bluuebunny/crossref_metadata_2025_split huggingface dataset:
473 Propensity-matched comparison of left atrial appendage occlusion and direct oral anticoagulation for thromboembolic prevention in octogenarians
Authors: Magnocavallo Michele , Della Rocca Domenico Giovanni , 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
A significant amount of atrial fibrillation patients does not receive appropriate anticoagulation, owing to contraindications and side effects. Octogenarians have higher competing comorbidities with a remarkable bleeding/thromboembolic (TE) risk. We aimed at analysing the clinical outcomes of LAAO compared with direct oral anticoagulation (DOAC) in octogenarians.

Methods and results
Data were extracted from two prospective databases including 488 LAAO and 825 DOAC patients. Patients aged 80 years or older accounted for 37.1% (n = 181) and 39.5% (n = 326). In order to attenuate the imbalance in covariates between the groups, a propensity score matching technique was used (covariates: age, sex, CHA2DS2-VASc, and HAS-BLED scores, follow-up duration; tolerance 0.02). This method resulted in matched populations with 108 octogenarian patients per group. The annual stroke/transient ischaemic attack (TIA) risk was estimated based on the CHA2DS2-VASc, and compared to the annualized observed risk, owing to calculate the % risk reduction associated with the two treatment strategies. A total of 216 octogenarians were included in the analysis (84 ± 3 years; CHA2DS2-VASc: 4.9 ± 1.4, HAS-BLED: 3.1 ± 0.9). A Watchman device was successfully deployed in all LAAO ≥ 80 patients; periprocedural adverse events were observed in 2.8% (n = 3) of LAAO patients. During a follow-up of 13 ± 4 months, 3 (2.8%) TE complications (1 stroke, 2 TIA) occurred in LAAO ≥ 80 pts and 4 (3.7%; 1 stroke, 3 TIA) in DOAC ≥ 80 pts (P = 0.99). The annualized risk of stroke/TIA was 2.5% in the first and 3.5% in the second group. Based on the estimated annual TE risk according to the CHA2DS2-VASc score, the % risk reduction after LAAO and DOAC was 54.5% and 36.4%, respectively. Major bleeding events were 3 [1 intracranial, 2 gastrointestinal (GI)] LAAO ≥ 80 pts, and 3 (2 intracranial, 1GI) in DOAC ≥ 80 pts (2.8% in both groups). Minor bleeding events were significantly higher in DOAC ≥ 80 pts [13.0% (n = 14) vs. 2.7% (n = 3); RR: 4.7, 95% CI: 1.4–15.7; P = 0.009].

Conclusions
LAAO was safe and similar to DOAC at preventing ischaemic/major bleeding events in a matched population of patients aged ≥80 years. A significantly higher incidence of minor bleeding events was observed in the DOAC group.
51 Palmitoylethanolamide associated to polydatin reduces inflammation in human endothelial vascular cells exposed to doxorubicin and trastuzumab through PPAR-a and NLRP3-related pathways
Authors: Quagliariello Vincenzo , Iovine Martina , Maurea Carlo , Buccolo Simona , Paccone Andrea , Maurea Nicola 
Published: December 2021

Abstract

Aims
Palmitoylethanolamide is an endogenous fatty acid mediator that is synthetized from membrane phospholipids by N-acyl phosphatidylethanolamine phospholipase D. Polydatin is a nutraceutical agent derived from trans-resveratrol with established anti-inflammatory and anti-atherogenic properties. We aimed to assess whether palmitoylethanolamide combined to polydatin, co-incubated during doxorubicin and trastuzumab, reduces anticancer drugs-related cardiotoxicity in cellular models.

Methods
Human vascular endothelial cells were exposed to subclinical concentration of doxorubicin (at 100 and 200 nM) combined to trastuzumab (at 100 and 200 nM) alone or in combination with a formulation composed by palmitoylethanolamide and polydatin (500 nM and 50 µM, respectively) for 48 h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4-hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro-inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of peroxisome proliferator-activated receptor-α; mTORC1 Fox01/3a; transcriptional activation of p65/NF-κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6).

Results
Palmitoylethanolamide combined to polydatin co-incubated with doxorubicin exerts vasculoprotective effects, enhancing cell viability of 54.7–68.3% compared to untreated cells (P &lt; 0.001 for all). The formulation reduced significantly the cardiotoxicity through peroxisome proliferator-activated receptor-α–related pathways and NLRP3 inflammasome but without the involvement of calcium homeostasis.

