bluuebunny/crossref_metadata_2025_split huggingface dataset:
383 ECG in biopsy-proven and clinically suspected myocarditis: morpho-functional correlates and prognostic implications
Authors: Giordani Andrea Silvio , Panzarella Alex , Candelora Andrea , Marcolongo Davide , Merola Chiara , Tarantini Giuseppe , Basso Cristina , Marra Martina Perazzolo , Marcolongo Renzo , Iliceto Sabino , Baritussio Anna , Caforio Alida Linda Patrizia 
Published: December 2021

Abstract

Aims
A distinction exists between biopsy-proven (BP) and clinically suspected (CS) myocarditis, the latter being an exclusion diagnosis based on clinical and instrumental findings. A clear diagnostic and prognostic role of the ECG in these two groups of patients has not yet been defined.
(i) To describe frequency and characteristics of ECG findings in myocarditis, and to assess any difference between CS and BP myocarditis; (2) to identify morpho-functional correlates between ECG and cardiac magnetic resonance (CMR); and (iii) to evaluate the prognostic value of ECG findings.

Methods and results
162 patients were included (median age 36 years, 70% male, median follow-up 32.9 months), 36 with BP and 126 with CS myocarditis. All patients underwent CMR; for ECG-CMR correlates, the ECG nearest in time to CMR was assessed. Surrogate outcome was defined as left ventricular (LV) ejection fraction (EF) &lt;50% and/or NYHA class &gt;I during follow-up. In the entire cohort ECG alterations were numerous: T-wave inversion (TWI) (82%), fragmented QRS (34%), low voltages (14%), ST elevation (STE) (13%). Compared to CS myocarditis, BP myocarditis patients showed higher frequency of non-sinus rhythm (17% vs. 2%, P &lt; 0.001), long QT (28% vs. 0%, P &lt; 0.001), lateral TWI (36% vs. 19%, P = 0.031) and bundle branch block (19% vs. 2%, P &lt; 0.001). BP myocarditis patients had worse clinical features at diagnosis: heart failure (64% vs. 6%, P &lt; 0.001), arrhythmic (14% vs. 4%, P = 0.029) and fulminant presentation (14% vs. 0%, P &lt; 0.001), and presented higher LV end-diastolic volume and lower LVEF by echocardiography and CMR (109.5 mL/m2 vs. 85.50 ml/m2, P &lt; 0.001; 31.5% vs. 59%, P &lt; 0.001). A correlation was observed between number of myocardial segments with oedema at CMR and low ECG voltages (P = 0.010) and between late gadolinium enhancement (LGE) mass at CMR and lateral STE (P = 0.004 and P = 0.049, respectively). Several ECG alterations correlated with the surrogate outcome: long QT (P = 0.029), lateral TWI (P = 0.006), left bundle branch block (P &lt; 0.001), ventricular ectopic beats (P = 0.020), and atrial fibrillation (P &lt; 0.001).

Conclusions
A significant difference in ECG findings between CS and BP myocarditis has been demonstrated: ECG alterations are more frequent and more severe in BP myocarditis and correlate with prognosis. Moreover, ECG alterations identified patients with pathologic morpho-functional correlates.
73 Prevalence and prognostic significance of ischaemic late gadolinium enhancement pattern in non-ischaemic dilated cardiomyopathy
Authors: De Angelis Giulia , De Luca Antonio , Merlo Marco , Nucifora Gaetano , Rossi Maddalena , Stolfo Davide , De Bellis Annamaria , Barbati Giulia , Santangeli Pasquale , Mase Marco , Pagnan Lorenzo , Muser Daniele , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Typical late gadolinium enhancement (LGE) patterns in dilated cardiomyopathy (DCM) include intramyocardial and subepicardial distribution. However, the ischaemic pattern of LGE (subendocardial and transmural) has also been reported in DCM without coronary artery disease (CAD), but its correlates and prognostic significance are still not known. On these bases, this study sought to describe the prevalence and prognostic significance of the ischaemic LGE pattern in DCM.

