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In the context of the current SARS-CoV-2 pandemic, associations of drugs which interfere with specific steps of the viral infectious cycle are currently being exploited as therapeutic strategies since a specific treatment by vaccination is still unavailable. A widespread association of repurposed agents is the combination of the antimalarial drug Hydroxychloroquine and the macrolide antibiotic Azithromycin in the setting of clinical trials. But a closer analysis of their mechanism of action suggests that their concomitant administration may be impractical, and this is supported by experimental data with other agents of the same classes. However a sequential administration of the lysosomotropic antimalarial with the addition of the macrolide proton pump inhibitor after the first has reached a certain threshold could better exploit their antiviral potential.

Background and aims Nowadays it is recommended to use risk scores to evaluate the magnitude of cardiovascular risk in healthy people, most popular being SCORE (Europe) and Framingham and ASCVD (US). Unfortunately, they are not enough motivating in young and old population, don’t consider protective factors and cannot be used in cardiovascular patients always included in very high risk category. To improve the evaluation everytime of individual cardiovascular risk we described a new score – CVRISK (cardiovascular relative individual risk). Methods It uses 15 items and can be used also in cardiovascular patients. The first seven items are clinical – age and gender, heredity, smoking, hypertension, obesity, psychosocial stress, previous cardiovascular disease. For items refer to laboratory data – LDL-C, HDL-C, TG, fasting plasma glucose (diabetes mellitus). The last two are protective factors – physical activity and healthy diet. Results Every item has a number of risk points and protective factors decrease with 25% and 15% the calculated risk. The risk can be automatically calculated after the introduction of the required data through an algorithm available at www.cvrisk.ro . Here, the calculated risk is compared with optimal and maximal risk. Thus the user is motivated to initiate or to continue preventive measures also suggested at www.cvrisk.ro , to improve cardiovascular health. Conclusion CVRISK is not a substitute of current risk scores, but a complimentary tool to appreciate and modulate the individual cardiovascular risk. It can be useful to prevent CV disease or to improve its evolution. Individuals themselves can calculate it in order to maintain or improve their health.

Myotonic dystrophy (MD) is associated with a high risk of cardiac mortality. Several causes are implicated, bradycardia, atrial and ventricular arrhythmias, dilated cardiomyopathy and sudden death. Heart rate variability evaluation (HRV) is a non invasive method used to evaluate the prognosis of patients with heart disease. The purpose of the study was to evaluate the prognostic value of HRV determination for the stratification risk and the follow-up of patients with MD.Methods156 patients, 79 men and 77 women, mean age 41±14 years, at the inclusion, were recruited for a MD. Patients were asymptomatic at the inclusion. The following studies were performed at the inclusion and repeated 4.5±3.5 years later in 124 of them. Recording of 24 hour Holter monitoring and measurement of HRV in the time domain was calculated every 5 minutes with the Elatec system; standard deviation of the mean RR intervals (SDNN) (ms) was determined. Left ventricular ejection fraction (LVEF) was evaluated at the same time by 2D echocardiography.ResultsLVEF decreased significantly from 62±8 to 58±11% (p< 0.03). None of them had sustained ventricular tachycardia. 19 patients died (12%) during the follow-up generally from cardiac and respiratory failure. Mean values of SDNN did not change significantly between first inclusion (126±42.5ms) and last study (126±47ms). At inclusion, SDNN was significantly shorter in patients who died than in alive patients (109±50msec vs 128±41) (p 100msec and only 3 patients died (3%)(p< 0.0001).ConclusionsThe modifications of HRV during the follow-up were not useful for the prediction of the occurrence of dilated cardiomyopathy or of life-threatening arrhythmias in myotonic dystrophy, although LVEF decreased with time. However, a low HRV (< 100msec) at the first evaluation was predictive of increasing mortality from 3 to 25%.

BackgroundSeveral arrhythmias were reported in myotonic dystrophy (MD). The most frequent would be conduction disturbances and ventricular arrhythmias. The purpose of the study was to evaluate the prevalence of atrial flutter and fibrillation (AF) in MD and the consequences.Methods157 patients, 80 men and 77 women, aged from 16 to 70 years, mean age 41±14 years, at the inclusion, were consecutively recruited for a type 1 MD. Patients were asymptomatic at the inclusion, except 4. Patients were followed during 4.5±3.5 years. ECG, left ventricular ejection fraction (LVEF) determination at echocardiography, Holter monitoring, signal-averaged ECG were obtained and repeated.Results24 patients presented sustained (> 1 hour) AF or atrial flutter (n=8). The prevalence was 15%. Among these patients 2 presented a 1/1 atrial flutter associated with syncope. In one of them, 16 years old, cardiac defibrillator was implanted for a diagnosis of ventricular tachycardia, but the real diagnostis was made after inappropriate shocks. Atrial flutter ablation was performed in 4 patients but 3 of them developed AF. During follow-up, 21 patients died (15%) during the follow-up generally from cardiac and respiratory failure. 7 of them had AF (29%) and 14 had no AF (10.5%) (p< 0.01). Univariate analysis indicated that age greater than 40 years (death: 51±14 vs 40±14 in alive patients), ECG, occurrence of sustained AF or flutter and LVEF less than 45% were significant predictive factors of death. At multivariate analysis AF at ECG (relative risk RR 6.72) was independent predictor of death.ConclusionsAtrial flutter and atrial fibrillation are frequent in MD and are associated with increasing mortality. Atrial flutter may present as a 1/1 atrial flutter (25%) with a poor tolerance and a risk of misdiagnostis.