Conclusion
The present study demonstrates that palmitoylethanolamide and polydatin protects against vasculotoxicity of doxorubicin and trastuzumab by promoting an anti-inflammatory phenotype, representing a new therapeutic approach to resolve doxorubicin-induced vasculotoxicity and inflammation.
61 Right ventricular function in patient with heart failure with reduced ejection fraction and sacubitril/valsartan treatment
Authors: Mazzeo Pietro , Fortunato Martino , Croella Francesca , Alfieri Simona , Fanizzi Angela Ilaria , Furore Andrea , Ferrara Salvatore , Tricarico Lucia , Correale Michele , Iacoviello Massimo , Di Biase Matteo , Brunetti Natale D 
Published: December 2021

Abstract

Aims
Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging.

Methods
Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA Classes II–III were followed up for 6 months after therapy with S/V. LV&RV function was assessed at baseline and after 6 months of therapy.

Results
After 6-month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP (31 ± 11 vs. 35 ± 10 mmHg, P &lt; 0.001), TAPSE (19 ± 3 vs. 18 ± 3 mm, P &lt; 0.001), RV FAC (38 ± 7 vs. 34 ± 6 mm, P &lt; 0.001), RV S’ (12 ± 2 vs. 10 ± 2 cm/sec, P &lt; 0.001), RV-FW-LS (−20 ± 5 vs. −18 ± 5%, P &lt; 0.001), RV-4Ch-LS (−16 ± 5 vs. −14 ± 5%, P &lt; 0.001). At multivariable analysis improvement in RV-FW-LS was associated to baseline levels of RV S’ (r 0.75, P &lt; 0.01) and RAV (r –0.32, P &lt; 0.05).

Conclusions
In a real-world scenario, 6-month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.
411 Reproducibility and applicability of automated speckle tracking echocardiography in patients with aortic valve stenosis
Authors: Butturini Caterina , Fanti Diego , Springhetti Paolo , Tadiello Enrico , Bergamini Corinna , Rossi Andrea , Ribchini Flavio Luciano , Benfari Giovanni 
Published: December 2021

Abstract

Aims
New speckle tracking echocardiography (STE) tools allow an automated detection of strain measurements, but in case of suboptimal image quality or electrocardiogram signal, both regions-of-interest (ROIs) tracking and cardiac cycle’s landmarks need to be edited. In this study, we aimed to assess the variability of STE measurement performed with Tomtec’s Autostrain LV/RV/LA® application across different operators’ expertise in patients with significant aortic valve stenosis, known to have often suboptimal acoustic windows.

Methods and results
Automated strain analysis was performed by two observers with different levels of expertise in STE (a student sonographer and a trained cardiologist) on scans from 30 consecutive patients with moderate to severe aortic stenosis. Interobserver variability was tested. Intra-observer variability was also assessed repeating measurements about one month after the first set. Manual editing of the automated ROIs or cardiac cycle landmarks tracing results was manually made from both users on the majority (&gt;80%) of examinations; notably RV strain analysis required the least editing. At repeated measurement test (Figure), the average strain values were not found to be significantly different for measurements of apical-four-chamber-global-longitudinal-strain (A4C-GLS) (mean difference 0.96%, P = 0.08), left-atrium-longitudinal strain (LALS) (peak-atrial-longitudinal-strain, PALS, mean difference −0.89% P = 0.37; peak-atrial-contraction-strain, PACS, mean difference −0.76%, P = 0.13) and right-ventricle-free-wall-strain (RV-FWS) (mean difference 0.44%, P = 0.59). A stronger agreement between testers was observed for patients with markedly reduced left-ventricle-global-longitudinal-strain (LV-GLS) and was not affected by the quality of acoustic windows. Similar trend was evident for the left atrial and right ventricular parameters.

