Abstract Background and Aims Currently, computed tomography cardiac imaging (CTCI) plays a fundamental role in the pre–procedural planning of degenerative–calcific aortic valve stenosis(AS) correction. However, its prognostic role in assessing mortality and major adverse cardiovascular events (MACE) has not been extensively explored. CTCI allows for the evaluation of coronary artery calcification(CAC), mitral annular calcifications (MAC), aortic valve calcifications (CVA), and thoracic aorta calcifications (CAT). The aim of our study was to assess whether the presence and extent of CAC, MAC, CVA, and CAT could influence non–cardiovascular mortality (NCM), cardiovascular mortality (CM), and MACE in patients undergoing valve replacement(VR). Materials and Methods We collected retrospectivelly clinical and instrumental data and reviewed CTCI using a semi–quantitative approach. CACs were classified according to the visual 2022 Coronary Artery Disease–Reporting and Data System. MACs were defined following the Guerrero et al. study, CVAs according to the Win Registry and CATs were assessed in the ascending aorta, aortic arch, and descending aorta according to the Vos classification. Results 244 patients(59% male, mean age 80.1±6.6 years), with 91% undergoing transfemoral VR, were enrolled(2016–2018). CM was significantly higher in patients with hypertension,cerebro/peripheral vascular disease, stage IV–V renal insufficiency and history of atrial fibrillation (p=0.012,p<0.001,p=0.005, p=0.034 and p=0.024, respectively). CM was also more pronounced in patients with STS SCORE≥6.7±5.2 and EuroSCOREII≥ 5.5±5.8(p=0.016 and p=0.037). Extensive CAC(p=0.019), a MAC score>7(p=0.051), moderate and severe AVC (p=0.029 and p=0.053) and TAC>270° in aortic arch(p=0.019) were linked to CM. In multivariate analysis, a high MAC score and the presence of moderate AVC persisted as risk factors for CM. The presence of a MAC score >7(p=0.006) and the extension of descending TAC >1.5 mm (p=0.034) were associated with an increased risk of NCM.The presence of extensive TAC (≥270°) measured in the aortic arch and descending aorta were associated with MACE (p=0.034 and p=0.0504 respectively). Conclusions CTCI emerges as a crucial tool for evaluating prognostic risk in patients undergoing VR for AS. This type of evaluation can assist clinicians in pre–procedural planning and patient management, allowing for better identification of high–risk patients and optimization of therapeutic strategies

Abstract Background Coronary atherosclerotic disease (CAD) is the leading cause of sudden cardiac death among master athletes (≥35 years). During pre-participation screening (PPS), the primary indication for investigating CAD in these population is ST-segment depression (STD) at exercise test (ET). Additionally, a developing indication involves the identification of high-risk premature ventricular beats (PVBs). Nevertheless, the prevalence of CAD among master athletes displaying PVBs remains uncertain. Objective The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to STD during ET (traditional indication). Methods We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT because of a positive ET during PPS, for PVBs or STD. The entity of the disease was assessed using the CAD-RADs scoring system. Results The population resulted to be composed by 130 Caucasian athletes, median age 54 (46.5-60.5 years, 84% male), 74% practiced endurance sports. Eighty-two (63%) of them underwent CCT for STD and 48 (37%) for high-risk PVBs. A CAD-RADs of 0 was detected in 64.3% of athletes, 1-2 in 22.2%, 3 in 6.3%, and 4A-4B in 7.1%. A significant CAD was found in 10.4% of athletes investigated for PVBs at ET, and 14.6% in subjects with STD (p=0.5). Among athletes with moderate-severe CAD, 82.4% had one or more cardiovascular risk factors, while 17.6% had no risk factors (Figure 1). Conclusions The prevalence of CAD in master athletes is equivalent in case of PVBs and STD. The severity of CAD increases with an increasing number of cardiovascular risk factors. Therefore, in these cases the number of risk factors is an important variable to consider in the prescription of CCT.Figure 1

Introduction: Coronary Computed Tomography Angiography (CCTA) represents a promising non-invasive alternative for evaluating Coronary Allograft Vasculopathy (CAV) in patients undergoing orthotopic heart transplantation (OHT), offering clinical and economic advantages over traditional invasive techniques.

The leading cause of sudden cardiac death in master athletes (≥35 years) is coronary atherosclerotic disease (CAD). During pre-participation screening (PPS), the primary indication for investigating CAD in this population is ST-segment depression at exercise test (ET); a second most debated indication is represented by high-risk premature ventricular beats (PVBs), which are considered another potential marker of ischemic heart disease. However, the prevalence of coronary artery disease in master athletes with PVBs is still unknown. The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to ST segment depression during ET (traditional indication). We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT due to non-common PVBs during PPS. We compared them with a control group of athletes with ST-segment depression during PPS. The entity of the disease was assessed using the CAD-RADs scoring system (0= no plaque, 1=minimal stenosis 1-24%, 2=mild stenosis 25-49%, 3= moderate stenosis 50-69%, 4A= severe stenosis 70-99%, 4B= severe stenosis 70-99% left main stem >50% or 3 vessels ≥70%, 5= total occlusion). The population resulted to be composed by 70 Caucasian athletes, median age 53 (44-59 years, 88% male), 73% practiced endurance sports. Thirty-five of them underwent CCT for ST-segment depression and 35 for high-risk PVBs. A CAD-RADs of 0 was detected in 63% of athletes, 1-2 in 25.6%, 3 in 5.7%, and 4A-4B in 5.7%. A CAD was found in 37% of athletes investigated for PVB at ET and the same prevalence was found among subjects with ST-depression (p=0.8). Between athletes with moderate-severe CAD, 75% had one or more cardiovascular risk factors, while 25% had no risk factors. The prevalence of CAD in master athletes resulted to be equivalent in case of PVBs and ST-segment depression and, in the majority of cases, was a mild disease. Despite a coronary artery stenosis >50% was detected just on 12% of athletes who underwent CCT for these indications, however in both groups (PVB and ST-segment depression) the severity of CAD increased with the rise of cardiovascular risk factors. Therefore, the systematic execution of CCT among master athletes with non-common PVBs does not seem justified, but the indication should be reserved for selected cases with cardiovascular risk factors.

