bluuebunny/crossref_metadata_2025_split huggingface dataset:
538 Impact of prior statin use on clinical outcomes in COVID-19 patients: data from tertiary referral hospital during COVID-19 pandemic in Italy
Authors: Mitacchione Gianfranco , Schiavone Marco , Curnis Antonio , Arca Marcello , Antinori Spinello , Gasperetti Alessio , Mascioli Giosuè , Severino Paolo , Sabato Federica , Caracciolo Maria , Arabia Gianmarco , D’Erasmo Laura , Viecca Maurizio , Mancone Massimo , Galli Massimo , Forleo Giovanni 
Published: December 2021

Abstract

Aims
Epidemiological evidence suggests that anti-inflammatory and immuno-modulatory properties of statins may reduce the risk of infections and infection-related complications. In this observational multi-centre study, we aimed to assess the impact of prior statin use on coronavirus disease (COVID-19) severity and mortality.

Methods and results
Consecutive patients hospitalized for COVID-19 were considered and enrolled in four tertiary referral hospitals (Luigi Sacco Hospital, Milan; Policlinico Umberto I Hospital, Rome; Spedali Civili Hospital, Brescia; Humanitas Gavazzeni Hospital; Bergamo) From 23 February 2020 to 31 March 2020, in-hospital mortality and severity of COVID-19 assessed with National Early Warning Score (NEWS) were deemed primary and secondary outcomes, respectively. Among 842 patients enrolled, 179 (21%) were treated with statins before admission. Statin patients showed more comorbidities and more severe COVID-19 [NEWS 4 (IQR: 2–6) vs. 3 (IQR: 2–5), P &lt; 0.001]. Despite having similar rates of intensive care unit admission, noninvasive ventilation, and mechanical ventilation, statin users appeared to show higher mortality rates. After balancing pre-existing relevant clinical conditions that could affect COVID-19 prognosis with propensity score matching, statin therapy confirmed its association with a more severe disease (NEWS ≥ 5; 61% vs. 48%, P = 0.025) but not with in-hospital mortality (26% vs. 28%, P = 0.185). At univariate logistic regression analysis, statin use was confirmed not to be associated with mortality (OR: 0.901; 95% CI: 0.537–1.51; P = 0.692) and to be associated with a more severe disease (NEWS ≥ 5 OR: 1.7; 95% CI: 1.067–2.71; P = 0.026).

Conclusions
Our results did not confirm the supposed favourable effects of statin therapy on COVID-19 outcomes. Conversely, they suggest that statin use should be considered as a proxy of underlying comorbidities, which indeed expose to increased risks of more severe COVID-19.
669 COVID-19-related acute pericarditis. A retrospective observational study
Authors: Parato Vito Maurizio , Galieni Maria Chiara , Marcelli Stefano , La Carruba Salvatore 
Published: December 2021

Abstract

Aims
Acute pericarditis is considered one of the cardiovascular complications of COVID-19. The published data suggest that the diagnosis of acute pericarditis in patients with COVID-19 infection may be more frequent than usually diagnosed and as a consequence, undertreated. The proposed investigation is a retrospective observational study in which 170 patients, admitted to an Intensive Care Unit because of a COVID-19 diagnosis, were analysed. All patients underwent cardiological evaluation including a bedside echocardiogram. The aim of the study was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion.

