Practical implementation of the Endocarditis Team in 'functional' reference centres: the Italian hospital network experience and recommendations of the Italian Society of Echocardiography and Cardiovascular Imaging.

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.

[Cardiologic evaluation of patients undergoing chemotherapy]. / La consulenza cardiologica "mirata" nel paziente oncologico sottoposto a chemioterapia: come prevenire e monitorare la cardiotossicità in maniera appropriate.

Life expectancy in patients affected by cancer has recently increased because of early diagnosis and actual therapies. In recent years, Oncology and Cardiology developed a tight relationship because of common risk factors (i.e., obesity, smoking, alcool intake, etc...), and for preventing the prothrombotic status due to cancer and the potential cardiotoxicity of chemotherapy. Cardiotoxicity incidence is reported from 1% up to 70% in retrospective analyses of drug protocols, mainly representing by left ventricular dysfunction (both reversible or irreversible), but also by arrhythmias, hypertension, atrioventricular block, coronary spasm, and arterial or venous thromboembolism. The early detection of the chemoterapy induced cardiotoxicity is now mandatory and can be obtained through a proper patients selection for different treatments and a strict monitoring during the follow-up period. The role of biomarkers of early cardiac damage, mainly, troponin I and brain natriuretic peptide-BNP, has been recently challenged, and algorithms are currently available. In the present paper, we propose how to perform a cardiological evaluation of patients undergoing chemotherapy tailored by the known adverse effects of the drugs.

[Role of statins in patients with acute coronary syndromes]. / La riduzione del rischio di nuovi eventi dopo sindrome coronarica acuta: qual è il ruolo delle statine?

After 10 years of studies on statins in acute coronary syndromes what have we learned? (1) The use of statins in acute coronary syndromes reduces coronary events during follow-up; (2) an "intensive" strategy based on the use of potent high dosage statins is effective on 4 to 6 months prognosis, nevertheless side effects and drug withdrawal are frequent; (3) beyond the usual paradigm "the lower the better", the new paradigm of "long term sustainability" should be developed, adopting adequate strategies; (4) a target-oriented study on statins in acute coronary syndrome is desirable, to evaluate which LDL values should be achieved or maintained for the best prognostic benefit.

[Association of pulmonary embolism secondary to deep venous thrombosis and left atrial myxoma: case report and review of the literature]. / Associazione tra embolia polmonare da trombosi venosa profonda e mixoma atriale sinistro: descrizione di un caso clinico e revisione della letteratura.

Left atrial myxoma is a benign tumor but it has a high prevalence of important complications. We report a case of a 73-year-old man affected by hypertension and chronic atrial fibrillation admitted to our hospital for pulmonary embolism, that resulted associated with a proximal deep venous thrombosis of the right leg and with an unknown left atrial myxoma.