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Myocardial Infarction: Prevention and Treatment

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Disease Prevention".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 25729

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Special Issue Editors

Dr. Saverio Muscoli

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Guest Editor

1. Department of Cardiology, University of Rome Tor Vergata, Rome, Italy
2. Faculty of Pharmacy, University of Rome Tor Vergata, Rome, Italy
Interests: cardiology; interventional cardiology; dyslipidemia; heart disease; valve disease; heart failure
Special Issues, Collections and Topics in MDPI journals

Dr. Marco Alfonso Perrone

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Guest Editor

Department of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy
Interests: cardiovascular disease; cardiac biomarkers; heart failure; cardiac imaging; congenital heart disease; sports cardiology; exercise training; pediatric cardiology; atherosclerosis; cardiovascular prevention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular diseases are the leading cause of death globally, and this record is linked to a number of risk factors that, acting alone or in integrated way, are responsible for the development and progression of atherothrombotic disease and its complications. Ischemic heart disease is also considered a complex disease as it is conditioned by both environmental factors and multiple genetic influences. Despite significant improvements over the past decades, acute myocardial infarction remains a major cause of mortality and morbidity and a major source of expense for the National Health System. This is partly due to the multiple presentation modes of myocardial infarction (STEMI, NSTEMI, MINOCA, Tako Tsubo, etc.) which affect the different methods of prevention and treatment. Mechanical reopening of the occluded coronary artery through percutaneous coronary intervention is the main and most effective intervention to restore coronary flow, myocardial perfusion and, consequently, decrease the extent of the infarction. Pharmacological treatment for myocardial infarction is a complex decision and still much debated especially for its duration. However, all this is valid only in the case of a coronary thrombotic occlusion; in fact, there are many cases of myocardial infarction in non-obstructive coronary artery disease (MINOCA) which require a different therapeutic approach.

The correct understanding of the pathophysiological, clinical, and therapeutic mechanisms would therefore be necessary to increase both mortality and morbidities of the patients as well as their quality of life.

The aim of this Special Issue is to offer the readers the best overview about prevention and treatment of myocardial infarction in its many ways in order to give a global and complete vision of the problem.

Dr. Saverio Muscoli
Dr. Marco Alfonso Perrone
Guest Editors

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Published Papers (13 papers)

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12 pages, 2441 KiB

Open AccessArticle

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

by Paolo Nardi, Calogera Pisano, Carlo Bassano, Fabio Bertoldo, Alessandro Cristian Salvati, Dario Buioni, Daniele Trombetti, Laura Asta, Mattia Scognamiglio, Claudia Altieri and Giovanni Ruvolo

Int. J. Environ. Res. Public Health 2023, 20(1), 212; https://doi.org/10.3390/ijerph20010212 - 23 Dec 2022

Cited by 4 | Viewed by 1678

Abstract

Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015–December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta–aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan–Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9–2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis–redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta–aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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10 pages, 1077 KiB

Open AccessArticle

Clinical Outcomes of a Non-Compliant Balloon Dilatation Catheter: MOZEC™ NC Study

by Akshyaya Pradhan, Pravesh Vishwakarma, Monika Bhandari, Rishi Sethi, Sharad Chandra, Gaurav Chaudhary, Akhil Sharma, Marco Alfonso Perrone, Sudhanshu Dwivedi and Varun Narain

Int. J. Environ. Res. Public Health 2022, 19(23), 16231; https://doi.org/10.3390/ijerph192316231 - 04 Dec 2022

