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Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.

we report a prospective study to define the epidemiological, clinical, microbiological, echocardiographic characteristics and the out-come of IE in different age groups in order to evaluate age-related differences.

Routine diagnostic work-up of patients with ventricular arrhythmias(VAs) commonly includes 12-leadelectrocardiogram (ECG), transthorac-ic echocardiography, exercise stress test and, in selected cases, invasivecoronary angiography [1]. According to these investigations, structuralheart disease (SHD), such as ischemic heart disease and non-ischemiccardiomyopathies,isfrequentlydiagnosedamongpatientswithVAsorig-inatingfromtheleftventricle(LV) [2].Lessfrequently,structuralmyocar-dialabnormalitiesarenotidentifi ed;inthesepatients,VAsareconsideredas idiopathic or of unknown etiology [1,2]. Cardiac magnetic resonanceimaging (cMRI) may refine the diagnostic work-up of these patients,allowing the identi fication of structural myocardial abnormalities, whichmay otherwise remain unrecognized [3–6]. Recognition of concealedSHD possibly representing the substrate of VAs has indeed a non-negligible relevance, carrying therapeutic and prognostic implica-tions [1,6].In the present report, the cMRI findings of two male patients pre-senting with apparently idiopathic VAs with right bundle branch block(RBBB) morphology (consistent with LV origin) are described. In addi-tion, a brief discussion of the evidence supporting the clinical value ofcMRI in the diagnostic work-up of these patients is provided.A48-yearoldmanwithoutknowncardiovascularriskfactorsandnoprevious history of heart disease presented to the emergency room forpalpitations with faintness. 12-Lead ECG showed a fast (290 beats/min) ventricular tachycardia with RBBB morphology (Fig. 1A), whichwas effectively treated with external electric cardioversion. 12-LeadECG subsequently obtained was within normal ranges (Fig. 1B) whiletransthoracic echocardiography was unremarkable. Invasive coronaryangiography ruled out coronary artery disease. cMRI was performed,showing normal LV wall thickness, biventricular volumes and function.T1-weightedandT2-weightedimagingdidnotdemonstrateanyabnor-mality; however, late gadolinium enhancement(LGE) imaging demon-strated non-ischemic myocardial scar involving the basal infero-lateralwall (Fig. 1C).A 23-year old man with family history of sudden cardiac death wasdiagnosed as having frequent premature ventricular beats with RBBBmorphology (Fig. 2A). Baseline 12-lead ECG (Fig. 2B) and transthoracicechocardiography were unremarkable while exercise stress test ruledout ischemic heart disease. The patient was subsequently referred tocMRI,whichconfirmednormalLVwallthickness,biventricularvolumesand function. T1-weighted and T2-weighted imaging did not demon-strate any abnormality; however, LGE imaging demonstrated non-ischemic myocardial scars involving the LV lateral wall and the inter-ventricular septum (Fig. 2C).ThetwopresentreportssupporttheconceptthatcMRIshouldbeal-waysperformedtofurtherrefi netheassessmentofpatientswithVAsofLV origin supposed to be idiopathic on the basis of routine diagnosticwork-up.cMRIprovidesindeedcomprehensivemyocardialtissuechar-acterization,allowingtheidenti ficationofmyocardialfattyreplacementthroughT1-weightedimaging,myocardialedemathroughT2-weightedimaging, and myocardial necrosis/ fibrosis through LGE imaging. In par-ticular,LGEimagingrepresentsausefultoolforthenon-invasiveidenti-ficationof arrhythmogenic substrate,since thepresence and amount offibrosisisassociatedwithconductiondelaysandincreasedvulnerabilityfor arrhythmias [7].According to the results of recent observations, cMRI allows theidentification of otherwise unrecognized SHD in a non-negligibleproportion of patients with apparently idiopathic VAs of LV origin

Aims Several trials demonstrated the life saving role of implantable cardioverter-defibrillators (ICD) in primary prevention of sudden cardiac death (SCD). The aim was to evaluate the clinical characteristics and 4-year outcome of consecutive patients treated in clinical practice by prophylactic ICD implantation on the basis of class I recommendations and up-to-date ICD programming. Methods and results IRIDE multi-center, prospective and observational study enrolled 604 consecutive patients (mean age: 66±10years) treated by ICD between 01/01/2006 and 30/06/2010. Main characteristics were similarly distributed among the inclusion criteria of MADIT II (24%), SCD-HeFT (24%), COMPANION (26%) and MADIT-CRT (18%) trials, while a small number of patients met the MUSTT and MADIT (7%) inclusion criteria. Single-chamber ICDs were implanted in 168 (28%) patients, dual-chamber in 167 (28%) and biventricular in 269 (43%) patients. ATP programming was activated in 546 (90%) patients. Overall survival and rate of appropriate ICD intervention by ATP and/or shock at 12–24–36–48months of follow-up were 94%, 89%, 80%, 75% and 16%, 28%, 37% and 50%, respectively. No difference in mortality rate between the groups who received or did not receive appropriate ICD interventions was demonstrated (p=ns). Conclusions The IRIDE study confirms the effectiveness in real world practice of ICD implantation in patients at risk of SCD. The life saving role of ICD therapy increases as the duration of follow-up is prolonged and the survival benefit is similar in patients who received or did not receive appropriate device treatment, thus suggesting a beneficial effect of up-to-date device programming.

Background Device follow-up is mandatory in the care of patients with a pacemaker. However, in most cases, device checks appear to be mere technical, time-consuming procedures. The aim of this research is to evaluate whether remote follow-up can replace in-clinic device checks by assessing clinical outcomes for pacemaker patients followed only via remote follow-up. Methods and results Consecutive pacemaker patients followed with remote monitoring were prospectively included by 6 Italian cardiology centers in an observational investigation. The workflow for remote monitoring included an initial assessment by nursing staff and, when necessary, by a responsible physician for medical decisions. No in-person visits were scheduled after the start of remote monitoring. One-thousand and two-hundred and fifty one patients (30% female, 75±11years old) were followed for a median observation period of 15months. Out of 4965 remote transmissions, 1882 (38%) had at least one clinically relevant event to be investigated further, but, only after 137 transmissions (2.8%), the patients were contacted for an in-clinic visit or hospitalization. Sixty-nine patients died and 124 were hospitalized for various reasons. Atrial fibrillation episodes were the most common clinical events discovered by remote transmissions, occurring in 1339 (26%) transmissions and 471 (38%) patients. Conclusions Our experience shows that remote monitoring in a pacemaker population can safely replace in-clinic follow-up, avoiding unnecessary in-hospital device follow-up.

Poitiers, Poitiers, France) for secretarial help, Elodie Rogeon (Inserm CIC0802, Poitiers, France) for organizational help and S. Brishoual and G. Mauco (Inserm1082 andBiochemistryDepartment, Poitiers, France) for biological determinations. Adjudication committee members are thanked for their excellent work: type 2 diabetes classification (SH, PJS, Xavier Piguel and Florence Torremocha, Endocrinology department — Poitiers, France), and cardiovascular disease classification (AM, SH, PS). We are grateful to Kurt Liittschwager— Alex Edelman and Associates (Malakoff, France) for editing the English of the manuscript.

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