Methods and results
The proposed investigation is a retrospective observational study enrolling patients admitted to Intensive Care Unit of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS-CoV-2 induced severe acute respiratory syndrome. No. 170 patients, admitted from 1 April 2020 to 30 April 2021, were enrolled. All patients presented a variable picture of bilateral interstitial pneumonia characterized by ground glass opacifications at HR-Chest CT. Some patients underwent oro-tracheal intubation and invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9-GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients (Table 1). The diagnosis of acute pericarditis was defined by: (i) different degree of pericardial effusion; (ii) C-reactive proteine elevation. All patients were divided in two groups: (1) pericarditis group (a); (2) pericarditis-free group (b). Of 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67.6 ± 13.3 [females: 70.5 (±16.2); males: 66.4 (±11.7)]. Of 170, n. 60 patients had a diagnosis of acute pericarditis (32.2%). Group A (patient with acute pericarditis) consisted of 60 patients, age 69.2 (±12.6), 39 (65%) male [age 69.3 (±10.6)], 21 (35%) female [age 69.1 (±16.0)]. Of 60, only 6 had a pericardial effusion &gt;10 mm (10%); the remaining group A-patients (90%) had a mild pericardial effusion (&lt;10 mm). No patient had tamponade picture. Group B (pericarditis-free patients) included 110 patients, age 66.7 (±13.7), 80 (72.7%) males [age 65.0 (±12.1)], 30 (27.3%) females [age 71.4 (±16.6)]. Group A-patients (with pericarditis) had more days of intubation and a prolonged global hospital stay compared with group B (pericarditis-free). Other demographic, clinical and laboratory parameters were similar between the two groups.

Conclusions
Pericarditis is a frequent cardiovascular complication of COVID-19 (32.2% in our study). It may have clinical and prognostic implications.
230 Antiplatelet therapy and outcome in COVID-19. Results from a multi-centre international prospective registry (HOPE-COVID)
Authors: Santoro Francesco , Vitale Enrica , Nunez-gil Ivan , Guerra Federico , El-battrawy Ibrahim , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
Standard therapy for Corona-virus-19 disease (COVID-19) is mainly developed for critical ill patients. Autopsy studies showed high prevalence of platelet-fibrin rich micro-thrombi in several organs. Aim of the study was to evaluate safety and efficacy of antiplatelet therapy (APT) 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 were recorded. Antiplatelet (AP) regimen, including aspirin and other antiplatelet drugs, was obtained for each patient. During hospitalization 730 (9%) patients received AP drugs with single (93%, n = 680) or dual APT (7%, n = 50). Patients treated with APT were older (74 ± 12 vs. 63 ± 17 years, P &lt; 0.01), more frequently male (68% vs. 57%, P &lt; 0.01) and had higher prevalence of diabetes (39% vs. 16%, P &lt; 0.01). Patients treated with APT compared with no APT showed no differences in terms of in-hospital mortality (18% vs. 19%, P = 0.64, Log Rank P = 0.23), need of invasive ventilation (8.7% vs. 8.5%, P = 0.88), embolic events (2.9% vs. 2.5% P = 0.34) and bleeding (2.1% vs. 2.4%, P = 0.43) but shorter duration of mechanical ventilation (8 ± 5 vs. 11 ± 7 days, P = 0.01); however, when comparing patients with APT vs. no APT and no anticoagulation therapy, APT was associated with lower mortality rates (Log Rank P &lt; 0.01, relative risk 0.79, 95% CI: 0.70–0.94). At multivariable analysis in-hospital APT was associated with a lower mortality risk (relative risk 0.39, 95% CI: 0.32–0.48, P &lt; 0.01).

Conclusions
APT during hospitalization for COVID-19 could be associated with lower mortality risk and shorter duration of mechanical ventilation, without increased risk of bleeding.
281 Home delivery of the communicator for remote monitoring of cardiac implantable devices: a multicentre experience during the COVID-19 lockdown
Authors: Bernardini Alessia , Magnocavallo Michele , Mariani Marco Valerio , Mei Maria Chiara , Di Iorio Martina , Vetta Giampaolo , Piro Agostino , Trivigno Sara , Giunta Giuseppe , Chimenti Cristina , Nicosia Antonino , Adduci Carmen , Grossi Stefano , Saporito Davide , Quaglione Raffaele , Rapacciuolo Antonio , Marini Massimiliano , Santarpia Giuseppe , Pentimalli Francesco , Rordorf Roberto , Vaccaro Paola , Campari Monica , Valsecchi Sergio , Fedele Francesco , Lavalle Carlo 
Published: December 2021

Abstract

Aims
During the COVID-19 pandemic in-person visits for patients with cardiac implantable electronic devices should be replaced by remote monitoring (RM), in order to prevent viral transmission. A direct home-delivery service of the RM communicator has been implemented at 49 Italian arrhythmia centres.

