bluuebunny/crossref_metadata_2025 huggingface dataset:
488 Candidacy for heart transplantation in adult congenital heart disease patients: a single-centre, retrospective, cohort study
Authors: D’Angelo Emanuela Concetta , Angeli Emanuela , Ragni Luca , Gargiulo Gaetano Domenico , Donti Andrea , Potena Luciano , Tonoli Federica , Bartolacelli Ylenia , Bulgarelli Ambra , Careddu Lucio , Ciuca Cristina , Zanoni Rossana , Assenza Gabriele Egidy
Published: December 2021

Aims

End-stage heart failure (HF) is the leading cause of death in adult congenital heart disease (ACHD) population. Heart transplantation (HTx) improves prognosis in ACHD end-stage HF but candidacy evaluation, referral pattern, and correct listing timing are not fully elucidated in this population. To evaluate factors associated to refusal from Htx in ACHD patients with end-stage HF referred for HTx evaluation.

Methods and results

This retrospective cohort study enrolled consecutive ACHD patients considered for HTx in our institution between 2014 and 2020 and patients undergone HTx between 2000 and 2013. Refusal from HTx served as primary study endpoint. Between 2014 and 2020, 46 ACHD patients were evaluated for HTx, 14 ACHD patients underwent HTx between 2001 and 2013. The main indication to HTx in patients with single ventricle physiology was Fontan failure, while in patients with systemic left ventricle and systemic right ventricle physiology, it was systemic ventricular dysfunction. We compared clinical, anatomical and demographic data of 41 patients accepted for transplantation with 15 patients refused after screening. Risk factors for refusal were: coexistence of multiple high risk features [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.1–12.9; P 0.048]; anatomical factors (OR: 14.5; 95% CI: 3.1–68.4; P 0.001), out-of-centre ACHD/HTx program referral (OR: 5.3; 95% CI: 1.5 to 19.0; p 0.01). Survival in patients accepted for HTx was significantly higher than survival in patients declined from HTx with landmark comparison at 20, 40 and 60 months of 87%, 78%, and 72% vs. 70%, 59%, and 20%, respectively. HTx refusal identifies a high risk ACHD patient subgroup (hazard ratio for overall mortality: 3.1; 95% CI: 1.1–8.3; P 0.02).

Conclusions

In our study risk factors for refusal from HTx are adverse anatomical features, coexistence of multiple conventional HTx high risk factors and out-of-centre referral. ACHD patients refused from HTx present shorter time to death. Efforts to increase HTx candidacy and to reduce referral delay in tertiary centre are strongly necessary for this growing population.
85 Diuretics trajectories in dilated cardiomyopathy
Authors: Nuzzi Vincenzo , Cannatà Antonio , Manca Paolo , Gregorio Caterina , Barbati Giulia , Stolfo Davide , Merlo Marco , Sinagra Gianfranco
Published: December 2021

Aims

Diuretics in heart failure (HF) are commended to relieve symptoms at lowest dosage effective. Dilated cardiomyopathy (DCM) is a particular HF setting with several variables that may influence disease trajectory. We aimed to assess the long-term use of diuretics in DCM, the possibility of withdrawal and to explore the prognostic correlations.

Methods and results

All consecutive DCM patients enrolled from 1990 to 2018 were considered eligible. All the patients had available the information about the furosemide-equivalent dose at baseline and at follow-up evaluation within 24 months. Patients were categorized in stable (diuretic dose variation <50%), increasers (diuretics dose increase ≥50% or initiation of diuretic therapy), and decreasers (diuretics dose decrease ≥50% or never prescribed diuretics in the 24-months observation period). The prognostic role of the diuretics trajectory group was assessed with Kaplan Meier analysis and with a time-dependent multivariable model. The outcome measure was a composite of all-cause death/heart transplantation/HF hospitalization (ACD/HTx/HFH). 908 patients were included [mean age 50 ± 16, 70% male sex, 24% NYHA class III or IV, mean left ventricular ejection fraction (LVEF) 31 ± 9%, 66% treated with diuretics at baseline]. The furosemide-equivalent dose at enrolment had a linear association with the risk of outcome. Compared to other groups, decreaser patients were younger, had less HF symptoms, higher LVEF and more dilated left atrium. Decreasers had a lower prescription rate of diuretics and less frequent indication to renin-angiotensin inhibitors and mineralocorticoid receptors antagonists. Over a median follow-up of 122 (62–195) months decreasers had the lowest incidence of outcome, followed by stable, while increasers had the worst outcome (P < 0.001). After adjustment for other prognosticators, compared to stable patients, decreasers had a reduced risk of ACD/HTx/HFH [HR: 0.497 (95% CI: 0.337–0.731)] while increasers had the highest risk of adverse outcome [HR: 2.027 (95% CI: 1.254–3.276)]. Similarly, amongst patients taking diuretics at baseline, the diuretics withdrawal was in independent outcome predictor. The only multivariable predictors of diuretics withdrawal were younger age and lower furosemide-equivalent dose at enrolment.

