bluuebunny/crossref_metadata_2025_split huggingface dataset:
282 Follow-up of hospitalized COVID-19 survivors: assessment of short- and long-term cardiovascular sequelae after SARS-CoV-2 infection
Authors: Birtolo Lucia Ilaria , Prosperi Silvia , Monosilio Sara , Cimino Sara , Filomena Domenico , Alfarano Maria , Manzi Giovanna , Neccia Matteo , Papa Silvia , Passarelli Ilaria , De Persis Francesca , Luca Alessandra De , Mei Mariachiara , Di Iorio Martina , D’Antoni Letizia , Di Pietro Gianluca , Francavilla Santi , Improta Riccardo , Marcon Serena , Mariani Marco Valerio , Agnes Gianluca , Piro Agostino , Rizzo Massimiliano , Rachele Edoardo Sebastian , Straito Martina , Tocci Marco , Francone Marco , Galea Nicola , Severino Paolo , Pasculli Patrizia , Colaiacomo Maria Chiara , Petroianni Angelo , Chimenti Cristina , Lavalle Carlo , Badagliacca Roberto , Palange Paolo , Mastroianni Claudio , Catalano Carlo , Pugliese Francesco , Ciardi Maria , Maestrini Viviana , Mancone Massimo , Fedele Francesco 
Published: December 2021

Abstract

Aims
Cardiovascular sequelae in COVID-19 survivors remain largely unclear and can potentially go unrecognized. Reports on follow-up focused on cardiovascular evaluation after hospital discharge are currently scarce. Aim of this prospective study was to assess cardiovascular sequelae in previously hospitalized COVID-19 survivors.

Methods and results
The study was conducted at ‘Sapienza’ University of Rome—Policlinico ‘Umberto I’. After 2 months from discharge, n = 230 COVID-19 survivors underwent a follow-up visit at a dedicated ‘post-COVID Outpatient Clinic’. A cardiovascular evaluation including electrocardiogram (ECG), Troponin and echocardiography was performed. Further tests were requested when clinically indicated. Medical history, symptoms, arterial-blood gas, blood tests, chest computed tomography, and treatment of both in-hospital and follow-up evaluation were recorded. A 1-year telephone follow-up was performed. A total of 36 (16%) COVID-19 survivors showed persistence or delayed onset of cardiovascular disease at 2-months follow-up visit. Persistent condition was recorded in 62% of survivors who experienced an in-hospital cardiovascular disease. Delayed cardiovascular involvement included: myocarditis, pericarditis, ventricular disfunction, new onset of systemic hypertension and arrhythmias. At 1-year telephone follow-up, 105 (45%) survivors reported persistent symptoms, with dyspnoea and fatigue being the most frequent. 60% of survivors showed persistent chest CT abnormalities and among those 28% complained of persistent cardiopulmonary symptoms at long term follow-up.

Conclusions
Our preliminary data showed persistent or delayed onset of cardiovascular involvement (16%) at short-term follow-up and persistent symptoms (45%) at long-term follow-up. These findings suggest the need for monitoring COVID-19 survivors.
288 The effects of cardiovascular diseases and treatment on clinical course of hospitalized COVID-19 patients
Authors: Prosperi Silvia , Birtolo Lucia Ilaria , Revivo Mia Yarden , Monosilio Sara , Cimino Sara , Filomena Domenico , Alfarano Maria , Manzi Giovanna , Neccia Matteo , Papa Silvia , Passarelli Ilaria , De Persis Francesca , De Luca Alessandra , Tanzilli Alessandra , Di Pietro Gianluca , Francavilla Santi , Improta Riccardo , Agnes Gianluca , Marcon Serena , Mariani Marco Valerio , Piro Agostino , Rizzo Massimiliano , Rachele Edoardo Sebastian , Straito Martina , Tocci Marco , Severino Paolo , Lavalle Carlo , Maestrini Viviana , Mancone Massimo , Fedele Francesco 
Published: December 2021

Abstract

Aims
Significant concern has been raised about the effect of pre-existing cardiovascular diseases (CVD), cardiovascular (CV) risk factors and CV therapies on COVID-19 course. On the other hand, COVID-19 could worse pre-existing CVD or trigger the development of new-onset CVD. The aim of this study was to evaluate the relationship between pre-existing CVD, CV risk factors, and CV therapy with the clinical course of hospitalized COVID-19 patients.

