bluuebunny/crossref_metadata_2025 huggingface dataset:
745 Meta-analysis comparing the safety and efficacy of ticagrelor monotherapy after a short course of ticagrelor-based dual antiplatelet therapy versus standard therapy in complex percutaneous coronary interventions
Authors: Condello Francesco , Sturla Matteo , Terzi Riccardo , Polimeni Alberto , Stefanini Giulio
Published: December 2021

Aims

Current guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor for 6–12 months after percutaneous coronary intervention (PCI). A shorter duration ticagrelor-based DAPT followed by ticagrelor monotherapy can significantly reduce bleeding events while preserving anti-ischaemic effects in patients undergoing conventional PCI. Whether this strategy can be safely and effectively applied to those patient that undergo ‘complex’ PCI is uncertain.

Methods

We performed a systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT vs. standard DAPT in patients undergoing complex PCI. A mixed-effects Poisson regression model with random intervention effects was used to estimate the pooled incidence rate ratios (IRR) with 95% confidence intervals (CI).

Results

Out of 10 689 studies screened, three were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor based DAPT, and 4209 on standard DAPT. Overall, the pooled analysis showed a strong evidence that compared to standard treatment, ticagrelor monotherapy after a short course of ticagrelor-based DAPT (1–3 months) reduced the risk of cardiovascular death [IRR 0.52; CI (0.28–0.96); P = 0.04; I2 = 0%], all-cause death [IRR 0.65; CI (0.49–0.86); P = 0.003; I2 = 0%], and any bleeding events [IRR 0.62; CI (0.47–0.81); P < 0.001; I2 = 44%]. Weak evidence was found of an association between the experimental strategy and a lower risk of myocardial infarction [IRR 0.79; CI (0.61–1.01); P = 0.06; I2 = 0%]. Instead, no significant difference in the risk of major bleeding [IRR 0.72; CI (0.48–1.08); P = 0.11; I2 = 61%], definite or probable stent thrombosis [IRR 0.77; CI (0.34–1.75); P = 0.53; I2 = 0%] and ischaemic stroke [IRR 0.83; CI (0.25–2.73); P = 0.76; I2 = 0%] was observed. We speculate that the observed mortality benefits might be related to the reduction of any bleeding events, mainly dictated by minor bleeding reduction, since major bleeding did not seem to be decreased in the shorter regimen group.

Conclusion

Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischaemic risk. As complex PCI procedures are being increasingly performed nowadays, and more comorbid patients are being treated, more studies are required to confirm and explain these findings. This could lead to optimization of antiplatelet therapy across a broad spectrum of patients.
244 Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation
Authors: Carbone Andreina , Santelli Francesco , Bottino Roberta , Attena Emilio , Mazzone Carmine , Parisi Valentina , D'Andrea Antonello , Golino Paolo , Nigro Gerardo , Russo Vincenzo
Published: December 2021

Aims

Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.

Methods

Data for this study were sourced from the multicentre prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus.

Results

A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC 1.45–6.83); P < 0.01], coronary artery disease [OR = 3.6 (95% IC 1.41–9.1); P< 0.01] and body mass index [OR = 1.27 (1.14–1.41); P < 0.01]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36–96); P < 0.01], with age [OR = 0.76 (95% IC; 0.61–0.96); P < 0.05], BMI [OR = 0.77 (0.11; 0.62–0.97); P < 0.05] and with previous bleedings [OR = 6.4 (0.7; 1.43–28) P < 0.05]. There wasn’t significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (P < 0.001).

Conclusion

In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs’ overdosage (diabetes mellitus Type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.
170 Evaluation of endothelial function in dyslipidaemic patients treated with anti-PCSK9 monoclonal antibody
Authors: Cersosimo Angelicac , Cimino Giuliana , Amore Ludovica , Drera Andrea , Gavazzoni Mara , Raddino Riccardo
Published: December 2021

Aims

According to new Guidelines, the use of an anti-PCSK9 monoclonal antibody in combination is recommended in secondary prevention in patients with very high risk who do not reach the target with the maximum tolerated dose of statin and ezetimibe, and in those patients with very high-risk familial hypercholesterolemia. The therapy is always combination, while the single treatment with anti-PCSK9 monoclonal antibody is indicated in patients with statin intolerance. The present study aims to determine the cardiovascular effects that are highlighted in the treatment of dyslipidaemia with the anti-PCSK9 monoclonal antibody, especially as regards the endothelial function (using the non-invasive methods of EndoPAT), the arterial stiffness (using the non-invasive methods of SphygmoCOR) and the effective improvement on the lipid profile (reduction total cholesterol, LDL and triglycerides).

Methods

The study is a single-centre prospective study enrolling 47 patients in primary and secondary prevention with non-target LDL cholesterol. Patients were evaluated and enrolled from April 2019 to June 2020 (recruitment period). The average follow-up was 12 weeks, from intaking one of anti-PCSK9, Alirocumab 75 or 150 mg and Evolocumab 140 mg. The scheduled evaluations of the enrolled population were before the beginning of the therapy and after a period of 12 weeks.