Methods and results
611 DCM patients with available cardiac magnetic resonance were retrospectively analysed. A composite of all-cause-death, major ventricular arrhythmias (MVAs), heart transplantation (HTx) or ventricular assist device (VAD) implantation was the primary outcome of the study. Secondary outcomes were a composite of sudden cardiac death or MVAs and a composite of death for refractory heart failure, HTx or VAD implantation. Ischaemic LGE was found in 7% of DCM patients without significant CAD or history of myocardial infarction, most commonly inferior/inferolateral/anterolateral. Compared to patients with non-ischaemic LGE, those with ischaemic LGE had higher prevalence of hypertension and atrial fibrillation or flutter. Ischaemic LGE was associated with worse long-term outcomes compared to non-ischaemic LGE (36% vs. 23% risk of primary outcome events at 5 years, respectively, P = 0.006), and remained an independent predictor of primary outcome after adjustment for clinically and statistically significant variables [adjusted hazard ratio 2.059 (1.055–4.015), P = 0.034 with respect to non-ischaemic LGE].

Conclusions
The ischaemic pattern of LGE is not uncommon among DCM patients without CAD and is independently associated with worse long-term outcomes.
413 Challenges in the field of cardiac tumours: the surgical experience of Trieste
Authors: Restivo Luca , De Luca Antonio , Castrichini Matteo , Pierri Alessandro , Rauber Elisabetta , Fabris Enrico , Bussani Rossana , Belgrano Manuel Gianvalerio , Pagnan Lorenzo , Pappalardo Aniello , Mazzaro Enzo , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary centre during almost a 20-year experience.

Methods and results
In this single centre study, 55 consecutive patients with cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 42% of patients were male and the mean age was 62 ± 12 years. Almost 27% of patients were symptomatic at the time of the diagnosis, mostly for dyspnoea and palpitations. The most frequent benign cardiac tumor was myxoma (58% of cases), occurring mainly in the left atrium (97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumour (7.2% of cases), mainly located in the ventricles (25% left ventricle; 50% right ventricle). In all cases of benign tumors surgery was successful with no relapses. In 50% of cases of pleomorphic sarcoma relapses were observed during follow-up. After a median follow-up of 44 months, 15 (27%) patients died. While malignant tumors presented a limited survival, benign tumours showed a very good prognosis.

Conclusions
Cardiac tumours require a multidisciplinary work-up to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, the prognosis of benign tumours was excellent, while malignant tumours had poor outcomes despite radical surgery.
585 Natural history of left ventricular hypertrophy in infants of diabetic mothers
Authors: Monda Emanuele , Verrillo Federica , Lioncino Michele , Altobelli Ippolita , Caiazza Martina , Rubino Marta , Cirillo Annapaola , Fusco Adelaide , Mauriello Alfredo , Amodio Federica , Di Fraia Francesco , Pacileo Roberta , Gragnano Felice , Passariello Annalisa , Pacileo Giuseppe , Calabrò Paolo , Russo Maria Giovanna , Limongelli Giuseppe 
Published: December 2021

Abstract

Aims
This study sought to describe the characteristics and the natural course of left ventricular hypertrophy (LVH) in a well-characterized consecutive cohort of infants of diabetic mothers (IDMs).

Methods and results
Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score &gt; −2 and &lt;2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness MWT [6.00 mm (IQR: 5.00–712) vs. 5.50 mm (IQR: 5.00–6.00), P-value &lt;0.001; MWT-z-score: 4.86 (IQR: 3.93–7.61) vs. 1.72 (IQR: 1.08–2.85), P-value &lt;0.001] compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively), except two patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was negatively associated with LV wall thickness regression at 1-year follow-up [MWT-mm: OR: 0.48 (0.29–0.79), P-value = 0.004; MWT-z-score: OR: 0.71 (0.56–0.90), P-value = 0.004].