Methods and results
Consecutive hospitalized COVID-19 patients admitted to the Cardiovascular COVID-19 Unit at Policlinico Umberto I of Rome between December 2020 and April 2021 were enrolled. All patients underwent a cardiovascular evaluation including troponin, electrocardiogram (ECG), and echocardiogram. Data on medical history, pre-existing CVD, CV risk factors, and therapy were collected. Admission to the Intensive Care Unit (ICU) or Cardiac Intensive Care Unit (CICU), as well as the development of new-onset CVD, were considered as endpoint of the study. Among n = 229 patients enrolled, 22 (10%) died. Nearly half of patients (112, 49%) were admitted to the ICU/CICU. The presence of prior ischaemic heart disease nearly doubled the probability of hospitalization in the ICU/CICU (HR: 2.09, 95% CI: 1.132–3.866, P 0.018). In regards of therapy, beta blockers reduced the likelihood of admission in the ICU/CICU (HR: −1016, 95% CI: 0.192–10.682, P 0.002). However, neither the use of RAAS blockers, heparin or dexamethasone influenced the risk of ICU/CICU admission (respectively, HR: 0.85, 95% CI: 0.498–1.450, P 0.551; HR: 0.768, 95% CI: 0.435–1.356, P 0.363; HR: 0.861, 95% CI: 0.453–1.635, P 0.647). N = 89 patients (39%) experienced a new onset CVD including arrythmias (18.3%) with nearly half experiencing atrial fibrillation, acute coronary syndrome (10.9%), acute pulmonary embolism (5.3%), heart failure (HF) (3%), and myocarditis and pericarditis (1.3%). A pre-existing diagnosis of HF substantially increased the likelihood of new onset CVD (HR: 2.380, 95% CI: 1.004–5.638, P 0.049). However, treatment with heparin or dexamethasone reduced the risk of new onset CVD (HR: 0.482 95% CI: 0.268–0.867, P 0.015; HR: 0.487, 95% CI: 0.253–0.937, P 0.031, respectively).

Conclusions
Our study found that hospitalized COVID-19 patients who have at least one CV risk factor or pre-existing CVD had a greater likelihood of being admitted to the ICU/CICU and experiencing new onset CVD.
123 Prophylactic anticoagulation and aspirin therapy for hospitalized patients with COVID-19: a propensity score-matched analysis of the hope-COVID-19 registry
Authors: Santoro Francesco , Vitale Enrica , Nunez-gil Ivan , Guerra Federico , El-battrawy Ibrahim , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
No standard therapy is currently recommended for moderately ill Corona-virus-19 disease (COVID-19) patients. Potential benefit in terms of survival for anticoagulation were found only in this subset of patients. Aim of this study was to evaluate safety and efficacy of add-on antiplatelet therapy with aspirin over prophylactic anticoagulation (PAC) in COVID-19 hospitalized patients and its impact on survival.

Methods and results
7824 consecutive patients with COVID-19 were enrolled in a multicentre-international prospective registry (HOPE-COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. Study population included only patients treated with aspirin and/or PAC. A comparison of clinical outcomes between add-on antiplatelet therapy and PAC and patients treated with PAC only was performed using an adjusted analysis with propensity score (PS) matching. Of 7824 patients, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC only. Propensity-score matching yielded 298 patients from each group. Mean age was 73 ± 11 years, 67% were male, prevalence of hypertension and diabetes was 79% and 33%, respectively, and 7.5 % underwent invasive ventilation. In the propensity score-matched population, cumulative incidence curves of in-hospital mortality were lower in patients treated with PAC and Aspirin vs. PAC only (15% vs. 21%, Log Rank P = 0.01). At multivariable analysis in propensity matched population of COVID-19 patients, including age, sex, hypertension, diabetes, kidney failure and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (HR: 0.62, CI: 95% 0.42–0.92, P = 0.018).