Conclusions

In DCM patients the diuretics dose at baseline is a strong prognosticator. Diuretics dose reduction or its withdrawal provides a prognostic benefit on hard outcome. Diuretics tapering in selected patients should be considered in the short-term follow-up to improve DCM prognosis.
279 Medical treatment with ARNI may reduce indications for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction: insights from discover-ARNI, a multicentre Italian register
Authors: Pastore Maria Concetta , Mandoli Giulia Elena , Giannoni Alberto , Benfari Giovanni , Dini Frank Lloyd , Rosa Gianmarco , Pugliese Nicola Riccardo , Taddei Claudia , Correale Michele , Brunetti Natale Daniele , Magnesa Michele , Carluccio Erberto , Mengoni Anna , Guaricci Andrea Igoren , Piscitelli Laura , Citro Rodolfo , Ciccarelli Michele , Novo Giuseppina , Corrado Egle , Pasquini Annalisa , Loria Valentina , Carli Giuseppe De , Degiovanni Anna , Patti Giuseppe , Santoro Ciro , Moderato Luca , Cicoira Mariantonietta , Canepa Marco , Malagoli Alessandro , Emdin Michele , Cameli Matteo
Published: December 2021

Aims

This sub-study deriving from a multicentre Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors.

Methods and results

In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months of therapy. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF ≤ 35% and New York Heart Association (NYHA) class = II–III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria (Figure 1). Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With ROC curves, age ≥ 75 years, LAVi ≥ 42 ml/m2 and LV GLS ≥ −8.3% were associated with ICD indications persistence (AUC = 0.65, 0.68, and 0.68, respectively). With univariate and multivariate analysis, age and LV GLS emerged as the only significant predictors of ICD indications at follow-up.

Conclusions

Sacubitril/valsartan provided early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline advanced age and reduced LV GLS were markers of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
393 Long-term prognostic value of haemodynamic determinants of right ventricular pulsatile afterload in patients with advanced heart failure
Authors: Rubino Francesca , Scarsini Roberto , Piccoli Anna , Biagio Livio San , Tropea Ilaria , Onorati Francesco , Faggian Giuseppe , Pighi Michele , Tavella Domenico , Mammone Concetta , Ribichini Flavio
Published: December 2021

Aims

Right ventricular (RV) dysfunction demonstrated a strong impact on survival of patients with advanced heart failure with reduced ejection fraction (HFrEF). Increased RV afterload is associated with poor prognosis in patients with HF. To examine the prognostic relevance of RV pulsatile afterload parameters, in particular pulmonary artery compliance (PAC), elastance (PAE), and pulsatile index (PAPi) in a large cohort of patients with advanced HFrEF evaluated for heart transplantation (HT).

Methods and results

149 patients with HFrEF enlisted for HT were evaluated with right heart catheterization (RHT) and echocardiography and were followed until death or any censoring events including HT, left ventricular assist device (LVAD), and hospitalization for acute heart failure (HHF). Cox regression and ROC-curve analysis were used to test the prognostic value of RV pulsatile afterload determinants. During a mean observation time of 500 ± 424 days, the primary endpoint occurred in 29 (19.5%) patients. The mean age was 56.6 ± 10.1 years and 85.2% were male. The most frequent etiology of HF was ischaemic cardiomyopathy (52.3%). Mean LV ejection fraction was 25.7 ± 10.2%. Patients who met the primary endpoint were significantly older and with worse haemodynamic profile than event-free survivors. In particular, the primary endpoint occurred in patients with lower PAC (1.8 ± 0.8 vs. 2.7 ± 2.0, P = 0.01), higher mean pulmonary arterial pressure (mPAP) (33.5 ± 11.3 vs. 29.3 ± 11.0, P = 0.05), PVR (3.0 ± 1.6 vs. 2.6 ± 2.0, P = 0.09), and PEA (1.12 ± 0.5 vs. 0.98 ± 0.6, P = 0.04). A significant increased risk of adverse outcome was observed in patients with PAC <1.9 ml/mmHg (HR: 3, 95% CI: 1.3–6, P = 0.007), PEA > 0.9 mmHg/ml (HR: 2.5, 95% CI: 1.1–5.2, P = 0.02) and mPAP ≥25 mmHg (HR: 3.0, 95% CI: 1.0–7.5, P = 0.03). The predictive value of PAC was superior compared with PVR (AUC comparison, P = 0.019) and PAPi (P = 0.03). Conversely, PAC presented similar prognostic accuracy compared with mPAP (P = 0.51) and PEA (P = 0.19). Moreover, PAC demonstrated incremental prognostic value compared with the cardiac index (P = 0.02), whereas mPAP and PAE did not.

Conclusions

Impaired haemodynamic RV parameters are associated with worse survival in patients with advanced HFrEF. Pulsatile RV afterload indices should be considered in the evaluation of patients enlisted for HT. PAC demonstrated an independent prognostic value in this highly selected cohort of patients awaiting HT.
545 Cardiac protection by pirfenidone after myocardial infarction: a bioinformatic analysis
Authors: Aimo Alberto , Iborra-Egea Oriol , Martini Nicola , Galvez-Monton Carolina , Burchielli Silvia , Panichella Giorgia , Passino Claudio , Emdin Michele , Bayes-Genis Antoni
Published: December 2021

Aims

Left ventricular (LV) remodelling after myocardial infarction (MI) is promoted by an intense fibrotic response, which could be targeted by an anti-fibrotic drug such as pirfenidone.

