bluuebunny/crossref_metadata_2025 huggingface dataset:
PULMONARY EMBOLISM: FROM MANAGEMENT IN THE EMERGENCY ROOM TO THE APPROPRIATENESS OF HOSPITALIZATION. INTRO-HOSPITAL SHARED MANAGEMENT ORGANIZATIONAL MODEL
Authors: Girasoli C , Picciolo A , Colonna G
Published: May 2024

Introduction

Pulmonary Embolism (PE) represents the final effect of the sudden obstruction of the pulmonary artery or one of its branches by an embolus and is burdened by high mortality when not promptly and adequately treated. The clinical presentation is often non-specific, which explains the diagnostic difficulty and the frequent autopsy finding of PE: 90% of fatal cases occur in patients who have not undergone treatment due to the failure to formulate the diagnostic suspicion, while less than 10% of all deaths occur in treated patients.

Materials and Methods

The established intra-hospital management path arises from the integration between clinical suspicion, first level diagnostic tests (ECG, EGA, chest x-ray, blood chemistry tests) and pre-test clinical probability (Wells, modified Geneva). In patients with Wells 0 to 4 and negative D-dimer, the diagnosis of PE can be excluded; in other cases a pulmonary CT angiography is performed. The sPESI Score with troponin measurement and echocardiogram are used in patients with diagnosis of high-risk PE for prognostic stratification and to identify the destination of hospitalization.

Results

The comparison of the epidemiological data regarding PE between 2021 and 2023 allowed us to verify how, thanks to the intra-hospital shared management process, a different distribution of hospitalizations was obtained in the Operating Units involved: hospitalizations in Cardiology are reduced by 50%; on the contrary, admissions to Internal Medicine increased by 60% in 2022, remaining stable in 2023; hospitalizations in the Pneumology Operating Unit are stable. Admissions to other departments of the hospital for patients suffering from other important prevalent co-morbidities went from 3% to 7%.

Conclusions

The clinical presentation of PE is often non-specific, which explains the diagnostic difficulty and the frequent autopsy finding of PE not diagnosed during life. We have established an internal management process ensuring the correct diagnostic classification and timely treatment, through stratification according to risk class and identifying the most appropriate hospitalization setting.
MANAGEMENT OF REMOTE MONITORING FOR IMPLANTABLE DEVICES CONTROLS: SINGLE CENTER EXPERIENCE
Authors: Bolognesi M , Rossi L , Biagi A , Bricoli S , Sticozzi C , Comastri G , Puccio F , Montedoro A , Aschieri D
Published: May 2024

Background

Nowadays the benefits of remote monitoring (RM)of cardiac implantable electronic devices (CIEDs) are Known: an improved both device surveillance and patient clinical management and a decrease in office follow up. So RM is used as supplement in clinic follow up for patients with CIED.However despite decades to RM utilization there are challenges in managing patients with RM including large number of trasmissions and lack of trained staff. There are many different model of care to RM management.

Methods

We describe our model of care to management CIED recipients with RM considering data collected from January 2021 to November 2023.

Results

Our model of care consists of 4 electrophysiologists Physicians and 4 Tecnicians. RM enrollment is performed at scheduled in office visit after ten days from hospital discharge after device implantation. implantable cardiac device(ICD)recipients with RM are annualy followed in office and biennal for pacemaker (PM) recipients and they send every three months transmissions. Trained tecnicians gives home monitor, take care of patients education and collected and screen transmissions. Tecnicians inform immediately physicians in case of urgent alert (shock or antitachicardia pacing therapy (ATP), sustained ventricular tachycardia(TV), ventricular fibrillation (Fv) indicator of elective replacement (ERI), lead releted alert or noise). Physician contact patients the same day (exept Saturday and Sunday). In addiction Physicians twice a week review less urgent and scheduled transmissions and call the patients by phone for visit in office for patients with low rate of biventricular pacing, detection of atrial fibrillation. We have 1000 patients with RM: 746 ICD recipients (103 Biotronik, 150 Abbott, 200 Boston scientific, 293 medtronic), 50 implantable cardiac monitor (ICM) recipients and 204 PM recipients. We analyze 12721 transmissions.Considering ICD recipient we detect 96 episode of ATP and 31 of shock. Shock of ICD was registered in 52 patients (6,9%)We received 1982 atrial fibrillation (AF) detection, with 35 for new detectable AF.The most of transmisisone were for low bIV pacing. We contacted these patients by phone about clinical status and in some case we called them in office.

Conclusions

Our model of care allows to control a large number of trasmissions with fast management of urgent alert trasmissions.
TIMES, ARE THEY A–CHANGING? IMPLANTATION AND FOLLOW–UP EXPERIENCE WITH LEADLESS PACEMAKERS (MICRA) AT PISA UNIVERSITY HOSPITAL
Authors: Barletta V , Parlato A , Tamborrino P , Parollo M , Sbragi S , Canu A , Di Cori A , Grifoni G , Segreti L , De Lucia R , Viani S , Paperini L , Soldati E , Bongiorni M , Zucchelli G
Published: May 2024

Background

Leadless pacing represents a pivotal advancement in cardiac stimulation. Eliminating traditional pacing leads, leadless devices offer reduced complications, a bailout strategy for many previously challenging cases and streamlined procedures.

