Music Conservatory of Mantova

Aims Studies assessing risk factors for common bile duct (CBD) stones were conducted on patients with gallbladder in situ [1]. Our aim was to assess predictive factors for CBD stones in patients with previous cholecystectomy.

AimsThere are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation.Methods and resultsWe retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse‐probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P < 0.001), more frequently male (82.5% vs. 75.5%, P = 0.02), and had higher heart rate (75.7 vs. 71.0 b.p.m., P < 0.001). Of the 229 AF patients, 162 (70.7%) received suboptimal CRT (<98%) and 67 (29.3%) had adequate CRT (≥98%). During a median follow‐up of 24 months, total mortality did not differ between AF and SR groups (propensity‐score‐weighted hazard ratio, HR 1.32 [95% confidence interval, 0.82–2.15], P = 0.25). The risk of appropriate shocks was significantly higher in the AF group with <98% CRT than in the SR group (weighted‐HR, 1.99 [1.21–3.26], P = 0.006) and was similar in the AF group with ≥98% CRT versus the SR group (1.29 [0.66–2.53], P = 0.45). During follow‐up, sinus rhythm was recovered in 23 patients in the AF group (10%) after a median time of 106 (42–256) days. The rate of sinus rhythm recovery in the AF group was 4.5 (95% CI, 2.8–6.7) per 100 patient‐years; the rate of permanent AF occurrence in the SR group was 2.5 (95% CI, 1.9–3.3) per 100 patient‐years.ConclusionsAlthough mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ≥ 98%.

Heart valve calcification (VC) is associated with increased cardiovascular risk, but the hemodynamic and functional profile of patients affected by VC has not been fully explored. The study population was formed by consecutive unselected patients included in seven echocardiographic laboratories in a 2-week period. A comprehensive echocardiographic examination was performed. VC was defined by the presence of calcification on at least one valve. Population was formed of 1098 patients (mean age 65±15years; 47% female). VC was present in 31% of the overall population. Compared with subjects without VC, VC patients were older (60±14 vs 75±9; P<.0001), had more hypertension (40% vs 57%; P=.0005), diabetes (11% vs 18%; P=.002), coronary artery disease (22% vs 38%; P=.04), and chronic kidney disease (4% vs 8%; P=.007). Furthermore, VC patients had lower ejection fraction (55±14 vs 53±25; P<.0001), worse diastolic function (E/e' 8.5±4.6 vs 13.0±7.1; P<.0001) and higher pulmonary artery pressure (29±9 vs 37±12; P<.0001). The association between VC and EF was not independent of etiology (p for VC 0.13), whereas the association with E/e' and PASP was independent in a full multivariate model (P<.0001 and P=.0002, respectively). Heart valve calcification patients were characterized by a worse functional and hemodynamic profile compared to patients with normal valve. The association between VC and diastolic function and PASP were independent in comprehensive multivariate models.

From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy. During the same period in 2020 (the first 40 days of the Covid-19 epidemic), 362 cases were reported — a 58% increase. Of the additional 133 cases in 2020, a total of 103 involved suspected or diagnosed Covid-19.

<b>Background:</b> Recent studies have shown that the onset of severe diaphragmatic dysfunction (DD) during exacerbated COPD (AECOPD) increases risk of noninvasive ventilation (NIV) failure and mortality. Data regarding the influence of mechanical derangement on diaphragmatic performance during acute phase are poor. <b>Aims:</b> To investigate the impact of respiratory mechanics on diaphragmatic function in AECOPD patients who failed NIV. <b>Methods:</b> Ten AECOPD admitted to the ICU of the University Hospital of Modena (I) from 2017-2018 undergoing endotracheal intubation due to NIV failure were enrolled. The study protocol consisted of two consecutive steps; first, we measured static respiratory mechanics and end expiratory lung volume (EELV) following 30 minutes of invasive ventilation; second, transdiaphragmatic pressure (Pdi) was calculated by means of a sniff maneuver (Pdisniff) following 30 minutes of a spontaneous breathing trial. <b>Results:</b> Average Pdisniff was 20.5 (IQR=1.5-21.7) cmH20 with 3 patients presenting bilateral diaphragm palsy. Pdisniff was directly correlated with static lung elastance (r=0.67, p=0.03) while inverse correlation was found with dynamic intrinsic PEEP (r=-0.74, p=0.015). No significant correlation was found with static intrinsic PEEP, EELV, airway resistance, chest wall and total elastance. Significant linear inverse correlation was found between Pdi/Pdisniff and Pdisniff (r=-0.82, p=0.02). <b>Conclusion:</b> Severe dynamic hyperinflation of the lung, that overlaps on an elastic substrate favoring volume overload, is a cause of diaphragmatic dysfunction leading to NIV failure during severeAECOPD.

To compare the long-term clinical outcomes of paclitaxel drug-coated-balloons (DCB) and everolimus-eluting-stents (EES) following the treatment of de novo small vessel coronary artery disease. It is currently unclear whether treatment of de novo small vessel coronary disease with DCB is comparable to second generation drug-eluting stents, which are the current standard of care. The present study enrolled 90 patients with small vessel coronary disease from the DCB treatment arm of the BELLO (Balloon Elution and Late Loss Optimization) trial and 2,000 patients treated with EES at the San Raffaele Scientific Institute. Propensity score matching was performed to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 181 patients: 90 patients with 94 lesions receiving DCB and 91 patients with 94 lesions receiving EES. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, recurrent non-fatal myocardial infarction, and target vessel revascularization. After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. The cumulative MACE rate at 1-year was 12.2% with DCB and 15.4% with EES (P = 0.538). Patients in the DCB group had similar TLR rates as compared to EES over the same interval (4.4% vs. 5.6%; P = 0.720). There were no cases of definite or probable stent or vessel thrombosis. The use of paclitaxel-DCB appears to be associated with similar clinical outcomes when compared to second-generation-EES in small coronary artery disease. The findings of this study should be confirmed with larger prospective randomized studies with longer follow-up. © 2017 Wiley Periodicals, Inc.