The usefulness of QRS Index for prediction of echocardiographic response in cardiac resynchronization therapy: a multicenter study.

BACKGROUND: The association between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been investigated by several studies, but their findings remain inconclusive. Aim of our study was to explore the relationship between QRS Index and echocardiographic response to CRT. METHODS: This multicenter, retrospective analysis included 326 consecutive patients (mean age was 70.0±10.1 years old; males 76.7%) who underwent CRT-D implantation in primary and secondary prevention between 2018 and 2020. The estimation of QRS shortening after CRT-D implantation was precisely assessed through the QRS Index, calculated as follows: [(QRS duration before implantation - paced QRS duration)/QRS duration before implantation]*100. RESULTS: After a mean follow-up of 12.7±4.5 months, 55.2% (180/326) of the patients showed an echocardiographic response to CRT. The median [25-75th] QRS Index was 3.85% [-14.1% - +13.9%]. The best predictive cut-off value of QRS Index was 1.40% (sensitivity 70.4%, specificity 64.5%, AUC 0.70). In patients with left bundle branch block, the median [25-75th] QRS Index was 9.85% [+3.87% - +16.7%]. In this subgroup, the AUC was 0.737 and the best predictive cut-off of QRS Index was 2.20% (sensitivity 78.3%, specificity 67%). The multivariable model showed that only left ventricular ejection fraction and QRS Index were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, P=0.01 and OR 1.057, CI 95% 1.026-1.089, P<0.001). CONCLUSIONS: The QRS Index tightly correlated with CRT response. Only LVEF and QRS Index were independently associated with echocardiographic response to CRT.

Quality of Life after Transcatheter Aortic Valve Replacement in Sarcopenic Patients Using the Toronto Aortic Stenosis Quality of Life Questionnaire.

BACKGROUND: Sarcopenia is the core component of frailty; however, its role in patients undergoing transcatheter aortic valve replacement (TAVR) is a matter of debate. The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) is a validated instrument for assessing quality of life (QoL) in patients with severe aortic stenosis (AS). AIMS: We aim to evaluate the QoL of sarcopenic and non-sarcopenic patients with severe AS undergoing TAVR. METHODS: TASQ was prospectively administered to patients undergoing TAVR. All patients completed the TASQ before TAVR and at a 3-month follow-up. The study population was divided in two groups according to sarcopenic status. The primary endpoint was the TASQ score in the sarcopenic and non-sarcopenic cohorts. RESULTS: In total, 99 patients were eligible for the analysis. In both sarcopenic (n = 56) and non-sarcopenic (n = 43) cohorts, significant changes were observed in the overall TASQ score and in all but one (i.e., health expectations) of the individual domains (p < 0.01). Sarcopenic and non-sarcopenic patients showed substantial improvements across TASQ subscores. The mean change in overall TASQ score at three months revealed a significant improvement in both cohorts (p < 0.01). Health expectations worsened in sarcopenic patients at the 3-month follow-up (p = 0.06). CONCLUSIONS: The TASQ questionnaire revealed changes in QoL after TAVR, regardless of patients' sarcopenic status. Health status improved substantially in both sarcopenic and non-sarcopenic patients following TAVR. Lack of improvement in health expectations seems to depend on patients' expectations regarding the procedure and specific aspects in the evaluation of the outcome.

Electrocardiographic predictors of echocardiographic response in cardiac resynchronization therapy: Update of an old story.

BACKGROUND: A better selection of patients with left bundle branch block (LBBB) might increase the response to cardiac resynchronization therapy (CRT). The aim of the study was to investigate the association between the Strauss criteria, absence of S wave in V5-V6, the Selvester score and response to CRT. METHODS AND RESULTS: The retrospective analysis included all consecutive patients having undergone implantation of biventricular defibrillators in primary prevention between 2018 and 2020. The final analysis included 236 patients (mean age 69.7 ± 9.9; 77.5% of males). The Strauss criteria were significantly associated with CRT response (p < 0.01) with a sensitivity of 71.3% and specificity of 64.1%. The Strauss criteria along with the absence of S wave in V5 and V6 showed a sensitivity of 56.7%, a specificity of 82.6% and a positive predictive value of 90.5%. The Selvester score was significantly and inversely associated with CRT response (OR 0.818, 95% CI 0.75-0.89; p < 0.001). The multivariable model showed that left ventricular ejection fraction (LVEF) and QRS duration (≥140 ms in males and ≥ 130 ms in females) were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, p = 0.01 and OR 3.70, CI 95% 1.12-12.21, p = 0.03). CONCLUSIONS: Strauss criteria, especially in association with absence of S wave in V5 and V6, were able to increase specificity and positive predictive value for predicting CRT response. The Selvester score was inversely associated with CRT response. Finally, LVEF and QRS duration were independently associated with echocardiographic response to CRT.

The impact of UEFA Euro 2020 football championship on Takotsubo Syndrome: Results of a multicenter national registry.

Objectives: The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE). Methods and results: Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6-495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P = 0.80)] or TTS [IRR 1.66(0.80-3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period. Conclusions: The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.

An unusual case of a primary blood collection tube with floating separator gel.