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Abstract

The present study sought to assess the clinical outcomes of the Mozec™ Non-compliant (NC) Rx PTCA balloon dilatation catheter (BDC) (Meril Life Sciences Pvt. Ltd., Vapi, India) for dilatation of coronary lesions. This was a post-marketing, single-centre, single-arm, retrospective study. In total, 57 patients who had undergone post-dilatation with the Mozec™ NC Rx PTCA balloon dilatation catheter were evaluated. The primary endpoint was procedural success defined as (i) successful delivery of the investigational device to and across the target lesion; (ii) successful inflation, deflation, and withdrawal of the investigational device; (iii) absence of vessel perforation, flow-limiting vessel dissection, increase in thrombolysis in myocardial infarction (TIMI) flow from baseline, clinically significant arrhythmia requiring medical treatment; and (iv) achievement of final TIMI flow grade 3 after percutaneous coronary intervention of the target lesion after single or multiple attempts to cross the target lesion. Procedural success was achieved in 57 (100%) patients. There were no incidences of major adverse cardiac events (MACE)/target lesion failure (TLF). Mozec™ NC Rx PTCA balloon dilatation catheter has demonstrated favourable outcomes for the dilatation of routine and complex coronary lesions in a small cohort, as evidenced by its 100% procedural success rate and absence of MACE. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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11 pages, 457 KiB

Open AccessArticle

Circadian Variations and Associated Factors in Patients with Ischaemic Heart Disease

by Marisa Estarlich, Carmen Tolsa, Isabel Trapero and Cristina Buigues

Int. J. Environ. Res. Public Health 2022, 19(23), 15628; https://doi.org/10.3390/ijerph192315628 - 24 Nov 2022

Cited by 6 | Viewed by 1188

Abstract

Circadian rhythms have been identified in cardiovascular diseases, and cardiovascular risk factors can modify the circadian rhythm. The purpose of this study was to describe the onset of ischaemic heart disease symptomatology in relation to the date and time, the day of the week of presentation, the season, AMI location and severity and the level of influence of individual patient characteristics in a retrospective cross-sectional study involving 244 ischaemic heart disease patients from the intensive care unit of La Ribera Hospital (Spain). The onset of pain was more frequent in the morning, the season with the highest frequency of ischaemic events was winter, and the lowest incidence was during weekends. Regarding the severity of ischaemic heart disease, the circadian rhythm variables of weekdays vs. weekends and seasons did not show a significant association. The length of hospital stay was associated with the onset of pain in the afternoon. The onset of pain at night was associated with the subendocardial location of the infarction. In conclusion, living in a Mediterranean country, the Spanish population showed a circadian pattern of AMI, where the onset of pain has an influence on AMI location and on the length of hospital stay and is the same in patients with different individual risk factors. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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16 pages, 1512 KiB

Open AccessArticle

Initial Surgical Strategy for the Treatment of Type A Acute Aortic Dissection: Does Proximal or Distal Extension of the Aortic Resection Influence the Outcomes?

by Carlo Bassano, Marta Pugliese, Charles Mve Mvondo, Calogera Pisano, Paolo Nardi, Dario Buioni, Fabio Bertoldo, Mattia Scognamiglio, Alessandro C. Salvati, Claudia Altieri and Giovanni Ruvolo

Int. J. Environ. Res. Public Health 2022, 19(14), 8878; https://doi.org/10.3390/ijerph19148878 - 21 Jul 2022

Cited by 3 | Viewed by 1326

Abstract

(1) Background: We sought to analyze and compare the outcomes in terms of early and late mortality and freedom from a redo operation in patients undergoing surgical treatment for a type A acute aortic dissection in relation to the initial surgical treatment strategy, i.e., proximal or distal extension of the aortic segment resection, compared with isolated resection of the supracoronary ascending aorta. (2) Methods: This is a retrospective study in which we included 269 patients who underwent operations for a type A acute aortic dissection in the Department of Cardiac Surgery of Tor Vergata University from May 2006 to May 2016. The patients were grouped according to the extent of the performed surgical treatment: isolated replacement of the supracoronary ascending aorta (NE, no extension), replacement of the aortic root (PE, proximal extension), replacement of the aortic arch (DE, distal extension), and both (BE, bilateral extension). The analyzed variables were in-hospital mortality, postoperative complications (incidence of neurological damage, renal failure and need for prolonged intubation), late mortality and need for a redo operation. (3) Results: Unilateral cerebral perfusion was performed in 49.3% of the patients, and bilateral perfusion—in 50.6%. The overall in-hospital mortality was 31.97%. In the multivariate analysis, advanced age, cardiopulmonary bypass time and preoperative orotracheal intubation were independent predictors of in-hospital mortality. In the population of patients who survived the surgery, the probability of survival at 92 months was 70 ± 5%, the probability of freedom from a redo operation was 71.5 ± 5%, the probability of freedom from the combined end-point death and a redo operation was 50 ± 5%. The re-intervention rate in the general population was 16.9%. The overall probability of freedom from re-intervention was higher in patients undergoing aortic root replacement, although not reaching a level of statistical significance. Patients who underwent aortic arch treatment showed reduced survival. (4) Conclusions: In the treatment of type A acute aortic dissection, all the surgical strategies adopted were associated with satisfactory long-term survival. In the group of patients in which the aortic root had not been replaced, we observed reduced event-free survival. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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11 pages, 2552 KiB