Results

After 12 weeks of treatment we demonstrated a statistically significant reduction in total cholesterol (P < 0.001) and LDL (P < 0.001). An important effect on the inflammatory profile was highlighted, resulting in a decrease in Hs-CRP at 12-weeks (P 0.057), associated with an improvement on endothelial function (P 0.003). Reduction of arterial stiffness was no significant (P 0.238).

Conclusions

Data confirm anti-PCSK9 monoclonal antibodies, associated with statins and/or ezetimibe to reach LDL target, improve significantly lipid profile and endothelial function. Furthermore anti-PCSK9 monoclonal antibodies are safe and practically free of side effects.
709 Non-invasive assessment of myocardial work: an useful tool for predicting LV remodelling after myocardial infarction?
Authors: Caminiti Rodolfo , Parlavecchio Antonio , Vetta Giampaolo , Pelaggi Giuseppe , Lofrumento Francesca , Licordari Roberto , Cusma Maurizio , Manganaro Roberta , Pucci M , Radano Ilaria , Citro Rodolfo , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Zito Concetta
Published: December 2021

Aims

Left ventricular function recovery (LV-REC) or left ventricular adverse remodelling (LV-REM) after acute myocardial infarction (AMI) play an important role for identifying patients at risk of heart failure. In this study we aim to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV-REC or LV-REM after AMI.

Methods and results

Fifty patients with AMI (mean age, 63.8 ± 13.4 years), treated by primary percutaneous coronary intervention (PCI), were prospectively enrolled. They underwent a baseline transthoracic Doppler echocardiography (TTE) within 48 h after PCI and a second TTE after a median of 31 days during the follow-up. MW was derived from the strain-pressure loops, integrating in its calculation the non-invasive arterial pressure, according to standard speckle tracking echocardiography recommendations. LV-REC was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥ 5% from LVEF at baseline, whereas LV-REM was defined as an increase of ≥ 20% of the LV end diastolic volume (LVEDV) at 1 month follow-up. We overall found a significant improvement from baseline to one-month follow-up for values of LVEF (49.8 ± 9.5% vs. 52.8 ± 9.3%, P = 0.001), global longitudinal strain (GLS) (−13.4 ± 3.9% vs. −18.7 ± 5.4%, P = 0.016), global work index (GWI) (1368.6 ± 435.2 vs. 1788 ± 493 mmHg/%, P = 0.0001), global work efficiency (GWE) (89.96 ± 9.3% vs. 91.3 ± 6.4%, P = 0.001), global constructive work (GCW) (1619.16 ± 497.9 mmHg/% vs. 2008.6 ± 535.3 mmHg/%, P = 0.0001), global wasted work (GWW) (188.8 ± 19.8 mmHg/% vs. 149.2 ± 16.5 mmHg/%). However, LV-REC at 1 month of follow-up was observed only in 36% of the population enrolled, whereas LV-REM was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 202 mmHg/% for baseline GWW (sensitivity 75%, specificity 62%, AUC 0.6667, CI 95%: 0.51618–0.81715, P = 0.0001) to identify patients with LV-REM at 1 month. With regards to conventional echo parameters, patients with LV-REC showed lower baseline wall motion score index (WMSI) than those without LV-REC (1.73 vs. 1.38, P = 0.007).

Conclusions

Among standard and advanced TTE parameters, only baseline GWW is able to predict early LV-REM at 1 month after primary PCI. Therefore, it could be used during baseline evaluation of AMI patients for a more accurate stratification of those at higher risk of heart failure. However, further larger scale studies are needed to validate these findings.
313 Prognostic value of different echocardiographic indices reflecting right ventriculo-arterial coupling in a large cohort of patients with various cardiac diseases
Authors: Florescu Diana Ruxandra , Muraru Denisa , Volpato Valentina , Tomaselli Michele , Caravita Sergio , Gavazzoni Mara , Florescu Cristina , Parati Gianfranco , Badano Luigi Paolo
Published: December 2021

Aims

Non-invasive parameters used to assess right ventricular (RV) function, i.e. tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), RV ejection fraction (RVEF), and RV free-wall longitudinal strain (RVFWLS) have shown their prognostic implications. However, since they are extremely load dependent, they do not provide an accurate representation of the RV intrinsic performance. On the other end, invasive indices of RV-arterial coupling (RVAC) derived from pressure–volume loops are not routinely performed, rising the urgency for more feasible, and reliable non-invasive estimates of RVAC. To (i) evaluate the prognostic value of echocardiography-derived RVAC surrogates: RVEF/sPAP, RVFWLS/sPAP, TAPSE/sPAP, FAC/sPAP, and RV stroke volume/end-systolic volume (SV/ESV); (ii) identify the cut-off values associated to all-cause mortality; and (iii) compare their prognostic value with that of classical parameters of RV function.

