Hyperuricemia increases the risk of cardiovascular mortality associated with very high HdL-cholesterol level

BACKGROUND AND AIMS

Whether the association between very high HDL-cholesterol levels and cardiovascular mortality (CVM) is modulated by some facilitating factors is unclear. Aim of the study was to investigate whether the risk of CVM associated with very high HDL-cholesterol is increased in subjects with hyperuricemia.

METHODS AND RESULTS

Multivariable Cox analyses were made in 18,072 participants from the multicentre URRAH study stratified by sex and HDL-cholesterol category. During a median follow-up of 11.4 years there were 1307 cases of CVM. In multivariable Cox models a J-shaped association was found in the whole population, with the highest risk being present in the high HDL-cholesterol group [>80 mg/dL, adjusted hazard ratio (HR), 1.28; 95%CI, 1.02-1.61; p = 0.031)]. However, a sex-specific analysis revealed that this association was present only in women (HR, 1.34; 95%CI, 1.02-1.77; p = 0.034) but not in men. The risk of CVM related to high HDL-cholesterol was much greater in the women with high uric acid (>0.30 mmol/L, HR 1.61; 95%CI, 1.08-2.39) than in those with low uric acid (HR, 1.17; 95%CI, 0.80-1.72, p for interaction = 0.016). In women older than 70 years with hyperuricemia the risk related to high HDL-cholesterol was 1.83 (95%CI, 1.19-2.80, p < 0.005). Inclusion of BMI in the models weakened the strength of the associations.

CONCLUSION

Our data indicate that very high HDL-cholesterol levels in women are associated with CVM in a J-shaped fashion. The risk of CVM is increased by concomitant hyperuricemia suggesting that a proinflammatory/oxidative state can enhance the detrimental cardiovascular effects associated with high HDL-cholesterol.

The prognostic role of the echocardiographic tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio and its relationship with NT-proANP plasma level in systemic sclerosis

Background

The tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio is an echocardiographic estimation of the right ventricle to pulmonary artery (RV/PA) coupling, with a validated prognostic role in different clinical settings. Systemic sclerosis (SSc) patients without evident cardiovascular involvement frequently display subtle RV impairment. The amino-terminal atrial natriuretic peptide (NT-proANP) plasma level relates to SSc disease progression and mortality. We aimed to assess the prognostic value of the TAPSE/sPAP ratio and its relationship with NT-proANP plasma level in SSc patients without overt cardiovascular involvement.

Methods

We retrospectively analysed 70 SSc consecutive patients, with no clinical evidence of cardiovascular involvement or pulmonary hypertension (PH), and 30 healthy controls (HC) in a retrospective, single-centre study. All SSc patients underwent recurrent clinical and echocardiographic assessments and NT-proANP plasma level was assessed at baseline. SSc-related cardiovascular events and deaths were extracted during a 6-year follow-up. The complete work-up for the diagnosis, treatment and management of PH performed along the 6 years of follow-up referred to the 2015 European Society of Cardiology guidelines.

Results

Systemic sclerosis patients showed lower TAPSE/sPAP ratio at baseline compared to HC [SSc median value = 0.71 mm/mmHg, (IQR 0.62-0.88) vs. HC median value = 1.00 mm/mmHg, (IQR 0.96-1.05); p < 0.001]. Multivariable Cox analysis revealed TAPSE/sPAP ratio as an independent predictor for SSc-related cardiovascular events [HR = 3.436 (95% CI 1.577-7.448); p = 0.002] and mortality [HR = 3.653 (95% CI 1.712-8.892); p = 0.014]. The value of TAPSE/sPAP ratio < 0.7 mm/mmHg was identified as an optimal cut-off for predicting adverse outcomes (p < 0.001) by receiver operating characteristic (ROC) analyses. NT-proANP level significantly related to TAPSE/sPAP ratio (r = 0.52, p < 0.001). TAPSE/sPAP ratio combined with NT-proANP showed an overall significant prognostic role in this SSc population, confirmed by Kaplan-Meier analysis (Log rank p < 0.001).

