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Statins represent a family of drugs that are potentially able to defend COVID-19 patients against uncontrolled systemic inflammatory response produced by the virus Sars-Cov-2. Therefore, some physicians proposed and used anti-inflammatory agents in the treatment regimen of patients with COVID-19 [1]. Statins are well known for their anti-inflammatory effects [2], and some hospitals included them in the COVID-19 treatment protocol [3]. In addition, studies in vitro verified that "there is evidence suggesting that statins exert anti-viral activity and may block the infectivity of enveloped viruses" [4]. In other words, statins could be efficient SARS-CoV-2 inhibitors of the main protease, a key coronavirus enzyme, which is a potential drug target [4]. Considering the above premises, we hypothesized that patients taking statins were better protected against mortality risk than those who do not take statins. We verified this hypothesis in a population of 71 consecutive patients with a pre-existing chronic cardiovascular disease, who become ill from COVID-19 between February 29, 2020, and May 20, 2020. The follow-up ended on June 15, 2020. The only endpoint of the study was all-cause mortality. Continuous variables were expressed as mean ± one SD or median (range) values; and categorical data as percentages. All dichotomous variables were compared utilizing the χ2 test; and continuous parameters using analysis of variance (ANOVA) or Mann-Whitney U test, as appropriate. Survival probabilities were estimated with the Kaplan-Meier method and survival curves plotted and compared between groups using the log-rank test. P < 0.05 was considered statistically significant.

Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.

Exercise might reduce blood pressure in mild essential hypertensive individuals, but it could raise left ventricular mass, counteracting the beneficial effects induced by a decrease in blood pressure. Seventeen (group 1) of 25 mild hypertensive patients, nonresponders to a 3-month low sodium diet (2 g/day), were admitted into a physical training program consisting of three weekly sessions of aerobics (20 minutes), bicycling at prefixed loads (20 minutes), and induced muscular relaxation (10 minutes). They were compared with 15 mild hypertensive patients (group 2), nonresponders to the low sodium diet who remained untrained. The follow-up lasted 15.7±5.8 months. There were significant blood pressure decreases in group 1 at rest (155 ±9. P hysical training has been used for the treatment of mild hypertensive patients with diverse results. Many authors 1 -2 have pointed out significant decreases in systolic and diastolic blood pressure (BP), whereas others have failed to demonstrate such beneficial effects. 3 We were able to get significant decreases in systolic and diastolic BP measured at rest and during exercise in a group of mild essential hypertensive patients who followed a physical training program (PTP) for at least 12 months. 4 It is known that trained people, mainly athletes, have cardiac enlargement. Endurance athletes develop cardiac dilation 5 -6 and hypertrophy, whereas "resistive" athletes such as lifters or throwers develop an inappropriate increase in left ventricular wall thickness. -8 This is not the case with hypertensive patients who followed a PTP From the Cardiology and Kinesiology Divisions, Policlinica Bancaria, Buenos Aires, Argentina.Address for correspondence: Hugo P. Baglivo, MD, Gaona 2197 (1416), Buenos Aires, Argentina. because the intensity of exercise is graded according to the individual physical capacity and BP levels; however, it is still possible that physical training can induce an increase in left ventricular mass (LVM), which could counteract the beneficial clinical effects produced by a BP decrease. This study was designed to investigate the effects of a moderate and prolonged PTP on LVM.Methods Twenty-five white mild essential hypertensive patients were placed on a low sodium diet (2 g/day) for 3 months; 17 of them had a persistent diastolic BP greater than 90 mm Hg. These patients (group 1), 12 men and five women, with a mean age of 50.8±7.9 years, were admitted into a PTP. They were compared with 15 untrained white mild essential hypertensive patients (group 2), 10 men and five women, with a mean age of 49.3±3.2 years, who were nonresponders to the same low sodium diet and who did not undergo any other treatment. All patients were subjected to routine examinations by guest on May 9, 2018 http://hyper.ahajournals.org/ Downloaded from

