Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil.

Background: Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection.

Objective: This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension.

Methods: This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A.

Cardiac allograft vasculopathy: Incidence and predictors in a single-center cohort.

Introduction And Aims: Cardiac allograft vasculopathy (CAV) is one of the most significant complications after orthotopic heart transplantation. We aimed to investigate the incidence and predictors of CAV in a large cohort of orthotopic heart transplantation patients.

Methods: We conducted a retrospective analysis on a prospective cohort of 233 patients who underwent transplantation between November 2003 and May 2014.

Renal artery wall 18F-NaF activity and glomerular filtration rate: an exploratory analysis in a high cardiovascular risk population.

Objectives: Atherosclerotic plaque molecular imaging with F-sodium fluoride (NaF) PET with computed tomography (PET-CT) may identify active unstable microcalcification. We sought to explore renal arteries calcification activity in a group of high cardiovascular (CV) risk subjects without manifest CV disease.

Methods: High CV risk hypertensive individuals from a single centre were prospectively scanned with F-NaF-PET-CT in major vascular territories.

Keeping prognostic assessment simple: The value of clinical features in normotensive cancer patients with pulmonary embolism.

Introduction: Although normotensive cancer patients with acute pulmonary embolism (PE) are a heterogeneous population, most validated clinical prognostic scores classify these patients as high-risk individuals, which limits their usefulness in this setting. In this study, we aimed to identify readily available clinical predictors of overall 30-day and one-year mortality in normotensive cancer patients with PE.

Methods And Results: We performed a retrospective single-center study that included all normotensive cancer patients with PE diagnosed by multidetector computed tomography (MDCT) during emergency department stay between January 2010 and December 2011.

Early manifestation of myocardial involvement in systemic sclerosis.

Introduction: Systemic sclerosis (SSc) is a systemic autoimmune disease involving multiple organs. We present a rare case of SSc in which clinical manifestations of cardiac fibrosis occurred early in the disease course.

Case Report: We report the case of a 40-year-old Caucasian man, previously diagnosed with SSc, who presented with decompensated heart failure.

Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen?

Introduction: Oral anticoagulants have proved to be highly effective in preventing atrial fibrillation (AF)-related strokes. The occurrence of stroke despite oral anticoagulation is unexpected and little is known about the mechanisms responsible. The aim of this study was to assess possible mechanisms for stroke occurrence, such as poor treatment adherence and inappropriate dosage, in patients chronically anticoagulated for AF.

An Alternative Method to Calculate Simplified Projected Aortic Valve Area at Normal Flow Rate.

Background: Simplified projected aortic valve area (EOAproj) is a valuable echocardiographic parameter in the evaluation of low flow low gradient aortic stenosis (LFLG AS). Its widespread use in clinical practice is hampered by the laborious process of flow rate (Q) calculation.

Objetive: This study proposes a less burdensome, alternative method of Q calculation to be incorporated in the original formula of EOAproj and measures the agreement between the new proposed method of EOAproj calculation and the original one.

Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a "resting ischemia test"?

With the introduction of high-sensitivity troponin (hsTNI) assays, the clinical significance unstable angina (UA) has become uncertain. We hypothesized that impaired left ventricular (LV) two-dimensional speckle-tracking echocardiography (2D-STE)-derived peak global longitudinal strain (GLS) was able to exclude the presence of significant coronary artery disease (CAD) in UA patients without prior cardiovascular (CV) events and with a normal LV ejection fraction (LVEF). From a cohort of 200 patients admitted with UA, we selected 61 patients without prior CV events and with a normal LVEF; of these, 48 (79%) underwent invasive coronary angiography (ICA) and 24 (39%) had at least ≥ 1 significant stenosis.

Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism.

Introduction: Intermediate-high risk pulmonary embolism (IHR-PE) has a poor prognosis, but is under-represented in trials of direct oral anticoagulants (DOACs) in venous thromboembolic disease (VTE). We aimed to assess whether the administration of DOACs was equivalent to the conventional (CONV) treatment of low-molecular weight heparin bridged with warfarin for treating IHR-PE.

