Maria Francesca Marchetti

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Background Left ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome. Methods and Results We enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99). Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

Prognosis and first diagnostic ECG in STEMI patients referred to the emergency medical system for primary PCI

BACKGROUND Pathological Q waves (QWs) in the first ECG recorded at hospital admission has been found to correlate with myocardial damage and mortality in STEMI patients. We investigated the association between new QWs recorded in the pre-hospital setting and adverse outcome during the hospital stay. METHODS A pre-hospital ECG was recorded in 248 patients with STEMI who underwent primary PCI. Patients were divided into two groups based on the presence (n = 44, QWs) or absence (n = 204, non-QWs) of new QWs. RESULTS Patients with new QWs had a higher prevalence of anterior infarct, cardiogenic shock and a lower LV ejection fraction. In-hospital mortality was higher in patients with new QWs. The percentage of patients with new QWs increased progressively with increasing pain to ECG time. CONCLUSIONS New QWs provide rapid prognostic information in the pre-hospital phase of STEMI by identifying patients at risk of adverse outcome during the hospital stay.

TAKO TSUBO CARDIOMYOPATHY OR MYOCARDITIS

Background: Tako Tsubo (CTS) cardiomyopathy is characterized by an acute and generally transient left ventricular regional systolic dysfunction, often triggered by a physical or emotional stressor, which predominantly affects postmenopausal women. At presentation it mimics an AMI in the absence of

REPERFUSION DELAYS IN WOMEN WITH STEMI

Background: Cardiovascular disease is the leading cause of mortality in women. There is a significant delay when treating Women with STEMI thus a higher mortality rate in females. Aim of the study: to assess the impact of gender on decision delay and system delay reperfusion therapy with primary

Feasibility, symptoms, adverse effects, and complications associated with noninvasive assessment of coronary flow velocity reserve in women with suspected or known coronary artery disease

Microvascular coronary impairment, defined as reduced coronary flow reserve, represents the predominant etiologic mechanism of ischemia in women with chest pain and no obstructive coronary artery disease. Transthoracic echocardiography (TTE) is a noninvasive method for assessing coronary flow velocity reserve (CFVR) in the left anterior descending coronary artery (LAD). The purpose of this investigation was to define the safety profile, feasibility, adverse events, and rate of complications of the test in women with suspected CAD.

IMPACT OF AN EMERGENCY STEMI NETWORK IN OCTOGENARIAN PATIENTS

early myocardial reperfusion is the target therapy to salvage ischemic myocardium in patients with ST elevation myocardial infarction (STEMI). In this perspective, it is recommended the establishment of a STEMI network that allows an early diagnosis and early reperfusion therapy. Octogenarians

INVASIVE VERSUS CONSERVATIVE THERAPY IN OCTOGENARIANS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION

In clinical trials that compare different treatment strategies in patients with acute ST elevation myocardial infarction (STEMI), elderly patients are poorly represented. Aim of this study was to investigate the cost/benefit ratio of invasive versus conservative therapy in STEMI octogenarian