Purpose

This retrospective study aimed to compare, starting from December 1st 2023, newer implants (within the 3 years preceding Dec 1st 2023) and older implants (>3 years before) in a single–center experience with M–TPS (Micra Transcatheter Pacing System) in terms of safety and efficacy, at baseline and in a short–term follow–up (6 months).

Methods

A comprehensive analysis was conducted on 195 patients who underwent leadless pacemaker implantation at our Center, and that were followed–up for a minimum of 6 months. The cohort was stratified into two groups: recent (n=73) and less recent implants (n=122). Procedural variables, patient demographics, and clinical outcomes were documented. Post–implantation follow–up data include pacing threshold, fluoroscopy time, and other relevant variables.

Results

Comparison between the two groups revealed significant differences fluoroscopy time. Newer implants demonstrated a reduced fluoroscopy time [8 (IQR 5–12) vs 10 minutes (IQR 7–14)], suggesting potential advancements in technique. No significant differences were observed in other procedural or electrical parameters. Discussion: The comparison between older and newer leadless pacemaker implants reveals reassuring constancy in most parameters, suggesting the reliability of the M–TPS. The reduced fluoroscopy time aligns with the evolving proficiency of implanters and improved procedural efficiency. The dependable consistency observed across various parameters strengthens the confidence in the M–TPS, reinforcing its status as a reliable and effective solution for pacing.

Conclusion

The implantation and follow–up experience at our center elucidates very few differences between newer and older implants. This nuanced analysis contributes to the ongoing evolution of leadless pacemaker technology, which heralds a transformative era in cardiac care. With several years of implementation, accumulated follow–up data unveils valuable insights into its sustained effectiveness, guiding clinicians in optimizing patient outcomes and solidifying leadless pacing as a breakthrough in the realm of cardiac rhythm management.
SAFETY AND EFFICACY OF A SINGLE PROCEDURE OF EXTRACTION AND REIMPLANTATION OF INFECTED CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE (CIED) IN COMPARISON WITH DEFERRAL TIMING: AN OBSERVATIONAL RETROSPECTIVE MULTICENTRIC STUDY
Authors: Sordelli C , Tascini C , Fele N , Weisz S , Guarino A , Verde R , De Vivo S , Corrado S , Severino S
Published: May 2024

Background

Infections are among the most frequent and life–threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single–procedure device extraction and contralateral implantation versus the standard–of–care (SoC) two–stage replacement for infected CIEDs.

Methods

We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure.

Results

Considering those lost to follow–up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single–procedure group and 84.6% in the SoC group (p = 0.075).

Conclusions

Single–procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED–dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single–procedure reimplantation.
HYBRID TRANSVENOUS AND SURGICAL APPROACH FOR THE EXTRACTION OF CORONARY SINUS LEADS: A CASE SERIES
Authors: Arabia G , Cerini M , Calvi E , Bellicini M , Falco R , Curnis A
Published: May 2024

Transvenous lead extraction (TLE) is the standard therapy for cardiac device–related infection, however sometimes the procedure cannot be completed through the transvenous route alone and it is necessary to rely on other techniques. Hybrid surgical and transvenous approach can be useful in these cases. We present 3 cases of hybrid surgical and transvenous approach. A 64–year–old male patient with a cardiac resynchronization therapy defibrillator (CRT–D) implanted in 2011, with an active–fixation coronary sinus (CS) lead. In order to perform the extraction, a locking stylet was inserted in the CS lead, then a mechanical sheath was advanced over the lead itself, however failing in detaching the lead from the surrounding adhesions. The lead was then extracted by left mini–thoracotomy. A 60–year–old male was implanted with a CRT–D in 2012. After the transvenous extraction of atrial and ventricular leads, we attempted to extract the coronary sinus lead, positioned in the anterolateral vein, using a locking stylet, telescoping mechanical sheaths, a 9 Fr hand–powered rotational sheath, and a 16–Fr excimer laser sheath. The lead was extensively fibrosed and could only be retrieved to the proximal part of the vein, approximately 2 cm from the body of the coronary sinus. Considering the high operative risk, a sternotomy was performed with complete extraction of the CS lead. A 74–year–old male was implanted with a CRT–D in 2012, with a bipolar CS lead positioned in the posterolateral vein. During CS lead extraction we firstly used a locking stylet, followed by the introduction of telescopic mechanical sheaths which ceased to advance at 3 cm from the tip of the lead due to strong fibrosis. The procedure was interrupted due to the risk of coronary sinus tear and a left minithoracotomy was performed, effective in the removal of the lead. Sometimes the TLE procedure cannot be completed through the transvenous route alone and there is a need for an hybrid approach with the aid of a cardiothoracic surgeon. Hybrid surgical and transvenous approach can be useful in these cases.
LDL TARGET IN PATIENTS WITH HIV AT HIGH CARDIOVASCULAR RISK: THE ROLE OF BEMPEDOIC ACID
Authors: Gatto M , Moschella Orsini F , Passarelli I , Antinori A
Published: May 2024

Background

Previous observational studies have shown that 70% of HIV–infected patients have clinical conditions that classify them at high or very high cardiovascular risk. Among these patients, only 12% succeed in achieving a target LDL < 55 mg/dl in accordance with the latest ESC guidelines.

