Mitral valve prolapse with ventricular arrhythmias: does it carries a worse prognosis?

The association of mitral valve prolapse (MVP) with ventricular arrhythmias has long been known and has generally been considered a benign condition. In recent years, however, a small but not negligible risk of malignant ventricular arrhythmias and sudden cardiac death has been documented in the large population of subjects with MVP. The main predictors of major arrhythmic risk identified so far include history of syncope, ventricular repolarization abnormalities in the inferior-lateral electrocardiogram leads, right bundle branch block morphology of ventricular ectopic beats, finding of areas of myocardial fibrosis on cardiac magnetic resonance, and mitral annular disjunction (MAD) on echocardiogram, as well as a possible pro-arrhythmic genetic substrate. The stratification of arrhythmic risk, with the active search for red flags and in particular of MAD, is important to identify patients with the malignant arrhythmic variant of MVP in whom to implement closer surveillance and possible therapeutic interventions.

[Influenza infection and risk of myocardial infarction: the protective effect of influenza vaccination. One more reason to vaccinate]. / Influenza e rischio di infarto miocardico acuto: ruolo protettivo della vaccinazione anti-influenzale. Un motivo in più per vaccinare.

Influenza infection, although considered a relatively benign pathology, is associated with a high number of hospital admissions and significant mortality, especially for the most vulnerable subjects. There is a great deal of evidence regarding the existence of an association between influenza and occurrence of cardiovascular events. Influenza vaccination by reducing the transmission of infection aims to reduce its complications, including cardiovascular events. The available studies have confirmed the safety of influenza vaccination in patients at high cardiovascular risk, even if performed during acute coronary syndrome hospitalization, and its efficacy in reducing coronary events. The cardiac benefit of influenza vaccination has been acknowledged by the cardiological scientific societies in the drafting of guidelines for both stable coronary artery disease and heart failure.

Severe low-gradient aortic stenosis, with preserved ventricular function: should it be treated?

Exists a group of patients with small AVA (<0,6 cm/m), and normal LVEF (≥50%) who display a low transvalvular flow (LF) [index stroke volume (SVi)<35 ml/m2] and/or low transvalvular gradient (LG). This condition is called severe paradoxical aortic stenosis (SAO) LFLG. In many studies this condition was associated to increased mortality both with medical therapy and with surgical intervention. Crucial is define correctly the diagnostical criteria of this condition. Indeed there are several specific anatomical and functional characteristics useful in differentiating paradoxical severe aortic stenosis from the other forms of aortic stenosis. In case of doubt in the diagnostical process, the Multidetector Computed Tomography (MDCT) could be useful in quantifying calcificazions of the aortic valve. The guidelines European Society of Cardiology (ESC) and American College of Cardiology (ACC) recomended aortic valve replacement for symptomatic patients with paradoxical LFLG severe aortic stenosis, recommending to accurately measure the flow in these patients as to differentiate them from those with NFLG and better prognosis.