bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Notion of g-Angle
in Normed
Authors: Nur Muh , Bahri Mawardi , Islamiyati Anna
Published: December 2021

We discuss the g-orthogonality (⊥
g
) and its basic properties in a normed space. We also define a new g-angle between two vectors and prove its basic properties by using the g-orthogonality (⊥
g
). Moreover, we prove the sufficient and necessary conditions for strictly convexity in a normed space by using a new g-angle.
Differences in Ethnomathematical Characteristics between Buton Traditional Houses
Authors: Kadir  , Jafar  , Samparadja Hafiludin , Arvyaty  , Sarniasih Ni Kadek , Nurtilawah
Published: December 2021

The mathematical practice of the Buton people can be seen from the ethnomathematics of the Buton traditional house. This qualitative study aims to explore the differences in ethnomathematical characteristics between Buton traditional houses. The subjects of this study were 3 traditional leaders and 3 builders of Buton traditional houses. Data were collected through measurements, interviews, and observations of the traditional Buton house in Baubau city, the capital of the Buton kingdom, Indonesia. The credibility of the data was tested by using triangulation of sources. Data were analyzed descriptively qualitatively from Miles, Huberman, and Saldana in the form of data condensation, data presentation, and conclusions. The results of data analysis showed that the differences in the ethnomathematical characteristics of the three Buton traditional houses can be seen from the size and area of the house, the angle of the roof and stairs, the arrangement of the roof, the number of poles, the number of rooms, the model of the house, and the type, model, and the number of windows used. Teachers need to know the differences in ethnomathematical characteristics so that they can be used to increase students’ active participation in learning mathematics in class.
Prediction of Sediment Yield Using the Algoritma Lavenberg-Marquardt
Authors: Uca  , Tabbu Muhammad Ansarullah S. , Makkawaru Andi
Published: December 2021

Erosion and sediment that occurs in the basin is very important to be studied scientifically.Forcasting of sediment yield in a basins area is important to used to evaluate the land-use/landcover change, soil erosion hazard, planning, water quality, water resources in river, and to determine the extent of the damage that occurred in the basins. The algoritmh lavenberg-marquardt can be used to forcest the total of sediment yield the basin area. Artificial neural networks using feedforward multilayer percePsron with three learning algorithms namely Levenberg-Marquardt. The number of neurons of the hidden layer is three to sixteen, while in the output layer only one neuron because only one output target. The root mean square error (RMSE), mean absolute error (MAE), coefficient of determination (R2 ), and coefficient of efficiency (CE). The performance value in the training process, R2, and CE (0.98 and 0.98). As well as for the testing process, R2 and CE (0.98 and 0.97). Based on the performance statistics value, LM is very suitable and accurate for to forcesting by modeling the non-linear complex behavior of sediment yield responses to water discharge, intensity of rainfall, and water depth in the river.
Digital processing of shadowgraph images taking into account the diffraction of light at a shock front
Authors: Mursenkova I , Timokhin M , Tikhonov M , Militsina A , Kuznetsov A
Published: December 2021

The aim of the study is to determine the shock wave position in experimental shadowgraph images and to evaluate the accuracy by digital image processing. The experimental images were obtained with the shock tube with a rectangular channel. The shadowgraph optical system formed a parallel light beam. It passed through the plane-parallel quartz glasses of the shock tube test section. The process synchronization system at the facility allows registering the shadowgraph images of unsteady flows with shock waves with a high-speed camera or with a single frame camera. The obtained spatial intensity profiles were used to determine the coordinates of gas-dynamic discontinuities at different stages of the flow evolution. shadowgraph patterns were analysed taking into account diffraction at the shock front in case of a laser light source.
Acousto-optic filtration in low-coherence spectral-domain interferometry
Authors: Burmak L
Published: December 2021

The basic principles of measurements in spectral-domain low coherence interferometry (optical coherence tomography, optical coherence microscopy) based on acousto-optic filtration are discussed. Relations for extracting information about sample’s spatial structure from a series of spectral interference images acquired with spectral tuning are given. The implementation of measurements in spectral domain using acousto-optic filtration is considered. The effect of the acousto-optic filter characteristics on depth measurement range and depth resolution is estimated. The results of modelling of the interference signal and experimental data obtained in the scheme with acousto-optic filtration of interfering beams at the output of Michelson interferometer are presented.
Determination of the concentration of CO2 and H2O vapor under conditions of overlapping spectral lines
Authors: Kugeiko M M , Baravik A A
Published: December 2021

The efficiency of determining the concentration of CO2 and H2O vapors in the atmosphere has been investigated taking into account the overlap of their spectral lines. It is proposed to use regression relationships established between the determined and measured parameters of the investigated medium. These ratios can be set both for fixed values of temperature and pressure, and for a set range of their values. When calculating the absorption value, all overlaps of spectral lines are taken into account, taking into account their broadening at different temperatures and pressures. This allows the method to be used in multicomponent media with strongly overlapping spectral lines. The established regression relations are resistant to errors in the measurement information, which also improves the accuracy of determining the concentrations of the component composition of the gas medium. In addition, they are determined promptly (in real time), since the calculation of concentrations using established relationships (analytical expressions) between the determined and measured values does not present computational difficulties.
Thermal conductivity measurement of infrared optical fibers based on silver halide solid solution crystals
Authors: Turabi A , Zhilkin B P , Zhukova L V , Shmygalev A S , Rudenko A V , Korsakov A S
Published: December 2021

