bluuebunny/crossref_metadata_2025_split huggingface dataset:
134 Impact of COVID-19 pandemic on timing and early clinical outcomes of transcatheter aortic valve implantation
Authors: Angellotti Domenico , Manzo Rachele , Franzone Anna , Esposito Giovanni , Avvedimento Marisa , Ilardi Federica , Castiello Domenico , Mariani Andrea , Iapicca Cristina , Faretra Antonella , Leone Attilio , Di Serafino Luigi , Piccolo Raffaele , Cirillo Plinio Lorenzo , Esposito Giovanni 
Published: December 2021

Abstract

Aims
COVID-19 pandemic deeply changed the management of patients with aortic stenosis. Many cardiac societies have drawn up guidelines for the optimal management of this population but applicability of such recommendations in the current clinical practice and their impact on clinical outcomes has not been adequately investigated.

Methods and results
A single-centre retrospective study included 315 patients undergoing transcatheter aortic valve implantation (TAVI) between April 2017 and June 2021. To analyse the impact of hospitalization pathways during the pandemic on clinical outcomes of TAVI patients, study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short- term complications. Pandemic group patients showed a more complex baseline clinical profile (NYHA III–IV, 70.1% vs. 56.3%; P = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; P = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.3 ± 3.5). Hospitalization length was similar in both group as well as all-cause mortality rate and the incidence of major periprocedural complications.

Conclusions
COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalization allowed to resume inpatient procedures while not affecting patients’ and healthcare workers’ safety.
623 Coronary ectasia in different clinical subsets: stable and acute coronary syndromes
Authors: Donati Francesco , Bendandi Francesco , Ghetti Gabriele , Taglieri Nevio 
Published: December 2021

Abstract

Aims
Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis.

Methods and results
A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients.

Conclusions
CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.
470 Percutaneous arterial closure devices and ultrasound-guided trans-femoral puncture observational investigation: insights from the PETRONIO registry
Authors: Iannopollo Gianmarco , Nobile Giampiero , Lanzilotti Valerio , Capecchi Alessandro , Verardi Roberto , Bruno Matteo , Somaschini Alberto , Rubboli Andrea , Pasquale Giuseppe Di , Casella Gianni 
Published: December 2021

Abstract

Aims
To evaluate the safety of a single and combined use of ultrasound-guided femoral puncture (U) and percutaneous arterial closure devices (P) in femoral artery procedures (FAP) compared to fluoroscopic guidance (F) and manual compression (M) in a large radial-focused interventional centre. U and P, taken individually, have improved safety in femoral arterial access procedures compared to traditional techniques.

Methods and results
All FAP performed between July 2017 and December 2018 in our centre were divided into three phases: (i) control period with F and M mainly performed; (ii) phase out period where U and P were introduced; and (iii) intervention period where a 6-month expertise on the novel techniques was acquired. The overall population was further stratified into subgroups: F/M, U/M, F/P, and U/P. The primary study endpoint was in-hospital access site bleeding events (BE) according to the BARC criteria. The secondary endpoint was vascular site complications (VASC). 418 procedures (14%) out of 3025 were performed via FA access during the study period. The overall access-site in-hospital BE were 97 (23%). Decreasing rates of BE (phase 1: n = 46, 29%; phase 2: n = 38, 22% e phase 3: n = 13, 15%; P = 0.027) and VASC were observed during the three periods. BE occurred significantly more often in F/M group (F/M: n = 48; 32%; U/M: n = 12, 16%; F/P: n = 18, 21%; U/P: n = 19, 17%; P = 0.008). F/M subgroup was an independent predictor of BE both in multivariable analysis and propensity score matching analysis.

Conclusions
The introduction of ultrasound-guided femoral puncture and percutaneous arterial closure devices has reduced access site bleeding with a progressive improvement after the first 6 months learning period.
90 Annular size and interaction with trans-catheter aortic valves for the treatment of severe bicuspid aortic valve stenosis: insights from the beat registry
Authors: Moscarella Elisabetta , Mangieri Antonio , Giannini Francesco , Tchetchè Didier , Kim Won-keun , Sinning Jan Malte , Landes Uri , Kornowski Ran , Backer Ole De , Nickenig George , Biase Chiara De , Soendergaard Lars , Marco Federico De , Bedogni Francesco , Ancona Marco , Montorfano Matteo , Regazzoli Damiano , Stefanini Giulio , Toggweiler Stefan , Tamburino Corrado , Immè Sebastiano , Tarantini Giuseppe , Sievert Horst , Schaefer Ulrich , Kempfert Jörg , Woehrle Jochen , Latib Azeem , Calabrò Paolo , Medda Massimo , Tespili Maurizio , Colombo Antonio , Ielasi Alfonso 
Published: December 2021

Abstract

Aims
Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type [balloon-expandable (BEV) vs. self-expanding (SEV)].

