bluuebunny/crossref_metadata_2025_split huggingface dataset:
582 Changes on diastolic and atrial functions following a single bout of two different exercise modalities in patients with hypertension and ischaemic heart disease
Authors: Caminiti Giuseppe , Perrone Marco , D’Antoni Valentino , Morsella Valentina , Catena Marco , Cascelli Giovanna , Iellamo Ferdinando , Volterrani Maurizio 
Published: December 2021

Abstract

Aims
Concurrent aerobic plus resistance exercise (RAE) and high intensive interval exercise (HIIE) are both effective on inducing post-exercise hypotension (PEH) in patients with hypertension. However central haemodynamic changes associated to PEH in hypertensive subjects with underlying ischaemic heart disease (IHD) have been poorly investigated. To compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function.

Methods and results
Twenty untrained male patients with history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent three exercise sessions: RAE, HIIE, and a control session without exercise each lasting 45 min. Echocardiography examination was performed before and between 30 and 40 min from the end of the exercise sessions. In the first hour post exercise, BP values decreased in a similar way in RAE and HIIE and were unchanged after control. Compared to pre-session, E/E1 ratio increased after HIIE and remained unchanged after both RAE and control sessions (between-sessions P 0.002). PALS increased slightly after RAE (+1.4 ± 1.1%), decreased after HIIE (−4.6 ± 2.4%). and was unchanged after control. (between-sessions P 0.03). PACS was mildly increased after RAE, was reduced after HIIE, and was unchanged after control. Atrial volume was unchanged after both sessions. Left ventricular and left atrial stiffness increased significantly after HIEE while remained unchanged after RAE and control. Stroke volume and cardiac output increased after RAE, decreased after HIIE, and were unchanged after control.

Conclusions
Single sessions of RAE and HIIE determined similar PEHs in hypertensive subjects with IHD, while they evoked different central haemodynamic adjustments. Given its neutral effects of on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD.
124 Tiny but useful transportable remote monitoring device during SARS-CoV-2 pandemic
Authors: Bozza Nicola , Loizzi Francesco , Carulli Eugenio , Carella Mariacristina , Latorre Maria , Achille Teresa , Tricarico Giuseppe , Soldato Nicolo , Amati Francesca , Favale Stefano 
Published: December 2021

Abstract
A 45-year-old woman, without cardiovascular risk factors and affected by chronic migraine, presented to the emergency department due to the onset of a typical chest pain. After performing an electrocardiogram she was promptly transported to the Cath lab, with the diagnosis of ST segment elevation myocardial infarction (STEMI), for urgent coronarography. A spontaneous dissection of the first obtuse marginal branch was detected which was treated with two drug eluting stents implantation. A day after the procedure, during a migraine crisis, at the continuous electrocardiographic monitoring it was registered a brief episode of complete atrioventricular block, which regressed spontaneously after a few minutes. For this reason, she underwent atropine test which resulted negative for AV conductance defects. No more episodes were recorded during the hospital stay, however it was decided to implant a loop recorder (Biotronik BIOMONITOR III) before the discharge. The patient received a remote monitoring device in order to allow a closer follow-up in course of the COVID-19-related lockdown, that caused a relevant reduction in the outpatients’ services. A few months later a sinusal pause of about 9 s was recorded with the emergence of an idioventricular rhythm at 25 b.p.m. When contacted by telephone the patient reported being hospitalized because of pulmonary complications of SARS-CoV-2 infection. She referred of being bedridden, without any cardiac monitor and of being asymptomatic for syncope. Thus, she was transferred to a Cardiology Unit dedicated to patients affected by SARS-CoV-2 disease, for further diagnostic investigations. This represents a case in which the remote monitoring technology resulted fundamental in the management of patients with implantable devices, in particular during COVID-19-related lockdown. However, it is at least as much important to encourage the patient to carry the transmitter with him, even in the case of unexpected events or hospitalizations, in order to gain access to all the information store in the CIED which might be useful to the diagnosis of the underlying disease. Biotronik has developed the smallest remote transmitter in commerce (CardioMessenger Smart) which is functional to this kind of use. Moreover, it has an automatic interrogation function which can send the alerts about the arrhythmic events quicker than the other brands and so it’s more practical in situations where the patient is hospitalized in non-cardiological units.
416 A very severe aortic stenosis secondary to radiation therapy for Hodgkin lymphoma: a case report
Authors: Carassia Claudia , Patti Giuseppe , Degiovanni Anna , Pastore Maria Concetta 
Published: December 2021