The aim of the study is to measure the thermal conductivity of silver halide light guides based on crystals of the AgCl-AgBr system used in PSD production technologies. The conductivity temperature coefficient of the samples under study were determined by the laser flash method using the LFA 467 (Hyper Flash) installation. We studied mono- and polycrystalline samples of solid solutions with the composition AgCl0,25AgBr0,75 in the temperature range 298–523 K. The thermal conductivity of the investigated materials was then calculated using literature data on density and heat capacity. The thermal conductivity coefficient ranges from 0.80±0,04 to 0.53±0,03 (W/mK), depending on the microstructure of the sample.
Incorrect application of the KDIGO acute kidney injury staging criteria
Authors: Yasrebi-de Kom Izak A R , Dongelmans Dave A , Abu-Hanna Ameen , Schut Martijn C , de Keizer Nicolette F , Kellum John A , Jager Kitty J , Klopotowska Joanna E
Published: December 2021

Background

Recent research demonstrated substantial heterogeneity in the Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) diagnosis and staging criteria implementations in clinical research. Here we report an additional issue in the implementation of the criteria: the incorrect description and application of a stage 3 serum creatinine (SCr) criterion. Instead of an increase in SCr to or beyond 4.0 mg/dL, studies apparently interpreted this criterion as an increase in SCr by 4.0 mg/dL.

Methods

Using a sample of 8124 consecutive intensive care unit (ICU) admissions, we illustrate the implications of such incorrect application. The AKI stage distributions associated with the correct and incorrect stage 3 SCr criterion implementations were compared, both with and without the stage 3 renal replacement therapy (RRT) criterion. In addition, we compared chronic kidney disease presence, ICU mortality rates and hospital mortality rates associated with each of the AKI stages and the misclassified cases.

Results

Where incorrect implementation of the SCr stage 3 criterion showed a stage 3 AKI rate of 29%, correct implementation revealed a rate of 34%, mainly due to shifts from stage 1 to stage 3. Without the stage 3 RRT criterion, the stage 3 AKI rates were 9% and 19% after incorrect and correct implementation, respectively. The ICU and hospital mortality rates in cases misclassified as stage 1 or 2 were similar to those in cases correctly classified as stage 1 instead of stage 3.

Conclusions

While incorrect implementation of the SCr stage 3 criterion has significant consequences for AKI severity epidemiology, consequences for clinical decision making may be less severe. We urge researchers and clinicians to verify their implementation of the AKI staging criteria.
A three-dimensional atlas of child’s cardiac anatomy and the unique morphological alterations associated with obesity
Authors: Marciniak Maciej , van Deutekom Arend W , Toemen Liza , Lewandowski Adam J , Gaillard Romy , Young Alistair A , Jaddoe Vincent W V , Lamata Pablo
Published: December 2021

Aims

Statistical shape models (SSMs) of cardiac anatomy provide a new approach for analysis of cardiac anatomy. In adults, specific cardiac morphologies associate with cardiovascular risk factors and early disease stages. However, the relationships between morphology and risk factors in children remain unknown. We propose an SSM of the paediatric left ventricle to describe its morphological variability, examine its relationship with biometric parameters and identify adverse anatomical remodelling associated with obesity.

Methods and results

This cohort includes 2631 children (age 10.2 ± 0.6 years), mostly Western European (68.3%) with a balanced sex distribution (51.3% girls) from Generation R study. Cardiac magnetic resonance short-axis cine scans were segmented. Three-dimensional left ventricular (LV) meshes are automatically fitted to the segmentations to reconstruct the anatomies. We analyse the relationships between the LV anatomical features and participants’ body surface area (BSA), age, and sex, and search for features uniquely related to obesity based on body mass index (BMI). In the SSM, 19 modes described over 90% of the population’s LV shape variability. Main modes of variation were related to cardiac size, sphericity, and apical tilting. BSA, age, and sex were mostly correlated with modes describing LV size and sphericity. The modes correlated uniquely with BMI suggested that obese children present with septo-lateral tilting (R2 = 4.0%), compression in the antero-posterior direction (R2 = 3.3%), and decreased eccentricity (R2 = 2.0%).

Conclusions

We describe the variability of the paediatric heart morphology and identify anatomical features related to childhood obesity that could aid in risk stratification. Web service is released to provide access to the new shape parameters.
37 Prognostic role of the lung ultrasound in the acute coronary syndrome
Authors: Tricarico Lucia , Persichella Paola , Mazzeo Pietro , Leopizzi Alessandra , Mallardi Adriana , Magnesa Michele , Fortunato Martino , Croella Francesca , Alfieri Simona , Correale Michele , Iacoviello Massimo , Brunetti Natale D
Published: December 2021

Aim

Acute coronary syndromes (ACS) represent one of the major causes of mortality in our country. Lung ultrasound is an important diagnostic tool in the assessment of lung and pleural diseases; it is easy to perform and provides low-cost analysis and it is also easily learned with a few hours of training. To evaluate the usefulness of lung ultrasound in the early diagnosis of pulmonary congestion in patients admitted to ICU for ACS and to evaluate its possible prognostic role in the short and long term.

