bluuebunny/crossref_metadata_2025_split huggingface dataset:
727 Circadian variations of platelet reactivity on Clopidogrel in patients treated with elective percutaneous coronary intervention
Authors: Circhetta Simone , Mangiacapra Fabio , Viscusi Michele Mattia , Paolucci Luca , De Luca Roberta , Nusca Annunziata , Melfi Rosetta , Ricottini Elisabetta , Ussia Gian Paolo , Grigioni Francesco 
Published: December 2021

Abstract

Aims
The potential diurnal variations of platelet reactivity in patients on clopidogrel treated with elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) are currently unknown.

Methods and results
We prospectively enrolled 15 patients with stable CAD treated PCI and on clopidogrel therapy for at least eight days. All patients received their maintenance 75-mg clopidogrel dose at 8 AM. Platelet reactivity was assessed with the Verifynow P2Y12 assay at three different time points (10 AM, 6 PM, and 6 AM). Platelet reactivity is expressed as P2Y12 reaction units (PRU) and PRU thresholds ≥208 and ≥240 were used to define high platelet reactivity (HPR). A significant heterogeneity in diurnal levels of platelet reactivity was found (P = 0.0004), with a peak occurring at the 6 AM assessment. In addition, at the 6 AM evaluation patients showed the highest prevalence of HPR (53.3% of patients with PRU ≥240, 66.7% of patients with PRU ≥208).

Conclusions
Platelet reactivity in patients with stable CAD treated with PCI and taking clopidogrel in the morning follows a circadian rhythm, thus suggesting that platelet inhibition may not be constant and sufficient throughout the day. Whether an evening or a bis in die administration of clopidogrel may result in a constant and more reliable antiplatelet inhibition, should be investigated in dedicated studies.
246 Air pollution and coronary plaque vulnerability and instability: an optical coherence tomography study
Authors: Montone Rocco Antonio , Camilli Massimiliano , Russo Michele , Vecchia Giulia La , Iannaccone Giulia , Rinaldi Riccardo , Gurgoglione Filippo , Crea Filippo , Niccoli Giampaolo 
Published: December 2021

Abstract

Aims
Air pollution is an emerging key player in determining the residual risk of coronary events. However, pathophysiological mechanisms linking air pollution and coronary events have been not adequately investigated. We aimed at assessing the relationship between exposure to air pollutants and mechanisms of coronary instability evaluated by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).

Methods and results
ACS patients undergoing OCT imaging were retrospectively selected. Mechanism of culprit lesion instability was classified as plaque rupture (PR) or intact fibrous cap (IFC) by OCT, and the presence of macrophage infiltrates (M&Oslash;I) and thin-cap fibroatheroma (TCFA) at the culprit site was also assessed. Based on each case’s home address, exposure to several pollutants was evaluated, including particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), and carbon monoxide (CO). Only patients with &gt;2 years of available data on air pollution exposure prior to ACS were enrolled. We included 126 patients [median age 67.0 years (55.5–76.0), 97 (77.0%) male]. Sixty-six patients (52.4%) had PR as mechanism of plaque instability. Patients with PR were exposed to significantly higher PM2.5 levels compared to IFC, and PM2.5 was independently associated with PR [odds ratio per unit = 1.194, 95% CI: (1.036–1.377), P = 0.015]. Moreover, exposure to higher levels of PM2.5 was independently associated with the presence of TCFA and of M&Oslash;I at the culprit site. Interestingly, PM2.5, PM10, and CO levels were positively and significantly correlated with serum levels of C-reactive protein. ROC curves were constructed to assess the ability of PM2.5 to predict the presence of plaque rupture, TCFA or M&Oslash;I. The AUC for PM2.5 to predict plaque rupture was 0.62 (95% CI: 0.52–0.71, P = 0.018), for TCFA was 0.71 (95% CI: 0.61–0.80, P &lt;0.001) and for M&Oslash;I was 0.80 (95% CI: 0.71–0.88, P &lt;0.001). Using a PM2.5 cut-off value of 13.40 μg/m3, the sensitivity and specificity for M&Oslash;I were 81% and 66%, respectively.

Conclusions
We provide novel insights into the missing link between air pollution and increased risk of coronary events. In particular, exposure to higher concentrations of air pollutants is a risk factor for vulnerable plaque features and for plaque rupture as mechanism of coronary instability mediated by systemic and local plaque inflammation. Of importance, the thresholds of air pollutants that predicted the presence of vulnerable plaque features are far lower than commonly accepted safety thresholds used to start preventive measures for public health, suggesting that further efforts are needed in order to reduce the adverse effects on the cardiovascular system.
588 Prognostic impact of early vs. deferred angiography in MINOCA patients
Authors: Armillotta Matteo , Sansonetti Angelo , Amicone Sara , Angeli Francesco , Fabrizio Michele , Stefanizzi Andrea , Bergamaschi Luca , Paolisso Pasquale , Magnani Ilenia , Donati Francesco , Foà Alberto , Rinaldi Andrea , Casella Gianni , Galiè Nazzareno , Pizzi Carmine 
Published: December 2021

Abstract

Aims
Although an early invasive strategy (coronary angiography performed &lt;24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (&lt;24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA.