Abstract

Aims
Hodgkin lymphoma is a highly curable disease, with survival rates around 85% at 5 years, thanks to its treatment, mainly based on radiation therapy alone or in association with chemotherapy. However, radiation therapy carries the risk of long-term complications, mainly represented by secondary malignancies or cardiovascular diseases. Indeed, patients treated with radiation remain at increased risk of coronary artery disease, congestive heart failure, valve disease, pericardial disease and sudden death. In particular, radiation-induced valve disease has been reported in approximately 10% of treated patients, with the most common being aortic or mitral regurgitation, followed by aortic stenosis. We describe the case of a very severe aortic valve stenosis developed 35 years after radiotherapy for Hodgkin Lymphoma.

Methods
A 60-years-old woman with history of Hodgkin Lymphoma treated with radiotherapy 35 years ago, no cardiovascular risk factors, complained progressive fatigue and worsening dyspnoea. She was referred to our centre from a spoke centre for congestive heart failure caused by aortic stenosis. At her arrival, we performed a transthoracic echocardiography finding a very-severe aortic stenosis (mean gradient 97 mmHg, AVA 0.3 cm2), a moderate functional mitral regurgitation and an important hypertrophy suspected of infiltrative pattern. No coronary artery disease was found at coronary angiography. Furthermore, she underwent a cardiac magnetic resonance showing a moderate left ventricular dilatation and hypertrophy with areas of non-ischaemic late gadolinium enhancement, significant for myocardial fibrosis with no specific pattern of infiltration. She was treated with surgical aortic valve replacement with biological prosthesis (Inspiris Resilia 21) with good results at the discharge echocardiography.

Discussion
Cardiovascular toxicity is nowadays the most common non-malignancy cause of death in radio-treated cancer survivors. At the level of the valvular apparatus, radiation damage is expressed with fibrosis of the myocardium and of the valvular endothelium, leading to thickening and calcification especially of the left-sided valves. Radio-treated patients have a 50% cumulative incidence of cardiovascular diseases at 40 years after treatment, and a clinically-relevant valve disease is found in approximately 6% of radio-treated patients at 20 years.

Conclusions
Thus, an early identification of the disease in a subclinical state is crucial. Nevertheless, there is still no consensus on the timing and the modality of cardiovascular screening after radiation therapy. Moreover, an elevated cardiovascular risk profile was found to be directly related to cardiotoxicity; this underlines the importance of identification and aggressive treatment of cardiovascular risk factors. Radiation dose reduction and the use of shields may further reduce the incidence of late cardiovascular complications in these patients.
763 Feasibility and reliability of a comprehensive three-dimensional transesophageal echocardiography screening process for transcatheter mitral valve replacement
Authors: Piroli Francesco , Boccellino Antonio , Ingallina Giacomo , Rolando Marco , Melillo Francesco , Ancona Francesco , Stella Stefano , Biondi Federico , Denti Paolo , Castiglioni Alessandro , Agricola Eustachio 
Published: December 2021

Abstract

Aims
The planning of transcatheter mitral valve replacement (TMVR) requires cardiac imaging assessment to establish patient eligibility according to mitral valve anatomy, device characteristics and risk of left ventricular outflow tract (LVOT) obstruction. In this setting, computed tomography (CT) is considered the reference method. Although recent studies demonstrated that three-dimensional transesophageal echocardiographic (3D-TEE) assessment of mitral anatomy presents a good agreement compared to CT, its potential role in the TMVR planning has never been fully evaluated. To test feasibility and reliability of a comprehensive 3D-TEE screening in candidates for TMVR.

