaban #VTE #efficacy #safet

The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator

Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy

Cardiac damage in athlete's heart: When the "supernormal" heart fails!

Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete's blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete's heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded

The Impact of the COVID-19 Outbreak on Patients’ Adherence to PCSK9 Inhibitors Therapy

PCSK9 inhibitors (PCSK9i) are monoclonal antibodies that have been shown to be effective in reducing both LDL cholesterol (LDL-C) values and major cardiovascular events in patients at high cardiovascular risk. Adherence to PCSK9i is critical for the success of the treatment. The aim of the present study is to evaluate patients’ adherence to PCSK9i during the COVID-19 pandemic. Patients referred to the Cardiac Diagnostic Unit of the University of Campania “Luigi Vanvitelli” Naples, taking PCSK9i, and who missed the cardiological follow-up visit during the first national COVID-19 lockdown (9 March–17 May 2020), were included. Each patient underwent medical teleconsultation to collect current clinical conditions, adherence to drug treatments, and lipid profile laboratory tests. Among 151 eligible patients, 20 were excluded for missing or untraceable telephone numbers and one for refusing to join the interview. The selected study population consisted of 130 patients (64 ± 9 years, 68% males), of whom 11 (8.5%) reported a temporary interruption of the PCSK-9 therapy for a mean period of 65 ± 1.5 days. The non-adherent patients showed a marked increase in LDL-C than in the pre-pandemic period (90.8 ± 6.0 vs. 54.4 ± 7.7 mg/dL, p < 0.0001), and 82% of patients moved out of the LDL-C therapeutic range. The non-adherent group was more likely to have a very high cardiovascular risk compared to the adherent group (81.8 vs. 33.6%, p < 0.001). Causes of interruption included drug prescription failure (63.6%) due to temporary interruption of the non-urgent outpatient visits and failure in drug withdrawal (36.4%) due to patients’ fear of becoming infected during the pandemic. The COVID-19 lockdown caused a remarkable lack of adherence to PCSK9i therapy, risking negative implications for the health status of patients at high cardiovascular risk. Facilitating patients’ access to PCSK9i and enhancing telemedicine seem to be effective strategies to ensure the continuity of care and appropriate management of these patients