Methods and results

We prospectively enrolled 366 patients with various cardiac diseases, undergoing clinically indicated comprehensive two- and three-dimensional echocardiography. During a mean follow-up of 7.6 ± 1 years, 80 (21.9%) patients died. At univariable Cox regression, most of the echocardiographic parameters were related to all-cause mortality. The echocardiographic parameters with significance at univariable analysis (P < 0.01) were included in a multivariable regression model. Left ventricular ejection fraction (LVEF), RVEF, TAPSE, RVEF/sPAP, and RVFWLS/sPAP remained independently associated to all-cause mortality (P < 0.05 for all). Subsequently, they were tested in receiving operator characteristics (ROC) curves. At ROC analysis, RVEF/sPAP (area under the curve, AUC = 0.807, P < 0.001) and RVFWLS/sPAP (AUC = 0.743, P < 0.001) showed the greatest predictive value (P < 0.001 between them). However, all RV parameters significantly improved their values after indexing for sPAP (P < 0.01 for all). The best cut-offs to predict the outcome were 1.5 for RVEF/sPAP (specificity 71%, sensitivity 83%) and 0.67 for RVFWLS/sPAP (specificity 72%, sensitivity 68%). At Kaplan–Meier analysis, patients with reduced RVAC (less than the predefined cut-offs) had significantly lower probability of survival (P < 0.001 for all).

Conclusions

RVAC surrogates provide incremental prognostic value compared to standard RV functional measurements. RVEF/sPAP, with a cut-off value of 1.5, was the best parameter for risk stratification, and was independently related to all-cause mortality.
511 Cardio-vascular remodelling during sacubitril/valsartan therapy in patients with heart failure and reduced ejection fraction
Authors: Monosilio Sara , Filomena Domenico , Luongo Federico , Neccia Matteo , Sannino Michele , Birtolo Lucia Ilaria , Cimino Sara , Benedetti Giulia , Tonti Giovanni , Pedrizzetti Gianni , Fedele Francesco , Maestrini Viviana , Agati Luciano
Published: December 2021

Aims

Sacubitril/valsartan (S/V) benefits in patients with heart failure and reduced ejection fraction (HFrEF) are partially related to cardiac reverse remodelling, in terms of volumes reduction and function improvement. Effects on vascular remodelling are less investigated. To evaluate cardiac and vascular remodelling in a cohort of patients with HFrEF after 6 months of therapy with S/V.

Methods and results

50 patients with HFrEF eligible to start a therapy with sacubitril/valsartan were enrolled. Clinical evaluation and standard and advanced echocardiography were performed at baseline and after 6 months of follow-up (FU). Standard left ventricular dimension and function parameters and global longitudinal strain (GLS) were calculated. Non-invasive pressure-volume curves (P-V loop) estimation was assessed with an off-line dedicated software using ST-E derived time-resolved LV volumes and brachial pressure as input. The following haemodynamic parameters were calculated based on P–V loop curves: left ventricular elastance (Ees), arterial elastance (Ea), and ventricular-arterial coupling (VAC). At 6 months F/U, a reduction of NYHA class in the vast majority of patients was detected (NYHA Class ≥ II, baseline vs. F/U = 100% vs. 50%; P < 0.001). Systolic and diastolic blood pressure were lower, in comparison with baseline values (119 ± 16 vs. 126 ± 11 mmHg; P = 0.002 and 71 ± 8 vs. 78 ± 8 mmHg; P = 0.001, respectively). At echocardiographic evaluation, left ventricular end-diastolic and end-systolic volumes decreased and ejection fraction and GLS significantly improved (Table). Moreover, a significant reduction of Ea and a significant improvement of Ees and VAC was observed (Table). 511 Table 1

Conclusions

Therapy with S/V in HFrEF patients determines both cardiac and vascular remodelling reflecting the complex mechanisms behind clinical improvement.
196 Cardiovascular magnetic resonance characterization of myocardial injury in recovered COVID-19 patients with elevated troponins during hospital stay
Authors: Sturla Matteo , Gaetano Liccardo , Condello Francesco , Bombace Sara , Stefanini Giulio G , Condorelli Gianluigi , Francone Marco , Monti Lorenzo
Published: December 2021

Aims

Despite being a common finding in hospitalized COVID-19 patients, cardiac troponin elevation remains a nonspecific detection of myocardial injury and further in-hospital investigation into the cause of myocardial injury is rarely done. COVID-19 patients with myocardial injury show a significantly higher in-hospital mortality rate compared with those without myocardial injury and among those with myocardial injury, greater degrees of troponin elevation are associated with higher mortality rates. There are still many questions regarding possible cardiovascular sequelae and prognostic significance in these patients. Being able to distinguish between inflammatory and ischaemic causes of myocardial injury cardiovascular magnetic resonance (CMR) is the non-invasive modality of choice to investigate myocardial involvement in these patients. Presented are the preliminary single-centre results from a multicentre study aimed to characterize the prevalence, type and extent of COVID-19-related cardiovascular sequelae using CMR imaging.

Methods and results

In this single-centre prospective observational cohort study, patients hospitalized with confirmed COVID-19 and at least one value of high sensitivity I troponin (hs-Tnl) >99th percentile during hospitalization were eligible for follow-up contrast-enhanced CMR imaging. Patients with any standard CMR contraindications were excluded. Images were acquired using a standardized myocarditis protocol including late gadolinium enhancement (LGE) and T1 and T2 mapping. Cutoff values of 1015 ms and 50 ms were used for abnormal T1 and T2 measurements, respectively. Of the 21 patients (65 ± 11.85 years) who underwent imaging, 15 (71.4%) were male. The mean follow-up duration from the date of confirmed COVID-19 diagnosis was 169 ± 19 days. The mean left ventricular ejection fraction was 64.1 ± 13.87 and 3 (14.3%) patients had evidence of wall motion abnormalities. LGE was seen in 9/20 (45.0%) patients, reflecting myocardial fibrosis. Increased native T1 signal representing myocardial fibrosis and/or oedema was seen in 9/20 (45.0%) patients. While increased native T2 signal, being more specific for oedema was observed in 3/20 (15.0%) patients. Considering CMR findings, 6 (28.6%) patients showed evidence of previous myocarditis.

