[Cardiac arrest caused by anomalous origin and course of the right coronary artery]. / Arresto cardiaco causato da coronaria destra ad origine e decorso anomali.

The anomalous origin of the right coronary artery from the left sinus with interarterial course is a rare but life-threatening coronary abnormality. Coronary computed tomography is crucial in identifying this disease whose treatment, based on coronary artery bypass grafting, is recommended in symptomatic patients but is more controversial in asymptomatic patients. The case report presented offers an opportunity to discuss the pathophysiological, diagnostic and therapeutic aspects of this congenital coronary artery disease.

[Takotsubo syndrome complicated by ventricular thrombosis and pericarditis]. / Sindrome takotsubo complicata da trombosi ventricolare e pericardite.

Takotsubo syndrome is a heart disease characterized by transient ventricular dysfunction; although it is considered a benign pathology, it is not free from serious complications. Intraventricular thrombosis is a rare occurrence as well as pericarditis, and the simultaneous presence of both complications is very exceptional. Here we describe a case. Diagnosis and therapeutic management was successfully guided by multimodality imaging.

[A case of anomalous origin of the left coronary artery from the pulmonary artery in the elderly]. / Origine anomala dell'arteria coronaria sinistra dall'arteria polmonare: un caso diagnosticato nell'età anziana.

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. The development of acquired collateral circulation between the right coronary artery and the left coronary artery allows, sometimes, survival until adulthood. In our clinical practice, we came across an exceptional case for the advanced age, 75 years. Coronary computed tomography, associated with other imaging modalities, has played a crucial role in accurately defining the origin, the course and the connection of the coronary arteries.

Absence of left atrial stunning after cardioversion of recent-onset atrial fibrillation in patients at low-stroke risk.

OBJECTIVE: The aim of the present study was to evaluate the presence and degree of spontaneous echo contrast (SEC) in the left atrium and of left atrial appendage (LAA) contractility before and after cardioversion (CV) in patients with recent-onset atrial fibrillation (AF). METHODS: Our study included 56 patients divided into two groups: group 1, comprising 32 clinically stable patients who were admitted to the Emergency Department with less than or equal to 48 h duration AF, and who underwent transoesophageal echocardiography (TEE)-guided CV; and the control group (group 2), comprising 24 patients admitted to the Cardiological Department for elective TEE-guided CV of greater than 48 h AF. All patients underwent repeat TEE within 1 h after successful CV. RESULTS: Patients with recent-onset AF (group 1) showed no thrombogenic milieu at baseline without any evidence of atrial stunning after successful CV. SEC mean grade (0-3 grading) was 0.09±0.3 versus 0.12±0.4 after CV (P=0.98), and LAA flow velocity was 60.7±19.4 versus 56.7±20.5 cm/s after CV (P=0.07). Group 2 patients showed a significantly higher degree of SEC compared with those in group 1 (0.09±0.3 vs. 0.66±0.7, P=0.0093) and significantly lower LAA flow velocities (60.7±19.4 vs. 32.5±12.4, P<0.0001), with significant worsening after successful CV (SEC degree: 0.66±0.9 vs. 1.37±0.9, P=0.0093; LAA flow velocity: 32.5±12.4 vs. 20.4±12.7 cm/s, P<0.0001). CONCLUSION: The absence of thrombogenic milieu and of left atrial stunning after CV in patients with recent-onset AF favours early CV without anticoagulation, at least in patients with a low thromboembolic risk profile. These patients could be discharged earlier from urgent care.

Superiority of the heart failure survival score to peak exercise oxygen consumption in the prediction of outcomes in an independent population referred for heart transplant evaluation.

BACKGROUND: The heart failure survival score (HFSS), a multivariable predictive index that has been shown to predict death or inotrope-dependent transplant in ambulatory patients referred for transplant evaluation has not been independently validated. We sought to independently assess the prognostic ability of the HFSS in a group of patients undergoing transplant evaluation in Italy, and to compare its prognostic value to that of peak exercise oxygen consumption (VO2), the standard tool for risk stratification in most transplant centers. METHODS: Data for the seven variables that constitute the HFSS, including peak VO2, were collected for 107 ambulatory patients referred to the heart transplant center of the University of Turin. Patients were followed prospectively for 997 +/- 32 days, with outcome events defined as death prior to transplant or inotrope-dependent transplant. RESULTS: The discriminative abilities of peak VO2 and the HFSS and their respective risk strata were compared. At univariate Cox regression models, peak VO2 did not successfully predict outcomes, neither when evaluated continuously (p = 0.25) nor when dichotomized at 14 ml/kg/min (p = 0.18). Both the HFSS (p = 0.011) and the HFSS strata (p = 0.008) successfully predicted outcome events. CONCLUSIONS: The HFSS was more accurate than peak VO2 for the prediction of event-free survival, both when evaluated continuously and as risk strata. The HFSS is a valid and widely applicable tool for the identification of patients who, in the absence of contraindications, would benefit from transplantation.