We describe an unusual case of a primary evacuated blood collection tube with floating separator gel, which has been collected from a 50-year-old man submitted to a percutaneous coronary intervention (PCI). The sample was collected from the femoral artery in a primary evacuated blood collection tube containing lithium-heparin. After centrifugation of the specimen, an unusual positioning of the separator gel was observed, which migrated at the topmost layer, whereas the packed blood cells remained in the middle and the plasma at the bottom. The potential interfering substance was found to be a contrast dye, 140 ml of which were administered to the patient during a revascularization procedure for acute myocardial infarction. The potential aspiration of the gel inappropriately positioned at the top of the tube by laboratory instrumentation can produce several technical and clinical problems, when not reliably detected. First, the needle of the instrument might be partially or completely obstructed by the gel, thus jeopardizing the integrity and correct functioning of the instrument. The aspiration of gel along with the sample matrix might also spuriously modify the test results, since an inappropriate amount of serum or plasma would be analyzed.

Annual recurrence of acute Left Ventricular Apical Ballooning.

Left Ventricular Apical Ballooning (LVAB) or Tako-tsubo syndrome is an emerging clinical entity. Little data exists in the literature regarding recurrence of the disease. We present an interesting case of relapse of LVAB after exactly 1 year.

[Percutaneous coronary intervention and immediate re-transfer to the referring hospital for patients with acute coronary syndrome. A single-center experience]. / Angioplastica coronarica e immediato ritrasferimento all'ospedale di provenienza nei pazienti con sindrome coronarica acuta. La nostra esperienza.

BACKGROUND: Current guidelines recommend early transfer of patients with acute coronary syndromes from primary care centers to hospitals with cath lab facilities. Few data exist about safety of re-transfer to primary care centers immediately after successful percutaneous coronary interventions. METHODS: We analyzed data regarding 102 consecutive patients (73 male, 29 female, mean age 69 +/- 10.9 years) transferred to the Bolzano hospital from centers without cath lab facilities for urgent percutaneous coronary intervention in acute coronary syndromes and planned immediate re-transfer after the procedure. Data about complications during re-transfer were obtained using a prepared data sheet completed by physicians and/or paramedics involved in the transport. RESULTS: Eighty-eight (87.1%) patients were re-transferred immediately after the cath lab procedure. Arterial hemostasis was achieved with arterial closure devices before leaving the cath lab. During re-transfer, 61 (69%) patients were accompanied by physicians and 27 (31%) patients by paramedics. No ischemic, arrhythmic or hemorrhagic complications were observed. CONCLUSIONS: In our experience immediate re-transfer to the referring hospital after successful urgent percutaneous coronary intervention for acute coronary syndrome is feasible and safe. If the patient is clinically stable after the procedure, re-transfer may not require the presence of a physician.

[Percutaneous coronary interventions in elderly patients: clinical indications and adjunctive medical treatment. The Italian Drug Evaluation in Angioplasty (IDEA) study]. / Procedure interventistiche coronariche percutanee in pazienti anziani: indicazioni cliniche e terapie farmacologiche concomitanti. Lo studio Italian Drug Evaluation in Angioplasty (IDEA).

BACKGROUND: Specific guidelines for interventional cardiology in elderly patients are not available, and it appears that aged patients are treated more conservatively. Nevertheless data on the real clinical practice are lacking. The aim of the study was to describe different therapeutic strategies in elderly patients enrolled in the Italian Drug Evaluation in Angioplasty (IDEA) study. METHODS: The IDEA study is a registry of consecutive percutaneous coronary interventions (PCI) performed from September 15 to 29, 2003, at 79 Italian cath-labs. RESULTS: Out of 1517 consecutive PCI patients, 491 (32%) were aged > or = 70 years. Compared to younger patients, those > or = 70 years old showed more frequently (p < 0.001) renal insufficiency (10.4 vs 4.4%), peripheral vasculopathy (18 vs 6.9%), history of stroke (7.3 vs 3.3%) or previous surgical coronary revascularization (15 vs 7.5%) and multivessel disease (61 vs 49%). In patients aged > or = 70 years, acute coronary syndrome was the more frequent clinical indication for PCI (54 vs 49% in patients < 70 years, p = 0.05). Globally, stent use was 89% with no differences related to the patients' age. Drug-eluting stents were used in 21% of the procedures in elderly patients and in 22% in younger patients. Use of glycoprotein IIb/IIIa receptor antagonists in acute coronary syndrome was not correlated with the patients' age; nevertheless in elderly patients with acute myocardial infarction these drugs were less used during primary angioplasty compared to younger patients (48 vs 72%, p = 0.001). In-hospital mortality was higher in patients aged > or = 70 years (2.9 vs 0.9%, p = 0.004), particularly in patients treated for acute coronary syndromes (5.5 vs 1.4%, p = 0.002). In these patients, more bleeding complications (7.1 vs 3.9%, p < 0.001) and heart failure (5.5 vs 1.6%, p = 0.004) were observed. CONCLUSIONS: Compared to younger patients, elderly patients enrolled in the IDEA study had a higher risk profile and higher in-hospital morbidity and mortality. Except for a lower use of glycoprotein IIb/IIIa receptor antagonists for acute myocardial infarction, no discriminations were observed in elderly patients in terms of clinical indications, antiplatelet therapy and drug-eluting stent use.

[Can clopidogrel be responsible for neutropenia?]. / Può il clopidogrel causare neutropenia?

We describe a case of neutropenia in an 80-year-old female patient. After a coronary intervention procedure with stent implantation, therapy with clopidogrel was started. Thirty-eight days after the beginning of this therapy, a serious lowering of neutrophil levels was found. Common causes of neutropenia were excluded and, after clopidogrel withdrawal, neutrophil levels normalized within a few days.