Methods and results
BEAT is a multicentre registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area &lt; 400 mm2 or perimeter &lt;72 mm), medium-annulus (area ≥ 400 and &lt; 575 mm2, perimeter ≥72 mm and&lt; 85 mm), large-annulus (area ≥575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, at younger age, had higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, P = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, P &lt; 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type.

Conclusions
TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
299 3-Year results of STEMI patients treated with a pre-specified BVS implantation strategy: BVS SYTEMI strategy-it long term
Authors: Moscarella Elisabetta , Campo Gianluca , Leoncini Massimo , Geraci Salvatore , Nicolini Elisa , Cortese Bernardo , Loi Bruno , Guiducci Vincenzo , Saccà Salvatore , Varricchio Attilio , Vicinelli Paolo , Candia Gianfranco De , Silvestro Antonio , Calabrò Paolo , Brugaletta Salvatore , Latib Azeem , Tespili Maurizio , Ielasi Alfonso 
Published: December 2021

Abstract

Aims
Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. To assess the 3-year clinical outcomes STEMI patients undergoing primary percutaneous coronary intervention (pPCI) with a pre-specified BVS implantation strategy.

Methods and results
BVS STEMI STRATEGY-IT (NCT02601781) included 505 STEMI patients undergoing pPCI with BVS following a dedicated implantation protocol. Device-oriented composite endpoint [(DOCE) cardiac death, ischemia-driven target lesion revascularization (ID-TLR) and target vessel myocardial infarction (TV-MI)] and scaffold thrombosis (ScT) at 3-year were evaluated. A subgroup analysis was performed on patients in whom dual antiplatelet therapy (DAPT) was continued 36 months after pPCI (‘longer-term DAPT’), and outcomes of this cohort compared to the remaining population (‘shorter-term DAPT’: &lt;36 months) are also reported. Three-year DOCE and ScT rates were low (2.4% and 1.0%, respectively). In 319 (63.2%) patients DAPT was continued 36 months after pPCI. DOCE rate was significantly lower in the longer- compared to shorter-DAPT group (HR: 0.29; 95% CI: 0.1–0.9; P = 0.03), driven by a lower rate of TV-MI (0% vs. 2.2%, P = 0.018). Significantly lower rate of ScT was observed in longer-DAPT group (0% vs. 2.7%, P = 0.007).

Conclusions
In STEMI patients undergoing pPCI, a strategy of optimized BVS implantation technique is associated with favourable DOCE and ScT rates at 3 year. DAPT extension up to 36 months further improves long-term clinical outcomes.
680 Peripheral intravascular lithotripsy of ILEO-femoral arteries to facilitate transfemoral TAVI: a multicentric prospective registry
Authors: Nardi Giulia , Backer Ole De , Saia Francesco , Sondergaard Lars , Ristalli Francesca , Meucci Francesco , Stolcova Miroslava , Mattesini Alessio , Demola Pierluigi , Wang Christina Xi , Jabri Anees Al , Bruno Antonio Giulio , Palmierini Tullio , Ielasi Alfonso , Belle Eric Van , Berti Sergio , Mario Carlo Di 
Published: December 2021

Abstract

Aims
The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF-TAVI in selected patients with peripheral artery disease (PAD). To report on the safety and efficacy of IVL-assisted TF-TAVI in an all-comers population.

Methods and results
Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF-TAVI in six high-volume European centres (2018–2020) were collected in this prospective, real-world, multicentre registry. IVL-assisted TF-TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI in 2018 to 2020, respectively. The target lesion was most often localized at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6 ± 0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversion to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of one perforation and three major dissections requiring stent implantation (two covered stents and two BMS). Access site related complication included three major bleedings. Three in-hospital deaths were recorded (2.8%, one failed surgical conversion after annular rupture, one cardiac arrest after initial valvuloplasty, one late hyperkalaemia in renal dysfunction).

