Cardiovascular effects of COVID-19 lockdown in professional football players.

BACKGROUND: The COVID-19 pandemic with the stay-at-home orders and lockdown has dramatically forced athletes to stop team training and competitions, causing deep changes in habits and lifestyle. Aim of this study was to evaluate in a retrospective single center study the cardiovascular (CV) health and fitness of elite football player after COVID-19 lockdown in Italy and to compare such findings with the 2019 off-season period, in order to identify potential differences in the CV features and outcomes. METHODS: All 29 professional football players of the first male team were enrolled before resuming training and competition after COVID-19 lockdown and underwent several exams including physical examination, resting and stress electrocardiography (ECG), echocardiography, spirometry and blood tests. RESULTS: Median age was 27 years (23; 31), with no athlete being COVID-19 positive at the time of the evaluation. In comparison with the usual off-season 2-month detraining, significant differences were found for left ventricular (LV) mass (189 g [172; 212] vs. 181 g [167; 206], P=0.024) and LV Mass Index for body surface area (94 g/m2 [85; 104] vs. 88 g/m2 [79.5; 101.5], P=0.017), while LV mass/fat free mass remained unchanged (2.8 g/kg [2.6; 2.9] vs. 2.9 g/kg [2.6; 3.2], P=0.222). Respiratory function and metabolic profile were improved, while no significant changes were found in ECG findings, at rest and during exercise. CONCLUSIONS: Prolonged abstinence from training and competitions induced by lockdown elicited significant changes in comparison with off-season in parameters ascribable to detraining, as the changes in LV mass, in respiratory function and in metabolic profile.

Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System.

BACKGROUND: The goal of this study was to determine changes in left ventricular (LV) and right ventricular (RV) function with three-dimensional (3D) speckle-tracking echocardiography (STE) after percutaneous mitral valve repair with the MitraClip system in high-risk surgical patients with moderate to severe or severe secondary mitral regurgitation (MR). METHODS: Thirty-two patients with MR undergoing MitraClip were prospectively included. Patients underwent two-dimensional (2D) and 3D transthoracic echocardiography before clip implantation and after 6-month follow-up. LV and RV longitudinal strain was obtained by 2D STE and 3D STE. LV circumferential, radial, and area strain was calculated by 3D STE. Data analysis was performed offline. RESULTS: At 6-month follow-up, significant improvements were seen in LV 2D global longitudinal strain (P < .005), 3D global longitudinal strain (P = .0002), and 3D area strain (P = .0001). Overall, significant improvements were also seen in 3D RV ejection fraction (P < .05) and 3D RV free-wall longitudinal strain (P < .05). A poor increase in LV strain after clip implantation (P = NS) occurred in patients with pronounced preexisting RV dysfunction. The areas under the receiver operating characteristic curves for LV and RV 3D speckle-tracking echocardiographic parameters showed high discriminative values (range, 0.87-0.91) in predicting unfavorable outcomes with persistent symptoms (New York Heart Association class > II) after the procedure. CONCLUSIONS: Three-dimensional STE showed overall LV and RV strain improvement after clip implantation as well as lower postprocedural LV strain values in patients with worse preexisting RV function. These findings could help in guiding MR treatment strategies, suggesting different therapies in the presence of marked RV impairment or anticipating the procedure in case of evolving RV dysfunction.

Comparison of clinical and angiographic prognostic risk scores in elderly patients presenting with acute coronary syndrome and referred for percutaneous coronary intervention.

BACKGROUND: Multiple risk prediction models have been validated in all-age patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI); however, they have not been validated specifically in the elderly. METHODS: We calculated the GRACE (Global Registry of Acute Coronary Events) score, the logistic EuroSCORE, the AMIS (Acute Myocardial Infarction Swiss registry) score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in a consecutive series of 114 patients ≥75 years presenting with ACS and treated with PCI within 24 hours of hospital admission. Patients were stratified according to score tertiles and analysed retrospectively by comparing the lower/mid tertiles as an aggregate group with the higher tertile group. The primary endpoint was 30-day mortality. Secondary endpoints were the composite of death and major adverse cardiovascular events (MACE) at 30 days, and 1-year MACE-free survival. Model discrimination ability was assessed using the area under receiver operating characteristic curve (AUC). RESULTS: Thirty-day mortality was higher in the upper tertile compared with the aggregate lower/mid tertiles according to the logistic EuroSCORE (42% vs 5%; odds ratio [OR] = 14, 95% confidence interval [CI] = 4-48; p <0.001; AUC = 0.79), the GRACE score (40% vs 4%; OR = 17, 95% CI = 4-64; p <0.001; AUC = 0.80), the AMIS score (40% vs 4%; OR = 16, 95% CI = 4-63; p <0.001; AUC = 0.80), and the SYNTAX score (37% vs 5%; OR = 11, 95% CI = 3-37; p <0.001; AUC = 0.77). CONCLUSIONS: In elderly patients presenting with ACS and referred to PCI within 24 hours of admission, the GRACE score, the EuroSCORE, the AMIS score, and the SYNTAX score predicted 30 day mortality. The predictive value of clinical scores was improved by using them in combination.

