bluuebunny/crossref_metadata_2025_split huggingface dataset:
395 Diagnostic role of native T1 mapping compared to conventional magnetic resonance techniques in cardiac diseases: a real-life study
Authors: Licordari Roberto , Grigoratos Chrysanthos , Todiere Giancarlo , Barison Andrea , Di Bella Gianluca , Aquaro Giovanni Donato 
Published: December 2021

Abstract

Aims
T1 mapping is a validated technique in cardiac magnetic resonance (CMR), however in real-life clinical practice its effectiveness to diagnose myocardial disease is still unclear. To compare native T1 mapping to conventional late gadolinium enhancement (LGE) and T2-STIR techniques for the evaluation of a cohort of consecutive patients undergoing CMR for the suspicion of myocardial disease.

Methods and results
CMR was performed in 323 patients, 206 males (64%), mean age 54 ± 8 years, and in 27 age- and sex-matched healthy controls. LGE, T2-STIR, and pre- and post-contrast T1 mapping were acquired as suggested by the SCMR position paper. The CMR findings of global and regional T1 mapping were compared to the respective results of LGE and T2-STIR techniques. The main baseline indications for CMR were: suspicion of ARVC in 20%; non-ischaemic DCM in 19%; HCM in 16%; chest pain without obstructive coronary artery in 14% of patients (suspicion of MINOCA, Tako-tsubo or myocarditis); other indications (amyloidosis, scleroderma, previous myocardial infarction, pericarditis, LV non-compaction) in the remaining of cases. At T2-STIR images myocardial hyperintensity suggesting oedema was found in 41 patients (27%). LGE images were positive in 206 patients (64%). Native T1 mapping was abnormal in 171 (49%). In 206 patients (64%) a matching between LGE and native T1 was found (both positive in 132 and negative in 74). T1 was also abnormal in 32 out of 41 (78%) with oedema at T2-STIR. Overall, LGE and/or T2-STIR were abnormal in 209 patients, whereas native T1 in 154(52%). Conventional techniques and T1 mapping were concordant in 208 patients (64%). Conventional techniques were abnormal in 76 (24%) of patients with negative T1 mapping. Finally, in 39 patients T1 mapping was positive despite negative conventional techniques (12%). Among these latter 39 patients, only in 18 T2-STIR were acquired based on clinical decision. Then, the percentage of cases where T1 mapping could have an additive role would range between 6% and 12%. T1 mapping was particularly able in conditions with diffuse myocardial damage as cardiac amyloidosis, scleroderma and fabry disease (additive role in 42%). On contrast, T1 mapping was less effective in cardiac disease with regional distribution of myocardial damage as myocardial infarction, HCM, myocarditis (additive role in 1%).

Conclusions
T1 mapping may give additive information in 6–12% of patient but is less effective cardiac disease presenting with regional or segmental distribution of myocardial damage. Results of the present study suggest that conventional LGE/T2-STIR and T1 mapping are complementary techniques and should be used together in every CMR examination.
672 Isolated pulmonic valve endocarditis. AN unusual case with giant vegetations detected by transthoracic echocardiography
Authors: Parato Vito Maurizio , Di Geso Luca , Parato Andrea Giovanni , Pelliccioni Simona 
Published: December 2021

Abstract

Aims
Isolated pulmonic valve infective endocarditis (PV-IE) is a rare form of endocarditis.

Methods and results
The authors report a case of giant vegetations detected by transthoracic echocardiography on pulmonic valve in a 33 year-old patient, with drug abuse history (Figure 1). Patient underwent surgical intervention by pulmonary valved bioconduit implantation. After operation a pulmonary embolism episode was treated by a direct oral anticoagulant. The final outcome was favourable. We report a short review of this rare pathology.

Conclusions
The difficulty in diagnosing PV-IE is due to inability to properly visualize the pulmonic valve by echocardiography. In this case, with such large vegetations, transthoracic echocardiography (TTE) allowed a correct diagnosis and an effective surgical planning, confirming its importance as diagnostic tool.
746 Assessment of intracardiac fluid-dynamics of patients with aortic stenosis
Authors: Sabatino Jolanda , Leo Isabella , Strangio Antonio , La Bella Sabrina , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Canino Giovanni , Spaccarotella Carmen , Di Salvo Giovanni , De Rosa Salvatore , Indolfi Ciro 
Published: December 2021

Abstract

Aims
Recent technological developments enabled visualization of intracardiac flow patterns. This study aims to evaluate intracardiac flow dynamics of patients with aortic stenosis (AS).