Methods and results
From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of &lt; 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (&lt;24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography.

Conclusions
We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.
80 The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction
Authors: Tonet Elisabetta , Ariza-solé Albert , Serenelli Matteo , Formiga Francesc , Juan Sanchis , Pavasini Rita , Diez-villanueva Pablo , Vitali Francesco , Bonanad Clara , Grazzi Giovanni , Carol Antoni , Chiaranda Giorgio , Pompei Graziella , Cardelli Laura Sofia , Caglioni Serena , Gibiino Federico , Volpato Stefano , Campo Gianluca 
Published: December 2021

Abstract

Aims
To investigate the prognostic role of sex and physical performance on long-term mortality in older adults hospitalized for acute coronary syndrome (ACS).

Methods and results
The analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed with the Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality. The study included 1388 patients, 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 (730–1168) days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (P &lt; 0.001). SPPB values emerged as independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR: 0.73, 95% CI: 0.56–0.96). Sex and physical performance showed a significant interaction (P = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival.

Conclusions
Two key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality and (ii) women with preserved physical performance have a better outcome compared to men.
730 Prediction of type 4a myocardial infarction with the angiography-derived haemodynamic (added) index
Authors: Viscusi Michele Mattia , Mangiacapra Fabio , Rinaldi Raffaele , Colaiori Iginio , Sticchi Alessandro , Paolucci Luca , Russo Massimo , Nusca Annunziata , Melfi Rosetta , Ricottini Elisabetta , Gallo Paolo , Ussia Gian Paolo , Grigioni Francesco 
Published: December 2021

Abstract

Aims
Percutaneous coronary intervention (PCI) is frequently complicated by type 4a myocardial infarction (MI). We assessed the usefulness of the angiography-derived haemodynamic index (ADDED) index in predicting type 4a MI in patients with chronic coronary syndrome (CCS) undergoing PCI.

Methods and results
We enrolled 442 patients treated with single-vessel PCI. The ADDED index was calculated as the ratio of the Duke Jeopardy Score (DJS) to the minimum lumen diameter (MLD) assessed with quantitative angiography analysis (QCA). Patients in the higher ADDED tertile presented higher occurrence of type 4a MI (17.7%, P &lt; 0.0001). At ROC curve analysis, the ADDED index could significantly discriminate between patients with and without type 4a MI (area under the curve 0.745). At multivariate analysis, an ADDED index value &gt;5.25 was the strongest independent predictor type 4a MI.

Conclusions
Our results support the role of the ADDED index as a predictor of type 4a MI in patients with CCS treated with elective PCI.
539 Frequency related left bundle branch block as cause of chest pain: ‘painful LBBB syndrome’
Authors: Stronati Giulia , Torselletti Lorenzo , Urbinati Alessia , Ciliberti Giuseppe , Barbarossa Alessandro , Principi Samuele , Silenzi Marco , Falanga Umberto , Compagnucci Paolo , Casella Michela , Russo Antonio Dello , Guerra Federico 
Published: December 2021

Abstract

Aims
A 47-years-old man presented to our cardiology ambulatory due to sudden chest pains, mainly on exertion. His only relevant cardiovascular risk factor was a familiarity for coronaropathy. In 2013 he had undergone a coronary angiography which was negative for stenotic lesions. Since then he was treated with beta-blockers and Ivabradine with mild improvement of the pain.

Methods and results
While his previous Holter-ECG reported sinus rhythm [heart rate (HR) 60 b.p.m.] and no alterations of atrioventricular nor of interventricular conduction, his ECG during his examination in our ambulatory showed sinus rhythm (HR 80 b.p.m.), normal atrioventricular conduction but presence of complete left bundle branch block. We therefore performed an ergometric test. His baseline ECG (HR around 65 b.p.m.), at the start of the test, showed no left bundle branch block and the QRS complex was narrow. During the test, at the heart rate of around 85 b.p.m., the ECG showed a complete left bundle branch block. At the same time the patient complained of typical chest pain. The ergometric test was submaximal as it was stopped at the beginning of the third Bruce stage due to the patient’s chest pain. No ST segment alterations were found. During the recovery phase, we noted that the left bundle branch block disappeared when the heart rate was below 75 b.p.m. A new coronary angiography was performed and again it showed no stenotic lesion. We therefore concluded our diagnostic workup and diagnosed a frequency related ‘painful left bundle branch block syndrome’.

