Publications by authors named "Merlo M"

Purpose Of Review: Hot phases are a challenging clinical presentation in arrhythmogenic cardiomyopathy (ACM), marked by acute chest pain and elevated cardiac troponins in the absence of obstructive coronary disease. These episodes manifest as myocarditis and primarily affect young patients, contributing to a heightened risk of life-threatening arrhythmias and potential disease progression. This review aims to synthesize recent research on the pathophysiology, diagnostic challenges, and therapeutic management of hot phases in ACM.

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  • The study analyzed changes in electrocardiographic (ECG) characteristics in patients with different types of cardiac amyloidosis (AL, ATTRv, and ATTRwt) and looked at their predictive value for patient outcomes.
  • In a large sample of 356 patients, it was found that those with ATTRwt had more conduction issues, while AL patients exhibited more signs of low QRS voltage and T wave inversion.
  • Overall, the ECG abnormalities progressed similarly in all subtypes, but a longer QRS duration at baseline was associated with worse survival, indicating it could be a potential marker for advanced disease.
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The knowledge of pericardial diseases has now improved, including prospective and retrospective cohort studies focusing on the pathogenesis, diagnosis, treatment, and outcomes. The complex interplay between genetic predisposition (especially for autoinflammatory conditions), inflammation, and autoimmunity is now known to trigger recurrences of pericarditis. Moreover, diagnostic capabilities have improved with the implementation of multimodality imaging, particularly cardiac magnetic resonance (CMR), to detect and monitor pericardial inflammation, to allow diagnosis in more complicated cases, and tailor the duration of therapy based on objective parameters.

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  • Exposure to organophosphorus compounds, like chlorpyrifos (CPF), can lead to various health issues affecting the brain and heart, primarily due to the inhibition of the enzyme acetylcholinesterase (AChE).
  • In a study on rats, intermittent CPF treatment was found to increase anxiety and impair motor functions, but it did not significantly affect depression symptoms or fear responses after a washout period.
  • Measurement of AChE activity showed significant reductions in key brain areas, indicating a link between CPF exposure and neurotoxicity, particularly at higher doses.
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  • The understanding of cardiac amyloidosis has significantly evolved in the past decade, leading to better diagnostic and treatment methods.
  • This complex disease requires collaboration among various medical specialists to ensure timely diagnosis, risk assessment, and effective management.
  • The inter-society consensus document aims to standardize diagnostic approaches in Italy and address clinical challenges for healthcare providers working with patients suspected of having cardiac amyloidosis.
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The synthesis atmosphere plays a fundamental role in determining the physicochemical properties and electrochemical performance of NMC811 cathode materials used in lithium-ion batteries. This study investigates the effect of carbonate impurities generated during synthesis by comparing three distinct samples: NMC811 calcined in ambient air, NMC811 calcined in synthetic air to mitigate carbonate formation, and NMC811 initially calcined in ambient air followed by annealing in synthetic air to eliminate carbonate species. Physicochemical characterization through XRD, SEM, FTIR, and TGA techniques revealed noticeable differences in the structural and chemical properties among the samples.

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Introduction: Mild cognitive impairment (MCI) or "mild neurocognitive disorder" represents an intermediate status between normality and dementia. It is characterized by cognitive decline that does not significantly interfere with normal daily living activities. Virtual reality (VR) is the new frontier of rehabilitation.

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Aims: Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.

Methods And Results: One-hundred-fifteen patients (median age 39 [IQR 28-52], 42% females) were identified at 6 referral centres.

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  • Systemic immune-mediated diseases (SIDs) may contribute to dilated cardiomyopathy (DCM), and this study aimed to explore the genetic predispositions present in DCM patients with SIDs.
  • The research involved 183 DCM-SID patients, identifying a significantly higher prevalence of pathogenic genetic variants in these individuals compared to healthy controls and DCM patients without SIDs.
  • Findings suggest that about 17-20% of DCM patients with SIDs have pathogenic variants, particularly truncating variants like TTN, indicating the importance of genetic testing for understanding the causes of immune-related DCM.
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  • Dilated cardiomyopathy (DCM) is a complex heart disease with various causes, remaining a major issue for heart failure and early death, despite recent treatment improvements.
  • Traditional DCM treatments focus on established heart failure therapies but there's a shift towards personalized medicine as genetic and environmental factors play a critical role in the disease's development.
  • The review discusses the diverse mechanisms behind DCM, emphasizing the need for future research on innovative treatments like gene therapy and prevention strategies against arrhythmic death.
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  • A study analyzed long-term outcomes in 1,184 patients with implantable cardioverter defibrillators (ICDs) to compare the risks of appropriate interventions and overall survival between those with ischemic heart disease (IHD) and non-ischemic heart disease (NIHD).
  • Findings revealed that all-cause mortality was significantly higher in patients with IHD (60%) compared to those with NIHD (43%), but the rate of appropriate ICD interventions did not differ significantly over ten years (34% for IHD vs. 40% for NIHD).
  • Additionally, within NIHD, certain types of heart disease like valvular disease and chemotherapy-related dilated cardiomyopathy showed higher mortality rates, while inappropriate
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Aims: Secondary mitral regurgitation (MR) negatively affects prognosis in acutely decompensated heart failure (ADHF), but can be rapidly sensitive to changes in volume status and medical interventions. We sought to assess the evolution of secondary MR in patients hospitalized for ADHF and its prognostic implications.