Methods and results
Sixty-one patients with severe AS and 38 healthy sex- and BSA-matched controls (CTRL) were prospectively included. Standard echocardiographic assessment was performed in all patients. Fluid dynamics were evaluated using the HyperDoppler software to measure vortex area (VA), vortex length (VL), and vortex depth (VD). The assessment of VA, VL, and VD was feasible and reliable, as the inter-rater variability (ICCs) were very good for VA (0.878, P = 0.033), VL (0.960, P = 0.004), and VD (0.905, P = 0.021). Mean VA, VL, and VD (P = 0.033, P = 0.026, and P &gt; 0.001, respectively) were significantly larger in AS patients compared with CTRL. A significant difference in the delta values of VA and VL, reflecting their change from before to after TAVI, was observed in patients with and without significant paravalvular leak.

Conclusions
The newly developed quantitative indices of flow dynamics, namely VA, VL, and VD, were significantly increased in the LV of patients with severe AS compared to controls and their measurement was feasible and reliable in a clinical setting.
324 Unilateral pulmonary artery agenesis with controlateral embolism: a double vascular trouble
Authors: Pierri Alessandro , De Luca Antonio , Restivo Luca , Bologna Alessandro , Poletti Angela , Belgrano Manuel Gianvalerio , Sinagra Gianfranco 
Published: December 2021

Abstract

Methods and results
A 60-year-old male patient underwent coronary angiography (CA) for a non-ST segment elevation myocardial infarction (NSTEMI). CA revealed significant multivessel disease. Both internal mammary arteries (AMI) were patent, with right IMA markedly larger than the left IMA. The exam revealed also an abnormal branch arising from the proximal right coronary artery extending backwards, likely to the right lung. Pre-operative chest radiograph demonstrated asymmetry of the two hemithoraces with slight elevation of the right hemidiaphragm, small ipsilateral lung, and mediastinal shift towards the right. The patient underwent urgent CABG surgery. Myocardial revascularization was successfully performed using both AMI and one saphenous vein segment. The postoperative course was complicated by respiratory failure requiring prolonged mechanical ventilation. A chest computed tomography angiography was performed, revealing complete absence of the right pulmonary artery and a left lower lobe segmental pulmonary embolism. Furthermore, blood in the hypoplastic right lung was supplied by multiple collaterals arising from RCA and right IMA. Intravenous heparin was started with clinical improvement. Two weeks later, a lung scintigraphy was performed, ruling out perfusion defects. The patient was discharged home on oral anticoagulation with warfarin.

Conclusions
Unilateral pulmonary artery agenesis (UPAA) is an uncommon congenital anomaly of the great vessels. Despite the absence of the pulmonary artery, blood supply of ipsilateral lung is provided by systemic collaterals originating from bronchial, intercostal, internal mammary, and sub-diaphragmatic arteries. More rarely, these collaterals may arise from the coronary arteries with different implications, ranging from asymptomatic condition to myocardial ischaemia and infarction. In our case, the condition was previously asymptomatic. The occurrence of pulmonary embolism contributed to worsen the ventilation–perfusion mismatch, explaining the respiratory failure during the postoperative period.
770 Small heart and single coronary artery in a young patient with chronic fatigue syndrome: a case report
Authors: Poleggi Cristina , Perfetti Silvia , Restelli Davide , Perna Alessia , Donato Rocco , Di Bella Gianluca 
Published: December 2021

Abstract

Aims
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by fatigue and unexplained aspecifical symptoms. Patients with CFS/ME frequently have reduced stroke volume with an inverse relation between cardiac output and post-exertional malaise severity. We describe a rare case of a young man affected by CFS/ME, small heart, and anomalous anatomy of left main coronary artery (LMCA).

