Suspected Takotsubo syndrome recurrence and asymptomatic malignant ventricular arrhythmias: the possible role of wearable cardioverter defibrillators No abstract available

Prognostic impact of anemia according to frailty status in elderly patients with acute coronary syndromes Aims Anemia is associated with poorer outcomes in patients with acute coronary syndromes (ACS), but the magnitude of this association in elderly patients remains poorly understood. No study has assessed the prognostic impact of anemia according to frailty status in this setting. Methods The LONGEVO-SCA registry included unselected ACS patients aged at least 80 years. A geriatric assessment was performed during hospitalization, including frailty assessment using the FRAIL scale. Anemia was defined by the WHO criteria. We evaluated the impact of anemia on 6-month mortality according to the presence of frailty. Results A total of 517 patients were assessed. Mean age was 84.3 years, and a total of 236 patients (45.6%) had anemia. Patients with anemia had a higher prevalence of comorbidities and higher prevalence of frailty (30.6 vs. 22.3%, P = 0.007). A total of 60 patients (12.1%) died at 6 months [40 with anemia (17.5%) and 20 without anemia (7.5%), P = 0.001]. Anemia was independently associated with mortality at 6 months in the whole cohort (hazard ratio 2.28, 95% CI 1.13–457, P = 0.021). The association of anemia and mortality was different according to frailty status, being significant in patients without frailty (hazard ratio 3.94, 95% CI 1.84–8.45, P = 0.001), but not in frail patients (hazard ratio 1.17, 95% CI 0.53–2.57, P = 0.705), (P value for interaction = 0.035). Conclusion A high proportion of elderly patients with ACS have anemia, leading to a worse prognosis in the whole cohort. The association between anemia and mortality was especially significant in robust patients, whereas the poorer prognosis in frail patients was not modified by the presence of anemia. Correspondence to Albert Ariza-Solé, Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain Tel: +34 932607924; fax: +34 932607618; e-mail: aariza@bellvitgehospital.cat Received 12 April, 2019 Revised 13 September, 2019 Accepted 21 September, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Left atrium: a forgotten biomarker and a potential target in cardiovascular medicine Emerging evidence shows the clinical usefulness of left atrium analysis in different fields of cardiovascular medicine in terms of diagnosis, prognosis and as a potential target for medical treatment. Left atrium structural and functional remodeling has been shown to be a sensitive marker able to detect high-risk individuals in the general population and in subjects with known cardiovascular diseases such as atrial fibrillation, heart failure, ischemic heart disease and valvular heart disease. This review aims to summarize the methods used to assess left atrium structure and function, focusing on its role to identify subclinical and clinical cardiovascular disease and to provide additional prognostic information for stratifying high-risk subjects. Correspondence to Andrea Rossi, MD, Division of Cardiology, Department of Medicine, University of Verona, Polo Confortini, P.le Stefani 1, 37126 Verona, Italy Tel: +39 045 8122952; e-mail: andrea.rossi@aovr.veneto.it Received 30 June, 2019 Revised 19 August, 2019 Accepted 20 September, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Evidence of impaired longitudinal strain in pre-Fontan palliation in functional single left ventricle Background We evaluated two-dimensional speckle-tracking echocardiography longitudinal strain (L2DSE) in functionally single left ventricles (LV). Methods We retrospectively analyzed 21 patients with functionally single LV. We divided patients into