Conclusions
IVL-assisted TF-TAVI proved to be a safe and effective approach, which helps expanding the indications for TF-TAVI in patients with severe calcific PAD. Still, these patients maintain a higher than average incidence of peri-procedural complication.
713 Culprit plaque morphology and healing capacity in patients with and without preinfarction angina: an optical coherence tomography imaging study
Authors: Vergallo Rocco , Ricchiuto Alfredo , Ridolfi Francesco , Buonpane Angela , Bianchini Emiliano , Maino Alessandro , Lombardi Marco , D’A mario Domenico , Montone Rocco , Romagnoli Enrico , Leone Antonio Maria , Buffon Antonino , Aurigemma Cristina , Burzotta Francesco , Trani Carlo , Crea Filippo 
Published: December 2021

Abstract

Aims
The relationship between culprit plaque morphology, healed culprit plaques prevalence and clinical presentation of acute myocardial infarction (AMI) remains largely unexplored. We hypothesized that angina preceding the occurrence of AMI (pre-infarction angina, PIA) may reflect a distinct morphologic phenotype of culprit plaques and potentially different healing capacity.

Methods and results
We conducted a retrospective observational study in patients with AMI who underwent intracoronary optical coherence tomography (OCT) imaging of the culprit lesion before PCI at the Fondazione Policlinico A. Gemelli–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome. Based on the clinical history, patients were classified into two groups: (i) PIA group, defined as either intermittent chest pain within 6 h preceding the final episode of chest pain, or unstable angina (or both) in the week preceding AMI or (ii) no-PIA group, defined as a single episode of chest pain without prodromal symptoms in the preceding week. Culprit plaques were classified as plaque rupture (PR) or intact fibrous cap (IFC), and presence of layered appearance (healed plaque, HP) was assessed. Thrombus burden (TB) was estimated, and prevalence of diffuse calcification, neovascularization, and OCT-defined macrophage accumulation were evaluated. A total of 102 patients with AMI were included (50 PIA, 52 no-PIA). Patients with PIA showed a higher prevalence of IFC than PR (58% vs. 42%, P = 0.030). PR in patients with PIA were more frequently associated with macrophage accumulation (71.4% vs. 28.6% P = 0.001), and TB tended to be lower [22.0 (15.8–30.3) vs. 38.5 (12.8–67.5), P = 0.145]. Diffuse calcifications were significantly less frequent in patients with PIA (22.0% vs. 40.4%, P = 0.045), while neovascularization tended to be more frequent (58.0% vs. 42.3%, P = 0.113). HPs prevalence was significantly higher in the PIA than in the no-PIA group (66.0% vs. 25.0%, P &lt; 0.001).

Conclusions
Patients with PIA have a distinct culprit plaque phenotype, more frequently characterized by IFC and a relatively lower TB, with a significantly higher prevalence of plaque healing.
377 Optimal timing for percutaneous coronary interventions in patients undergoing TAVI
Authors: Venturi Gabriele , Lunardi Mattia , Sole Paolo Alberto Del , Pighi Michele , Scarsini Roberto , Ribichini Flavio 
Published: December 2021

Abstract

Aims
PCI timing in patients undergoing TAVI is still controversial, with most cases treated before TAVI, because of concerns about potential ischaemic complications during valve replacement. This study aims to compare procedural and in-hospital outcomes in patients undergoing PCI before or after TAVI.

Methods and results
Patients undergoing TAVI and PCI from 2010 to 2021 at Verona University Hospital were included. High-risk PCI were defined when performed in unprotected left main, proximal left anterior descending, proximal dominant right coronary artery or in 3-vessel disease. The primary endpoint was the cumulative incidence of any TAVI procedural complication and in-hospital adverse events (VARC-3 criteria). 129/940 TAVI patients underwent PCI was performed before TAVI in 33.4% of cases. Most patients (76.4%) were at high-risk. The primary endpoint occurred in 30.2% PCI pre-TAVI vs. 23.3% post-TAVI (HR: 0.72; 95% CI: 0.26–2.86; P = 0.671); and in 37.9% vs. 18.5% respectively, among high-risk PCI (HR: 1.62; 95% CI: 0.86–3.76; P = 0.102). At 24 months, MACCE-free survival was comparable (PCI pre-TAVI 91.7% vs. post-TAVI 97.5%, HR: 0.88, 95% CI: 0.13–4.77, P = 0.765).

