Self-organization in Rome: a map

Durante gli ultimi anni, diverse ricerche sono state realizzate a Roma sul tema dello spazio e dell’autorganizzazione e molte di queste contengono importanti mappature. Tuttavia, questi processi sono molto dinamici e la situazione a Roma cambia ogni anno. Per questa ragione a novembre 2017 abbiamo deciso di realizzare, per della conferenza “City and Self-organization”, tenutasi a Roma a dicembre 2017, un aggiornamento della situazione dell’autorganizzazione romana, legata all’utilizzo dello spazio, attraverso una mappa, al fine di comprendere meglio la portata e i significati del fenomeno. Le principali domande alla base del contributo sono: perché, anche se questi spazi sono così numerosi, non riescono ad influenzare le politiche urbane? Perché sono concentrate prevalentemente in alcuni quartieri della città e cosa rappresenta questa concentrazione? Quali sono le loro caratteristiche rispetto ad altri contesi europei? In che misura riescono a cambiare le istituzioni pubbliche?During the last years many different researches regarding social spaces have been realized in Rome, sometimes containing different maps representing these experiences. Nevertheless, these processes are very dynamic and the situation of Rome changes every year. For this reason in November, 2017 we decided to realize, during the International Conference “Cities and Selforganization” held in Rome on December 2017, an updated map of all the selforganization experiences within the city of Rome in order to better understand the reach and the meanings of this phenomenon. The main questions at the base of the present research are: why, even though these spaces are so copious, are not they able in influencing urban policies? Why are they concentrated mainly in some specific quarters of the city? What are their features compared to others European cities? To what extent are they able to change the public institutions

The Swiss cheese model in takotsubo syndrome

No abstract availabl

Advanced Cardiovascular Magnetic Resonance Imaging in Takotsubo Syndrome: Update on Feature Tracking and Tissue Mapping

Backgrounds: Takotsubo syndrome (TTS) is an intriguing clinical entity characterized by transient myocardial dysfunction. The precise pathophysiological mechanism of TTS is still unknown, but recent evidence suggests a central role of systemic inflammation associated with adrenergic discharge. Although initially considered benign, TTS has shown several potential short-term and long-term complications and adverse outcomes. To improve understanding and management, advanced cardiovascular magnetic resonance (CMR) techniques, such as feature tracking (FT) and parametric mapping, have gained attention. Purpose of Review: The purpose of this review is to summarize the current literature on the clinical applications of CMR-FT and mapping in TTS. Additionally, the most significant and recent findings will be discussed. Recent Findings: FT-CMR enables the parametric quantification of myocardial deformation, allowing a comprehensive evaluation of left ventricular, right ventricular, and atrial function. It provides an accurate definition of areas of myocardial dysfunction and potentially serves as a superior prognostic tool compared to ejection fraction. Tissue mapping techniques enable precise and comprehensive tissue characterization by quantifying areas of oedema, and myocardial fibrosis. Summary: FT-CMR and mapping techniques serve as valuable prognostic tools both in the acute and chronic phases of TTS. They can detect subtle alterations and pan-cardiac involvement, while also providing important insights into the complex underlying mechanisms of the syndrome

Characterization of COVID-19-related lung involvement in patients undergoing magnetic resonance T1 and T2 mapping imaging: a pilot study

