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Context. Low-energy (<300 keV) protons entering the field of view of XMM-Newton can scatter with the X-ray mirror surface and reach the focal plane. They are observed in the form of a sudden increase in the background level, the so-called soft proton flares, affecting up to 40% of the mission observing time. Soft protons can hardly be disentangled from true X-ray events and cannot be rejected on board. Aims. All future high throughput grazing incidence X-ray telescopes operating outside the radiation belts are potentially affected by soft proton-induced contamination that must be foreseen and limited since the design phase. In-flight XMM-Newton's observations of soft protons represent a unique laboratory to validate and improve our understanding of their interaction with the mirror, optical filters, and X-ray instruments. At the same time, such models would link the observed background flares to the primary proton population encountered by the telescope, converting XMM-Newton into a monitor for soft protons. Methods. We built a Geant4 simulation of XMM-Newton, including a verified mass model of the X-ray mirror, the focal plane assembly, and the EPIC MOS and pn-CCDs. Analytical computations and, when available, laboratory measurements collected from literature were used to verify the correct modelling of the proton scattering and transmission to the detection plane. Similarly to the instrument X-ray response, we encoded the energy redistribution and proton transmission efficiency into a redistribution matrix file (RMF), mapping the probability that a proton from 2 to 300 keV is detected in a certain detector channel, and an auxiliary response file (ARF), storing the grasp towards protons. Both files were formatted according to the standard NASA calibration database and any compliant X-ray data analysis tool can be used to simulate or analyse soft proton-induced background spectra. An overall systematic uncertainty of 30% was assumed on the basis of the estimated accuracy of the mirror geometry and transmission models. Results. For the validation, three averaged soft proton spectra, one for each filter configuration, were extracted from a collection of 13 years of MOS observations of the focused non X-ray background and analysed with Xspec. A similar power-law distribution is found for the three filter configurations, plus black-body-like emission below tens of keV used as a correction factor, based on the dedicated spectral analysis of 55 in-flight proton flares presented in Paper II. The best-fit model is in agreement with the power-law distribution predicted from independent measurements for the XMM-Newton orbit, spent mostly in the magnetosheath and nearby regions. For the first time we are able to link detected soft proton flares with the proton radiation environment in the Earth's magnetosphere, while proving the validity of the simulation chain in predicting the background of future missions. Benefiting from this work and contributions from the Athena instrument consortia, we also present the response files for the Athena mission and updated estimates for its focused charged background. [ABSTRACT FROM AUTHOR]

Context. Low-energy (< 300 keV) protons entering the field of view of the XMM-Newton telescope scatter with the X-ray mirror surface and might reach the X-ray detectors on the focal plane. They manifest in the form of a sudden increase in the rates, usually referred to as soft proton flares. By knowing the conversion factor between the soft proton energy and the deposited charge on the detector, it is possible to derive the incoming flux and to study the environment of the Earth magnetosphere at different distances, given the wide and elliptical XMM-Newton orbit. Thanks to detailed Geant4 simulations, we were able to build specific soft proton response matrices for MOS and PN. Aims. In this second paper, we present the results of testing these matrices with real data for the first time, while also exploring the seasonal and solar activity effect on the proton environment. The selected spectra are relative to 55 simultaneous MOS and PN observations with flares raised in four different temporal windows: December-January and July-August of 2001-2002 (solar maximum) and 2019-2020 (solar minimum). Methods. We selected and extracted the flare mean spectra and count rates in the 2–11.5 keV energy range for the four epochs. After investigating the rate variations among the MOS1, MOS2, and PN instruments, we fit the X-ray spectra using XSPEC and the proton response matrices. The best-fitting parameters derived for the three instruments were compared in order to obtain the systematic errors. Results. There is no seasonal or solar activity effect on the soft proton mean count rates, but we find large discrepancies in the instrument cross-correlations across the 20 years of satellite operations. In 2001-2002, after a few years of operation, the MOS1 and MOS2 rates are similar, and about 20% with regard to the PN ones. After 20 years, PN does not present any variation in its response, while MOS1 suffers a reduction of ∼30%, in addition to the 30% loss due to the damage of two CCDs, and MOS2 is affected by an even worse degradation (70%). The main result of the spectral analysis is that the physical model representative of the proton spectra at the input of the telescope is a power law. However, a second and phenomenological component is necessary to take into account imprecision in the generation of the matrices at softer (< 5 keV) energies. This component contributes for 21% for the MOS and 5% for the PN to the total flux in the 2–5 keV energy range. Conclusions. This study, which is the first application of the soft proton response matrices to real data, shows coherent results between detectors and allows us to estimate systematic uncertainties in the measured spectra of 3% between the two MOS detectors and of 24% between MOS and PN, together with a systematic in the input flux of about a factor of two. They are all likely due to uncertainties in the proton transmission models, with the presence of additional passive material in front of the front-illuminated MOS, and element deposition on its electrode structure across the mission life. Dedicated studies and laboratory measurements are required for improving the accuracy of the proton response files. [ABSTRACT FROM AUTHOR]