Conclusions

In this single centre Italian study of patients hospitalized with COVID-19 and elevated cardiac enzymes, myocarditis-like injury was evident in about a quarter of the patients. Whether these findings will lead to long-term cardiac complications is still to be confirmed.
26 Procedural planning and tip-to-base lampoon to succeed in a complex valve-in-valve TMVR procedure
Authors: Baggio Sara , Lancini Damiano Regazzoli , Bragato Renato Maria , Reimers Bernhard , Pagnotta Paolo Antonio , Colombo Antonio
Published: December 2021

Aims

Left ventricle outflow tract (LVOT) obstruction is a feared complication of transcatheter mitral valve replacement (TMVR) procedures. Multimodal imaging evaluation is the key to identify at-risk patient and select the best management.

Methods and results

An 83-year-old woman with a history of mitral valve replacement with a 27-mm Carpentier-Edwards bioprosthesis (Edwards Lifesciences, Irvine, CA) for rheumatic heart disease was admitted to our department complaining worsening effort dyspnoea. Clinical evaluation revealed a grade 3/6 holosystolic murmur. She underwent combined transthoracic and transesophageal echocardiography (TEE) which demonstrated mitral bioprosthesis degeneration leading to severe stenosis (mean gradient = 13 mmHg, PHT-derived area = 0.9 cm2) and moderate regurgitation, with preserved biventricular function, and severe pulmonary hypertension (pulmonary artery systolic pression = 65 mmHg). The patient presented a high estimated risk for redo-surgery (Society of Thoracic Surgeons score estimated mortality: 6%) due to her complex medical history, including advanced chronic kidney disease and permanent atrial fibrillation; therefore, she underwent evaluation for valve-in-valve TMVR. Cardiac computed tomography (CT) revealed bioprosthetic anterior leaflet in tight contact with the septum in systole; predicted neo-LVOT using virtual 26-mm Sapien S3 (Edwards Lifesciences, Irvine, CA) valve was 150 mm2, conferring a high risk of fixed LVOTO. A 26-mm Sapien S3 valve was selected based on CT derived surgical valve ID of 24 mm. After Heart Team discussion, we performed a modified LAMPOON technique to achieve tip-to-base laceration of the bioprosthetic leaflet beside the LVOT, in order to prevent LVOT obstruction. Briefly, after transseptal puncture through right femoral vein access (16 Fr), we crossed the mitral prosthesis using a balloon wedge end-hole catheter, through which we advanced a 300 cm 0.014-inch wire into the ascending aorta, where it was snared from left arterial femoral access (8 Fr) and covered by a micro-catheter. The wire was previously kinked mid-shaft to form a ‘flying-V’ that was focally denuded and positioned at the target bioprosthetic leaflet’s tip using TEE and fluoroscopy. The guidewire was pulled toward the valve ring and electrified at 70 W with continuous 5% dextrose flush until adequate tip-to-base leaflet laceration. Thereafter, we successfully implant a 26-mm Sapien S3 valve. Maximal LVOT gradient post implant was 5 mmHg. The patient was discharged on post-operative day two and she recovered well, reporting functional and symptomatic improvement at 6-month follow-up.

Conclusions

our case highlights the importance of multimodality imaging and careful procedural planning to succeed even in complex valve-in-valve TMVR procedures. Transcatheter electrosurgery is an emerging tool for percutaneous structural heart interventions.
233 Prognostic implications of the automated detection of lipid core burden index at optical coherence tomography: post hoc analysis of the CLIMA study
Authors: Biccirè Flavio Giuseppe , Budassi Simone , Isidori Francesco , Lella Eugenio , Romagnoli Enrico , Albertucci Mario , Paoletti Giulia , Manna Alessio La , Boi Alberto , Burzotta Francesco , Ozaki Yukio , Mintz Gary S , Alfonso Fernando , Prati Francesco
Published: December 2021

Aims

Plaque vulnerability features are associated with major coronary events and poor outcomes. However, routinary and reproducible manual assessment of plaque vulnerability features at optical coherence tomography (OCT) is still challenging. We recently developed and validated an OCT-derived automated approach that can identify the intra-plaque lipid core burden index (LCBI). Our aim was to investigate the association between the automated detection of OCT-derived LCBI and clinical events.