Conclusions
LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.
436 A peri-myocarditis unmasks an underlying hypertrophic cardiomyopathy
Authors: Rubino Francesca , Capocci Sofia , Portolan Leonardo , Gambaro Alessia , Pighi Michele , Ribichini Flavio Luciano 
Published: December 2021

Abstract

Methods and results
A 41-year-old black man complaining of severe oppressive chest pain radiated to the back presented to our accident & emergency department (A&E). His symptoms started few days before his hospital admission. Past medical history was remarkable for arterial hypertension in medical therapy and microdrepanocytosis. In A&E, the patient’s physical examination and vital signs were normal, he was normotensive, apyretic with normal oxygen saturation. The ECG showed ST elevation in anterior and lateral leads. Because of his history of arterial hypertension, and the severe chest pain irradiated to the back, an angio-CT was indicated at first. The CT ruled out acute aortic disease. Excluded the acute aortic disease, the patient underwent an urgent coronary angiography. No coronary stenosis was found. Therefore, the patient was admitted in cardiac intensive care unit. The blood test showed an elevation of high sensitive cardiac troponin T (cTnT peak 3093 ng/L) and inflammatory index (leukocytosis 13.65 109/l and protein C reactive peak 347 mg/L). An in-depth anamnestic collection revealed fever with respiratory symptoms about 2 weeks before. The echocardiography demonstrated left ventricular (LV) dysfunction with increased ventricular wall thickness and mild pericardial effusion. No LV outflow tract obstruction was found. A provisional diagnosis of peri-myocarditis was made. During hospitalization, anti-remodelling cardiac therapy was introduced and up titrated. To confirm the provisional diagnosis, a Gadolinium cardiac Magnetic Resonance (CMR) was performed, and it revealed myocardial oedema on basal anterior interventricular septum and multiple areas of late gadolinium enhancement with subepicardial pattern. Moreover, severe LV hypertrophy was confirmed (interventricular septum 19 mm, inferior wall 17 mm). This pattern was consistent to the diagnosis of peri-myocarditis on a hypertrophic cardiomyopathy (HCM). Main infectious causes of peri-myocarditis were investigated, but the results were inconclusive. Unfortunately, genetic test results are still not available. Patient was discharged with recovered LV systolic function and free of symptoms on optimal medical therapy; no ventricular arrhythmias was detected during hospitalization. HCM risk sudden cardiac death (SCD) was lower than 4%.

Conclusions
Peri-myocarditis can mimic symptoms of an acute coronary syndrome. Furthermore, the inflammation of cardiac muscle and the subsequent interstitial oedema may cause an increase in LV wall thickness. In this setting, the diagnosis of an underlying cardiomyopathy is challenging. This interesting and unusual case highlights the relevance of an accurate diagnostic work up to deliver good clinical practice. In particular, Gadolinium CMR is of paramount importance in this setting.
329 Heart failure predictive value of the electric risk score in patients suffering from thalassemia major
Authors: Tomarelli Elisa , Moscucci Federica , Losardo Anna Annunziata , Pugliese Pellegrina , Schina Mauro , Sciomer Susanna 
Published: December 2021

Abstract

Aims
Complications associated with iron accumulation were highly recurrent in thalassemia patients, who underwent frequent blood transfusions, in particular hemosiderotic cardiomyopathy which could lead to heart failure and arrhythmias. Nowadays, the better iron chelation therapy has improved cardiovascular morbidity in these patients; nevertheless, mild impairment should be seek for and eventually treated. The objective of our study was to evaluate the possibility of using early electrocardiographic markers of myocardial damage and predictors of mortality, such as the Electric Risk Score (ERS).

Methods and results
73 patients with thalassemia major were enrolled in this study, which were divided into two groups, with 45 years old as cut off. Anamnestic, clinical, electrocardiographic, and echocardiographic data were collected. From ECG, ERS was obtained. over 45 yrs-old group of pts, in addition to a predictable increase in the prevalence of traditional cardiovascular risk factors and drug intake, an alteration of the QRS-T angle (14[30] vs. −4[28], p value: &lt;0.0001) and an increased prevalence of left ventricular hypertrophy (2.88 ± 0.86 vs. 2.40 ± 0.57 p value: &lt;0.05) were found. In patients taking drugs with possible interactions with the ventricular repolarization phase, there is a slight increase in the QT interval, left ventricular hypertrophy and a reduction in Tpeak-Tend (Table 1). Electrocardiographic values in groups of patients with different age groups who are taking therapies that can affect QT. The echocardiogram revealed an increase in the end-diastolic diameter of the right ventricle (26 ± 3 vs. 28 ± 3 mm, P-value: 0.05) in the group of patients over the age of 45, a decrease in the acceleration time of the pulmonary systolic flow (138 ± 25 vs. 125 ± 13 ms, P-value: 0.04) and TAPSE (25 ± 3 vs. 22 ± 4 mm, P-value: 0.002).