Aim

To evaluate the impact of bempedoic acid therapy in achieving the LDL target for HIV–infected patients.

Methods

From April 2023 to September 2023, all HIV–infected patients referred to our dedicated cardiology outpatient clinic were consecutively screened. Inclusion criteria were: acquisition of informed consent, high cardiovascular risk (defined in accordance with the latest ESC guidelines), need to optimize anti–dyslipidemic therapy to achieve LDL target < 55mg/dl. Planned follow–ups were at 3 and 6 months. Clinical and laboratory data were collected in spreadsheets and analyzed with GraphPad Prism 8.

Results

Thirty–two patients were enrolled, 94% male with a mean age 61±4 years. At baseline the laboratory’s data (mean ± SD) were: total cholesterol 202±50 mg/dl, LDL 130±40 mg/dl, HDL 56±15 mg/dl, triglyceride 105±24 mg/dl. The 75% of patients was on statin+ezetimibe, but only 37% of them were taking high–intensity statins. No patients reached the target of LDL < 55 mg/dl and, therefore, all patients were prescribed bempedoic acid 180 mg/day. At three months of follow–up, all patients were compliant with bempedoic acid therapy, and none reported any side effects; the laboratory monitoring of the lipid profile showed a mean LDL 80±35 mg/dl, –39% from baseline and a mean total cholesterol of 156±44 mg/dl, –26% from baseline. The 12% of patients reached LDL target < 55 mg/dl with a reduction >50% from baseline.

Conclusion

The use of bempedoic acid, in addition to statin+ezetimibe therapy, or ezetimibe alone in statin–intolerant patients, reduces baseline LDL by 39% and achieves the guideline–recommended LDL target in 12% of cases with an excellent safety and tolerability profile in HIV–infected patients.
EARLY MOBILIZATION POST ACS: IMPACT OF QUALITY IMPROVMENT NURSING PROJECT
Authors: Barp L , Pacucci N , Melillo F , Gallizioli E , Lanno V , Massi S , Berardinelli E , Patrignani S , Contino V , Ottaviani V , Pagnini N , Tarsi G , Cantarini L , Battistini A , Frassini S , Rasori S
Published: May 2024

Background

Acute Coronary Syndrome (ACS) accounts for about seven million deaths every year. Early mobilization is needed to optimize health status in ACS patients as recommended by current European Society of Cardiology (ESC) Guidelines and American Heart Association (AHA) guidelines.

Aims

Evaluate the impact of a quality improvement nursing project on early mobilization after ACS, analyzing data before and after the implementation of an evidence–based company protocol.

Materials and Methods

From 04/01/2023 to 30 /07/2023 the first data collection phase (baseline) took place detecting mobilization times and complications in patients according to the habits of the care setting in the ICCU. A protocol was then created and implemented. The second data collection phase (post implementation) began on 01/09/2023 and will end on 31/12/2023 with the same data collection method. Data were collected consecutively in patients admitted to the ICCU of the AST Pesaro/Urbino (S.Salvatore Pesaro establishment) because of uncomplicated ACS, patients were self–sufficient at home, without cognitive disorders and comorbidities limiting mobilization, absence of femoral introducer. Data collection form was created containing: personal data, medical diagnosis, patient characteristics, complications during mobilization, Troponin I value.

Results

50 patients were enrolled at baseline and post–implementation data collection is still underway. From an initial analysis of the data, an average reduction in the length of stay of 6.19%, equal to 0.43 days, was recorded. Patients in the experimental group developed a lower complication rate than the control group (9% vs 4.52%) with a reduction in the complication rate of 4.48%.

Conclusions

The implementation of the protocol allows a standardization of assistance in the mobilization of patients, also guaranteeing psycho–physical benefits. The first results highlight a reduction in hospitalization times and complications related to mobilization. Further data will be analyzed at the end of data collection on 12/31/2023. Limitations: low sample size and unfavorable environment (absence of telemetry and nearby toilets).
THE TALK TEST AS A VALUABLE REHABILITATION TOOL IN PATIENTS WITH HEART FAILURE
Authors: Scalabrino N , Crespi L , Lazzarini E , Colombo F , Guzon S , Saporiti L , Picozzi A
Published: May 2024

Aim

To determine whether a rehabilitation program for heart failure patients in interval training, established by Talk Test, is more effective than the protocol in endurance training set by 6MWT.

