Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.

Purpose The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (≥65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response. Methods This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) ≥15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling. Results The mean age was 62±11 years, with 36 elderly patients (41%). The baseline QRS duration was 145± 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (≥65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm 2 before CRT, but not comorbidities.Conclusion This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.

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BACKGROUND Simple and reproducible echocardiographic parameters are still the cornerstone of daily clinical practice. These data provides important information for the evaluation of patients with ST-segment elevation myocardial infarction (STEMI). The identification of prognostic echocardiographic parameters in STEMI would help in risk stratification. PURPOSE To evaluate the discriminatory capacity of echocardiographic parameters after a STEMI. METHODS Single centre retrospective observational study of 303 patients with STEMI who survived hospital stay and had a complete echocardiographic evaluation. The following ecocardiographic parameters were collected at discharge: left ventricular (LV) systolic and diastolic volumes; septal and posterior wall thickness; LV ejection fraction (LVEF); left atrial (LA) diameter; estimated systolic pulmonary artery pressure (SPAP). One year and long-term all cause mortality were analyzed. RESULTS For the patients enrolled (71% males, 64.6 ± 14.1 years old), peak troponin I was 99.1 ± 126.5 ng/mL; mean GRACE score was 153.6 ± 38.8 points and mean LVEF was 46.2 ± 11.2%. One year mortality was 8.3% and during a median 73 months follow-up, 25.1% patients were deceased. After adjustment for echocardiographic variables in a Cox regression model, SPAP (HR 1.07, 95%CI 1.02-1.12, P = 0.007) and septal thickness (HR 1.36, 95%CI 1.08-1.73, P = 0.01) were both independently associated with one year mortality. A Kaplan-Meier survival methodology using stratified SPAP and septal thickness showed a trend of different event rate (log rank P = 0.003 and P = 0.035, respectively), with a gradation of cumulative risk for all-cause mortality, with a sharp increase at &gt;40mmHg and &gt;11mm, respectively. Regarding longterm follow-up, only increased SPAP proved to be an independent predictor of mortality (HR 1.04, 95%CI 1.01-1.08, P = 0.016). The difference in favor of an SPAP &lt;33mmHg (sensitivity 86.67% and specificity 54.1%) was seen early after the STEMI event and maintained at each interim analysis (log rank P = 0.002). Upon the visual analysis of the cubic spline curves, patients with SPAP &lt; ± 30mmHg had a good long-term survival. No association of LV volumes or LVEF was noted for both one year and long-term mortality. CONCLUSION Classic echocardiographic parameters still have a role to estimate prognosis after STEMI. Estimated SPAP had the greatest discriminatory capabilities, surpassing left ventricular ejection fraction! Abstract 571 FIGURE 1

Background: Rifampicin has been employed in various endocarditis antibiotic regimens, particularly in prosthetic, staphylococcus aureus (SA) and culture-negative cases. However, this practice is not without controversy. Purpose: To perform a meta-analysis aimed at ascertaining the efficacy and safety of adjunctive rifampicin use in endocarditis. Methods: We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to June 1st, 2021, for studies comparing rifampicin-containing antibiotic regimens with those comprising no rifamycin derivatives, in the setting of endocarditis. The primary endpoint was all-cause death, while relapse, bail-out valvular surgery, microbiological failure (lasting positivity of blood cultures) and hepatotoxicity (fivefold or higher increase in transaminase levels) were secondary outcomes. SA infections were investigated separately, with respect to the primary endpoint. Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model. Results: 2 randomized, 1 non-randomized prospective and 6 retrospective studies, featuring 886 patients (of whom 322 allocated to rifampicin), were included. While 8 studies addressed staphylococcal endocarditis (with 3 of them dealing exclusively with SA infections), prosthetic and culture-negative cases were only focused on 1 study each. There were 96 deaths (from 7 studies), 32 relapses (from 6 studies), 35 bail-out valvular surgeries (from 4 studies), 14 microbiological failures (from 2 studies) and 32 hepatotoxicity cases (from 5 studies). Rifampicin use was associated with a tendency towards higher all-cause mortality (OR 1.63, 95% CI 0.85-3.12, P 0.14, i 2 12%), which held true for SA infections (OR 1.63, 95% CI 0.67-3.92, P 0.28, i 2 20%), and bail-out valve surgery (OR 2.03, 95% CI 0.65-6.34, P 0.22, i 2 5%). Relapse and microbiological failures rates were similar between groups (OR 1.25, 95% CI 0.59-2.65, P 0.56, i 2 0% and OR 1.3, 95% CI 0.24-6.90, P 0.76, i 2 41%, respectively). Hepatotoxicity odds were greater in the rifampicin arm (OR 3.24, 95% CI 1.35-7.77, P 0.008, i 2 0%). Conclusion: Currently available evidence does not support rifampicin use in endocarditis.

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Background: Revascularization is a crucial therapy in acute coronary syndromes (ACS). Purpose: to assess ACS patients outcomes, stratified according to the coronary angiography and/or angioplasty. Population and methods: 786 consecutive ACS patients submitted to an invasive strategy, divided in 3 groups: A (n=111) normal coronary angiogram; B (n=327) fully revascularized; C (n=348) incomplete revascularization. A 1-year follow up targeting major adverse cardiovascular events (MACE) was performed. Results: Group A had more females (38.7 vs 21.1 vs 24.4% p<0.01), patients were more admitted for unstable angina (37.3 vs 14.9 vs 17.9% p<0.01) and had a higher left ventricular ejection fraction (LVEF). Group B were more on previous statin therapy, had more often an admission for ST elevation acute myocardial infarction (17.3 vs 51.7 vs 42.4% p<0.001) and higher peak levels of cardiac biomarkers. Group C were older and had more frequently a previous history of coronary disease. Group C patients had a worse in-hospital mortality (1.8 vs 1.2 vs 7.5% p<0.01) and morbidity. The MACE free survival rate was significantly lower for group C (92.9% vs. 92.9% vs. 78.2%; log rank p<0.001). In a multivariate Cox regression analysis, incomplete revascularization remained an independent predictor of MACE at 1 year (HR 2.74, CI 1.50 – 4.94), in a model that included, age, gender, LVEF, diabetes, coronary anatomy, and admission diagnosis. Conclusion: Our data strongly support the use of an aggressive invasive strategy in ACS, aimed at achieving full revascularization, as these patients had the same medium term prognosis as those with normal coronary angiogram.