Methods and results

We explored the relationship between protein modulation by pirfenidone and post-MI remodelling, based on publicly available molecular information and transcriptomic data from a swine model of MI. We also compared the effects of pirfenidone and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), mineralocorticoid receptor blockers (MRA) and beta-blockers. We identified six causative motives of post-MI remodelling (cardiomyocyte cell death, impaired myocyte contractility, extracellular matrix remodelling and fibrosis, hypertrophy, renin–angiotensin–aldosterone system activation, and inflammation), 4 pirfenidone targets and 21 bioflags (indirect effectors). When considering both targets and bioflags, pirfenidone showed a broad relationship encompassing all six motives. p38γ-MAPK12 blockade inhibits cardiomyocyte apoptosis, cardiomyocyte hypertrophy and inflammation. Furthermore, pirfenidone can modulate extracellular matrix remodelling and cardiac fibrosis by targeting the TGFβ1-SMAD2/3 pathway and other effector proteins such as matrix metalloproteases 2 and 14, PDGFA/B, and IGF1, which promote myocardial fibrosis, cardiomyocyte hypertrophy and impaired contractility. All the gold standard drugs were found to be important for specific clinical motives, but pirfenidone had a more widespread action on the molecular pathways active in the post-MI setting.

Conclusions

A bioinformatic approach allowed to identify several possible mechanisms of action of pirfenidone with beneficial effects in the post-MI LV remodelling, and suggests additional effects over guideline-recommended therapies. These findings support clinical studies evaluating the beneficial effects of pirfenidone in patients with MI.
766 Distal embolization protection systems. A rare complication
Authors: Aste Francesca , De Candia Gianfranco , Lai Giorgio , Cadeddu Mauro , Secchi Sara , Pettinau Antonio , Ricci Sara Jane , Meloni Luigi , Montisci Roberta
Published: December 2021

Aims

The no reflow phenomenon is a not rare complication that occurs in up to 30% of patients with acute coronary syndrome undergoing myocardial reperfusion by percutaneous coronary intervention. The use of coronary artery thrombus aspiration or distal embolization protection systems has reduced the risk of distal embolization and no-reflow phenomenon.

Methods and results

We describe the case of a 77 year old female suffering from hypertension presented at our emergency department for inferior STEMI. An urgent coronary angiography was performed, showing a three-vessel coronary artery disease with right coronary artery sub-occluded in the middle segment (culprit lesion), with a voluminous endoluminal minus image, as intracoronary thrombosis. Before performing the coronary angioplasty, a Spider FX3 filter was placed on the distal segment of the right coronary artery; thrombus aspiration was performed, which was ineffective, then angioplasty and Zotarolimus eluting stent implantation in the mid segment of the right coronary artery. After stent implantation, an image of minus was highlighted inside the basket of the filter, as a migrated and incarcerated thrombotic formation; then, the filter was removed. During the removal of the filter, longitudinal crush of the distal portion of the stent is caused, with limitation of the downstream flow, in the absence of haemodynamic instability. The stent was recrossed with Fielder XT guidewire supported by Turnpike LP Microcatheter. Multiple dilations werenperformed with semi-compliant and non-compliant increasing-caliber balloons and then Zotarolimus eluting stent implantation, in partial overlap with the distal portion of the previously implanted stent, with TIMI flow 3. The echocardiogram showed a normal global systolic function, with alterations in regional kinetics. On the 6th day, angioplasty and Zotarolimus eluting stent implantation was performed on the mid-proximal segment of the left anterior descending artery. During the hospitalization the patient was stable and has been discharged in good condition on the ninth day.

Conclusions

The interest of this case is the evidence of a rare complication related to the use of distal embolization protection system, probably due to an incomplete closure of the filter before removal, due to the high amount of thrombotic material inside it. The rapid recrossing of the stent after the longitudinal crush, the angioplasty and the second stent implantation, led to a quick flow restoration, without haemodynamic and clinical consequences on the patient's outcome.
658 Impairment of strain reserve extends to remote myocardium in the sub-acute phase of ST-elevation myocardial infarction
Authors: Diana Giovanni , Manfredonia Laura , Filice Monica , Ravenna Emanuele , Ingrasciotta Gessica , Ruscio Eleonora , Graziani Francesca , Lombardo Antonella , Lanza Gaetano Antonio , Crea Filippo , Locorotondo Gabriella
Published: December 2021

Aims

In ST-elevation myocardial infarction (STEMI), subtle tissutal changes in remote myocardium predict long-term left ventricular (LV) remodelling and prognosis, independently of infarct size and microvascular obstruction. Whether there is a subclinical dysfunction of remote myocardium, detectable by longitudinal strain (LS) at echocardiography, and whether it varies in different locations of STEMI and with adenosine (ADO) challenge, is still unknown.