Conclusions
Add-on anti-platelet therapy with aspirin over PAC in COVID-19 hospitalized patients was associated with lower mortality risk in a propensity score matched population.
534 Takotsubo syndrome secondary to vaccination for SARS-CoV-2
Authors: Torselletti Lorenzo , Giulia Stronati , Corraducci Francesca , Belleggia Sara , Maiorino Francesco , Casella Michela , Dello Russo Antonio , Guerra Federico 
Published: December 2021

Abstract

Methods and results
A 79-year-old woman, with a history of subclinical hypothyroidism, obesity and smoke presented to the Emergency Room with dyspnoea and cold sweating. She had undergone her first dose of COVID-19 Moderna mRna vaccination just four days prior to her admission. She showed elevated HS troponin and elevated BNP at her laboratory exams. Her 12-lead ECG showed T wave inversion in the antero-lateral leads and prolongued QTc. Her transthoracic echocardiogram showed severe ejection fraction reduction due to hypokinesia of the mid-apical segments of the anterior and lateral walls of the heart. The patient was then admitted to the Cardiology ward in order to perform a coronary angiography which sowed no significant coronary stenosis. She was started on appropriate medication and discharged after a six day in-hospital stay. At discharge she showed partial recovery of her ejection fraction (EF 44%). A cardiac magnetic resonance was performed after discharge which showed no late gadolinium enhancement. Such finding allowed us to rule out the diagnosis of myocarditis. Moreover at her 3-month follow-up her ejection fraction had recovered completely. We concluded for the diagnosis of Takotsubo Syndrome secondary to vaccination.

Conclusions
We presented a case of Takotsubo syndrome after vaccination with the Moderna vaccine for COVID-19. Two other similar case reports can be found in current medical literature. Female sex, post-menopausal age and the inevitable psychological stress derived by the pandemic and the vaccination may have triggered the condition.
459 Evaluation of LDL-C reductions by siRNA treatment with inclisiran in patients with diabetes mellitus, metabolic syndrome or neither
Authors: Wright R. Scott , Kallend David , Ray Kausik K , Leiter Lawrence , Koenig Wolfgang , Raal Frederick , Wijngaard Peter , Kastelein John J.P 
Published: December 2021

Abstract

Aims
Patients with diabetes (DM) and metabolic syndrome (MS) have elevated risks for atherosclerotic cardiovascular disease (ASCVD). Aggressive LDL-C lowering reduces risks. Inclisiran, a new siRNA, lowers LDL-C and was evaluated in patients with Type 2 diabetes (DM), metabolic syndrome (MS) without DM or neither (N) in the ORION-10 trial.

Methods
ORION-10 was a double-blind, randomized, placebo controlled trial evaluating inclisiran in 1561 patients with ASCVD on maximally tolerated therapy for lowering LDL-C. 781 inclisiran (INC) participants and 780 placebo (P) patients received 1.5 mL SQ tx at Days 1, 90, then every 6 months until Day 540. We evaluated the time adjusted change in LDL-C from baseline after Days 90–540 in DM (n = 702), MS (n = 455) and N participants (n = 404).

Results
There were no differences in baseline demographics and background therapies between INC and P. Statins were utilized in 89.8% INC and 88.7% of P. High intensity statins were utilized in 67.2% of INC and 68.8% of P; ezetimibe in 10.2% of NC and 9.5% of P participants. INC reduced LDL-C by − 54.4% (−58.3, −50.6 95% CI) in DM, (P &lt; 0.001), −58.6% (−62.3, −54.8), P &lt; 0.001 in-MS and −56.0% (−60.2, −51.7), in N subjects P &lt; 0.001 (see Figure).

