This study compiles data to determine if procalcitonin (PCT) values may predict both the risk of bacterial infection and potentially negative long-term outcomes in patients with acute coronary syndromes (ACS). All patients with a diagnosis of ACS that had PCT levels assessed during the first 24 h of hospitalization were enrolled in this study. The primary outcome was to detect the presence of bacterial infection defined as the occurrence of fever and at least one positive blood or urinary culture with clinical signs of infection. The secondary outcome was to monitor the occurrence after 1 year of the composite outcome of all-cause mortality, stroke and myocardial infarction. Overall, 569 patients were enrolled (mean age 69.37 ± 14 years, 30% females). Of these, 44 (8%) met the criteria for bacterial infection. After multivariate analysis, PCT and SBP were found to be independent predictors of bacterial infections (OR for PCT above the cut-off 2.67, 95% CI 1.09–6.53, p = 0.032 and OR for SBP 0.98, 95% CI 0.97–0.99, p = 0.043). After 1 year, the composite outcome of all-cause death, MI and stroke occurred in 104 patients (18%). PCT was not found to be an independent predictor of these outcomes. In conclusion, when assessing ACS, we found that testing for PCT levels during hospital admissions procedures was a good predictor of bacterial infections but not of all-cause mortality, stroke, or myocardial infarction. Clinicaltrial.org identifier: NCT02438085.

Background: Heart rate variability (HRV) is widely used in professional soccer players as a tool to assess individual response to training load. Different devices and methods are available for HRV assessment. The relationship between HRV and competitive soccer matches performance is not documented. Methods: We monitored HRV in professional soccer players throughout a game season. Measurements were performed with a portable lightweight device in weekly 5 min sessions from which we obtained the value of the square root of the mean squared differences of successive beat-to-beat intervals (rMSSD). Game parameters of run and velocity were collected. Results: Twenty-seven players were monitored with a total of 121 observations. The rMSSD significantly related with the total distance covered (p = 0.036) and with the distance covered running at >15 km/h (p = 0.039) during soccer games. Conclusions: HRV was associated with competition performance in professional soccer players.

Background. His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. Furthermore, studies reporting a comprehensive assessment of the ventricular function, using myocardial work (MW) evaluation are lacking. Objectives. (1) To evaluate the systematic use of the 3D-EAM as a guide to HBP; (2) to assess the electrical and mechanical activations with high-density mapping, comparing spontaneous ventricular activation (SVA), HBP and RVP; (3) to assess the myocardial function through speckle-tracking echocardiography (STE) and MW analysis in SVA, HBP and RVP. Methods. 3D-EAM was performed in consecutive patients undergoing HBP implantation with a low use of fluoroscopy. All patients were systematically evaluated with high-density mapping, MW and STE. Results. Fifteen patients were enrolled, of whom three had an implant failure (20%). RV activation time was not statistically different between SVA and HBP (103 vs. 104 ms, p = 0.969) but was significantly higher in RVP (133 ms, p = 0.011 vs. SVA and p = 0.001 vs HBP). Global constructive work was significantly lower during RVP (1191 mmHg%) than during SVA and HBP (1648 and 1505 mmHg%, p = 0.011 and p = 0.008, respectively) and did not differ between SVA and HBP (p = 0.075). Conclusions. 3D-EAM and MW evaluation showed that HBP was comparable to the physiological SVA in terms of activation time and cardiac performance. Compared to both SVA and HBP, RVP was associated with a worse activation timing and ventricular efficiency.

The percutaneous closure of the left atrium appendage (LAA) is a valuable therapeutic tool in patients with atrial fibrillation (AF) who have contraindications to anticoagulant drugs. However, the procedure can lead to complications and the device positioning determines a risk of thrombosis that can‘t be underestimated, especially during the first period from the intervention. In this report we propose the case of a 72 years old man in chronic therapy with NOAC (non–vitamin K antagonist oral anticoagulants) for a paroxysmal AF (CHA2DS2–VASC = 3), that presented intracranial hemorrhage after 3 years due to a cerebral arteriovenous malformation. This condition represents an absolute contraindication to anticoagulant therapy, because of the high hemorrhagic risk, and led to the percutaneous device positioning (WATCHMAN 24 mm) for LAA closure. After the implantation procedure we started a single antiplatelet therapy (SAPT) with clopidogrel 75 mg for 6 months. At one month follow–up a trans–esophageal echocardiogram (TEE) showed the presence of a swinging samll trombotic formation (4x2,5 mm) attached to the device. At that time antithrombotic therapy with enoxaparin 6000 IU was started, in addition to SAPT. Ten days later, another TEE showed the thrombus resolution and we decided to continue with clopidogrel alone. No relevant clinical events were observed to the subsequent follow–up.

Few stories in the history of medical research can generate interest and inspire as much as the mythical journey from ‘Poison to Panacea’. When Ferreira travelled from Santiago to London to work in the laboratory of Sir John Vane, he could not have imagined that a bite from Bothrops jararaca, a Brazilian viper, could give rise to angiotensin-converting enzyme (ACE) inhibitors, which to date have arguably the strongest portfolio of placebo-controlled trials in medicine. After the discovery of these drugs, the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) I was conducted and proved pivotal in the practice of cardiology. CONSENSUS I gave both hope and belief—hope that breathless patients with advanced congestive heart failure (CHF) could be treated with a drug that can impact significantly the natural history of the disease, and belief that a new class of medicine had finally arrived as a result of this study and of many subsequent others that have shown that ACE inhibitors have a demonstrable efficacy in patients with left ventricular dysfunction with or without CHF symptoms, in those after an acute myocardial infarction, and even in the prevention of myocardial infarction and its associated sequelae in the context of primary or secondary prevention. Treatment of all these patients is supported by both American and European guidelines, expert opinion, and convincing clinical trials. It is a practical first-line recommendation to all clinicians, healthcare providers, and policymakers to mirror the details of the main trials as much as possible with regard to the drug, dosage, and frequency of administration. This chapter describes the journey of the ACE inhibitor drug class from its origins—the poisonous venom of the Brazilian pit viper Bothrops Jararaca to its use (rather than non-use) during the actual Covid-19 pandemic.