bluuebunny/crossref_metadata_2025_split huggingface dataset:
452 Saline-induced coronary hyperaemia is mediated by intravascular haemolysis
Authors: Gallinoro Emanuele , Candreva Alessandro , Paolisso Pasquale , Fernandez-peregrina Estefania , Sonck Jeroen , Bermpeis Kostantinos , Bertolone Dario Tino , Esposito Giuseppe , Collet Carlos , Barbato Emanuele , De Bruyne Bernard 
Published: December 2021

Abstract

Aims
Absolute coronary blood flow can be measured by intracoronary continuous thermodilution of saline through the lateral side holes of a dedicated infusion catheter placed in the proximal segment of the coronary artery. A room-temperature saline infusion rate at 15–20 ml/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. The aim of the present study is to test whether local haemolysis is a potential mechanism of coronary hyperaemia.

Methods and results
Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured using the continuous intracoronary thermodilution of saline through a dedicated infusion catheter (RayFlow®). Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 ml/min); hyperaemia (Hyperaemia, saline infusion at 20 ml/min); post-hyperaemia [Post-Hyperaemia, 2 min after the cessation of saline infusion; and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min). Haemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperaemia phase. As compared to Rest, during Hyperaemia both LDH [131.50 ± 21.89 U/dL (Rest) and 258.33 ± 57.40 U/dl (Hyperaemia), P &lt; 0.001] and plasma-free haemoglobin [PFHb, 4.92 ± 3.82 mg/dl (Rest) and 108.42 ± 46.58 mg/dl (Hyperaemia), P &lt; 0.001] significantly increased in the coronary sinus. The percentage of haemolysis was significantly higher during the hyperaemia phase [0.04 ± 0.02% (Rest) vs. 0.89 ± 0.34% (Hyperaemia), P &lt; 0.001].

Conclusions
Saline-induced hyperaemia through a dedicated intracoronary infusion catheter is associated with haemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation. The role of other substances released by erythrocytes in inducing hyperaemia cannot be excluded and requires further investigations.
222 Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery
Authors: Nanni Samuele , Corsini Anna , Garofalo Mattia , Schinzari Matteo , Nardi Elena , Semprini Franco , Baiocchi Massimo , Castelli Andrea , Pacini Davide , Galie Nazzareno 
Published: December 2021

Abstract

Aims
The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and/or instrumental findings. However, there is not a clear cut-off value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease.

Methods and results
We retrospectively enrolled all consecutive adult patients undergoing CABG at our Institution over 1 year. Hs-cTnI concentrations (Access assay, Beckman-Coulter) were serially measured in the post-operative period and correlated with post-operative outcomes. 300 patients were enrolled; 71.3% of them underwent CABG alone, mainly on-pump (96.7%), 33.7% in the setting of an acute coronary syndrome. Most patients showed hs-cTnI values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, and 10.6% showed a LVEF decrease ≥10%. Hs-cTnI concentrations did not correlate with death or PMI whereas they did correlate with LVEF decrease ≥ 10% (P-value &lt; 0.05 at any time interval). Indeed, higher hs-cTnI values at 9–12 h post-operatively, along with previous cardiac surgery, number of surgical procedures, longer cardiopulmonary bypass time, and PMI diagnosis were predictors of LVEF decrease.

Conclusions
After CABG surgery, hs-cTnI at 9–12 h post-operatively may be a useful method to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.
609 Prognostic role of renal function in patients with previous myocardial infarction. A study with cardiac magnetic resonance
Authors: Restelli Davide , Licordari Roberto , Piaggi Paolo , Carerj Scipione , Santoro Domenico , Arcadi Vittoria , Aquaro Giovanni Donato , Pingitore Alessandro , Di Bella Gianluca 
Published: December 2021

Abstract

Aims
There is not strong evidence in literature about the impact of renal function on the prognosis of patients with ischaemic cardiomyopathy. Thus, the aim of the study was to investigate mild renal impairment [estimated glomerular filtration rate (eGFR): 60–89 ml/min] as an independent prognostic factor in patients with history of myocardial infarction (MI).