Methods
We performed a single-centre retrospective observational study including 59 consecutive patients referred to our centre for TMVR due to high surgical risk, who performed a pre procedural CT and 3D-TEE screening. The measurements of mitral annulus (MA), native LVOT and predicted Neo-LVOT, assessed with CT and 3D-TEE were collected in order to evaluate their concordance in the assessment of TMVR eligibility. The final suitability decision was given by the valve manufacturer based on CT measurements and then compared with the screening results obtained with 3D-TEE evaluation. 3D-TEE measurements were obtained with a post processing analysis using a novel automated software platform (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands).

Results
Excellent correlation was found between 3D-TEE and CT measurements for MA area (r =0.85), antero-posterior diameters (r= 0.81), native LVOT (r=0.82) and Neo-LVOT areas (r=0.95) (all P-values &lt;0.0001). Among 59 patients screened, 17 did not undergo the intervention because were found ineligible due to small predicted neo-LVOT, too small or too large MA area. Among the 42 patients with a successful screening, 32 underwent TMVR and all of them showed a correct implantation and no LVOT obstruction at post procedural echocardiographic evaluation. An almost perfect agreement among CT and 3D-TEE was found in assessing the eligibility for TMVR implantation (Cohen kappa 0.82, P&lt;0.001). Interobserver and intraobserver agreements were found excellent for the parameters appraised with ICCs &gt;0.80.

Conclusions
3D-TEE appraisements of MA dimensions, native LVOT and Neo-LVOT are feasible in patients candidate for TMVR, showing good correlations with CT measurements and high accuracy to predict TMVR screening success.
13 Isolated exercise-induced pulmonary hypertension is associated with clinical worsening and poor immunological control in HIV patients
Authors: Madonna Rosalinda , Fabiani Silvia , Morganti Riccardo , Forniti Arianna , Mazzola Matteo , Menichetti Francesco , De Caterina Raffaele 
Published: December 2021

Abstract

Aims
Exercise-induced pulmonary hypertension (Ex-PH) may represent the earliest sign of pulmonary arterial hypertension (PAH) in human immunodeficiency virus (HIV) patients. We investigated its association with clinical and immunological status, virologic control, and response to antiviral therapy.

Methods and results
In 32 consecutive HIV patients with either low (n = 29) or intermediate probability (n = 3) of PH at rest, we evaluated the association of isolated Ex-PH with: time to HIV diagnosis; CD4+ T-cell count; clinical progression to acquired immunodeficiency syndrome (AIDS); development of resistance to antiretroviral therapy (ART); HIV RNA levels; time to beginning of ART; current use of protease inhibitors; combination of ART with boosters (ritonavir or cobicistat); immuno-virologic response to ART; and ART discontinuation. Isolated Ex-PH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) &gt;45 mmHg or a &gt; 20 mmHg increase during low-intensity exercise cardiac output (&lt;10 l/min). In our cohort, 22% (n = 7) of the enrolled population developed Ex-PH which was inversely related to CD4+ T-cell count (P = 0.047), time to HIV diagnosis (P = 0.014) and time to onset of ART (P = 0.041). Patients with Ex-PH had a worse functional class than patients without Ex-PH (P &lt; 0.001). Ex-PH and AIDS showed a trend (P = 0.093) to a direct relationship. AIDS patients had a higher pulmonary vascular resistance compared to patients without Ex-PH (P = 0.020) at rest echocardiography.