Conclusions
Inclisiran potently and durably reduces LDL-C across patients with DM, MS and those with neither, demonstrating potent efficacy and durability across glycaemic categories. Inclisiran may also represent a potent LDL-C lowering treatment for those with DM and MS.
755 Rat engineered heart tissue is a novel in vitro model to evaluate cardiomyocyte proliferation and fibroblast activation after injury
Authors: Ciucci Giulio , Rahhali Karim , Cimmino Giovanni , Golino Paolo , Sinagra Gianfranco , Loffredo Francesco 
Published: December 2021

Abstract

Aims
Adult mammals, including humans, fail to regenerate the majority of the lost cardiomyocytes (CMs) that are replaced with scar tissue after injury. This lack of regenerative response is due to the loss of proliferative capacity of adult CMs which in mice occurs 7 days after birth. An in vitro model that recapitulates these changes has not been developed yet. Using rat engineered heart tissues (rEHTs) we have developed a custom-made cryoinjury system to test the hypothesis that maturation of CMs in EHTs regulates the proliferative response of CMs after injury.

Methods
rEHT were generated using neonatal rat heart cells. A discrete lesion was produced on the mid-section of mature (Day 18) and immature (Day 6) EHTs using a custom-made system based on liquid nitrogen and a 23G needle and medium was supplemented with EdU for 48 h.

Results
Cryoinjury in mature EHTs produces a localized injury, preserving their residual contractile activity that does not recover over time. We observed a significant increase of EdU+CMs post injury (6.3 ± 1.9% vs. 10.1 ± 1.6%) without significant changes in Ki67+ and pH3+ CMs suggesting that cryoinjury in mature rEHTs induces DNA synthesis but not CM proliferation. Injury in mature EHTs induced also significant proliferation and activation of fibroblasts with collagen deposition. Interestingly, cryoinjury performed in immature EHTs stimulated a significant proliferative response in CMs

Conclusions
Similar to adult rodents, we show that cryoinjury induces DNA synthesis in CMs without proliferative response and contractile recovery. On the other hand, cryoinjury in immature EHTs leads to CMs proliferation. Moreover, mature EHT fibroblast response to injury retraces the activation progression of cardiac fibroblast after infarction characterized by proliferation, increase of activation markers, increase of collagen deposition suggesting EHTs as a novel model to investigate the biology of cardiac regeneration upon injury.
24 Gliflozins and ventricular function in patients affected by chronic heart failure with diabetes mellitus
Authors: Fortunato Martino , Mazzeo Pietro , Correale Michele , Paradiso Matteo , Furore Andrea , Fanizzi Angela Ilaria , Tricarico Lucia , Maiellaro Pasquale , Pastore Giuseppe , Alfieri Simona , Lamacchia Olga , Iacoviello Massimo , Biase Matteo Di , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
Diabetes is the most common comorbidity of HF patients. SGLT2 inhibitors has been shown to reduce hospitalization in patients with HF. The cardioprotective mechanisms of gliflozines have not been elucidated. The aim of our study was to evaluate the effect of SGLT2 inhibitors on right and left ventricular function in T2DM patients with HF.