Methods

Forty-three patients with ACS admitted in the ICU of Foggia were enrolled in the study between April 2020 and July 2020 (mean age 64.7 ± 12.7 years, male: 67.4%). Medical history, physical examination, ECG, blood analysis, chest X-ray, lung ultrasound and echocardiography were collected at the admission in ICU, after 24 h and at the dismission. All patients were re-evaluated, through a telephone follow-up 3 months after discharge. The primary endpoints were re-hospitalization at 30 days and the following MACEs: development of acute pulmonary oedema during hospitalization, cardiogenic shock, death and the need for oxygen therapy or the use of non-invasive ventilation. The secondary endpoints were out-of-hospital death from cardiac causes and re-hospitalization after 3 months.

Results

The analysis of the ROC curves showed that pulmonary ultrasound performed on admission in the ICU predicted more than the thoracic physical examination [AUC 0.536 (0.367–0.699); P = 0.111], chest radiograph (AUC 0.561 (0.391–0.721); P = 0.109] and LVEF [AUC 0.525 (0.357–0.689); P = 0.119], the risk of adverse cardiovascular events hospital, although not reaching the cut-off for statistical significance [AUC 0.661 (0.489–0.806); P = 0.0895]. Among all in-hospital events, pulmonary ultrasound predicted higher sensitivity and specificity [AUC 0.665 (0.493–0.809); P = 0.0927] than chest radiography [AUC 0.588 (0.417–0.745); P = 0.113], clinical examination [AUC 0.550 (0.380–0.711); P = 0.116] and LVEF [AUC 0.515 (0.348–0.680); P = 0.125], the use of oxygen therapy and NIV during hospitalization stay.

Conclusions

In patients with ACS, on admission lung ultrasound predicts the risk of in-hospital events, particularly the use of oxygen therapy or non-invasive mechanical ventilation more than physical examination, chest X-ray and LVEF estimated by echocardiography. It can be considered a complementary method to echocardiography in the evaluation of cardiac function, allowing to estimate the amount of extra-vascular lung water.
446 Relationship between out of hospital cardiac arrest and COVID-19 pandemic: impact on outcome
Authors: Giovenzana Fulvio Lorenzo Francesco , Franzosi Cinzia , Genoni Paola , Golino Michele , Foieni Marta , Marazzato Jacopo , De Ponti Roberto
Published: December 2021

Aims

During 2020, Italy was hit by the pandemic of the ‘Coronavirus disease 2019’ (COVID-19) with an incidence/100 000 citizens characterized by two peaks. An increase in out-of-hospital cardiac arrest (OHCA) mortality during the first pandemic peak has already been described, but there are few data on the whole year. The goal of our study is to evaluate the impact of the pandemic on post-OHCA mortality.

Methods

We considered patients with OHCA in Varese territory from January to December 2020 with medical aetiology according with Utstein 2014 classification. The primary endpoint of the study was the assessment of acute post-arrest mortality and which parameters influence this outcome. In particular, both the role of pandemic peaks (‘first peak’ from 11 March 2020 to 23rd May 2020 and ‘second peak’ from 7 October 2020 to 31 December 2020) and the average rescue times, i.e.: (i) interval between OHCA and call for first aid (delay in activation of assistance); (ii) the interval between the call and the arrival of the rescue vehicles (delay in the arrival of the first aid) and finally; (iii) the time between the arrival of the rescue vehicles and the end of Cardiopulmonary Resuscitation (CPR), interrupted due to death or Recovery of Spontaneous Circulation (ROSC). Finally, we performed a multivariate analysis to assess which of the variables considered had the greatest impact on the outcome.

Results

We analysed 708 patients (mean age 76 + 14.09 years; 40% women). Overall mortality was 89%. During the peaks there was an increase in mortality compared to the pre-pandemic period (first peak 96% vs. 83%, OR 4.49; second peak 92% vs. 83%, OR 2.45) (Figure 1). The time between the collapse and the call for help was significantly higher during the first pandemic peak compared to the second peak and the pre-pandemic period (P = 0.003); the time between the call and the arrival on the patient was significantly longer during both pandemic peaks than in the previous period (P = 0.002) and there was no significant difference in CPR duration time between the periods analysed. In a multivariate model, the only time associated with an increase in mortality is the period between the call for help and the arrival on the patient, regardless of the COVID-19 pandemic.

Conclusions

During the COVID-19 pandemic there has been an increase in mortality of patients with OHCA. Among the variables considered, the increase in mortality is mainly associated with the delay in the arrival of emergency vehicles on site. This delay, although decreasing, was also maintained during the second peak of the pandemic.
522 A strange case of bradycardia in a 38-year-old woman postpartum
Authors: Bastianoni Gianmarco , Paolini Federico , Stronati Giulia , Casella Michela , Antonio Dello Russo , Guerra Federico
Published: December 2021