Materials and Methods

For this retrospective study, 32 subjects with reduced left ventricular ejection fraction (LVF) <40%, enrolled at the outpatient decompensation clinic of Multimedica Castellanza, age 40–75 years, without neurological, oncological and orthopedic comorbidities were evaluated. Half of the patients worked in endurance training on the basis of the 6MWT. Observed patients who performed endurance training were placed in the control group (GC) while half of the patients who worked in interval training were placed in the study group (GS). All patients were evaluated before the start of ambulatory training (T0) and were assessed by: 6MWT, SPPB, Gait Speed and Sit to Stand. GS subjects underwent Talk Test and worked in interval training. After 3 weeks (T1), at the end of the physical training program, all patients were reassessed with the same tests performed at T0. After 3 months after the end of the outpatient rehabilitation cycle (T2), all patients were evaluated by cycle ergometer stress test.

Results

A nonparametric statistical analysis was used; the two groups were homogeneous with each other at T0. The data obtained showed a statistically significant improvement in functional ability for both groups. The GS obtained better functional results than the GC, especially in 6MWT, Gait Speed and Sit to Stand. At T2, by exercise test, the GS subjects obtained better results than the GC, moreover, there was a statistically significant difference in maximum load in watts at stress test (p<0.04). All patients on echocardiography performed at follow–up (T2) showed a significant increase in ejection fraction. Recovery of left ventricular contractile function in the GS appears to be more significant.

Conclusions

Both workouts can be considered valuable in the treatment of patients with heart failure but interval training was found to be the better choice and the one that could maintain the results obtained longer over time. The Talk Test proved to be a valuable tool to set higher loads in the absence of cardiopulmonary testing.
ASSESSMENT MANAGER A NEW DIGITAL PLATFORM FOR REHABILITATION CARDIOLOGY: PRACTICAL, EVALUATIVE AND PRESCRIPTIVE ASPECTS
Authors: Camera F , Caligari M , Marconi M , Monina E , Mazza A
Published: May 2024

Physical activity is a real medicine for preventing and treating a wide range of diseases, its prescription must have the same precision and accuracy in order to optimize the effects avoiding at the same time clinical risks since patients are often frail. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of the" Internet of Things (IoT),"is based on the idea of "smart" objects interconnected with each other to exchange the information possessed, collected and/or processed. All this will allow real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine, and cloud computing begin to enable an integration of people, equipment and data.

Aims

To evaluate whether an assessment procedure with digital Assessment Manager® (AM) support, can optimize the execution and writing time of the physiotherapy assessment.

Materials and Methods

We evaluated 751 patients admitted to the Cardiology Rehabilitation Unit using a Tablet with AM® software exclusively from the following integrated care pathways: Chronic Heart Failure, Acute Coronary Syndrome and Post Cardiac Surgery Syndrome. Discussion on the use of Assessment Manager. In the hospital setting, patient assessment is a crucial moment, and in this context AM® is a tool that allows the easy collection of a series of assessment data through questionnaires, tests, and validated clinical scales, and the instant compilation of a complete physiotherapy assessment. The other key aspect is that the system sends all data and findings in real time to the Health Information System called Galileo for immediate consultation accessible to all ward staff. This facilitates communication in the hospital environment, helping to reduce errors and reporting times.

Results

Among the practical considerations, analysing the timing of the ‘standard‘ CRP evaluation and comparing 20 patients divided into two groups (group evaluated with AM and group evaluated with paper), a time saving assessable around 30% is noted, but what is the added value is the standardisation of the evaluation procedures, as tools that make the performance of the activities as objective, systematic and verifiable as possible, especially in cases of high rehabilitation complexity, ultimately a higher ‘quality‘ of the results, obviously important for scientific research.
EVALUATION OF THE EFFECTIVENESS OF VIDEO SUPPORT FOR HOME PHYSICAL ACTIVITY MAINTENANCE IN CARDIAC SURGERY PATIENTS POST–DISCHARGE
Authors: Scalabrino N , Crespi L , Lazzarini E , Cavalleri N , Rossi M , Saporiti L , Picozzi A
Published: May 2024

Introduction

A difficulty in maintaining a regular post–hospitalization physical activity program by cardiac surgery patients is reported in the literature. This reduces the long–term benefit that a cardiac rehabilitation program can provide, and therefore it has become increasingly relevant to understand how to maintain high compliance in these patients.

Purpose

To evaluate whether a video support containing specific exercises can be more effective in maintaining adherence to physical activity, compared with the paper–only support in use at the specialist cardiac rehabilitation department of Multimedica, Castellanza.

Materials and methods

patients <65 years old, after cardiac surgery, with preserved left ventricular ejection fraction (LVEF), without orthopedic neurological and oncological comorbidities. All subjects at discharge were divided into two groups by simple randomization. GC (control group): 15 patients who were given a paper discharge program containing examples of exercises to be performed at home. GS (study group): 15 patients, also given the paper discharge program containing exercises to be performed at home plus a video support representing the same exercises.

Outcome Measures

6MWT (6–minute walking test), SPPB (short physical performance battery), 30"STS (sit to stand), 10m GST (Gait speed test), carried out upon discharge (T0) and 2 months after discharge (T2). In addition, an Adherence Questionnaire was given at 1 month after discharge T1 and 2 months after discharge (T2).

Results

At 2 months after discharge (T2), both groups maintained the functional autonomy obtained during hospitalization. In the GS, a statistically significant increase (p<0.05) was observed in meters walked at 6MWT, walking speed over 10 m, sit to stand (STS) and adherence to the home program (questionnaire).