Open AccessArticle

The Transaxillary Route as a Second Access Option in TAVI Procedures: Experience of a Single Centre

by Saverio Muscoli, Valeria Cammalleri, Michela Bonanni, Francesca Romana Prandi, Angela Sanseviero, Gianluca Massaro, Marco Di Luozzo, Marcello Chiocchi, Andrea Ascoli Marchetti, Arnaldo Ippoliti, Alessia Zingaro, Gian Paolo Ussia, Francesco Romeo and Pasquale De Vico

Int. J. Environ. Res. Public Health 2022, 19(14), 8649; https://doi.org/10.3390/ijerph19148649 - 16 Jul 2022

Cited by 1 | Viewed by 1679

Abstract

Background: The aim of our study was to determine the feasibility and efficacy of transaxillary (TAX) TAVI in patients not eligible for the transfemoral route. Methods: This is a retrospective study of a single center. We analysed 262 patients treated with TAVI. In 17 patients (6.5%), the procedure was performed with the TAX approach. Procedural and hospital data, 30-day safety, and clinical efficacy were assessed and compared between the transfemoral and TAX groups. Results: In the TAX groups, we found a higher prevalence of men (p = 0.001), smokers (p = 0.033), and previous strokes (p = 0.02). The EUROSCORE II was higher in the TAX group (p = 0.014). The success rate of the device was 100%. TAX was associated with a longer procedure time (p = 0.001) and shorter median device time (p = 0.034) in minutes. Patients treated with TAX had a longer hospital stay (p = 0.005) and higher overall bleeding rate (p = 0.001). Peripheral neurological complications were more frequent with TAX (p = 0.001), which almost completely resolved by 30 days. Conclusions: TAX TAVI is safe and effective and should be considered as a second choice when transfemoral TAVI is not feasible due to severe comorbidities. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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9 pages, 733 KiB

Open AccessArticle

Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique

by Carlo Bassano, Paolo Nardi, Dario Buioni, Laura Asta, Calogera Pisano, Fabio Bertoldo, Claudia Altieri and Giovanni Ruvolo

Int. J. Environ. Res. Public Health 2022, 19(1), 275; https://doi.org/10.3390/ijerph19010275 - 27 Dec 2021

Cited by 2 | Viewed by 1986

Abstract

Study objective: To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG). Methods: From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up. Results: As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, p-value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% (p-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (p-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (p-value 0.015). Conclusions: Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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Review

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18 pages, 2411 KiB

Open AccessReview

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

by Akshyaya Pradhan, Aashish Tiwari, Giuseppe Caminiti, Chiara Salimei, Saverio Muscoli, Rishi Sethi and Marco Alfonso Perrone

Int. J. Environ. Res. Public Health 2022, 19(15), 8977; https://doi.org/10.3390/ijerph19158977 - 23 Jul 2022