Methods and results

A 38-year-old woman at her 4th day postpartum from a twin pregnancy, presented to the Emergency Room with general malaise, headache, and dyspnoea. Her symptoms had started to show 2 days prior to her ER admission and were worsened by bilateral pitting oedema. In particular they had started when she was administered cabergoline to suppress lactation. Her blood pressure was elevated (160/80 mmHg) and her heart rate was 40 b.p.m. On examination she was oriented in time and space. Her laboratory exams showed anaemia (Hb 8.8 g/dl), with negative D-dimer and troponin. She had no urine proteinuria, which allowed pre-eclampsia to be excluded from the diagnostic hypotheses. A 12-lead ECG was performed and showed junctional rhythm with isorhythmic dissociation at 40 b.p.m. She was admitted to the cardiology ward for diagnostic workup. Her echocardiogram showed no structural alteration and preserved ejection fraction. A cardiac magnetic resonance confirmed the absence of structural alterations or late gadolinium enhancement. During her hospital stay, sinus rhythm was spontaneously restored at 42 b.p.m.; in addition to this, restoration of sinus rhythm, although bradycardic, was associated to the resolution on both her symptoms and of her pitting oedema. She was discharged with a diagnosis of bradycardia secondary to carbegoline use. Her Holter ECG, performed 7 days after discharge, showed sinus bradycardia with occasional isorhythmic dissociation.

Conclusions

Cabergoline is an ergot-derived dopamine agonist usually used in the treatment of Parkinson’s disease. It acts selectively on D2 receptors. It can be associated to orthostatic hypotension, cardiac valvular fibrosis, and angina pectoris. No cases of cabergoline-induced bradycardia can be currently found in literature; however, a similar effect was seen with the use of methylergometrine in a women during her post-partum period. Furthermore, studies on mice have shown that ergot derivatives may cause reduction of heart rate. It therefore seems possible that in our case, the use of cabergoline induced the patient’s bradyarrhythmia.
662 Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy
Authors: Bertolone Dario Tino , Gallinoro Emanuele , Monizzi Giovanni , Sonck Jeroen , Candreva Alessandro , Mileva Niya , Nagumo Sakura , Munhoz Daniel , Buytaert Dimitri , Mastrangelo Angelo , Andreini Daniele , Galli Stefano , Bartonelli Antonio , Barbato Emanuele , Bruyne Bernard De , Collet Carlos
Published: December 2021

Aims

Percutaneous coronary interventions (PCI) in calcified coronary artery lesions are associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using calcium modifying techniques such as Rotational Atherectomy (RA) or Intravascular Lithotripsy (IVL) has been advocated. Studies comparing these technologies are lacking. We aimed to compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either RA or IVL.

Methods and results

Patients undergoing either RA- or IVL-assisted PCI from two European centres were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post-PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90. From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0.65 ± 0.13 RA and 0.67 ± 0.11 IVL). After PCI, in-stent pressure gradients was significantly lower in the IVL group (0.032 ± 0.026 vs. 0.043 ± 0.026 in the RA group, P = 0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; P = 0.669).

Conclusions

Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL. 662 FigureIn stent gradients after RA and IVL. (A) Box plot depicting the distribution of the in-stent pressure gradient vFFRgrad between the two groups. (B) Cumulative frequency distribution curves demonstrating lower vFFRgrad after intravascular lithotripsy compared to rotational atherectomy. RA, rotational atherectomy; IVL, intravascular lithotripsy; vFFRgrad, in-stent pressure gradient.
586 Effect of sacubitril/valsartan combination in an experimental model of heart failure
Authors: Angelis Antonella De , Cappetta Donato , Telesca Marialucia , Bellocchio Gabriella , Urbanek Konrad , Berrino Liberato
Published: December 2021

Aims

The majority of elderly patients with heart failure has a preserved ejection fraction (HFpEF) that constitutes a syndrome characterized by frequent hospitalizations and high mortality. Despite the growing social burden of HFpEF, the comprehension of its pathophysiology is incomplete, and treatment remains largely undefined. Ageing itself may contribute independently to deterioration of diastolic function.

Methods and results

An 18-month-old female Fischer 344 rats were treated with oral administration of either sacubitril/valsartan (60 mg/kg/die, 1:1 ratio) or valsartan alone (30 mg/kg/die) for 12 weeks. Tail-cuff method was used to monitor blood pressure weekly. Echocardiography and left ventricle catheterization were employed to assess systolic and diastolic function, at baseline, and before sacrifice. Cardiac tissue was used for molecular biology and histochemistry assays. Tail-cuff analysis indicated a comparable decrease in blood pressure between treatments. Hypertrophy also showed a significant reduction with both treatments. On the contrary, myocardial function analysis demonstrated that no treatment was efficacy on diastolic dysfunction. The lack of improvement of cardiac function could be attributed to the inability of the treatments to counteract the accumulation of fibrotic tissue in the left ventricle, which, in turn, is attributable to the failure to reduce the inflammatory process and oxidative stress, and to the inability to modulate angiotensin II pathway.

Conclusions

Our results evidenced that both sacubitril/valsartan or valsartan treatment was able to improve diastolic function and pro-fibrotic remodelling, partly due to a lack of effect on classical and non-classical pathways of angiotensin II.
495 New-onset left ventricular dysfunction and critical coronary artery disease: an MRI can help—a clinical case
Authors: Portolan Leonardo , Minnucci Ilaria , Piccolo Solange , Pighi Michele , Ribichini Flavio
Published: December 2021

Aims

Understanding the aetiology of heart failure is crucial for treatment. Gadolinium cardiac magnetic resonance (CMR) is a powerful technique to distinguish dilated cardiomyopathy (DCM) from left ventricular (LV) dysfunction related to coronary artery disease (CAD).

