Donato Quagliara

Th2-dependent cytokine release in patients treated with coronary angioplasty.

AimThe aim of this study is to investigate the T helper (Th)2-dependent release of interleukin(IL)-4 and IL-13 in patients with unstable angina treated with coronary angioplasty (PCI). MethodsThis study involved 48 consecutive patients with unstable angina who underwent PCI. Blood samples were taken before and 48 h after PCI to evaluate serum IL-4 and IL-13 levels. Coronary atherosclerosis was assessed in terms of the severity of the treated lesions and the presence of multivessel disease, and compared with IL release. ResultsBefore and after PCI, serum IL-4 levels were, respectively, 53.1±110.7 and 35.1±16.9 pg/ml (P not significant), and serum IL-13 levels 6.7±3.7 and 6.0±2.9 pg/ml (P<0.05). A correlation was present between the severity of the treated coronary lesions and serum IL-13 levels (r 0.36; P<0.05). The patients with multivessel coronary artery disease had a higher periprocedure ratio of IL-4 than those with single-vessel coronary artery disease (1.46±0.76 vs. 0.89±0.34, P<0.001). ConclusionA significant decrease was observed in Th2-dependent IL concentrations after PCI; increased Th2-dependent IL levels before PCI seem to correlate with the severity of coronary atherosclerosis.

Sudden cardiac death secondary to demonstrated reperfusion ventricular fibrillation in a woman with Takotsubo cardiomyopathy

Takotsubo cardiomyopathy is a left ventricle cardiomyopathy characterized by a reversible dyskinesia responsible for the typical apical ballooning aspect. The disease is considered benignant with a full recovery within a few weeks. We present the case of a 52-year-old woman who presented with angina diagnosed with Takotsubo cardiomyopathy on the basis of both noninvasive (electrocardiography, echocardiography) and invasive (angiography) exams. At discharge, a Holter monitor was fitted to the patient. During the recording the patient faced sudden cardiac death. The analysis of the Holter traces allowed some speculations on the mechanism of this unexpected arrhythmic death. The cause of the fatal ventricular fibrillation appears to be the fast reperfusion following a short occlusion of an epicardial coronary artery. This case highlights the epicardial vasospasm as an important pathogenic mechanism of the syndrome and the possible usefulness of diagnostic tests able to elicit the spasm susceptibility and guide a more targeted pharmacological therapy. Some considerations are also possible on the cellular processes linking the rapid reperfusion and the arrhythmias onset.

Aortic coarctation: guidelines mismatch across the ocean.

Pseudocoarctation is a rare congenital anomaly characterized by aorta elongation and kinking, without significant obstruction. We report the case of an elderly patient with history of congestive heart failure (CHF) and aortic regurgitation (AR) who was referred for progressive exertional dyspnoea. After multimodal imaging evaluation, aortic coarctation with significant trans-stenosis gradient but mild luminal narrowing was diagnosed; this borderline patient was not addressed to repair, according to ESC guidelines and in spite of AHA ones. He rather met the criteria for pseudocoarctation diagnosis. An integration of functional and anatomical data is essential for a reliable diagnostic process in similar cases.

TIME RELATED BENEFIT OF ANTIPLATELET THERAPY ON CORONARY REPERFUSION IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS

Background: The goal of STEMI treatment is early reperfusion. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor demonstrated to improve angiographic results of primary percutaneous coronary intervention (pPCI) and clinical prognosis, but their onset of action is significantly impaired

‘Broken-heart’ syndrome: ventricular septal perforation in a takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a form of acute left ventricular dysfunction usually reversible and with favorable prognosis. Ventricular septal perforation (VSP) is a very rare life-threatening complication. Percutaneous closure of VSP, despite being challenging, is a possible alternative to surgical repair. We present the first case of an 84-year-old patient with a TTC-related VSP treated by percutaneous approach. The case highlights the need of reconsidering the worldwide accepted consideration of TTC as benignant and allows some speculations on the optimal management of VSP in terms of timing, patient selection and possible alternative interventions.

THE SLOW CORONARY FLOW PHENOMENON IS NOT A GOOD PREDICTOR OF CORONARY MICROCIRCULATORY DYSFUNCTION AS ASSESSED BY ABSOLUTE CORONARY FLOW RESERVE IN PATIENTS WITH ANGIOGRAPHICALLY NORMAL CORONARY ARTERIES

The meaning of the slow coronary flow phenomenon (SCF) as visualized in patients (pts) with angiographically normal coronary arteries, is controversial. Non-invasively assessed absolute coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD) by transthoracic colour guided

Invasive Assessment of Left Ventricular Function in Ischemic Heart Disease

Left ventricular function considerably affects prognosis and choice of treatment in patients with coronary artery disease (CAD). Nevertheless, a correct assessment of left ventricular (LV) performance, irrespective of the influence of pre- and after-load, is a hard and still unresolved problem, although solving it has been the aim of a number of clinical and experimental studies.