Echocardiographic findings in simple and complex patent foramen ovale before and after transcatheter closure.

AIMS: Percutaneous closure of patent foramen ovale (PFO) in cryptogenic cerebrovascular events is an alternative to medical therapy. The interpretation of residual shunts after implantation of different devices for PFO with different morphologies is controversial. METHODS AND RESULTS: Transcatheter PFO closure was performed in 123 patients with a history of ≥1 paradoxical embolism using three different devices: Amplatzer (n = 46), Figulla Occlutech (n = 41), and Atriasept Cardia (n = 36). Fifty-six patients presented with simple PFO and 67 patients had complex morphologies. All patients were studied with contrast enhanced transesophageal echocardiography (TEE) before interventional procedure and thereafter at 1 and 6 months and every 6-12 months in case of incomplete closure. Definite closure was confirmed in at least two consecutive TEE studies. Various PFO morphologies were identified by TEE before device implantation. The device size to PFO diameter ratio was significantly increased in patients with complex PFO compared with those patients with a simple PFO morphology (P < 0.05). The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer P = 0.0027, Figulla P = 0.0043, and Atriasept P < 0.01). The mean follow-up period was 3.4 years (median 2.7 years) with a cerebrovascular re-event rate of 2.4% per year. In three patients, thrombi were detected in the 6-month TEE controls and resolved after medical therapy. In three other patients, the implantation of an adjunctive device was necessary for residual shunt. CONCLUSION: In our series of patients, the closure rate was dependent on PFO morphology more than occluder size and type. An adjunctive device was implanted in selected cases.

Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography.

BACKGROUND: The aim of this study was to assess changes in right ventricular (RV) parameters determined by three-dimensional (3D) echocardiography and speckle-tracking echocardiography in patients with acute pulmonary embolism and RV dysfunction without systemic hypotension (submassive pulmonary embolism). METHODS: Sixty-six patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days and 6 months. Sixty-six controls were selected. RV fractional area change, tricuspid annular plane systolic excursion, and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. Three-dimensional RV ejection fraction (RVEF) was calculated. Two-dimensional peak systolic RV longitudinal strain (RVLS) was measured in the basal free wall, mid free wall (MFW), and apical free wall and the septum. RESULTS: Tricuspid annular plane systolic excursion and fractional area change were smaller and myocardial performance index was larger compared with controls (P < .05). Global RVLS (P < .05), MFW RVLS (P < .001), and 3D RVEF (P < .001) were lower in patients with pulmonary embolism than in controls. There was earlier reversal of MFW RVLS values on 30-day follow-up and longer reversal of 3D RVEF and RV systolic pressure values at 6-month follow-up. Receiver operating characteristic curve analysis showed that changes in 3D RVEF and MFW RVLS were the most sensitive predictors of adverse events. By multivariate analysis, RV systolic pressure (P = .007), MFW RVLS (P = .002), and 3D RVEF (P = .001) were independently associated with adverse outcomes. CONCLUSIONS: Acute submassive pulmonary embolism has a significant impact on RV function as assessed by 3D echocardiography and speckle-tracking echocardiography. Decreases in MFW RVLS and 3D RVEF may persist during short-term and long-term follow-up and correlate with unfavorable outcomes.

Horizontal glottectomy: is it an out-of-date procedure?

PURPOSE: The aim of the study is to illustrate our experience with horizontal glottectomy (HG), reviewing the indications and results of this uncommon partial laryngectomy. MATERIALS AND METHODS: It is a retrospective study. We completed a chart review of patients who underwent partial laryngectomy between May 2003 and June 2010. Patients who underwent HG were included in the study. Data obtained were collected and analyzed. RESULTS: Seven male patients were included in the study (mean age was 78 years; range, 69-88 years). In all cases, the TNM classification was pT1bN0M0 apart from one patient who had pT1N1M0. Three patients had a moderately differentiated neoplasm (G2), whereas 4 patients had a well-differentiated tumor (G1). Tracheotomy tube removal, oral feeding, and voice analysis have been evaluated and reported in the study. Mean follow-up was 16 months. CONCLUSIONS: Horizontal glottectomy might be a worthwhile treatment option in selected patients nowadays. In older patients with anterior commissure involvement, this procedure guarantees adequate functional and good oncological results. This study may possibly help surgeons dealing with glottic cancer involving the anterior commissure because we believe that some patients could benefit from HG, even in this radiotherapy and transoral laser surgery "era."

Diagnosis of anal human papillomavirus infection: polymerase chain reaction or cytology?