We report the AGILE observations of GRB 220101A, which took place at the beginning of 2022 January 1 and was recognized as one of the most energetic gamma-ray bursts (GRBs) ever detected since their discovery. The AGILE satellite acquired interesting data concerning the prompt phase of this burst, providing an overall temporal and spectral description of the event in a wide energy range, from tens of kiloelectronvolts to tens of megaelectronvolts. Dividing the prompt emission into three main intervals, we notice an interesting spectral evolution, featuring a notable hardening of the spectrum in the central part of the burst. The average fluxes encountered in the different time intervals are relatively moderate, with respect to those of other remarkable bursts, and the overall fluence exhibits a quite ordinary value among the GRBs detected by MCAL. However, GRB 220101A is the second farthest event detected by AGILE, and the burst with the highest isotropic equivalent energy of the entire MCAL GRB sample, releasing E iso = 2.54 Ă— 1054 erg and exhibiting an isotropic luminosity of L iso = 2.34 Ă— 1052 erg sâˆ'1 (both in the 400 keVâ€"10 MeV energy range). We also analyzed the first 106 s of the afterglow phase, using the publicly available Swift-XRT data, carrying out a theoretical analysis of the afterglow, based on the forward shock model. We notice that GRB 220101A is with high probability surrounded by a wind-like density medium, and that the energy carried by the initial shock shall be a fraction of the total E iso, presumably near ∼50%. [ABSTRACT FROM AUTHOR]

We report on a systematic search for hard X-ray and γ-ray emission in coincidence with fast radio bursts (FRBs) observed by the AGILE satellite. We used 13 yr of AGILE archival data searching for time coincidences between exposed FRBs and events detectable by the MCAL (0.4–100 MeV) and GRID (50 MeV–30 GeV) detectors at timescales ranging from milliseconds to days/weeks. The current AGILE sky coverage allowed us to extend the search for high-energy emission preceding and following the FRB occurrence. We considered all FRB sources currently included in catalogs and identified a subsample (15 events) for which a good AGILE exposure with either MCAL or GRID was obtained. In this paper we focus on nonrepeating FRBs, compared to a few nearby repeating sources. We did not detect significant MeV or GeV emission from any event. Our hard X-ray upper limits (ULs) in the MeV energy range were obtained for timescales from submillisecond to seconds, and in the GeV range from minutes to weeks around event times. We focus on a subset of five nonrepeating and two repeating FRB sources whose distances are most likely smaller than that of 180916.J0158+65 (150 Mpc). For these sources, our MeV ULs translate into ULs on the isotropically emitted energy of about 3 × 1046 erg, comparable to that observed in the 2004 giant flare from the Galactic magnetar SGR 1806–20. On average, these nearby FRBs emit radio pulses of energies significantly larger than the recently detected SGR 1935+2154 and are not yet associated with intense MeV flaring. [ABSTRACT FROM AUTHOR]