Methods and results

We conducted a post hoc analysis of the CLIMA study, a large prospective observational, multicentre registry recruiting all consecutive patients undergoing assessment of the proximal left anterior descending artery (LAD) segment by OCT in the context of clinically indicated coronary angiography. The automated detection of maximum LCBI was carried out in 4 mm of intervention-naïve proximal LAD segment (maxLCBI4mm) by using the validated software. The mean and median value of LCBI in all study population (n = 1003) was 407.6 and 411.1, respectively. Patients with higher LCBI (≥400) were more frequently male (P = 0.016) and affected by insulin-dependent diabetes mellitus (0.046). Furthermore, they showed more frequently at OCT analysis the vulnerable plaque characteristics investigated in the CLIMA study (Table 1). At Cox regression analysis, a maxLCBI4mm ≥400 predicted at 1 year both a hard endpoint of cardiac death and target-vessel myocardial infarction [hazard ratio (HR): 2.56, 95% confidence interval (CI): 1.2–5.3, P 0.011], as well as a composite endpoint of cardiac death, any myocardial infarction and target vessel revascularization (HR: 1.87, 95% CI: 1.1–3.1, P = 0.011).

Conclusions

In our study, the automated detection of LCBI at OCT was feasible and related to poorer clinical outcome at 1-year follow-up.
494 Glycoprotein IIB/IIIA inhibitors may modulate the clinical benefit of radial access as compared to femoral access in primary percutaneous coronary intervention: a meta-regression and a meta-analysis of randomized trials
Authors: Cristiano Ernesto , Cava Francesco , Monaco Maria Lo , Tempestini Federica , Giovannelli Francesca , Tommasino Antonella , Zardi Domenico , Berni Andrea , Volpe Massimo
Published: December 2021

Aims

Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favour of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access.

Methods and results

We computed pooled estimates by the random effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. We analysed 14 randomized controlled trials and 11 090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality [risk difference 0.01 (0.00, 0.01), P = 0.03], MACE [risk difference 0.01 (0.00, 0.02), P = 0.003], and major bleedings [risk difference 0.01 (0.00, 0.02), P = 0.02]. At meta-regression, we observed a significant correlation of mortality with both GPI use (P = 0.011) and year of publication (P = 0.0073), whereas no correlation was observed with major bleedings.

Conclusions

In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.
376 Incomplete functional revascularization is associated with adverse clinical outcomes after TAVI
Authors: Venturi Gabriele , Scarsini Roberto , Pighi Michele , Ribichini Flavio
Published: December 2021

Aims

Whether incomplete functional revascularization has an impact on the clinical outcome of patients treated with transcatheter aortic valve implantation (TAVI) is still unknown. We aim to assess the prognostic value of residual functional Syntax score (rFSS) in a cohort of patients undergoing TAVI.

Methods and results

One-hundred-twenty-four patients (229 lesions) with severe aortic stenosis and coronary artery disease (CAD) underwent fractional flow reserve (FFR)-guided revascularization. The primary endpoint of the study was the composite of cardiac death, myocardial infarction and revascularization at last available follow-up after TAVI. Median Syntax score (SS) and Functional Syntax score (FSS) at baseline were 7 (range 5–12) and 0 (range 0–7) respectively. After revascularization or deferral according to FFR, residual SS (rSS) and rFSS were 5 (range 0–8) and 0 (range 0–0), respectively. At COX regression analysis, angiographic incomplete revascularization (rSS = 0) was not associated with the primary endpoint (HR: 1.26; 95% CI: 0.40; 3.95; P-value 0.698), whereas functional incomplete revascularization was associated with worse event-free survival at Follow-up after adjusting for clinical confounders (HR: 3.74, 95% CI: 1.02–13.75, P = 0.047).

Conclusions

Incomplete functional revascularization is associated with adverse clinical outcome after TAVI. rFSS may be regarded as a treatment goal for patients with CAD undergoing TAVI. Further studies are warranted to confirm our hypothesis. 376 Central FigureMACEs free survival analysis of patients stratified according to complete revascularization vs. incomplete revascularization assessed according to anatomy (residual SYNTAX score) (A) or physiology (residual functional SYNTAX score) (B).
701 ECMO assistance during TAVI in high-risk patient with recent COVID-19 pneumonia
Authors: Vizzari Giampiero , Ceresa Fabrizio , Mancini Nastasia , Colarusso Luigi , Perna Alessia , Paola Federico Di , Mobilia Gianni , Iannello Pietro , Patanè Francesco , Micari Antonio
Published: December 2021

Methods and results

A 87 years old woman, with history of dyslipidemia and permanent Atrial Fibrillation, already undergone full SARS-CoV2 vaccination few months before, referred to our E.R. with complain of dyspnoea and chest pain. COVID-19 molecular test resulted positive and CT Scan of the chest confirmed the presence of several areas of ground-glass opacity and consolidation together with bilateral pleural effusion (right 6 cm with pulmonary atelectasis; left 2 cm), not requiring drainage. Moreover, it showed severe calcification of both the aortic valve and root. Transthoracic echocardiogram showed eccentric LV hypertrophy with diffuse hypokinesia (EF 20–25%), ectatic ascending aorta (45 mm) with severe LF-LG aortic stenosis (AVAi 0.19 cm2) and moderate regurgitation, moderate-severe mitral regurgitation. During hospitalization in the COVID-19 Unit, despite O2 therapy she experienced worsening of the respiratory status with concomitant pulmonary oedema, hypotension and acute kidney injury, requiring administration of i.v. dobutamine and high dose diuretics. After gradual stabilization and COVID-19 negativization on 10th molecular test, she was transferred to our Coronary Care Unit. Coronary angiography showed absence of significant stenoses in the main vessels. In the following days the patient underwent a new clinical deterioration with dyspnoea, hypotension (BP 85/50 mmHg), oliguria and ankle swelling, requiring Ventimask O2 therapy and Dobutamine infusion. Transtoracic echocardiogram confirmed EF of 25% with PASP 30 mmHg. We decided to perform a ‘Rescue’ TAVI procedure, facilitated by extra-corporeal cardiac and respiratory support. CT Angiography of the chest, performed with low-dose contrast injection under amines infusion, showed severly calcific aortic valve with large sizes of the ring (Virtual Basal Ring area 620 mm2, perimeter 91 mm), measures compatible with the largest sizes of TAVI prostheses. After Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO) cannulation, we performed the implantation of a 34 mm Evolut R (Medtronic) TAVI prosthesis, post-dilated with 24 mm balloon for under-expansion due to massive calcification. During both self-expandable TAVI delivery and balloon inflation the patient underwent two phases of cardiac arrest, during which the ECMO flow provided a proper circulatory support.

