Giornale italiano di cardiologia最新文献

We report the case of a 78-year-old patient with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI) of the right coronary artery, subsequently found to have a large subepicardial mass. The patient underwent a non-invasive multimodal diagnostic work-up including cardiac computed tomography and cardiac magnetic resonance imaging, which led to the diagnosis of subepicardial hematoma following coronary perforation during primary PCI. Due to clinical stability and absence of active bleeding sources, the patient was managed conservatively with gradual absorption of the mass and favorable prognostic outcome.

The perspective on cardiac amyloidosis has deeply changed over the last 10 years following major advances in diagnosis and treatment options. This heterogeneous disease requires the interaction among experts of different specialties and subspecialties. Suspicion of disease, timely recognition and confirmation of final diagnosis, prognostic stratification, overall management and therapeutic strategies represent ongoing challenges in the clinical setting. Missing or delayed diagnosis may have significant impact on patient outcome, especially in light-chain amyloidosis. The present inter-society consensus document aims to provide a standardized approach to the diagnosis of cardiac amyloidosis in Italy, and to discuss the challenging clinical scenarios encountered in routine activity for cardiologists and physicians of different specialties dealing with patients with suspected or established cardiac amyloidosis. This document may be adapted to the setting of each specific region.

Pulmonary embolism in the post-partum period is a critical condition with significant implications for maternal and infant health. We present a case report illustrating the challenges in the clinical management of a patient with intermediate-high risk pulmonary embolism who developed signs of hemodynamic instability in light of current clinical practice.

Atrial fibrillation is the most common cardiac arrhythmia in adults and increases the risk of stroke 5-fold. In patients with non-valvular atrial fibrillation, left atrial appendage is the most common site for cardiac thrombus. For this reason, left atrial appendage closure (LAAC) represents an effective alternative to oral anticoagulants in patients who have relative or absolute contraindications to oral anticoagulation. Transesophageal echocardiography (TEE) is considered the gold standard imaging modality to guide LAAC. However, general anesthesia and tracheal intubation are often required with the TEE approach, increasing risks in elderly patients. There is an unmet need to overcome these limitations identifying an ideal "minimalist approach" to guide LAAC. Intracardiac echocardiography (ICE) represents a minimalist approach but it suffers from the lack of standardization and it may result in an suboptimal image quality compared with TEE. Another innovative approach is represented by the use of ICE via the transesophageal route (ICE-TEE), which has been already validated to identify the presence of left atrial appendage thrombi and to perform other procedures. In this paper, we suggest that ICE-TEE could be a good alternative imaging technique to guide the LAAC procedure without general anesthesia. A trial is ongoing to demonstrate its safety and effectiveness as ultrasound modality to guide LAAC.

Coronary stent fracture is an infrequent event, with an incidence ranging from 1% to 8%. In rare cases, this complication may result in acute occlusion of the affected coronary artery. We report the case of a patient who experienced acute coronary syndrome following a stent fracture implanted 3 years previously. Myocardial infarction was caused by thrombosis occluding the vessel and probably triggered by endothelial injury caused by the protruding metal strut of the fractured stent. Vessel tortuosity, hinge motion, overlapping stents, increased stent length, smaller stent diameter and high post-dilation pressure are risk factors for stent fracture. In conclusion, to ensure proper recognition of this often-misunderstood clinical entity, it is necessary to be aware of its occurrence.

Background: The prospective, single-arm, observational, phase 4 ETNA-AF Europe study collected real-world data about safety, effectiveness and therapeutic adherence in European patients with non-valvular atrial fibrillation newly prescribed with edoxaban and followed up for 4 years.

Methods: Overall, 13 164 patients were included in the full-analysis set, which means that they had at least one documentation after baseline at 4 years. The current paper reports about the 3329 Italian patients out of the whole European population.

Results: In the Italian cohort, median age was 76.0 (69.0-82.0) years, with 57.4% of the patients being ≥75 years old. The CHA2DS2-VASc score was >4 in 586 (18.1%) patients. At baseline, 670 (20.8%) patients were classified as frail by the investigators. Edoxaban 30 mg/day was prescribed to 1013 (31.8%) patients: these were older, with more comorbidities and a lower estimated creatinine clearance compared with those receiving 60 mg/day. All-cause mortality was 4.1%/year and there were very low yearly rates of bleeding and thromboembolic events: major bleeding, 0.9%; intracranial hemorrhage, 0.2%; ischemic stroke, 0.3%; systemic embolism, <0.1%. These events were more frequent in patients ≥75 years or in patients with renal impairment or treated with edoxaban 30 mg/day. Advancing age was not associated with an increased incidence of intracranial bleeding.

Conclusions: These findings confirm the favorable long-term safety and effectiveness profile of edoxaban in non-valvular atrial fibrillation patients treated in routine clinical care in Italy.

We report a rare case of angina in a patient with anomalous left circumflex artery origin from the right sinus of Valsalva with retroaortic course and a double myocardial bridging of the anterior descending artery. In a modified apical 4-chamber view during transthoracic echocardiography the "crossed aorta sign" (or "RAC sign") was found. Usually, the diagnosis of this congenital anomaly of coronary circulation is established during coronary angiography. In our case, the diagnosis was suspected during angiography but confirmed by echocardiography and coronary computed tomography angiography.