The follow-up of external science alerts received from gamma-ray burst (GRB) and gravitational wave detectors is one of the AGILE Team's current major activities. The AGILE team developed an automated real-time analysis pipeline to analyze AGILE Gamma-Ray Imaging Detector (GRID) data to detect possible counterparts in the energy range 0.1–10 GeV. This work presents a new approach for detecting GRBs using a convolutional neural network (CNN) to classify the AGILE-GRID intensity maps by improving the GRB detection capability over the Li & Ma method, currently used by the AGILE team. The CNN is trained with large simulated data sets of intensity maps. The AGILE complex observing pattern due to the so-called "spinning mode" is studied to prepare data sets to test and evaluate the CNN. A GRB emission model is defined from the second Fermi-LAT GRB catalog and convoluted with the AGILE observing pattern. Different p-value distributions are calculated, evaluating, using the CNN, millions of background-only maps simulated by varying the background level. The CNN is then used on real data to analyze the AGILE-GRID data archive, searching for GRB detections using the trigger time and position taken from the Swift-BAT, Fermi-GBM, and Fermi-LAT GRB catalogs. From these catalogs, the CNN detects 21 GRBs with a significance of ≥3σ, while the Li & Ma method detects only two GRBs. The results shown in this work demonstrate that the CNN is more effective in detecting GRBs than the Li & Ma method in this context and can be implemented into the AGILE-GRID real-time analysis pipeline. [ABSTRACT FROM AUTHOR]

The accuracy of Monte Carlo simulations in reproducing the scientific performance of space telescopes (e.g., angular resolution) is mandatory for a correct design of the mission. A brand-new Monte Carlo simulator of the Astrorivelatore Gamma ad Immagini LEggero (AGILE)/Gamma-Ray Imaging Detector (GRID) space telescope, AGILESim, is built using the customizable Bologna Geant4 Multi-Mission Simulator (BoGEMMS) architecture and the latest Geant4 library to reproduce the instrument performance of the AGILE/GRID instrument. The Monte Carlo simulation output is digitized in the BoGEMMS postprocessing pipeline, according to the instrument electronic readout logic, then converted into the onboard data handling format, and finally analyzed by the standard mission on-ground reconstruction pipeline, including the Kalman filter, as a real observation in space. In this paper we focus on the scientific validation of AGILESim, performed by reproducing (i) the conversion efficiency of the tracker planes, (ii) the tracker charge readout distribution measured by the on-ground assembly, integration, and verification activity, and (iii) the point-spread function of in-flight observations of the Vela pulsar in the 100 MeV–1 GeV energy range. We measure an in-flight angular resolution (full width at half-maximum) for Vela-like point sources of and in the 100–300 and 300–1000 MeV energy bands, respectively. The successful cross-comparison of the simulation results with the AGILE on-ground and in-space performance validates the BoGEMMS framework for its application to future gamma-ray trackers (e.g., e-ASTROGAM and AMEGO). [ABSTRACT FROM AUTHOR]

Aims. We present the second AGILE–GRID catalogue (2AGL) of γ-ray sources in the energy range 100 MeV–10 GeV. Methods. With respect to previous AGILE–GRID catalogues, the current 2AGL catalogue is based on the first 2.3 years of science data from the AGILE mission (the so-called pointing mode) and incorporates more data and several analysis improvements, including better calibrations at the event reconstruction level, an updated model for the Galactic diffuse γ-ray emission, a refined procedure for point-like source detection, and the inclusion of a search for extended γ-ray sources. Results. The 2AGL catalogue includes 175 high-confidence sources (above 4σ significance) with their location regions and spectral properties and a variability analysis with four-day light curves for the most significant. Relying on the error region of each source position, including systematic uncertainties, 122 sources are considered as positionally associated with known counterparts at different wavelengths or detected by other γ-ray instruments. Among the identified or associated sources, 62 are active galactic nuclei (AGNs) of the blazar class. Pulsars represent the largest Galactic source class, with 41 associated pulsars, 7 of which have detected pulsation; 8 supernova remnants and 4 high-mass X-ray binaries have also been identified. A substantial number of 2AGL sources are unidentified: for 53 sources no known counterpart is found at different wavelengths. Among these sources, we discuss a subclass of 29 AGILE–GRID–only γ-ray sources that are not present in 1FGL, 2FGL, or 3FGL catalogues; the remaining sources are unidentified in both 2AGL and 3FGL catalogues. We also present an extension of the analysis of 2AGL sources detected in the energy range 50–100 MeV. [ABSTRACT FROM AUTHOR]