Conclusions

Since percutaneous valve replacement the patient’s recovery was fast with rapid ECMO removal and discontinuation of inotropic therapy. Few weeks after discharge, at first follow-up examination, the patient appeared asymptomatic, in excellent clinical conditions. 701 Figure
780 Appearing and disappearing right-heart thrombus: a case reporto in COVID-19 patient
Authors: Campi Giacomo , Finocchi Martina , Palagano Nicolas , Calcagno Emanuela , Pesci Alessandra , Vinci Costanza , Aspite Silvia , Cimolato Barbara , Vannucchi Vieri , Landini Giancarlo
Published: December 2021

Aims

Venous thromboembolism represents frequent complication of patients with severe COVID-19 disease. Several reports about atypical thrombosis are described, rarely it has been described a right venticular thrombus during the course of infection. We report a case of right endoventricular thrombosis in a patient with SARS-Cov-2 pneumonia.

Methods and results

A 58-year-old man was admitted to our ward for severe respiratory failure in interstitial pneumonia. The nasopharyngeal swab for COVID-19 resulted positive. Steroids and prophylaxis with LMWH were started, associated to CPAP to maintain good gas exchange. During hospitalization a venous ECD was performed with evidence of left popliteal thrombosis despite the therapy. d-Dimer was 4463  ng/ml. A new onset AF was documented at the telemetry, without troponin elevation. A cardiac ultrasound was performed showing a right endoventricular lesion of 1.8  cm adhering to the free wall of the right ventricle. A CT-pulmonary angiogram (CTPA) resulted negative for pulmonary embolism and confirmed suspected right ventricular thrombus. Treatment with fondaparinux 7.5 mg was started. After 10 days, cardiac ultrasound shown complete resolution of thrombosis, and CT confirmed the disappearing of the mass. Dabigatran 150  mg twice/day was started. Patient clinically improved and he was discharged after 20 days of hospitalization.

Conclusions

SARS-CoV-2 infection may cause inflammation with cytokine storm and hypercoagulability leading to venous thromboembolism. Atypical thrombus formation was reported, including right-ventricle free wall. Early caridac ultrasound was critical to make diagnosis and starting prompt treatment, therefore routine cardiac ultrasound is mandatory in severe COVID-19 patients.
260 Impact of ‘atherosclerotic pabulum’ on in hospital mortality for SARS-CoV-2 infection. Is calcium score alone enough to identify at risk patients?
Authors: Dellino Carlo Maria , Cabrelle Giulio , Previtero Marco , Continisio Saverio , Montonati Carolina , Marra Martina Perazzolo , De Conti Giorgio , Motta Raffaella , Iliceto Sabino , Pergola Valeria
Published: December 2021

Although the primary cause of death in COVID-19 infection is respiratory failure, there are evidences that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID-19 is associated with a high incidence of thrombotic complications. Two-hundred-eighty-four patients with proven SARS-CoV-2 infection who had a non-contrast Chest CT at our facility were analysed for coronary calcium score. Clinical and radiological data were retrieved. Patients with coronary calcium had higher inflammatory burden at admission (d-dimer, CRP, Procalcitonin) and higher Troponin at admission and at zenith. While there was no correlation with presence of consolidation and ground glass opacities, patients with coronary calcium had higher incidence of bilateral infiltration and higher in-hospital mortality. Peak troponin was associated with higher mortality, intensive care unit admission and mechanical ventilation in both univariable at multivariate analysis. Calcium score has demonstrated to be a good prognostic indicator for in-hospital mortality in patients with SARS-CoV-2 infection. Patients with higher atherosclerotic burden are at higher risk of fatality and complications. Our findings could have significant clinical implications in selecting at risk patients for allocation of resources especially in those with ‘atherosclerotic pabulum’, where inflammation activated by SARS-CoV-2 may play a role in fatal and non-fatal events.
405 Myopericarditis after SARS-CoV-2 MRNA vaccination: casual or causal relationship?
Authors: Golino Michele , Licciardello Claudio , Matteo Federica , Giovenzana Fulvio Lorenzo Francesco , Franzosi Cinzia , Blasi Federico , Genoni Paola , Seganfreddo Fancesca , Cadonati Cristina , Morello Matteo , Di Martino Sara Elena , Marazzato Jacopo , Angeli Fabio , De Ponti Roberto
Published: December 2021

Aims

Myopericarditis have been reported as rare event after SARS-CoV-2 vaccination with mRNA-1273 and BNT162b2. However, these data referred to the month of May 2021, when only a few people under the age of 30 had been vaccinated. The aim was to report cases diagnosed with myopericarditis short after vaccination admitted to our hospital.

