bluuebunny/crossref_metadata_2025_split huggingface dataset:
348 Uric acid is associated with acute heart failure and cardiogenic shock at presentation in acute coronary syndrome patients
Authors: Maloberti Alessandro , Rebora Paola , Centola Marco , Morici Nuccia , Sacco Alice , Scarpellini Sara , Occhino Giuseppe , Viola Giovanna , Oreglia Jacopo , Castini Diego , Carugo Stefano , Algeri Michela , Valsecchi Maria Grazia , Oliva Fabrizio , Giannattasio Cristina 
Published: December 2021

Abstract

Aims
we focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcome were acute HF and cardiogenic shock at admission, secondary outcomes were the need of Non Invasive Ventilation (NIV) use and the admission Left Ventricular Ejection Fraction (LVEF).

Methods and results
we consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Hyperuricaemia was defined as a value higher than 6 mg/dl for females and 7 mg/dl for males.
All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (n = 292): acute HF 35.8 vs. 11.1% (P &lt; 0.0001), cardiogenic shock 10 vs. 3.1% (P &lt; 0.0001), NIV 24.1 vs. 5.1% (P &lt; 0.0001) with lower admission LVEF (42.9 ± 12.8 vs. 49.6 ± 9.9, P &lt; 0.0001). By multivariable analyses, UA was confirmed to be significantly associated with all the outcomes with the following odds ratio (OR): acute HF OR = 1.119; 95% CI: 1.019–1.229; cardiogenic shock OR = 1.157; 95% CI: 1.001–1.337; NIV use OR = 1.208; 95% CI: 1.078–1.354; LVEF β = −0.999; 95% CI: −1.413 to − 0.586.

Conclusions
The main result of our study was the finding of a significant association between UA and acute HF, cardiogenic shock, NIV use and LVEF. Due to the cross-sectional nature of our study no definite answer on the direction of these relationship can be drawn and further longitudinal study on UA changes over time during an ACS hospitalization are needed.
128 Clinical impact of changes in mitral regurgitation severity after optimization of medical therapy in heart failure: insights from BIOSTAT-CHF
Authors: Pagnesi Matteo , Adamo Marianna , Sama Iziah E. , Anker Stefan D. , Cleland John G. , Dickstein Kenneth , Filippatos Gerasimos S. , Inciardi Riccardo M. , Lang Chim C. , Lombardi Carlo M. , Ng Leong L. , Ponikowski Piotr , Samani Nilesh J. , Zannad Faiez , Van Veldhuisen Dirk J. , Voors Adriaan A. , Metra Marco 
Published: December 2021

Abstract

Aims
Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-directed medical therapy (GDMT) in heart failure (HF). We evaluated the evolution and impact of MR after GDMT in the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF).

Methods and results
A retrospective post hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization. Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate–severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate–severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint [unadjusted hazard ratio (HR), 2.03; 95% confidence interval (CI): 1.57–2.63; P &lt; 0.001], also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR: 1.85; 95% CI: 1.43–2.39; P &lt; 0.001). Younger age, LVEF ≥50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of moderate–severe MR at 9 months, whereas older age was the only predictor of worsening MR.

Conclusions
Among patients with HF undergoing GDMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate–severe MR after GRMT was associated with worse outcome.
581 Ventricular–arterial coupling derived from proximal aortic stiffness and aerobic capacity across the heart failure spectrum
Authors: Pugliese Nicola Riccardo , Balletti Alessio , Armenia Silvia , Biase Nicolò De , Faita Francesco , Ruschitzka Frank , Ghiadoni Lorenzo , Taddei Stefano , Williams Bryan , Antonini-canterin Francesco , Masi Stefano 
Published: December 2021

Abstract

Aims
Ventricular–arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS). To evaluate VAC across the spectrum of heart failure (HF).