Context. The flat-spectrum radio quasar 4C +71.07 is a high-redshift (z = 2.172), γ-loud blazar whose optical emission is dominated by thermal radiation from the accretion disc. Aims. 4C +71.07 has been detected in outburst twice by the AGILE γ-ray satellite during the period from the end of October to mid-November 2015, when it reached a γ-ray flux of the order of F(E >  100 MeV)=(1.2 ± 0.3)×10−6 photons cm−2 s−1 and F(E > 100 MeV)=(3.1 ± 0.6)×10−6 photons cm−2 s−1, respectively, allowing us to investigate the properties of the jet and the emission region. Methods. We investigated its spectral energy distribution by means of almost-simultaneous observations covering the cm, mm, near-infrared, optical, ultraviolet, X-ray, and γ-ray energy bands obtained by the GASP-WEBT Consortium and the Swift, AGILE, and Fermi satellites. Results. The spectral energy distribution of the second γ-ray flare (whose energy coverage is more dense) can be modelled by means of a one-zone leptonic model, yielding a total jet power of about 4 × 1047 erg s−1. Conclusions. During the most prominent γ-ray flaring period our model is consistent with a dissipation region within the broad-line region. Moreover, this class of high-redshift, flat-spectrum radio quasars with high-mass black holes might be good targets for future γ-ray satellites such as e-ASTROGAM. [ABSTRACT FROM AUTHOR]

In recent years, a new generation of space missions has offered great opportunities for discovery in high-energy astrophysics. In this article we focus on the scientific operations of the Gamma-Ray Imaging Detector (GRID) on board the AGILE space mission. AGILE-GRID, sensitive in the energy range of 30 MeV-30 GeV, has detected many γ-ray transients of both galactic and extragalactic origin. This work presents the AGILE innovative approach to fast γ-ray transient detection, which is a challenging task and a crucial part of the AGILE scientific program. The goals are to describe (1) the AGILE Gamma-Ray Alert System, (2) a new algorithm for blind search identification of transients within a short processing time, (3) the AGILE procedure for γ-ray transient alert management, and (4) the likelihood of ratio tests that are necessary to evaluate the post-trial statistical significance of the results. Special algorithms and an optimized sequence of tasks are necessary to reach our goal. Data are automatically analyzed at every orbital downlink by an alert pipeline operating on different timescales. As proper flux thresholds are exceeded, alerts are automatically generated and sent as SMS messages to cellular telephones, via e-mail, and via push notifications from an application for smartphones and tablets. These alerts are crosschecked with the results of two pipelines, and a manual analysis is performed. Being a small scientific-class mission, AGILE is characterized by optimization of both scientific analysis and ground-segment resources. The system is capable of generating alerts within two to three hours of a data downlink, an unprecedented reaction time in γ-ray astrophysics. [ABSTRACT FROM AUTHOR]

Although mitral annular calcification is a common degenerative condition of the fibrous mitral annulus, tricuspid annular calcification, especially isolated, is rare. We report the case of a 73-year-old male, with a history of hypertension and severe kyphoscoliosis, referred to the emergency department for progressive dyspnea and leg swelling. Echocardiography revealed a dilated right heart with a homogeneous, hyperechoic, crescent shaped mass along the tricuspid annulus. Computed tomography confirmed the calcific nature of the lesion. Right heart catheterization revealed mild pre-capillary pulmonary hypertension and a mild spirometrically-defined restrictive ventilatory defect. Kyphoscoliosis has recently been associated with alterations in cardiac deformation and with an increased risk of restrictive lung disease. In our patient, we hypothesized that both these anomalies could have led to premature tricuspid annular degeneration resulting in a giant tricuspid calcification.

