Clinical Discussions in Antithrombotic Therapy Management in Patients With Atrial Fibrillation: A Delphi Consensus Panel.

Background: In recent years, direct-acting oral anticoagulants (DOACs) have entered clinical practice for stroke prevention in non-valvular atrial fibrillation or prevention and treatment of venous thromboembolism. However, remaining uncertainty regarding DOAC use in some clinical scenarios commonly encountered in the real world has not been fully explored in clinical trials.

Methods: We report on use of a Delphi consensus process on DOAC use in non-valvular atrial fibrillation patients.

Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

Background: We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider.

Methods: Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated.

Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support.

Background: Heat waves have been reported as being associated with increased rates of hospitalizations and deaths.

Materials And Methods: In July 2011, a heat wave hit southern Italy. We enrolled 9,282 consecutive patients who called the Apulia (southeastern Italy) regional free public emergency medical service (EMS) "118" number (out of 4 million inhabitants) during July 2011.

Prevalence of cardiac arrhythmias in pre-hospital tele-cardiology electrocardiograms of emergency medical service patients referred for syncope.

Aim: To evaluate the rate of prevalence of significant arrhythmias in emergency medical service (EMS) subjects referred for syncope and screened with pre-hospital tele-cardiology ECG.

Methods: 2648 consecutive EMS patients referred for syncope were evaluated with tele-cardiology support. Pre-hospital ECGs were sent to a single tele-cardiology "hub", active 24/7 and serving a region of 4-million inhabitants, and promptly read by a cardiologist.

[Tako-tsubo syndrome during an attempt of pacemaker implantation in a patient with persistent left superior vena cava and absent right superior vena cava].

Persistent left superior vena cava is a rare congenital abnormality. Cases of persistent left superior vena cava with an absent right superior vena cava or the presence of other congenital cardiovascular abnormalities have been rarely described. To the best of our knowledge, this is the first case of a patient with persistent left superior vena cava, absent right superior vena cava and tako-tsubo syndrome observed during an attempt of pacemaker implantation.

A regional prehospital electrocardiogram network with a single telecardiology "hub" for public emergency medical service: technical requirements, logistics, manpower, and preliminary results.

Background: In patients with a major cardiac event, the first priority is to minimize time-to-treatment. For many patients, the first and fastest contact with the health system is through emergency medical services (EMS). However, delay to treatment is still significant in developed countries, and international guidelines therefore recommend that EMS use prehospital electrocardiogram (ECG).

Atrial fibrillation with symptoms other than palpitations: incremental diagnostic sensitivity with at-home tele-cardiology assessment for emergency medical service.

Background: Clinical presentation of atrial fibrillation (AF) is usually represented by palpitations; nevertheless, atypical presentation of AF with symptoms other than palpitations may be not uncommon in elderly patients. This study therefore aimed to evaluate incremental diagnostic value of tele-medicine at-home assessment in patients who called emergency medical service (EMS).

Methods: A total of 27,841 consecutive EMS patients referred for suspected heart disease underwent ECG assessment with a mobile ECG-recorder device.

Telecardiology improves quality of diagnosis and reduces delay to treatment in elderly patients with acute myocardial infarction and atypical presentation.

Aim: To assess whether telemedicine technology applied to public emergency healthcare system improves overall quality of home diagnosis in case of acute myocardial infarction among elderly patients, often characterized by higher rates of atypical presentation.

Methods: About 27 841 patients from Apulia (Italy) who called public emergency healthcare number '118' underwent home ECG evaluation. Data were transmitted with a mobile telephone support to a telecardiology 'hub' active continuously (24/7).

Cardiac biomarkers in acute coronary syndromes: a review.

Early recognition is indispensable for the optimal management of Acute Coronary Syndrome (ACS); moreover, early prognostic stratification of patients with established ACS is useful to improve strategies for these patients. The paper focuses attention on troponins (I and T), the most validated biomarker for early diagnosis of ACS and on B-type natriuretic peptide (BNP) and N-terminal proB-type natriuretic peptide (NT-proBNP), the most powerful cardiac marker after troponin to be used as prognostic indicator in patients with ACS. We pay particular attention to the troponin story in ACS, including discussions about high sensitivity methods and on the most recent techniques (e.