Methods and results
A 19-year-old Caucasian male referred to our clinic complaining weakness, lack of concentration, and sleepiness. He suffered by CFS/ME, D hypovitaminosis, inflammatory bowel disease, and exocrine pancreas insufficiency. Blood tests revealed no pathological findings. Faecal exams documented intestinal dysbiosis and low pancreatic elastase. He was treated with oxygen-ozone rectal insufflations and probiotics. Physical examination was unremarkable. Electrocardiogram showed normal sinus rhythm. Echocardiogram revealed reduced diameters of the left ventricle (LV), normal aortic root dimensions and, in a five-chamber apical view, a binary structure that seemed to cross the aorta perpendicularly. Cardiac magnetic resonance (CMR) found reduced LV stroke volume (34 ml/m2) and end-diastolic volume (57 ml/m2) together with reduced end-diastolic wall mass (51 g/m2). Right ventricle volumes were reduced too. In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro-aortic course. Mechanism of CFS/ME remains unknown, although various factors have been implicated, including immune activation, chronic viral infection, and emotional disorders. A considerable number of patients affected by CFS has an anatomically small heart. Small heart syndrome, in fact, may contribute to the onset of CFS/ME. Previous studies hypothesized that clinical manifestations of CMS/ME were caused by reduced venous return, cardiac output, and heart mass, together with decreased arterial oxygen saturation. Single coronary artery is an uncommon congenital anatomic abnormality identified by a single coronary ostium giving rise to all arteries supplying the heart. Thus, we reported a rare case of a very young man affected by chronic fatigue syndrome and small heart, investigated not only with echocardiogram but also with CMR, not often used in this clinical setting. More, we found an anomalous origin of LMCA. From literature, it’s not reported any cases of a patient including these three rare conditions (CFS/ME, small heart, and single coronary artery).

Conclusions
This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association between cardiac congenital anomalies and CFS/ME.

770 Figure
422 Atrioventricular blocks in children: clinical aspects and special features in a cohort of Italian patients
Authors: Ridolfi Lorenzo , Bronzetti Gabriele , Donti Andrea , Lanari Marcello , Gargiulo Gaetano Domenico 
Published: December 2021

Abstract

Aims
The natural history of atrioventricular blocks (AVBs) in children is not completely clarified, with particular regard for isolated, acquired, and non-immune disorders. Moreover, there is still concern on when—and not on if—a pacemaker (PM) implantation is indicated. In this retrospective study, we investigated diagnostic and therapeutic approach to AVBs in children and we described complications occurred in PM recipients.

Methods and results
We analysed 73 patients with a diagnosis of AVB who were submitted to a regular follow-up between 2015 and 2020 at the Paediatric Cardiology and Cardiac Surgery Unit of an Italian referral centre. Forty-four patients (60%) were diagnosed with a complete AVB and after a mean follow-up of 8.2 ± 6.8 years, 35 patients (79.5%) had received a permanent PM. AVB was asymptomatic in 52 children (71.2%) and a congenital heart disease was present in 13 cases (17.8%). Anti-SSA/B autoantibodies were detected in eight patients (11%) with complete block and their prognostic role was substantially redefined. The mean interval between diagnosis and implantation and the complication rate in PM recipients were similar to data available on literature, regardless of the age at diagnosis.

Conclusions
From a diagnostic point of view, we identified several differences between partial and complete AVBs. As regards the timing of pacing therapy, the moment of implantation should be accurately chosen but should not depend only on the age at diagnosis or the presence of maternal autoantibodies, since the incidence of device-related complications was independent from those features.
720 Angiography-derived index of microvascular resistance (IMR-angio) in Takotsubo syndrome
Authors: Castaldi Gianluca , Fezzi Simone , Widmann Maddalena , Mammone Concetta , Rizzetto Francesca , Lia Micaela , Prati Daniele , Pighi Michele , Pesarini Gabriele , Tavella Domenico , Scarsini Roberto , Ribichini Flavio 
Published: December 2021

Abstract

Aims
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an ‘adrenergic storm’ upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify coronary microvascular disfunction in patients with TTS using the recently developed angiography-derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation.

