Background: Sarcopenia is the core component of frailty; however, its role in patients undergoing transcatheter aortic valve replacement (TAVR) is a matter of debate. The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) is a validated instrument for assessing quality of life (QoL) in patients with severe aortic stenosis (AS). Aims: We aim to evaluate the QoL of sarcopenic and non-sarcopenic patients with severe AS undergoing TAVR. Methods: TASQ was prospectively administered to patients undergoing TAVR. All patients completed the TASQ before TAVR and at a 3-month follow-up. The study population was divided in two groups according to sarcopenic status. The primary endpoint was the TASQ score in the sarcopenic and non-sarcopenic cohorts. Results: In total, 99 patients were eligible for the analysis. In both sarcopenic (n = 56) and non-sarcopenic (n = 43) cohorts, significant changes were observed in the overall TASQ score and in all but one (i.e., health expectations) of the individual domains (p < 0.01). Sarcopenic and non-sarcopenic patients showed substantial improvements across TASQ subscores. The mean change in overall TASQ score at three months revealed a significant improvement in both cohorts (p < 0.01). Health expectations worsened in sarcopenic patients at the 3-month follow-up (p = 0.06). Conclusions: The TASQ questionnaire revealed changes in QoL after TAVR, regardless of patients’ sarcopenic status. Health status improved substantially in both sarcopenic and non-sarcopenic patients following TAVR. Lack of improvement in health expectations seems to depend on patients’ expectations regarding the procedure and specific aspects in the evaluation of the outcome.

Data about contrast-associated acute kidney injury (CA-AKI) in oldest old (age ≥85 years) ST-elevation myocardial infarction (STEMI) patients are scarce. We evaluated the incidence and the 1-year prognostic impact of CA-AKI in this population. Patients were included in a multicenter real-world registry, and CA-AKI was defined according to KDIGO (Kidney Disease Improving Global Outcomes) criteria. Major adverse cardiac and cerebrovascular events (MACCEs) were defined as the composite of all-cause death, stroke, unplanned coronary revascularization, and heart failure hospitalization. The primary outcome was the incidence and impact of CA-AKI on MACCEs at 1 year follow-up. Out of 461 STEMI patients (mean age 88.6 ± 2.9 years), 102 (22.1%) patients developed CA-AKI. Chronic kidney disease was the strongest predictor of CA-AKI (odds ratio [OR]: 4.52, 95% CI: 2.81–7.30, P < .01). The CA-AKI cohort showed a higher risk of MACCEs (adjusted HR: 1.75, 95% CI: 1.13–2.71, P = .01), driven mainly by all-cause death (adjusted hazard ratio [HR]: 2.39, 95% CI: 1.41–4.07, P = .01) and followed by heart failure hospitalization (adjusted HR: 2.01, 95% CI: 1.08–3.76, P = .01). Among oldest old STEMI, CA-AKI was frequent and associated with a higher incidence of MACCEs at 1-year follow-up.

Aim: The aim of our study is to assess the predictors and the prognostic role of left ventricle ejection fraction (LVEF) recovery after Impella-supported percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (AMI). Methods: This retrospective, observational study included patients admitted for AMI who underwent Impella-supported PCI in two Italian high-volume cardiac catheterization laboratories. Only patients who underwent an echocardiographic assessment of left ventricle ejection fraction (LVEF) before the procedure (acute LVEF) and during follow-up (follow-up LVEF) were included in the present analysis. Patients with a baseline LVEF ≥40% were excluded from the present analysis. LVEF recovery was calculated as the difference between follow-up LVEF and acute LVEF. A delta ≥5% was considered significant and was used to define the responder group. Results: From April 2007 to December 2020, 64 consecutive patients were included in our study. A total of 55 patients (86%) received hemodynamic support with Impella 2.5, and 9 patients (14%) with Impella CP. Median LVEF at follow-up was significantly higher compared to baseline (36% (30–42) vs. 30% (24–33), p < 0.001). Based on LVEF recovery, 37 patients (57.8%) were deemed responders. According to multivariate analysis, complete functional revascularization was an independent predictor of a significant EF recovery (OR: 0.159; 95% CI: 0.038–0.668; p = 0.012). At three-year follow-up, lack of LVEF recovery was the only predictor of mortality (HR: 5.315; 95% CI: 1.100–25.676; p = 0.038). Conclusions: Functional complete revascularization is an independent predictor of the recovery of LVEF in patients presenting with AMI who underwent Impella-supported PCI. The recovery of LV function is associated with improved prognosis and could be used to stratify the risk of future events at long-term follow-up.

Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29–3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32–8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03–1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01–1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32–3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29–1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.

Background: Up to 50% of patients with ST‐segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) develop coronary microvascular dysfunction (CMD). Aims: This study aims to assess whether a prothrombotic state of coronary blood, defined by thromboelastography (TEG), is associated with post‐pPCI CMD in STEMI. Methods: TEG analysis of infarct‐related coronary artery (IRA) blood was performed in 25 consecutive STEMI patients before and after successful pPCI. CMD was defined by high values of the angiography‐derived index of microcirculatory resistance (IMR _angio ≥ 40 units). Results: The median age was 59 (IQR 51−71) years. CMD was observed in 13 (52%) patients. Pre‐pPCI Reaction (R) and Kinetic (K) time of the coronary blood from the IRA were inversely correlated with IMR _angio (rho −0.45, p = 0.02; rho −0.62, p = 0.002 respectively). R time was significantly shorter in patients who developed CMD (10.7 [IQR 8.8, 13.1] vs. 18.2 [IQR 12.6, 24.2], p = 0.05), and it provided an overall good diagnostic accuracy in predicting CMD (AUC 0.75, [95% CI 0.53−0.96] p = 0.05). Similar relationship was founded for K time: 3.5 [IQR 2.2−4.6] versus 10.6 [IQR 4.5−30.0] min, p = 0.01; AUC 0.82, [95% CI 0.64−0.99] p = 0.01. Moreover, α angle was significantly larger (57.4 [IQR 46.5−64.8] vs. 40.0 [IQR 39.0−49.5], p = 0.03) in patients with CMD (AUC 0.78, [95% CI 0.57−0.98], p = 0.03). Coronary post‐pPCI TEG parameters were not associated with CMD. Conclusions: In this proof‐of‐concept study, a prothrombotic state of coronary blood from the IRA is associated with CMD. Further studies are warranted to evaluate if TEG may enhance individualized therapies in patients with STEMI at risk of CMD.

Stereotactic ablative body radiotherapy (SABR) is arising as a promising non-invasive alternative for the treatment of ventricular tachycardia. There are limited data concerning the radiobiologic changes occurring post-therapy. We report a challenging case of a patient undergoing a combined epicardial and endocardial ablation after SABR.