Methods and results

Fifty-three patients (age 65 ± 12.5 years, 44 male, 20 anterior and 33 non-anterior, P = 0.01) underwent rest/stress echocardiography at 7 ± 2 days after successfully treated STEMI, and at 6-months follow-up. Global LS (GLS), ischaemic and remote LS (iLS and rLS) were analysed in anterior and non-anterior STEMI. Both at rest and at follow-up, GLS was stratified by ejection fraction (EF) into three groups: EF < 40%, 40–49%, and ≥50%. Normal subjects, undergoing ADO stress echo, represented controls. Anterior STEMI showed lower GLS than controls (P < 0.001) and non-anterior STEMI (P < 0.001). ADO increased GLS in controls (P = 0.05), but neither in anterior nor in non-anterior STEMI, GLS changed during ADO stress, although significantly improved at follow-up (P < 0.001 and P = 0.002, respectively). In anterior STEMI, rLS was comparable to iLS at rest, during stress and at follow-up (P = ns), while in non-anterior STEMI rLS was higher than iLS throughout the study (P < 0.001). Patients with EF < 40% and 40–49% had similar values of GLS, iLS, and rLS, which were, both at rest and at follow-up, lower than those of patients with EF ≥ 50% (P < 0.001).

Conclusions

In the subacute phase, anterior STEMI shows the worst impairment of LS in both ischaemic and remote regions. Strain reserve to ADO is absent in remote myocardium, as well as in ischaemic zone, regardless of MI location. Global, ischaemic and remote LS may improve at follow-up.
243 Mental health status and sexual habits in young patient after acute coronary syndrome
Authors: Nicolò Claudio , Franzino Marco , Pistelli Lorenzo , De Sanctis Giulia , Parisi Francesca , Migliorato Alessandro , Grimaldi Patrizia , Crea Pasquale , Luzza Francesco , Carerj Scipione , Di Bella Gianluca , Costa Francesco , Micari Antonio
Published: December 2021

Aims

Acute coronary syndrome (ACS) has a huge potential impact on patients’ life, and little is known on the long-term effect on mental health in young patients.

Methods and results

We included consecutive young patients (≤45 years at presentation) with ACS referred from October 2013 until March 2021 to our clinic. Physical and mental status was evaluated through the standardized SF12 scale for physical (PCS) and mental status (MCS). Depression and perceived stress were evaluated with the patient health questionnaire 9 (PHQ9) and perceived stress scale (PSS). A total of 91 patients have been included and followed for a median of 40 months. History of anxiety or depression at baseline was reported in 1.1% and 2.2%, respectively. Physical and mental health status was impaired in 65.8% and 42.1% of patients, respectively (Figure). Predictors of poorer physical health were lower LVEF, WMSI, and multivessel disease. Predictors of poorer mental health were age and nuisance bleeding during follow-up. Mild/moderate depression was reported in 47.3%. Moderate/high stress was reported in 78.1%. 37.1% patients affirmed that their career trajectory worsened after the event and 37.8% declared a reduction of income. 53.8% declared mild to significant changes in their sexual activity, while 83.8% declared to have received no advises on sexual activity from their Doctor.

Conclusions

In conclusion, ACS is a dramatic event with a significant impact on young patients’ life at a physical, mental, and social level. Measures of social/psychological support in the aftermath of the event merit consideration in future research.
401 Myocardial viability and ischaemia assessment in chronic coronary total occlusions according to collaterals distribution: a retrospective analysis
Authors: Pinto Giuseppe , Chiarito Mauro , Liccardo Gaetano , Baggio Sara , Bacci Elodi , Gasparini Gabriele , Francone Marco , Stefanini Giulio , Condorelli Gianluigi , Monti Lorenzo
Published: December 2021

Aims

Whether CTO-PCI (chronic total occlusions—percutaneous coronary intervention) offers clinical benefit over optimal medical therapy is still a matter of debate. Viability and ischaemia assessment could improve selection of candidates to PCI. Traditionally, well-developed collaterals are considered a marker of myocardial viability in CTO territory. Current literature offers few data concerning the relationship between viability/ischaemia and collaterals distribution.

Methods and results

We retrospectively analysed the Cardiovascular Magnetic Resonance (CMR) studies and coronary angiographies of patients with at least one CTO referred at Humanitas Research Hospital between June 2009 and September 2020. We included 131 patients who underwent CMR with LGE assessment; of them, 111 (85%) underwent stress-CMR with adenosine. AHA segments (16 segment/patient for a total of 2096 segment assessed) were assessed on three short axis projection and scored for WMSI on cine images, for the presence of ischaemia on first pass perfusion, and for viability on LGE images. Viability was defined as LGE transmurality ≤50% and WMSI (wall motion score index) >1. Patients were divided in three groups according to collaterals distribution at coronary angiography:

Patients with TD collaterals were more likely to have viable segments in the CTO-territory (90% of the segments in TD, 76% in WD, and 71% in PD, coeff. 0.107, P < 0.001). No statistically significant differences were found between groups as regard the amount of ischaemic segments (61% of the segments in TD, 65% in WD, and 60% in PD, P = 0.189).