Abstract Background Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits. Purpose 1) assess the non-inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non-immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary-fat-attenuation-index (pFAI) at CCTA in the progression of CAV. Methods 179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022. Results CCTA and CA showed similar radiation doses (8.47 [1.46-30] versus 8.15 [1.38-87.34]; p=0.796) and rate of complications (0 (0%) vs 3 (3%); p=0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 12.31 hours; p<0.001), lower costs (120 euros versus 2800 euros; p<0.001) and less contrast agent (60.4 8.7 ml versus 95.68 47.6ml; p<0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p=0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p=0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47-45.81; p=0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (>-70.1HU) and the progression of CAV (p=NS). Conclusions CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.

Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS) and sudden death (SD). This condition predominantly affects young women with a few or no conventional risk factors for CAD. Diagnosis is traditionally made with invasive coronary angiography (ICA); nevertheless, coronary computed tomography angiography (CCTA) is going to be a new useful tool in the acute diagnosis and at follow-up in these patients. Conventional treatment could involve a conservative approach with medical therapy or an invasive approach with percutaneous coronary intervention (PCI). We retrospectively analyzed data of 57 SCAD patients followed up with Coronary CT angiography (CCTA) at our centre. Clinical and angiographic (invasive and non invasive) data were collected at baseline and at the follow-up. The primary outcome was a composite of all cause mortality and hospitalization for cardiovascular cause evaluated at 1690,7±1082,3 days; the secondary outcome was the evaluation of the vessels with CCTA at 777,9 ± 271,6 days. 57 patients were divided in 2 groups: 46 patients underwent a conservative treatment (80,7%) and 11 patients a PCI treatment (19,3%). The first group is composed of 15,2% male and the second of 27,3% male (p=0,387), mean age is 52,8±11,1 years vs 48,0±10,7 years (p=0,201). Patients treated with PCI has a significative higher incidence of smoking habits (45,5% vs 15,2%; p=0,042), peripheral arteriopathy (18,2% vs 0%; p=0,034), higher troponin peak (40425,8 vs 13436; p=0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p=0,050). Moreover the PCI population has a more common involvement of 2 vessels (72,7% vs 6,5%; p<0,001), of the left main coronary artery (45,4% vs 0%; p<0,001) and of the circumflex coronary artery (45,4% vs 2,2%; p=0,001). At the follow up, there were no statistical differences for the primary and secondary outcomes between the 2 groups (p>0,05). Among patients treated with conservative therapy, there were a more frequent recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p=0,033). in patients with SCAD, conservative management is comparable to PCI treatment in terms of clinical and angiographic outcomes. Among patients treated with conservative therapy, DAPT at discharge was independently associated with a higher rate of SCAD recurrence at follow-up.

58–year–old woman, previous smoking habit. In medical history holosystolic murmur since childhood. At echocardiogram performed in 2019: "VS with preserved FE, mild–to–moderate IA, likely perimembranous DIV." No major comorbidities. In June 2021, she was admitted to the Mestre NICU for paroxysmal complete atrioventricular block. On echocardiogram, mild worsening of IA was described, with a sub–valvular shunt and doubtful aortic bicuspidia. At 24 hours after admission, the patient underwent definitive bicameral PM implantation. In light of the clinical and echocardiographic suspicious, we began to think of a possible organic genesis of the event; a hypothesis supported by the finding of serotin fever and a dental examination with dental hygiene that the patient reported having performed a month earlier. So, on suspicion of an infectious genesis, cold blood cultures were requested and found to be positive for Gemella Morbillorum. The endocarditis hypothesis was confirmed by performing a TE echo and PET/CT scan. Antibiotic therapy was then set up, and an infectious source was subsequently searched for, through a CT scan of the dental arches, which was positive for foci of periodontopathy, and through a rectosigmoidocolonoscopy finding an adenoma with high–grade dysplasia. HOT TOPIC: infective endocarditis is a disease with a high risk of mortality and complications. Among the complications, conduction disturbances are relatively rare. A–V block is often paroxysmal, driven by inflammation, and therefore potentially reversible. Hence, the paramount importance of performing a thorough echocardiogram and resolving any suspicions before referring the patient for definitive device implantation. The case also turns out to be particularly interesting not only for the onset of symptomatology but also for the etiology of the latter. In fact, the microorganism responsible is not among the most frequent germs but represents a rare cause of which there are few cases described in the literature. The main infectious source in humans is the dental system, but several studies have shown a correlation between Gemella morbillorum and rectal colon cancer. Ultimately, the above case represents a typical example of how a "easy" hospitalization for a conduction disorder can actually reveal a much more complex pathology.