Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight ...fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m
2
(25th–75th percentile 12.7–15.6 kg/m
2
). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th–75th percentile 47–471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.
Abstract
Background
Right Ventricular (RV) dysfunction and pulmonary hypertension (PH) are two very likely acute and long term targets of COVID-19 pneumonia, with a potential prognostic implications.
...Purpose
To determine the COVID-19 pneumonia effects on the right ventricular to pulmonary circulation coupling through bedside echocardiography and extend its implications to prognostic assessment.
Methods
Single-centre study including consecutive subjects hospitalized for COVID-19 pneumonia who underwent a clinical indicated echocardiogram between March 2020 and December 2020. Extensive analysis of cardiac function was performed offline by an operator blinded to clinical data, laboratory findings and CT scans.
Results
133 patients were enrolled (mean age 69±12 years, 57% men), 38% of whom already had cardiac disease in their medical history. In-hospital mortality was 26% (35 pts), during a mean hospital stay of 26±16 days. Non survivors had higher pulmonary artery systolic pressure (PASP) and worse RV function, assessed with both standard parameters (i.e. TAPSE) and with the novel speckle tracking analysis by RV-Global Longitudinal Strain (RV-GLS) and RV-Free Wall Longitudinal Strain (RV-FWLS). The combination of these two variables in TAPSE/PASP ratio allows assessment of RV to pulmonary circulation (Pc) coupling and was strongly associated with in-hospital death (HR 0.73, 95% CI 0.59–0.89, p=0.003) and patients with TAPSE/PASP<0.57 mm/mmHg had a more than 4-fold increased risk of in-hospital death (HR 4.8, 95% CI 1.7–13.1, p=0.003). In patients where speckle tracking analysis was feasible, we examined RV-GLS/PASP and RV-FWLS/PASP and found that it was associated with in-hospital mortality. The best cut-offs for predicting in-hospital mortality was 0.51 for RV-GLS/PASP (94% sensitivity and 59% specificity) and 0.49 for RV-free wall LS (87% sensitivity and 70% specificity). At the multivariable analysis RV to Pc remained associated with in-hospital death after adjustments for age, PaO2/FiO2, LVEF, and severity of lung involvement at the CT.
Conclusions
Either PH and RV dysfunction predict in-hospital mortality in patients with COVID-19 pneumonia. The assessment of RV to Pc coupling, however, better describes the adaptive RV response to increased PASP and gives additional prognostic information in a population with a relevant prevalence of comorbidities.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Introduction and methods
During Coronavirus disease 2019 (COVID-19) pandemic a reduction in ST-elevation acute myocardial infarction with an increase in in-hospital mortality has been ...observed. In our region the pandemic temporal trend was sinusoidal with peaks and valleys. A first outbreak (phase-peak 1 “P-P1”) was in March 2020 (248.12 cases for 100,000 inhabitants), a reduction (phase-valley 1 “P-V1”) in May 2020 (16.68 cases for 100,000 inhabitants) and a second outbreak (phase-peak 2 “P-P2”) in November 2020 (540.17 cases for 100,000 inhabitants; data from Italian Health Ministry). Our hospital was reorganized as one of the 13 Macro-Hubs identified in Lombardy for the treatment of STEMI. Here we describe our experience in the treatment of STEMI patients in the three different phases of COVID-19 pandemic.
Results
In the three different phases the groups were superimposable for mean characteristics, but they differ for COVID-19 infection incidence (table). At multivariate analysis for the entire population COVID-19 infection (OR 45.8 95% CI 1.39–1511.79; p=0.03) was the only independent predictor of in-hospital mortality. Focusing on COVID-19 patients (figure) they experienced a 5-time increased incidence of in-hospital mortality (COVID-19pos vs COVID-19neg, 50% vs 11.1%; p=0.02). Moreover, the compresence of COVID-19 infection induced an 8 times increased risk of death (OR 8; 95% CI 1.85–34.60; p=0.005) determined by a higher incidence respiratory complications (COVID-19pos vs COVID-19neg, 33.3% vs 8.9%; p=0.03) with a similar incidence of cardiac death (COVID-19pos vs COVID-19neg, 16.7% vs 11.17%; p=0.60).
Conclusions
In conclusion our data suggest the crucial necessity of an early and precise diagnosis of COVID-19 infection in STEMI to establish a correct management of this very high risk patients.
Funding Acknowledgement
Type of funding sources: None.