Conclusions
New tool AutoStrain LV/RV/LA® for automated strain analysis showed a good agreement between operators with different levels of expertise in the challenging setting of patients with aortic valve stenosis. The reproducibility was particularly accurate for A4C view and in patients with worse LV-GLS values, independently from image quality.
704 Stress echocardiography: myocardial work ‘works’
Authors: Cusma Maurizio , Caminiti Rodolfo , Parlavecchio Antonio , Vizzari Giampiero , Fichera Nunzio , Mancini Nastasia , De Sarro Rosalba , Trio Olimpia , Manganaro Roberta , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Zito Concetta 
Published: December 2021

Abstract
Stress echocardiography is a widely employed diagnostic technique relying on subjective assessment of left ventricular wall motion and particular expertise. We report a case of a male patient with chronic coronary syndrome, who underwent dipyridamole echocardiography before planned non cardiac surgery. Despite the absence of symptoms and relevant electrocardiographic and wall motion changes, only 2D strain and, especially, Myocardial Work analysis was able to detect abnormalities suggestive of myocardial ischaemia. Thus, coronary angiography was performed, showing critical stenosis of the proximal Circumflex artery, that was treated with angioplasty and drug-eluting stent implantation. Interestingly, the location of strain and myocardial work abnormalities was consistent with the culprit vessel territory. This case highlights the particular usefulness of advanced echocardiographic techniques, especially for the detection of one-vessel coronary artery disease, during stress echocardiography.
491 Short-term prognostic implications of left ventricular myocardial work indices in advanced heart failure patients treated with repetitive Levosimendan infusions
Authors: Fazzari Fabio , Cannata Francesco , Banfi Daniele , Pellegrino Marta , Pagliaro Beniamino , Loiacono Ferdinando , Mantovani Riccardo , Donghi Valeria , Curzi Mirko , Maurina Matteo , Condello Francesco , Liccardo Gaetano , Francone Marco , Condorelli Gianluigi , Stefanini Giulio Giuseppe , Pini Daniela , Bragato Renato Maria 
Published: December 2021

Abstract

Aims
Repetitive Levosimendan treatment in advanced heart failure patients has not been investigated yet via myocardial work indices (MWI), which could more accurately detect the effects of this both inotropic and vasodilatory drug. The aims of this study were (1) to describe variations of myocardial work indices, as a consequence of repetitive Levosimendan infusions and (2) to assess the prognostic value of myocardial work parameters in these patients.

Methods and results
Fourteen patients with advanced heart failure treated with intermittent in-hospital levosimendan infusions were prospectively included. Clinical, laboratory, and echocardiographic assessment were performed before and after every Levosimendan infusion. The primary endpoint was a composite of any episode of decompensated HF, urgent HF rehospitalization, cardiogenic shock, cardiac arrest and cardiovascular death at 4–6 weeks follow-up after each planned infusion. During follow-up (mean: 150 ± 99 days) a total of 37 infusions were performed and a total of 11 cardiovascular events occurred. Global constructive work (GCW), global work efficiency (GWE), and global work index (GWI) increased after Levosimendan infusion in 62.2%, 73.0%, and 70.3% of cases, with significant differences between patients with and without outcomes [delta GCW: −7.36 mmHg% (134.12) vs. 113.81 mmHg% (204.41), P = 0.007; delta GWE: −3.27% (8.38) vs. 4.30% (5.58), P = 0.002]. Delta value of GWE showed the largest area under curve (AUC: 0.82, 95% CI: 0.64–1.00, P = 0.002) for outcome prediction with a cut-off point of 0.5%. Independent prognostic value of GWE variation was confirmed in multivariable regression models (OR: 0.825, 95% CI: 0.702–0.970, P = 0.02).

Conclusions
GWE and GCW provided incremental and independent prognostic value at short-term follow-up over traditional echocardiographic parameters. The differentiation of patients into ‘workers’, whose GWE improved after Levosimendan infusion, and ‘non-workers’, who failed to improve their GWE, permitted to identify patients at higher risk of forthcoming cardiovascular events. Monitoring these patients with MWI may have relevant clinical implications.
750 Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: arrhythmogenic substrate or anatomical variant?
Authors: Figliozzi Stefano , Bombace Sara , Stankowski Kamil , Olivieri Marzia , Lofino Ludovica , Di Dedda Emanuele , Donghi Valeria , Cannata Francesco , Mantovani Riccardo , Fazzari Fabio , Curzi Mirko , Bragato Renato M , Stefanini Giulio G , Francone Marco , Condorelli Gianluigi , Monti Lorenzo 
Published: December 2021

Abstract

Aims
Mitral annulus disjunction (MAD) has been associated with sudden cardiac death in selected patients with arrhythmic presentation, while its clinical significance in unselected cohorts remains unknown. Our purpose was to assess the prevalence and clinical significance of MAD in consecutive patients referred to cardiovascular-magnetic-resonance (CMR).

