In this study we found a significant prevalence of exercise-induced HTN in adult patients after successful AC repair despite adequate BP control at rest. Exercise-induced HTN was significantly related to higher peak gradient in the descending aorta and treatment with ACEI. These results highlight the complexity of the adult AC population and show that, even after a good surgical result, several patients remain at high cardiovascular risk and require long-term follow-up.

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Aims. Optimal outcome after cardiogenic shock (CS) depends on a coordinated healing response in which both debris removal and repair of the tissue extracellular matrix play a crucial role. Excessive inflammation can perpetuate a vicious circle, positioning leucocytes as central protagonists and potential therapeutic targets. High levels of circulating Triggering Receptor Expressed on Myeloid cells-1 (TREM-1), were associated with death in acute myocardial infarction confirming excessive inflammation as determinant of bad outcome.The present study aims to describe the association of soluble TREM-1 with 90-day mortality and with various organ injuries in patients with CS. Methods and results. This is a post-hoc study of CardShock, a prospective, multicenter study assessing the clinical presentation and management in patients with CS. At the time of this study, 87 patients had available plasma samples at either baseline, and/or 48 hours and/or 96-120 hours for soluble TREM-1 (sTREM-1) measurements. Plasma concentration of sTREM-1 was higher in 90-day non-survivors than survivors at baseline (median: 1392 IQR: (724 -2128) vs. 621 (525 -1233) pg/mL, p = 0.008), 48 hours (p=0.019) and 96-120 hours (p=0.029). The highest tertile of sTREM-1 at baseline (threshold: 1347 pg/mL) was associated with 90-day mortality with an unadjusted HR: 3.08 CI95% (1.48 -6.42). sTREM-1 at baseline was not associated to hemodynamic parameters (heart rate, blood pressure, use of vasopressors or inotropes) but rather with markers of organ injuries: renal (estimated glomerular filtration rate, p=0.0002), endothelial (bio-adrenomedullin, p=0.018), myocardial (Suppression of Tumourigenicity 2, p=0.002) or hepatic (bilirubin, p=0.008). Conclusion.In CS patients TREM-1 pathway is highly activated and gives an early prediction of injuries of vital organ and outcome.

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Right ventricular infarction is uncommon in isolation but can be observed in 50% of cases of inferior wall myocardial infarction. Diagnosis is difficult and suspicion of this condition should always be borne in mind. Progression to cardiogenic shock is not uncommon, when the outcome is similar to left ventricular infarction; mortality can reach 60%. We present the case of a 64-year-old woman with known coronary disease who was admitted to our coronary care unit after an anterior myocardial infarction. Cardiac catheterization showed diffuse stenosis of the left descending and 70% stenosis of the posterior descending arteries. She was surgically revascularized with a favorable evolution, but was later readmitted for acute decompensated heart failure with cardiogenic shock. She was refractory to medical therapy, with biventricular dysfunction on echocardiographic examination. Cardiac magnetic resonance imaging confirmed the diagnosis of right ventricular infarction.

One of the greatest challenges in medicine consists of arriving at a correct diagnosis despite different presentations of the disease. We present a case in which, notwithstanding the initial diagnosis, the search for the etiology was essential for clinical guidance. Left ventricular non-compaction (LVNC) was first described by Chin et al. in 1990. This relatively new entity is characterized by excessive thickening of the myocardial wall, formed of a thin epicardial layer and a substantially thicker non-compacted endocardial layer. The clinical presentation is highly variable but it must always be borne in mind that heart failure, atrial and ventricular arrhythmias and embolic events are common complications of LVNC.

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