Renal denervation (RDN) is a safe and effective strategy for the treatment of difficult to treat hypertension. The blood pressure (BP)-lowering efficacy of RDN is comparable to those of many single antihypertensive medications and it allows to consider the RDN as a valuable option for the treatment of difficult to treat hypertension together with lifestyle modifications and medical therapy. A multidisciplinary team is of pivotal importance from the selection of the patient candidate for the procedure to the post-procedural management. Further studies are needed to investigate the effect of RDN on clinical outcomes and to better identify the predictors of BP response to RDN in order to recognize the patients who are more likely to benefit from the procedure.

The elderly represent an increasing proportion of patients presenting with acute coronary syndrome (ACS). Various data have shown that the benefits of percutaneous coronary revascularization are maintained in elderly patients presenting with ACS. Conversely, the management of antiplatelet therapy remains challenging and controversial, because older patients are usually at a high risk of both ischemia and bleeding. Moreover, the recommended ischemic and bleeding risk scores in patients with ACS were developed from studies with a low representation of older patients. New antiplatelet strategies have been developed, but their evidence in elderly patients is limited because they are usually underrepresented in randomized clinical trials due to their clinical complexity. The aim of this review is to summarize the different factors associated with increased ischemic and/or bleeding risk and the scientific evidence about the different antiplatelet strategies in elderly patients presenting with ACS and undergoing percutaneous coronary revascularization.

Arterial hypertension is the most prevalent cardiovascular risk factor worldwide. Despite the availability of many and effective antihypertensive medications, the prevalence of uncontrolled blood pressure (BP) remains high. As sympathetic hyperactivity has long been recognized as a major contributor to resistant hypertension, catheter-based renal denervation (RDN) has emerged as a new strategy to reduce BP. RDN aims to interrupt the activity of renal sympathetic nerves by applying radiofrequency (RF) energy, ultrasound (US) energy, or injection of alcohol in the perivascular space. The Symplicity HTN-3 trial, the largest sham-controlled trial using the first-generation RF-based RDN device, failed to significantly reduce BP. Since then, new devices and techniques have been developed and consequently many sham-controlled trials using second-generation RF or US-based RDN devices have demonstrated the BP lowering efficacy and safety of the procedure. A multidisciplinary team involving hypertension experts, interventionalists with expertise in renal interventions and anesthesiologists, plays a pivotal role from the selection of the patient candidate for the procedure to the post-procedural care. The aim of this consensus document is to summarize the current evidence about the use of RDN in difficult to treat hypertension and to propose a management strategy from the selection of the patient candidate for the procedure to the post-procedural care.

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerotic disease. PAD patients have a poor prognosis with an increased risk of cardiovascular (CV) events, including myocardial infarction (MI), stroke, limb ischemia and CV death; therefore, it is important to detect and treat PAD early. PAD and coronary artery disease (CAD) share a common pathogenesis and risk factors for development; therefore, cardiologists are in a unique position to screen, diagnosis and treat PAD. Moreover, PAD and CAD also share some treatment goals, including an aggressive modification of risk factors to reduce the risk of CV events. However, PAD remains an underdiagnosed and undertreated disease with medico-legal implications. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinicians to the significance of PAD.

Carotid artery stenting (CAS) is a valid alternative to conventional carotid endarterectomy for treatment of carotid artery stenosis. Distal embolization of atherosclerotic debris causing cerebrovascular accidents during CAS has been the most significant concern limiting widespread application of CAS technology. A variety of embolic protection devices (EPDs) with different mechanism of action, have been designed to minimize the risk of major embolization causing stroke and their use is recommended by current guidelines. Two general types of EPDs are available: proximal protection devices (PPDs) and distal protection devices (DPDs). However, there is no convincing clinical evidence of the clinical superiority of one device over another. This review will examine the different types of available devices and also innovative devices and techniques, including strengths and weaknesses of each, and present the available evidence and rationale for their routine use during CAS.

Background: The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover., Aims: We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively., Methods: The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively., Results: The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover., Conclusions: The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.