Methods and results
We studied 339 consecutive patients (65 ± 13 years old, female 13%) from 2001 and 2012 with previous MI. Patients with eGFR &lt;60 ml/min were excluded. We performed cardiac magnetic resonance (CMR) in all patients to quantify left ventricular ejection fraction (LVEF), volumes, and wall motion score index (WMSI), and to measure the infarction extent by late gadolinium enhancement (LGE). Renal function was estimated by creatinine value with Cockcroft–Gault formula and patients were divided according to normal (≥90 ml/min) and reduced (60–89 ml/min) eGFR. Patients with normal eGFR were 106 (31%, 56.9 ± 10.5 years old), 233 (69%, 66.1 ± 9.9 years old) had renal impairment. During follow-up (median 3.5 years), cardiac events (cardiac death or appropriate intra-cardiac defibrillator shock) occurred in 28/233 (12%) of patients with eGFR &lt;90 ml/min and in 4/106 (4%) of patients with eGFR ≥90 ml/min (P &lt; 0.05). Furthermore, survival curve showed a significantly worst prognosis in patients with renal impairment (P &lt; 0.03). In the group of patients with ejection fraction (EF) &lt; 35% (121 patients), cardiac events were observed only in patients with eGFR &lt;90 ml/min (23/99, 23%, P &lt; 0.05). At multivariate stepwise analysis, age &gt;65 years old, eGFR &lt;90 ml/min and WMSI &gt;1.7 turned out to be independent predictor of cardiac events (P &lt; 0.05).

Conclusions
In patients with previous MI, a mild renal impairment (eGFR between 60 and 89 ml/min) was an independent predictor of prognosis, especially if combined with left ventricular disfunction.
16 Impaired glucose tolerance and cardiovascular outcomes after an acute coronary syndrome—the important role of 1-h plasma glucose at the oral glucose tolerance test
Authors: Zywicki Viola , Capozza Paola , Caravelli Paolo , De Caterina Raffaele 
Published: December 2021

Abstract

Aims
2-h plasma glucose (PG) ≥140 mg/dl but &lt;200 mg/dl at the oral glucose tolerance test (OGT), defined as impaired glucose tolerance (IGT), has been reported as related to adverse cardiovascular outcomes in non-diabetic patients. The added value of 1-h plasma glucose (PG) ≥155 mg/dl at the OGTT is unknown. We investigated the value of 1-h PG in IGT patients admitted for an acute coronary syndrome (ACS) in relation to in hospital outcome.

Methods and results
Among 109 patients admitted to Coronary Care Unit for an ACS, with both no previous diagnosis of diabetes and first-line in-hospital screening with glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) negative for either diabetes and prediabetes, OGTT was performed. On the basis of the OGTT results, 21 patients (19.3%) were newly diagnosed diabetes. The remaining 88 patients were divided into: Group A: ‘fully glucose tolerant’, with 1 h PG-OGTT &lt;155 mg/dl and 2 h PG-OGTT &lt;140 mg/dl; Group B: ‘early-impaired IGT’ with 1 h-PG at OGTT ≥155 mg/dl and 2 h-PG &lt;140 mg/dl; Group C: ‘late impaired-IGT’, with 1 h-PG at OGTT &lt;155 mg/dl and 2 h PG-OGTT ≥140 mg/dl; and Group D: ‘fully impaired IGT’, with 1 h-PG at OGTT ≥155 mg/dl and 2 h PG-OGTT ≥140 mg/dl. In this analysis we compared the four groups as to cardiac markers and days of hospitalization by the Kruskal–Wallis test and correcting multiple comparisons with the Bonferroni’s adjustment. On the basis of the OGTT results, 12 patients (13.5%) belonged to Group A, 32 (39%) to Group B, 8 (9%) to Group C, and 35 (39%) patients to Group D. Group D patients had significant higher Hs-TnT at admission compared to Group A (P = 0.013), Group B (P = 0.023), and Group C (P = 0.005). Group D patients featured significant higher Hs-TnT peak compared to Group A (P = 0.016) and Group B (P = 0.005). Patients in Group D had a longer hospitalization compared to Group A (P = 0.005).