Conclusions

The presence of myocardial viability is slightly associated with the degree of coronary collateralization at coronary angiography while the amount of ischaemia is not. Stress CMR should be considered in CTO patients before a reopening attempt.
418 Titin mutations and female sex characterize dilated cardiomyopathy in the elderly
Authors: Cannata Antonio , Merlo Marco , Dal Ferro Matteo , Manca Paolo , Paldino Alessia , Barbati Giulia , Graw Sharon , Bromage Daniel , Johnson Renee , Roy Darius , Gigli Marta , Stolfo Davide , Abbate Antonio , Parkih Victoria , Ashley Euan , Lakdawala Neal , Carr-White Gerry , Fatkin Diane , Mcdonagh Theresa , Taylor Matthew , Mestroni Luisa , Sinagra Gianfranco
Published: December 2021

Aims

Dilated cardiomyopathy (DCM) is frequently caused by genetic factors. Studies identifying deleterious rare variants have predominantly focused on early-onset cases, and little is known about the genetic underpinnings of the growing numbers of patients with DCM who are diagnosed after 60 years of age (i.e. late-onset DCM). The aim is to investigate the prevalence, type, and prognostic impact of disease-associated rare variants in late-onset DCM patients.

Methods and results

We analysed a population of late-onset DCM patients who had undergone genetic testing in seven international tertiary referral centres worldwide. A positive genotype was defined as the presence of ‘pathogenic’ or ‘likely pathogenic’ (P/LP) variants. The study outcome was all-cause mortality. 184 patients over age 60 years (56% females, mean age 67 ± 6 years, mean left ventricular ejection fraction 32 ± 10%) were studied. Sixty-six patients (36%) were carriers of a P/LP variant. Titin truncating variants (TTNtv) were the most prevalent (present in 25% of the total population and accounting for 69% of all genotype-positive patients). During a median follow-up of 42 months (interquartile range: 10–115), 23 patients (13%) died; 17 of these (25%) were carriers of P/LP variants while six patients (5.1%) were genotype-negative (P < 0.001).

Conclusions

In the largest series worldwide, to date, of patients with late-onset DCM, we found a high prevalence of female sex and a high genetic mutation burden, largely due to TTNtv. Patients with a positive genetic test had higher mortality than genotype-negative patients. These findings support the extended use of genetic testing also in the elderly.
415 Correlation between tissue abnormalities and myocardial deformation indices in arrhythmogenic cardiomyopathy: a pilot study
Authors: De Luca Antonio , Cappelletto Chiara , Perotto Maria , Stolfo Davide , Merlo Marco , Sinagra Gianfranco
Published: December 2021

Aims

To evaluate the correlation between cardiac magnetic resonance (CMR) tissue abnormalities and impairment of myocardial deformation indices in patients with definite diagnosis of arrhythmogenic cardiomyopathy (AC).

Methods and results

41 AC Patients with available CMR study were enrolled. Myocardial deformation indices (i.e. global longitudinal strain -GLS-; global circumferential strain -GCS-; global radial strain -GRS-) for both ventricles were calculated using feature tracking analysis. Quantification of tissue abnormalities (i.e. late gadolinium enhancement -LGE- extension expressed as percentage of total ventricular mass) was performed. Spearman’s rho correlation was evaluated. Mean age was 44 ± 13 years and 26 (63%) patients were male. Mean left ventricular (LV) ejection fraction (EF) was 54 ± 10% and mean right ventricular (RV) EF was 49 ± 12%. Median LV LGE extension was 8.9% (1.05–21) and median RV LGE extension was 0 (0–6.92). All myocardial deformation indices were moderately associated with LGE extension (for LV 3D GLS Spearman’s Rho 0.423, P 0.016; 2D GCS Spearman’s Rho 0.388, P 0.028; 3D GCS 0.362, P 0.042; 2D GRS Spearman’s Rho −0.417, P 0.018; 3D GRS −0.396, P 0.025; for RV 2D GLS Spearman’s Rho 0.385, P 0.030; RV GCS Spearman’s Rho 0.450, P 0.010; RV GRS Spearman’s Rho −0.459, P 0.008).

Conclusions

All myocardial deformation indices showed a moderate association with LGE extension in a cohort of patients with definite AC. Further studies are needed to validate this observation and understand its implications.
423 Prevalence and prognostic significance of atrial arrhythmias in arrhythmogenic cardiomyopathy
Authors: De Luca Antonio , Cappelletto Chiara , Romani Simona , Perotto Maria , Gregorio Caterina , Barbati Giulia , Stolfo Davide , Merlo Marco , Sinagra Gianfranco
Published: December 2021

Aims

Limited data are available concerning atrial arrhythmias (AA) role in arrhythmogenic cardiomyopathy (AC). The aim of the present study was to assess the prevalence and incidence of AA in a large cohort of AC patients and to evaluate its association with clinical outcomes.

