Nitrogen dioxide pollution increases vulnerability to COVID-19 through altered immune function.

Previous ecological studies suggest the existence of possible interplays between the exposure to air pollutants and SARS-CoV-2 infection. Confirmations at individual level, however, are lacking. To explore the relationships between previous exposure to particulate matter < 10 µm (PM10) and nitrogen dioxide (NO2), the clinical outcome following hospital admittance, and lymphocyte subsets in COVID-19 patients with pneumonia. In 147 geocoded patients, we assessed the individual exposure to PM10 and NO2 in the 2 weeks before hospital admittance. We divided subjects according to the clinical outcome (i.e., discharge at home vs in-hospital death), and explored the lymphocyte-related immune function as an index possibly affecting individual vulnerability to the infection. As compared with discharged subjects, patients who underwent in-hospital death presented neutrophilia, lymphopenia, lower number of T CD45, CD3, CD4, CD16/56 + CD3 + , and B CD19 + cells, and higher previous exposure to NO2, but not PM10. Age and previous NO2 exposure were independent predictors for mortality. NO2 concentrations were also negatively related with the number of CD45, CD3, and CD4 cells. Previous NO2 exposure is a co-factor independently affecting the mortality risk in infected individuals, through negative immune effects. Lymphopenia and altered lymphocyte subsets might precede viral infection due to nonmodifiable (i.e., age) and external (i.e., air pollution) factors. Thus, decreasing the burden of air pollutants should be a valuable primary prevention measure to reduce individual susceptibility to SARS-CoV-2 infection and mortality.

[Efficacy and safety of ambulatory electric cardioversion of atrial fibrillation with monophasic and biphasic shock]. / Efficacia e sicurezza della cardioversione elettrica della fibrillazione atriale in regime di day-hospital con shock mono e bifasico.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of ambulatory external cardioversion (EC) by means of monophasic and biphasic shock in patients with persistent atrial fibrillation (AF). METHODS: One hundred and twenty-seven consecutive patients with AF were submitted to EC, preceded by short general anesthesia with propofol, after pretreatment with oral anticoagulants for at least 3 weeks and, if not contraindicated, with amiodarone. In 87 of these patients we used monophasic shock and in 40 patients we used biphasic shock. Our protocol provided for up to 3 shocks delivered at an energy level ranging between 200 and 360 J for monophasic and from 70 to 175 J for biphasic shock. The patients were discharged after 4 hours of ECG monitoring and following a determination of serum CK-MB at the fourth hour. RESULTS: The mean age of the patients submitted to EC with monophasic and biphasic shock (65 +/- 9 vs 67 +/- 7 years) and the duration of AF (34 +/- 22 vs 32 +/- 25 days) were similar. The efficacy of EC with monophasic shock was 85% and the mean energy delivered was 266 +/- 81.5 J. The efficacy of the EC with biphasic shock was 98% and the mean energy delivered was 127 +/- 40 J. The difference between the percentage of efficacy and the number of joules delivered was statistically significant (p < 0.05). The mean value of the CK-MB after 4 hours following delivery of the shock was not significantly different: 2.5 ng/ml for monophasic vs 1.7 ng/ml for biphasic shock (p = NS). CONCLUSIONS: In our patients, ambulatory EC of persistent AF is safe and feasible; biphasic shock is more efficacious and requires less energy with respect to monophasic shock.

T wave normalization in infarct-related electrocardiographic leads during exercise testing for detection of residual viability: comparison with positron emission tomography.