Conclusions
In the setting of ACS, compared to non-diabetic patients with a normal OGTT, only IGT patients characterized by both 1 h-PG ≥155 mg/dl and 2 h PG ≥ 140 mg/dl had more severe myocardial injury and longer hospitalization. These results suggest that, within currently defined IGT patients, 1 h-PG importantly contributes to assessing cardiac risk.
515 Exertional syncope and ventricular arrhythmia in a patient with cardiac amyloidosis
Authors: Fede Giuseppe , Abate Giuseppe , Belluardo Paolo , Guccione Nicoletta , Tasca Giovanni , Guarrella Maria Luisa , Di Tommasi Carmelo , Piccione Guglielmo , Sulsenti Giuseppe , Ficili Sabina 
Published: December 2021

Abstract

Aims
Systemic amyloidosis is a multisystem disorder caused by the misfolding, aggregation, and deposition of certain proteins in various organs and tissues. Cardiac involvement is common and worsens the prognosis. Atrial fibrillation is the most frequent arrhythmia in cardiac amiloidosis (CA), but many cases of ventricular arrhythmias (VA) and sudden cardiac death (SCD) have been described.

Methods and results
We present a case of a 64-year-old man admitted following exertional syncope occurred after climbing a flight of stairs. In the previous 2 weeks he had experienced fatigue and poor tolerance to exertion; moreover, 2 days before he had another episode of transient loss of consciousness after exertion. His medical history included left gonarthrosis and surgery for right carpal tunnel syndrome one year before. Physical examination did not revealed signs of heart failure. A 12-lead electrocardiogram (ECG) showed a pseudoinfarction pattern with QS waves in V2 and V3 leads and low voltage in all limb leads (Figure 1). Routine blood tests revealed N-terminal pro-bran natriuretic peptide (NT-ProBNP) of 3436 pg/ml (n.v. 0–125) and high-sensitive troponin T of 67 pg/ml (n.v. &lt; 58). A trans-thoracic echocardiogram showed left ventricle (LV) concentric thickening wall with granular and sparkling pattern, mild reduced ejection fraction, reduced global longitudinal strain with apical sparing, grade 3 diastolic disfunction, biatrial enlargement, mild mitral regurgitation, right ventricle free wall thickening (8 mm), mild reduced TAPSE, and mild pericardial effusion. Cardiac magnetic resonance (CMR) confirmed ventricular wall thickening with evidence at T1 mapping of interstitial infiltration more evident in the septum and inferior-lateral wall with apical savings (Figure 2). A total body 99mTc-HDP scintigraphy showed cardiac uptake with intensity similar to bone signal (Perugini Score 2) suggesting ATTR cardiac amyloidosis (Figure 3). Both kappa and lambda concentrations were normal. The genetic testing did not reveled mutations in the TTR gene. We concluded for a diagnosis of ATTR wild-type CA. The Holter ECG monitoring registered numerous ventricular ectopic beats and an episode of non-sustained ventricular tachycardia. A coronary angiography ruled out coronary artery disease. In consideration of the clinical-instrumental picture an ICD was implanted.

Conclusions
In conclusion, CA is still underdiagnosed. VA and SCD may further complicate the prognosis. Early diagnosis and adequate stratification of the arrhythmic risk are essential to ensure patients the best therapeutic strategies.
790 Pacemaker lead and atrial thrombosis, a rare event but of high clinical importance
Authors: Pistelli Lorenzo , Dattilo Giuseppe , Parisi Francesca , Crea Pasquale , Gurioli Lorenzo , Marra Walter Grosso 
Published: December 2021

Abstract

Aims
Trans-venous lead-related thrombosis is an undervalued issue. Since the lack of guidelines or evidences regarding the best therapeutic option, treatment of endocavitary clots on pacemaker wire is left to individual decision between surgical catheter extraction, thrombolysis, or anticoagulation therapy. In some patients, the labile equilibrium between hemorrhagic and thrombotic events may further complicate management.

Methods and results
We report the case of a 86-years-old man with heart failure (HF) severely reduced ejection fraction due to chronic ischaemic cardiomyopathy and several co-morbidities. He had a reacution of HF requiring hospitalization secondary to new-onset atrial flutter. During hospital stay, in light of episodes of severe bradycardia, he underwent single-lead PM implantation. Few days after discharge he developed deep vein thrombosis in situ of PM electro catheter insertion (poor compliance to anticoagulation therapy was reported) which improved after few days of regular therapy assumption. After few months anticoagulation therapy was dismitted due to etiology unknown-anemization requiring transfusion, but 20 days later he was once again admitted, this time because of pulmonary embolism. Trans thoracic echocardiography (TTE) enlightened a severely dysfunctioning right ventricle and a mass in right atrium hanging the wire. Trans oesophageal echocardiography was then performed showing hyper-reflective and highly mobile material with numerous ‘arborizations’. Intravenous heparin was started as pulmonary embolism therapy. Once infective etiology was excluded, total body computer tomography was performed to investigate a possible paraneoplastic origin. Presence of a meningioma was enlightened. Heart-team evaluation excluded catheter extraction in light of patient’s frailty, while thrombolysis was controindicated. Vitamin K antagonists was then started. At 1 month follow up no further embolic neither haemorrhagic events were reported. TTE showed a reduction in mass dimension and an improvement in right ventricle function.