STEMI mortality in COVID+ vs COVID−
Abstract
Background
Following the PARADIGM trial, some studies have identified cardiac remodeling as major background for hard end point benefits of Sacubitril/Valsartan (S/V), but few adopted a well ...described definition in the literature.
Purpose
We aimed at a comprehensive evaluation of the effects of S/V on echo-derived measures of cardiac remodeling along with clinical and laboratory data over a medium-term follow-up pointing to a real-world HFrEF population.
Methods
This is a prospective observational study of HFrEF patients on optimal medical therapy (OMT) initiated with S/V at Heart Failure Clinic of our institute (January 2017-January 2020). In 62 HFrEF, echocardiographic, laboratory and clinical data were collected at baseline and over 10 (Q1-Q3 8–13) months after S/V initiation. Mean age was 68±12 years, 79% men. Left ventricular reverse remodeling (LVRR) was defined as: 1) an absolute increase in LVEF ≥10 points or a LVEF ≥50% at follow-up and 2) a relative decrease in indexed left ventricular end-diastolic diameter of at least 10% or an indexed left ventricular end-diastolic diameter ≤33 mm/m2.
Results
Compared to baseline, S/V promoted a significant improvement of LV ejection fraction (LVEF, from 30% to 37%; p<0,0001) with an absolute median increase in LVEF of 8 points. Parallel significant reductions in left ventricular and atrial volumes, lower mitral regurgitation degree and a better diastolic dysfunction along with clinical improvement (NYHA class and NT-proBNP values) were observed at follow up. sPAP (systolic Pulmonary Arterial Pressure) was significantly decreased at follow-up evaluation (37 mmHg vs 31 mmHg p=0,005) (Table 1). Overall, LVRR as defined above was observed in 30% of patients. Younger age (64 vs 74 years, p=0,007), a shorter duration of the disease (7 vs 23 months, p=0,009), and non ischaemic etiology (79% vs 33% p=0,003), along with a smaller baseline LAESVi (Left Atrial End Systolic Volume, 41 vs 48 ml/m2 p=0,012) were more common in patients with LVRR. sPAP and Right Ventricular (RV) function estimated by tricuspid annular plane systolic excursion (TAPSE) were significantly better in LVRR patients along with TAPSE/sPAP ratio (Table 2).
Conclusions
Our data point to a remarkable medium-term reverse remodeling effect by S/V in HFrEF. Findings reinforce the concept that the main benefits of S/V on hard end-points are mediated by its cardiac-related effects. Both a left and right reverse remodeling occur in HFrEF patients who start S/V in the most adaptable phase of the disease supporting an early administration.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared as a pandemic by the World Health ...Organization (WHO) on 11 March 2020. Clinical presentation ranges from asymptomatic to acute respiratory distress syndrome (ARDS) that can lead to death. Patients with concomitant cardiac diseases have an extremely poor prognosis, and SARS-CoV-2 may cause direct acute and chronic damage to the cardiovascular system. Echocardiography may provide useful information, especially in critical care patients, because it can be performed quickly at the bedside. However, the recommendations relating to the use of echocardiography in the COVID-19 pandemic must be considered only as expert suggestions due to the lack of evidence-based scientific outcome data. To date, there is no means to predict the impact of the virus on patient outcome probably because the pathophysiology of COVID-19 remains unexplained.
Purpose
To assess the prognostic utility of quantitative 2D-echocardiography, including strain, in patients with COVID-19 disease.
Methods
COVID-19 patients admitted to the San Paolo University Hospital of Milan, that underwent a clinically indicated echocardiographic exam were included in the study. To limit contamination all measurements were performed offline. Quantitative measurements were obtained by an operator blinded to the clinical data.
Results
Among the 49 patients, non-survivors (33%) had worse respiratory parameters, index of multiorgan failure and worse markers of lung involvement. Right Ventricular (RV) dysfunction (as assessed by conventional and 2-dimensional speckle tracking, fig. 1) was a common finding and a powerful independent predictor of mortality. At the ROC curve analyses, RV free-wall longitudinal strain (LS) showed an AUC 0.77 ± 0.08 in predicting death, p = 0.008, and global RV LS (RV-GLS) showed an AUC 0.79 ± 0.04, p = 0.004. This association remained significant after correction for age (OR= 1.16, 95%CI 1.01-1.34, p = 0.029 for RV free-wall LS and OR = 1.20, 95%CI 1.01-1.42, p = 0.033 for RV-GLS), for oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen (OR= 1.28, 95%CI 1.04-1.57, p = 0.021 for RV free wall-LS and OR = 1.30, 95%CI 1.04-1.62, p = 0.020 for RV-GLS) and for the severity of pulmonary involvement measured by a computed tomography lung score (OR = 1.27, 95%CI 1.02-1.19, p = 0.034 for RV free-wall LS, and OR = 1.30, 95%CI 1.04-1.63, p = 0.022 for RV-GLS).
