ABSTRACT
BACKGROUND: The extent of residual mitral regurgitation (MR) (1+ vs ≥2+) has a notable impact on the outcome of MitraClip (MC) repair of significant functional MR. In this retrospective single-center study, we evaluated the predictors of MI ≥2+ at 1 year in one of our case series. METHODS: Overall, 58 patients with moderate severe functional MR underwent MC implantation; of these, 48 patients had instrumental clinical follow-up for 1 year. RESULTS: At 1 year, 10 patients died (mortality 17.2%). In the remaining 48 patients, the incidence of rehospitalization was 8.3%, and the incidence of MR grade 1+ and ≥2+ was 54.1% (n = 26) and 45.9% (n = 22), respectively. In patients with MR ≥2+, clinical and instrumental outcomes were worse than in patients with MR 1+. The height of the posterior leaflet and the extent of immediate postprocedural MR were independent predictors of MR ≥2+. CONCLUSIONS: Percutaneous repair with MC of moderate/severe functional MR has favorable 1-year outcomes in terms of mortality and rehospitalizations. The best results are achieved in patients with residual MR 1+. Echocardiographic parameters are independent predictors of residual MR ≥2+.
Subject(s)
Mitral Valve Insufficiency , Humans , Mitral Valve Insufficiency/surgery , Retrospective Studies , Echocardiography , Patient ReadmissionABSTRACT
COVID-19 has threatened the capability of receiving and allocating patients in emergency departments (EDs) all over the world. This is a retrospective cohort study to explore the role of a simple procedure like an ECG to screen for the severity of COVID-19 on admission to the ED. For this study, 548 consecutive patients were enrolled in a multicenter international registry and stratified upon ECG on admission with a simple distinction between normal vs. abnormal rhythm. Among patients in the abnormal ECG group were those with heart rates higher than 100 beats per minute and/or atrial fibrillation. Survival in patients with normal ECG rhythm was deemed below 75% after 58 days and then stabilized, while survival in patients with abnormal ECG rhythm was deemed below 75% after 11 days and below 50% after 21 days. A multivariate analysis including abnormal rhythm, gender, age, diabetes, obesity, respiratory failure during hospitalization, heart failure during hospitalization, and abnormal rhythm was an independent predictor of death (HR 7.20 95% CI 3.63-14.28, p < 0.01). This finding, if confirmed in large prospective studies, is promising for identifying a cheap and simple procedure for patients in need of a closer look.
ABSTRACT
BACKGROUND: Prolonged QTc intervals and life-threatening arrhythmias (LTA) are potential drug-induced complications previously reported with antimalarials, antivirals, and antibiotics. Our objective was to evaluate the prevalence and predictors of QTc interval prolongation and incidences of LTA during hospitalization for coronavirus disease 2019 (COVID-19) among patients with normal admission QTc. METHODS: We enrolled 110 consecutive patients in a multicenter international registry. A 12-lead electrocardiograph was performed at admission, after 7, and at 14 days; QTc values were analyzed. RESULTS: After 7 days, 15 (14%) patients developed a prolonged QTc (pQTc; mean QTc increase 66 ± 20 msec; +16%; P < .001); these patients were older and had higher basal heart rates, higher rates of paroxysmal atrial fibrillation, and lower platelet counts. The QTc increase was inversely proportional to the baseline QTc level and leukocyte count and directly proportional to the basal heart rate (P < .01).We conducted a multivariate stepwise analysis including age, male gender, paroxysmal atrial fibrillation, basal QTc values, basal heart rate, and dual antiviral therapy; age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00-1.13; P < .05), basal heart rate (OR, 1.07; 95% CI, 1.02-1.13; P < .01), and dual antiviral therapy (OR, 12.46; 95% CI, 2.09-74.20; P < .1) were independent predictors of QT prolongation.The incidence rate of LTA during hospitalization was 3.6%. There was 1 patient who experienced cardiac arrest and 3 with nonsustained ventricular tachycardia. LTAs were recorded after a median of 9 days from hospitalization and were associated with 50% of the mortality rate. CONCLUSIONS: After 7 days of hospitalization, 14% of patients with COVID-19 developed pQTc; age, basal heart rate, and dual antiviral therapy were found to be independent predictors of pQTc. Life-threatening arrhythmias have an incidence rate of 3.6%, and were associated with a poor outcome.
Subject(s)
COVID-19 , Long QT Syndrome , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Electrocardiography , Hospitalization , Humans , Male , Registries , SARS-CoV-2ABSTRACT
: We report coronary angio findings of very late (10-year) coronary spasm inducing acute myocardial infarction with typical chest pain in a heart transplant recipient. Coronary spasm was promptly relieved by intra-coronary infusion of nitrates.
Subject(s)
Coronary Vasospasm/etiology , Heart Transplantation/adverse effects , ST Elevation Myocardial Infarction/etiology , Coronary Angiography/methods , Coronary Vasospasm/diagnostic imaging , Coronary Vasospasm/drug therapy , Electrocardiography , Humans , Infusions, Intra-Arterial , Male , Middle Aged , Nitrates/administration & dosage , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/drug therapy , Treatment Outcome , Vasodilator Agents/administration & dosageABSTRACT
Radiotherapy (RT) is one of the main therapeutic options for malignancy treatment; nevertheless, RT is not free from side effects, including an increased risk for secondary neoplasms and other organs injury. Cardiovascular complications are the second most frequent fatal post-RT sequelae, which physicians should be aware of and ready to diagnose early and cure. This review therefore aims to examine epidemiology, pathogenesis and clinical dose-correlated manifestations of RT-induced cardiovascular disease. Future perspectives on screening, prevention and treatment are also provided.
Subject(s)
Cardiovascular Diseases/etiology , Cardiovascular System/radiation effects , Radiation Injuries/epidemiology , Cardiovascular Diseases/epidemiology , Global Health , Humans , Incidence , Neoplasms/radiotherapy , Radiation Injuries/complicationsABSTRACT
We report a case of 46 year-old man, admitted to our Department for a possible massive pulmonary embolism. Instead, diagnosis of Tetralogy of Fallot was established by echocardiography and cardiac catetherization.
Subject(s)
Heart Failure/etiology , Tetralogy of Fallot/complications , Cardiac Catheterization , Humans , Male , Middle Aged , Tetralogy of Fallot/diagnosis , Tetralogy of Fallot/diagnostic imaging , UltrasonographyABSTRACT
BACKGROUND: The aim of the present study was to investigate the relationship between carotid and aortic atherosclerosis in asymptomatic subjects. METHODS: Eighty-three consecutive patients without history of cardio- and cerebrovascular disease, referred for transesophageal echocardiography, were enrolled into the study. RESULTS: Aortic plaques were found in 40 out of 83 patients, whereas carotid atherosclerosis was present in 43% of the entire study population and in 75% of patients with aortic atherosclerosis (30 out of 40 patients). At multivariate logistic analysis, the presence of carotid atherosclerosis was a predictor of aortic atheroma, independently of traditional risk factors. CONCLUSIONS: In asymptomatic patients, aortic plaque occurrence may reflect the presence of carotid plaques and an ultrasound assessment should be advised.