Current Use of Oral Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation: Results from an Italian Multicenter Prospective Study-The ISNEP Study

Background: Atrial fibrillation (AF) is the most common heart arrhythmia, and its prevalence increases with age. Oral Anticoagulant Therapy (OAT) with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) is essential to avoid thromboembolic events in AF. However, this treatment is associated with a high risk of bleeding and low adherence in elderly patients. Aim: The aim was to evaluate the real-world use of OAT in a population of patients aged >= 80 years in twenty-three Italian centers and to investigate the tolerance of and patient satisfaction with this therapy. Methods: The ISNEP Study is a multicenter cross-sectional study enrolling patients with AF and aged >= 80 years and treated with either NOACs or VKAs. A written questionnaire was administered to each patient to evaluate the adherence to and patient satisfaction with this therapy. Results: The study included 641 patients with a mean age of 85 (82-87) years. The use of NOACs was reported in 93.0% of cases, with the remaining 7.0% treated with VKAs. A history of stroke events was reported in five (11.1%) and one (0.2%) patients in the VKA and NOAC groups, respectively. The rate of referred ecchymosis/epistaxis was significantly higher in the VKA group compared to the NOAC group (p < 0.001). Patients receiving NOACs reported a substantial improvement in their quality of life compared to the VKA group. Conclusions: A small, but not negligible, proportion of elderly AF patients is still treated with VKAs. Patients treated with NOAC have a higher level of satisfaction with the therapy and complete adherence

Imaging the Right Heart-Pulmonary Circulation Unit : The Role of MRI and Computed Tomography

The different components of the right heart pulmonary circulation unit can be investigated by MRI and computed tomography. MRI has clear advantages over echocardiography for accurate definition of right heart function and structure and to derive functional information regarding the pulmonary vasculature. Computed tomography is superior for the assessment of parenchymal and vascular pathologies of the lung with indications in the diagnostic work-up of pulmonary hypertension, but with more limited capability to evaluate right ventricular function and in deriving pulmonary hemodynamics. Recent technical developments with these imaging modalities could allow a better evaluation of the right heart pulmonary circulation unit

Imaging the "Hot Phase" of a Familiar Left-Dominant Arrhythmogenic Cardiomyopathy

: We describe the case of a young man with an initial diagnosis of acute myocarditis that was finally recognized as a familial left-dominant arrhythmogenic cardiomyopathy. The diagnostic process was also based on demonstration, serial cardiac magnetic resonance imaging, and typical patterns of myocardial damage, including features of the disease's inflammatory "hot phase"

Device's dehiscence 3 months after implant for mitral perivalvular leak

Our case is about a complication in a case of percutaneous closure of a perimitral leak in a patient with beleaflet mechanical mitral prosthesis. An Amplatzer vascular plug III was implanted. At the time of procedure the leak was successfully closed, however after three months a device's dehiscence developed. Percutaneous closure of mitral perivalvular leak is currently a feasible alternative in highly selected individuals, whose symptoms are not adequately palliated by medical therapy and who are at high surgical risk. Our case demonstrates that the presence of a wide calcification of the native annulus may represent a contraindication to this kind of treatment. Further studies on percutaneous approaches to perivalvular prosthetic regurgitation in presence of heavy calcification are needed, in order to define optimal patient selection and the late complications of this procedure. Moreover it will also be useful to design a device adapted for the anatomy of such defects in various sizes