two groups according to pre-Fontan cardiac catheterization data: group 1, adequate data for Fontan procedure and group 2, inadequate data. Results LV strain correlated with predicted pressure in the Fontan system (r = 0.64; P = 0.003), pressure in the Glenn system (r = 0.57; P = 0.010), and transpulmonary gradient (r = 0.59; P = 0.008), but not with left atrial pressure (r = 0.292; P = 0.226) or ejection fraction (r = 0.254; P = 0.294). In multiple regression analysis, four-chamber LV strain was correlated with predicted pressure in the Fontan (β = 0.642: P = 0.003), whereas no association was found with LV ejection fraction (β = 0.254; P = 0.294), or time from Glenn palliation (β = 0.082; P = 0.893). When dividing the population into two groups according to catheterization data, significantly lower four-chamber longitudinal 2DSE (−25.8 ± 3.2 vs.−19.5 ± 5.1; P = 0.004) was found to be not suitable for the Fontan procedure, as compared with those who underwent successful Fontan completion. Conclusion Regardless of ejection fraction, four-chamber L2DSE is associated with high predicted pressure in the Fontan system. Patients with hemodynamic data unsuitable for Fontan operation have significantly lower mean longitudinal strain parameters. 2DSE may represent a valuable tool in assessing patients with single LV physiology and might provide useful pre-Fontan information. Correspondence to Alessia Del Pasqua, MD, Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy Tel: +39 668593263; fax: +39 668592838; e-mail: alessia.delpasqua@opbg.net Received 23 March, 2019 Revised 5 September, 2019 Accepted 21 September, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Assessing bleeding in acute coronary syndrome using the Bleeding Academic Research Consortium definition Background The Bleeding Academic Research Consortium (BARC) definition was proposed to overcome the heterogeneity among the many bleeding definitions. The aim of this study-level meta-analysis was to explore the incidence of BARC-assessed bleeding in acute coronary syndrome (ACS) studies and to ascertain the relation between these events and variables related to bleeding risk. Methods and Results We searched the literature for studies that reported bleeding events according to BARC criteria in ACS patients. An analysis on heterogeneity between studies in bleeding reports was performed with I2 test. A meta-regression was conducted to explore the relation between different types of BARC bleedings and patient and procedural features. Nine studies were included in the analysis. Overall, BARC 2 rates were higher than BARC 3 or 5 rates (6.3 versus 2.6%). An extremely high level of heterogeneity was detected both for BARC 2 (I2 99.3%) and BARC 3 or 5 (I2 97.5%) bleedings. Increasing age [β coefficient 0.4% (0.2–0.6%); P < 0.001] and renal impairment [β coefficient 1 6.5% (1–32.1%); P  = 0.037] were associated with increased BARC 3 or 5 rates, whereas the use of glycoprotein IIb/IIIa inhibitors was the only factor related to an increased incidence of BARC 2 bleeding [β coefficient 2 2.3% (5.5–39%); P  = 0.009]. Conclusion The high level of heterogeneity in BARC bleeding reports only partially explained by bleeding risk profile suggests that a regulatory guidance to properly evaluate bleedings and to estimate the risk--benefit in clinical trials investigating different antithrombotic treatments in ACS patients is needed. Correspondence to Federico Fortuni, MD, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy Tel: +39 382503158; fax: +39 382503159; e-mail: fortuni.ff9@gmail.com Received 5 July, 2019 Revised 18 September, 2019 Accepted 21 September, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcardiovascularmedicine.com). © 2019 Italian Federation of Cardiology. All rights reserved.