Methods: We retrospectively enrolled 782 patients admitted for ADHF with at least two in-hospital echocardiographic evaluations of MR.

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  • * A retrospective analysis was conducted on 811 patients from the DIAMOND study, which included a total of 1281 patients diagnosed in Italy between 2016-2021, focusing on characteristics leading to their diagnosis and calculating their respective scores.
  • * Findings showed that only 1% of patients had early diagnoses, with significant differences in prognostic variable distribution based on diagnostic pathways, and both NAC and Columbia scores were linked to all-cause mortality.
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Background: The introduction of a noninvasive diagnostic algorithm in 2016 led to increased awareness and recognition of cardiac amyloidosis (CA).

Objectives: The purpose of this study was to analyze the impact of the introduction of the noninvasive diagnostic algorithm on diagnosis and prognosis in a multicenter Italian CA cohort.

Methods: This was a retrospective analysis of 887 CA patients from 5 Italian Cardiomyopathies Referral Centers: 311 light-chain CA, 87 variant transthyretin (TTR)-related CA, 489 wild-type TTR-related CA.

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  • Pathogenic variants in the desmoplakin (DSP) gene lead to a unique type of cardiomyopathy that doesn't fit neatly into existing categories like DCM, NDLVC, or ARVC, with limited past studies on potential predictors of severe outcomes.
  • Researchers analyzed 800 patients with DSP variants from a global network over an average of 3.7 years, finding that 17.4% experienced sustained ventricular arrhythmias (VAs) and 9.0% had heart failure (HF) hospitalizations.
  • Key risk factors for developing VAs included female sex, history of non-sustained and sustained VAs, and lower left ventricular ejection fraction, while T-wave inversion was linked to HF
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  • Secondary tricuspid regurgitation (TR) is linked to worse outcomes in patients with acute decompensated heart failure (ADHF), and this study investigates how TR changes during hospital treatment and its impact on patient prognosis.
  • The research included 1054 ADHF patients, finding that nearly half (49%) of those with severe TR at admission improved during their hospital stay, which correlated with better recovery and lower long-term risk of dying or being readmitted for heart failure.
  • Factors like atrial fibrillation and higher diuretic doses were associated with less likelihood of TR improvement, but better TR status was significantly tied to better 5-year survival rates and heart failure hospitalization outcomes.
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  • Pathogenic variants in the desmoplakin (DSP) gene are linked to a specific type of arrhythmogenic cardiomyopathy, which increases the risk of serious heart rhythm issues, but current evaluation methods are unreliable for these patients.
  • A study was conducted with patients from the DSP-ERADOS registry to track the occurrence of sustained ventricular arrhythmia (VA) over time, using a detailed statistical analysis to create a new clinical prediction tool.
  • The research identified five key clinical factors that can help predict the risk of developing sustained VA, resulting in a new DSP risk score that demonstrated strong prediction capabilities in both the initial and external testing groups.
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Non-dilated left ventricular cardiomyopathy (NDLVC) is a newly categorized cardiomyopathy phenotype includingseveral aetiologies with a linking characteristic represented by the normal left ventricular volume. Inflammatory heart disease (InHD) is a heterogeneous process with variegate clinical manifestations, sometimes in overlap with NDLVC. A 26-year-old woman was admitted forcomplete heart block (CHB) and persistently raised troponin.

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Background: The prognostic impact of catheter ablation (CA) of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients has not yet been satisfactorily elucidated.

Objectives: The aim of the study was to assess the impact of CA of AF on clinical outcomes in a large cohort of HCM patients.

Methods: In this retrospective multicenter study, 555 HCM patients with AF were enrolled, 140 undergoing CA and 415 receiving medical therapy.

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  • * The study finds that a history of nonsustained ventricular tachycardia is a strong predictor of future VA occurrences, although traditional risk factors such as age and male sex do not show a significant association with VA events.
  • * The ARVC risk calculator, which is intended to evaluate the risk of VA, performs inadequately in this patient population, highlighting the need for a more tailored, gene-specific risk
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The study of digeneans and their association with mollusks commenced in Europe and South America during the mid-19th to early 20th centuries. Digenean infestation can severely degrade host tissue, leading to diminished energy resources and eventual host mortality. However, these parasites can also induce various non-lethal effects, including changes in growth rates, survival rates, and reproductive capabilities, alongside physiological and behavioral alterations.

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  • The study aimed to explore the prevalence of transthyretin amyloidosis variant cardiomyopathy (ATTRv-CM) among relatives at risk, assess the effectiveness of repeated evaluations, and analyze first-line diagnostic methods like ECG and echocardiogram.
  • Among 159 relatives evaluated, 25% were diagnosed with ATTRv-CM, and half of those diagnosed exhibited heart failure symptoms, showcasing a high negative predictive value for screening based on specific criteria.
  • The findings emphasize the need for ongoing monitoring, as 13% of patients with ATTRv-CM showed no initial cardiac signs, suggesting regular follow-up testing is crucial for early detection and management.
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A dyssynchronous biventricular activation, which can be determined by left bundle branch block, chronic right ventricular pacing, frequent premature ventricular complexes, or pre-excitation, can cause a global abnormal contractility, thus leading to systolic dysfunction and left ventricular remodelling in a unique nosological entities: abnormal conduction-induced cardiomyopathies. In this clinical scenario, the mainstay therapy is eliminating or improving LV dyssynchrony, removing the trigger. This usually ensures the improvement and even recovery of cardiac geometry and left ventricular function, especially in the absence of genetic background.

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