Conclusions

Video support was found to be effective in maintaining adherence to the proposed home physical activity program. All patients in possession of the video continued their home exercise consistently, keeping the benefits, which were visible in follow–up evaluations with statistically significant results (p<0.05).
LONG–TERM FOLLOW–UP IN PATIENTS ON PCSK9 INHIBITOR THERAPY: COMBINING FAST TRACK STRATEGY AND OUTPATIENT MANAGEMENT
Authors: Matteucci A , Alonzo A , Castello L , Spinelli A , Marino G , Schiaffini G , Di Fusco S , Aquilani S , Aiello A , Colivicchi F
Published: May 2024

Background

Dyslipidemia is a significant risk factor for cardiovascular diseases, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as an effective treatment option. This study aims to investigate the lipid profile in the long–term follow–up of dyslipidemic patients receiving PCSK9 inhibitor therapy in an entirely outpatient setting.

Methods

We enrolled 381 patients from our dyslipidemia outpatient clinic. Study population included both patients with a first dyslipidemia visit and those discharged from a cardiology unit with fast fast–track protocol. Patients were followed up at 6 (n = 252), 12 (n = 191), and 36 months (n = 77) to assess the effects of PCSK9 inhibitor therapy on lipid profile.

Results

At the 6–month follow–up, the total cholesterol levels decreased significantly (223.1±35.2 mg/dL vs 129.6±31.9 mg/dL p < 0.001) as LDL cholesterol levels (148±45 vs 72.6±46 mg/dL p < 0.001). The 12–month follow–up maintained similar levels of lowering (total cholesterol 123.6±39 mg/dL LDL 67.5±41 mg/dL p < 0.001) as well as the 36–month follow–up (total cholesterol 138.1±43 mg/dL LDL 71.6±44 mg/dL p < 0.001). No significant reductions in triglycerides and HDL levels were observed during follow–up.

Conclusion

The study highlights the feasibility and effectiveness of the long–term management of dyslipidemic patients with PCSK9 hypercholesterolemia in an entirely outpatient setting, including patients referred through the fast–track protocol.
CARDIOVASCULAR INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: De Carlini C , Loffreno A , Chiappa L , Achilli F
Published: May 2024

Background

Cardiovascular involvement is frequent in systemic lupus erythematosus (SLE). Aortic insufficiency is a common valvular abnormality seen in patients with systemic lupus erythematosus (SLE), it may be caused by a primary valve pathology or by an aortitis One of the cardiac manifestations associated with SLE and antiphospholipid syndrome (APLS) is Libman–Sacks endocarditis, also known as non–bacterial thrombotic endocarditis Although rare, there are reported cases of lupus aortitis which has also been associated with dissection, aneurysm and thrombus.

Case Report

We present a case of a 40 –years–old lady with lupus glomerulonephritis requiring immunosuppression and dialysis, who presented to the emergency department with fever and dyspnea. She was first treated with dialysis. Blood cultures drawn from central venous catheter peripheral were positive for staphylococcus epidermidis, the cultures from peripheral blood was negative instead.Transthoracic and transesophageal Echocardiography showed severe aortic regurgitation (not present three month earlier) with doubt valvular vegetations and with a focal enlargement of the aortic root (figure 1, 2).The patient met one major criterion (blood culture) and two minor criteria (high risk and fever), implying possible infective endocarditis. The patient was then started on intravenous antibiotics (vancomycin) and immunosuppression was reduced. Given the hemodynamic instability due to the severe aortic insufficiency, an Heart CT scan was performed to planned the surgical intervention. The CT scan confirmed the presence of small, multiple vegetation attached to the aortic leaflet and an aortic dissection on the right coronary cusp (figure 3). She proceeded to urgent surgery with aortic valve and aortic root replacement, the histology revealed evidence of Libman–Sacks endocarditis and aortitis.

Discussion

Our patient showed two different cardiovascular complications of SLE: the more frequent Libman –Sack endocarditis and the rare lupus aortitis associated to aortic dissection.The patient had risk factors for infective endocarditis and she did fulfil the modified Duke’s criteria for infective endocarditis and was treated with antibiotics and with a reduction of immunosuppression therapy. In fact, it can be difficult to distinguish between infective endocarditis and Libman–Sacks endocarditis especially in the setting of risk factors for both. Antibiotics and immunosuppressants should be used both.
A RARE CASE OF LATE RUPTURE OF POSTINFARCT PSEUDOANEURYSM (PA) OF THE INTERVENTRICULAR SEPTUM (IVS)
Authors: Rossini D , Gianfaldoni M , Amati R , Stroppa S
Published: May 2024

