Prognostic stratification of elderly patients with chronic obstructive pulmonary disease (COPD) is difficult due to the wide inter-individual variability in the course of the disease. No marker can exactly stratify the evolution and natural history of COPD patients. Studies have shown that leukocyte count is associated with increased risk of mortality in COPD patients. The aim of this study was to evaluate the possible role of relative lymphocyte count as a risk marker for mortality in elderly patients with COPD. This is a3-year prospective study. A total of 218patients, mean age 75.2±7 years, with moderate to severe COPD and free from conditions affecting lymphocyte count were enrolled. The population was divided into two groups according to the relative lymphocyte count, with a cut-off of 20%. Eighty-five patients (39%) had a relative lymphocyte count ≤20%. Three-year mortality rates from any cause in patients with relative lymphocyte count ≤ or > 20% were 68 and 51%, respectively (p = 0.0012). Survival curve analysis showed higher mortality in patients with relative lymphocyte count ≤20% (p = 0.0005). After adjustment for age and sex, the hazard ratio for mortality risk according to lymphocyte count was 1.79 (95% confidence interval [CI]: 1.26–2.57, p = 0.0013), even in the analysis limited to the 171 patients without congestive heart failure (1.63; 95% CI: 1.03–2.58, p = 0.038). Low relative lymphocyte count was associated with higher mortality in elderly patients with severe COPD.

Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by using appropriate personal protection equipment. Operators wore FFP2 in 58 centers (83%) during trans-thoracic echocardiography (TTE), in 65 centers (93%) during transesophageal echocardiography (TEE) and 63 centers (90%) during stress echocardiography. The second wave caused a significant reduction in number of echocardiographic exams, compared to November 2019 (from 513 ± 539 to 341 ± 299 exams per center, −34%, p < 0.001). On average, there was a significant increase in the outpatient waiting list for elective echocardiographic exams (from 32.0 ± 28.1 to 45.5 ± 44.9 days, +41%, p < 0.001), with a reduction of in-hospital waiting list (2.9 ± 2.4 to 2.4 ± 2.0 days, −17%, p < 0.001). We observed a large diffusion of point-of-care cardiac ultrasound (88%), with a significant increase of lung ultrasound usage in 30 centers (43%) during 2019, extended to all centers in 2020. Carbon dioxide production by examination is an indicator of the environmental impact of technology (100-fold less with echocardiography compared to other cardiac imaging techniques). It was ignored in 2019 by 100% of centers, and currently it is considered potentially crucial for decision-making in cardiac imaging by 65 centers (93%). Conclusions: In one year, major changes occurred in echocardiography practice and culture. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing.

Anderson–Fabry disease (AFD) remains a therapeutic challenge despite advances in early diagnosis and the availability of enzyme replacement therapies (ERTs). While early initiation of therapy can mitigate disease progression, resistance mechanisms—such as the development of anti-drug antibodies—limit the efficacy of current treatments, particularly in patients with severe genetic variants. Chaperone therapy provides a targeted option for a subset of patients, yet significant gaps remain in treating those with complete enzyme deficiency. This perspective article explores the existing therapeutic landscape and reflects on emerging treatments, such as mRNA and gene therapies, which hold promise for overcoming the resistance mechanisms. By addressing the limitations of current pharmacological options and considering future innovations, this article aims to outline the path forward for more effective and personalized treatment strategies in Anderson–Fabry disease.

Hypertrophic cardiomyopathy (HCM) is a cardiac disorder characterized by unexplained left ventricular hypertrophy and a clinical presentation that is heterogeneous, ranging from asymptomatic cases to sudden cardiac death (SCD). The condition’s complex pathophysiology encompasses myocyte disarray, fibrosis, and impaired cellular metabolism. Advancements in non-invasive cardiac imaging, notably echocardiography and cardiac magnetic resonance (CMR), have led to substantial progress in the domains of early diagnosis, phenotypic characterization, and risk stratification. Echocardiography is the preferred diagnostic modality, as it provides a comprehensive evaluation of ventricular hypertrophy patterns, left ventricular outflow tract (LVOT) obstruction, mitral valve abnormalities, left atrial size, and diastolic function. Novel techniques, such as speckle-tracking strain imaging, have emerged as means to detect subclinical myocardial dysfunction and to provide significant prognostic information. Cine-CMR sequences, tissue characterization with late gadolinium enhancement, and quantitative techniques such as strain imaging have been shown to enhance diagnostic precision and prognostic evaluation. The integration of multimodality imaging has been demonstrated to enhance the management of patients with HCM, both in the short term and in the long term, by facilitating individualized monitoring. This review summarizes the role of cardiac imaging in the comprehensive evaluation of HCM, emphasizing the impact of these methods on diagnosis, risk assessment, and personalized patient care, particularly in challenging clinical settings, such as cases of athlete’s heart and pathological ventricular hypertrophy.

Purpose: To evaluate waiting lists during the coronary artery bypass graft (CABG) diagnostic–therapeutic pathway of patients, in order to detect the actual waiting time between diagnostic evaluation and surgery, and to explore if coronary angiography provides an option as a starting point of waiting lists for CABG patients. Methods: We analyzed 496 hospital discharge cards (year 2009) from main cardiac surgery units in Apulia, Italy. Exclusion criteria were emergency patients coming from regions other than Apulia, and CABG associated with cardiac valve surgery. Results: A total of 97.6% patients underwent CABG within 0–30 days of their reservation date, and 81.7% passed from the first diagnostic step to coronary angiography within 0–30 days. The mean time delay in the diagnostic (ie, the time elapsing from the date of first test performed to detect coronary heart disease and that of coronary angiography) and therapeutic (ie, the time elapsing from the date of waiting-list admission and that of cardiac surgery unit admission) phases was 17.3 ± 31.306 and 5.09 ± 9.375 days respectively; 27% and 19.8% underwent CABG within the same day or at least the day after reservation day, whilst 47.2% completed the diagnostic phase on the same day. Conclusion: The waiting lists for CABG surgery diagnostic–therapeutic phase in Apulia are short.