Methods and results
We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n = 104) or reduced ejection fraction (HFrEF, n = 132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress. aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (P &lt; 0.01). PWVs were directly related and increased with age (all P &lt; 0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.08 ± 0.36) and HFpEF (1.05 ± 0.22), while aa-PWV/GLS was more impaired in HFpEF (0.69 ± 0.11) than HFrEF (0.60 ± 0.15; P &lt; 0.01). Stages A and B had values of cf-PWV/GLS and aa-PWV/GLS (0.66 ± 0.25 and 0.47 ± 0.12) higher than controls (0.47 ± 0.10 and 0.40 ± 0.10) but lower than Stage C (all P &lt; 0.01). Peak AVO2diff was inversely related with cf-PWV/GLS and aa-PWV/GLS (all P &lt; 0.01). cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2 = 0.32 and 0.35; all P &lt; 0.0001) but only aa-PWV/GLS was independently associated with flow reserve during exercise (R2 = 0.51; P &lt; 0.0001).

Conclusions
Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.
192 Study of endothelial function and vascular stiffness in patients affected by dilated cardiomyopathy on treatment with sacubitril/valsartan
Authors: Amore Ludovica , Alghisi Fabio , Cersosimo Angelica , Cimino Giuliana , Pascariello Greta , Pancaldi Edoardo , Bernardi Nicola , Calvi Emiliano , Lombardi Carlo , Vizzardi Enrico , Metra Marco 
Published: December 2021

Abstract

Aims
It has already been demonstrated the efficacy of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction, but many of its properties are still unknown especially regarding its effects on endothelial dysfunction and arterial stiffness.

Methods and results
To this purpose, a longitudinal study involving 15 patients with dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF) was started; the purpose was collecting at the beginning and at the end of the study blood pressure measurements, transthoracic echocardiography images, parameters of endothelial function with peripheral arterial tonometry (EndoPAT®), and non-invasive evaluation of the aortic stiffness parameters by using applanation tonometry (SphygmoCor® Px system). Aortic stiffness parameters weren’t different at 6 months, compared to baseline. There was a slight, not significant increase in augmentation pressure (P = 0.889), augmentation index (P = 0.906), and sphygmic wave velocity (P = 0.263). Systolic, diastolic, and differential central arterial pressure didn’t change. RHI (reactive hyperaemia index) increased significantly after 6 months (P = 0.001) as well as augmentation index corrected for 75 b.p.m. Ejection fraction (32.21% ± 5.7 to 38.43% ± 8.4; P = 0.010) and diastolic dysfunction degree (P = 0.021) improved significantly. Mitral regurgitation improvement wasn’t statistically significant (P = 0.116). Tricuspid annular plane systolic excursion didn’t change while pulmonary systolic arterial pressure increased, although not significantly (22.83 mmHg ± 4 to 27.33 mmHg ± 6; P = 0.068) and within the normal range values.

Conclusions
Sacubitril/valsartan can improve endothelial function significantly in patients with dilated cardiomyopathy and reduced LVEF. It can also improve left ventricular function, mitral regurgitation, and diastolic function. Conversely, this drug seems to have no effects on vascular stiffness.
259 Incidence, predictors, and prognostic role of complications occurring during intracoronary provocative test with acetylcholine in patients with myocardial ischaemia and non-obstructive coronary arteries
Authors: Montone Rocco Antonio , Rinaldi Riccardo , Gurgoglione Filippo , Del Buono Marco , Russo Michele , Caffè Andrea , Vecchia Giulia La , Niccoli Giampaolo , Crea Filippo 
Published: December 2021

Abstract

Aims
Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischaemia and non-obstructive coronary arteries. However, data on safety, predictors, and prognostic role of complications during intracoronary provocative testing are scarce. We aimed at assessing the safety of ACh provocative test in patients with myocardial ischaemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test.

Methods and results
We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-h ECG dynamic Holter monitoring and angina status were assessed at follow-up. We enrolled 310 patients [mean age 60.6 ± 11.9; 169 (54.5%) chronic coronary syndromes (CCS) and 141 (45.5%) with myocardial infarction and non-obstructive coronary arteries (MINOCA)]. The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS [10 (7.1%) vs. 18 (10.7%), P = 0.276, respectively]. At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation [odds ratio (OR): 12.324, confidence interval (CI): 95% (4.641–32.722), P = 0.015] and moderate/severe diastolic dysfunction [OR: 3.827, 95% CI (1.296–11.304), P = 0.015] were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden.