Rupture of the IVS is a mechanical complication of acute myocardial infarction (AMI), rare since the spread of percutaneous coronary revascularisation techniques. In a recent US case study, it was documented in 0.25% of cases. However, it is something to think about in the event of unexpected, rapid haemodynamic deterioration. We report the case of a 73–year–old man with a clinical history of COPD in heavy smoker, who was admitted on 04/14/2022 for a sub–acute inferior MI. After percutaneous revascularisation of the circumflex artery, the patient (pt) was discharged clinically stable. On transthoracic echocardiogram (TTE), the left ventricle (LV) appeared normal in size, with a large proximal inferior wall aneurysm (A) and slightly reduced global systolic function (EF = 45%). On 09/16/2022 admission to surgery for gastric perforation peritonitis from abuse of non–steroidal anti–inflammatory drugs. The pt survived the surgery without cardiac complications and remained well–compensated and asymptomatic in the following months. On 06/23/2023 new admission for heart failure: worsening dyspnoea and pulmonary and systemic congestion. The TTE showed a dilated LV (TDV = 162 ml), infero–lateral akinesia, a mid–basal inferior wall A and moderate global systolic dysfunction (EF = 40%). High velocity systolic flow was also documented in the right ventricle, which appeared to originate from an aneurysmal portion of the posterior IVS in continuity with the inferior wall A (Fig.1–2). Cardiac MRI confirmed the presence of a postinfarct PA involving the inferior wall and the basal and middle IVS with multiple jets responsible for significant left–right shunt (Qp/Qs = 2.9). Once clinical stabilisation was achieved, the pt was referred for cardiac surgery for direct closure of the interatrial defect and endoventriculoplasty. After the early postoperative phase, characterised by the need for pharmacological and mechanical haemodynamic support, there was a progressive clinical improvement. PA is most frequently localised infero–posteriorly, and is distinguished from A by its narrow collar (ratio of collar diameter to aneurysm diameter ≤ 0.5) and the absence of muscle tissue in the wall. 55% of PA are postischemic. They are classified, according to the distance from AMI, into acute (within 2 wks), subacute (between 2 wks and 3 mth) and chronic (after 3 mth); chronic PA are often large and asymptomatic but easily rupture, causing, as in our case, a late complication of the AMI.
CONTEMPORARY CLINICAL PRESENTATION, MANAGEMENT AND OUTCOMES OF SPONTANEOUS CORONARY ARTERY DISSECTION: DATA FROM A SINGLE SECONDARY CENTRE
Authors: Bosi D , Guiducci V , Ferretti M , Pignatelli G , Musto D‘Amore S , Demola P , Solinas E , Pergola V , Zedde M , Pascarella R , Navazio A , Mantovani F
Published: May 2024

Background

Extra–coronary involvement is identified in more than 50% of patients presenting with SCAD, mainly as fibromuscular dysplasia (FMD) pattern. This association might suggest that they share at least partially some pathomechanisms. However, no recommendations on FMD screening in SCAD patients exist to date in international consensus documents, and this is therefore left at clinician discretion.

Aim

We sought to determine the rate of FMD screening in historical cohort of patients with SCAD at our institution.

Methods

Observational retrospective study of all consecutive SCAD patients admitted to catheterization laboratory.

Results

From January 2015 to June 2021, 41 patients received a SCAD diagnosis and represented our study cohort. Mean age was 55 ± 11 years with a high prevalence of female gender (34 patients, 83%). Traditional risk factors showed a marked prevalence especially regarding smoke habits (12 patient, 30%) and dyslipidaemia (21 patients, 51%). Left anterior descending artery was the vessel more frequently involved (49%) followed by circumflex artery (41%) and right coronary artery (10%). SCAD was more frequently classified as type II (68%) followed by type IV (17%), type I (10%) and type III (5%) according to Saw classification. Screening for FMD was performed in 6 patients (12%) among the most recent SCAD diagnoses; of these 1 patients received a diagnosis of FMD, with involvement of carotid and mesenteric arteries. Table.

Conclusion

In our single centre experience, screening for FMD was historically performed in a minority of patients with a perceived trend for a systematic screening in more recent years.
THE ROLE OF MULTIPARAMETRIC EVALUATION PRIOR TO L–VAD IMPLANT IN RIGHT VENTRICLE DISFUNCTION: A CASE REPORT
Authors: Caputo A , Loffredo F , Liccardo B , Amarelli C , Marra C , Del Giudice C , Golino P
Published: May 2024

Background

Right ventricular failure is the most common post–operative complication after L–VAD implant and it represents an important cause of mortality in these patients. Pre–existing right ventricular disfunction is considered an absolute contraindication to L–VAD implant, though in some cases right ventricular hypokinesia could be the expression of elevated pressure in the pulmonary circulation secondary to high left heart filling pressures. Numerous clinical, echocardiographic and hemodynamic parameters have been proposed for the evaluation of L–VAD eligibility. Among these Michigan right ventricle failure score, rest and dobutamine stress echocardiography (TAPSE, S wave peak, right wall longitudinal strain) and right heart catheterization parameters showed an adequate correlation with L–VAD implant outcome.