Methods and results
Our population included 103 consecutive patients undergoing CMR at our Institution, between August and September 2021. MAD was defined as a  ≥ 1 mm atrial displacement of the mitral leaflet hinge point in standard long-axis cine images during end-systole. MAD analysis was performed in 97 patients (feasibility = 94%) and resulted positive in 49 (51%). MAD—patients were more often males (75% vs. 57%; P = 0.045) and affected by ischaemic (35% vs. 12%, P = 0.01) and non-ischaemic cardiomyopathy (38% vs. 16%, P = 0.026) compared to MAD+ patients. No significant differences were found in terms of age, history of ventricular arrhythmias, bi-ventricular and bi-atrial volumes, bi-ventricular ejection fraction, native T1 and T2 mapping values, extracellular volume, and prevalence of late gadolinium enhancement (P &gt; 0.05 for all) between MAD + vs. MAD—patients. MAD extent was higher in patients with mitral valve prolapse (MVP; n = 7), (3.5 ± 1.5 mm in MVP+ vs. 2.0 ± 1.0 mm in MVP– patients; P = 0.004). No significant differences were conversely found in MAD extent between patients with and without ventricular arrhythmias (2.5 ± 1.1 mm vs. 2.3 ± 1.1 mm; P = 0.815).

Conclusions
Our findings suggest a high prevalence of MAD in unselected cohorts of patients, with no clinical significance. Prospective studies are needed to further elucidate the interplay between MAD and malignant ventricular arrhythmias in unselected cohorts of patients.
70 Estimation of pulmonary arterial pressures by tricuspid regurgitation: a comparison with invasive data
Authors: Landra Federico , Mandoli Giulia Elena , Chiantini Benedetta , Barilli Maria , Merello Giacomo , De Carli Giuseppe , Sciaccaluga Carlotta , Lisi Matteo , Focardi Marta , D’Ascenzi Flavio , Fineschi Massimo , Iadanza Alessandro , Bernazzali Sonia , Valente Serafina , Cameli Matteo 
Published: December 2021

Abstract

Aims
The evaluation of the haemodynamic of pulmonary circulation is essential in various pathological conditions. Right heart catheterization (RHC) is the gold standard for the measurement of pressures and resistances in this context. However, since indications for RHC are limited, a more accessible estimation method would be helpful. This study aimed to explore the reliability of an echocardiographic method based on tricuspid regurgitation (TR) to estimate mean, systolic and diastolic pulmonary arterial (PA) pressures in a cohort of patients with advanced heart failure considered for heart transplantation.

Methods and results
All consecutive patients with advanced heart failure considered for heart transplantation from 2016 to 2021 that had already performed right heart catheterization (RHC) as part of the workup and with an available echocardiographic exam were included (n = 91). Mean PA pressure was obtained adding mean right ventricular-right atrial (RV-RA) gradient to mean RA pressure. Systolic PA pressure was obtained adding maximum RV-RA gradient to mean RA pressure. Diastolic PA pressure was derived from mean and systolic PA pressures. Results were compared with PA pressures by RHC. Median time between RHC and echocardiography was 0 months [interquartile range (IQR): 0–3.5]. Median age was 58 years (IQR: 52–61.5), most of the patients were men (83.5%). The absolute mean difference between mean, systolic and diastolic PA pressures by RHC and echocardiography was 0.46 ±9.78 mmHg, 2.18 ±12.92 mmHg and −2.30 ±8.61 mmHg, respectively. PA pressures by echocardiography significantly correlated with PA pressures by RHC (mean PA pressure: r = 0.460, P &lt; 0.001; systolic PA pressure: r = 0.520, P &lt; 0.001; diastolic PA pressure: r = 0.372, P &lt; 0.001). AUC for prediction of pulmonary hypertension, defined as mean PA &gt; 25 mmHg, by mean PA pressure by echocardiography was 0.828 and a cut-off of 25.5 mmHg demonstrated a high specificity (sensibility 66.7%, specificity 93.2%).

Conclusions
Estimation of pulmonary arterial pressures through an echocardiographic method mainly based on tricuspid regurgitation gradients is reliable and an estimated mean pulmonary arterial pressure &gt;25.5 mmHg has a high specificity for predicting pulmonary hypertension.
47 Quantified mitral regurgitation and left atrial function in HFrEF: intraplay and outcome implications
Authors: Malagoli Alessandro , Rossi Luca , Zanni Alessia , Sticozzi Concetta , Piepoli Massimo Francesco , Benfari Giovanni 
Published: December 2021

Abstract

Aims
The debate about the independent prognostic responsibility of functional mitral regurgitation (FMR) is still in turmoil. Growing findings about the predictive role of left atrial (LA) function are emerging in several scenarios. This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with LA function in a prospective cohort of consecutive heart failure patients with reduced ejection fraction (HFrEF).

