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Right ventricle strain serum biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT) and NT-pro-brain natriuretic peptide (NT-proBNP), are prognostic in patients with pulmonary embolism (PE). Prognosis accuracy in patients with discordancy between serum biomarkers remains, however, unknown. We performed a retrospective analysis in patients with intermediate or high risk PE and discordant serum biomarkers of RV strain as follows: high hs-cTnT and low NT-proBNP ('high troponin discordance'), compared to patients with low hs-cTnT and high NT-proBNP ('high NT-proBNP discordance'). Cut-off values for high hs-cTnT were ≥14 pg/mL in patients <75 years and ≥45 pg/mL in patients >75-year. Cut-off values for high NT-proBNP were ≥600 pg/mL. The primary end-point was a composite of death, resuscitated cardiac arrest, mechanical ventilation, and inotrope use at one month. 'High troponin discordance', age, sex and body mass index (BMI) were included in a logistic regression model. Time to event analysis was performed using Kaplan Meier curves and Log-rank test. 73 patients were included. 'High troponin discordance' patients (n =41) were younger, presented with a higher heart rate, more frequent bilateral PE, and received more thrombolytics as treatment compared with 'high NT-proBNP discordance' patients (n = 32). Primary end-point was significantly higher in the 'high troponin discordance' patients (29.3% vs 9.4%, p =0.045). 'High troponin discordance' was independently associated with the primary end-point after adjusting for age, sex and BMI. Log rank test confirmed worse outcome in the high troponin discordance group (p =0.037). High troponin discordance' patients with intermediate/high risk PE, had worse outcomes than patients with high BNP discordance. • Thirty six percent of patients with pulmonary intermediate and high risk pulmonary embolism present with discordant serum biomarkers. • Among patients with discordant serum biomarkers, 'High troponin discordance' patients presented with higher risk pulmonary embolism, and was associated with worse outcome [ABSTRACT FROM AUTHOR]

ST-segment elevation myocardial infarction (STEMI) remains a significant source of morbidity and mortality worldwide. Despite advances in treatment leading to a significant reduction in the early complications and in-hospital mortality, a significant proportion of STEMI survivors develop heart failure (HF) at follow-up. The classic paradigm of HF after STEMI is one characterized by left ventricular adverse remodeling (LVAR) and encompasses the process of regional and global structural and functional changes that occur in the heart as a consequence of loss of viable myocardium, increased wall stress and neurohormonal activation, and results in HF with reduced ejection fraction (HFrEF). More recently, however, with further improvements in the treatment of STEMI the incidence and entity of LVAR appear to be largely reduced, yet the risk for HF following STEMI is not abolished and remains substantial, identifying a new paradigm by which patients with STEMI present with HF and preserved EF (HFpEF) characterized by reduction of diastolic or systolic reserve independent of LVAR. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) leads to molecular, structural, geometric, and functional changes in the heart in a process known as ventricular remodeling. An intense organized inflammatory response is triggered after myocardial ischemia and necrosis and involves all components of the innate immunity, affecting both cardiomyocytes and noncardiomyocyte cells. Inflammation is triggered by tissue injury; it mediates wound healing and scar formation and affects ventricular remodeling. Many therapeutic attempts aimed at reducing inflammation in AMI during the past 3 decades presented issues of impaired healing or increased risk of cardiac rupture or failed to show any additional benefit in addition to standard therapies. More recent strategies aimed at selectively blocking one of the key factors upstream rather than globally suppressing the response downstream have shown some promising results in pilot trials. We herein review the pathophysiological mechanisms of inflammation and ventricular remodeling after AMI and the results of clinical trials with anti-inflammatory strategies. [Copyright &y& Elsevier]

High thrombus burden in ST segment elevation myocardial infarction (STEMI) patients increases the risk of adverse events. In this report, we review current strategies for high thrombus burden and present a case report with the combination of two different techniques: aspiration through a guide extension catheter followed by local intracoronary thrombolysis with 'marinade' technique. • High thrombus burden in STEMI is associated with adverse outcomes. • GECs are a valuable tool to treat high thrombus burden in different ways. • GECs can both aspirate organized thrombus, and selectively administer local fibrinolytic agents • There are several devices for this complex scenario, with different mechanism of action and different levels of clinical evidence. [ABSTRACT FROM AUTHOR]