Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. Although relatively rare, the association of ITP and coronary artery disease represents a complex therapeutic challenge. In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention.

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In 30-60 % of patients presenting with ST-segment elevation myocardial infarction (STEMI), significant stenoses are present in one or more non-infarct-related arteries (IRA). This correlates with an increased risk of major adverse cardiac events (MACE). Current guidelines, do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock or persistent ischemia after primary percutaneous coronary intervention (PCI). Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results regarding the optimal revascularization strategy in STEMI patients with multivessel disease. Recently, randomized studies (PRAMI, CvLPRIT, and DANAMI 3-PRIMULTI) provide encouraging data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. Differently, in the PRAGUE-13 trial there were no differences in MACE between complete revascularization and culprit-only PCI. Several meta-analyses were recently published including randomized and non-randomized clinical trials, showing different results depending on the included trials. In conclusion, the current available evidence from the randomized clinical trials, with a total sample size of only 2000 patients, is not robust enough to firmly recommend complete revascularization in STEMI patients. This uncertainty lends support to the continuation of the COMPLETE trial. This ongoing trial is anticipated to enroll 3900 patients with STEMI from across the world, and will be powered for the hard outcomes of death and myocardial infarction. Until the results of the COMPLETE trial are reported, physicians need to individualize care regarding the opportunity and the timing of the non-IRA PCI.

Background Severe pulmonary regurgitation (PR) and progressive right ventricular (RV) disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF), and CMR has become the gold standard for PR and RV volumes assessment. However, in paediatric patients CMR use can be limited by the need for general anaesthesia. Purpose The aim of our study was to analyse a paediatric population (<18 years) of r-TOF with at least moderate PR (regurgitant fraction (RF) >20%), assessed by CMR and to assess which Echo or CMR parameter is associated with functional capacity evaluated by cardiopulmonary exercise test (CPET). Methods Consecutive r-TOF patients regularly followed at our Institution, with at least moderate PR (RF >20% by CMR), were included in the study. Echocardiographic and CMR studies were performed within six months. Echo study: PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT), PR index, ratio of diastolic and systolic time-velocity integrals (DSTVI) of the main pulmonary artery. RV end-diastolic area (RVEDA), end-systolic area (RVESA), right ventricle outflow tract (RVOT) end-diastolic area, fractional area change (FAC) and TAPSE were calculated. By speckle tracking analysis we measured also RV global longitudinal strain (RVGLS) and right atrial strain (RAS). CMR study: we evaluated PR as RF, end-diastolic and systolic volumes (RVEDV, RVESV) and right ventricle ejection fraction (RVEF). In addition, patients underwent CPET within one month from CMR and peak oxygen consumption (Vo2) values were measured. Results We studied 53 r-TOF patients (aged 13.8 ± 2.5 years, ranged between 7.1 and 17.6 years, male 57%, surgical repair at a mean age of 1.1 ± 0.75 years). Based on CMR data, 38 out of 53 had free PR (RF >35%) and nobody had > mild tricuspid regurgitation. We found a good correlation between RVEDA and CMR RVEDV (p <0.0001, r =0.73), which slightly improved adding RVOT area (p < 0.0001, r =0.75). RVEDA indexed (RVEDAi) > 21.3 cm2/mq was found to have a good sensitivity (83.3%, specificity 64.9%, AUC0.74) for RVEDV indexed (RVEDVi) >150 ml/mq. No correlation was found between TAPSE, FAC, RVGLS measured by echo and RVEF calculated by CMR. No correlation was found between echo Doppler parameters used to assess PR severity and PR RF measured by CMR. None of the CMR studied parameters (RV volumes, RVEF, RF) correlated with peak Vo2. Among the Echo parameters only RAS demonstrated a good correlation (p <0.0001, r =0.70) with peak Vo2. At the multivariate analysis including RAS, TAPSE, FAC, RVGLS, RVEF and RVEDV, RAS was the best independent predictor of peak Vo2 (p <0.0001). Conclusion Echo parameters studied to assess PR are unsatisfactory and showed no correlation with PR RF by CMR. RVEDAi is well correlated with CMR volumes. Right atrial strain is the best predictor of peak Vo2 in young patients with r-TOF and should be included in their follow up. Abstract 1160 Figure.