Methods and results
286 consecutive outpatients with chronic HFrEF were enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography (STE). The primary endpoint was defined as a composite of congestive HF hospitalization and CV death. The majority (81%) of patients were men (mean age: 67 ± 11 years, mean LVEF: 32 ± 6%). The median global PALS was 17.7% ranging from 2.7% to 49.2%. FMR was quantifiable in 240 (84%) patients. During a median follow-up period of 6.4 (IQR: 3.9–7.7) years, the primary endpoint occurred in 88 (31%) patients (35 HF admissions, and 53 deaths). EROA showed independent prediction for the primary endpoint [HR: 1.30 (1.05–1.57), P = 0.01]. The spline modelling of the risk by EROA values showed an excess event risk starting at about the EROA value of 0.1 cm2 (Figure 1). There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of congestive HF hospitalization and CV death (P = 0.0004). Any FMR grade presenting with reduced LA function (PALS &lt; 14%) was associated with dismal outcome (event rate of 63 ± 10% for EROA exceeding 0.3 cm2 and 49 ± 6% for EROA ≥0.1 cm2 at 5 years). Conversely, the presence of EROA ≥0.1 in the context of preserved global PALS showed a better outcome (Figure 2). 47 Figure 1 47 Figure 2

Conclusions
Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. The risk of CV events starts at a low EROA value, reaching a severe level above the threshold of 0.3 cm2. Within a moderate EROA range, the LA function mitigates the clinical consequences of the mitral regurgitation, providing measurable proof of the interplay between the regurgitation and the LA compliance.
100 Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF
Authors: Porcari Aldostefano , Merlo Marco , Baggio Chiara , Gagno Giulia , Cittar Marco , Barbati Giulia , Paldino Alessia , Castrichini Matteo , Vitrella Giancarlo , Pagnan Lorenzo , Cannata Antonio , Andreis Alessandro , Cecere Annagrazia , Cipriani Alberto , Raafs Anne , Bromage Daniel I , Rosmini Stefania , Scott Paul , Sado Daniel , Di Bella Gianluca , Nucifora Gaetano , Marra Martina Perazzolo , Heymans Stephane , Imazio Massimo , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular (LV) ejection fraction (EF) relies mostly on late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) imaging. In this specific AM population, LV peak global longitudinal strain (LV-GLS) measured by feature tracking (FT) analysis might provide further prognostic information.

Methods and results
Data of patients undergoing CMR for clinically suspected AM in seven European Centres, between January 2013 and August 2020, were retrospectively analysed. Those patients fulfilling CMR Lake Louise Criteria (LLC) for the diagnosis of AM and presenting with normal LVEF (≥50%) were included. Patients presenting with heart failure (HF) or significant arrhythmic events, LVEF &lt;50% or haemodynamic instability were excluded. CMR-LGE extent (localized vs. diffuse), localization (subepicardial vs. mid-wall), and distribution (anteroseptal vs. inferolateral) were visually assessed. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including a composite of cardiac death, development of heart failure, life-threatening arrhythmias, or development of LVEF &lt;50%. In patients experiencing more than one event, the first one was considered for the outcome analysis. Of 389 patients with clinically suspected AM, 256 (66%) had confirmed AM with LVEF ≥50% and were included. Median age was 36 years, 71% were males, median LVEF was 60%, and median LV-GLS −17.3%. CMR was performed at a median time of 4 (IQR: 2–12) days from hospital admission. At a median follow-up of 27 months, 24 (9%) patients experienced at least one ACE with development of LVEF &lt;50% accounting for 17 [71%]. Compared to the others, patients experiencing ACEs had lower median LV-GLS values at baseline (−13.9% vs. −17.5%, P = 0.001). At Kaplan–Meier analysis, impaired LV-GLS (both considered as &gt;-20% or quartiles), diffuse and mid-wall LGE were associated with a significantly higher rate of ACEs. LV-GLS remained independently associated with ACEs after adjustment for diffuse or mid-wall LGE as covariate at bivariable analysis.

Conclusions
In AM with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE, improving risk stratification and providing a rationale for further studies of therapy in this cohort.

100 Figure