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OBJECTIVE The excess of visceral adipose tissue might hinder and delay immune response. How people with abdominal obesity (AO) will respond to mRNA vaccines against SARS-CoV-2 is yet to be established. We evaluated SARS-CoV-2 specific antibody responses after the first and second dose of the BNT162b2 mRNA vaccine comparing the response of individuals with AO to those without, discerning between individuals with or without prior infection. METHODS IgG neutralizing antibodies against the Trimeric-complex (IgG-TrimericS) were measured at four time points: at baseline, at day 21 after vaccine dose 1, at one and three months after dose 2. Nucleocapsid antibodies were assessed to detect prior SARS-CoV-2 infection. Waist circumference was measured to determine AO. RESULTS Between the first and third month after vaccine dose 2, the drop in IgG-TrimericS levels was more remarkable in individuals with AO compared to those without AO (2.44 fold [95%CI: 2.22-2.63] vs 1.82 fold [95%CI: 1.69-1.92], respectively, p

Aims Female sex and heart failure (HF) are considered poor prognostic factors for surgery. We aimed to investigate the association between sex and surgical outcomes in patients with ischaemic HF undergoing surgical ventricular reconstruction and coronary artery bypass grafting. Methods and results From July 2001 to June 2017, 648 patients [111 women (17%) and 537 men (83%)] were referred to our centre. Follow‐up continued through June 2018. All patients underwent surgical ventricular reconstruction; coronary artery bypass grafting was performed in 582 patients (90%). Primary outcome was defined as all‐cause mortality. Secondary outcome included all‐cause mortality or all‐cause hospitalization. Women were older (70 vs. 65 years, P

The natural history of secondary mitral regurgitation (MR) is unfavorable. Nevertheless, there are no evidence that its correction can improve the outcome. If from one side the original cause of secondary MR can be such to limit the possibilities of improvement, from the other side it is possible that the surgical technique widely applied to repair, restrictive mitral annuloplasty, is not adequate to correct the regurgitation. The addition of valvular and/or subvalvular techniques has been considered a possible technical solution. However, we do not know the prevalence of each technique, how many times mitral replacement is used to correct secondary MR. This aspect is of particular importance, as we know that a successful mitral repair causes a better left ventricular systolic remodeling than a unsuccessful repair or replacement. This study is a prospective, observational registry, conceived to understand what is done in the real world. Any surgeon will use the technique he thinks the most suitable for the patient. Every year, for 5 years, patients will have a clinical and echocardiographic follow-up, to evaluate the risk factors for a worse result (death, rehospitalization for heart failure, reoperation for MR return, moderate, or more MR return). This knowledge will give us the possibility to understand which is the technique, or the strategy, more efficient to treat this disease and the real efficacy of the surgical treatment.

Background: Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet. Objective: To determine the real incidence of sudden cardiac death (SCD) and sustained ventricular tachycardia/ventricular fibrillation (sustained VT/VF) in patients following CABG added to SVR and to define their clinical and echocardiographic parameters predicting in-hospital and long-term arrhythmic events (SCD + sustained VT/VF). Methods: Pre- and postoperative clinical and echocardiographic values as well as postoperative electrocardiogram Holter data of 65 patients (21 female, 63 ± 11 years) who underwent SVR + CABG were retrospectively evaluated. Results: Mean follow-up was 1,105 ± 940 days. At 3 years, the SCD-free rate was 98% and the rate free from arrhythmic events was 88%. Multivariate logistic analysis identified a preoperative left ventricular end-systolic volume index (LVESVI) > 102 mL/m2 (odds ratio [OR] 1.4, confidence interval [CI] 1.073–1.864, P = 0.02; sensitivity 100%, specificity 94%) and a postoperative pulmonary artery systolic pressure (PASP) > 27 mmHg (OR 2.3, CI 1.887–4.487, P = 0.01; sensitivity 100%, specificity 71%) as independent predictors of arrhythmic events. Conclusions: Our and previous studies report a low incidence of arrhythmic events in patients following SVR added to CABG, considering the high-risk profile of the study population. A preoperative LVESVI > 102 mL/m2 and a postoperative PASP > 27 mmHg had a good sensitivity and specificity in predicting arrhythmic events. (PACE 2010; 33:1054–1062)

Aims A left ventricular end-systolic volume (LVESV) ≥60 mL/m2 has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well-established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of ≥ or

Background: Perioperative heart failure (HF) in coronary operations is accompanied by a high operative mortality rate. An intra-aortic balloon pump (IABP) is often used to treat this syndrome. The correct timing for IABP insertion after completion of the operation has not yet been investigated. The aim of this study was to investigate the operative mortality in perioperative HF patients who had undergone coronary operations with respect to the early or the late use of IABP. Methods: This is a retrospective study including 7,270 patients who had undergone coronary surgery with or without associated procedures. A population of patients with perioperative HF was extracted and analyzed with respect to the use of drugs, intra-operative or post-operative IABP to treat this condition. Results: A total of 1,051 (14.5%) patients had perioperative HF. The mortality rate in this group was 13.5%. Early (intra-operative) IABP insertion was performed in 123 patients. In contrast, 928 patients were treated with inotropic drugs only, and, of these patients, 59 developed a drug-refractory HF requiring late IABP insertion. Operative mortality was significantly (P=0.001) higher in patients requiring late (64.4%) vs. early (41.5%) IABP insertion. Independent risk factors for developing a drug-refractory HF were age, pre-operative serum creatinine value and an associated mitral valve procedure. Conclusions: Postponing the use of IABP may be deleterious in patients with drug-refractory HF. In the presence of the three factors independently associated with the risk of a drug-refractory HF, early IABP insertion is suggested.