Let's go fishing: snaring a Reducer coronary sinus stent in the right atrium No abstract available

Percutaneous treatment of aortic root rupture after transcatheter aortic valve replacement procedure Annular rupture is a feared complication of transcatheter aortic valve replacement (TAVR), mainly after the use of balloon-expanding prosthesis. The treatment depends on the type of annular rupture and its clinical presentation. Therapeutic approaches reported in literature include conventional surgical procedure, isolated pericardial drainage, and conservative strategy. A discussion in a multidisciplinary setting is needed, to improve outcomes after TAVR. We report the case of a sovra-annular rupture after self-expanding TAVR, with a fistula between the aortic root and the right ventricle inflow tract, treated with urgent transradial embolization by vascular plug. This is the first ever reported successful case of transcatheter percutaneous intervention for annular rupture secondary to TAVR. Correspondence to Antonio Pignatelli, MD, Department of Cardiovascular Disease, Mater Dei Hospital, 70100 Bari, via S. Hahnemann 10, Italy Tel: +39 805076727; fax: +39 805076722; e-mail: apignatelli@hotmail.it Received 4 February, 2018 Revised 4 April, 2019 Accepted 11 September, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcardiovascularmedicine.com). © 2019 Italian Federation of Cardiology. All rights reserved.

Transfemoral transcatheter aortic valve replacement in the presence of a mitral prosthesis Purpose In the current case series, we present our experience with the self-expanding CoreValve or Evolut R (Medtronic Inc.) in patients with severe symptomatic aortic valve stenosis and concomitant mitral valve prosthesis. Methods Twelve patients with previous mitral valve prosthesis underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and/or aortic valve regurgitation. All patients underwent evaluation with an echocardiogram, computed tomography and coronary angiogram. After the index intervention and before discharge all patients underwent transthoracic echocardiography. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria. Results Eleven patients underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and one patient for severe aortic valve regurgitation. There was immediate improvement of patients’ hemodynamic status; no cases of procedural death, stroke, myocardial infarction, or urgent cardiac surgery occurred. There was no 30-day mortality and all patients improved, with 91.6% in functional New York Heart Association class I–II. Conclusion The current study demonstrates that in patients with severe aortic valve stenosis or regurgitation and mitral valve prosthesis, the implantation of a self-expanding aortic valve via the transfemoral route is safe and feasible, with maintained long-term results. Correspondence to Konstantinos Toutouzas, MD, First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, 26 Karaoli and Dimitriou Str., Holargos, 15562 Athens, Greece Tel: +30 210 6510860; fax: +30 210 7250153; e-mail: ktoutouz@gmail.com Received 28 October, 2018 Revised 22 June, 2019 Accepted 7 July, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Hypertrophic cardiomyopathy, long QT interval and coronary perforator disease in the Noonan syndrome The current article deals with original electrocardiographic and echocardiographic findings from a young adult patient with Noonan syndrome. Massive hypertrophic cardiomyopathy, long QT interval and abnormal intramural coronary blood flow velocity were simultaneously demonstrated. Correspondence to Cesare de Gregorio, MD, Dipartimento di Medicina Clinica e Sperimentale, Resp. Outpatient Heart Failure and Cardiomyopathy Lab, AOU Policlinico ‘G. Martino’, Via Consolare Valeria, 98125 Messina, Italy Tel: +39 090 221 3531; fax: +39 090 221 3531; e-mail: cdegregorio@unime.it Received 24 January, 2019 Revised 5 July, 2019 Accepted 10 September, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.

Hypertrophic cardiomyopathy and membranous subaortic stenosis: a rare, but possible association A 69-year-old male was admitted to our hospital with exertional angina and dyspnea. Transthoracic echocardiography showed asymmetric left ventricular (LV) hypertrophy and an elevated subaortic pressure gradient, in absence of dynamic LV outflow tract obstruction. Transesophageal echocardiography and cardiac computed tomography scan revealed the presence of a subvalvular membrane causing a fixed subaortic obstruction. Cardiac magnetic resonance showed typical findings of hypertrophic cardiomyopathy. A final diagnosis of subaortic stenosis associated with hypertrophic cardiomyopathy was made. This case highlights the key role of multimodality imaging in morphological assessment, risk stratification and differential diagnosis of these complex cases of cardiomyopathy, as it may help in identifying concealed concomitant causes of LV outflow tract obstruction. Correspondence to Angelica B. Delogu, MD, Department of Woman and Child Health and Public Health, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy Tel: +39 0630154187; e-mail: angelicabibiana.delogu@policlinicogemelli.it Received 22 March, 2019 Revised 21 May, 2019 Accepted 11 September, 2019 © 2019 Italian Federation of Cardiology. All rights reserved.