Chronic heart failure (CHF) has different stages and they include pre-HF (PHF), a state of high risk of developing myocardial dysfunction and subsequently, advanced CHF (ACHF). Some major behavioral risk factors of PHF are Western diet, tobacco, alcoholism, sedentary life style and chronic mental disorders (anxiety, depression). These insults might predispose to biological risk factors such as obesity, diabetes mellitus dyslipidemia hypertension, myocardial infarction and cardiomyopathy. These risk factors damage the myocytes leading to fibrosis, apoptosis, cardiac hypertrophy, along with alterations in cardiomyocyte’ size and shape. A condition of physiological subcellular remodeling resulting into a pathological or deformation state might be developed conductiong to PHF. Both PHF and HF are associated with the activation of phospholipases and protease, mitochondrial dysfunction, oxidative stress and development of intracellular free Ca2+ [Ca2+]i overloading or an elevation in diastolic [Ca2+]i. Simultaneously, cardiac gene expression is activated leading to further molecular, structural and biochemical changes of the myocardium. The sub-cellular remodeling may be intimately involved in the transition of cardiac hypertrophy to heart failure. Two-dimensional (2D) and three-dimensional (3D) speckle tracking-echocardiography (STE) have been used to quantify regional alterations of longitudinal strain and area strain, through their polar projection, which permits a further assessment of both sites and degrees of myocardial damage. The examination of strain can identify sub-clinical cardiac dysfunction or cardiomyocyte remodeling. It is concluded that during remodeling of the myocardium, cardiac strain is attenuated which can be used for the assessment of disease progression and subsequently for therapeutic interventions.

Massive myocardial calcification is a very rare finding. Accurate identification and characterization may help the clinicians to determine the etiology and clinical significance. In this case, the diagnostic pathway excluded previous myocardial infarction, myocarditis and calcium-phosphate disorders. A possible dystrophic etiology was considered. There are no standardized imaging features available to classify specific subtypes of intramyocardial calcifications. The relative merits of cardiac computed tomography and magnetic resonance in providing complimentary diagnostic information for calcific myocardial lesions is shown. Knowledge of the potential etiology and their imaging patterns are important to provide a concise and accurate differential diagnosis.

Background: The early detection of COVID-19 patients with interstitial pneumonia at high risk of dismal outcome is necessary to deliver proper care and optimize management of limited resources. Objective: The aim of this study was to analyse the performance of pre-existing scores in predicting in-hospital mortality and ICU transfer at admission in an Acute Medical Unit. Methods: 106 consecutive patients with acute respiratory failure due to COVID-19 interstitial pneumoni admitted to Acute Medical Unit were enrolled. The performances of NEWS, SIRS, RAPS, REMS, qSOFA, APACHE II, CURB-65 and PSI were analysed by the Area Under the Receiver Operator Characteristic (AUROCs) and standard indices of accuracy. Results: Considering in-hospital mortality PSI and APACHE II had the higher AUROCs, 0.83 (95% CI 0.75-0.91) and 0.80 (95% CI 0.71-0.88), followed by REMS, 0.77 (95% CI 0.67-0.86), and CURB-65, 0.73 (95% CI 0.63-0.82), whereas the AUROCs of the other scores were < 0.7. PSI and APACHE II had good sensitivity (0.92 and 0.97), negative predictive value (0.96 and 0.97) and negative likelihood ratio (0.1 and 0.1), accurately identifying patients at low risk to die. However, the low specificity (0.70 and 0.47) and positive likelihood ratio (3.1 and 1.8) could limit their usefulness in predicting in-hospital mortality. Considering ICU admissions all the scores, except NEWS, SIRS and qSOFA, showed a worse performance. Conclusions: PSI and APACHE II showed good prognostic results in predicting in-hospital mortality but no pre- existing score validated for acute care settings was totally satisfactory to predict adverse outcomes in COVID-19 interstitial pneumonia after admission to Acute Medical Unit. The application setting and selected outcome criteria should always be considered to evaluate and compare scoring systems’ performance analysis.

A case of a severe paravalvular mechanical mitral prosthesis leak in a high-risk patient that underwent previously 4 mitral valve surgeries is described. An Amulet-Amplatzer device was correctly implanted on the left atrial appendage, with the temptative to close also the contiguous severe leak. A residual moderate paravalvular leak caused acute hemolysis with severe renal failure requiring hemodialysis. The transesophageal echocardiogram is crucial in localizing and defining the extent of the paravalvular leak. It is not clear if the hemolysis was precipitated by the evolution of the disease or by the residual regurgitation after Amulet device deployment. Certainly, given the intricacy of the procedure the results might be limited also for highly expert operators. To our knowledge, this is the first case reporting the use of the Amulet-Amplatzer device for paravalvular leak closure.

Patient presenting with breathlessness has a variety of reasons in the middle age. Apart from respiratory, metabolic, cardiac, infectious, cases have been reported in the literature with compression/impression of Left Atrium (LA) by extracardiac structures like the gastrointestinal tract, aorta / intrapericardial , pulmonary and mediastinal structures. Amongst mediastinal compression, no case has been reported to date due to compression by the dorsal spine. We report such a case of compression of LA due to the dorsal spine, secondary to trauma at a young age, and presenting in the middle age with increasing breathlessness.

SARS-CoV-2 not only causes viral pneumonia but has major implications for the cardiovascular system. Nevertheless, we assisted to a drastic reduction in the number of ACS during this period. Telemedicine and telecardiology, intended as integration to the traditional management appear precious tools especially in Covid-19 era. Given the decrease in new Covid-19 cases worldwide20, now we are approaching the so-called “Phase 2” challenge of a gradual return to pre-Covid-19 life. The epidemiological and clinical situation is rapidly evolving and practice patterns with policies depend on institutions and local availability.