Methods and results
According to individual patient preference or the organizational decision of the centre, patients were assigned to the home-delivery group or the standard in-clinic delivery group. In the former case, patients received telephone training on the activation process and use of the communicator. In June 2020, the centres were asked to reply to an ad hoc questionnaire to describe and evaluate their experience in the previous 3 months. RM was activated in 1324 patients: 821 (62%) received the communicator at home and the communicator was activated remotely. Activation required one additional call in 49% of cases, and the median time needed to complete the activation process was 15 min (25th–75th percentile: 10–20). 753 (92%) patients were able to complete the correct activation of the system. At the time when the questionnaire was completed, 743 (90%) communicators were regularly transmitting data. The service was generally deemed useful (96% of respondents) in facilitating the activation of RM during the COVID-19 pandemic and possibly beyond.

Conclusions
Home delivery of the communicator proved to be a successful approach to system activation, and received positive feedback from clinicians. The increased use of a RM protocol will reduce risks for both providers and patients, while maintaining high-quality care.
190 SARS-CoV-2 associated myopericarditis in a patient with previous myocarditis
Authors: Amore Ludovica , Alghisi Fabio , Vizzardi Enrico , Cersosimo Angelica , Cimino Giuliana , Pancaldi Edoardo , Pascariello Greta , D’Aloia Antonio , Farina Davide , Gavazzi Emanuele , Metra Marco 
Published: December 2021

Abstract

Aims
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is well described as being responsible for multi-organ involvement and SARS-CoV-2 cardiac involvement was observed since the beginning of the spread of the infection. However, there are no descriptions of acute myopericarditis in patient with previous myocarditis.

Methods and results
Cardiac involvement was assessed with electrocardiographic and echocardiographic changes and with increased levels of cardiac high-sensitivity troponin T (hs-cTnT). Diagnosis was confirmed with cardiac magnetic resonance imaging (CMR) and coronary artery disease (CAD) was excluded with coronary angiography. A 53-years-old woman with hypokinetic cardiomyopathy due to a previous myocarditis and recent COVID-19 pneumonia reached the Emergency Department with chest pain and tachycardia in December 2020. Twelve-lead ECG was not conclusive and after detection of significative increase of hs-cTnT she was admitted to the Cardiology Department. Transthoracic echocardiography showed reduction of left ventricle ejection fraction, subendocardial bright appearance and mild pericardial effusion. Coronary angiography excluded obstructive CAD and CMR confirmed diagnosis of recent myocarditis and worsening of left and right ventricular ejection fraction compared to a previous CMR. Patient was treated with evidence-based therapy for heart failure, prednisone, intravenous immunoglobulins, ibuprofen, and colchicine. Cardiac biomarkers reduced within the normal range, symptoms improved, and the patient was discharged asymptomatic and haemodynamically stable.

Conclusions
SARS-CoV-2, as already described in literature, can be associated with inflammatory cardiac involvement. This is the first report of SARS-CoV-2 associated myopericarditis in a patient with previous history of myocarditis and recent SARS-CoV-2 pneumonia. In our experience the patient was successfully treated with evidence-based therapy for heart failure and immunomodulation therapy.
254 Impact of sacubitril/valsartan on implantable defibrillator eligibility in heart failure: a real-world experience
Authors: Monzo Luca , Ferrari Ilaria , Gaudio Carlo , Cicogna Francesco , Tota Claudia , Petronilli Valentina , Mennuni Silvia , Ruvo Ermenegildo De , Calò Leonardo 
Published: December 2021

Abstract

Aims
Current guidelines recommend an implantable cardiac defibrillator (ICD) in patients with symptomatic heart failure and reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) ≤35%] despite ≥3 months of optimal medical therapy. Recent observations demonstrated that sacubitril/valsartan induces beneficial reverse cardiac remodelling in eligible HFrEF patients. Given the pivotal role of LVEF in the selection of ICD candidates, we sought to assess the impact of sacubitril/valsartan on ICD eligibility and its predictors in HFrEF patients.