OBJECTIVES: We investigated the sensitivity and specificity of exercise-induced T wave normalization (TWN) in infarct-related electrocardiographic leads (IRLs) for detection of residual viability in the infarct area. BACKGROUND: The meaning of exercise-induced TWN on IRLs is not yet well understood. Recent reports suggest that TWN during dobutamine echocardiography could indicate the presence of viable myocardium. METHODS: We evaluated 40 consecutive patients with a recent acute myocardial infarction and negative T waves in at least two IRLs. All patients underwent exercise testing; positron emission tomography (PET) with nitrogen-13 ammonia and fluorine-18 fluorodeoxyglucose; and coronary angiography. RESULTS: Twenty-four patients showed exercise-induced TWN: 18 at a work load < or =50 W (group la) and 6 at a work load > or =75 W (group 1b); 16 patients did not show TWN (group 2). On the PET study, viability in the infarct area was present in 17 patients (94%) from group la, in only 1 (16%) from group 1b and in 4 (25%) from group 2 (p < 0.0001). The sensitivity, specificity and diagnostic accuracy of exercise-induced TWN, in comparison with residual viability, were, respectively, 82%, 67%, 75% for TWN at every work load and 77%, 94%, 85% for TWN at a work load < or =50 W. Moreover, the sensitivity and diagnostic accuracy of TWN at the low work load were higher for anterior infarctions (87% and 88%, respectively). CONCLUSIONS: Exercise-induced TWN on IRLs at low work loads is a sensitive and specific index for the presence of residual viability in the infarct area. Sensitivity and diagnostic accuracy of this sign are higher for anterior infarctions.

[Dobutamine echocardiography and positron emission tomography in the assessment of viable myocardium after a thrombolized acute myocardial infarction. Comparison with spontaneous recovery]. / Test ecodobutamina e tomografia and emissione di positroni nella identificazione del miocardio vitale dopo un infarto miocardico acuto trombolisato. Confronto con la ripresa funzionale spontanea.

BACKGROUND: Aim of the present study was to compare the ability of low-dose (5-10 gamma/Kg/min) dobutamine echocardiography (DE) and of positron emission tomography (PET), performed after a thrombolized acute myocardial infarction (AMI), to predict the spontaneous functional recovery (SFR) of viable but akinetic myocardial segments. PATIENTS AND METHODS: Twenty-one pts were studied by DE, 10 +/- 2 days (DE1) and 31 +/- 2 days (DE2), after a thrombolized AMI, and by PET (18F-FDS, glucose load) within 7 days after DE2; a basal echo was also performed 3 months after AMI. The left ventricle was divided in 16 segments, both in echo and PET examination. DE viability was defined as improvement in wall motion of akinetic seg; PET viability was defined as an FDG uptake > or = 40% of the maximum. RESULTS: In the 89 akinetic segments, DE1, DE2 and PET, respectively, identified, 16, 27 and 60 viable segments; the concordance with PET, in viable and not viable segments, resulted of 50% for DE1 and of 62% for DE2. After 3 months 29/89 segments had a SFR. In comparison with SFR the sensitivity of DE1 and DE2 was lower (51% and 68%) than PET (89%); the specificity was higher for DE1 and DE2 (98% and 96%) respect to PET (43%). CONCLUSIONS: In comparison with DE performed 10 days after a thrombolized AMI, DE performed 30 days after AMI revealed a greater extension of viable myocardium and a greater diagnostic accuracy in predicting SFR of akinetic segments. The concordance between DE and PET is high, if all myocardial segments are considered, and lower, if only akinetic segments are considered; in fact, PET identifies, as viable, a greater number of segments. In comparison with SRF, DE revealed the greatest specificity and PET the greatest sensitivity.

[Traumatic rupture of the chordae tendineae in acute tricuspid insufficiency. Early detection with transesophageal echocardiography]. / Rottura traumatica di corde tendinee con insufficienza tricuspidale acuta. Diagnosi precoce con ecocardiografia transesofagea.

An uncommon case of traumatic rupture of chordae tendineae with tricuspid regurgitation is described. The early diagnosis, in a patient with polydistrectual injuries, was done by transesophageal echocardiography. This technique allowed accurate diagnosis of the type of lesion suggesting the opportunity to perform an echocardiogram, possibly transesophageal, in all patients with blunt thoracic trauma, even in the absence or with subtle clinical manifestations of cardiovascular involvement.

[Endocarditis at risk of embolism. An indication for prophylactic surgical treatment?]. / Endocardite a rischio embolico. Indicazione al trattamento chirurgico profilattico?

Two cases of embolic infective endocarditis on bicuspid aortic valve are described. The trans-thoracic and trans-esophageal echocardiographic aspect could leave easily suppose the possibility of embolism. The prophylactic surgical treatment, during the active phase, also if the indication is debated, could have probably avoided the serious consequences of embolism.