Methods and results

Clinical case: a 61 years old Caucasian woman with a history of hypertension and dyslipidaemia presented to the emergency department of our hospital with pulmonary oedema and hypertensive crisis, requiring non-invasive ventilatory support. She complained about shortness of breath and exertional angina for almost one year. On admission, the echocardiography showed severe LV systolic dysfunction and severe functional mitral regurgitation (FMR). Troponin levels were slightly increased, and NT-proBNP was 2809 pg/ml. Once obtained clinical stability, anti-remodelling cardiac therapy was introduced and up titrated. Due to the history of angina and the new-onset severe LV systolic dysfunction, coronary angiography was performed, showing critical stenosis of the left main (LM) and of the proximal tract of the left anterior descending artery (LAD). In deciding the best treatment pathway for the patient evaluate myocardial viability and characterize myocardial tissue was of paramount importance. Subsequently, a CMR confirmed severe LV systolic dysfunction and severe functional mitral regurgitation but demonstrated myocardial viability, with no late gadolinium enhancement.

Therefore the patient underwent surgical myocardial revascularization with triple coronary artery bypass grafts (left internal mammary artery-LAD, saphenous vein graft-obtuse marginal artery, saphenous vein graft-diagonal branch of LAD) and mitral valve repair (annuloplasty). The patient underwent a period of cardiac rehabilitation asymptomatic and in good clinical status. Three months later, echocardiography demonstrated an initial recovery of LV systolic dysfunction with signs of reverse cardiac remodelling and a good result of mitral valve repair. The patient is now on optimal medical therapy, free of symptoms and in good clinical and functional condition.

Conclusions

Cardiovascular magnetic resonance (CMR) is an excellent diagnostic tool in heart failure. This clinical case can be formative, confirming once again the importance of an accurate and complete diagnostic workup and a subsequent therapy of aetiology in heart failure.
92 Eligibility and reimbursement of SGLT2 inhibitors in a heart failure outpatient cohort
Authors: Tarantini Roberto , Vecchi Andrea Lorenzo , Matteo Federica , Guerci Marco , Ponti Roberto De
Published: December 2021

Aims

In patients affected by heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction, sodium–glucose cotransporter type 2 inhibitor drugs (SGLT2i) have shown unexpected and extraordinary results, regardless of the co-presence of diabetes mellitus (DM). The results of the clinical trials have recently allowed the national drug agency (AIFA) to summarize and simplify SGLT2i indications for treatment; however, the reimbursement of these drugs is currently only ensured to diabetic patients, who represent a small subgroup of heart failure (HF) population. The study aims to determine eligibility for SGLT2i in HF outpatients, according to the inclusion criteria of the main clinical trials, comparing the drug label proposed by EMA/AIFA with the current reimbursement criteria.

Methods and results

In this retrospective, observational study, 206 HF outpatients were enrolled from September 2018 to September 2019. The percentages of eligible patients according to the DECLARE-TIMI 58, EMPA-REG OUTCOME, DAPA-HF, EMPEROR REDUCED, and EMPEROR PRESERVED inclusion criteria were analysed, comparing the indications proposed by the EMA/AIFA label and the current reimbursement criteria. Among the 206 patients enrolled, the mean age was 71 ± 12 years, 24% were diabetic, the mean MDRD eGFR was 61 ± 22 ml/min/1.73m2, the mean ejection fraction (LVEF) was 38 ± 11% (LVEF <40 in 65% of the whole cohort). According to EMA/AIFA indications, eligible patients for SGLT2i in this cohort are 66%, representing almost the entire HFrEF population. This percentage, which is far higher than the eligibility of the main clinical trials, is motivated by the more stringent inclusion criteria proposed by the latter, in which the prevailing limiting factors were NYHA class and NTproBNP values. The reimbursement of these drugs is currently only ensured for diabetic patients with eGFR > 60 ml/min/1.73 m2; in our study only 8% of patients met these criteria. Assuming soon to extend the EMA/AIFA indication to HFpEF patients, wider eligibility for SGLT2i is expected for most patients with HF, irrespective of DM and LVEF.

Conclusions

Two-thirds of our HF population is currently eligible for SGLT2i prescription, according to the drug label proposed by EMA/AIFA; this eligible cohort includes almost all HFrEF patients. When the indications will be updated according to the results of HFpEF trials on SGLT2i, eligibility will be extended almost to the entire cohort of HF outpatients. Most eligible patients are not diabetic, however, they have not currently access to drug reimbursement. The constant updating of the SGLT2i label and reimbursement criteria is the main limiting factor in current clinical practice.
691 Distribution of wall motion abnormalities in young patients presenting with acute coronary syndrome
Authors: De Santis Giulia , Pistelli Lorenzo , Franzino Marco , Nicolo Claudio , Parisi Francesca , Cusma Maurizio , Trio Olimpia , Manganaro Roberta , Zito Concetta , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Costa Francesco
Published: December 2021

Aims

Distribution of wall motion abnormalities (WMA) in young patients presenting with acute coronary syndrome (ACS) is not well described.