Conclusions
From the data in our study it emerged that an appropriate iron-chelation therapy is able to effectively counteract the hemosiderotic cardiomyopathy of thalassemic patients so as to detect electro- and echocardiographic anomalies only in patients of more advanced age, a result that we think both the consequence, not so much of iron overload, but of an increase in the prevalence of age- and gender-related cardiovascular risk factors. The initial changes in cardiac electromechanics, which can be assessed with the aforementioned methods, we believe, can become a very early sign of specific myocardial damage. 329 Figure 1Electrical risk score parameters.
592 The growth of telehealth during SARS-CoV-2 time
Authors: Ferraiolo Mario , Di Trocchio Emily , Follero Paola 
Published: December 2021

Abstract

Aims
Improve the management of frail patients, particularly in times of pandemic, through an assistance based on a remote digitalized platform, which allows rapid interventions, able to reduce access to the emergency room, and decreased mortality from cardiovascular causes.

Methods and results
(i) Heart failure management—Enrollment in the digital platform. Use of devices: sphygmomanometer, scale, oximeter, single-track ECG. Daily analysis of the haemodynamic parameters on the platform. Communication by e-mail exchange and tele/videoconsultations, drug management, and therapeutic strategies. Possibility to perform echocardiogram at home. (ii) Remote monitoring management—Enrollment in the digital platform. Supply of transmitters for the management of thresholds, objectives, and alarms. Daily parametric check. (iii) Infarct network management—Integrated operating system for assistance between the in-hospital and out-of-hospital environment, in patients suffering from AMI. Execution, transmission, and reporting of the ecg-graphic trace on equipment provided with a remote transmission system. Allow to reduce the time of diagnosis and treatment. At our centers, over 1000 patients are followed on a digital platform, including those at risk of heart failure and device wearers. In addition, there is an annual trend of over 400 patients who are diagnosed electronically with AMI and relative percutaneous coronary treatment. The use of remote systems has allowed for some patients to early highlight threatening arrhythmias and/or device malfunctions, for others to prematurely intercept symptoms and signs of congestive heart failure. A clear improvement in prognosis and quality of life was therefore observed.

Conclusions
Cardiovascular diseases are the leading cause of death in Western countries. Therefore, the close follow-up and identification of haemodynamic and clinical parameters on digitized platforms, allows to: reduce access to the emergency room, guarantee the best therapeutic strategies, improve the quality of life, and decrease the mortality rate. In conclusion, we found a high approval rating as the patient reports feeling better, feeling constantly followed, and a clear improvement in compliance and adherence to the therapy.
391 First CARMAT implantation in Italy: a nurse’s experience
Authors: Pettillo Vincenzo , Artiola Gaetano 
Published: December 2021

Abstract

Aims
CARMAT is a new fully implantable device that simulates heart function. CARMAT has three characteristics that allow a physiological simulation that is at the top of biomedical engineering: it is blood-compatible for the use of bovine pericardium; it is pulsatile because it has hydraulic pumps that mimic systole and diastole; it is capable of self-regulating with the physiological needs of the patient. CARMAT has four biological valves that allow the intake of cardioaspirin avoiding the use of Coumadin and continuous blood draw. CARMAT also has two hybrid membranes with an internal part formed by bovine pericardium and an external polyurethane membrane; CARMAT has self-regulation sensors that adapt the system to the patient’s efforts. The operation is relatively simple because the rollers placed inside move the silicondressingstely and so it pushes the walls creating systole and diastole not synchronously as it normally happens but asynchronously, one ventricle at a time. Evaluation of the patient’s haemodynamics, monitoring of vital parameters, dressings of the drive-line, and psychological state.

Methods and results
Training in the field by the manufacturer due to the absence of material in literature. Since it was the first CARMAT implantation in Italy, we tried to combine experience with the clinical practice of other artificial hearts. The patient was weaned from anesthesia early and extubated; the patient did not show neurological damage. Psychologically, the artificial heart was accepted without any problems by the patient, the drive line had no infections, and the patient was discharged quickly.

