Unexplained cardiac arrest after near drowning in a young experienced swimmer: insight from cardiovascular magnetic resonance imaging

Cardiac magnetic resonance imaging (cMRI) is a well-established noninvasive imaging modality in clinical cardiology. Its ability to provide tissue characterization make it well suited for the study of patients with cardiac diseases. We describe a multi-modality imaging evaluation of a 45-year-old man who experienced a near drowning event during swimming. We underline the unique capability of tissue characterization provided by cMRI, which allowed detection of subtle, clinically unrecognizable myocardial damage for understanding the causes of sudden cardiac arrest and also showed the small damages caused by cardiopulmonary resuscitation

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

Mapping Woody Volume of Mediterranean Forests by Using SAR and Machine Learning: A Case Study in Central Italy

In this paper, multi-frequency synthetic aperture radar (SAR) data at L- and C-bands (ALOS PALSAR and Envisat/ASAR) were used to estimate forest biomass in Tuscany, in Central Italy. The ground measurements of woody volume (WV, in m3/ha), which can be considered as a proxy of forest biomass, were retrieved from the Italian National Forest Inventory (NFI). After a preliminary investigation to assess the sensitivity of backscatter at C- and L-bands to forest biomass, an approach based on an artificial neural network (ANN) was implemented. The ANN was trained using the backscattering coefficient at L-band (ALOS PALSAR, HH and HV polarization) and C-band (Envisat ASAR in HH polarization) as inputs. Spatially distributed WV values for the entire test area were derived by the integration (fusion) of a canopy height map derived from the Ice, Cloud, and Land Elevation Geoscience Laser Altimeter System (ICESat GLAS) and the NFI data, in order to build a significant ground truth dataset for the training stage. The analysis of the backscattering sensitivity to WV showed a moderate correlation at L-band and was almost negligible at C-band. Despite this, the ANN algorithm was able to exploit the synergy of SAR frequencies and polarizations, estimating WV with average Pearson’s correlation coefficient (R) = 0.96 and root mean square error (RMSE) ≃ 39 m3/ha when applied to the test dataset and average R = 0.86 and RMSE ≃ 75 m3/ha when validated on the direct measurements from the NFI. Considering the heterogeneity of the scenario (Mediterranean mixed forests in hilly landscape) and the small amount of available ground measurements with respect to the spatial variability of different plots, the obtained results can be considered satisfactory. Moreover, the successful use of WV from global maps for implementing the algorithm suggests the possibility to apply the algorithm to wider areas or even to global scales

Remote sensing techniques for water management and climate change monitoring in drought areas: case studies in Egypt and Tunisia

ABSTRACTThis study focused on monitoring the water status of vegetation and soil by exploiting the synergy of optical and microwave satellite data with the aim of improving the knowledge of water cycle in cultivated lands in Egyptian Delta and Tunisian areas. Environmental analysis approaches based on optical and synthetic aperture radar data were carried out to set up the basis for future implementation of practical and cost-effective methods for sustainable water use in agriculture. Long-term behaviors of vegetation indices were thus analyzed between 2000 and 2018. By using SAR data from Sentinel-1, an Artificial Neural Network-based algorithm was implemented for estimating soil moisture and monthly maps for 2018 have been generated to be compared with information derived from optical indices. Moreover, a novel drought severity index was developed and applied to available data. The index was obtained by combining vegetation soil difference index, derived from optical data, and soil moisture content derived from SAR data. The proposed index was found capable of complementing optical and microwave sensitivity to drought-related parameters, although ground data are missing for correctly validating the results, by capturing drought patterns and their temporal evolution better than indices based only on microwave or optical data.