Methods and results
One hundred and fifteen consecutive outpatients with CHF and T2DM were screened in the Daunia Heart Failure Registry. Seventy-eight of them were enrolled and followed up between May 2019 and September 2020. All patients underwent conventional, TDI and strain echocardiography in an ambulatory setting, at the beginning and after 3 months of therapy with SGLT2 inhibitors. Seventy-eight consecutive outpatients with CHF and T2DM (mean age 67.4 ± 8.4 years, male: 83%) were enrolled in the study. Thirty-eight of them started the treatment with SGLT2 inhibitors, while the remaining forty continued their original therapy. After 3 months of therapy, LVEF, LVEDD, and LVESD statistically improved (respectively, from 39.68 ± 7.78% to 45.08 ± 9.04%, P: 0.001 and 57.32 ± 9.76 mm to 54.16 ± 6.54 mm, P: 0.01 and from 47.51 ± 1.58 mm to 43.24 ± 8.12, P: 0.0008). Changes in left ventricular function and dimensions were not significant in patients who did not started a therapy with SGLT2 inhibitors. There was a statistically significant reduction of E/E′ (from 16.51 ± 22.55 to 9.73 ± 3.35, P: 0.0007) in patients with treatment with SGLT2i. Moreover, there was an improvement of right ventricular function, due to a statistically significant reduction of PAPs and increase of TAPSE (respectively, from 30.63 ± 8.80 to 24.00 ± 8.35, P: 0.008; from 19.16 ± 2.54 to 21.18 ± 2.84, P: 0.0003) and S′ (10.42 ± 2.09 to 12.91 ± 2.50, P: 0.000) 3 months after the administration of SGLT2 inhibitors therapy vs. the control group.

Conclusions
In a real-world scenario, our results showed that the treatment with SGLT-2 inhibitors in patients with CHF and diabetes is associated with an echocardiographic biventricular function improvement.
46 A clinical and echocardiographic score to differentiate pulmonary hypertension due to heart failure with preserved ejection fraction from idiopathic pulmonary hypertension: the PH-HFpEF score
Authors: Chietera Francesco , Dardi Fabio , Rotunno Mariangela , Palazzini Massimiliano , Guarino Daniele , Ballerini Alberto , Magnani Ilenia , Bertozzi Riccardo , Donato Federico , Rapparini Luca , Manes Alessandra , Galiè Nazzareno 
Published: December 2021

Abstract

Aims
One of the most challenging differential diagnoses in pulmonary hypertension clinical practice, is the discrimination between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
We elaborate a score (considering patient clinical history, demographics, and echocardiographic characteristics) that can predict, noninvasively, PH-HFpEF vs. IPAH diagnosis.

Methods and results
Data were prospectively collected on 466 consecutive patients with a final diagnosis of IPAH or PH-HFpEF referred to a single tertiary pulmonary vascular disease centre. Data included clinical history, demographics, and parameters of an electrocardiogram and a transthoracic echocardiogram. A multivariate regression model was developed to predict a PH-HFpEF diagnosis, and an integer risk score was generated using adjusted regression coefficients of the multivariate logistic regression analysis. At the multivariate logistic regression a high ratio between left and right ventricular dimensions, a history of atrial fibrillation (AF), a high body mass index (BMI), a reduced mitral deceleration time and a high E-wave at trans-mitral Doppler, an advanced age and a high right ventricular fractional area change (FAC) were predictors of PH-HFpEF. The derived PH-HFPEF score (Figure), with a cut-point ≥11, yielded a specificity/sensitivity, respectively, for the diagnosis of PH-HFpEF, of 100%/49% with an AUC of 0.987.

ED, end-diastolic; LV, left ventricle; RV, right ventricle.

Conclusions
The PH-HFPEF score can predict PH-HFpEF vs. IPAH. The PH-HFPEF score may be used to potentially avoid an invasive diagnostic testing in almost half of PH-HFpEF patients.
388 Haemodynamic arterial changes in heart failure: a proposed new paradigm of heart and vessels failure. The Copernican revolution?
Authors: Galati Giuseppe , Germanova Olga , Iozzo Renato V. , Buraschi Simone , Germanov Andrey , Germanov Vladimir , Fedorina Marina , Senni Michele , Margonato Alberto 
Published: December 2021

Abstract

Aims
Although heart failure (HF) is one of the most common conditions affecting the heart, little attention has been placed on the role of arteries in contributing to the progression of this disease. We sought to determine the haemodynamic change of arteries in HF patients subdivided according to left ventricular ejection fraction. The major goal was to establish the active compensatory role of arteries in HF.