Conclusions
In a guidelines-lacking field, VKA can be an effective option in cases of lead-related thrombosis when surgery or thrombolysis is not suitable. Further studies are needed to establish their real effectiveness in management of E-C-related endocavitary thrombi.
305 Usefulness of CHA2DS2-VASc scoring system for predicting risk of embolism in patients with cardiac tumours: a single-centre study
Authors: Magnani Ilenia , Paolisso Pasquale , Chiti Chiara , Angeli Francesco , Foa Alberto , Rinaldi Andrea , Bergamaschi Luca , Fabrizio Michele , Sansonetti Angelo , Stefanizzi Andrea , Armillotta Matteo , Galiè Nazzareno , Pizzi Carmine 
Published: December 2021

Abstract

Aims
The link between pro-protein convertase subtilisin/kexin 9 (PCSK9) and inflammatory-related disease has been supported in several experimental and human studies, which show how the protein could acts independent its canonical mechanism, by activation of inflammatory, apoptotic and immune pathways. Among these, TLR4/NFKB signalling pathway has been found to be one of the main pathways mediating the PCSK9-induced increase of pro-inflammatory and pro-thrombotic molecules, such as TNF-alpha, IL-6, IL-1, MCP-1, and TF. To investigate the direct involvement of hTLR4 in recognition of exogenous human recombinant (hr) PCSK9.

Methods and results
Experiments were carried out in three cell line: (i) HEK293-hTLR4-GFP cell lines obtained by stable co-transfection of HEK293 cells with the pUNO1-hTLR4-GFP, a plasmid expressing the hTLR4 gene fused to a GFP gene; (ii) HEK293-hTLR4+ cells obtained by co-transfection of hTLR4 receptor and its accessory proteins MD-2 and CD14, and an inducible secreted embryonic alkaline phosphatase (SEAP) reporter gene; (iii) HEK293-Null2 cells, a cell line lacking TLR4 expression, used as negative control. NFkB activity were measured by the SEAP reporter gene assay using a fluorescence detection method, while localization of hTLR4 and exogenous hrPCSK9 by confocal microscopy. hrPCSK9 (1 µg/mL) activates NFkB in HEK293-hTLR4+ cells [SEAP activity-OD 620 nm: from a baseline of 0.18 ± 0.06 to 0.68 ± 0.05 (N = 8), P &lt; 0.001] to an extent comparable to lipopolysaccharide, the specific agonist of TLR4. Co-localization of hrPCSK9 and TLR4s was clearly documented by quantitative confocal microscopy in HEK293-hTLR4-GFP cell line, that comprises the analysis of more than 80 fields in ∼2.105 cells/well and showing a percentage of co-localization of ∼4% in membrane spots (P &lt; 0.01).

Conclusions
Our data support the results reported in previous studies that attribute to PCSK9 a pathophysiological role in development of chronic inflammation and related-diseases such as atherothrombosis. A behavior that extends far beyond LDLR degradation, via a mechanism that might be mediated at least in part by recognition of PCSK9 by the TLRs and later activation of NFkB intracellular pathway. Future studies will be important to better investigate the specific binding site engaged in the PCSK9-TLR interaction and to discriminate the intracellular transduction pathways involved in this response, in order to provide a theoretical basis for the development of innovative therapeutic strategies.
544 Two cases of constrictive pericarditis temporally associated with mRNA-1273 COVID-19 vaccination
Authors: Diana Davide , Cardillo Ilaria , Polizzi Vincenzo , Musumeci Francesco 
Published: December 2021

Abstract

Aims
The SARS-CoV-2 pandemic has led to the development of the mRNA vaccines in humans which are well tolerated, safe, and highly efficacious; however, post-marketing surveillance is revealing potential rare cardiac adverse effects as acute pericarditis. We herein report two cases of symptomatic constrictive pericarditis following administration of the second dose of mRNA-1273 (Moderna) SARS-CoV-2 vaccine.