Cited by 7 | Viewed by 2694

Abstract

Dual antiplatelet therapy (DAPT) has remained the cornerstone for management of acute coronary syndrome (ACS) over the years. Clopidogrel has been the quintessential P2Y12 receptor (platelet receptor for Adenosine 5′ diphosphate) inhibitor for the past two decades. With the demonstration of unequivocal superior efficacy of prasugrel/ticagrelor over clopidogrel, guidelines now recommend these agents in priority over clopidogrel in current management of ACS. Cangrelor has revived the interest in injectable antiplatelet therapy too. Albeit the increased efficacy of these newer agents comes at the cost of increased bleeding and this becomes more of a concern when combined with aspirin. Which P2Y12i is superior over another has been intensely debated over last few years after the ISAR-REACT 5 study with inconclusive data. Three novel antiplatelet agents are already in the pipeline for ACS with all of them succeeding in phase II studies. The search for an ideal antiplatelet remains a need of the hour for optimal reduction of ischemic events in ACS. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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19 pages, 468 KiB

Open AccessReview

Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery

by Marco Alfonso Perrone, Alberto Aimo, Sergio Bernardini and Aldo Clerico

Int. J. Environ. Res. Public Health 2022, 19(9), 5182; https://doi.org/10.3390/ijerph19095182 - 24 Apr 2022

Cited by 5 | Viewed by 2027

Abstract

Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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8 pages, 2710 KiB

Open AccessCase Report

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

by Rocco Edoardo Stio, Marina Comisso, Luca Paolucci, Silvio Coletta, Vincenzo Cesario, Michele Gioia, Marco Stefano Nazzaro, Guglielmo Saitto, Carlo Contento, Emilio D’Avino, Francesco De Felice, Domenico Gabrielli and Francesco Musumeci

Int. J. Environ. Res. Public Health 2022, 19(10), 5976; https://doi.org/10.3390/ijerph19105976 - 14 May 2022

Viewed by 1646

Abstract

In patients with advanced heart failure (HF), left ventricular assist devices (LVADs) have demonstrated to be effective in improving the quality of life and reducing further hospitalizations. Although uncommon, LVAD outflow graft obstruction (OGO) is a potentially life-threatening complication and percutaneous treatment has been proposed as a standard intervention strategy in such cases. We report the case of a 69 year old man admitted due to LVAD failure causing unstable HF. Past medical history included percutaneous intervention on the outflow graft with stent implantation one year before. The patient was under chronic treatment with vitamin K antagonists (VKA). Emergent percutaneous angiography was performed, showing recurrent OGO due to thrombosis located at a kinking site, distally to the previously treated segment. Using distal anchoring technique, a balloon-expandable 10 × 79 mm endoprosthesis (GORE^® Viabahn^® VBX) was effectively positioned and post-dilated. Final angiography confirmed the patency of the stent implanted one-year before. Despite the procedure succeeding in restoring LVAD function, the patient died due to septic shock ten days after. Our case suggests that recurrent OGO can be effectively treated with percutaneous redo and that long-term stent patency can be achieved with a standard antithrombotic treatment, despite further thrombotic events in other segments of the graft are still possible (especially at the kinking site). Moreover, other noncardiac conditions as infective complications, can dramatically impact the clinical course and lead to unfavorable outcomes. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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6 pages, 1618 KiB

Open AccessCase Report

Management of Transcatheter Aortic Valve Implantation and Complex Aorta Anatomy: The Importance of Pre-Procedural Planning

by Alfredo Intorcia, Vittorio Ambrosini, Michele Capasso, Riccardo Granata, Fabio Magliulo, Giannignazio Luigi Carbone, Stefano Capobianco, Francesco Rotondi, Francesca Lanni, Fiore Manganelli and Emilio Di Lorenzo

Int. J. Environ. Res. Public Health 2022, 19(8), 4763; https://doi.org/10.3390/ijerph19084763 - 14 Apr 2022

Cited by 1 | Viewed by 1400

Abstract

Aortic stenosis is the most common primary valve lesion requiring surgery or, especially for older patients, transcatheter intervention (TAVI). We showcase a successful transfemoral TAVI procedure in a very high-risk patient and an extremely tortuous S-shaped descending aorta, characterized by heavy calcifications and multiple strong resistance points. We demonstrated that transfemoral TAVI using the “buddy stiff guidewire” technique could be a feasible, simple, quick, and easy procedure able to straighten an extremely abdominal aorta tortuosity. With all techniques available and careful pre-procedural planning, and thanks to the flexibility of new generation TAVI delivery systems, it is possible to safely perform the procedure even in the most challenging patients. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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6 pages, 1581 KiB