Telecardiology applied to a region-wide public emergency health-care service.

Aim: To assess feasibility and reliability of telecardiology technologies applied to a region-wide public emergency health-care service.

Methods: About 27,841 patients from all over Apulia (19.362 km(2), 4 million inhabitants) were referred from October 2004 until April 2006 to public emergency health-care number "118" and underwent ECG evaluation according to a previously fixed inclusion protocol.

Clinical impact of the troponin 99th percentile cut-off and clinical utility of myoglobin measurement in the early management of chest pain patients admitted to the Emergency Cardiology Department.

Objective: To verify the clinical impact of different low cut-offs for troponin I/cardiac troponin I (99th percentile to 10% CV) and for myoglobin, in early risk stratification of patients with suspected acute coronary syndrome.

Methods: A total of 516 consecutive non-ST-elevation patients admitted to hospital were followed. The first measurement of cardiac markers was performed at the point-of-care in the Emergency Cardiology Department, using Stratus CS.

Atherosclerosis in HIV patients: a new face for an old disease?

As we have become more familiar with the pathogenesis of atheroma, it has become recognized atherogenesis is mainly an inflammatory disease. Therefore, it is not surprising that a body of evidence demonstrates that endothelium injury is associated with the progression and severity of HIV infection. Another important question is: do antiretroviral drugs increase or reduce endothelial injury? Various studies support the hypothesis that HAART does induce activation of endothelial function.

Proteomic approach to the diagnosis of acute coronary syndrome: preliminary results.

Background: Cardiac multimarker strategy is recommended by the IFCC, ESC and the ACC for an early risk stratification in non-ST-segment elevation (NSTE) ECG patients with chest pain. A new approach, based on protein biochip array technology, performs simultaneously: cTnI, CK-MB, myoglobin, CAIII, GFBB and FABP using a single chip.

Methods: We evaluated the analytical performance of the Randox-Evidence Investigator -biochip cardiac panel according to IFCC recommendations and NCCLS guidelines; a preliminary clinical evaluation was carried out on chest pain NSTE ECG patients, to evaluate the accuracy of the multimarker approach in an early diagnosis of AMI, related to the final diagnosis (ACC/ESC criteria).

Integration between point-of-care cardiac markers in an emergency/cardiology department and the central laboratory: methodological and preliminary clinical evaluation.

To achieve rapid assessment of chest pain in emergency/cardiology departments, a short turnaround time for cardiac marker testing is necessary. Nevertheless, Total Quality Management principles must be incorporated into the management of point-of-care testing (POCT); in this setting we implemented the Stratus CS assay as POCT for cardiac markers in our emergency/cardiology department. The analytical performance of the troponin I method was evaluated; information connectivity between the Stratus CS data management system and the laboratory information system was implemented and practical training of testing personnel was carried out at the POCT site.

Comparative effect of lercanidipine, felodipine, and nifedipine GITS on blood pressure and heart rate in patients with mild to moderate arterial hypertension: the Lercanidipine in Adults (LEAD) Study.

This multicenter, double-blind, parallel-group study compared the effects of three dihydropyridine calcium channel blockers (lercanidipine, felodipine, and nifedipine gastrointestinal therapeutic system) on blood pressure and heart rate in 250 patients with mild to moderate hypertension (diastolic blood pressure > or =95 and 109 mm Hg). Patients were randomized to 4 weeks of treatment with once-daily doses of lercanidipine 10 mg, felodipine 10 mg, or nifedipine gastrointestinal therapeutic system 30 mg. After 4 weeks of treatment, the dose was doubled in nonresponding patients.

Appropriateness of point-of-care testing (POCT) in an emergency department.

Background: Acute coronary syndrome is a major cause of death, morbidity and access in emergency departments (ED).

Methods: We evaluated a point-of-care testing (POCT) for the determinations of cardiac markers in an emergency department (ED), defining the clinical efficiency (management of patient with chest pain) and economic effectiveness (rationalization of preanalytical phase) related to data of Core Lab.

Results: The results of analytical performances showed a good correlation (cTnI r(2)=0.