Conclusion

The TAPSE/sPAP ratio, as an index of RV/PA coupling, is an affordable predictor of cardiovascular events and mortality in SSc and, combined with NT-proANP level, may improve the clinical phenotyping and prognostic stratification of SSc patients.

Serum uric acid / serum creatinine ratio as a predictor of cardiovascular events. Detection of prognostic cardiovascular cut-off values

OBJECTIVE

In the frame of the Uric Acid Right for Heart Health (URRAH) study, a nationwide multicenter study involving adult participants recruited on a regional community basis from all the territory of Italy under the patronage of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension, we searched for the cut-off values of the ratio between serum uric acid (SUA) and serum creatinine (sCr) able to predict cardiovascular (CV) events.

METHODS

Among 20 724 participants followed-up for 126 ± 64 months, after detecting cut-off by the receiver operating characteristic curves, we calculated by Cox models adjusted for confounders having CV events as dependent variable the hazard ratio (HR) of SUA/sCr > cut-off. We also verified if the role of cut-off varied with increasing SUA/sCr.

RESULTS

A plausible prognostic cut-off of SUA/sCr was found and was the same in the whole database, in men and in women (>5.35). The HR of SUA/sCr > cut-off was 1.159 (95% confidence interval [CI] 1.092-1.131, P < 0.03) in all, 1.161 (95% CI 1.021-1.335, P < 0.02) in men, and 1.444 (95% CI 1.012-1.113, P < 0.03) in women. In increasing quintiles of SUA/sCr the cut-offs were >3.08, >4.87, >5.35, >6.22 and >7.58, respectively. The HRs significantly increased from the 3rd to the 5th quintile (1.21, 95% CI 1.032-1.467, P = 0.018; 1.294, 95% CI 1.101-1.521, P = 0.002; and 1.642, 95% CI 1.405-1.919, P < 0.0001; respectively), that is, over 5.35, whereas the 2nd quintile was not significantly different from the 1st (reference).

CONCLUSION

Having SUA/sCr >5.35 is an independent CV risk indicator both in men and women. The cut-off is dynamic and significantly increases with increasing SUA/sCr.

1,5-disubstituted-1,2,3-triazoles counteract mitochondrial dysfunction acting on F1FO-ATPase in models of cardiovascular diseases

The compromised viability and function of cardiovascular cells are rescued by small molecules of triazole derivatives (Tzs), identified as 3a and 3b, by preventing mitochondrial dysfunction. The oxidative phosphorylation improves the respiratory control rate in the presence of Tzs independently of the substrates that energize the mitochondria. The F₁F_O-ATPase, the main candidate in mitochondrial permeability transition pore (mPTP) formation, is the biological target of Tzs and hydrophilic F₁ domain of the enzyme is depicted as the binding region of Tzs. The protective effect of Tz molecules on isolated mitochondria was corroborated by immortalized cardiomyocytes results. Indeed, mPTP opening was attenuated in response to ionomycin. Consequently, increased mitochondrial roundness and reduction of both length and interconnections between mitochondria. In in-vitro and ex-vivo models of cardiovascular pathologies (i.e., hypoxia-reoxygenation and hypertension) were used to evaluate the Tzs cardioprotective action. Key parameters of porcine aortic endothelial cells (pAECs) oxidative metabolism and cell viability were not affected by Tzs. However, in the presence of either 1 μM 3a or 0.5 μM 3b the impaired cell metabolism of pAECs injured by hypoxia-reoxygenation was restored to control respiratory profile. Moreover, endothelial cells isolated from SHRSP exposed to high-salt treatment rescued the Complex I activity and the endothelial capability to form vessel-like tubes and vascular function in presence of Tzs. As a result, the specific biochemical mechanism of Tzs to block Ca²⁺-activated F₁F_O-ATPase protected cell viability and preserved the pAECs bioenergetic metabolism upon hypoxia-reoxygenation injury. Moreover, SHRSP improved vascular dysfunction in response to a high-salt treatment.