The management and prognosis of heart diseases (HD) or arrhythmias may depend on the patient gender. The purpose of the study was to look for the influence of gender on the indications and the long-term results of ablation of atrial flutter (AFl).Methods965 patients, 743 males, 222 females (23%), mean age 64 ± 12 years were consecutively referred for radiofrequency ablation of recurrent or poor-tolerated AFL Clinical history, other arrhythmias as atrial fibrillation (AF), data of echocardiography were collected. The patients were followed from 3 months up to 10 years.ResultsWomen tended to be older than men (65.5±12 vs 64±11.5 years) (p< 0.08). Underlying HD was as frequent in women as in men (76%). HD nature differed: women had more congenital HD (10 vs 2%, p

BackgroundPatients with heart disease (HD) and syncope are at high risk of sudden death. Implantable defibrillator (ICD) is recommended in patients with unexplained syncope and left ventricular ejection fraction (LVEF) < 30% or in patients with LVEF >30% and inducible ventricular tachycardia (VT).AimThe purpose of the study was to evaluate the prognostic significance of QRS duration measurement in patients with HD and syncope.Methods528 patients, 89 women and 439 men, mean age 65±12 years, were admitted for syncope. All of them had an HD, either ischemic HD (n=382) or left ventricular impairment of other origin (n=115). Holter monitoring, electrophysiological study and head-up tilt test were systematic. Filtered QRS duration was measured at signal-averaged ECG (Fidelity 2000 of Cardionics) (filter 40 Hz, noise level < 0.6 μV). The patients were followed from 3 months up to 18 years (mean 5 ±4 years).ResultsMean LVEF was 40±14%. Cardiac defibrillator was implanted in 73 patients. 30 patients died suddenly, 75 died from heart failure or were transplanted (n=9). Remaining patients are alive or died from non cardiac death (n= 8). The last group differed from group who died suddenly by an higher LVEF (42±14% vs 32±13) (p< 0.00001) and a shorter QRS duration (125±34 msec vs 144±31) (p< 0.026). They tended to be older (65±12 years vs 61±13) (p

The risk of atrial fibrillation (AF) in patients with paroxysmal supraventricular tachycardia (SVT) is well-known. AF is a cause of embolic event and a risk of stroke in patients with SVT can be expected. The purpose of the study was to assess the prevalence of unexplained stroke in patients presenting with SVT and to look for the risk factors. Methods Electrophysiological study (EPS) was performed in 1379 patients without anterograde conduction through accessory pathway (AP) for SVT. Clinical and electrophysiological data were collected. Results Stroke was noted in 38 patients (group I) (prevalence 2.8%). 1341 patients had no stroke (group II). 1) Clinical data: Group I was older than group II (62±13 vs 49±19 years) (p Conclusions Unexplained stroke was a rare event in patients with paroxysmal SVT (2.8%). Old age, and AF history were the only independent significant factors associated with the history of stroke in these patients. They had a risk of severe adverse events during the follow-up as spontaneous AF (21%) or death (8%). SVT ablation did not reduce the risk of new stroke, spontaneous AF or death.

Supraventricular reentrant tachycardia (SVT) can be due to atrioventricular node reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia (AVRT) in a concealed or an overt accessory pathway (AP) in patients with a Wolff-Parkinson-White syndrome (WPW). The purpose of the study was to look for the mode of SVT induction and to correlate the mode of induction with the mechanism of the tachycardia.Methods1818 patients were consecutively referred for a SVT. 438 had a WPW (group I). Remaining patients had a normal ECG. At electrophysiological study (EPS), SVT was related to AVRT in 251 patients (group II), to typical AVNRT in 969 patients (group II) and to atypical AVNRT in 160 patients (group IV). Atrial pacing and programmed atrial stimulation with one and 2 extrastimuli were performed in control state (CS). If SVT was not induced, the protocol was repeated after isoproterenol (0.02 to 1 μg. min-1) infused to increase sinus rate to at least 130bpm.ResultsGroups differed by age and gender: group I was younger than group II (36±17 vs 42±17 years) (p < 0.001). Group II was younger than group III (49±19)(p

Programmed ventricular stimulation (PVS) after myocardial infarction (MI) was used 20 years ago to stratify arrhythmic risks. Recent studies recommend PVS early after MI to detect a risk of ventricular tachycardia (VT) and sudden death (SD). The purpose of the study was to look for the actual prognostic significance of inducible ventricular arrhythmias after MI.MethodsPVS was performed between 1985 and January 2012, from 4 to 8 weeks after acute MI in 808 patients with MI, without syncope or ventricular arrhythmias. LVEF was evaluated by echocardiography. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle).ResultsMonomorphic VT 265bpm) or fibrillation (VF) in 206 (25%). PVS remained negative in 418 patients (52%). Mean follow-up was 8±6.5 years. Cardiac defibrillator (ICD) was implanted in 83 patients from 1994 (10%). Nineteen patients developed spontaneous sustained VT, 35 died suddenly; 103 died from heart failure or were transplanted (HF); 11 died from a noncardiac cause. Their comparison with patients alive or dying from noncardiac death (n=660) indicated that monomorphic VT induction was the only univariate predictor of SD (37%)(p