Conclusions
In patients hospitalized with COVID-19, offline quantitative 2D-echocardiographic assessment of cardiac function is feasible. Parameters of RV function are frequently abnormal and have an independent prognostic value over markers of lung involvement. Early identification of RV dysfunction with speckle tracking might be useful not only to guide management acutely (i.e. fluid management, monitoring high-PEEP response in intubated patients) but also to tailor follow-up subsequently.
Abstract Figure 1
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Anorexia nervosa (AN) is one of the most common form of eating disorders and it is a severe and potentially fatal disease ...with high rates of morbidity and mortality especially in the population aged 15-25 years. Cardiac involvement occurs in approximately 80% of patients with AN. Cardiovascular complications include changes in the autonomic regulation (increased vagal tone, bradycardia, orthostatic hypotension, syncope), arrhythmias, congestive heart failure and sudden death. Few reports have described, in small series, a variety of echocardiographic abnormalities including decreased cardiac mass, mitral valve prolapse, pericardial effusion and reduced left ventricular (LV) dimensions. No previous studies, however, examined if there is a change in these abnormalities with weight fluctuations.
Purpose
To describe echocardiographic findings among male and female patients with AN and to examine the effect of weight gain on clinical and echocardiographic parameters.
Methods
We performed a single center, retrospective, study of patients diagnosed with AN using the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Clinical, laboratory and ECG-graphic data were obtained by reviewing each patient’s medical records. Echocardiographic parameters were measured off-line.
Results
The study population consisted of 81 patients, mean age 24.5 ± 11.6 years, 92.6% females. 75% showed an extreme AN degree. Mean body mass index (BMI) was 15.2 ± 2.1 kg/m2. Mean heart rate was 57.2 ± 12.7 beats per minute. Some patients showed right bundle branch block (7.4%) or prolonged QT interval (14.8%). Patients with BMI below the mean value had more often pericardial effusion, smaller LV mass and LV end-diastolic volume and thinner interventricular septum (all p < 0.05). However, when index to BSA, LV mass and volumes were within normal range in the 90% of the population. They also showed mitral valve abnormalities and low values of white blood cells and platelets. The presence of pericardial effusion was not related to inflammatory parameters or protein deficiency. For 39 patients echocardiographic exams at the highest and the lowest weight were available. With weight gain, there was an improvement in LV mass, interventricular septum thickness, pericardial effusion and an increase in white blood cells and platelet count.
Conclusions
Our study showed that patients with AN have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates, hypothesis confirmed by the regression with weight gain. It is possible that pericardic effusion fills the gap left by mass loss.
An integrated portable genetic analysis microsystem including PCR amplification and capillary electrophoretic (CE) analysis coupled with a compact instrument for electrical control and laser-excited ...fluorescence detection has been developed. The microdevice contains microfabricated heaters, temperature sensors, and membrane valves to provide controlled sample positioning and immobilization in 200-nL PCR chambers. The instrument incorporates a solid-state laser and confocal fluorescence detection optics, electronics for sensing and powering the PCR reactor, and high-voltage power supplies for conducting CE separations. The fluorescein-labeled PCR products are amplified and electrophoretically analyzed in a gel-filled microchannel in <10 min. We demonstrate the utility of this instrument by performing pathogen detection and genotyping directly from whole Escherichia coli and Staphylococcus aureus cells. The E. coli detection assay consists of a triplex PCR amplification targeting genes that encode 16S ribosomal RNA, the fliC flagellar antigen, and the sltI shigatoxin. Serial dilution demonstrates a limit of detection of 2−3 bacterial cells. The S. aureus assay uses a femA marker to identify cells as S. aureus and a mecA marker to probe for methicillin resistance. This integrated portable genomic analysis microsystem demonstrates the feasibility of performing rapid high-quality detection of pathogens and their antimicrobial drug resistance.