Case Report

A 67 yo patient affected by advanced heart failure secondary to ischemic dilatative cardiomyopathy was referred to our unit for frequent exacerbations of heart failure despite optimal medical therapy. Echocardiography detected severe left ventricle disfunction, severe mitral regurgitation and a hypokinetic right ventricle that was not present at a previous evaluation showing only a mild disfunction. We therefore performed a dobutamine stress echocardiography to assess right ventricular contractile reserve, which demonstrated an adequate systolic response at hight dose of dobutamine (20 y/Kg/min). These data were confirmed by right heart catheterization, which allowed the evaluation of hemodynamic predictors of post L–VAD RV failure. After Heart Team discussion the L–VAD was successfully implanted. The patient was extubated at day 1 PO and weaned from inotropes at day 4, he did not present any clinical and hemodynamic signs of RV failure and is currently undergoing post–surgical rehabilitative care.

Conclusions

Our experience strengthen the importance of a standardized multiparametric assessment in patients affected by advanced heart failure proposed for L–VAD and showing right ventricle contractile impairment.
MONOCENTRIC EXPERIENCE FROM A CARDIOGENIC SHOCK NETWORK: ROLE OF ECLS IN REFRACTORY CARDIOGENIC SHOCK, KEY TO SURVIVAL OR BRIDGE TO ADVANCED HEART FAILURE THERAPIES
Authors: Fusi C , Marchese A , Sorini Dini C , Righini F , Cesareo F , Gentilini R , Bernazzali S , Maccherini M , Valente S
Published: May 2024

Background

Extra–Circulatory Life Support (ECLS) is a vital therapeutic option in patients (pts) with refractory cardiogenic shock (CS). Few centers can assure optimal assistance to these delicate pts and early centralization in the context of regional networks is essential.

Methods

We enrolled all consecutive pts with ECLS for refractory CS admitted to our Intensive Cardiac Care Unit (ICCU) from January 2021 to November 2023. The primary endpoints evaluated were weaning from ECLS and in–hospital mortality. The secondary endpoints included neurological outcomes and major complications.

Results

We enrolled 21 consecutive pts (90% male, 55y median age) with refractory CS and indication for peripheral Veno–Arterial Extracorporeal Membrane Oxygenation (VA–ECMO), percutaneously or surgically positioned, with antegrade perfusion to avoid limb ischemia. Fourteen pts (67%) came from other hospitals, 8 (38%) of which already had been implanted with ECLS. Concerning the CS etiology, we observed 8 (38%) heart failure, 12 (57%) post–myocardial infarction, 1 (5%) adrenergic storm and 10 (48%) cardiac arrests. Six pts (28%) were deemed eligible for heart transplant (HT) list before the CS episode. In all pts we assured left ventricle unloading with IABP (9), Impella CP (3), Impella 5.5 (1). Five pts underwent apical left ventricular venting and escalation of mechanical support. The median duration of ECLS support was 10.1 days. Eleven pts (52%) were successfully weaned from VA–ECMO due to myocardial recovery (n=6; 29%) or HT (n=5; 24%); of the latter, 1 died due to peri–operative complication. Overall in–hospital mortality rate was 52%. Ten pts were discharged: 7 without neurological deficit (CPC 1), 2 with mildly impaired neurological function (CPC 2–3) and 1 with severe disability (CPC 4). During ECLS we observed the following complications: bleeding (28%), AKI (28%), infections (28%), neurological complications as acute ischemic stroke or intracerebral hemorrhage (19%); no limb ischemia occurred.

Conclusions

ECLS provides cardiac and respiratory support and serves as a bridge to recovery or heart replacement therapies (LVAD, HT). Tertiary Shock Centers in a Regional Network assure optimal assistance for this vital support.
INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM
Authors: Mazza A , Paneroni M , Marconi M , Maestri A , Giardini A
Published: May 2024

Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.
THE IMPACT OF NURSE–LED EDUCATION, ON QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A REVIEW OF THE LITERATURE
Authors: Li Vigni M , Meucci B , Gambone F , Giordano V
Published: May 2024

Introduction

The complex mosaic of cardiac rehabilitation (CR) in heart failure (HF) is composed of several "pieces": adherence to the rehabilitation program (Mazza & Paneroni, 2019), therapeutic education, improvement of perceived QoL and self–care (Deek et al., 2017). To improve the patient‘s QoL, however, it is imperative to position them at the focal point of the care process. Several studies, have documented the favorable impact of CR on QoL in HF patients (Conway et al., 2015). Although variations in therapeutic and rehabilitative treatment plans vary according to each stage of the disease, adopting lifestyle changes is a recommended strategy regardless of the stage of HF from which the person is affected (ACC/AHA 2005; Yancy et al., 2005). However, despite the evidence–based benefits of post–discharge interventions combined with patient education in HF patients, the specific impact and benefits of nurse–led patient education alone, independent of the broader health care system, remain still unclear.

Objective

This review aims to investigate the influence of the nurse‘s educational role on the quality of life of patients with HF in the setting of cardiac rehabilitation.

Materials and Methods

A comprehensive literature review was conducted using databases such as PubMed, Scopus, CIHNAL Complete and EMBASE. The review followed the PICO methodology, with the formulation of a research question. MeSH terms and keywords were combined using Boolean operators and inclusion criteria. The primary outcome of interest was improved QoL. Relevant articles were subjected to preliminary analysis on the Rayyan platform. They were first evaluated by title and abstract, then selected for full–text reading, and finally subjected to "quality appraisal".