OBJECTIVES: To investigate the relationship between human immunodeficiency virus (HIV)-positive and HIV-negative patients engaging in promiscuous behaviors and anal human papillomavirus (HPV) infection diagnosed by polymerase chain reaction (PCR) and cytology. METHODS: Fifty-six HIV-positive patients and 49 HIV-negative patients who engaged in sexually promiscuous behavior were enrolled in the study. We performed cytological exams using the Pap smear and PCR for HPV-DNA detection, with identification of oncogenic strains. The 2001 Bethesda System terminology was used for the cytological exams. We also evaluated the immunologic status of the HIV-infected patients. RESULTS: PCR positivity for HPV-DNA was higher in the group of HIV-positive patients than in the group of HIV-negative patients with a statistically significant difference. In contrast we did not find any statistically significant difference by cytological exam. Oncogenic strains were equally distributed in the two groups. CONCLUSIONS: Our results indicate the importance of the cytological exam for anal HPV screening in the population at high risk of sexually transmitted disease and that HPV-DNA PCR can be used only as adjunct test.

Right coronary artery chronic total occlusion in presence of anomalous origin of left coronary artery.

Right sinus origin of left coronary artery is a very uncommon congenital coronary anomaly. The presence of an associated totally occluded right coronary artery represents an exceedingly rare picture. An accurate morphologic identification of anomalous arteries, by multi-detector computed tomography, is mandatory before planning any therapeutic intervention. We report an interesting case of chronic total occlusion of the right coronary artery in a young patient with anomalous left coronary artery.

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: our experience and review of literature.

OBJECTIVE: To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ). MATERIALS AND METHODS: Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a "double blinded method" and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared. RESULTS: Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan. CONCLUSIONS: CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue.

Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions.

OBJECTIVE: Purpose of our study was to assess the potential role of diffusion-weighted imaging (DWI) in the differential diagnosis between benign and malignant nodes. SUBJECT AND METHODS: We enrolled 32 subjects: 14 with benign lymphadenopathy, 17 patients with histologically proved malignant disease before beginning treatment and 1 patient with lymphoma after chemotherapeutic treatment. In all patients we used fast spin echo T2-weighted images in axial and coronal planes, fast spin echo T1-weighted images before and after contrast medium of administration in axial and coronal planes. Before contrast administration diffusion sequences were acquired on the axial and coronal plane (b factor of 0.500 and 1000 s/mm(2)) and then apparent diffusion coefficient (ADC) maps were reconstructed. RESULTS: On diffusion images, 13/14 patients with benign nodes showed low signal intensity and had high signal on ADC maps, whereas all patients with malignant diseases appeared hyperintense on diffusion images and with low signal intensity on ADC maps. Only a patient with tuberculosis showed a low ADC value. The mean ADC value of malignant nodes was about 0.85 × 10(-3)mm(2)/s, the mean value of benign nodes was 1.448 × 10(-3)mm(2)/s; this difference was statistically significant (p < 0.01). The mean ADC value of treated nodes was 1.75 × 10(-3)mm(2)/s. The best threshold value was 1.03 × 10(-3)mm(2)/s, obtaining a sensitivity of 100% and a specificity of 92.9%. CONCLUSIONS: Diffusion imaging could be considered an important supportive tool for the diagnosis of enlarged cervical lymphadenopathies.

Assessment of coronary stenosis, plaque burden and remodeling by multidetector computed tomography in patients referred for suspected coronary artery disease.

AIMS: To compare multidetector computed tomography (MDCT) with intravascular ultrasound (IVUS) and invasive quantitative coronary angiography (QCA) for assessment of coronary lesions in patients referred for suspected coronary artery disease (CAD). METHODS AND RESULTS: We studied 57 patients (48 men; mean age: 63 ± 10 years) who underwent 64-slice MDCT because of atypical chest pain, stable angina, or ECG abnormalities and were diagnosed with CAD. All patients subsequently underwent QCA and IVUS. We analyzed 102 coronary lesions using the three techniques. Measurements of luminal area stenosis and cross-sectional area by MDCT (72.9 ± 7.0% and 4.5 ± 1.8 mm, respectively) were in good agreement with those by IVUS [72.7 ± 6.7% and 4.5 ± 1.6 mm, respectively; Lin's concordance correlation coefficient r = 0.847; 95% confidence interval (CI) = 0.792-0.902 and r = 0.931; 95% CI = 0.906-0.956, respectively] but not QCA (r = 0.115; 95% CI = 0.040-0.189 and r = 0.433; 95% CI = 0.291-0.576, respectively). Plaque cross-sectional area and plaque volume measured by MDCT (12.4 ± 3.8 mm and 104.7 ± 52.8 microl, respectively) were in good agreement with those by IVUS (12.2 ± 3.7 mm and 102.8 ± 54.1 microl; r = 0.913; 95% CI = 0.880-0.945 and r = 0.979; 95% CI = 0.969-0.990, respectively). Remodeling index measurements by MDCT (1.22 ± 0.22) were in good agreement with those by IVUS (r = 0.876; 95% CI = 0.831-0.922). Positive remodeling occurred in 63% of stenoses. CONCLUSION: MDCT allows accurate noninvasive assessment of coronary stenosis, plaque burden and remodeling in patients referred for suspected CAD. Positive remodeling is a frequent finding in stable lesions.