755 ATRIAL NATRIURETIC PEPTIDE STIMULATES AUTOPHAGY/MITOPHAGY AND IMPROVES MITOCHONDRIAL DISFUNCTION IN CHRONIC HEART FAILURE

Background

Mitochondrial dysfunction, causing increased reactive oxygen species production, is a molecular feature of heart failure (HF) and it has been reported in circulating leucocytes of patients with HF with reduced ejection fraction (HFrEF). Atrial natriuretic peptide (ANP) exerts many cardiac beneficial effects, including the ability to protect cardiomyocytes by promoting autophagy.

Objective

To test the impact of ANP on autophagy/mitophagy responses, altered mitochondrial structure and function and increased oxidative stress in chronic HFrEF patients.

Experimental design. The present study used both ex-vivo and in-vivo approaches. We examined sixteen consecutive chronic HFrEF patients referring to the outpatient clinic of the Cardiology unit of Sant’Andrea Hospital in Rome. Out of them, for the ex-vivo study we enrolled 10 patients matching the following inclusion criteria: age under 75 years and left ventricle ejection fraction &lt;40%. For the in-vivo study we recruited six patients and evaluated them before and after 2-month treatment with the Angiotensin Receptor Neprilysin inhibitor (ARNi) sacubitril/valsartan started at the dosage of 49/51 mg twice daily, rapidly uptitrated at the dosage of 97/103 mg twice daily, while maintaining unchanged the remaining therapy. Patients with recent hospitalizations for acute HF or other acute conditions within the last 3 months before the enrollment, with malignancy, inflammatory or infectious diseases, diabetes mellitus, history of cigarette smoking and alcohol abuse were excluded.

Results

The ex-vivo direct exposure to αANP caused an improvement of mitochondrial membrane potential with a restoration of the mitochondrial protonmotive force (p&lt;0.05) and promoted the recovery of the IMM extension with a significant improvement in the IMM/OMM index (p&lt;0.05). The production of ROS was significantly decreased after the exposure to αANP (p&lt;0.05). Analyzing the mitochondrial stress, we observed that the treatment with αANP induced a down-modulation of p66shc mRNA (p&lt;0.01). The αANP treatment induced a rapid and significant autophagic response. The cytofluorimetric analysis showed a significant increase of LysoTracker levels highlighting a rise of intracellular acidic compartments (p&lt;0.05), with the up modulation of the LC3 and Beclin mRNA levels (p&lt;0.01 and p&lt;0.05 respectively). The significant reduction in mitochondrial mass observed in treated PBMCs evoked an increase of the mitophagic process related to αANP (p&lt;0.01). In vivo, the efficacy of the treatment with sacubitril/valsartan was proved by the increase in αANP levels (p&lt;0.01) whereas levels of NT-proBNP decreased (p&lt;0.05). PBMCs collected after treatment were characterized by lower mitochondrial oxidative stress levels and were provided of structurally more intact mitochondria characterized by better functional performances (p&lt;0.05). PBMCs of the treated patients showed an increased level of acid compartments associated with an up-modulation of LC3 and Beclin mRNA levels and a reduction of mitochondrial mass (p&lt;0.05). Also in this experimental context, the activation of autophagy was confirmed by ultrastructural morphometric evaluation (p&lt;0.05).

Conclusions

αANP stimulates both autophagy and mitophagy responses, counteracts mitochondrial dysfunction and damage ultimately reducing mitochondrial oxidative stress generation in PBMCs from chronic HF patients. These properties were confirmed upon sacubitril/valsartan administration, a therapeutic approach indicated for HFrEF treatment.

898 ROLE OF 3D ECHOCARDIOGRAPHY IN AORTIC VALVE ABNORMALITIES: TWO CASES REPORT

Introduction

Aortic valves with a number of cusps different from two or three are infrequent congenital anomalies that might manifest with valvular disease in young patients. We present two cases of unicuspid and quadricuspid aortic valve diagnosed in our Center.

Clinical Cases

Case 1. A 23-year-old asymptomatic male was admitted to our Hospital because of the necessity of bone marrow transplantation for Hodgkin lymphoma. He had a previous diagnosis of bicuspid aortic valve and presented a 5/6 mid-systolic harsh murmur, heard best at the right upper sternal border and radiating to the neck. ECG showed sinus rhythm with left ventricular hypertrophy. BNP was in normal range (31 pg/ml).