Methods and results

We included 91 consecutive young patients (≤45 years at presentation) with ACS with obstructive or without obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Wall motion abnormalities, wall motion score index (WMSI) and left ventricle ejection fraction (LVEF) were evaluated. A wall motion abnormality in at least one segment was present in 78.7% of patients. Mean LVEF was 50.9 ± 8.8% and mean WMSI was 1.38 ± 0.37%. Akinesia of at least one segment was present in 49.4%, dyskinesia and aneurysm were rare (1.1%, respectively). Ventricular thrombus was observed in 4.7%. Distribution of wall motion abnormalities is presented in Figure A. Most frequently WMA affected the apex and the basal inferior wall. The severity of WMA for each segment is presented in Figure B. The mean highest severity of WMA affected the apex, and the inferior and infero-septal wall. In the subgroup of patients presenting without obstructive coronary artery disease, WMA were less prevalent (37.5%), LVEF was higher (57.1% vs. 50.4% P = 0.032), and WMSI was lower (1.16% vs. 1.40% P = 0.07), but similarly affected with higher frequency the apex area.

Conclusions

In conclusion, WMA are frequent in young patients presenting with ACS, mostly affecting the apex. More severe abnormalities of wall kinesis affect the apex and the inferior and infero-septal wall.
752 Acute coronary syndrome in young patients: long-term follow-up and quality of life assessment
Authors: Parisi Francesca , Nicolò Claudio , Franzino Marco , De Santis Giualia , Pistelli Lorenzo , Recupero Antonino , Pugliatti Pietro , Dattilo Giuseppe , Cimino Claudia , De Gregorio Cesare , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Costa Francesco
Published: December 2021

Aims

Early onset acute coronary syndrome (ACS) is associated with a more aggressive evolution and its consequences can be devastating to the quality of life (QOL), affecting the patient’s psychology, ability to work, and the socioeconomic burden. In the last decade, the incidence of ACS in young patients (≤45 years old) is increased but unfortunately, little is known about long-term follow-up and impact on quality of life. The aim of this study was to analyse the clinical evolutions and the QOL in this specific group of patients.

Methods and results

We included 91 consecutive young patients (≤45 years at the time of presentation) with ACS referred from October 2013 until March 2021 to our clinic. All enrolled patients underwent angiography. We analysed the clinical presentation, echocardiography, and therapy at the time of discharge. Furthermore, patients underwent telephone follow-up after 40 months: new hospitalizations, cardiovascular events, bleeding, and relevant changes in medical therapy were investigated. In addition, patients were also invited to participate to a survey to investigate QOL, sexual, and socioeconomic changes after ACS. QOL was explored through the EQ-5D scale using the time trade-off (TTO) and visual analogue scale (VAS) technique based on European values. Mean age was 40.6 ± 3.6 years and 17.6% were women. Most patients had obstructive coronary artery disease at angiography (90.1%) and 85.7% underwent PCI. At a median follow-up of 40 months, major adverse cardiovascular events (MACE) a composite of death, myocardial infarction, stroke and definite stent thrombosis, occurred in 12% of patients (Figure 1). Patient reported bleeding occurred in 29.8%, while bleeding requiring hospitalization in 3.6%. Univariate predictors of MACE were previous stroke, Killip class at presentation, current drug use, left ventricle ejection fraction, wall motion score index (WMSI), and haemoglobin at admission. Young patients showed reduced levels of QOL (TTO: 0.85 ± 0.17—VAD: 0.79 ± 0.17), with higher levels among individuals without obstructive coronary artery disease (Figure 2). Predictors of lower quality of life were WMSI, left anterior descending (LAD) stenting, left ventricular aneurysm and ventricular thrombus (Figure 3). After 12 months from the index event, 31.5% of patients were still on dual antiplatelet therapy, and the mean number of medications was 4.65 ± 2.3.

Conclusions

In conclusion, young patients have a high residual risk of ischaemic and bleeding events and impaired QOL. Optimization of medical therapy and better patient information is of upmost importance to mitigate residual risk of adverse events.
373 Utility of the early phase of DPD scintigraphy in the diagnosis of correlated TT-R cardiac amyloidosis
Authors: Graziani Tiziano , Cidda Carla , Serra Walter , Mattioli Maria , Sammartano A. , Migliari S. , Ruffini Livia
Published: December 2021

Aims

The importance of cardiac scan with phosphonate-based radiotracers in the diagnosis of cardiac amyloidosis is now well established. Standard imaging is performed 3 h after tracer injection with a planar view on the cardiac region. This study sought to evaluate the predictive role of early-phase myocardial uptake (10 min after injection) of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) compared compared with standard late acquisition, in patients with suspected hereditary transthyretin-related cardiac amyloidosis (TTR-CA).