Background: Contemporary definitions of bleeding endpoints are restricted mostly to clinically overt events. Whether hemoglobin drop per se, with or without overt bleeding, adversely affects the prognosis of patients with acute coronary syndrome (ACS) remains unclear., Objectives: The aim of this study was to examine in the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial the incidence, predictors, and prognostic implications of in-hospital hemoglobin drop in patients with ACS managed invasively stratified by the presence of in-hospital bleeding., Methods: Patients were categorized by the presence and amount of in-hospital hemoglobin drop on the basis of baseline and nadir hemoglobin values and further stratified by the occurrence of adjudicated in-hospital bleeding. Hemoglobin drop was defined as minimal (<3 g/dl), minor (≥3 and <5 g/dl), or major (≥5 g/dl). Using multivariate Cox regression, we modeled the association between hemoglobin drop and mortality in patients with and without overt bleeding., Results: Among 7,781 patients alive 24 h after randomization with available hemoglobin data, 6,504 patients (83.6%) had hemoglobin drop, of whom 5,756 (88.5%) did not have overt bleeding and 748 (11.5%) had overt bleeding. Among patients without overt bleeding, minor (hazard ratio [HR]: 2.37; 95% confidence interval [CI]: 1.32 to 4.24; p = 0.004) and major (HR: 2.58; 95% CI: 0.98 to 6.78; p = 0.054) hemoglobin drop were independently associated with higher 1-year mortality. Among patients with overt bleeding, the association of minor and major hemoglobin drop with 1-year mortality was directionally similar but had wider CIs (minor: HR: 3.53 [95% CI: 1.06 to 11.79]; major: HR: 13.32 [95% CI: 3.01 to 58.98])., Conclusions: Among patients with ACS managed invasively, in-hospital hemoglobin drop ≥3 g/dl, even in the absence of overt bleeding, is common and is independently associated with increased risk for 1-year mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox; NCT01433627)., Competing Interests: Author Disclosures The MATRIX trial was sponsored by Società Italiana di Cardiologia Invasiva (a nonprofit organization), which received grant support from The Medicines Company and Terumo. This substudy did not receive any direct or indirect funding. Dr. Leonardi has received grants and personal fees from AstraZeneca, Bristol Myers Squibb/Pfizer, and Chiesi; and has received personal fees from Bayer outside the submitted work. Dr. Gragnano has received research grant support from the European Society of Cardiology outside the submitted work. Dr. Gargiulo has received consultant fees from Daiichi-Sankyo outside the submitted work. Dr. Vranckx has received personal fees from AstraZeneca, Terumo, CSL Behring, Daiichi-Sankyo, and Bayer Health Care outside the submitted work. Dr. Frigoli is affiliated with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in the design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU Bern’s conflicts of interest, visit the University of Bern Web site (and see Research, Declaration of Interest). Dr. Windecker has received research and educational grants to the institution from Abbott, Amgen, Bristol Myers Squibb, Bayer, Boston Scientific, Biotronik, Cardinal Health, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Johnson & Johnson, Medtronic, Querbet, Polares, Sanofi, Terumo, and Sinomed outside the submitted work. Dr. Valgimigli has received grants and personal fees from Abbott, Terumo, AstraZeneca; has received personal fees from Chiesi, Bayer, Daiichi-Sankyo, Amgen, Alvimedica, Biosensors, and Idorsia; and has received grants from Medicure outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study sought to evaluate 1-year safety and efficacy of dual-layered mesh-covered carotid stent systems (DLS) for carotid artery stenting (CAS)., Background: Small clinical studies evaluating 1-year outcomes of CAS performed with 2 available DLS, Roadsaver (RS) (Terumo Corp., Tokyo, Japan) and CGuard (CG) (InspireMD, Boston, Massachusetts), have been published., Methods: The authors performed an individual patient-level meta-analysis including studies enrolling more than 100 CAS with DLS. The primary endpoint was the death and stroke rate; secondary endpoints were restenosis and in-stent thrombosis rates at 1 year., Results: Patients were divided into 2 groups according to DLS (RS n = 250; CG n = 306). At 1 year, 11 patients