Results, Discussion and Conclusions

Individuals with HF experience a decline in QoL and are at increased risk of poor prognosis, characterized by exacerbation episodes leading to frequent re–hospitalizations and increased mortality rates (Heo et al., 2009; Rechenberg et al., 2020; Freedland et al., 2021). Therefore, improving QoL in patients with HF is a priority from both care and organizational perspectives (Ades et al., 2013; Darkins et al., 2015). Notably, a tailored CR educational program helps to improve self–care management and, consequently, improve QoL. That highlights the importance of nurse–led CR for HF patients in improving health behaviors and adherence to therapeutic practices.
PERCUTANEOUS TREATMENT OF ABDOMINAL AORTIC ANEURYSM AND AORTIC VALVE STENOSIS WITH ‘STAGED’ EVAR & TAVR
Authors: Casilli F , Medda M , Briguglia D , D‘Alessandro V , Donatelli F
Published: May 2024

Symptomatic AS and AAA are critical clinical conditions, increasingly more prevalent with aging of the population. TAVR is a treatment of choice in high risk and inoperable patients with symptomatic severe AS, who are often elderly. A continuous increase in the number of TAVR procedures–per–year is expected due to the increasingly robust evidence that TAVR is advantageous in the population with non–increased surgical risk. Our ‘tailored’ interventional approach has planned an endovascular correction of the AAA as the first step, followed by a ‘staged’ TAVR. The AAA was treated first because was it considered strategically better in the presence of severe AS in stable clinical conditions. Moreover the potential elevation of the systolic arterial pressure after TAVR might provoke enhanced strain at the AAA wall increasing the risk of rupture. During the EVAR procedure all the material needed to proceed to an ‘urgent’ aortic valvuloplasty or TAVR if necessary was available and ready. The proposed treatment was effective in all treated patients, offering the resolution of both problems through totally percutaneous treatment in patients with a significant high risk for both mortality and vascular complications. The risk of acute kidney injury is reduced compared to simultaneous procedures because the total amount of contrast agents used overall is spread among two different procedures after an adequate time of recovery. The main clinical, technical and procedural considerations of TAVR procedure in this case series were: Transfemoral access into the bifurcated endoprosthesis was feasible in 100% of patients The use of highly supportive stiffer guides (or buddy wire technique) to overcome the tortuosity of the iliac–femoral approaches should be considered; The introducer advancement under fluoroscopic guidance and through–and–through wire technique is strongly recommended in the presence of tortuosity; The strategy to protect the main vascular access must be personalized choosing between the ipsilateral femoral approach or the radial (or omeral) approach; The total amount of contrast medium administered to patients should be carefully monitored; The procedures should always be conducted with as much ‘contrast zero‘ methods as possible. Define a delay time between EVAR and TAVR according to the clinical status, the age and the co–morbidities of patients even in the presence of clinical stability, is highly debated.
A VERY COMPLEX CASE OF DORV TYPE FALLOT: A CASE REPORT
Authors: Testa S , Ricci M , Sabina G , Renda G , Ricci F
Published: May 2024

Double outlet right ventricle (DORV) is a rare CHD characterized by ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. Its prevalence is 0.9% of all CHDs. Several chromosomal abnormalities have been associated with DORV, including trisomy 13, trisomy 18, and chromosome 22q11 deletion. Hearts with DORV are an extremely heterogeneous group showing various morphological features, connections, and relationships at each level of the cardiac segments and intersegmental junctions. As a consequence, the clinical manifestations and required surgical procedures for patients with DORV are variable. The anatomical spectrum is higly variable: it can be associated with ventricular septal defect, transposition of the great arteries (TGA) and functional single ventricle. We report the case of an infant with prenatal diagnosis of CHD and finding partial duplication of the short arm of the X chromosome. Pregnant woman at 22 weeks comes to the outpatient clinic to perform follow–up ultrasound. At that site finding of CHD which was later confirmed at birth and therefore prostaglandin therapy was started. Echocardiogram showed a wide DIV from malalignment with antero–cephalic deviation of the conal septum with significant aortic destroposition configuring picture of double outlet right ventricle. It also presents a complex right efflux obstruction already at subvalvular pulmonary departure. The pulmonary valve presented dysplastic, with en dome motion, hypoplastic. Pulmonary perfusion appears to be provided predominantly by the Botallo‘s duct originating from the isthmic region of the aorta and leading with a long and tortuous course to the pulmonary confluence near the left pulmnary artery with high velocity flow. The remaining findings are normal. Therefore, in view of the clinical picture, he was subjected to palliative surgery of right systemic–pulmonary shunt between the brachiocephalic trunk and right pulmonary artery (modified Blalock–Taussing surgery) in 3.5mm PTFE and ligation of Botallo‘s duct. At subsequent follow–up, the systemic–pulmonary shunt appeared pervious with regular flow. Wide DIV from anterior malalignment with aorta cavalier to DIV. Severe stenosis at complex pulmonary outflow with max gradient up to 124mmHg with dynamic and valvular component. For the subsequent course of treatment, the patient will be discussed collegially.