Methods and results

Fifty five patients with suspected of TTR-CA with typical aspects of the relative apical sparing at two-dimensional speckle-tracking echocardiography, reported as a specific pattern for cardiac amyloidosis, were enrolled after having signed informed written consent. They have been subjected to a 99mTc-DPD cardiac scintigraphy with planar acquisition at 10 min and 3 h after tracer injection (13 Mbq/Kg). Patients with cardiac uptake on the planar images concluded the examination with a SPECT-CT (cardiac protocol) to assess the affected myocardial segments. On planar images the heart-to-mediastinum-ratio was measured. Subsequently, the diagnosis of amyloidosis has to be confirmed with morphologic examinations such as biopsy and genetic tests. Of the enrolled patients with clinical and echocardiographic aspect of TTR-CA, 22 were positive for cardiac amyloidosis. All of them showed tracer uptake in both early and late images. In patients with positive results, the early-phase showed a Heart-to-mediastinum-ratio >1.2. SPECT/CT showed involvement of almost two myocardial segments: in all patients the ventricular septum showed significant tracer uptake.

Conclusions

Our small group of patients showed that 99mTc-DPD myocardial uptake intensity on early-phase scintigraphy can be used to anticipate the results of late images in diagnosis of TTR cardiac amyloidosis.
753 Facilitators and barriers in adherence to infection prevention and control recommendations among healthcare providers in cardiac settings
Authors: Chialà Oronzo , Chiaretti Ludovica , Ruggiero Antonio , Carnevale Angelica , Fiorini Jacopo , Esposito Giuseppe , Mongardi Maria
Published: December 2021

Aims

The infection prevention and control (IPC) represents a global issue. In cardiac settings, it is a fundamental aspect, mostly in interventional procedures (PMK and valves implantation, angiography procedures), even if with different levels of incidence, mortality, and morbidity. Different guidelines and recommendations have been published to reduce complications related to cardiac procedures infections. Although there are several recommendations, the presence of specific protocols and the adherence to them in medical treatment facilities are controversial. The aim is to identify facilitators and barriers to IPC guidelines in health care providers of cardiac settings.

Methods and results

The research will be conducted in three phases: (1) an integrative review, to identify the main IPC recommendations related to the most common invasive procedures in cardiac interventional settings and the most cited facilitator and barriers; (2) the information collected by the review will help to conduct an explorative survey, involving health care providers from cardiac settings, to better understand what are the most helpful facilitators and the hardest barriers to face; and (3) a qualitative study, using explorative interviews will be held to analyze the experiences of health care providers in their professional action.

Conclusions

Generally, the adherence to IPC recommendations results difficult and time-consuming. For example, even if healthcare workers may value the use of IPC guidelines, such as wearing PPE, these are not always available, adequate for purpose, or comfortable. Identifying which factors could be considered facilitators or barriers will help authorities and healthcare facilities in developing effective strategies to support health care providers to undertake IPC measures.
567 Wolff–Parkinson–White syndrome and sport activity: a peculiar case in a young athlete
Authors: Licciardello Claudio , Golino Michele , Seganfreddo Francesca , Matteo Federica , Giovenzana Fulvio Lorenzo Francesco , Franzosi Cinzia , Genoni Paola , Marazzato Jacopo , De Ponti Roberto
Published: December 2021

Aims

Wolff–Parkinson–White (WPW) is a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles. Palpitations, presyncope, or syncope that result from supraventricular tachycardia represent classic symptoms; however, especially in young athletes, the syndrome can occur with sudden cardiac death. As result, the presence of an accessory pathway (AP) and tachycardia induced by physical activity contraindicates agonist physical activity and represents an indication to perform an electrophysiology (EP) study to stratify the arrhythmic risk, also allowing an eventual transcatheter ablation (TCA) of the AP.

Methods and results

An agonist football player, known since the age of 6 years for Wolff–Parkinson–White syndrome from an intermittent right midseptal parahissian AP, underwent a transesophageal EP study and subsequently ineffective TCA with radiofrequency when he was 13 years old. For evidence of intermittent ventricular preexcitation (VPE), at the age of 15 he underwent a further endocavitary EP study with documentation of poor conductive abilities of the AP. Subsequently, at the age of 17, he had a resumption of palpitation and lipotimie during effort; during another sport medical examination with an exercise stress test (EST), a persistent VPE with the start of an orthodromic atrioventricular reentrant tachycardia during the recovery phase was documented. A new EP study with isoprenaline infusion confermed the precence of the parahissian AP and the inducibility of an orthodromic atrioventricular reentrant tachycardia (Picture 1-2B); therefore, after mapping the arrhythmia, a cryoablation of AP was performed (Picture 1c-1d). Nevertheless, 12 h after the procedure, there was still evidence of intermittent VPE. The patient was then discharged and, after a month, he repeated the EST with documentation of persistent VPE which suddenly disappeared at the peak of the exercise and reappeared during the recovery phase. At the 1-year follow-up, no arrhythmic recurrence but persistence of VPE was reported and a successive EST confirmed abrupt interruption of VPE at the peak of the exercise. Due to the low arrhythmic risk, sport activity was not more restricted.