Conclusions
The presence of isolated Ex-PH associates with a worse clinical status and poor immunological control in HIV patients. Assessment of Ex-PH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.
810 Incidence and determinants of permanent pacemaker implantation after transcatheter aortic valve replacement
Authors: Bellantoni Antonio , Sorrentino Sabato , Boccuto Fabiola , Carabett Nicole , Giordano Salvatore , Cacia Michele Antonio , Polimeni Alberto , Leo Isabella , Varano Ylenia , Augusto Florinda Maria , Mongiardo Annalisa , De Rosa Salvatore , Indolfi Ciro , Spaccarotella Carmen 
Published: December 2021

Abstract

Aims
conduction disturbances requiring pacemaker implantation (PPM) are among the most common complications in patients undergoing transcatheter aortic valve replacement (TAVR). Introduction in clinical practice of a new generation of TAVR devices is contributing to a significant reduction in procedural complications. However, limited data is available regarding PPM implantation after TAVR with the latest available devices. Accordingly, in this analysis we aimed to investigate the incidence and risk factors for new permanent pacemaker implantation after TAVR according to the type and diameter of valve implanted.

Methods
Patients who underwent TAVR at our Institution from September 2008 to November 2020 were included in this analysis. Out of 407, 38 (9.3%) were excluded because they already presented a PPM/ICD, received only balloon angioplasty or for procedural unsuccess. The independent association between baseline clinical and procedural variables and the occurrence of PPM implantation was investigated with cross-sectional logistic regression analysis.

Results
Out of 368 TAVR procedures included in the final analysis, 89 (24.2%) required in-hospital PPM implantation. No differences were observed for age and common cardiovascular risk factors between groups. Among procedural variables, patients requiring PPM had lower left ventricular ejection fraction (LVEF) and experienced a longer intensive care unit stay. Valve types used were Corevalve n = 98 (26.6%) (first-generation devices), Evolute R, n = 191 (51.9%), Evolute Pro, n = 3 (1.1%), Portico n = 2 (0.5 %), or Sapien 3, n = 73 (19.8%) (second-generation devices). Clinical and procedural correlates of PPM implantation were depicted in Figure. Of note, compared to the first generation of self-expandable devices, the second generation is associated with a lower risk of PPM implantation, albeit non-significant for the subgroup of second generation self-expandable devices. Finally, valve diameter was also an independent predictor of PPM implantation

Conclusions
PPM was required in 24.2% of patients who underwent TAVR with first- and second-generation balloon or self-expandable valves. For instance, in our population, second-generation TAVR devices were associated with a lower risk of PPM implantation compared to the previous generation. However, further investigations are warranted to assess the impact of new implantation techniques and valve technology on such an important outcome.
816 UNA Diagnosi . . . Incidentale
Authors: Bava Annita , Nadia Aricò Concetta , Caridi Rocco , Rodà Filippo , Franzutti Claudio , Scappatura Giuseppe , Grillone Nadine , Rao Massimo 
Published: December 2021

Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequent genetic disease of the myocardium, with a prevalence of 1:500 cases in the general population. The salient feature is a hypertrophy, symmetrical or not, of the walls of the left ventricle (mainly the septum, but also less typical locations, such as the apex or the infero-lateral wall), not linked to abnormal load conditions. HCM is mostly an autosomal dominant inherited disease with incomplete penetrance and variable expressivity, mainly linked to mutations in genes coding for sarcomeric proteins. Several studies have shown an up-regulation of the ACE-2 gene, perhaps indicative of a compensatory anti-hypertrophic and anti-fibrotic response of the myocardium, in hypertrophic cardiomyopathy. Being the ACE-2 receptor target of the Sars-CoV-2 virus, these patients may have an increased risk of infection and a worse outcome.
A 47-year-old man, with no known comorbidities, was hospitalized in our Emergency Medicine Department for bilateral Sars-CoV-2 pneumonia. Noninvasive mechanical ventilation c-PAP (FiO2 60%, PEEP 7.5 cmH20) was started for hypoxemic respiratory failure and an ECG showed diffuse ventricular repolarization abnormalities suggestive of left overload (asymmetric negative T waves V4 to V6, in I, II and aVL, flat in aVF. Figure 1), with a deep Q wave in III. The patient was asymptomatic for chest pain and equivalents and D-dimer and indices of myocardionecrosis were normal. Echocardiographic evaluation was performed, with evidence of marked asymmetric concentric hypertrophy of the left ventricle (interventricular septum: 16 mm), without significant anomalies in segmental kinetics, noteworthy valvulopathies and pericardial effusion. The family and personal medical history were negative for syncope, sudden cardiac death and resuscitated cardiac arrest and the estimated risk of sudden cardiac death at five years (HCM Risk-SCD) was &lt;4% (1.33%). The diagnostic hypothesis of non-obstructive hypertrophic cardiomyopathy was advanced. During hospitalization, ECG monitoring showed no sustained ventricular arrhythmias and the patient remained asymptomatic for dyspnoea, chest pain and equivalents. Subsequent echocardiograms showed no new changes. A progressive weaning from oxygen support was carried out and, after thirty days, the patient was discharged to home fiduciary isolation, with optimal cardiological therapy and indication to study with cardiac magnetic resonance to the negativization of the nasal swab for Sars-CoV-2. MRI, performed about two months later, confirmed the suspicion of hypertrophic cardiomyopathy, with no signs of late enhancement in T1-weighted sequences (Figure 2). The patient was then referred to a genetic study and cardiological follow-up, still in progress. 816 Figure 1816 Figure 1
Deep Conservation of Histone Variants in Thermococcales Archaea
Authors: Stevens Kathryn M , Hocher Antoine , Warnecke Tobias 
Published: December 2021

Abstract
Histones are ubiquitous in eukaryotes where they assemble into nucleosomes, binding and wrapping DNA to form chromatin. One process to modify chromatin and regulate DNA accessibility is the replacement of histones in the nucleosome with paralogous variants. Histones are also present in archaea but whether and how histone variants contribute to the generation of different physiologically relevant chromatin states in these organisms remains largely unknown. Conservation of paralogs with distinct properties can provide prima facie evidence for defined functional roles. We recently revealed deep conservation of histone paralogs with different properties in the Methanobacteriales, but little is known experimentally about these histones. In contrast, the two histones of the model archaeon Thermococcus kodakarensis, HTkA and HTkB, have been examined in some depth, both in vitro and in vivo. HTkA and HTkB exhibit distinct DNA-binding behaviors and elicit unique transcriptional responses when deleted. Here, we consider the evolution of HTkA/B and their orthologs across the order Thermococcales. We find histones with signature HTkA- and HTkB-like properties to be present in almost all Thermococcales genomes. Phylogenetic analysis indicates the presence of one HTkA- and one HTkB-like histone in the ancestor of Thermococcales and long-term maintenance of these two paralogs throughout Thermococcales diversification. Our results support the notion that archaea and eukaryotes have convergently evolved histone variants that carry out distinct adaptive functions. Intriguingly, we also detect more highly diverged histone-fold proteins, related to those found in some bacteria, in several Thermococcales genomes. The functions of these bacteria-type histones remain unknown, but structural modeling suggests that they can form heterodimers with HTkA/B-like histones.
Rates of Protein Evolution across the Marsupial Phylogeny: Heterogeneity and Link to Life-History Traits
Authors: Luzuriaga-Neira Agusto R , Alvarez-Ponce David 
Published: December 2021

Abstract
Despite the importance of effective population size (Ne) in evolutionary and conservation biology, it remains unclear what factors have an impact on this quantity. The Nearly Neutral Theory of Molecular Evolution predicts a faster accumulation of deleterious mutations (and thus a higher dN/dS ratio) in populations with small Ne; thus, measuring dN/dS ratios in different groups/species can provide insight into their Ne. Here, we used an exome data set of 1,550 loci from 45 species of marsupials representing 18 of the 22 extant families, to estimate dN/dS ratios across the different branches and families of the marsupial phylogeny. We found a considerable heterogeneity in dN/dS ratios among families and species, which suggests significant differences in their Ne. Furthermore, our multivariate analyses of several life-history traits showed that dN/dS ratios (and thus Ne) are affected by body weight, body length, and weaning age.