[Left cor triatriatum in a man over 60]. / Cuore triatriato sinistro in uomo ultrasessantenne.

A case of cor triatriatum in a 66-year-old man is reported. The patient died of pneumonia; ante mortem diagnosis was made with both transthoracic and transesophageal echocardiography. Autopsy finding showed a very good correlation between anatomical and echocardiographic abnormalities. Cor triatriatum is amenable to surgical correction and echocardiography is extremely helpful in the diagnosis.

[Long-term evaluation of a new single lead VDD pacemaker]. / Valutazione a lungo termine di un nuovo pacemaker VDD monocatetere.

Since June 1988 we have implanted 36 VDD pacemakers with single lead catheter which has floating differential sensing (Phymos). The patients were affected by 2nd and 3rd degree AV block with normal sinus node function. The reliability of the pacing system was assessed acutely and after 1 and 3 months and then every six months with ECG, Holter 24 hours monitoring, exercise stress test and nifedipine test. Two patients died during the follow-up period and two had atrial fibrillation. In the remaining patients an AV synchronization between 95 and 100% was demonstrated.

[Hemopericardium caused by cardiac perforation during anticoagulation therapy. Description of 2 cases]. / Emopericardio da perforazione cardiaca in corso di terapia anticoagulante. Descrizione di due casi.

We describe two cases of cardiac tamponade following a right ventricular wall perforation, due to temporary stimulating catheter, during acute myocardial infarction. The pericardial effusion, which occurred after the catheter remotion, could have been favoured by the anticoagulant treatment.

[Anomalous muscle band of the left heart ventricle and negative anterior T wave in young men]. / Banda muscolare anomala del ventricolo sinistro e T negative in sede anteriore nel giovane.

Two cases of left ventricular bands, detected by two-dimensional echocardiography, in two young men are described. In both cases anterior negative T waves were present. Therefore, the possible presence of these structures should always be investigated, by two-dimensional echocardiography, when anterior negative T waves are present in normal young people.

[Post-infarction rupture of the interventricular septum. A report on 2 cases studied by color-coded Doppler]. / Rottura post-infartuale del setto interventricolare. Descrizione di due casi studiati con Doppler a codice di colori.

Rupture of interventricular septum is an infrequent but serious complication of acute myocardial infarction. We report the cases of two patients admitted to our department for acute myocardial infarction whose clinical course was complicated by rupture of the interventricular septum. They died from cardiogenic shock on the 13th and 6th days. Two dimensional and color coded echocardiography correctly detected the presence and the site of the rupture.

[Micro-Ebstein. Presentation of 3 cases and analysis of the literature]. / Micro-Ebstein. Presentazione di tre casi e analisi della letteratura.

The authors describe three cases of micro-Ebstein diagnosed using 2D-echocardiography in patients affected by extrasystolic cardiopalm. The most important echocardiographic criterion for diagnosis was an apical displacement of the septal cusp of the tricuspid valve of at least 8 mm/m2 BA. It is generally reported that the severity of arrhythmias is independent of the degree of tricuspid malformation. The anatomical substrates of arrhythmias are persistent anomalous muscular by-passes between the atrium and the ventricles, and intrinsic anomaly of the right ventricular myocardium. For these reasons, it is necessary to follow-up patients and monitor arrhythmias using Holter-ECG. Echocardiography is now recognised as being the most important tool for the identification of this anomaly.

[Aneurysm of the thoracic aorta as a cause of heart failure. Description of a case]. / Aneurisma dell'aorta toracica come causa di scompenso cardiaco. Descrizione di un caso.

The Authors describe the case of a 81 year old patient admitted to their department for cardiac failure. The patient was submitted to chest x-ray, bidimensional and Doppler echocardiography and computerized tomography. These exams identified the presence of an enormous aneurysm of thoracic and abdominal aorta. Intraluminal thrombus was present. The aneurysm compressed the left atrium and obstructed diastolic filling of left ventricle. Because of the poor conditions of the patient, surgery was not taken in account.

[Cardiac angioma. A case report and review of the literature]. / Angioma cardiaco. Presentazione di un caso e revisione della letteratura.