Methods and results
Using sphygmography, we systematically studied a cohort of 228 HF patients and 52 healthy controls. We focused on the common carotid as the main elastic artery and the posterior tibial as the main muscular artery (Figure 1). Moreover, we categorized the three HF groups, HFrEF, HFmrEF, HFpEF, into two subgroups (A and B) according to the presence or absence of HF signs at baseline. We discovered that all the parameters of measured arterial kinetics, i.e. work, power, acceleration, and speed, were significantly increased (P &lt; 0.001 by one-way ANOVA) in the groups without HF signs. In contrast, all the arterial kinetics parameters were significantly reduced (P &lt; 0.001) in the groups exhibiting HF signs. Similar results were obtained in both types of arteries and were consistently observed across all the three different types of HF, although with some differences in magnitude. Finally, we discovered that HFpEF patients exhibited more compromised arterial function vis-à-vis HFrEF patients [Figure 2: Patients disposition (Top) and quantification of arterial kinetics and haemodynamic parameters (Down) from the common carotid artery (A) and the posterior tibial artery (B)].

Conclusions
We provide the first documentation of an active compensatory role of arteries during HF. Mechanistically, we explain these findings by a dual activity of large arteries accomplished via an active propulsive work and a concurrent haemodynamic suction. These underestimated arterial functions partially compensate for the heart dysfunction in HF, underlining a key interplay between the heart and the vessels. We propose a new paradigm that we define as ‘heart and vessels failure’ that explicitly focuses on both heart and vessels’ interaction during the progression of HF.
157 Efficacy and tolerability of sacubitril/valsartan in patients with chronic heart failure and reduced ejection fraction
Authors: Cerciello Antonio , Lamaida Norman 
Published: December 2021

Abstract

Aims
The PARADIGM-HF study has shown, as is well known, that the association of sacubitril/valsartan (SV) was superior in terms of efficacy compared to enalapril in patients suffering from heart failure chronic cardiac (SC) and reduced systolic function (HFrEF). We have analysed the use of SV in patients with symptomatic HF and HFrEF, andits effect on humoural and functional parameters of easy evaluation.

Methods and results
From March 2018 to December 2019 we have introduced the SV in 158 patients 135 M and 23 F mean age 40–80 years with fraction of ejection &lt;35% with idiopathic dilated cardiomyopathy (six patients) or post-ischaemic (150 patients), in NYHA III class. Patients were declared eligible according to the ESC 2016 criteria (EF 40%, NT-proBNP&gt; 400 ng/l, target dose of ACE inhibitors/receptor antagonists angiotensin, GFR&gt; 30 ml/min/1.73 m2, serum S-potassium &lt;5.2 mmol/l, treatment with beta-blockers and antialdosteronics). Initially the administration of SV was a cp of 49/51 mg bid up to maximum tolerated dose (one tablet of 97/103 mg bid). All the patients had stopped taking ACE-I or sartans 48 h before and were evaluated at 4-week intervals for two years. In all patients we evaluated: ejection fraction (FE), filtered glomerular, systolic blood pressure, body weight, side effects, hospitalization and mortality. Of the 156 patients, 17 achieved the optimal dose of SV (97/103 mg), 113 achieved SV 49/51 mg bid. In all patients did not experience side effects or alterations of the electrolyte picture and renal function. The SV has determined an improvement NYHA class of at least 1; the echocardiogram showed a significant increase in FE: at follow-up 89 patients reached FE 45%, 44 patients FE 40–44%, and 6 patients about 50%; besides it is an improvement in indexed end-diastolic volume in moles was noted above patients (from 118.4 ± 38.4 to 110.9 ± 30 ml/m2). No case of re-hospitalization.

Conclusions
Our experience shows that the use of SV is well tolerated, improves functional capacity and ventricular remodelling and that does not modify the parameters of renal function and electrolytic of the patients.