Conclusions
PCI performed after TAVI does not expose patients to higher risks of peri-procedural or long-term complications when compared with pre-TAVI procedures, even in presence of high-risk lesions. 377 FigureAn example of post-TAVI high risk PCI. Pre-TAVI coronary angiography showed ostial left main critical lesion (A). After Symetis Aortic valve deployment, balloon angioplasty and stent implantation were performed (B and C) with good final angiographic result (D).
482 Dressler’s syndrome following catheter ablation of atrial fibrillation: a case series
Authors: Magnocavallo Michele , Rocca Domenico Giovanni Della , Lavalle Carlo , Chimenti Cristina , Carola Gianni , Mohanty Sanghamitra , Trivedi Chintan , Bassiouny Mohamed , Al-Ahmad Amin , Burkhardt David J , Gallinghouse Joseph G , Sanchez Javier E , Horton Rodney P , Natale Andrea 
Published: December 2021

Abstract

Aims
Dressler’s syndrome is a secondary form of pleuro-pericarditis caused by an immune system response to heart damage. The onset of Dressler’s syndrome following catheter ablation has been previously described in rare case reports. We sought to report clinical manifestations, management, and outcomes of Dressler’s syndrome after atrial fibrillation (AF) catheter ablation.

Methods and results
Data from five AF patients who underwent radiofrequency ablation that was complicated by the development of Dressler’s syndrome were extracted from a prospective, single-centre database. Five out of 12 747 patients (0.04%) developed Dressler’s syndrome post AF ablation, 100% of which were females, with a mean age of 75.8 ± 3.4 years. All patients had persistent AF, and had pulmonary vein (PV) antrum, plus posterior wall isolation, plus non-PV trigger ablation. The mean procedure, fluoroscopy, and radiofrequency times were 183.20 ± 48.0, 50.3 ± 24.0, and 78.03 ± 27.9 min, respectively. All procedures were uncomplicated, and patients were discharged after overnight observation. Hospital re-admission was required in all after an average of 13.2 ± 5.2 days, due to worsening dyspnoea, pleuritic pain, and low-grade fever. At re-admission, all five patients had moderate-severe leucocytosis with neutrophilia, as well as bilateral rales and pericardial friction rub. Transthoracic echocardiography showed a mean pericardial circumferential effusion of 8 ± 2 mm, and chest X-ray was suggestive of bilateral mild pleural effusion in all. Corticosteroids were prescribed in three and NSAIDs plus colchicine in two patients. Pericardial drain placement was required in three patients after a median of 3 days, due to increasing pericardial effusion with hemodynamic impairment. The drainage tube was removed after a median of 2 days. All patients had complete resolution of symptoms and remained free from pericardial/pleural effusion within 1-month post-admission. Four of five patients had repeat ablation without recurrent Dressler’s syndrome.

Conclusions
Dressler’s syndrome occurred in older female patients, who underwent extensive ablation for AF. If promptly treated, its clinical course appears favourable with complete resolution of symptoms and pleuro-pericardial involvement.
317 Aldosterone and interleukin-6: the synergic effect in COVID-19
Authors: Campana Pasquale , Palaia Maria Emiliana , Conte Maddalena , Petraglia Laura , Ferrante Lorenzo , Dario Leosco , Parisi Valentina 
Published: December 2021

Abstract

Aims
Several evidence have identified the role of Interleukin-6 (IL-6) in the cytokine storm induced by COVID-19. Interestingly, the correlation between the serum levels of IL-6 and the plasma aldosterone has already been demonstrated in patients affected by primary aldosteronism (PA). Thus, we suppose that hyperaldosteronism may increase IL-6 levels in COVID-19.

Methods and results
We report a case of 47-year-old female Covid-19 patient who had developed severe pneumonia complicated by Guillain–Barreé syndrome (GBS). Blood test revealed high levels of IL-6 (serum IL-6: 402 pg/ml) and of its soluble receptor (soluble IL-6 receptor &gt;1900 pg/ml) and she required mechanical ventilation for severe hypoxaemia. Furthermore, the evidence of right adrenal adenoma, resistant hypertension, severe hypokalaemia, and high serum levels of aldosterone with high aldosterone/renin ratio were also consistent with diagnosis of PA. Thus, Spironolactone was administered with rapid improvements in clinical condition. Finally, she was diagnosed with acute motor sensitive neuropathy and started the rehabilitation phase.

Conclusions
Elevated aldosterone levels in PA may stimulate IL-6 production, inducing more severe forms of COVID-19 with the development of serious complications such as GBS. Hyperaldosteronism may also contribute to the poorest prognosis of patients with secondary aldosteronism such as heart failure and COVID-19, in which elevated IL-6 levels could exert its detrimental effects, mostly on the progression of ventricular dysfunction. Further studies are necessary to evaluate therapy with mineralocorticoid receptors antagonists such as spironolactone in COVID-19.