At trans-thoracic echocardiography, there was severe aortic stenosis [peak/mean gradient of 100/67 mmHg with an aortic valve area of 1.04 cm2 (0.54 cm2/m2); V max was 5 m/s] without regurgitation and dilation of the ascending aorta (39 mm), however the morphology of the aortic valve remained undefined. Left ventricle showed hypertrophy (maximum wall thickness = 13 mm) with normal volumes and systolic function. Thus, the patient underwent to 3D-Transesophageal echocardiography, which demonstrated unicuspid aortic valve with a lone commissure between L-NC and anterior calcification. After multidisciplinary discussion, the patient underwent close follow-up and aortic valve replacement was planned after the bone marrow transplantation.

Case 2. A 21-year-old male was referred by general practitioner to our outpatient clinic for palpitations. Cardiovascular physical examination and ECG were normal with no evidence of arrhyhtmia or cardiac murmurs.

Transthoracic echocardiography revealed central mild aortic valve regurgitation in a suspected quadricuspid aortic valve (i.e., an X-shaped commissure pattern during diastole and a rectangular appearance during systole in the parasternal short-axis view). Left ventricular size and function and ascending aorta dimensions were normal. There was no associated congenital cardiovascular abnormality. 3D-Transesophageal echocardiography confirmed the evidence of a quadricuspid aortic valve. The cusps appeared to be of different size: two equal larger cusps and two equal smaller cusps (Type C, Hurwitz and Robert's classification), thin and mobile. The patient was advised to echocardiographic follow-up at intervals of 12 months.

Conclusions

We describe two cases of aortic valve congenital anomalies in two coetaneous patients with completely different impacts on hemodynamics. Severe aortic stenosis complicated unicuspid aortic valve whereas quadricuspid aortic valve was associated with mild aortic regurgitation. 3D-Transesophageal echocardiography was essential for accurate morphological characterization of the aortic valves.

814 SLEEP DISORDERS AND DYSBIOSIS: CULPRITS IN CARDIOVASCULAR DISEASES

Introduction

Primary prevention of cardiovascular disease, the leading cause of death worldwide, has become a mainstay in addressing this considerable global challenge. It has become clear that the gut microbiome plays a vital role in human metabolism, immunity, and reactions to diseases, including cardiovascular disease. Growing evidence suggests that sleep quality can be influenced by the Gut Microbiome (GM), since probiotic supplementation has been found to improve subjective sleep healthy. Disruption of sleep and sleep/wake functions has been associated with both short (increased stress responsivity or psychosocial issues) and long term health consequences, including cancer and cardiovascular diseases. Emerging evidence suggests that disturbance of circadian rhythm, which incorporates essential physiological and humoral functions in a 24-hour cycle, could be an understudied risk factor for cardiovascular disease. While impaired sleep quality is a significant contributor to circadian rhythm disturbance, the evidence regarding sleep interventions and their effect on cardiovascular events is lacking. We conduct a literature review to synthesize a body of evidence on the interaction between sleep and GM in order to achieve robust and broad conclusions and implications with the cardiovascular system.

Methods

We reviewed the literature on the relationship between sleep, gut microbiome and cardiovascular disease, from January 2017 up until August 2022.

Results

The human GM can influence health through a bidirectional communication channel linking the brain and gut, the Brain-Gut-Microbiome Axis (BGMA). Many authors have described several underlying factors that could be involved in sleep-disorder, such as the immune system, the vagus nerve (VN), the neuroendocrine system, and bacterial metabolites. Furthermore, several interventions targeting the GM have been proved to be beneficial for amelioration of sleep problems: gamma-amino butyric acid (GABA) produced by the intestinal microbiota may influence the central nervous system through the VN and have an influence on sleep, as some studies reported

Conclusions

Sleep health may constitute a novel cardiovascular risk factor and target for preventive intervention. More research and well-designed studies are needed to better evaluate the role of the microbiome in the multi-directional relationship between sleep, diet and CVD. From our analysis GM provides a wide range of potential therapeutic targets. Challenges ahead include the development of therapeutic interventions that target reversing gut dysbiosis, at an early stage, combined with good sleep behavior, which may open new horizons to prevent cardiovascular disease.

