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BACKGROUND:Patients with congestive heart failure or COPD may share an increased response in minute ventilation (V E ) to carbon dioxide output (V CO 2 ) during exercise. The goal of this study was to ascertain whether the V E /V CO 2 slope and V E /V CO 2 intercept can discriminate between subjects with congestive heart failure and those with COPD at equal peak oxygen uptake (V O 2 ). METHODS: We studied 46 subjects with congestive heart failure (mean age 61 ؎ 9 y) and 46 subjects with COPD (mean age 64 ؎ 8 y) who performed a cardiopulmonary exercise test. RESULTS: The V E /V CO 2 slope was significantly higher in subjects with congestive heart failure compared with those with COPD (39.5 ؎ 9.5 vs 31.8 ؎ 7.4, P < .01) at peak V O 2 < 16 mL/kg/min, but not > 16 mL/kg/min (28.3 ؎ 5.3 vs 28.9 ؎ 6.6). The V E /V CO 2 intercept was significantly higher in both subgroups of subjects with COPD compared with the corresponding values in the subjects with congestive heart failure (3.60 ؎ 1.7 vs ؊0.16 ؎ 1.7 L/min, P < .01; 3.63 ؎ 2.7 vs 0.87 ؎ 1.5 L/min, P < .01). According to receiver operating characteristic curve analysis, when all subjects with peak V O 2 < 16 mL/kg/min were considered, subjects with COPD had a higher likelihood to have the V E /V CO 2 intercept > 2.14 L/min (0.92 sensitivity, 0.96 specificity). Regardless of peak V O 2 , the end-tidal pressure of CO 2 (P ETCO 2 ) at peak exercise was not different in subjects with congestive heart failure (P ‫؍‬ .42) and was significantly higher in subjects with COPD (P < .01) compared with the corresponding unloaded P ETCO 2 . CONCLUSIONS: The ventilatory response to V CO 2 during exercise was significantly different between subjects with congestive heart failure and those with COPD in terms of the V E /V CO 2 slope with moderate-to-severe reduction in exercise capacity and in terms of the V E /V CO 2 intercept regardless of exercise capacity.

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The recent outbreak of 2019 severe acute respiratory syndrome coronavirus-2 is having major repercussions on healthcare services provision in Italy and worldwide. Data suggest the virus has a strong impact on the cardiovascular system, and cardiac imaging will play an important role in patients affected by coronavirus disease-2019. Although paediatric patients are mildly affected, they represent a clear accelerator in spreading the virus, and healthcare workers are at higher risk of infection. The aim of this position paper is to provide clinical recommendation regarding the execution of imaging investigations for the cardiac diagnostic work-up of paediatric patients with suspected or confirmed infection.

The Anderson-Fabry disease (AFD, or simply Fabry Disease, FD; MIM #301500) is a rare X-linked lysosomal storage disorder (Xq22.1) characterized by progressive renal failure, leading to morbidity through cardio- and cerebro-vascular involvement. Despite the classic phenotype, only cardiac involvement (cardiac variant of AFD; MIM 301500) is frequent in about 40% of male and 28% of female AFD patients, as reported by the Fabry Registry (https://www.registrynxt.com). Morphologically, the cardiac characteristic of the disease, occurs as left ventricular hypertrophy, is accompanied by myocardial fibrosis. Cardiologists may come across these patients during clinical and instrumental evaluation in individuals with non-specific symptoms such as chest pain and arrhythmias, or after instrumental evidence of left ventricular hypertrophy/hypertrophic cardiomyopathy (HCM; MIM 192600). A comprehensive cardiological work-up, including a cardiological visit, a baseline electrocardiogram (ECG) and imaging by both echocardiography (ECHO) and magnetic resonance (MRI) enables identification of the cardiac involvement in patients with a proven diagnosis of AFD. The heart involvement is present in up to 75% of AFD patients irrespective of their sex. Involvement includes ECG and echocardiography features which suggest AFD and not HCM. Cardiac imaging plays an important role in detecting this sub-type of cardiomyopathy, which, since 2001, has benefited from the introduction of the enzyme replacement therapy (ERT) in symptomatic and pre-symptomatic patients.