Conclusions
Intracoronary provocative testing with ACh test is safe in patients with myocardial ischaemia and non-obstructive coronary arteries (including MINOCA patients). History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. However, occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events, and angina burden.
719 Prevalence and clinical impact of high platelet reactivity in patients with chronic kidney disease treated with percutaneous coronary intervention: an updated systematic review and meta-analysis
Authors: Mangiacapra Fabio , Paolucci Luca , Viscusi Michele Mattia , Mangiacapra Roberto , Ferraro Pietro Manuel , Nusca Annunziata , Melfi Rosetta , De Luca Leonardo , Gabrielli Domenico , Ussia Gian Paolo , Grigioni Francesco 
Published: December 2021

Abstract

Aims
High platelet reactivity (HPR) on clopidogrel and chronic kidney disease (CKD) are recognized as potent risk factors for adverse outcomes in patients suffering coronary artery disease (CAD) and undergoing percutaneous coronary intervention (PCI). However, conclusive evidence regarding their reciprocal interaction and the consequent impact on clinical events is still lacking. We performed a meta-analysis with the aim to evaluate the prevalence of HPR in patients with and without CKD and the incidence of major adverse cardiovascular events (MACE) according to the renal and platelet function status in current literature (co-primary endpoints). Secondary endpoints were myocardial infarction (MI), all cause death and definite/probable stent thrombosis (ST).

Methods and results
We searched on PubMed, EMBASE, and Cochrane Library studies investigating CKD and HPR on clopidogrel in patients suffering CAD who underwent PCI and their related outcomes. Overall, 13 studies including 22.464 patients were selected. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model with the Mantel–Haenszel method. Patients with CKD presented significantly higher odds of HPR compared with those without CKD [OR: 1.51 (95% CI: 1.29–1.76)]. In patients without CKD, HPR was associated with increased odds of MACE [OR: 1.31 (95% CI: 1.01–1.72)], MI [OR: 1.48 (95% CI: 1.17–1.86)] and definite/probable ST [OR: 2.45 (95% CI: 1.08–5.60)]. In patients with CKD, HPR was associated with higher odds of both MACE [OR: 1.61 (95% CI: 1.14–2.27)] and MI [OR: 1.69 (95% CI: 1.11–2.59)], compared to those without HPR.

Conclusions
Our analysis shows that HPR on clopidogrel is more frequent in patients with CKD treated with PCI. Patients with HPR are exposed to a high risk of MACE after PCI, regardless of the renal function status.
184 The presence of atrial fibrillation in acute myocardial infarction patients and hyperglycaemia
Authors: Fabrizio Michele , Paolisso Pasquale , Bergamaschi Luca , Angeli Francesco , Toniolo Sebastiano , Magnani Ilenia , Donati Francesco , Stefanizzi Andrea , Sansonetti Angelo , Armillotta Matteo , Chiti Chiara , Bartoli Lorenzo , Rinaldi Andrea , Foà Alberto , Casella Gianni , Galiè Nazzareno , Pizzi Carmine 
Published: December 2021

Abstract

Aims
In patients with acute myocardial infarction (AMI), hyperglycaemia is a common feature determining a worse prognosis. Few studies have examined the relationship between hyperglycemic status and atrial fibrillation in-hospital stay. To evaluate the relationship between admission hyperglycaemia (aHGL) and occurrence of atrial fibrillation (AF) in-hospital stay in patients with AMI, categorized as myocardial infarction with obstructive coronary artery disease (MIOCA) and myocardial infarction with nonobstructive coronary artery disease (MINOCA).