Prevention of cardiorenal damage: importance of albuminuria

Chronic kidney disease (CKD) is projected to become a leading global cause of death by 2040, and its early detection is critical for effective and timely management. The current definition of CKD identifies only advanced stages, when kidney injury has already destroyed &gt;50% of functioning kidney mass as reflected by an estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 or a urinary albumin/creatinine ratio &gt;six-fold higher than physiological levels (i.e. &gt; 30 mg/g). An elevated urinary albumin-excretion rate is a known early predictor of future cardiovascular events. There is thus a ‘blind spot’ in the detection of CKD, when kidney injury is present but is undetectable by current diagnostic criteria, and no intervention is made before renal and cardiovascular damage occurs. The present review discusses the CKD ‘blind spot’ concept and how it may facilitate a holistic approach to CKD and cardiovascular disease prevention and implement the call for albuminuria screening implicit in current guidelines. Cardiorenal risk associated with albuminuria in the high-normal range, novel genetic and biochemical markers of elevated cardiorenal risk, and the role of heart and kidney protective drugs evaluated in recent clinical trials are also discussed. As albuminuria is a major risk factor for cardiovascular and renal disease, starting from levels not yet considered in the definition of CKD, the implementation of opportunistic or systematic albuminuria screening and therapy, possibly complemented with novel early biomarkers, has the potential to improve cardiorenal outcomes and mitigate the dismal 2040 projections for CKD and related cardiovascular burden.

The enigma of resistant hypertension: from lifestyle changes and pharmacological treatment to renal denervation

Resistant hypertension consists in the failure to achieve effective control of blood pressure despite the use of at least three drugs, including a diuretic, at the maximum tolerated dosage. Despite the progress made in terms of improving awareness and effectiveness of the available therapeutic strategies, the percentage of patients with resistant hypertension represents up to 18% of the entire hypertensive population. The management of resistant hypertension includes the combination of different strategies from lifestyle changes to complex interventional procedures. Lifestyle interventions include reducing salt intake, weight loss, quitting smoking and alcohol consumption, and performing aerobic physical activity. With regard to drug therapy, international guidelines recommend the introduction of a mineralocorticoid receptor antagonist or, if not tolerated, of a loop diuretic, or of the beta-blocker bisoprolol, or of the alpha-blocker doxazosin. In the last few years, promising results have been obtained from studies that have evaluated the efficacy and safety of the denervation of the renal arteries by ablation. This procedure may constitute an increasingly widespread option for those patients suffering from resistant hypertension despite the use of different drug classes, or who are intolerant or poorly adherent to medical therapy.

Lipoprotein(a) and the risk of recurrent events in patients with acute myocardial infarction treated by percutaneous coronary intervention

BACKGROUND

The role of Lipoprotein(a) (Lp[a]) in risk stratification following an acute myocardial infarction (AMI) is still debated. We aimed to investigate whether elevated Lp(a) levels in patients with AMI treated by percutaneous coronary intervention (PCI) are associated with worse outcomes.

METHODS

We designed a retrospective registry including patients with AMI undergoing PCI. The occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as death from cardiovascular causes, recurrent myocardial infarction, unplanned coronary revascularization and stroke, was assessed at follow up and compared between patients with high (≥ 30 mg/dl) and low (< 30 mg/dl) Lp(a) levels. Cox proportional hazard analysis was performed in order to assess independent predictors of MACCE.

RESULTS

During a 3-year period (2018-2020) we identified 634 patients with AMI treated by PCI and known Lp(a) blood levels; follow up visits were performed in 414 patients (median length 29 months [19-38]). Median Lp(a) level was 18 mg/dl [8-42]. The incidence of MACCE was significantly higher in high as compared to low Lp(a) group (log-rank p=0.018). The following independent predictors were identified at multivariate Cox regression: Lp(a) ≥30 mg/dl (HR 1.82 [95% CI 1.04-3.19], peripheral artery disease (HR 4.62 [95% CI 2.50-8.54]), number of diseased coronary vessels (HR 1.51 [95% 1.03-2.24] and presence of a coronary chronic total occlusion at coronary angiography (HR 3.46 [95% CI 1.77-6.76]).