Conclusions
The CARMAT system appears to be the one that best simulates the physiology of the heart because it involves fewer complications than other artificial hearts. This device is used as a bridge to transplant, but research and continuous studies tend to transform it as a therapy to end for patients who leave the transplant list and therefore the possibility of having a heart transplant.
783 The effects of reduced physical activity on the lipid profile in patients with high cardiovascular risk during COVID-19 lockdown
Authors: Perrone Marco Alfonso , Padua Elvira , Pieri Massimo , Russo Carmelo , Iellamo Ferdinando , Parisi Attilio 
Published: December 2021

Abstract

Aims
The COVID-19 pandemic is a serious global health problem. In Italy, to limit the infections, the government ordered lockdown from March 2020. This measure, designed to contain the virus, led to serious limitations on the daily life of the individuals it affected, and in particular in the limitation of physical exercise. The aim of this study was to evaluate the effects of reduced physical activity on the lipid profile in patients with high cardiovascular risk.

Methods and results
We enrolled 38 dyslipidaemic patients, 56% male, with an age range of 44–62 years, considered to be at high cardiovascular risk. All patients were prescribed statin drug therapy (atorvastatin 40 mg) and a vigorous physical activity program four times a week, 1 h per session. In addition, a personalized Mediterranean diet was prescribed to all the patients. Total cholesterol, LDL, HDL, and triglycerides were measured in patients at T0 before lockdown and at T1 during lockdown. Data showed a significant increase (P &lt; 0.01) in total cholesterol (+6.8%) and LDL (+15.8%). Furthermore, the analysis of the data revealed a reduction in HDL (−3%) and an increase in triglycerides (+3.2%), although both were not significant (P &gt; 0.05). Of the 14 patients who were all in perfect therapeutic range at T0, only 4 (28%) had LDL &lt;70 mg/dL at T1.

Conclusions
Our study showed that the reduction in physical activity during lockdown led to an increase in LDL levels, and therefore, in the risk of ischaemic heart disease in dyslipidaemic patients with high cardiovascular risk.
149 Myocardial performance in opera singers
Authors: Stefani Laura , Corsi Marco , Orlandi Goffredo 
Published: December 2021

Abstract

Aims
Opera singers are subjected to continuous exercise in the cardiopulmonary district, however the impact on cardiac performance has not been studied in depth. In addition to the standard echo parameters, the deformation one offer the possibility to evaluate more clearly the myocardial performance. Objective was to verify the impact of singing in heart’s performance by the evaluation of traditional and particularly deformation parameters as strain, rotation, and twist.

Methods and results
A population of 17 OS (opera singers, aged 50 ± 5 years) (M/F: 7/9; 5 sopranos; 2 tenors; 2 contraltos; 2 basses) have been submitted to an echocardiographic evaluation (MLX8exp Release F100001) by standard 2D and deformation parameters (Figure 1). The data expressed as mean as SD were compared to an high level athletes (A) group (M 16) regularly trained. T-Student test for paired data was used and P &lt; 0.05 was considered significant. All the 2D standard systo-diastolic parameters were within the normal range and the pulmonary pressure (PP) as well in both. In SO group were: LVDd: 47.31 ± 3.77 mm; LVSd: 30.48 ± 4.42 mm; E/A: 1.07 ± 0.32; RV: 27.63 ± 4.50 mm; in A group: LVDd: 50.81 ± 2.97 mm; LVSd: 31.44 ± 4.26 mm; E/A: 2.68 ± 1.67; RV: 27.63 ± 4.50 mm. As expected Cardiac mass index (CMI) was significantly greater in athletes, while the ejection fraction (EF) resulted to be higher in OS. Despite the deformation parameters were not different among the two groups, with the exclusion of GLS expressing a major value in athletes, on the contrary the rotational parameters resulted, in OS group similar to the athletes and in agreement with an high performance status.

Conclusions
OS show an high myocardial performance as athletes. The data obtained are suggestive for a positive impact of regular training as an opera singers. Deformation parameters highlight the fitness status in this particular group. Classic music singing seems to have a training effect on the heart. Further studies will be necessary to confirm this hypothesis