Methods and results
Case summary: A 75 years old male with history of hypertension and COPD presented to our Hospital approximately one month after the second dose of mRNA-1273 SARS-CoV-2 Vaccine with dyspnoea and leg oedema. Routine analysis resulted normal, no increasing of inflammatory markers or ECG abnormalities. Echocardiogram showed circumferential fibrinous pericardial effusion without tamponade and typical features of constrictive pericarditis: annulus reversus, ventricular interdependence, expiratory diastolic flow reversal in hepatic vein, inferior vena cava plethora. Pleural ultrasound showed bilateral pleural effusion that was sampled and showed a transudate fluid. Tumoral marker and a CT Scan, autoimmunity panel, blood tests for bacteraemia and Quantiferon were negative. Cardiac magnetic resonance imaging confirmed thickening of pericardium. A 68 years old male with history of ischaemic heart disease with previous CABG, hypertension, dyslipidaemia and chronic kidney disease presented with palpitations and mild legs swelling. Approximately, 2 months before he received the second dose of mRNA-1273 SARS-CoV-2 vaccine. Routine blood examinations resulted normal, ECG showed a right bundle branch block. Echocardiogram showed a mild enlargement of LV with normal systolic function, a moderate primary mitral regurgitation and a circumferential pericardial effusion, showing signs of constrictive syndrome. CT Scan demonstrated pericardium thickness. Constrictive pericarditis may represent a subacute complication of an asymptomatic exudative acute pericarditis. Although cases of acute pericarditis have been reported after SARS-CoV-2 vaccine, to our knowledge, the association with constrictive pericarditis has not been described. The temporal link between vaccination and symptoms development as the biological plausibility of autoimmune or cross-reaction response to vaccination in predisposed subjects could suggest a possible correlation as an adverse event, even if causality could not be established.

Conclusions
We present two cases of constrictive pericarditis occurring after mRNA-1273 SARS-CoV-2 vaccination, aiming further data to confirm a causal role.
172 Two mutations, one patient: which phenotype?
Authors: Giovannetti Alessandro , Accietto Antonella , Caponetti Angelo Giuseppe , Saturi Giulia , Ponziani Alberto , Massa Paolo , Sguazzotti Maurizio , Longhi Simone , Galiè Nazzareno , Gagliardi Christian 
Published: December 2021

Abstract

Methods and results
Woman, 55 years old, she has as comorbidity high blood pressure and mild obesity. She came at our attention to perform screening cardiological exams after her brother, who was affected by amyloidotic TTR-related cardiomyopathy with Val30Met mutation, died for sudden cardiac death. At the first evaluation the patient is completely asymptomatic, she has not angor, dyspnoea and heartbeat. The ECG and echocardiography were negative for amyloidotic signs of heart involvement. The Tc-99-DPD scintigraphy showed no cardiac uptake (visual score = 0). To complete the diagnostic path the patient had been evaluated by a neurologist with electromyography, which was negative, and genetic test, which confirmed the presence of Val30Met mutation of TTR-gene. For this last outcome we decided to follow the patient at our clinics. In the following years the patient developed a progressive reduction of exercise tolerance and symmetric negative T waves in anterolateral and inferior lead at ECG. The echocardiogram showed a progressive medio-apical septal hypertrophy. To exclude an ischaemic cause the patient made a stress myocardial scintigraphy, which was negative for ischaemic signs, and she underwent to cardiac MRI which showed a septal thickness of 16 mm without amyloidotic radiological signs in T1-weighted and LGE sequences. For this reason, we suspected that the patient had a hypertrophic cardiomyopathy and she had been undergone another time to genetic test which confirmed the Val30Met TTR-mutation and MYBPC3 mutation. Usually, this last gene mutation for myosin binding protein C is associated with late-onset hypertrophic cardiomyopathy. Into account the new diagnosis and her sudden cardiac death family history we calculated the patient’s HCM-risk score which was under 4%, so that we did not undergo the patient to ICD implantation.

Conclusions
The case report is a rare example of coexistence of the transthyretin gene mutation and myosin binding protein C in the same patient. In this case to perform a correct diagnosis, it is crucial use an integrated multimodal approach including ECG, echocardiography and cardiac MRI.