Methods and results

We retrospectively analysed 115 patients with definite diagnosis of ARVC, according to 2010 Task Force Criteria, enrolled in the Trieste Heart Muscle Disease Registry. Subjects were further classified into two phenotypic variants, based on ventricular involvement: right-dominant and biventricular form. Uni- and multivariable, extended Kaplan-Meier and cumulative incidence function analysis were performed, as appropriate, for the primary composite endpoint of death and heart transplant (HTx) and for the two distinct secondary endpoints of: (i) death, HTx and first heart failure (HF) hospitalization; (ii) first major ventricular arrhythmias (MVA). Mean age of patients at the time of enrollment was 39 ± 16 years and 80% were male. 73 patients (63%) had a right-dominant form, while 42 (37%) presented a biventricular involvement. AA occurred in the 26% of our study population at baseline or during a median follow-up of 214 months (IQR: 105–311), with a non-significant trend in higher cumulative incidence of AA in patients with biventricular form. At baseline, patients experiencing AA were older (44 ± 18 vs. 37 ± 15 years, P = 0.044) and had larger atrial dimensions, in particular of the right atrium (RA) (23, IQR: 19–27 vs. 18, IQR: 15–25 cm2, P < 0.007). AA emerged as independently associated to death/HTx (HR 2.68, 95% CI: 1.02–7.05, P = 0.046) along with NYHA class >2 (HR: 7.08, 95% CI: 2.50–20.1, P < 0.001) and RA area (HR: 1.05, 95% CI: 1.01–1.09, P = 0.011). Consistently, AA were also independently associated with the secondary endpoint of death/HTx/HF hospitalization (HR: 2.50, 95% CI: 1.06–5.88, P = 0.036), together with NYHA >2, the presence of biventricular involvement, higher RA and left atrium area. Finally, AA did not emerge as independently correlated to MVA during follow-up.

Conclusions

This observational long-term study suggests that AA were common in patients with AC and were independently associated with poor outcomes, mostly related to HF events. A prompt identification throughout the follow-up of AA appears relevant in improving the clinical management of AC patients.
403 Acute myopericarditis after mRNA COVID-19 vaccine
Authors: Sciaccaluga Carlotta , D’Ascenzi Flavio , Cameli Matteo , Gallotta Milena , Menci Daniele , Antonelli Giovanni , Banchi Benedetta , Mochi Veronica , Valente Serafina , Focardi Marta
Published: December 2021

Aims

Cases of myocarditis and myopericarditis after mRNA COVID-19 vaccines have been reported, especially after the second dose and in young males. Their course is generally benign, with symptoms onset after 24–72 h from the dose.

Methods and results

We report two cases of myopericarditis after the second dose of the mRNA-1273 COVID-19 vaccine in two young males, 20-years old and 21-years old. Both the patients were administered the vaccine on the same day. They both experienced fever on the same day of the vaccine and symptoms consistent with myopericarditis three days after the dose, which was confirmed by cardiac magnetic resonance. Figure 1 summarizes the main non-invasive findings that suggested and confirmed the diagnosis of acute myopericarditis. The disease course was benign in both patients, and only one patient presented rare ventricular arrhythmias on the admission day. They were both discharged on the 9th day of the in-hospital stay.

Conclusions

Myopericarditis is usually considered an uncommon adverse reaction after various vaccinations, reported also after the mRNA COVID-19 vaccine. Several explanations have been proposed, including an abnormal activation of the immune system leading to a pro-inflammatory cascade responsible for myocarditis development. The temporal aspect of these case reports is rather peculiar and it is useful to underscore that both vaccines belonged to the same batch of vaccines. However, despite these cases, vaccination against COVID-19 far outweighs the risk linked to COVID-19 infection and remains the best option to overcome this disease. 403 Figure
501 Investigating the epidemiology of cardiac amyloidosis: design of the ‘cardiac amyloidosis registry’ (CARRY)
Authors: Vergaro Giuseppe , Castiglione Vincenzo , Mandoli Giulia Elena , Aimo Alberto , Cappelli Francesco , Ambrosio Giuseppe , Olivotto Iacopo , Emdin Michele , Cameli Matteo
Published: December 2021

Aims

Amyloidosis are a group of diseases characterized by the extracellular deposition of amyloid fibrils. The two most common forms of cardiac amyloidosis (CA) are caused by the accumulation of immunoglobulin light-chains (AL) or transthyretin (ATTR). While previously considered as a rare disease, increased awareness and recent advances in diagnostic tools have shown that prevalence of CA is likely underestimated. Nonetheless, large-scale population registries of CA, also focusing on the pathways leading to the final diagnosis, are still missing.

Methods and results

The Cardiac Amyloidosis RegistRY (CARRY) is an observational, prospective, multicentre study endorsed by the Italian Society of Cardiology (Sezione Regionale Tosco-Umbra), collecting data from in- and outpatients referred with the clinical suspicion of CA. Clinical, laboratory (including natriuretic peptides and high-sensitivity troponins), and echocardiographic data at enrollment will be collected. Detailed information about the diagnostic procedures up to the final diagnosis of either CA or mimicking conditions will be registered. Patients with a diagnosis of CA will be followed up, and the baseline assessment will be repeated at 1-year (Figure). Twenty centres in Tuscany and Umbria, including amyloidosis referral centres as well as second-level Hospitals, are contributing to the CARRY registry. A common, web-based, case report form is being used for data collection. Recruitment begun in July 2021 and will end in July 2022. The first interim analysis is planned in January 2022.

Conclusions

The CARRY registry is expected to give novel information on the epidemiology of CA, with a focus on the incidence and diagnostic pathways of CA in Tuscany and Umbria, setting the bases for a larger nationwide registry. Clarification of the epidemiology of CA through the data from the CARRY registry may prove useful in the next future for either clinicians and policy makers. FigureStudy flow chart of the CARRY registry.
596 Multidisciplinary in-depth investigation in a young athlete suffering from syncope caused by myocardial bridge
Authors: Brancaccio Mariarita , Cesaro Arturo , Monda Emanuele , D'Argenio Valeria , Casaburi Giorgio , Mazzaccara Cristina , Limongelli Giuseppe , Calabro Paolo , Lombardo Barbara , Scudiero Olga , Frisso Giulia
Published: December 2021

Aims

Laboratory medicine along with genetic investigations are taking on an increasingly important role in monitoring athlete’s health conditions. Acute or intense exercise can lead to metabolic imbalances, muscle injuries, or can point up cardiovascular disorders.