Methods and results
41 consecutive TTS patients were retrospectively analysed. Three different formulas for compute non-hyperemic IMRangio (NH-IMRangio) derived by 3D-Quantitative Coronary Angiography (3D-QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was deﬁned as an IMRangio ≥25. Moreover, correlation between NH-IMRangio and clinical presentation and a comparation between the three formulas were provided. Median age was 76 years, 85.7% were women and mean LVEF at first echocardiogram was 41.2%. All patients presented CMD with NH-IMRangio ≥25 in at least one territory. Mean NH-IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either Oxford-NH-IMRangio (52.7 ± 18.6 vs. 35.3 ± 13.6 vs. 41.4 ± 15.1, P-value &lt; 0.001), Madrid-NH-IMRangio (47.2 ± 17.3 vs. 31.8 ± 12.2 vs. 37.3 ± 13.7, P-value &lt;0.001) or Ferrara-NH-IMRangio (52.7 ± 19 vs. 36.1 ± 14.1 vs. 41.8 ± 16.1, P-value &lt; 0.001). Furthermore, the mean values of NH-IMRangio were not significantly different using the different equations (OXFvsMAD P-value = 0.1930; OXFvsFER P-value = 0.9609; MADvsFER P-value = 0.2144). NH-IMRangio in LAD territory was significantly higher in pts presenting with LVEF impairment (≤40%) than pts with preserved ventricular global function (mean NH-IMRangio LAD 59.3 ± 18.1 vs. 46.3 ± 16, P-value = 0.030). NH-IMRangio assessed in LAD territory showed a trend towards linear association with LVEF (Figure 1). 720 Figure

Conclusions
CMD, assessed with NH-IMRangio, is a common finding in TTS and it is associated with LVEF dysfunction and LVEF recovery. The validated formulas for NH-IMRangio computation have a superimposable diagnostic performance and accuracy.
397 Long-term follow-up after balloon expandable covered stents implantation for management of TAVI-related vascular access complications
Authors: Maurina Matteo , Regazzoli Damiano , Condello Francesco , Mangieri Antonio , Stefanini Giulio Giuseppe , Bongiovanni Dario , Leone Pier Pasquale , Baggio Sara , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Reimers Bernhard 
Published: December 2021

Abstract

Aims
Despite increasing experience and device innovation with transcatheter aortic valve implantation (TAVI), vascular complications are still a major problem and endovascular management is generally the first option. When stent implantation is required, self expandable (SE) stents are generally preferred over balloon expandable (BE) stents as they are more elastic and less compressible. However, BE stents support higher radial outward force, adhere to the vase lumen with greater precision and are less expensive. As no large registry reported data about stents BE alone in this setting, we report our experience with BE stents implantation to manage a vascular complication after TAVI. We believe that our work could be useful and possibly serves as a starting point for future research.

Methods and results
We retrospectively collected baseline, procedural and follow-up data about 78 patients who were implanted with a BE stent to manage a vascular complication after TAVI. At a median clinical follow-up of 410 days (IQR: 66–1016 days), no percutaneous or surgical interventions were reported after discharge. No cases of symptomatic leg-ischaemia were reported and only one patient was symptomatic for claudication. Doppler follow-up (available for 25 patients; 32%) showed no cases of stent fracture or displacement.

Conclusions
Our experience showed good acute and long-term results of BE covered stent implantation to manage a vascular complication after TAVI. It is possible that a greater radial outward force is a good choice in terms of hemostasis without necessarily being associated with stent deformation/fracture resulting in restenosis or further interventions. While present data may not be generalized, they may be useful to critically re-evaluate (and eventually reduce) the need of SE stents when treating femoral arteries bleedings.
442 Thrombocytopenia following transcatheter aortic valve implantation in portico and Evolute recipients
Authors: Totaro Antonio , Sacra Cosimo , Missiroli Bindo , Massetti Massimo , Testa Gianluca 
Published: December 2021

Abstract

Aims
Thrombocytopenia (TP) following transcatheter aortic valve implantation (TAVI) is a common phenomenon and is associated with mortality and complications. The underlying mechanisms are still unclear. Few data exist on differential risk of thrombocytopenia between different types of transcatheter valves.