Lamin A/C gene mutations can be associated with cardiac diseases, usually referred to as ‘cardiolaminopathies’ characterized by arrhythmic disorders and/or left ventricular or biventricular dysfunction up to an overt picture of heart failure. The phenotypic cardiac manifestations of laminopathies are frequently mixed in complex clinical patterns and specifically may include bradyarrhythmias (sinus node disease or atrioventricular blocks), atrial arrhythmias (atrial fibrillation, atrial flutter, atrial standstill), ventricular tachyarrhythmias and heart failure of variable degrees of severity. Family history, physical examination, laboratory findings (specifically serum creatine phosphokinase values) and ECG findings are often important ‘red flags’ in diagnosing a ‘cardiolaminopathy’. Sudden arrhythmic death, thromboembolic events or stroke and severe heart failure requiring heart transplantation are the most dramatic complications of the evolution of cardiolaminopathies and appropriate risk stratification is clinically needed combined with clinical follow-up. Treatment with cardiac electrical implantable devices is indicated in case of bradyarrhythmias (implant of a device with pacemaker functions), risk of life-threatening ventricular tachyarrhythmias (implant of an ICD) or in case of heart failure with wide QRS interval (implant of a device for cardiac resynchronization). New technologies introduced in the last 5 years can help physicians to reduce device-related complications, thanks to the extension of device longevity and availability of leadless pacemakers or defibrillators, to be implanted in appropriately selected patients. An improved knowledge of the complex pathophysiological pathways involved in cardiolaminopathies and in the determinants of their progression to more severe forms will help to improve clinical management and to better target pharmacological and non-pharmacological treatments.

Red cell distribution width (RDW) has been shown to predict adverse outcomes in specific scenarios. We aimed to assess the association between RDW and all-cause death and a clinically relevant composite endpoint in a population with various clinical manifestations of cardiovascular diseases. We retrospectively analyzed 700 patients (median age 72.7 years [interquartile range, IQR, 62.6–80]) admitted to the Cardiology ward between January and November 2016. Patients were divided into tertiles according to baseline RDW values. After a median follow-up of 3.78 years (IQR 3.38–4.03), 153 (21.9%) patients died and 247 (35.3%) developed a composite endpoint (all-cause death, acute coronary syndromes, transient ischemic attack/stroke, and/or thromboembolic events). With multivariate Cox regression analysis, the highest RDW tertile was independently associated with an increased risk of all-cause death (adjusted hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.63–4.56) and of the composite endpoint (adjusted HR 2.23, 95% CI 1.53–3.24). RDW showed a good predictive ability for all-cause death (C-statistics: 0.741, 95% CI 0.694–0.788). In a real-world cohort of patients, we found that higher RDW values were independently associated with an increased risk of all-cause death and clinical adverse cardiovascular events thus proposing RDW as a prognostic marker in cardiovascular patients.

Background Femoropopliteal bypass occlusions are a significant issue in patients with critical limb ischemia and chronic total occlusion of the native superficial femoral artery, which challenges vascular surgeons and interventional radiologists. Performing a secondary femoropopliteal bypass is still considered the standard of care, although it is associated with a higher complication rate and lower patency rate in comparison with primary bypass. Over the past few years, angioplasty has been commonly used, with the development in endovascular technologies, to treat chronic total occlusions of the native superficial femoral artery, with a good technical success rate and clinical prognosis. The purpose of the study is to assess the outcome of endovascular recanalization of chronic total occlusions of the native superficial femoral artery, in patients unfit for surgery with critical limb ischemia after failed femoropopliteal bypass. Results A total of 54 patients were treated. 77.8 % of the conduits were PTFE grafts; the remainder were single-segment great saphenous veins. The most common clinical presentation was rest pain. Technical success was achieved in 51 (94.4 %) of 54 limbs. Angiographically, 77.8 % of the lesions were TASC II category D, while 22.2 % were TASC II category C. The average length of the native SFA lesions was 26.8 cm. Clinical success, with improved Rutherford classification staging, followed each case of technical success. The median follow-up value was 5.75 years (IQR, 1.5–7). By Kaplan-Meier survival analysis, primary patency rates were 61 % (± 0.07 SE) at 1 year and 46 % (± 0.07 SE) at 5 years. Secondary patency rates were 93 % (± 0.04 SE) at 1 year and 61 % (± 0.07 SE) at 5 years. Limb salvage rates were 94 % (± 0.03 SE) at 1 year and 88 % (± 0.05 SE) at 5 years. Conclusions The endovascular recanalization of chronic total occlusions (CTO) of the native superficial femoral artery (SFA) after a failed femoropopliteal bypass is a safe and effective therapeutic option in patients unfit for surgery with critical limb ischemia.

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