Patent foramen ovale occlusion with the Cocoon PFO Occluder. The PROS-IT collaborative project

BackgroundThe Cocoon patent foramen ovale (PFO) Occluder is a new generation nitinol alloy double-disk device coated with nanoplatinum, likely useful in patients with nickel hypersensitivity. Early results and mid-term outcomes of this device in percutaneous PFO closure are missing. AimsTo assess the preliminary efficacy and safety profile of PFO closure with Cocoon device in an Italian multi-center registry. MethodsThis is a prospective registry of 189 consecutive adult patients treated with the Cocoon PFO Occluder at 15 Italian centers from May 2017 till May 2020. Patients were followed up for 2 years. ResultsClosure of the PFO with Cocoon Occluder was carried out successfully in all patients, with complete closure without residual shunt in 94.7% of the patients and minimal shunt in 5.3%. Except from a case of paroxysmal supraventricular tachycardia and a major vascular bleeding, no procedural and in-hospital device-related complications occurred. No patient developed cardiac erosions, allergic reactions to nickel, or any other major complications during the follow-up. During the follow-up period, 2 cases of new-onset atrial fibrillation occurred within thirty-day. ConclusionsPercutaneous closure of PFO with Cocoon Occluder provided satisfactory procedural and mid-term clinical follow-up results in a real-world registry

Secondary prevention and follow-up of patients with ACS and not-at-target LDL: An Italian real-world retro-prospective analysis by the inertia group

Background: In patients with recent ACS, the latest ESC/EAS guidelines for management of dyslipidaemia recommend intensification of LDL-C-lowering therapy. Objective: Report a real-world picture of lipid-lowering therapy prescribed and cholesterol targets achieved in post-ACS patients before and after a specific educational program. Methods: Retrospective data collection prior to the educational course and prospective data collection after the course of consecutive very high-risk patients with ACS admitted in 2020 in 13 Italian cardiology departments, and with a non-target LDL-C level at discharge. Results: Data from 336 patients were included, 229 in the retrospective phase and 107 in the post-course prospective phase. At discharge, statins were prescribed in 98.1% of patients, alone in 62.3% of patients (65% of which at high doses) and in combination with ezetimibe in 35.8% of cases (52% at high doses). A significant reduction was obtained in total and LDL cholesterol (LDL-C) from discharge to the first control visit. Thirty-five percent of patients achieved a target LDL-C <55 mg/dL according to ESC 2019 guidelines. Fifty percent of patients achieved the <55 mg/dL target for LDL-C after a mean of 120 days from the ACS event. Conclusions: Our analysis, though numerically and methodologically limited, suggests that management of cholesterolaemia and achievement of LDL-C targets are largely suboptimal and need significant improvement to comply with the lipid-lowering guidelines for very high CV risk patients. Earlier high intensity statin combination therapy should be encouraged in patients with high residual risk

Efficacy, safety, adherence and persistence of PCSK9 inhibitors in clinical practice: A single country, multicenter, observational study (AT-TARGET-IT)

Background and aims: Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) are recommended in patients at high and very-high cardiovascular (CV) risk, with documented atherosclerotic CV disease (ASCVD), and for very-high risk patients with familial hypercholesterolaemia not achieving LDL-cholesterol (LDL-C) goal while receiving maximally tolerated dose of lipid-lowering therapy (LLT). However, single country real-life data, reporting the use of PCSK9i in clinical practice, are limited. Therefore, we designed AT-TARGET-IT, an Italian, multicenter, observational registry on the use of PCSK9i in clinical practice. Methods: All data were recorded at the time of the first prescription and at the latest observation preceding inclusion in the study. Results: 798 patients were enrolled. The median reduction in LDL-C levels was 64.9%. After stratification for CV risk, 63.8% achieved LDL-C target; of them, 83.3% took LLTs at PCSK9i initiation and 16.7% did not. 760 patients (95.2%) showed high adherence to therapy, 13 (1.6%) partial adherence, and 25 (3.1%) poor adherence. At 6 months, 99.7% of patients enrolled in the study remained on therapy; there were 519 and 423 patients in the study with a follow-up of at least 12 and 18 months, respectively. Persistence in these groups was 98.1% and 97.5%, respectively. Overall, 3.5% of patients discontinued therapy. No differences in efficacy, adherence, and persistence were found between alirocumab and evolocumab. Conclusions: PCSK9i are safe and effective in clinical practice, leading to very high adherence and persistence to therapy, and achievement of recommended LDL-C target in most patients, especially when used as combination therapy