Narrative Medicine to integrate patients’, caregivers’ and clinicians’ migraine experiences: the DRONE multicentre project

Background: Although migraine is widespread and disabling, stigmatisation and poor awareness of the condition still represent barriers to effective care; furthermore, research on migraine individual and social impact must be enhanced to unveil neglected issues, such as caregiving burden. The project investigated the migraine illness experience through Narrative Medicine (NM) to understand daily life, needs and personal resources of migraneurs, their caregivers and clinicians, and to provide insights for clinical practice. Methods: The project involved 13 Italian headache centres and targeted migraneurs, their caregivers and migraine specialists at these centres. Written narratives, composed by a sociodemographic survey and illness plot or parallel chart, were collected through the project’s webpage. Illness plots and parallel charts employed open words to encourage participants’ expression. Narratives were analysed through Nvivo software, interpretive coding and NM classifications. Results: One hundred and seven narratives were collected from patients and 26 from caregivers, as well as 45 parallel charts from clinicians. The analysis revealed migraine perception in social, domestic and work life within the care pathway evolution and a bond between chaos narratives and day loss due to migraine; furthermore, narratives suggested the extent of the caregiving burden and a risk of underestimation of migraine burden in patients’ and caregivers’ life. Conclusion: The project represents the first investigation on migraine illness experience through NM simultaneously considering migraneurs’, caregivers’ and clinicians’ perspectives. Comparing narratives and parallel charts allowed to obtain suggestions for clinical practice, while NM emerged as able to foster the pursuing of migraine knowledge and awareness

Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis

reserved6noPurpose of Review: The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT). Recent Findings: CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT. However, the concepts, limits, and potential applications of all these echocardiographic evaluations are unclear to most clinicians. Summary: The use of left ventricular dyssynchrony and discoordination indices may help to identify those significant mechanical alterations whose correction may increase the probability of a favorable CRT response. Assessment of myocardial work and intracardiac flow dynamics may overcome some limitations of the conventional evaluation of cardiac mechanics but more investigations are needed before extensive clinical application.mixedMele D.; Trevisan F.; Fiorencis A.; Smarrazzo V.; Bertini M.; Ferrari R.Mele, D.; Trevisan, F.; Fiorencis, A.; Smarrazzo, V.; Bertini, M.; Ferrari, R

Ruolo attuale dell’imaging cardiaco nella diagnosi di endocardite infettiva [Role of cardiac imaging in the diagnosis of infective endocarditis]

L’endocardite infettiva è una malattia di riscontro sempre più frequente in ambito ospedaliero. Anche se le linee guida della Società Europea di Cardiologia del 2015 trattano in maniera estensiva molti aspetti dell’endocardite infettiva, vi sono problematiche relative alla diagnosi e in particolare all’uso appropriato delle metodiche di imaging cardiaco che richiedono un ulteriore approfondimento. L’obiettivo di questa rassegna è analizzare vantaggi e limiti delle metodiche di imaging ecocardiografiche, radiologiche e nucleari al fine di identificare percorsi diagnostici applicabili nella pratica clinica.Infective endocarditis is an increasingly common disease in the hospital setting. Although the 2015 guidelines of the European Society of Cardiology deal extensively with many aspects of infective endocarditis, there are still unsolved problems related to diagnosis, in particular to the appropriate use of cardiac imaging methods, that require further study. The aim of this review is to analyze the advantages and limitations of the echocardiographic, radiological and nuclear imaging methods in order to identify diagnostic pathways applicable in clinical practice

Ruolo attuale dell'ecocardiografia nei pazienti con fibrillazione atriale [Current role of echocardiography in patients with atrial fibrillation]

Atrial fibrillation is the most common arrhythmia encountered in clinical practice. Cardiologists are often called upon to manage atrial fibrillation both in the acute urgent setting for the presence of hemodynamic compromise and electively for rhythm and/or heart rate control as well as for anti-remodeling strategies. In all these cases echocardiography is generally used. In particular, different echocardiographic techniques (transthoracic, transesophageal) and modalities (two-dimensional, three-dimensional, speckle tracking) can be indicated depending on the stage of the arrhythmia management and the need for cardioversion or interventional procedures. The purpose of this review is to clarify the current role of echocardiography, including specific techniques and modalities, in the managing process of atrial fibrillation

Ruolo attuale dell’ecocardiografia nei pazienti con embolia polmonare [Current role of echocardiography in patients with pulmonary disease]

Pulmonary embolism is a major health problem. Clinical presentation may vary from cardiovascular emergency with high mortality risk to mild or atypical illness, and the diagnosis is not always easy. However, the timeliness of diagnosis and prognostic stratification are crucial because immediate treatment and thromboembolic prophylaxis are highly effective. Echocardiography can play a key role in pulmonary embolism regarding different aspects: diagnosis, risk stratification, and follow-up but sometimes it is not properly used. Therefore, it is important for a physician to know exactly how to utilize echocardiography in pulmonary embolism. The purpose of this paper is to review the role of echocardiography as part of the diagnosis, management and follow-up of acute pulmonary embolism in the light of current literature

Cardiac resynchronization therapy guided by multimodality cardiac imaging

Aims: Up to 30\u201345% of implanted patients are non-responders to CRT. We evaluated the role of a \u2018CRT team\u2019 using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing. Methods and results: A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of 6515% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The \u2018CRT team\u2019 identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT. Conclusions: Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate

Impact of the “atherosclerotic pabulum” on in-hospital mortality for SARS-CoV-2 infection. Is calcium score able to identify at-risk patients?

Background: Although the primary cause of death in COVID-19 infection is respiratory failure, there is evidence that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID-19 is associated with a high incidence of thrombotic complications. Hypothesis: Evaluate if the coronary artery calcium (CAC) score was useful to predict in-hospital (in-H) mortality in patients with COVID-19. Secondary end-points were needed for mechanical ventilation and intensive care unit admission. Methods: Two-hundred eighty-four patients (63, 25 years, 67% male) with proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who had a noncontrast chest computed tomography were analyzed for CAC score. Clinical and radiological data were retrieved. Results: Patients with CAC had a higher inflammatory burden at admission (d-dimer, p =.002; C-reactive protein, p =.002; procalcitonin, p =.016) and a higher high-sensitive cardiac troponin I (HScTnI, p = 200 ng/dl was a better determinant of all outcomes in both univariate (p = <.001) and multivariate analysis (p = <.001). Conclusion: The main finding of our research is that CAC was positively related to in-H mortality, but it did not completely identify all the population at risk of events in the setting of COVID-19 patients. This raises the possibility that other factors, including the presence of soft, unstable plaques, may have a role in adverse outcomes in SARS-CoV-2 infection