Methods and results

This study aimed to monitor the health status of a basketball player, through an integrated approach including biochemical and genetic investigations and advanced imaging techniques, to shed light on the causes of recurrent syncope he experienced during exercise. Biochemical analyses showed that the athlete had abnormal iron, ferritin, and bilirubin levels. Coronary computed tomographic angiography highlighted the presence of an intramyocardial bridge, suggesting this may be the cause of the observed syncopes. The athlete was excluded from competitive activity. To understand if this cardiac malformation could be caused by an inherited genetic condition, both array-CGH and whole exome sequencing were performed. Array-CGH showed two intronic deletions involving MACROD2 and COMMD10 genes, which could be related to the congenital heart defect; the whole exome sequencing highlighted the genotype compatible with the Gilbert syndrome. However, no clear pathogenic mutations related to the patient’s cardiological phenotype were detected, even after applying machine learning methods.

Conclusions

This case highlights the importance and the need to provide exhaustive personalized diagnostic work-up for the athletes to cover the cause of their malaise, safeguarding their health. This multidisciplinary approach can be useful to create ad personam training and treatments, thus avoiding the appearance of diseases and injuries which, if underestimated, can become irreversible disorders and sometimes can lead to the death of the athlete.
799 Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis
Authors: Serio Alessandro , Iodice Franco , Sperlongano Simona , Di Vilio Alessandro , Radmilovic Juri , Gambardella Francesco , Picano Eugenio , D'andrea Antonello , Golino Paolo , Carbone Andreina
Published: December 2021

Aims

The real effects of the chronic consumption of anabolic–androgenic steroids (AAS) on cardiovascular structures are subjects of intense debate. Aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS.

Methods and results

115 top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. LA volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), PASP (beta = 0.43, P < 0.001) at peak effort, and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data.

Conclusions

STE represents a promising technique to assess RV myocardial function in athletes abusing steroids. AAS users showed a more impaired RV deformation, closely associated with reduced functional capacity during physical effort, and—during exercise—more pulmonary congestion.
4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis
Authors: Maiello Maria , Cecere Annagrazia , Ciccone Marco Matteo , Palmiero Pasquale
Published: December 2021

Aims

The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients.

Methods and results

We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P < 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P < 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity.

Conclusions

We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.
427 The role of virtual visits in cardiology: from the pandemic era to future perspectives
Authors: Mei Mariachiara , Di Iorio Martina , Bernardini Alessia , Magnocavallo Michele , Vetta Giampaolo , Piro Agostino , Giunta Giuseppe , Quaglione Raffaele , Chimenti Cristina , Trivigno Sara , Mitacchione Gianfranco , Fedele Francesco , Schiavone Marco , Forleo Giovanni Battista , Lavalle Carlo
Published: December 2021

Aims

During the Coronavirus Disease 2019 (COVID-19) pandemic in-person visits were reduced to prevent potential risk of exposure. Virtual visits (VVs) represent an innovative model to take care of patients with cardiac implantable electronic devices (CIEDs). The aim of this study is to evaluate the safety and feasibility of VV in the management of CIED patients.

Methods and results

We performed a prospective study including all CIED patients who received a VV from July 2020 to July 2021. Blood pressure, arterial oxygen saturation, heart rate, and body weight were registered by the patient. Moreover, we sent to the patient a questionnaire to evaluate the patients’ satisfaction about VV. We enrolled 182 patients in the study period. The mean age of patients was 70.2 ± 13.5 years-old and the majority (61.1%) was male. In two cases, VVs were not performed due to technical issues. Overall, 70.9% of patients utilized a smartphone, while 20.1% and 9% used, respectively, a tablet or a personal computer. The mean duration of VV was 27.8 ± 7.8 min. Patients helped by a caregiver were 64 (35.2%). One urgent/emergent in-person visit was performed in a patient with acute heart failure. Overall, VV was preferred to in-person evaluation.

Conclusion

VV is a safe and feasible approach to follow-up CIED patients. A high degree of patient satisfaction was reached after VV. The use of VV has promising potential and should be implemented beyond COVID-19 period and integrated in the healthcare system as a new model of care.
229 Long-term clinical and echocardiographic outcome following TAVR in patients with severe aortic stenosis and different transvalvular flow state
Authors: Fusini Laura , Muratori Manuela , Tamborini Gloria , Ali Sarah Ghulam , Gripari Paola , Mantegazza Valentina , Roberto Maurizio , Trabattoni Piero , Agrifoglio Marco , Bartorelli Antonio , Alamanni Francesco , Pontone Gianluca , Pepi Mauro
Published: December 2021

Aims

Haemodynamic classifications of severe aortic stenosis (AS) have important prognostic implications, with low flow state (defined on the basis of a stroke volume index, SVi<35 mL/m2) known to be a predictor of worse prognosis. As transcatheter aortic valve replacement (TAVR) has become widely used for patients with severe AS, issues were raised concerning its efficacy in patients with different haemodynamic classifications combining transvalvular flow state and pressure gradients. In fact, data on TAVR outcomes in patients with low gradient (LG) AS are limited and in some cases controversial. The aim of this study was to evaluate the efficacy and long-term clinical and echocardiographic outcome of TAVR in patients with different transvalvular flow-gradient patterns.

