Filippo Masi

Serum osteoprotegerin and carotid intima–media thickness in acute/chronic coronary artery diseases

Aims Osteoprotegerin (OPG) plays a key role in atherosclerosis progression and plaque destabilization. We investigated the relationship between intima–media thickness of the common carotid artery (CCA-IMT; an early marker of atherosclerosis) and OPG levels in patients with acute coronary syndrome (ACS) and chronic coronary artery disease (CAD). Methods We studied 133 consecutive patients, mean age 65 ± 9 years, referred to our department for coronary angiography. They were evaluated for cardiovascular risk factors, OPG levels and CCA-IMT and accordingly divided in two subgroups: ACS and chronic CAD. Results Except for age, the two groups were similar according to conventional cardiovascular risk factors. The chronic CAD group showed a CCA-IMT lower than the ACS group (0.86 ± 0.15 vs. 0.94 ± 0.22 mm, P = 0.027); there were no differences regarding the extension of coronary atherosclerosis on angiograms. The OPG levels were higher in chronic CAD patients than in ACS patients (5.36 ± 3.06 vs. 3.85 ± 2.96 pmol/l, P = 0.004). Moreover, the CCA-IMT was significantly correlated with the age of the patients (r = 0.5; P < 0.001). OPG values were not related either to age or to the CCA-IMT. At analysis of covariance, when adjusting the groups for age, the comparison of the two groups lost statistical significance for CCA-IMT (P = 0.41), whereas the OPG values remained significant after the correction (P = 0.001). Conclusion OPG levels are higher in chronic CAD patients. CCA-IMT confirmed its importance in predicting CAD, showing significantly higher values in the patients in the ACS group as compared with those in the chronic CAD group.

A Striking Coronary Artery Pattern in a Grown-Up Congenital Heart Disease Patient

Left ventricular noncompaction (LVNC) is a myocardial disorder probably due to the arrest of normal embryogenesis of the left ventricle. It could be isolated or associated with other extracardiac and cardiac abnormalities, including coronary artery anomalies. Despite the continuous improvement of imaging resolution quality, this cardiomyopathy still remains frequently misdiagnosed, especially if associated with other heart diseases. We report a case of LVNC association with both malposition of the great arteries and a very original coronary artery pattern.

Bioresorbable vascular scaffolds: design, clinical trials, and current applications.

In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practice. The main advantage of BVS is that they overcome the problem of the foreign body in the treated artery. BVS, once placed into narrowed coronary vessels, behave like a conventional drug-eluting stent, but a device that disappears over time can preserve the anatomy and physiology of the treated vessel. The progression of stenosis after stenting has been attributed, at least in part, to inflammation around metallic struts, that, however, disappears gradually when using BVS. BVS have proven to be effective and safe as drug-eluting stents; in fact, the rate of adverse cardiovascular events and scaffold thrombosis in patients is low. The aim of this review article is to provide a comprehensive and updated description of the status of the art on BVS, highlighting the current evidence and future perspectives of this technology.

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.

Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques

Aortic diseases include a wide range of pathological conditions: aortic aneurysms, pseudoaneurysms, acute aortic syndromes, atherosclerotic and inflammatory conditions, genetic diseases and congenital anomalies. Acute aortic syndromes have acute onset and may be life-threatening. They include aortic dissection, intramural haematoma, penetrating aortic ulcer and traumatic aortic injury. Pain is the common denominator to all acute aortic syndromes. Pain occurs regardless of age, gender and other associated clinical conditions. In this review, we deal with the main findings in the clinical setting and the most recent indications for diagnostic imaging, which are aimed to start an appropriate treatment and improve the short- and long-term prognosis of these patients.

TCT-509 Eighteen-month results of high-risk patients treated with ultrathin-strut biodegradable-polymer Orsiro DES. The Bioflow-III Satellite Italy Subgroups analysis.

Thin-strut biodegradable-polymer DES (Orsiro), a new generation DES, shows a performance similar to last generation DES and very low LLL if compared with everolimus-eluting stents in general population. We aimed to evaluate global performance in high-risk subgroups: diabetics, AMI and small vessels

Fractional flow reserve and intravascular scan as part of the coronary fistulas diagnostic process: Future perspectives

Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy Department of Cardiology, General Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany Department of Cardiology, Hospital “Santa Maria”, GVM Care and Research, Bari, Italy

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

A concealed case of takotsubo syndrome as consequence of ab ingestis episode in a revascularized patient

Letter to the EditorWe report the case of secondary Takotsubo syndrome as a consequence of an ingestis episode in an elderly woman with a history of myocardial revascularization and ischemic stroke with residual emiparesis and dysphagia. Particularly, the invasive coronary angiography showed the lef

‘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.