TAKO-TSUBO CARDIOMYOPATHY AND THYROID DYSFUNCTION

This work provides important information about the correlation between Tako-Tsubo Cardiomyopathy (TTC) and Thyroid dysfunction (TD). The article gives evidence to how doctors may have to refer to when confronted with a patients with such condiction as thyroid dysfunction and TTC, and the diverse methods that can be used to treat these conditions (TTC with TD)

Hiding in plain sight: observing planet-starspot crossings with the James Webb Space Telescope

Transiting exoplanets orbiting active stars frequently occult starspots and faculae on the visible stellar disc. Such occultations are often rejected from spectrophotometric transits, as it is assumed they do not contain relevant information for the study of exoplanet atmopsheres. However, they can provide useful constraints to retrieve the temperature of active features and their effect on transmission spectra. We analyse the capabilities of the James Webb Space Telescope in the determination of the spectra of occulted starspots, despite its lack of optical wavelength instruments on board. Focusing on K and M spectral types, we simulate starspots with different temperatures and in different locations of the stellar disc, and find that starspot temperatures can be determined to within a few hundred kelvins using NIRSpec/Prism and the proposed NIRCam/F150W2$+$F322W2's broad wavelength capabilities. Our results are particularly promising in the case of K and M dwarfs of mag$_K \leq 12.5$ with large temperature contrasts

Comparative analysis of right ventricular strain in Fabry cardiomyopathy and sarcomeric hypertrophic cardiomyopathy

Aims To perform a comparative analysis of right ventricle (RV) myocardial mechanics, assessed by 2D speckle-tracking echocardiography (2D-STE), between patients with Fabry disease and patients with sarcomeric disease.Methods and results Patients with Fabry cardiomyopathy (FC) (n = 28) were compared with patients with sarcomeric hypertrophic cardiomyopathy (HCM), matched for degree of left ventricle hypertrophy (LVH) and demographic characteristics (n = 112). In addition, patients with Fabry disease and no LVH [phenotype-negative carriers of pathogenic alpha-galactosidase gene mutations (GLA LVH-)] (n = 28) were compared with age and sex-matched carriers of sarcomeric gene mutations without LVH [Phenotype-negative carriers of pathogenic sarcomeric gene mutations (Sarc LVH-)] (n = 56). Standard echocardiography and 2D-STE were performed in all participants. Despite a subtle impairment of RV global longitudinal strain (RV-GLS) was common in both groups, patients with FC showed a more prominent reduction of RV free wall longitudinal strain (RV-FWS) and lower values of difference between RV-FWS and RV-GLS (Delta RV strain), in comparison to individuals with HCM (P Conclusion Patients with FC show a specific pattern of RV myocardial mechanics, characterized by a larger impairment of RV-FWS and lower Delta RV strain in comparison to patients with HCM, which may be helpful in the differential diagnosis between these two diseases.[GRAPHICS].</p

Patients with acute myocardial infarction and non-obstructive coronary arteries: Safety and prognostic relevance of invasive coronary provocative tests

Functional alterations of epicardial coronary arteries or coronary microcirculation represent a frequent cause of myocardial infarction and non-obstructive coronary arteries (MINOCA). We aimed at assessing the prognostic value of intracoronary provocative tests in patients presenting with MINOCA and in which other causes of MINOCA have been excluded. Methods and results We prospectively evaluated patients with a diagnosis of MINOCA, excluding patients with aetiologies other than suspected coronary vasomotor abnormalities. Immediately after coronary angiography, an invasive provocative test using acetylcholine or ergonovine was performed. The incidence of death from any cause, cardiac death, and recurrence of acute coronary syndrome (ACS) was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires (SAQ). We enrolled 80 consecutive patients [mean age 63.0±10.7 years, 40 (50%) male]. Provocative test was positive in 37 (46.2%) patients without any complication. Among patients with a positive test, epicardial spasm was detected in 24 (64.9%) patients and microvascular spasm in 13 (35.1%) patients. After a median follow-up of 36.0 (range 12.0-60.0)months, patients with a positive test had a significantly higher occurrence of death from any cause [12 (32.4%) vs. 2 (4.7%); P= 0.002], cardiac death [7 (18.9%) vs. 0 (0.0%); P= 0.005], and readmission for ACS [10 (27.0%) vs. 3 (7.0%); P= 0.015] as well as a worse angina status as assessed by SAQ [Seattle score: 88.0 (33.0-100.0) vs. 100.0 (44.0-100.0); P = 0.001] when compared with patients with a negative test. Conclusions We demonstrate that in patients presenting with MINOCA and suspected coronary vasomotor abnormalities, a positive provocative test for spasm is safe and identifies a high-risk subset of patients

Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk. an expert-based multidisciplinary delphi consensus

Background: Continuous glucose monitoring (CGM) shows in more detail the glycaemic pattern of diabetic subjects and provides several new parameters (“glucometrics”) to assess patients’ glycaemia and consensually guide treatment. A better control of glucose levels might result in improvement of clinical outcome and reduce disease complications. This study aimed to gather an expert consensus on the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk or with heart disease. Methods: A list of 22 statements concerning type of patients who can benefit from CGM, prognostic impact of CGM in diabetic patients with heart disease, CGM use during acute cardiovascular events and educational issues of CGM were developed. Using a two-round Delphi methodology, the survey was distributed online to 42 Italian experts (21 diabetologists and 21 cardiologists) who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. Results: Forty experts (95%) answered the survey. Every statement achieved a positive consensus. In particular, the panel expressed the feeling that CGM can be prognostically relevant for every diabetic patient (70%) and that is clinically useful also in the management of those with type 2 diabetes not treated with insulin (87.5%). The assessment of time in range (TIR), glycaemic variability (GV) and hypoglycaemic/hyperglycaemic episodes were considered relevant in the management of diabetic patients with heart disease (92.5% for TIR, 95% for GV, 97.5% for time spent in hypoglycaemia) and can improve the prognosis of those with ischaemic heart disease (100% for hypoglycaemia, 90% for hyperglycaemia) or with heart failure (87.5% for hypoglycaemia, 85% for TIR, 87.5% for GV). The experts retained that CGM can be used and can impact the short- and long-term prognosis during an acute cardiovascular event. Lastly, CGM has a recognized educational role for diabetic subjects. Conclusions: According to this Delphi consensus, the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk is promising and deserves dedicated studies to confirm the experts’ feeling

Perspectives in noninvasive imaging for chronic coronary syndromes

Both the latest European guidelines on chronic coronary syndromes and the American guidelines on chest pain have underlined the importance of noninvasive imaging to select patients to be referred to invasive angiography. Nevertheless, although coronary stenosis has long been considered the main determinant of inducible ischemia and symptoms, growing evidence has demonstrated the importance of other underlying mechanisms (e.g., vasospasm, microvascular disease, energetic inefficiency). The search for a pathophysiology-driven treatment of these patients has therefore emerged as an important objective of multimodality imaging, integrating "anatomical" and "functional" information. We here provide an up-to-date guide for the choice and the interpretation of the currently available noninvasive anatomical and/or functional tests, focusing on emerging techniques (e.g., coronary flow velocity reserve, stress-cardiac magnetic resonance, hybrid imaging, functional-coronary computed tomography angiography, etc.), which could provide deeper pathophysiological insights to refine diagnostic and therapeutic pathways in the next future

HADES RV Programme with HARPS-N at TNG. IV. Time resolved analysis of the Ca II H&K and Hα chromospheric emission of low-activity early-type M dwarfs

Context. M dwarfs are prime targets for current and future planet search programs, particularly those focused on the detection and characterization of rocky planets in the habitable zone. In this context, understanding their magnetic activity is important for two main reasons: it affects our ability to detect small planets and it plays a key role in the characterization of the stellar environment. Aims: We analyze observations of the Ca II H&K and Hα lines as diagnostics of chromospheric activity for low-activity early-type M dwarfs. Methods: We analyze the time series of spectra of 71 early-type M dwarfs collected in the framework of the HADES project for planet search purposes. The HARPS-N spectra simultaneously provide the Ca II H&K doublet and the Hα line. We develop a reduction scheme able to correct the HARPS-N spectra for instrumental and atmospheric effects, and also to provide flux-calibrated spectra in units of flux at the stellar surface. The Ca II H&K and Hα fluxes are then compared with each other, and their time variability is analyzed. Results: We find that the Ca II H and K flux excesses are strongly correlated with each other, while the Hα flux excess is generally less correlated with the Ca II H&K doublet. We also find that Hα emission does not increase monotonically with the Ca II H&K line flux, showing some absorption before being filled in by chromospheric emission when Ca II H&K activity increases. Analyzing the time variability of the emission fluxes, we derive a tentative estimate of the rotation period (on the order of a few tens of days) for some of the program stars, and the typical lifetime of chromospheric active regions (on the order of a few stellar rotations). Conclusions: Our results are in good agreement with similar previous studies. In particular, we find evidence that the chromospheres of early-type M dwarfs could be characterized by different filament coverage, affecting the formation mechanism of the Hα line. We also show that chromospheric structure is likely related to spectral type