Ce-modified mesostructured MCM-41-type hybrid materials with different Si/Ce molar ratios (Si/Ce = 10, 30 and 50) were synthesized by the surfactant-assisted hydrothermal method and their structural ...and optical properties were characterized by small angle X-ray scattering (SAXS), field emission scanning electron microscopy (FE-SEM) equipped with embedded EDS system, ultraviolet and visible diffuse reflectance (UV–vis DR) spectroscopy, X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy. Ce-MCM-41 samples show highly ordered 2D porous hexagonal mesostructures and oval and spherical morphologies with particle size between 300 and 600 nm, depending on the incorporated Ce amount. Incorporation of Ce
4+
into ordered mesoporous silica generates oxygen defects in ceria-silica composites with the formation of Ce
3+
species as confirmed by the XPS analyses. Cerium incorporation modified their structural regularity and resulted in an effective red shifting of the band gap (2.82 eV at 2.64 eV) due to the creation of intermediate energy states. Both asymmetry and broadening of Raman active F
2g
mode confirmed the presence of the structural defects. These ordered mesoporous Ce-MCM-41 hybrid materials are potentially attractive for their use as novel photocatalysts in the degradation of organic pollutants present in wastewater employing UV and visible light.
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•NiW/γ-Al2O3 catalysts were prepared at different pHs and in presence of a chelating agent (CyDTA).•The influence of sulfurization pressure and its effect on the active species for ...hydrodesulfurization.•The surface species of sulfided catalysts was studied by several characterization techniques.•Sulfided catalysts were tested in HDS of thiophene.
In this paper NiW/γ-Al2O3catalysts were prepared by consecutive impregnation of a W/γ-Al2O3 catalyst with an aqueous solution of nickel salt. The structural control of the nickel ion precursor in the impregnation solution was achieved by the addition of 1, 2-cyclohexanediamine-N, N, N’, N’-tetraacetic acid (CyDTA) as a chelating agent at different pH. The influence of the sulfidation pressure (1 bar vs 40 bar) on the activity and structure of the NiW catalysts was investigated. The catalysts performances were tested in hydrodesulfurization (HDS) of thiophene after sulfidation at atmospheric or high pressure. The catalysts were characterized by X-Ray photoelectron spectroscopy (XPS), temperature-programmed reduction (TPR) and infrared spectroscopy of adsorbed CO (IR/CO) to explain the modification in surface species composition due to the chelating agent CyDTA and sulfiding conditions.
NiW catalysts prepared in presence of CydTA and sulfided under high pressure displayed the highest HDS activity. These two factors enhanced the sulfidation degree of W-based species as characterized by XPS. A linear correlation was found between the HDS activity and the sulfidation degree. In addition, chelating agent addition induced a decrease on metal-support interaction, as pointed out by TPR, and strongly favored the creation of CUS sites on the NiWS phase as seen by IR/CO. All these features favored a high catalytic activity. In addition, high pressure sulfidation not only leads to more active NiW catalysts but improved the butene-over-butane ratio.
Community-acquired pneumonia (CAP) is complicated by cardiac events in the early phase of the disease. Aim of this study was to assess if these intrahospital cardiac complications may account for ...overall mortality and cardiovascular events occurring during a long-term follow-up. Three hundred one consecutive patients admitted to the University-Hospital, Policlinico Umberto I, with community-acquired pneumonia were prospectively recruited and followed up for a median of 17.4 months. Primary end point was the occurrence of death for any cause, and secondary end point was the occurrence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction MI, and stroke). During the intrahospital stay, 55 patients (18%) experienced a cardiac complication. Of these, 32 had an MI (29 non–ST-elevation MI and 3 ST-elevation MI) and 30 had a new episode of atrial fibrillation (7 nonmutually exclusive events). During the follow-up, 89 patients died (51% of patients with an intrahospital cardiac complication and 26% of patients without, p <0.001) and 73 experienced a cardiovascular event (47% of patients with and 19% of patients without an intrahospital cardiac complication, p <0.001). A Cox regression analysis showed that intrahospital cardiac complications, age, and Pneumonia Severity Index were significantly associated with overall mortality, whereas intrahospital cardiac complications, age, hypertension, and diabetes were significantly associated with cardiovascular events during the follow-up. In conclusion, this prospective study shows that intrahospital cardiac complications in the early phase of pneumonia are associated with an enhanced risk of death and cardiovascular events during long-term follow-up.
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