Methods

In this single centre study, 1078 patients (mean age 81±7 years) with severe symptomatic AS (AVA<1 cm2) undergoing TAVR were categorized according to flow-gradient patterns as follow: 867 patients (80%) with normal flow-high gradient (NF-HG: mean transaortic gradient DP mean>40 mmHg), 94 (9%) with paradoxical low flow LG (pLF-LG: DP mean<40 mmHg, ejection fraction EF > 50%, and SVi<35 mL/m2), and 117 (11%) classical LF-LG (DP mean<40 mmHg, EF < 50%, SVi<35 mL/m2).

Results

TAVR was feasible in all AS subtypes with similar rate of unsuccessful procedure (1.3% NF-HG, 1.1% pLF-LG, 0% LF-LG P=470). Valvular function after TAVR was excellent over time with respect to aortic pressure gradient (mean and peak) and aortic valve area regardless of flow state group (Figure A). Overall, intraoperative (P=957) and 30-day mortality (P=817) did not differ significantly among the 3 groups. Longer follow-up showed that, compared to NF-HG patients, pLF-LG had similar all-cause mortality rate [HR 1.35(0.95–1.90), P=0.094] up to 5 years and LF-LG had a significant higher mortality rate [HR 1.89(1.43–2.49), P<0.001],(Figure B). Moreover, LF-LG patients had higher rehospitalization for heart failure (NF-HG: 3%, pLF-LG: 6%, LF-LG 10%, P=0.001).

Conclusions

We provided evidence that TAVR is an effective procedure in all patients with severe AS regardless of transvalvular flow-gradient patterns. A careful haemodynamic classifications of severe AS is of utmost importance for identifying patients who benefits the most from TAVR procedure.
Effects of mannan oligosaccharides andLactobacillus mucosaeon growth performance, immune response, and gut health of weanling pigs challenged withEscherichia colilipopolysaccharides
Authors: Li Yanshuo S , San Andres Joice V , Trenhaile-Grannemann Melanie D , van Sambeek Dana M , Moore Kelly C , Winkel Shana M , Fernando Samodha C , Burkey Thomas E , Miller Phillip S
Published: December 2021

Addition of pre- and probiotics may confer growth and health benefits when added to the diet of pigs. To determine the effects of feeding mannan oligosaccharide (MOS) and Lactobacillus mucosae (LM) as prebiotic and probiotic sources in weanling pigs under immune challenge, 96 weaned pigs were randomly allotted to 16 experimental pens within a 2 × 2 factorial arrangement of treatments. Control diets with or without 0.1% yeast-derived MOS were randomly assigned to pens and 109 cfu/pig LM broth or a control broth were top-dressed daily. Pigs were fed one of four dietary treatments (control, MOS, LM, and MOS+LM) in Phases I and II (days 0 to 7 and days 7 to 21 postweaning, respectively) and a common diet during Phase III (days 21 to 35 postweaning). On day 14, all pigs were challenged with 100 µg/kg body weight (BW) Escherichia coli lipopolysaccharide (LPS) via intraperitonial injection. Feed disappearance and pig BW were measured weekly. Blood and fecal samples were collected weekly, and additional blood samples were collected on days 1 and 3 post-LPS challenge. On days 15 and 21, one pig per pen was euthanized for collection of ileal mucosa and duodenal and ileal tissue samples. From days 0 to 14, feeding LM decreased gain-to-feed ratio (G:F; P < 0.05). An interaction between LM and MOS was observed for G:F on days 14 to 21 (P < 0.05); G:F in LM (715 g/kg) was greater compared with MOS+LM (P < 0.05; 600 g/kg) and control (P < 0.10; 615 g/kg), but was not different (P > 0.10) from MOS (674 g/kg). After pigs were fed a common diet (days 21 to 35), G:F was decreased (P < 0.05) in the LM treatment groups. Pigs fed diets that included MOS had increased serum immunoglobulin (Ig) G on days 1 and 3 post-LPS challenge and 2 wk after removal of treatments (P < 0.05) and on days 14 and 21 postweaning (P < 0.10) compared with pigs fed diets without MOS. On day 15, mucosal immunoglobulin G was increased (P < 0.05) in control vs. MOS and LM groups. Circulating IL-1β in control and MOS+LM pigs increased (P < 0.05) on day 1 post-LPS challenge but did not change (P > 0.10) in MOS and LM groups. On day 15, pigs fed LM had decreased (P < 0.05) ileal crypt depth compared with pigs fed the control diet. On day 21, fecal propionate and butyrate tended to be lower (P < 0.10) in pigs fed MOS vs. control and MOS+LM diet. These preliminary findings suggest that feeding LM alone improved feed efficiency and ileal morphological structure during the first week of LPS challenge; additionally, feeding LM and MOS may have beneficial effects relative to immune biomarkers.