Background. Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction in the last month of pregnancy or in the first five months following delivery in women without other known causes of heart failure. PPCM incidence and prevalence are highly variable in different populations and geographical areas. The etiology of PPCM is likely multifactorial, with genetic predisposition, autoimmune conditions, nutritional deficiencies, hormonal and metabolic changes, myocardial inflammation, enhanced oxidative stress, vascular dysfunction, and angiogenic imbalance all listed as possible contributing factors. Objectives. The complexity and multifactorial nature of PPCM can be explored by large-scale “omics” investigations, and their integration has the potential to identify key drivers and pathways that have the largest contribution to the disease. The scarcity of relevant knowledge and experience with most rare diseases raises the unique need for cooperation and networking. Methods and results. In the context of PPCM, we hypothesize that the creation of prospective patient registries could represent an answer to this criticality. Therefore, we created a multicenter national registry of PPCM in different geographical areas in Italy. Conclusions. We expect that the integration of clinical, imaging and omics-based data might provide novel insights into PPCM pathophysiology and allow in the future early detection, risk assessment, and patient-specific therapeutic interventions, thereby offering new perspectives in precision medicine.

Background: The withdrawal timing of direct oral anticoagulants (DOACs) among patients in need of elective invasive surgery is based on DOAC pharmacokinetics in order to perform the procedure out of the DOAC peak plasma concentration. We aimed to investigate the prevalence and predictors of plasma levels of DOACs out of trough range in patients with atrial fibrillation (AF) in need of elective cardiac procedure. Materials and Methods: We evaluated all consecutive AF patients on DOAC therapy in need of elective cardiac procedure, admitted to our division from January 2022 to March 2022. All patients underwent DOAC plasma dosing the morning of procedure day. They were categorized as in range, above range, and below range, according to the DOAC reference range at the downstream point. The timing of discontinuation of DOAC therapy was considered as appropriate or not, according to the current recommendations. The clinical predictors of out-of-range DOAC plasma levels have been evaluated. Results: We included 90 consecutive AF patients (56.6% male, mean age 72.95 ± 10.12 years); 74 patients (82.22%) showed DOAC concentration out of the expected reference range. In half of them (n, 37), the DOAC plasma concentration was below the trough reference range. Of the study population, 17.7% received inappropriate DOAC dosages (10% overdosing, 7% underdosing), and 35.5% had incorrect timing of DOAC withdrawal (26% prolonged, 9.5% shortened). At multivariable analysis, inappropriate longer DOAC withdrawal period (OR 10.13; P ≤ 0.0001) and increased creatinine clearance (OR 1.01; P = 0.0095) were the independent predictors of plasma DOAC levels below the therapeutic trough range. In contrast, diabetes mellitus (OR 4.57; P = 0.001) was the only independent predictor of DOAC plasma level above the therapeutic trough range. Conclusion: Increased creatinine clearance and inappropriate longer drug withdrawal period are the only independent predictors of DOAC plasma levels below the reference range; in contrast, diabetes is significantly correlated with DOAC plasma levels above the reference.

A 65–year–old woman was scheduled for coronary angiography during the pre–surgery evaluation because of an abdominal aortic aneurysm (AAA) detected at ultrasound (Figure). The patient referred worsening dyspnoea and asthenia in the last few months, associated with atypical chest pain. Because of these symptoms and taking into account that AAA patients are very high cardiovascular risk, exclusion of coronary artery desease semmed appropriate. At admission, patient showed enlarged lymph nodes at cervical and inguinal region. In the suspicion of a malignant cancer, a contrast enhanced comupter tomography was scheduled, showing an increase in para–aortic, inguinal, cervical and maxillary lynph nodes size in absence of the AAA (figure). After blood tests and haematologic consultation, a final diagnosis of chornic myeloid leukaemia was made. The echo–colour doppler is the first line imaging test for diagnosis of AAA. However, in some cases it might be not sufficient. Para–aortic lymphadenopathy should be considered as a possible pitfall in the differential diagnosis of abdobinal aortic aneurysm. Open in new tab Download slide

We report a case of a patient admitted to our coronary intensive care unit with chest pain and elevated cardiac troponin. Coronary angiography showed no obstructive coronary artery disease. The patient had a history of chronic rhinosinusitis and nasal polyps, treated with dupilumab. Laboratory tests revealed marked hypereosinophilia, prompting a cardiac MRI, which showed findings consistent with eosinophilic myocarditis. This diagnosis was later confirmed by endomyocardial biopsy. This case highlights the importance of differential diagnosis in cases of myocardial injury (characterized by increased cardiac troponin) and underscores the value of CMR as the most accurate non-invasive technique for detecting myocarditis.

In the last few years, growing evidence indicate that gut miocrobiome is linked to irritable bowel syndrome (IBS) and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have been also recorded. Triobiotix is a nutraceutical consisting of: maltodextrin; mineralized extract of Lithothamnion; Bioecolians® gluco–oligosaccharides; ferment mix; short–chain fructo–oligosaccharides powder. We analyzed the database of 40 Italian General Practitioners (GPs). A total of 587 patients with IBS and on Triobiotix were identified. Of these, in only 535 patients, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia. Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the TO evaluation. Triglycerides levels were also significantly decreased (186.37+66.4 vs. 176.13+67.9; p < 0.05). Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL–C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low–moderate dyslipidaemia.