Methods and results
Hyperglycaemia was defined as a serum glucose level ≥140 mg/dl at the time of hospital admission. AF was defined as a beat-to-beat variability in cycle length and morphology with irregular fibrillatory waves on surface ECG. Among 2702 patients (32.1% were female, mean age was 70.1 ± 13.4 years), 24.2% were diabetic. Out of 2702 patients, 2457 were MIOCA and 245 (9.1%) were MINOCA patients. At admission, the mean value of serum glucose levels was 146 ± 66 mg/dl. At hospital admission, hyperglycemic status was present in 37.7% of patients and 8.3% presented atrial fibrillation. At hospital admission, atrial fibrillation (aAF) was significantly frequent in hyperglycemic than normoglycaemic patients (11.5% vs. 6.3%, respectively; P &lt; 0.001). In aHGL MIOCA patients had a higher rate of aAF (10.7%) than normoglycaemic MIOCA (6.4%; P &lt; 0.001). In aHGL MINOCA patients had 31% aAF than normoglycaemic MINOCA patients (7.5%; P &lt; 0.001). During the hospital stay, the new onset of atrial fibrillation was higher in aHGL than normoglycaemic status in total population (6.3% vs. 2.9%, P &lt; 0.001), in MIOCA subgroup (6.3% vs. 3.1%, P &lt; 0.001) and MINOCA subgroup (7.3% vs. 1.5%, P = 0.003). Multivariate analysis adjusted for age, sex, and diabetes revealed that the presence of hyperglycaemia was an independent predictor for the onset of atrial fibrillation (OR: 1.7; 95% CI: 1.1–2.6; P = 0.02).

Conclusions
Hyperglycaemia was an independent predictor of new atrial fibrillation during hospitalization in patients with AMI. Moreover, at hospital admission, patients with hyperglycemic status presented a higher incidence of atrial fibrillation, both in MIOCA and MINOCA subgroups. Further studies are needed to understand the biological mechanisms involved in these associations.
729 Clinical profile and management of acute myocardial infarction in elderly patients
Authors: Romano Letizia Rosa , De Rosa Salvatore , Kosuke Fujita , Sabatino Jolanda , Polimeni Alberto , Sorrentino Sabato , Spaccarotella Carmen , Mongiardo Annalisa , Indolfi Ciro , Canino Giovanni 
Published: December 2021

Abstract

Aims
The management of acute myocardial infarction (AMI) in elderly patients is often challenging for their peculiar clinical profile and the limited clinical evidence available. This represents a major unmet need in cardiovascular medicine, given the progressive ageing of population in western Countries. To investigate the clinical characteristics of elderly patients with AMI at a single tertiary university hospital.

Methods and results
The EMIR is an ongoing registry including elderly patients (≥75 years) consecutively referred to a single tertiary centre with diagnosis of acute myocardial Infarction with indication for coronary angiography. A total of 760 patients were enrolled to date, 39.6% were female, while mean age was 80 ± 4 years. Most patients had a NSTEMI, while 28% had a STEMI. Time from symptoms’ onset to presentation was 9.4 ± 14.6 for STEMI and 26.5 ± 30.4. Percutaneous coronary intervention (PCI) was performed in 64% of cases. Concomitant PCI of a non-target lesion (NTL) was performed within the same procedure in 8.8% of cases. A staged PCI of NTL was performed in 14% of cases. An elective surgical revascularization was performed after PCI of the IRA in 2.1% of cases. Altogether, a complete revascularization was achieved in 43% of cases before discharge. No evidence of critical coronary stenoses (CCS) was reported in 12.1% of cases, more frequently in females (18%) than in males (8.3%). Patients with no CCS were younger (P = 0.007), more frequently female (P &lt; 0.001), had lower LV-EF (P = 0.002) and a longer time from symptoms’ onset to presentation (P = 0.008). Atrial fibrillation (AF) was present in 17.4% of patients, although only 12.1% of patients had any knowledge of carrying AF. Among patients with AF, 16.7% had no CCS, while the remaining had a formal indication to a combined antiplatelet/anticoagulant treatment.