Tissue characterization by mapping techniques is a recent magnetic resonance imaging (MRI) tool that could aid the tissue characterization of lung parenchyma in coronavirus disease-2019 (COVID-19). The aim of the present study was to compare lung MRI findings, including T1 and T2 mapping, in a group of n = 11 patients with COVID-19 pneumonia who underwent a scheduled cardiac MRI, and a cohort of healthy controls. MRI scout images were used to identify affected and remote lung regions within the patients’ cohort and appropriate regions of interest (ROIs) were drawn accordingly. Both lung native T1 and T2 values were significantly higher in the affected areas of patients with COVID-19 as compared to the controls (1375 ms vs. 1201 ms, p = 0.016 and 70 ms vs. 30 ms, p < 0.001, respectively), whereas no significant differences were detected between the remote lung parenchyma of the COVID-19 patients and the controls (both p > 0.05). When a larger ROI was identified, comprising the whole lung parenchyma within the image irrespective of the affected and remote areas, the COVID-19 patients still retained higher native T1 (1278 ms vs. 1149 ms, p = 0.003) and T2 values (38 ms vs. 34 ms, p = 0.04). According to the receiver operator characteristics curves, the T2 value of the affected region retained the higher accuracy for the differentiation of the COVID-19 patients against the controls (area under the curve 0.934, 95% confidence interval 0.826–0.999). These findings, possibly driven by the ability of MRI tissue mapping to detect ongoing inflammation in the lungs of patients with COVID-19, suggest that T1 and T2 mapping of the lung is a feasible approach in this clinical scenario

Statin therapy and outcome in Takotsubo syndrome patients: Results from the multicenter international GEIST registry

Endothelial dysfunction; Statin; Takotsubo syndromeDisfunció endotelial; Estatina; Síndrome de TakotsuboDisfunción endotelial; Estatina; Síndrome de TakotsuboBackground and aims Several studies have shown that endothelial dysfunction plays a role in the pathogenesis of Takotsubo syndrome (TTS). Given the potential benefit of statin therapy on endothelial dysfunction, we hypothesized that such treatment could improve outcome. Aim of our study was to evaluate clinical characteristics and outcome of TTS patients treated with statin therapy. Methods Patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Demographic data, clinical features and drug therapy at discharge were recorded. Primary study outcome was the occurrence of all-cause death at follow-up. Results Study population included 2429 consecutive TTS patients: 1293 (53.2%) discharged on statin and 1136 (46.8%) without statin. Patients with statin were older (age 72 ± 11 vs 69 ± 13 years, p < 0.001), with higher prevalence of hypertension (74.3% vs 60.3%, p < 0.001), diabetes (21.1% vs 14.7%, p < 0.001), dyslipidemia (56.1% vs 23.3%, p < 0.001), history of coronary artery disease (13.3% vs 6.3%, p < 0.001) and lower rates of in-hospital complications (14.7% vs 19.3%, p = 0.003). Survival analysis showed similar mortality rates between groups (log rank p = 0.803). At univariable analysis, statin therapy at discharge was not associated with lower mortality (HR: 0.97, 95% CI 0.74–1.26, p = 0.803). At multivariable analysis age (HR: 1.06 95% CI 1.04–1.08, p < 0.001), male sex (HR: 1.83, 95% CI 1.20–2.80, p = 0.005), diabetes (HR: 2.55, 95% CI 1.83–3.54 p < 0.001), malignancies (HR: 2.41, 95% CI 1.68–3.44, p < 0.001) and physical trigger (HR: 2.24, 95% CI 1.62–3.10, p < 0.001) were associated with increased mortality. Conclusions Statin therapy after a TTS event was not associated with better prognosis at follow-up

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Uremic cardiomyopathy (UC) is the cardiac remodelling that occurs in patients with chronic kidney disease (CKD). It is characterised by a left ventricular (LV) hypertrophy phenotype, diastolic dysfunction and generally preserved LV ejection fraction. UC has a major role mediating the increased rate of cardiovascular events, especially heart failure related, observed in patients with CKD. Recently, the use of T1 and T2 mapping techniques on cardiac MRI has expanded the ability to characterise cardiac involvement in CKD. Native T1 mapping effectively tracks the progression of interstitial fibrosis in UC, whereas T2 mapping analysis suggests the contribution of myocardial oedema, at least in a subgroup of patients. Both T1 and T2 increased values were related to worsening clinical status, myocardial injury and B-type natriuretic peptide release. Studies investigating the prognostic relevance and histology validation of mapping techniques in CKD are awaited

