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Anthracycline chemotherapy remains a critical component of cancer treatment despite its established risk of cardiotoxicity. To investigate whether the AIDA protocol, which combines idarubicin, mitoxantrone, and all-trans retinoic acid (ATRA) for treatment of acute promyelocytic leukemia (APL) results in late cardiotoxicity, 34 APL patients in longterm remission were evaluated. The cumulative dose of idarubicin and mitoxantrone were 80 mg ⁄ m 2 and 50 mg ⁄ m 2

Subtle abnormalities of cardiac structure or function are often identified in patients with liver cirrhosis and have been termed cirrhotic cardiomyopathy. However, in the absence of a precise definition, its diagnosis remains a challenge. Cardiac dysfunction in patients with cirrhosis can often be attributed to concomitant diseases such as hypertension, ischaemic heart disease or excess alcohol consumption in many patients. Further research is required to identify the existence, origin and importance of abnormal cardiac function due specifically to liver disease. Cardiac dysfunction may be masked by treatments given to cirrhotic patients, such as mineral-corticoid receptor antagonists, or by co-existing conditions, such as anaemia. New imaging tests or plasma biomarkers might be able to detect abnormal cardiac function at an early stage of its development.

Congenitally corrected transposition of the great arteries (CCTGA) is a rare disease accounting for 0.5-1.4% of patients with congenital heart disease. In this congenital cardiopathy, the left atrium is connected to the right ventricle, from which the aorta stems. We present a case of an adult with CCTGA associated with aortic stenosis and bicuspid aortic valve-an association not yet described to our knowledge.

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Background High-risk (HR) Crohn’s Disease (CD) is associated with high surgical and progression rates. Therefore, recent ESPGHAN guidelines (GL) suggest starting an early anti-TNFα treatment to modify the natural history of the disease. The aim of our study was to evaluate the surgical rate in a population of HR-CD paediatric patients treated with up-front anti-TNFα agents and long-standing biologic therapy Methods This is a retrospective, observational, single-center study conducted at the Paediatric Gastroenterology, Hepatology, and Endoscopy Unit at Policlinico Umberto I Hospital – Sapienza University of Rome. We collected data from all patients diagnosed with CD under 18 years, with a minimum follow-up of 12 months. between June 2008 to July 2022. Patients were then stratified at the diagnosis into HR and LR, based on ESPGHAN GL criteria. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at 6, 12, 24, 36, 48, and 60 months Results 130 patients were enrolled, 76 HR (58%) and 54 LR (42%) [median age 12.5 (IQR) yrs, female 45 (35%), medium follow-up 54±24 months]. The HR group included 39 patients (51%) with panenteric disease, 15 (20%) with a structuring behavior (B2), 3 (4%) with structuring/penetrating disease (B2-B3), and 26 (34%) with perianal involvement (p). Early anti-TNFα agents were started in 80% of patients <6 months from the diagnosis, while 15 (20%) started biological therapy between 6 and 12 months from the diagnosis. All patients continued biologic therapy throughout the study follow-up: 20 (26%) optimized anti-TNF, 25% switched biologic, 11% added an immunomodulator, and 4% combined 2 biological drugs. The surgical rate at 5 years was 29% (n=22) and 29% n=16) in HR and LR groups respectively (p-value 1,0). Eleven % (n=8) of HR patients needed surgical resection, while perianal surgery (seton drainage, fistulotomy, fistulectomy) was performed in 18% (n=14), with no significant difference with LR group [(intestinal resection 18% (10/55), perianal surgery 11% (6/55), p > 0.05]. Perianal disease resulted positively associated with surgical risk (p 0.002, OR 5.62 CI 1.84-17.15) while small bowel imaging at the diagnosis was a protective factor for surgery (p 0.017, OR 0.23 CI 0.07-0.77). No significant difference was found in the interval free from surgery between HR and LR, although HR children mainly needed surgery in the first 12 months after the diagnosis. Conclusion Our data suggest that paediatric patients with HR-CD treated with early anti-TNF agents and long-standing biologic therapy have a similar disease course and surgical risk to those with LR disease. At a 5-year follow-up, one-third of patients needed surgery, mainly in the first year after the diagnosis

Introduction: CRT by biventricular PM appears to be an effective treatment in pts with severe and refractory HF. CRT improves symptoms and quality of life; reduces hospitalization rate and risk of death for CV or any other cause. The gravity of A-V, intra-ventricular and inter-ventricular dyssynchrony appears correlated to the response to CRT. However there is a proportion of 20-30% pts, who do not respond to CRT in some trials.Our survey's aim had been that to identify pts with dyssynchrony who had a very similar response to CRT. It has been used echo-standard and TDI to assess regional electromechanical activation pattern and to evaluate the regional delay in LV. Secondary end point has been that to determine the effects of CRT on clinical and Echo-parameters after 6 months. Methods: Pts have been selected by international guidelines. There had been chosen12 pts with an age between 43-75 years old. These pts have been undergone through many clinical and echocardiography assessment at baseline and 6 months further than CRT. Before CRT NYHA had been III in 8 pts and IV in 4 pts; EF < 30%; QRS duration ≥ 120 msec in 6 pts and < 120 msec in the others 6; LVEDD ≥ 55 mm. Has been evaluated IVMD and SPWMD, TDI-echo with parameters defined by Yu and by Bax. RESPONDERS to CRT are those pts who showed a 10% decrease in LVESV and an improvement in NYHA. Results: After 6 months a real evaluation has been possible for 11 pts one of them died precociously after CRT. Before CRT the mean value of LVEDV was 210 ml; the one of LVESV 159 ml; EF was 23%. 9/12 had a delay by Yu; 6/12 by BAx/3/12 by Pitzalis and 6/12 by IVMD. 11 Pts had been evaluated after 6 months. A heart had been transplanted to one of them some months later CRT due to a progress of disease. NYHA has been improved in 10 of our pts after CRT. No significant differences have been found in LVEDV and in LVEDD. There has been a remarkable decrease of mean value of LVESV (from 159 ml to 142 ml after CRT) and an increase of EF(from 23% to 30% after CRT) in all pts.Severity of MR decreased significantly (7/11).No one of the pts needed to be admitted into the hospital during the following 6 months. Conclusions:The results of this study suggest that parameter defined by YU appears the most effective to identify potential responders to CRT, even in pts with QRS duration < 120 msec.In fact CRT is able to assess intra-ventricular dyssynchrony and its extent. Although the number of our pts had been exiguous, benefits in short time have been discovered through the improvement of clinical and echo-parameters after CRT. 791The role of left ventricle isovolumic contraction and ejection phase parameters at rest and during stress echocardiography in predicting exercise tolerance in ischemic heart failure patients Background: The role of left ventricle (LV) isovolumic contraction parameters, including isovolumic acceleration, in determining exercise capacity is still unclear and under intense investigation. Aim: To assess LV isovolumic and ejection phase parameters, using tissue Dop...

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