Search

Graphical abstract

The accuracy of current prediction tools for ischaemic and bleeding events after an acute coronary syndrome (ACS) remains insufficient for individualised patient management strategies. We developed a machine learning-based risk stratification model to predict all-cause death, recurrent acute myocardial infarction, and major bleeding after ACS.

Il contributo studia l’apporto di Francesco Novati, ufficialmente incaricato dalla Società dantesca di attendere all'edizione critica delle opere minori latine, alla storia dell’edizione critica delle epistole dopo Witte. L’archivio Novati, conservato a Milano, permette di verificare lo stato del lavoro di edizione, che è risultato ancora molto parziale. L’analisi della documentazione permette di chiarire i criteri e la metodologia di Novati, che non mancò di confrontararsi continuamente, ma non esplicitamente, con le scelte critiche di Witte.

The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction.

L’essai propose une étude du ms. Assisi, Biblioteca della Chiesa Nuova, 9. Il s’agit d’un manuscrit transmettant de riches miscellanées de textes franciscains, normatifs ou dévotionnels, entièrement rédigés en langue provençale. L’analyse matérielle de ce codex converge avec celle du contenu de l’anthologie pour suggérer la proximité du manuscrit avec des communautés béguines originaires du Languedoc, dans l’aire située entre Narbonne et Béziers. Leur présence en Italie à cette époque (milieu du xivesiècle) est en effet attestée. Ce manuscrit fait également figure de modèle du codex « paupériste » d’après les doctrines de Pierre de Jean Olieu (dit aussi Olivi). L’essai retrace enfin l’histoire de la communauté des Frères des Carceri d’Assise, auprès de qui le manuscrit a sans doute été produit.

Aim— The aim of the present study is to provide, in a large cohort of patients, a description of the left atrium (LA) and pulmonary veins (PV) anatomy in relation to ablation outcome.Background— The role of LA imaging, assessed before transcatheter ablation of atrial fibrillation (AF), is unknown.Methods— 330 patients referred for transcatheter ablation of AF (paroxysmal 62.7%; persistent 25.5%; long-standing 11.8%) underwent contrast-enhanced magnetic resonance imaging (MRI) before the procedure. Transcatheter ablation was performed aiming to AF interruption and/or absence of inducibility. Patients were followed clinically, by ECG, and 24-hour Holter ECG at 1-3-6-12-18-24 months.Results— The MRI preceding the procedure depicted a typical PV branching pattern, two left and two right, in 130 (39.4%) patients; 117 (35.4%) presented common left trunk (short and long) and 75 (22.7%) at least one accessory PV. Mean atrial volume was 142.0 ± 48.5 ml. The ablation procedure resulted successful, after 15.6 ± 7.2 months follow-up, in 174 (52.7%) patients. PV branching pattern did not relate (P= 0.304) to ablation outcome. A multiple Cox proportional hazard model, adjusted for potential confounders, proved that only LA volume was independently related to ablation outcome (HR 1.007, 95% CI 1.003-1.011; P= 0.001). A LA cut-off volume of 135 ml emerged as a significant predictor of ablation failure (ROC curve area 0.651, 95% CI 0.591-0.710; P< 0.001).Conclusions— Less than half of the patients referred for transcatheter AF ablation present a typical PV branching pattern; the PV branching pattern, however, does not affect ablation outcome. LA volume strongly predicts AF ablation outcome.

Supplemental Digital Content is available in the text.

Prognosis in pulmonary hypertension is strictly linked to right ventricle failure, which results from uncoupling between right ventricle function and its afterload. This study sought to describe how to estimate with echocardiography right ventricular wall tension, its correlation with right ventricle haemodynamics and its prognostic role. A total of 190 patients without overt right ventricle failure but with suspected pulmonary hypertension on a previous echocardiogram underwent right heart catheterization and nearly-simultaneous echocardiography. Right ventricular wall tension was estimated according to Laplace’s law as right ventricle length × tricuspid regurgitation peak gradient and it was correlated with right ventricle haemodynamic profile; its potential prognostic impact was tested along with canonical right ventricle function parameters. Right ventricular wall tension correlated significantly with invasive estimation of right ventricle end-diastolic pressure (R: 0.343, p< 0.001) and with several other haemodynamic variables, such as mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, right atrial pressure and right ventricle stroke work index (all p< 0.001). At a mean follow-up of five years and three months, only right ventricular wall tension was associated to all-cause mortality (p= 0.036), while tricuspid annular plane systolic excursion (p= 0.536), right ventricle fractional area change (p= 0.383), right ventricle fractional area change (p= 0.076), tricuspid regurgitation peak gradient (p= 0.107) and tricuspid annular plane systolic excursion/tricuspid regurgitation peak gradient (p= 0.181) could not. We identified a novel bedside echocardiographic predictor of altered right ventricle haemodynamics, which is precociously altered in patients without overt right ventricle failure and is associated to all-cause mortality at a long-term follow-up. Further studies are needed to confirm its role in pulmonary hypertension patients.

Aims The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined. Methods All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs. nonST-elevation myocardial infarction (NSTEMI) vs. unstable angina (UA) vs. stable angina pectoris (SAP)]. Results One hundred and fifty citations were initially appraised at the abstract level and 23 full-text studies were assessed. The mean prevalence of CPR and TCFA was 48.1% (40.5–55.8) and 48.7% (37.4–60.1), respectively. The prevalence of CPR and TCFA were higher in STEMI (70.4 and 76.6%) than in NSTEMI (55.6 and 56.3%) and UA (39.1 and 52.9%) or SAP (6.2 and 22.8%). In the overall population at meta-regression analysis, TCFA and current smoking were the only predictors of CPR (B 3.6:2.0–5.1, P < 0.001 and 0.06:0.02–0.1, P = 0.002, respectively). The factors associated with CPR were different depending on clinical presentation. Hypertension was the only clinical predictor for STEMI (B 3.3: 1.2.–5.3 P = 0.001), while advanced age (B 0.12: 0.02–0.22, P = 0.021), diabetes mellitus (B 0.04: 0.01–0.08, P = 0.012), and hyperlipidaemia (B 0.07:0.02–0.11, P = 0.005) were the predictors in NSTEMI and UA. No clinical predictor was found in SA. Conclusions Our analysis showed high rates of CPR and TCFA detected by OCT in CAD patients, especially in those with ACS, although their prevalence is not negligible in stable patients. TCFA seems to be a strong predictor of CPR in all the ACS scenarios.

Supplemental Digital Content is available in the text.