Methods and results
This retrospective study aimed to evaluate the different behaviour of platelet count in Portico or Evolut recipients. Patients underwent TAVI between Feb 2017 to Aug 2021 at Gemelli Molise Hospital were enrolled and were divided in two groups: Portico (n = 90) and Evolut recipients (n = 64). Blood samples and platelets count were collected at admission (T1), implantation day (T2), second post TAVI day (T3), third post TAVI day (T4) and at discharge (T5). Drop platelets count (DPC) was calculated in this way: 100% × (baseline platelet count–nadir platelet count)/(baseline platelet count). CT and echo data were collected. The overall analysis consisted of a total of 154 patients who underwent TAVI. Among these patients, 90 patients (58%) were implanted with Portico valve, and 64 patients (42%) with an Evolut valve. We observed no differences among baseline characteristic between two groups. Interestingly, patients implanted with Portico valve, showed a high degree of thrombocytopenia at time T3, T4 and T5 (respectively, 122 ± 42 vs. 143 ± 43, P 0.004; 111 ± 39 vs. 137 ± 43, P 0.000; 136 ± 56 vs. 173 ± 69, P 0.001). DPC was greater in Portico valve (44 ± 16 vs. 31 ± 15, P = 0.000). No differences were found among inflammation variables (neutrophil lymphocyte ratio, CRP), implantation depth, degree of calcification evaluated with CT (FACTS score) and PVL. Balloon post dilatation (BPD) was performed in 33% of Portico recipients vs. 18% of Evolut recipients (P 0.044). No correlations were found between DPC and BPD in Portico patients (r = 0.035, P = 0.744) and Evolut recipients (r = 0.074, P = 0.569).

Conclusions
Our study suggests a more thrombocytopenia in Portico recipients, irrespective inflammation, valve calcification, perivalvular leak, implantation factors. Larger studies are needed to confirm these data.
637 Real-world experience with the new watchman FLX device: data from two high volume sicilian centres. The FLX-iest registry
Authors: Vizzari Giampiero , Mazzone Paolo , Sardone Andrea , Laterra Giulia , Frazzetto Marco , Sacchetta Giorgio , Micari Antonio , Tamburino Corrado , Contarini Marco , Carmelo Grasso 
Published: December 2021

Abstract

Aims
Left Atrial Appendage closure (LAAC) represents a standard therapy for patients with Atrial Fibrillation and contraindication to oral anticoagulation (OAC). The ‘Watchman FLX’ presented innovative features: higher conformability to LAA shapes, reduced length of the device, closed ‘atraumatic’ distal end with ‘flex-ball’ shape during deployment, flattened covered external surface. We report the early ‘real-world’ experience with the innovative Watchman-FLX device, in two centres at high-procedural volume with consolidated LAAC experience.

Methods and results
From May 2019 to January 2021, we enrolled 200 consecutive patients treated with Watchman FLX in a non-randomized double-centre registry. We collected procedural data and followed up the patients for mid-term clinical outcomes. Mean age was 77 ± 7.18 years (67.5% male). Patients presented hypertension in 93% of cases, CKD in 57.5% (mean creatinine level 2 ± 1.1), Diabetes mellitus in 41.5%, Coronary artery disease and Heart failure in 55%. 29% had previous stroke and 56.5 bleeding events. Mean CHA2DS2-VASc was 5 ± 1.40 and HAS-BLED 4 ± 1.01. LAAC indication was: 39.5% of cases symptomatic Haemorrhage, 39% need for Triple antithrombotic therapy, 32% gastro-intestinal bleeding; 18% of patients presented OAC intolerance. TEE guidance was feasible in 186 cases (93%), of which 96 (48%) in general anesthesia and 90 (45%) in conscious sedation (MID-DEX) protocol. 14 ICE cases (7%) were performed in local anesthesia. FLX device repositioning after first attempt was required in 40 cases (20%) without any complication. Device size change, after first choice was needed in eight cases (4%). In one exceptional case simultaneous implant of two Watchman FLX devices was performed in a bi-lobed LAA. Peri-device leak was found in two cases (1%), one solved by changing FLX size (31 to 35 mm). Final procedural success was 99.5%; one unsuccessful case due to LAA reverse chicken-wing with very short depth; no device embolization. Six complications were related to access-site (3%), two cases of combined LAAC-Mitraclip procedure; two major bleedings occurred and one in-hospital death due to hemorrhagic shock (HAS-BLED = 6). At mean follow-up of 272 ± 172.76 days, only 2% of (non-device-related) stroke and 0.6% fatal bleeding resulted.

Conclusions
Our registry in a high-risk population treated with the innovative Watchman FLX device, showed high technical procedural success with easy implant and repositioning, no embolization, good LAA sealing and low rate of ischaemic/bleeding complications. 637 Figure