L'Istat, grazie alle sinergie attivate con il Ministero dell'Interno per l'acquisizione tempestiva dei dati ANPR è in grado di contribuire alla diffusione di informazioni utili alla comprensione della situazione legata all'emergenza sanitaria da COVID-19.L'utilizzo a fini statistici, e il relativo trattamento, delle informazioni che l'Istituto nazionale di statistica acquisisce dall'Anagrafe Nazionale della Popolazione Residente (ANPR), come previsto dal DPCM n.194/2014, permette di diffondere i dati relativi alla mortalità generale di una parte dei comuni subentrati nell'ANPR, che a oggi ammontano a 5.866, circa tre quarti del totale dei comuni italiani.

Objectives Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. Methods This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox’s regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. Results In the derivation cohort, the median age was 69 (IQR, 58–77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59–77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253–2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154–2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796–0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758–0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). Conclusion Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19. Key Points •Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. •Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. •The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.

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Background and aims Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients. Methods and results This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25 th to April 19 th , 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25 th -75 th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO 2 /FiO 2 was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO 2 /FiO 2 identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p<0.0001). Conclusion Increased EAT attenuation, a marker of EAT inflammation, but not obesity or EAT volume, predicts critical COVID-19. Trial registration NCT04318366.

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Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.

Aims:The aim of this study was to evaluate the impact of a horizontal aorta (HA) on device success and short-term clinical outcomes of transcatheter aortic valve implantation (TAVI). Methods and results:We retrospectively assessed 547 consecutive patients treated with transfemoral second-generation non-balloon-expandable (NBE) (n=447) and balloon-expandable (BE) (n=100) TAVI for symptomatic severe aortic stenosis. Aortic angulation (AA) was evaluated with preprocedural computed tomography. Patients were dichotomised according to a previously established AA cut-point: HA group (AA ≥48°, n=230) and normal aorta (NA) group (AA <48°, n=317). Endpoints were considered according to the Valve Academic Research Consortium-2 definitions. Fluoroscopy time (32.8±16.4 vs 30.3±13.9 minutes, p=0.060) and radiation dose (kerma area product 120.8±99.7 vs 103.7±81.1 Gy•cm 2 , p=0.033) were higher in the HA group as compared to the NA group. No difference in device success was observed between patients with and without an HA (88.3% vs 88.0%, p=0.929). No differences in device success and 30-day outcomes were observed when comparing HA and NA patients, according to BE and NBE prostheses. Conclusions:The presence of an HA has no impact on device success and short-term clinical outcomes of TAVI with either second-generation NBE or BE devices.

he coronary sinus (CS) Reducer (Neovasc, Inc, Richmond, BC, Canada) is a percutaneous device aiming at symptoms control in patients suffering from refractory angina. Its clinical effect 1 may be exerted through flow redistribution toward ischemic territories as a consequence of increased coronary drainage pressure resulting from CS narrowing. 2 Current imaging evidences are limited. 1,2 We evaluated the impact of the Reducer upon regional myocardial ischemia in patients with refractory angina using stress Cardiac Magnetic Resonance (stress-CMR). Consecutive patients with RA 1 and evidence of inducible ischemia involving at least 1 myocardial segment at stress-CMR were included. The study was approved by the institutional review committee, and all patients gave informed consent. Study database is available from the corresponding author on request. Stress-CMR was performed at baseline and 4 months after reducer implantation at 1.5T (Philips Ingenia, Best, The Netherlands). First-pass perfusion was performed using a saturation-recovery prepared balanced steady-state free precession for 3 short-axis slices within each cardiac cycle (45-dynamics). Stress was induced with dipyridamole (0.56-0.84 mg/kg in 4-6 minutes). Ischemic burden was defined as the percentage of LV wall involved by inducible perfusion defect (IPD). Visual inducible perfusion defect was scored according to AHA 16-segment model and transmurality (1=1%-25%; 2=25%-50%; 3=51%-75%; 4=>75%). Segmental myocardial perfusion reserve index (MPRI) was calculated (CVI42, Circle Cardiovascular Imaging, Inc, Canada) according to myocardial layers (subendocardial, mesocardial, subepicardial, and transmural). MPRI<1.3 defined severe ischemia. Patient-level comparisons were carried by paired Wilcoxon signed-rank test. Segment-level ΔMPRI data were analyzed using linear mixed-effects models with random intercept per patient. Two models were defined: to compare ΔMPRI between ischemic and nonischemic segments and among the 3 myocardial layers. Two patients were excluded for poor image quality at baseline CMR. Final population included 15 patients (93.3% males; age 66 [IQR, 58.5-74] years; ejection fraction 57% [55.0-62.5]; 3-vessel disease 86.7%; previous percutaneous (66.6%); and surgical (93.3%) coronary revascularization; Canadian Cardiovascular Society class 3 [3-3]; number of anti-ischemic drugs 3 [3-3]). Four months following reducer implantation, 13 (86.7%) patients improved by at least 1 Canadian Cardiovascular Society class (from 3 [3-3] to 1 [1-2]; P=0.001). At CMR, median per-patient ischemic burden reduced from 13.00% to 10.88% (P=0.0092) and the number of segments with inducible perfusion defect from 6 (2-9) to 5 (2-6; P=0.0138). The overall number of segments with inducible perfusion defect reduced from 92/240 (38%) to 69/240 (29%; P<0.001, by logistic mixed-effects model). Reducer implantation led to a significant increase in transmu