Prognostic role of neoplastic markers in Takotsubo syndrome.

Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9-14.8, HR = 7.8 95% CI 2.4-25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6-52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.

Stroke and left atrial thrombi after cryoballoon ablation of atrial fibrillation: incidence and predictors. Results from a long-term follow-up.

Stroke after catheter ablation (CA) of atrial fibrillation (AF) is a potential complication with long term consequences. Aim of this study was to determine incidence and potential predictors of stroke and left atrial appendage (LAA) thrombi after AF ablation with cryo-energy. Two hundred nine consecutive patients with symptomatic drug refractory AF (65% male; 61 ± 11 yo, 69% paroxysmal AF, mean CHA2DS2-VASc score 2 ± 1.4) were enrolled between October 2012 until December 2015. Long term follow-up was performed with outpatient clinic visits at 6-month intervals. Incidence of stroke after CA was 1.4% (3/209 pts) at long term follow-up. Two out of 3 pts experienced stroke during the first 3 month after CA and one after 36 months. At long term follow-up LAA thrombi were found in two patients (1%) that were on therapeutic oral anticoagulation. Recurrence of AF was found in 4 out of 5 pts with stroke or LAA thrombi. Patients with stroke or LAA thrombi did not differed from those without in term of age, gender, CV risk factors, LA size and AF type. They differed only for EHRA score (2.4 vs 1.3, p = 0.01) before CA. At multivariate analysis after correction for age, gender, LA size, LVEF and AF type, only EHRA score (ß 1.92, 95% C.I. 1.3-35 p = 0.02), was an independent predictor of stroke/LAA thrombi. Incidence of stroke after cryoablation is low, with a relative higher prevalence during the first 3 months after CA. Prospective, multicenter long-term registries are needed for a better stroke risk stratification.

Liver disease and heart failure.

INTRODUCTION: Several systemic conditions, inflammatory disease, infections and alcoholism, may affect both the heart and the liver. Common conditions, such as the non-alcoholic fatty liver disease (NAFLD), may increase the risk of cardiac dysfunction. Patients with acute decompensated HF (ADHF) may develop acute ischemic hepatitis and, chronic HF patients may develop congestive hepatopathy (CH). EVIDENCE ACQUISITION: Laboratory anomalies of hepatic function may predict the outcome of patients with advanced HF and the evaluation of both cardiac and hepatic function is very important in the management of these patients. In clinically apparent ischemic hepatitis more than 90% of patients have some right-sided HF. There are systemic disorders characterized by the accumulation of metals or by metabolism defects that may affect primarily the liver but also the heart leading to symptomatic hypertrophic cardiomyopathy (HCM). EVIDENCE SYNTHESIS: Abnormal LFTs indicate the mechanism of liver injury: liver congestion or liver ischemia. In AHF, it's important an adequate evaluation of heart and liver function in order to choose the treatment in order to ensure stable hemodynamic as well as optimal liver function. CONCLUSIONS: Measurements of LFTs should be recommended in the early phase of ADHF management. Physicians with interest in HF should be trained in the evaluation of LFTs. It's very important for cardiologists to know the systemic diseases affecting both heart and liver and the first imaging or laboratory findings useful for a diagnosis. it is very important for internists, nephrologists, cardiologists, primary physicians and any physicians with interest in treating HF to recognize such signs and symptoms belong to rare diseases and liver diseases that could be mistaken for HF.