Methods and results
We retrospectively evaluated 48 chronic HFrEF patients receiving sacubitril/valsartan and previously implanted with an ICD in primary prevention. We assumed that ICD was no longer necessary if LVEF improved &gt;35% (or &gt; 30% in asymptomatics) at follow-up. Over a median follow-up of 11 months, sacubitril/valsartan induced a significant drop in LV end-systolic volume (−16.7 ml/m2, P = 0.023) and diameter (−6.8 mm, P = 0.022), resulting in a significant increase in LVEF (+3.9%, P &lt; 0.001). As a consequence, 40% of previously implanted patients resulted no more eligible for ICD at follow-up. NYHA class improved in the 50% of population. A dose-dependent effect was noted, with higher doses associated to more reverse remodelling. Among patients deemed no more eligible for ICD, lower NYHA class [odds ratio (OR): 3.73 (95% CI: 1.05–13.24), P = 0.041], better LVEF [OR: 1.23 (95% CI: 1.01–1.48), P = 0.032], and the treatment with the intermediate or high dose of sacubitril/valsartan [OR: 5.60 (1.15–27.1), P = 0.032] were the most important predictors of status change.

Conclusions
In symptomatic HFrEF patients, sacubitril/valsartan induced beneficial cardiac reverse remodelling and improved NYHA class. These effects resulted in a significant reduction of patients deemed eligible for ICD in primary prevention.
41 Circulating levels and prognostic cut-offs of sST2, high-sensitivity troponin T, and NT-proBNP in women vs. men with chronic heart failure
Authors: Gentile Francesco , Aimo Alberto , Jannuzzi James Lj , Richards Mark , Lam Carolyn Sp , Boer Rudolf A. De , Meems Laura Mg , Latini Roberto , Staszewsky Lidia , Anand Inder S. , Cohn Jay N. , Ueland Thor , Guellestad Lars , Aukrust Pal , Rocca Hans-peter Brunner-la , Bayes-genis Antoni , Lupon Josep , Yoshihisa Akiomi , Egstrup Michael , Gustafsson Ida , Gaggin Hanna K. , Eggers Kai M. , Huber Kurt , Gamble Greg D. , Ling Lieng H. , Leong Kui Toh Gerard , Yeo Poh Shuah Daniel , Ong Hean Yee , Jaufeerally Fazlur , Ng Tze P. , Troughton Richard , Doughty Robert N. , Devlin Gerry , Lund Mayanna , Giannoni Alberto , Passino Claudio , Emdin Michele , Vergaro Giuseppe 
Published: December 2021

Abstract

Aims
Limited evidence exists on sex-related differences in clinical value of biomarkers in chronic heart failure (HF). We aimed to define plasma levels, determinants, and optimal prognostic cut-offs of soluble suppression of tumourigenesis-2 (sST2), high-sensitivity troponin T (hs-TnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in female and male chronic HF patients.

Methods and results
Individual data of patients from the BIOS (Biomarkers In Heart Failure Outpatient Study) Consortium with sST2, hs-TnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1-year cardiovascular death and HF hospitalization. The secondary endpoints were 5-year cardiovascular and all-cause death. The cohort included 4540 patients (age: 67 ± 12 years, LVEF 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/ml, P &lt; 0.001) and hs-TnT level (15 vs. 20 ng/l, P &lt; 0.001), and similar concentrations of NT-proBNP (1540 vs. 1505 ng/l, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut-off was lower in women for sST2 (28 vs. 31 ng/ml) and hs-TnT (22 vs. 25 ng/l), while NT-proBNP cut-off was higher in women (2339 ng/l vs. 2145 ng/l). The use of sex-specific cut-offs improved risk prediction compared to the use of previously standardized prognostic cut-offs (Figure).