Conclusions
Elderly patients with AMI are a specific population, posing peculiar clinical needs and demanding dedicated clinical management protocols.
448 Comparison of quantitative flow ratio, Pd/Pa, and diastolic hyperaemia-free ratio vs. fractional flow reserve in non-culprit lesion of patients with non-ST-segment elevation myocardial infarction
Authors: Tebaldi Matteo , Biscaglia Simone , Erriquez Andrea , Penzo Carlo , Tumscitz Carlo , Scoccia Alessandra , Marrone Andrea , Scala Antonella , Gibiino Federico , Pompei Graziella , Tolomeo Paolo , Campo Gianluca 
Published: December 2021

Abstract

Aims
To investigate the correlation between quantitative flow ratio (QFR), Pd/Pa, diastolic hyperaemia-free ratio (DFR), and fractional flow reserve (FFR, gold standard) in non-culprit lesion (NCL) of patients with non ST-segment elevation myocardial infarction (NSTEMI). The non-hyperemic pressure ratio (NHPR) and the angiography-based indexes have been developed to overcome the limitation of the use of the FFR.

Methods and results
Between January and December 2019, 184 NCL from 116 NSTEMI patients underwent physiologic assessment and were included in the study. NCLs were investigated with QFR, Pd/Pa, DFR, and FFR. Mean values of QFR, Pd/Pa, DFR, and FFR were 0.85 ± 0.10, 0.92 ± 0.07, 0.93 ± 0.05, and 0.84 ± 0.07, respectively. DFR and FFR showed a good correlation (r = 0.76). Bland and Altman plot showed a mean difference of 0.080. DFR diagnostic accuracy was 88%. The area under the ROC curve (AUC) for DFR was 0.946 (95% CI: 0.90–0.97, P = 0.0001). Similar findings were reported for Pd/Pa [r = 0.73; mean difference 0.095, diagnostic accuracy 84%, AUC 0.909 (95% CI: 0.85–0.94, P = 0.0001)] and QFR [r = 0.68; mean difference: 0.01; diagnostic accuracy: 88%, AUC: 0.964 (95% CI: 0.91–0.98, P = 0.0001)]. FFR, QFR, Pd/Pa, and DFR identified 31%, 32%, 30%, and 32% potentially flow-limiting lesions, respectively.

Conclusions
In NSTEMI patients, QFR, Pd/Pa, and DFR showed equivalence as compared to gold standard FFR in the discrimination of non-culprit lesions requiring revascularization.
96 Meta-analysis of placebo-controlled trials of Levosimendan in acute myocardial infarction
Authors: Tumminello Gabriele , Cereda Alberto , Barbieri Lucia , Biondi-zoccai Giuseppe , Lucreziotti Stefano , Mafrici Antonio , Carugo Stefano 
Published: December 2021

Abstract

The treatment of acute myocardial infarction is the early revascularization strategy. Heart failure and cardiogenic shock may complicate acute myocardial infarction nevertheless the best disposable strategy applied. Levosimendan is relatively new drug to treat heart failure with a peculiar mechanism of action: calcium sensitization of myocardial fibres. Levosimendan has a direct inotropic effect but also pleiotropic effects; through the K+ATP channels opening it has also a vasodilator effect with may participate concretely to the global effects of the drug. Literature has focused the attention on the anti-heart failure and anti-cardiogenic shock properties of Levosimendan, but it may have effects also preventing the development of myocardial insufficiency in the acute setting of acute myocardial infarction. Scope of the meta-analysis is to evaluate the effect of Levosimendan on acute myocardial infarction in placebo-controlled trials.

Based on the eight studies selected we found a beneficial effect of Levosimendan on acute and long-term mortality of patients affected by acute myocardial infarction with no significative increase in adverse events (Figure 1). With caution in interpreting the results of this meta-analysis, our data support the idea that Levosimendan may already have a role in the treatment of acute ischaemic heart disease. Further studies, specifically designed to investigate the early role in the treatment of ischaemic heart failure, are needed.