Exploring the influence of takotsubo syndrome on oncologic patients' mortality

It has been reported that patients affected by takotsubo syndrome (TTS) with a concurrent diagnosis of cancer suffer from greater mortality as compared to their non-cancer counterpart. It remains unclear whether TTS worsens the prognosis of cancer patients as well. Aim of this study was to compare outcomes of cancer patients with and without TTS. We combined data from two independent cohorts: one consisted of a prospective multicentre TTS registry; the second cohort consisted of all oncologic patients from two Cardio-Oncology Outpatient Clinics, who did not have cardiovascular conditions at the time of the cardio-oncologic visit. From the TTS registry, we selected patients with cancer (cancer-TTS patients). Next, we matched these patients with those from the cardio-oncologic cohort (cancer non-TTS patients) in a 1:2 fashion by age, sex, and type and cancer staging. Study endpoint was all-cause mortality. Among 318 TTS patients, 42 (13%) had a concurrent diagnosis of cancer. Characteristics of cancer-TTS patients and of the 84 matched cancer non-TTS subjects were comparable with the exception of diabetes mellitus, which was more common in cancer non-TTS patients. All-cause mortality was similar between cancer-TTS and cancer non-TTS patients. At Cox regression analysis TTS was not associated with mortality (OR 1.4, 95% CI 0.6-3.3, p = 0.43). Our findings show that even in the presence of acute heart failure due to TTS, the prognosis of oncologic patients is driven by the malignancy itself. Our results may prove useful for integrated management of cardio-oncologic patients

Smoking influence in Takotsubo syndrome: insights from an international cohort

Aims: To assess the influence of tobacco on acute and long-term outcomes in Takotsubo syndrome (TTS).Methods: Patients with TTS from the international multicenter German Italian Spanish Takotsubo registry (GEIST) were analyzed. Comparisons between groups were performed within the overall cohort, and an adjusted analysis with 1:1 propensity score matching was conducted.Results: Out of 3,152 patients with TTS, 534 (17%) were current smokers. Smoker TTS patients were younger (63 +/- 11 vs. 72 +/- 11 years, p &lt; 0.001), less frequently women (78% vs. 90%, p &lt; 0.001), and had a lower prevalence of hypertension (59% vs. 69%, p &lt; 0.01) and diabetes mellitus (16% vs. 20%, p = 0.04), but had a higher prevalence of pulmonary (21% vs. 15%, p &lt; 0.01) and/or psychiatric diseases (17% vs. 12%, p &lt; 0.01). On multivariable analysis, age less than 65 years [OR 3.85, 95% CI (2.86-5)], male gender [OR 2.52, 95% CI (1.75-3.64)], history of pulmonary disease [OR 2.56, 95% CI (1.81-3.61)], coronary artery disease [OR 2.35, 95% CI (1.60-3.46)], and non-apical ballooning form [OR 1.47, 95% CI (1.02-2.13)] were associated with smoking status. Propensity score matching (PSM) 1:1 yielded 329 patients from each group. Smokers had a similar rate of in-hospital complications but longer in-hospital stays (10 vs. 9 days, p = 0.01). During long-term follow-up, there were no differences in mortality rates between smokers and non-smokers (5.6% vs. 6.9% yearly in the overall, p = 0.02, and 6.6%, vs. 7.2% yearly in the matched cohort, p = 0.97).Conclusions: Our findings suggest that smoking may influence the clinical presentation and course of TTS with longer in-hospital stays, but does not independently impact mortality

Statin therapy and outcome in Takotsubo syndrome patients: Results from the multicenter international GEIST registry