Conclusions
In patients with chronic HF, levels of sST2 and hs-TnT, but not of NT-proBNP are lower in women. Lower sST2 and hs-TnT and higher NT-proBNP cut-offs for risk stratification could be used in women.
572 Different renal function patterns in acute heart failure patients
Authors: Ruocco Gaetano , Feola Mauro , Luschi Lorenzo , Brazzi Angelica , Ghionzoli Nicolo , Rossi Arianna , Pagliaro Antonio , Crescenzi Federico , Palazzuoli Alberto 
Published: December 2021

Abstract

Aims
The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients.

Methods and results
This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization.
We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P &lt; 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P &lt; 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P &lt; 0.001 and HR: 0.47 (0.35–0.67); P &lt; 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion and reduced BNP decrease at discharge.

Conclusions
Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.
29 Comparison between pure tachycardiomyopathy and acute heart failure and structural heart disease
Authors: Stronati Giulia , Urbinati Alessia , Ciliberti Giuseppe , Barbarossa Alessandro , Falanga Umberto , Silenzi Marco , Principi Samuele , Manfredi Roberto , Compagnucci Paolo , Casella Michela , Russo Antonio Dello , Guerra Federico 
Published: December 2021

Abstract

Aims
Tachycardiomyopathy (TCM) is a reversible cause of left ventricular dysfunction, secondary to rapid and/or asynchronous, irregular myocardial contraction. The disease can be divided in two main subgroups: arrhythmia-induced TCM also known as pure TCM, where the arrhythmia is the sole reason for the dysfunction, and impure TCM also known as arrhythmia mediated TCM, where the arrhythmia can exacerbate or worsen heart failure (HF) or an underlying heart disease. Pure TCM has already been described as affecting almost 1 out of 10 patients admitted for de novo acute HF. The aim of our study was to compare pure TCM and de novo acute HF and structural heart disease patients in terms of mortality and cardiovascular (CV)-related hospitalizations.

Methods and results
Prospective, observational study enrolling all consecutive patients with a confirmed diagnosis of TCM and all patients admitted for de novo acute HF. The TCM diagnosis was suspected in all patients admitted for HF-related symptoms, an ejection fraction &lt;50% with concomitant persistent atrial or ventricular arrhythmia, and confirmed after clinical and echocardiographic recovery. Acute HF diagnosis was made in all patients with an ejection fraction &lt;50%, new HF-like symptoms, diagnosis of structural heart disease and no evidence of clinical or echocardiographic recovery. For each patient, all-cause death and CV-related hospitalizations were recorded. One-hundred-and-ten patients with TCM (61.8% males, 68 ± 13 years old) were propensity matched with a control population of patients with HF and structural heart disease (76.6% males, 71 ± 15 years old, 75% ischaemic heart disease). After a median follow-up of 5.1 years (1st–3rd quartile 2.6–7.0 years) TCM patients showed an overall higher estimate of survival when compared to HF patients (78% vs. 58%; P = 0.031; Figure 1A) but a lower estimate of time free from CV-related hospitalization (31% vs. 57%, P = 0.014; Figure 1B). TCM patients got most often readmitted for AF-related elective procedures (60.8% of all hospitalizations) such ablation procedures or elective cardioversion, TCM recurrence (13.7%), and elective coronary angiography (5.9%). On the other hand, HF patients got readmitted for HF worsening (40.9%), cardiac or vascular surgery (22.7%), and elective coronary angiography (9.1%). Propensity-score matched analysis confirmed the results for all-cause death (81% vs. 49%; P = 0.006) and CV-related hospitalizations (29% vs. 54%; P = 0.007).

Conclusions
TCM is associated with higher rate of survival when compared to de novo acute HF, even after propensity score adjustment. On the other hand, patients with TCM got readmitted more frequently, requiring more often elective procedures in order to control the triggering arrhythmia.