Methods and results

An observational study was performed recording all cases of patients (pts) hospitalized for myopericarditis which occurred within 14 days of SARS-CoV-2 mRNA vaccination. From June to August 2021, 12 pts were hospitalized for myopericarditis; four of them (33%) were young male pts (29 ± 12 years old) with no history of CVDs or SARS-CoV-2 infection but with a recent second dose of Covid-19 mRNA-1273 vaccine (mean interval from the injection 3 ± 2 days). ECG showed diffuse ST-segment elevation without specularity (Figure 1). SARS-CoV-2 molecular swab tested negative; laboratory (lab) test showed a slight increase of white blood cells (11 267 ± 1047 108/l) and a marked increase of C-reactive protein (78 ± 79 mg/l), troponin T (179 ± 179 ng/l), and Nt-proBNP (876 ± 198 ng/l); transthoracic echocardiogram showed normal left ventricle ejection fraction (mean 55 ± 3%) and in one case only mild pericardial effusion; chest X-ray showed pleural effusion in one case only. Pts were then hospitalized for an average of 7 ± 2 days and an anti-inflammatory therapy based on acetylsalicylic acid and colchicine (in one case also with cortisone) was established. In the following days, pts gradually recovered and were discharged home. After 10 days, two pts underwent a cardiac magnetic resonance imaging (cMRI) revealing myocardial oedema and late gadolinium enhancement in the subepicardial and midmyocardium, along the basal and mid-apical lateral wall; due to relative contraindications, the same examination was scheduled later for the other two pts. These cases deserve specific considerations on the causal relationship between heart inflammation and SARS-CoV-2 mRNA vaccines. Among the various pathophysiological hypothesis there is the high levels of antibodies that mRNA vaccines can generate in young male subjects or the consideration of mRNA as a natural adjuvant capable of activating disproportionately the innate immune system; in both cases, the result is an immune overreaction that can affect various organs including the heart.

Conclusions

Although the number of our cases is small and all pts recovered in a short time, the timing of symptoms and the similarities in clinical findings and lab characteristics call for further investigations.
308 Sex-related differences in long COVID-19 syndrome
Authors: Pelà Giovanna , Aiello Marina , Solinas Emilia , Mantovanelli Luca , Cavalli Chiara , Tagliaferri Sara , Ranzieri Silvia , Frizzelli Annalisa , Marchi Laura , Corradi Massimo , Mori Pier Anselmo , Majori Maria , Goldoni Matteo , Chetta Alfredo
Published: December 2021

Aims

Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f) were found to be less prone to develop a severe disease than males (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome.

Methods and results

The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection from a sex-perspective. For this purpose, we enrolled 223 patients (89 F and 134 M) who experienced a SARS-CoV-2 infection. In the acute phase of the illness, females reported more frequently than males: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhoea, and myalgia without significant differences in breathlessness, cough, and sleep disturbance. After a mean follow-up time of 5 months after the acute phase, females were significantly more likely than males to report weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnoea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough and sleep disturbance were not influenced by sex.

Conclusions

We demonstrated that females were more symptomatic than males not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID syndrome because it is a significant predictor of persistent symptoms in females, such as dyspnoea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex-perspective in order to implement early preventive and personalized therapeutic strategies.
724 Cardiovascular morbidity and mortality related to non-alcoholic fatty liver disease: a systematic review and meta-analysis of prospective studies
Authors: Bisaccia Giandomenico , Ricci Fabrizio , Melchiorre Eugenia , Tana Claudio , Renda Giulia , Khanji Mohammed , Fedorowski Artur , De Caterina Raffaele , Gallina Sabina
Published: December 2021

Aims

Whether non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiovascular (CV) events is still debated. Currently available evidence derives from non-homogeneous studies yielding conflicting results. We set out to assess the relationship between NAFLD and CV morbidity and mortality by pooling results of previous studies.

Methods

We performed a systematic review and meta-analysis of prospective observational studies published from 1966 through 2021 reporting summary-level outcome data in subjects with and without NAFLD. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for all-cause mortality, CV mortality, myocardial infarction (MI), stroke, major adverse cerebrocardiovascular events (MACCE) and atrial fibrillation (AF) were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. We performed post hoc subgroup analysis stratified by geographical region and univariate mixed-effect model meta-regression analysis to address statistical heterogeneity.

