Amyloid beta is associated with carotid wall echolucency and atherosclerotic plaque composition.

Circulating amyloid-beta 1-40 (Αb40) has pro-atherogenic properties and could serve as a biomarker in atherosclerotic cardiovascular disease (ASCVD). However, the association of Ab40 levels with morphological characteristics reflecting atherosclerotic plaque echolucency and composition is not available. Carotid atherosclerosis was assessed in consecutively recruited individuals without ASCVD (n = 342) by ultrasonography. The primary endpoint was grey scale median (GSM) of intima-media complex (IMC) and plaques, analysed using dedicated software. Vascular markers were assessed at two time-points (median follow-up 35.5 months). In n = 56 patients undergoing carotid endarterectomy, histological plaque features were analysed. Plasma Αb40 levels were measured at baseline. Ab40 was associated with lower IMC GSM and plaque GSM and higher plaque area at baseline after multivariable adjustment. Increased Ab40 levels were also longitudinally associated with decreasing or persistently low IMC and plaque GSM after multivariable adjustment (p < 0.05). In the histological analysis, Ab40 levels were associated with lower incidence of calcified plaques and plaques without high-risk features. Ab40 levels are associated with ultrasonographic and histological markers of carotid wall composition both in the non-stenotic arterial wall and in severely stenotic plaques. These findings support experimental evidence linking Ab40 with plaque vulnerability, possibly mediating its established association with major adverse cardiovascular events.

Acute coronary occlusion following TAVI.

Transcatheter aortic valve implantation (TAVI) has nowadays replaced open heart surgery as an alternative therapeutic tool in selected patients. Thirty-five percent of patients with severe degenerative aortic valve stenosis (AS) remain untreated because of the existing comorbidities that increase their perioperative risk. TAVI is a relatively new technique that has "come to stay" in the everyday clinical practice considering, that is the only alternative to surgery and appears to have excellent long term results. Herein, we describe a vascular complication immediately after the implantation of the Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis, followed by ad hoc percutaneous coronary intervention.

Recurrent apical ballooning syndrome "The masquerading acute cardiac syndrome".

Left ventricle (LV) apical ballooning syndrome (ABS) is a recently established reversible cardiomyopathy (CM) that presents as acute coronary syndrome (ACS) with ST segment elevation and specific echocardiographic (Echo) findings in the absence of significant coronary artery disease. Synonyms of ABS include "stress-induced CM" and "Takotsubo CM", terms that describe primarily the pathophysiology and the Echo findings of the syndrome respectively. This syndrome is a rare entity, accounting for the 2.2% of the ST segment elevation ACS, while recurrence rates reach 10% four years after the initial episode [1]. Herein we describe the first case in the literature of an 83 year-old (yo), female patient who suffered two episodes of ABS, the first in 1999 when the syndrome was unknown and diagnosis was "ST segment elevation myocardial infraction (STEMI)'' and the other one eight years later in 2007.