We report the case of a 4-year old child who underwent echocardiographic examination which revealed a multicystic tumor mass involving the infero-lateral wall of the left ventricle. It was necessary to perform a biopsy to make a reliable diagnosis. Histological studies indicated haemangiomatous and fibrous tissue of benign origin. The extensive involvement of the left ventricular free wall did not favour resection so we advised periodic clinical examination and Holter ECG to highlight any eventual occurrence of hypo or hyperkinetic arrhythmias.

[Aortic valve stenosis: current physiopathological and therapeutic aspects]. / Stenosi valvolare aortica. Aspetti fisiopatologici e terapeutici attuali.

On the premise that the increased average life expectancy and a reduced incidence of rheumatic diseases have changed the epidemiological profile of valvulopathies, the paper analyses the causes, pathological anatomy, physiopathology and therapy of aortic valvular stenosis. First of all, the differences of acquired calcific stenosis, in which the orifice may be "forced" by the ventricular pump leading to a late onset of symptoms, are underlined. Clinical symptomatology must include angina, syncope or decompensation, rather than merely and elevated gradient, before surgical therapy is proposed. In addition to traditional therapeutic methods (valvular replacement) there is now the possibility of using balloon valvuloplasty which has provided good results in terms of increased valvular area and recovery of ventricular function; however, this is only a palliative step in cases where major surgery is contra-indicated.

[Bacterial endocarditis in pregnancy. Description of 2 cases and review of the literature]. / Endocardite batterica in gravidanza. Descrizione di due casi e revisione della letteratura.

Bacterial endocarditis in pregnancy is uncommon. We described two cases: the first case of endocarditis, caused by staphylococcus epidermidis (at the 35th week of pregnancy) was complicated by severe aortic valvular insufficiency; the second case, endocarditis caused by streptococcus alpha hemolytic (at the 32nd week of pregnancy) was complicated by severe mitral valvular insufficiency associated with multiple systemic emboli. Therapy consisted, in the first case of partum-induction followed by antibiotic therapy; in the second case it consisted of specific antibiotic therapy followed by gestation. There was no maternal or fetal mortality in the two cases.

[Efficacy of diltiazem in blood pressure increase caused by exertion]. / Efficacia del diltiazem sull'incremento pressorio da sforzo.

After examining the properties of the 3 most widely used calcium antagonists, the paper assesses the efficacy of Diltiazem in reducing blood pressure rises after exercise in a group of 7 patients with chronic atrial fibrillation. The blood pressure response to a standard load (50 W x 3 m2) on the exercise cycle was monitored in a group of patients under chronic digitalis treatment (phase I) after which the same patients' response to varying doses of Diltiazem (180-240 mg/day) was assessed (phase II) and finally (phase III) their response to treatment with Diltiazem alone but no digitalis. A significantly greater reduction in the systolic pressure and heart rate after exercise was noted in patients given Diltiazem with or without Digoxin than in those given digitalis alone. It is therefore concluded that Diltiazem may be useful in controlled blood pressure and heart rate increases after exercise, especially in patients with ischaemic heart disease.

[Cardiac rhabdomyoma in a newborn infant with tuberous sclerosis. Value of 2-dimensional and Doppler echocardiography]. / Rabdomioma cardiaco in neonato con sclerosi tuberosa. Ruolo dell'ecocardiografia bidimensionale e Doppler.

Cardiac rhabdomyomas are the most frequent primary cardiac tumors in infancy and childhood and in about 50% of cases are associated with tuberous sclerosis. They are often responsible for a high mortality rate because of their critical location and extent of involvement. This report describes a patient with tuberous sclerosis and multiple cardiac rhabdomyomas, both intramyocardial and intracavitary--diagnosed by two dimensional and Doppler echocardiography at birth. The infant was followed till nine months of age. To date, the tumors have not increased their size and don't provoke moderate or severe obstruction of blood flow. The child is, at present, free from cardiac signs and symptoms, and does not take digitalis or diuretics. We have not detected any arrhythmias. Two-dimensional and Doppler echocardiography are very useful non-invasive techniques in the diagnosis and longitudinal follow-up of patients with cardiac rhabdomyomas.