CONCLUSIONS

In this study, Lp(a) values ≥30 mg/dl were associated to worse outcomes in patients with AMI receiving PCI. Lp(a) could represent a useful tool to identify patients at high risk of recurrent events.

Exploring the influence of takotsubo syndrome on oncologic patients' mortality

It has been reported that patients affected by takotsubo syndrome (TTS) with a concurrent diagnosis of cancer suffer from greater mortality as compared to their non-cancer counterpart. It remains unclear whether TTS worsens the prognosis of cancer patients as well. Aim of this study was to compare outcomes of cancer patients with and without TTS. We combined data from two independent cohorts: one consisted of a prospective multicentre TTS registry; the second cohort consisted of all oncologic patients from two Cardio-Oncology Outpatient Clinics, who did not have cardiovascular conditions at the time of the cardio-oncologic visit. From the TTS registry, we selected patients with cancer (cancer-TTS patients). Next, we matched these patients with those from the cardio-oncologic cohort (cancer non-TTS patients) in a 1:2 fashion by age, sex, and type and cancer staging. Study endpoint was all-cause mortality. Among 318 TTS patients, 42 (13%) had a concurrent diagnosis of cancer. Characteristics of cancer-TTS patients and of the 84 matched cancer non-TTS subjects were comparable with the exception of diabetes mellitus, which was more common in cancer non-TTS patients. All-cause mortality was similar between cancer-TTS and cancer non-TTS patients. At Cox regression analysis TTS was not associated with mortality (OR 1.4, 95% CI 0.6-3.3, p = 0.43). Our findings show that even in the presence of acute heart failure due to TTS, the prognosis of oncologic patients is driven by the malignancy itself. Our results may prove useful for integrated management of cardio-oncologic patients.

Renal denervation in the antihypertensive arsenal - knowns and known unknowns

Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.

Extemporaneous combination therapy with nebivolol/zofenopril in hypertensive patients: usage in Italy

OBJECTIVE

Clinically describing hypertensive patients initiating nebivolol/zofenopril extemporaneous combination (NZ-EXC) and estimating the number of patients currently receiving NZ-EXC and of those potentially eligible for the fixed-dose combination of the two molecules (NZ-FDC) in Italy.

METHODS

This retrospective observational study used data from IQVIA Italian Longitudinal Patient Database (LPD). Adult hypertensive patients firstly prescribed NZ-EXC between 1 July 2011 and 30 June 2020 were identified and their demographic and clinical characteristics were extracted. Treatment adherence was evaluated as proportion of days covered (PDC) and classified as low (PDC <40%), intermediate (PDC ≥40% and <80%) or high (PDC ≥80%). Two additional cohorts were identified in 2019 to provide the national-level yearly estimates of patients prescribed NZ-EXC and of patients eligible for NZ-FDC.

RESULTS

In total 1745 patients were prescribed NZ-EXC: 60% were women; mean age was 65 years. The most frequent comorbidities were dyslipidemia (19.0%), diabetes (15.5%) and thyroid diseases (13.1%); the most common co-prescribed treatments were antithrombotics (29.1%), lipid-lowering agents (28.8%), nonsteroidal anti-inflammatory drugs (26.1%) and antihyperglycemic agents (13.5%). Mean PDC was 39%, and 57% of the patients had a PDC < 40%. The yearly estimate of patients prescribed NZ-EXC in 2019 was 59,000, while potential users of NZ-FDC were estimated to be 29,000.

CONCLUSIONS

NZ-EXC in hypertensive patients is a common practice in Italy and the development of a NZ-FDC can be a viable treatment option for hypertensive patients who are already receiving nebivolol and zofenopril through the concomitant assumption of two distinct pills. As supported by scientific literature, FDCs of antihypertensive drugs could simplify treatment, improve adherence and potentially reduce health-care costs as related to a better control of blood pressure.

The impact of UEFA Euro 2020 football championship on Takotsubo Syndrome: Results of a multicenter national registry

Objectives

The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE).

Methods and results

Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6-495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P = 0.80)] or TTS [IRR 1.66(0.80-3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period.

Conclusions

The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.