Conclusions

This represents an original clinical case, as it raises the question of what practical criteria should be defined as an effective TCA of AP in a competitive athlete with unfavorable anatomy. The current guidelines (Sport Cardiology and Exercise 2020) provide useful indications in linear and common cases, but may be a source of doubts in particular cases. Therefore, only the experience and the careful evaluation of the individual patient can provide the key to a correct management of the cases like this.
Non-linear particle reacceleration by multiple shocks
Authors: Vieu T , Gabici S , Tatischeff V
Published: December 2021

When the pressure of particles accelerated at shock waves is no longer negligible compared to the kinetic pressure of the gas, the linear theory of diffusive shock acceleration breaks down. This is expected in particular when the shock sweeps up pre-existing cosmic rays, or when multiple shocks reaccelerate successively the same particles. To describe these systems, one has to account for the non-linear backreaction of the particles on the magnetohydrodynamic flow. Using an up-to-date semi-analytical model of particle reacceleration at non-linear shocks, we show that the presence of pre-existing energetic particles strongly affects the shock profile, in such a way that the reacceleration of non-thermal particles or the acceleration of particles from the thermal bath becomes less efficient. We further describe the evolution of the distribution of particles after several shocks and study the properties of the asymptotic solution. We detail the case of identical shocks as well as more realistic scenarios, including the heating of the medium or superbubble environments. When the particles are efficiently confined in the acceleration region, it is generally found that the spectrum converges toward a concave solution after a few tens of shocks, with a spectral index around 3.5 at the highest energy. The post-shock cosmic ray pressure reaches an asymptotic value of about 4–5 per cent of the ram pressure of one shock. Most of the shock pressure is transferred to escaping particles.
Daytime napping is associated with retinal microcirculation: a large population-based study in China
Authors: Liu Xin , Wang Guowei , Wang Xiaoyan , Wang Yueye , Min Yan , Zhang Janice , Chang Robert T , Zhao Xueyin , He Wei , Moshfeghi Darius M , Lu Ying , Hsing Ann W , Yao Ke , Zhu Shankuan
Published: December 2021

Study Objectives

To investigate the association between daytime napping and retinal microcirculation.

Methods

This is a cross-sectional study from a prospective population-based cohort. 2,662 participants were recruited after quota sampling. Information on napping was collected through face-to-face interviews. Retinal vascular calibers (RVCs), including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arterio-to-venous ratio (AVR), were obtained from fundus photography. Multivariate regression and restricted cubic spline curve were performed to determine the association between RVCs and daytime napping duration.

Results

56.4% participants reported daytime napping regularly. Compared to no nap, daytime nap was related to higher CRAE, with nap duration of 0.5–1 h showing the most significant association. 0.5–1 h daytime nappers displayed an average of 4.18 µm (95% confidence interval [CI] 2.45–5.91, p < 0.001) wider CRAE than non-nappers after adjustment. No significant association was found between CRVE and daytime napping. Moreover, individuals with 0.5–1 h daytime napping had a lower risk for AVR reduction (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.56–0.86, p = 0.001) than non-nappers. Similar association persisted in non-hypertensive population. Restricted cubic spline indicated a J-shaped relationship between AVR reduction and nap duration.

Conclusion

Retinal microcirculation was positively associated with self-reported 0.5–1 h daytime napping. Better indicators of retinal microcirculation were probably related to nap duration in a J-shaped manner. Also, the possibly beneficial role of 0.5–1 h daytime napping on retinal microcirculation might be independent of clinically diagnosed vascular diseases.
The possible thyroid disruptive effect of di-(2-ethyl hexyl) phthalate and the potential protective role of selenium and curcumin nanoparticles: a toxicological and histological study
Authors: Sherif Naima Abd El-Halim , El-Banna Asmaa , Abdel-Moneim Rehab Ahmed , Sobh Zahraa Khalifa , Balah Manal Ibrahim Fathy
Published: December 2021

Di-(2-ethylhexyl) phthalate (DEHP) is one of the ubiquitous pollutants worldwide. This study aimed to clarify the potential thyroid disrupting effect of DEHP and explore the probable ameliorative effects of selenium nanoparticles (Se-NPs) and curcumin nanoparticles (CUR-NPs). Forty-two male albino rats were divided into seven groups (n = 6): Group I (negative control); group (II) orally received DEHP (500 mg/kg BW, dissolved in corn oil); Group (III) orally received Se-NPs (.2 mg/kg BW) in combination with DEHP; Group (IV) orally received CUR-NPs (15 mg/kg BW) alongside with DEHP; Group V (corn oil); Group VI (Se-NPs) and Group VII (CUR-NPs). The duration of the experiment was 30 days. DEHP administration significantly decreased serum free T4 and significantly increased serum free T3 as compared to control group, whereas thyroid-stimulating hormone showed no significant change. DEHP disrupted redox status leading to accumulation of malondialdehyde and depletion of reduced glutathione. Histologically, the effect of DEHP on thyroid follicles was confirmed by light and electron microscopic examination and morphometric analysis. Se-NPs slightly improved thyroid parameters as well as redox status. CUR-NPS reinstated the values of all studied thyroid parameters to nearly control levels. This research provides Se-NPs and CUR-NPs as novel protective agents against DEHP-thyroid disrupting effects.
RAPIDO
Authors: Castro Alejandra , Leal Andrea Ancer , Montiel Tahani Casameni , Sharrief Anjail , Denny Mary Carter , Beauchamp Jennifer E.S.
Published: December 2021

The mnemonic BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) has been developed for the public to better remember and identify the warning signs of stroke. However, discrepancies may arise when translating stroke educational materials from English to Spanish. This article discusses the use of a culturally tailored tool, RAPIDO, to raise stroke awareness in Spanish-speaking populations.