died (1.97%), 7 patients in the group RS (2.8%) and 4 patients in the CG one (1.31%); and 10 strokes occurred, 4 in the group RS (1.6%) and 6 in the CG one (1.96%). Overall death and stroke rate was 3.77% (n = 21), 11 events in the group RS group (4.4%) and 10 in the CG group (3.27%). Symptomatic status was the only predictor of death and or stroke. At 1 year, restenosis occurred in 12 patients (2.1%), 10 in the group RS (4%) and 2 in the CG one (0.65%) (p = 0.007). In-stent thrombosis occurred in 1 patient (0.18%) in the CG group (0.32%). RS use was the only independent predictor of restenosis., Conclusions: This study suggests that DLS use for CAS is associated with a low 1-year death and stroke rate, and the specific DLS stent used could affect the restenosis rate., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The twelve‑lead electrocardiogram (ECG) has become an essential tool for the diagnosis, risk stratification, and management of patients with acute coronary syndromes (ACS). However, several areas of residual controversies or gaps in evidence exist. Among them, P-wave abnormalities identifying atrial ischemia/infarction are largely neglected in clinical practice, and their diagnostic and prognostic implications remain elusive; the value of ECG to identify the culprit lesion has been investigated, but validated criteria indicating the presence of coronary occlusion in patients without ST-elevation are lacking; finally, which criteria among the multiple proposed, better define pathological Q-waves or success of revascularisation deserve further investigations., Methods: The Minimizing Adverse hemorrhagic events via TRansradial access site and systemic Implementation of AngioX (MATRIX) trial was designed to test the impact of bleeding avoidance strategies on ischemic and bleeding outcomes across the whole spectrum of patients with ACS receiving invasive management. The ECG-MATRIX is a pre-specified sub-study of the MATRIX programme which aims at analyzing the clinical value of ECG metrics in 4516 ACS patients (with and without ST-segment elevation in 2212 and 2304 cases, respectively) with matched pre and post-treatment ECGs., Conclusions: This study represents a unique opportunity to further investigate the role of ECGs in the diagnosis and risk stratification of ACS patients with or without ST-segment deviation, as well as to assess whether the radial approach and bivalirudin may affect post-treatment ECG metrics and patterns in a large contemporary ACS population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: In patients affected by hypertrophic cardiomyopathy (HCM), left atrial volume index (LAVi) is associated with an increased risk of tachyarrhythmias and major clinical events. To date, the clinical meaning of LAVi measured during exercise (stress LAVi [sLAVi]) has not yet been investigated in HCM. This study sought to evaluate the correlation between LAVi/sLAVi and clinical outcome (risk of arrhythmias and heart failure [HF]) in patients with HCM., Methods and Results: We enrolled a total of 51 consecutive patients with HCM (39 men; mean age: 39.41 ± 17.9 years) who underwent standard and stress echocardiography, following a common protocol. During follow-up (median follow-up was 1.82 years), the following composite endpoints were collected: ARRHYT endpoint (atrial fibrillation, paroxysmal supraventricular tachycardia, nonsustained ventricular tachycardia (VT), sustained VT, ventricular fibrillation, syncope of likely cardiogenic nature, and sudden cardiac death) and HF endpoint (worsening of functional class and left ventricular ejection fraction, hospitalization, and death for end-stage HF). Eight patients were lost at follow-up. ARRHYT endpoint occurred in 13 (30.2%) patients (8, 18.6%, supraventricular and 10, 23.2%, ventricular arrhythmias), whereas HF endpoint occurred in 5 (11.6%) patients. sLAVi (mean value of 31.16 ± 10.15 mL/m 2 ) performed better than rLAVi as a predictor of ARRHYT endpoint (Akaike Information Criterion: 48.37 vs. 50.37, if dichotomized according to the median values). A sLAVi value of 30 mL/m 2 showed a predictive accuracy of 72.1% (C-statistics of 0.7346), with a high negative predictive value (87.5%)., Conclusion: These findings encourage future studies on sLAVi, as a potential predictor of arrhythmias and adverse outcome in patients with HCM., Competing Interests: There are no conflicts of interest.