Methods: We conducted a retrospective cohort study including 59 consecutive patients admitted with IHR-PE and followed for up to three months after discharge.

MicroRNA-424(322) as a new marker of disease progression in pulmonary arterial hypertension and its role in right ventricular hypertrophy by targeting SMURF1.

Aims: MicroRNAs (miRNAs) have been implicated in the pathogenesis of pulmonary hypertension (PH), a multifactorial and progressive condition associated with an increased afterload of the right ventricle leading to heart failure and death. The main aim of this study was to correlate the levels of miR-424(322) with the severity and prognosis of PH and with right ventricle hypertrophy progression. Additionally, we intended to evaluate the mechanisms and signalling pathways whereby miR-424(322) secreted by pulmonary arterial endothelial cells (PAECs) impacts cardiomyocytes.

Who still remains at risk of arrhythmic death at time of implantable cardioverter-defibrillator generator replacement?

Background: Implantable cardioverter-defibrillator (ICD) is associated with reduction in arrhythmic mortality. However, at the time of generator replacement (GR) some patients had not experienced therapies and had a different clinical profile. Therefore, the risk-benefit ratio of ICD may have changed.

Atherosclerotic plaque metabolism in high cardiovascular risk subjects - A subclinical atherosclerosis imaging study with F-NaF PET-CT.

Background And Aims: Atherosclerotic plaque molecular imaging with F-sodium fluoride (NaF) in positron emission tomography with computed tomography (PET-CT) provides potential discrimination between active unstable microcalcification and established dormant calcification. We aimed to study F-NaF atherosclerotic plaque uptake in high cardiovascular (CV) risk participants and its associations with CV risk factors, coronary calcium score and thoracic fat volume.

Methods: High CV risk hypertensive individuals from a single centre were prospectively scanned with F-NaF-PET-CT in the coronary, aortic and carotideal arteries.

Assessment of atherosclerotic plaque calcification using F18-NaF PET-CT.

Background: The aim of the present study was to evaluate the uptake of F18-NaF by the arterial wall in patients with high cardiovascular (CV) risk profile. The tracer uptake was assessed in relation to gender and the number of CV risk factors.

Methods And Results: 25 patients without known CV disease were included and evaluated by PET-CT with F18-NaF: 14 (56%) men and 11 (44%) women.

Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease.

Left atrium function is essential for cardiovascular performance and is evaluable by two-dimensional speckle-tracking echocardiography (2D-STE). Our aim was to determine how echocardiographic parameters interrelate with exercise capacity and ventilatory efficiency in subjects with no structural heart disease. Asymptomatic volunteers, in sinus rhythm and with normal biventricular size and function, were recruited from a community-based population.

Disruption of bioresorbable vascular scaffold struts due to loss of radial integrity: insights from optical coherence tomography.

Strut disruption of bioresorbable vascular scaffold is a known potential concern, although uncommon when adequate lesion preparation is achieved and nominal size of the scaffold is respected. It is usually difficult to detect with angiography and/or intravascular ultrasound. Three-dimensional reconstructions of optical coherence tomography facilitates understanding of complex luminal anatomy and configuration of stent struts, providing evaluation of stent integrity immediately after deployment and therefore optimization of the complex revascularization procedure.

Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review.

Background: Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings.

Heart transplant coronary artery disease: Multimodality approach in percutaneous intervention.

Coronary artery disease is the most important cause of late morbidity and mortality after heart transplantation. It is usually an immunologic phenomenon termed cardiac allograft vasculopathy, but can also be the result of donor-transmitted atherosclerosis. Routine surveillance by coronary angiography should be complemented by intracoronary imaging, in order to determine the nature of the coronary lesions, and also by assessment of their functional significance to guide the decision whether to perform percutaneous coronary intervention.

Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis.

Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. In addition, the persistence of pulmonary hypertension (PH) after PMV is a complication for which mechanisms and prognostic implications are unclear. Our aims were (1) to report the long-term outcomes of patients with rheumatic mitral stenosis treated with PMV; (2) to determine the risk factors for long-term poor outcomes; and (3) to analyze the prevalence and predictors of persistent PH.