Background and aims: Several studies have shown that endothelial dysfunction plays a role in the pathogenesis of Takotsubo syndrome (TTS). Given the potential benefit of statin therapy on endothelial dysfunction, we hypothesized that such treatment could improve outcome. Aim of our study was to evaluate clinical characteristics and outcome of TTS patients treated with statin therapy. Methods: Patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Demographic data, clinical features and drug therapy at discharge were recorded. Primary study outcome was the occurrence of all-cause death at follow-up. Results: Study population included 2429 consecutive TTS patients: 1293 (53.2%) discharged on statin and 1136 (46.8%) without statin. Patients with statin were older (age 72&nbsp;±&nbsp;11 vs 69&nbsp;±&nbsp;13 years, p&nbsp;&lt;&nbsp;0.001), with higher prevalence of hypertension (74.3% vs 60.3%, p&nbsp;&lt;&nbsp;0.001), diabetes (21.1% vs 14.7%, p&nbsp;&lt;&nbsp;0.001), dyslipidemia (56.1% vs 23.3%, p&nbsp;&lt;&nbsp;0.001), history of coronary artery disease (13.3% vs 6.3%, p&nbsp;&lt;&nbsp;0.001) and lower rates of in-hospital complications (14.7% vs 19.3%, p&nbsp;=&nbsp;0.003). Survival analysis showed similar mortality rates between groups (log rank p&nbsp;=&nbsp;0.803). At univariable analysis, statin therapy at discharge was not associated with lower mortality (HR: 0.97, 95% CI 0.74-1.26, p&nbsp;=&nbsp;0.803). At multivariable analysis age (HR: 1.06 95% CI 1.04-1.08, p&nbsp;&lt;&nbsp;0.001), male sex (HR: 1.83, 95% CI 1.20-2.80, p&nbsp;=&nbsp;0.005), diabetes (HR: 2.55, 95% CI 1.83-3.54 p&nbsp;&lt;&nbsp;0.001), malignancies (HR: 2.41, 95% CI 1.68-3.44, p&nbsp;&lt;&nbsp;0.001) and physical trigger (HR: 2.24, 95% CI 1.62-3.10, p&nbsp;&lt;&nbsp;0.001) were associated with increased mortality. Conclusions: Statin therapy after a TTS event was not associated with better prognosis at follow-up

Age-Related Differences in Takotsubo Syndrome: Results From the Multicenter GEIST Registry

Background: The role of age in the short- and long-term prognosis of takotsubo syndrome (TTS) is controversial. The aim of the present study was to evaluate age-related differences and prognostic implications among patients with TTS. Methods and results: In total, 2492 consecutive patients with TTS enrolled in an international registry were stratified into 4 groups (&lt;45, 45-64, 65-74, and ≥75 years). The median long-term follow-up was 480 days (interquartile range, 83-1510 days). The primary outcome was all-cause mortality (in-hospital and out-of-hospital mortality). The secondary end point was TTS-related in-hospital complications. Among the 2479 patients, 58 (2.3%) were aged &lt;45 years, 625 (25.1%) were aged 45 to 64 years, 733 (29.4%) were aged 65 to 74 years, and 1063 (42.6%) were aged ≥75 years. Young patients (&lt;45 years) had a higher prevalence of men (from youngest to oldest, 24.1% versus 12.6% versus 9.7% versus 11.4%; P&lt;0.01), physical triggers (46.6% versus 27.5%, 33.9%, and 38.4%; P&lt;0.01), and non-apical forms of TTS (25.9% versus 23.7%, 12.7%, and 9%; P&lt;0.01) than those aged 45 to 64, 65 to 74, and ≥75 years. During hospitalization, young patients experienced a higher rate of in-hospital complications (32.8% versus 23.4%, 27.4%, and 31.9%; P=0.01), but in-hospital mortality was higher in the older group (0%, 1.6%, 2.9%, and 5%; P=0.001). Long-term all-cause mortality was significantly higher in the older cohort (5.6%, 6.4%, 11.3%, and 22.3%; log-rank P&lt;0.001), as was long-term cardiovascular mortality (0%, 0.9%, 1.9%, and 3.2%; log-rank P=0.01). Conclusions: Young patients with TTS have a typical phenotype characterized by a higher prevalence of male sex, non-apical ballooning patterns, and in-hospital complications. However, in-hospital and long-term mortality are significantly lower in young patients with TTS