Carotid stenting and transcranial Doppler monitoring: indications for carotid stenosis treatment.

BACKGROUND: Recently, angioplasty and stenting of carotid arteries (CAS) have taken the place of surgery. The aim of our study is to assess the role of transcranial Doppler (TCD) monitoring during CAS to address the embolic complications during the stages of the procedure, with or without embolic cerebral protection devices. METHODS: A total of 152 patients were submitted to carotid stenting. All patients were submitted to carotid arteries Duplex scanning. RESULTS: Neurological complications are related to TCD detection of corpuscolate signals in rapid succession. Even if no reduction of the overall incidence rate of microembolic signals (MES) was observed, a decrease in the number of corpuscolate emboli were recorded when a cerebral protection was working. CONCLUSIONS: According to our study, even in selected patients on the basis of preoperative diagnostic criteria, CAS is burdened by a nonnegligible risk of subclinical embolic ischemic events detected at TCD and confirmed by diffusion-weighted magnetic resonance imaging (DW-MRI).

Interstitial high-dose-rate brachytherapy after breast conserving surgery.

We evaluated local recurrence, toxicity rate and cosmetic outcome in 72 patients treated with high-dose-rate (HDR) brachytherapy after breast conserving surgery. HDR brachytherapy was administered: i) as partial breast irradiation (PBI) in 64 patients with low-risk early stage breast cancer, enrolled in a phase II prospective study; ii) as PBI after a second conservative surgery as treatment of local relapse in 3 patients; iii) for delivering a boost after whole breast external beam radiotherapy in 5 patients. Implantation was done during surgery (breast conserving or re-excision to achieve adequate surgical margins), with the wound open, or postoperatively. The implant was well tolerated in all patients, so no premature catheter removal was required. At a median follow-up of 32 months (range 5-52) no local recurrence has been observed. Toxicity was very low. Cosmetic outcome was excellent/good in a high percentage of patients. Our results suggest that PBI administered with HDR brachytherapy is feasible in selected patients with low risk early stage breast carcinoma. PBI seems feasible to repeat radiotherapy after a salvage breast conserving surgery for local relapse in a second attempt to preserve the breast.

Type B aortic dissection in a patient with unknown left ventricular non-compaction cardiomyopathy: cardiovascular magnetic resonance diagnosis.

A 61-year-old man was referred at our hospital for a cardiac evaluation after an episode of oppressive chest pain at rest. He was discharged with a MRI diagnosis of non-compaction cardiomyopathy presented with typical angina, left ventricle dysfunction and ischemic EKG findings without atherosclerotic narrowing and also with a type B aortic dissection, documented also by computed tomography.

First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension.

OBJECTIVE: Previous studies have suggested an association between low levels of first trimester serum Pregnancy Associated Plasma Protein-A (PAPP-A) and the occurrence of hypertension in pregnancy (PIH). The purpose of this study was to determine the predictive value of maternal PAPP-A levels in the identification of women at risk of PIH. METHODS: Maternal serum PAPP-A was measured between 11-13 + 6 wks' gestation, as part of the first trimester screening of aneuploidies. Our study included only singleton pregnancies (973 cases) over a three years period. PAPP-A levels were expressed as gestational age-specific multiples of the median (MoM). Hypertension in pregnancy was documented by standard criteria. RESULTS: One hundred and eleven pregnant women developed hypertension (8.9%). In these patients, PAPP-A levels ranged from 0.53 to 1.08 MoM. After performing a backward stepwise regression equation and a ROC curve procedure, a PAPP-A MoM value <0.8 was able to significantly predict PIH (p < 0.001, area under the ROC curve 83%, sensitivity 68%, specificity 86%, 95 degrees CI 0.57-0.94). CONCLUSION: Low levels of serum PAPP-A (?0.8 MoM) may be a potential resource in order to early screen pregnant women at increased risk of hypertension in pregnancy.

Double superior vena cava: right connected to left atrium and left to coronary sinus.

Left persistent superior vena cava connected to coronary sinus may coexist with right superior vena cava connected to left atrium. Surgical correction is not mandatory if there is no cyanosis due to a big interjugular bridging vein.

Multi-slice tomographic diagnosis of isolated right aortic arch in an elderly patient.

Occasional report of asyntomatic right aortic arch in a 90-year-old man with any congenital defect associated.