The HADES RV programme with HARPS-N at TNG. XI. GJ 685 b: a warm super-Earth around an active M dwarf

Context. Small rocky planets seem to be very abundant around low-mass M-type stars. Their actual planetary population is however not yet precisely understood. Currently, several surveys aim to expand the statistics with intensive detection campaigns, both photometric and spectroscopic. Aims: The HADES program aims to improve the current statistics through the in-depth analysis of accurate radial-velocity (RV) monitoring in a narrow range of spectral sub-types, with the precision needed to detect small planets with a few Earth masses. Methods: We analyse 106 spectroscopic HARPS-N observations of the active M0-type star GJ 685 taken over the past five years. We combine these data with photometric measurements from different observatories to accurately model the stellar rotation and disentangle its signals from genuine Doppler planetary signals in the RV data. We run an MCMC analysis on the RV and activity index time series to model the planetary and stellar signals present in the data, applying Gaussian Process regression technique to deal with the stellar activity signals. Results: We identify three periodic signals in the RV time series, with periods of 9, 24, and 18 d. Combining the analyses of the photometry of the star with the activity indexes derived from the HARPS-N spectra, we identify the 18 d and 9 d signals as activity-related, corresponding to the stellar rotation period and its first harmonic, respectively. The 24 d signal shows no relation to any activity proxy, and therefore we identify it as a genuine planetary signal. We find the best-fit model describing the Doppler signal of the newly found planet, GJ 685 b, corresponding to an orbital period Pb = 24.160-0.047+0.061 d and a minimum mass MP sin i = 9.0-1.8+1.7 M⊕. We also study a sample of 70 RV-detected M-dwarf planets, and present new statistical evidence of a difference in mass distribution between the populations of single- and multi-planet systems, which can shed new light on the formation mechanisms of low-mass planets around late-type stars. Based on observations made with the Italian Telescopio Nazionale Galileo (TNG), operated on the island of La Palma by the INAF - Fundación Galileo Galilei at the Roche de Los Muchachos Observatory of the Instituto de Astrofísica de Canarias (IAC); photometric observations made with the APACHE array located at the Astronomical Observatory of the Aosta Valley; photometric observations made with the robotic telescope APT2 (within the EXORAP programme) located at Serra La Nave on Mt. Etna

HADES RV Programme with HARPS-N at TNG. XIII. A sub-Neptune around the M dwarf GJ 720 A

Context. The high number of super-Earth and Earth-like planets in the habitable zone detected around M-dwarf stars in recent years has revealed these stellar objects to be the key to planetary radial velocity (RV) searches. Aims: Using the HARPS-N spectrograph within The HArps-n red Dwarf Exoplanet Survey (HADES) we have reached the precision needed to detect small planets with a few Earth masses using the spectroscopic radial velocity technique. HADES is mainly focused on the M-dwarf population of the northern hemisphere. Methods: We obtained 138 HARPS-N RV measurements between 2013 May and 2020 September of GJ 720 A, classified as an M0.5 V star located at a distance of 15.56 pc. To characterize the stellar variability and to distinguish the periodic variation due to the Keplerian signals from those related to stellar activity, the HARPS-N spectroscopic activity indicators and the simultaneous photometric observations with the APACHE and EXORAP transit surveys were analyzed. We also took advantage of TESS, MEarth, and SuperWASP photometric surveys. The combined analysis of HARPS-N RVs and activity indicators let us address the nature of the periodic signals. The final model and the orbital planetary parameters were obtained by simultaneously fitting the stellar variability and the Keplerian signal using a Gaussian process regression and following a Bayesian criterion. Results: The HARPS-N RV periodic signals around 40 days and 100 days have counterparts at the same frequencies in HARPS-N activity indicators and photometric light curves. We thus attribute these periodicities to stellar activity; the first period is likely associated with the stellar rotation. GJ 720 A shows the most significant signal at 19.466 ± 0.005 days with no counterparts in any stellar activity indices. We hence ascribe this RV signal, having a semi-amplitude of 4.72 ± 0.27 m s−1, to the presence of a sub-Neptune mass planet. The planet GJ 720 Ab has a minimum mass of 13.64 ± 0.79 M⊕, it is in circular orbit at 0.119 ± 0.002 AU from its parent star, and lies inside the inner boundary of the habitable zone around its parent star. Based on observations collected at the Italian Telescopio Nazionale Galileo (TNG), operated on the island of La Palma by the Fundación Galileo Galilei of the INAF (Istituto Nazionale di Astrofisica) at the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofísica de Canarias, in the framework of the HArps-n red Dwarf Exoplanet Survey (HADES)