Background: Previous studies have evaluated average electrocardiographic (ECG) values in healthy subjects or specific subpopulations. However, none have evaluated ECG average values in not selected populations, so we examined ECG changes with respect to age and sex in a large primary population. Methods: From digitized ECG stored from 2008 to 2021 in the Modena province, 130,471 patients were enrolled. Heart rate, P, QRS and T wave axis, P, QRS and T wave duration, PR interval, QTc, and frontal QRS-T angle were evaluated. Results: All ECG parameters showed a dependence on age, but only some of them with a straight-line correlation: QRS axis (p < 0.001, R² = 0.991, r = 0.996), PR interval (p < 0.001, R² = 0.978, r = 0.989), QTc (p < 0.001, R² = 0.935, r = 0.967), and, in over 51.5 years old, QRS-T angle (p < 0.001, R² = 0.979, r = 0.956). Differences between females and males and in different clinical settings were observed. Conclusions: ECG changes with ageing are explainable by intrinsic modifications of the heart and thorax and with the appearance of cardiovascular diseases and comorbidities. Age-related reference values were computed and applicable in clinical practice. Significant deviations from mean values and from Z-scores should be investigated.

We report a case of multiple myeloma (MM) displaying an unusual course, with metastatic spread in uncommon sites (gastroduodenal and upper respiratory tract, breast, skin and liver) and with a fatal outcome. In our patient this plasma cell neoplasm was associated with a rare condition named crystal-storing histiocytosis (CSH), resulting from the storage in reactive histiocytes of crystalline immunoglobulin inclusions. These crystal-forming paraprotein components are secreted by the neoplastic plasma cells and give rise to the crystalline material of the histiocytes only after their ingestion and degradation by the same histiocytes. In this disorder crystal-storing cells may be present in various tissues (in our case mainly in bone marrow), often with functional alterations of the involved organs. In our opinion the association of this “atypical” MM with CSH is to be considered an uncommon event.

Article: Effects of Cholecalciferol Supplementation in Patients with stable heart failure and LOw vITamin D levels (ECSPLOIT-D): a double-blind, randomized, placebo-controlled pilot study - Minerva Cardioangiologica 2017 December;65(6):553-62 - Minerva Medica - Journals

Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart) will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery. The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. (ClinicalTrials.gov): NCT00547872

Through a simple machine learning approach, we aimed to assess the risk of all-cause mortality after 5 years in a European population, based on electrocardiogram (ECG) parameters, age, and sex. The study included patients between 40 and 90 years old who underwent ECG recording between January 2008 and October 2022 in the metropolitan area of Modena, Italy. Exclusion criteria established a patient cohort without severe ECG abnormalities, namely, tachyarrhythmias, bradyarrhythmias, Wolff-Parkinson-White syndrome, second- or third- degree AV block, bundle-branch blocks, more than three premature beats, poor signal quality, and presence of pacemakers and implantable cardioverter- defibrillators. Mortality was assessed using a set of logistic regression models, differentiated by age group, to which the Akaike Information Criterion was applied. Model fitting was evaluated using confusion matrix-related performance metrics, the area under the receiver operating characteristic (ROC) curve (AUC), and the predictive significance against the no-information rate (NIR). 53692 patients were enrolled, of whom 14353 (26.73 %) died within 5 years of ECG registration. The logistic regression model distinguished between those who died and those who survived based on the predicted mortality probability for all age groups, obtaining a significant difference between the predicted mortality and the NIR in 14 of the 55 age groups. Good accuracy and performance metrics were observed, resulting in an average AUC of 0.779. The proposed model showed a good predictive performance in patients without severe ECG abnormalities. Therefore, this study highlights the potential of ECGs as prognostic rather than diagnostic tools.