Results

We identified a total of 29 studies pooling an overall population of 5 626 573 middle-aged individuals (mean age 56 ± 8; male sex 53%; NAFLD 5.8%, n = 326 389). Mean follow-up was 10 ± 6 years. Compared with control population, presence of NAFLD was associated with similar risk of all-cause death (RR 1.17; 95% CI 0.89–1.52) and CV death (RR 0.84; 95% CI 0.64–1.10). When analysed by geographic location, pooled estimates of RR (95% CI) for all-cause death were 1.57 (1.00–2.48) for Western countries, and 0.81 (0.52–1.1.26) for Eastern countries (test for subgroup difference, P = 0.04). Meta-regression analysis showed a stronger relationship between NAFLD and all-cause mortality proportional to increasing body mass index (P = 0.048). NAFLD was associated with increased risk of myocardial infarction (RR 1.35; 95% CI 1.09–1.68), stroke (RR 1.20; 95% CI 1.06–1.35), MACCE (RR 2.09; 95% CI 1.57–2.78), and atrial fibrillation (RR 1.37; 95% CI 1.05–1.78).

Conclusion

NAFLD portends excess all-cause mortality but only in Western countries. CV mortality was similar in NAFLD and non-NAFLD groups. NAFLD is associated with increased risk of incident MI, stroke, MACCE, and AF.
738 Role of non-coding RNA uc.194 and uc.443+A in the intrastent restenosis
Authors: Boccuto Fabiola , Tammè Laura , Iaconetti Claudio , Sabatino Jolanda , Polimeni Alberto , Sorrentino Sabato , Carbone Andrea , Gareri Clarice , Mancuso Teresa , De Rosa Salvatore , Indolfi Ciro
Published: December 2021

Aims

Vascular smooth muscle cells (VSMCs) play a key role in the vessel wall, being active partaker in vascular remodelling and influencing multiple pathophysiological phenomena, such as progression of atherosclerosis, in-stent restenosis and vascular reactivity. Recently antisense oligonucleotides have shown promising results as a therapeutic option. The aim of this study was to analyse the expression profile and function of T-UCRs in vascular smooth muscle cells (VSMCs)—both in vitro and in vivo—and to evaluate the effects of their inhibition by the use of specific antisense oligonucleotides.

Methods

After obtaining cell cultures of vascular smooth muscle cells, we modified their phenotype varying growth conditions. A microarray and qRT-PCR expression profile analysis and a cell cycle analysis with cell proliferation/apoptosis/migration assay were performed. In vivo studies were performed on rat carotids after cell damage and administration of specific antisense oligonucleotides.

Results

There were significant differences in the expression of T-UCRs in VSMCs with a proliferating and quiescent phenotype. In particular, 5 T-UCRs were found to be upregulated in VSMCs. These types of cells were subsequently transfected with specific antisense oligonucleotides obtaining a reduction in their proliferative activity in particular with the inhibition of the T-UCRs uc.194 and uc.443 + A. MiR-10A and miR-34b-5p were identified with complementary sequences respectively to uc.194 and uc.443 + A. The increase of these miRs following the inhibition of the T-UCRs were closely related to the inhibition of the proliferative signals of VSMCs. Similarly, the same results were obtained in vivo.

Conclusions

The expression levels of non-coding RNAs uc.194 and uc. 443 + A increase in proliferating smooth muscle cells in vitro and in the vascular wall following damage, suggesting an important role of these molecules in the phenomenon of intra-stent restenosis. Through the inhibition of uc.194 and uc.443 + A using an antisense strategy, we demonstrated a reduction in cell proliferation and migration processes and, consequently, in the formation of neointima. A possible relationship was also highlighted between the aforementioned non-coding RNAs and some micro-RNAs (miR-10A and miR-34b-5p), negative regulators of the proliferative phenotype of VSMCs. The inhibition of the analysed T-UCRs would allow the maintenance of the contractile phenotype thanks to the activity of the miRs analysed in this study. Our results might pave the way for the identification of new therapeutic targets in order to prevent and reduce the incidence of intra-stent restenosis.
25 Atrial remodelling in patients affected by chronic heart failure in therapy with sacubitril/valsartan
Authors: Magnesa Michele , Mazzeo Pietro , Fortunato Martino , Mennella Raffaele , Tricarico Lucia , Correale Michele , Croella Francesca , Mallardi Adriana , Leopizzi Alessandra , Ceci Vincenzo , Alfieri Simona , Iacoviello Massimo , Biase Matteo Di , Brunetti Natale Daniele
Published: December 2021

Aims

Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death. Previous studies showed left ventricle ejection fraction (LVEF) improvement and reverse remodelling can be achieved after therapy with sacubitril/valsartan in real-world settings. We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic HF after therapy with sacubitril/valsartan.

Methods and results

Patients affected by chronic HF with LV dysfunction (LVEF < 35%), NYHA functional class II–III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography Follow-up at baseline and after 6 months of therapy with sacubitril/valsartan. Measures of LA structure [LA end-systolic volume (LAESV)] and function [left atrial emptying fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain and peak atrial contraction strain (PACS)] were calculated. A total of 47 patients (median age 66 ± 7.97, male gender 85%, mean LVEF 28.33 ± 5.61%) were enrolled. The left atrial strain parameters (PALS and LA conduit) resulted higher at 6 months follow-up respect to baseline values, (14.68 ± 7.16 vs. 18.67 ± 8.03, P < 0.001, and −7.61 ± 4.07 vs. −9.71 ± 5.23, P = 0.007, respectively).

Conclusions

Treatment with sacubitril/valsartan in patients with HFrEF is associated with an improvement in LA functional remodelling in a real-world scenario.