Open AccessCase Report

A Case of Successful Use of the “Anchoring Technique” for Percutaneous Treatment of Left Ventricular Assist Device Graft Occlusion

by Rocco Edoardo Stio, Andrea Montalto, Alfredo Intorcia, Vincenzo Polizzi, Mariano Feccia, Carmine Musto, Mauro Pennacchi, Luca Paolucci, Regina Stumpo, Emilio D’Avino, Francesco De Felice, Domenico Gabrielli and Francesco Musumeci

Int. J. Environ. Res. Public Health 2022, 19(4), 2441; https://doi.org/10.3390/ijerph19042441 - 20 Feb 2022

Cited by 2 | Viewed by 1549

Abstract

Left ventricular assist device (LVAD) obstruction can be a dramatic and life-threatening complication in patients with advanced heart failure (HF). Despite surgical redo is often required in these patients, it is associated with a high risk of periprocedural negative outcome. We report the case of a 68-year-old male with a thrombotic stenosis of the LVAD proximal outflow-graft. Following Heart Team debate, a percutaneous intervention was planned during veno-arterial Extra Corporeal Membrane Oxygenation (ECMO) assistance. To achieve the needed catheter support, we used the “distal balloon anchoring technique” through the outflow-graft and managed to implant a covered stent, rapidly restoring the flow through the LVAD. The patient was discharged without further complications. Our case shows that, in selected cases, percutaneous treatment of LVAD obstructions can be feasible, especially using advanced techniques derived from the experiences in coronary interventions and under ECMO assistance. More cases and prospective studies are mostly needed to explore long-term patency of the LVADs and clinical outcomes in these high-risk patients. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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10 pages, 4982 KiB

Open AccessCase Report

A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation

by Francesca Romana Prandi, Federica Illuminato, Chiara Galluccio, Marialucia Milite, Massimiliano Macrini, Alessio Di Landro, Gaetano Idone, Marcello Chiocchi, Francesco Paolo Sbordone, Domenico Sergi, Francesco Romeo and Francesco Barillà

Int. J. Environ. Res. Public Health 2022, 19(2), 791; https://doi.org/10.3390/ijerph19020791 - 11 Jan 2022

Cited by 1 | Viewed by 1668

Abstract

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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6 pages, 2367 KiB

Open AccessCase Report

Sudden Unexpected Death Caused by Cardiac Metastasization from Histiocytic Sarcoma

by Alessandro Feola, Paola Ciamarra, Mariavictoria De Simone, Anna Carfora, Gelsomina Mansueto and Carlo Pietro Campobasso

Int. J. Environ. Res. Public Health 2021, 18(24), 12911; https://doi.org/10.3390/ijerph182412911 - 07 Dec 2021

Cited by 1 | Viewed by 2306

Abstract

Background: Haematological malignancies, such as lymphoma and leukaemia, can have a variety of clinical manifestations. The most frequent cause of death from haematological malignancies is multiple organ failure due to neoplastic organ infiltration and/or septic shock. Histiocytic sarcoma (HS) is a rare malignant nodal or extranodal tumour with histiocytic immunophenotype that originates from a lymphohematopoietic precursor. The patients with HS usually have a poor prognosis due to its aggressive clinical behaviour. Rare cases of undiagnosed sudden HS death have been described in the literature. Methods: A forensic autopsy of a 46-year-old white male who died at home suddenly and unexpectedly without warning conditions or known diseases. Gross analysis, histology and toxicology were also performed. Results: The diagnosis of HS of the ileum with secondary nodal and cardiac metastatization was made. Conclusions: A prompt diagnosis of HS in life is paramount because it can make a difference in prognostic outcomes. Full article

(This article belongs to the Special Issue Myocardial Infarction: Prevention and Treatment)

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