Conclusions
‘Painful left bundle branch block syndrome’ is defined as the presence of typical chest pain together with left bundle branch block, in the absence of signs of myocardial ischaemia. The pain improves once the conduction defect disappears. The mechanism of the syndrome is not known although it seems to be related to dyssynchrony of the myocardium. It may often be frequency related.
417 Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis
Authors: Aimo Alberto , Fabiani Iacopo , Giannoni Alberto , Mandoli Giulia Elena , Pastore Maria Concetta , Vergaro Giuseppe , Spini Valentina , Chubuchny Vladyslav , Pasanisi Emilio Maria , Petersen Christina , Poggianti Elisa , Taddei Claudia , Castiglione Vincenzo , Latrofa Sara , Panichella Giorgia , Sciaccaluga Carlotta , Georgiopoulos Georgios , Passino Claudio , Cameli Matteo , Emdin Michele 
Published: December 2021

Abstract

Aims
Amyloid deposits in all cardiac chambers, impairing their function. We investigated for the first time if a speckle-tracking echocardiography (STE) analysis extended to all four chambers might hold additive diagnostic value for CA and its subtypes [amyloid transthyretin (ATTR-) and light-chain (AL)-CA].

Methods and results
We evaluated 423 consecutive patients undergoing a diagnostic workup for CA in two referral centres from 2015 to 2020. CA was diagnosed in 261 patients (62%; ATTR-CA, n = 144, 34%; AL-CA, n = 117, 28%). Patients with CA had an impaired function of all cardiac chambers, particularly those with ATTR-CA. Peak left atrial longitudinal strain (LA-PALS) was the only STE parameter that predicted CA and ATTR-CA independent of laboratory and standard echocardiographic variables (Model 1). It also predicted ATTR-CA among patients with unexplained hypertrophy regardless of a diagnostic score (IWT score). Patients with either LA-PALS or LA-peak atrial contraction strain (PACS) in the first quartile (LA-PALS &lt;6.65% or LA-PACS &lt;3.62%) had an almost 4-fold higher likelihood of CA and ATTR-CA regardless of Model 1. Among patients with unexplained hypertrophy, those with LA-PALS or LA-PACS in the first quartile had an almost 9-fold higher likelihood of ATTR-CA irrespective of Model 1, and a 2-fold higher likelihood of ATTR-CA beyond the IWT score.

Conclusions
STE measures of all two chambers are abnormal in patients with CA, particularly in those with ATTR-CA. LA strain holds independent diagnostic significance. Among patients screened for CA, those with LA-PALS &lt;6.65% and/or LA-PACS &lt;3.62% have a high likelihood of CA and ATTR-CA.
430 Diagnosis and management of a case of biventricular arrhythmogenic cardiomyopathy: a case report
Authors: Gionti Luigia , Imparato Livio , Viggiano Aniello , Losi Maria Angela , Gargiulo Giuseppe , Mancusi Costantino , Dellegrottaglie Santo , Scatteia Alessandra , Esposito Giovanni 
Published: December 2021

Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disorder characterized by fibro-fatty replacement of myocardium which may affect the right ventricle (‘dominant right’ variant), the left ventricle (‘dominant left’ variant) or both (‘biventricular disease’ variant). Despite of ACM is one of the main causes of sudden cardiac death (SCD) in young people and athletes as well, the diagnosis of this complex clinical entity still remains a challenge. We report on a case of a 29 years old non-athletic woman with family history of SCD and a long-standing personal history of palpitations leading to frequent accesses to the Accident & Emergency Department. Her echocardiogram was normal while twelve leads ECG revealed negative T waves in the right precordial leads (V1–V3) and post-excitation epsilon waves. ECG Holter monitoring recorded frequent (up to 17 000 in 24 h) polymorphic premature ventricular contractions (PVCs) seldom organized in couplets or triplets. She was followed-up in our clinic and started on Propanolol 40 mg bid with slight relief of symptoms and reduction of PVCs. Cardiac magnetic resonance (CMR) showed regional dyskinesia of both ventricles and RV dilatation. Moreover, tissue characterization findings revealed the presence of diffuse subepicardial late gadolinium enhancement (LGE) of the LV. Genetic analysis was performed and a variant of uncertain significance (VUS) in Desmoplakin was identified. Non sustained monomorphic ventricular tachycardia was induced during electrophysiologic study by programmed ventricular stimulation. In light of these results, we diagnosed biventricular ACM and, after carefully discussion with the patient, a subcutaneous implantable cardioverter defibrillator (ICD) was implanted. The present case should be a persisting reminder that must be considered more than just a single diagnostic tool when dealing with arrhythmic presentations especially in young patients and the importance of contrast CMR along with genetic testing in order to aid clinicians in the demanding selection of the best candidates for ICD implantation.
125 Sex differences in myocarditis natural history
Authors: Castrichini Matteo , Merlo Marco , Baggio Chiara , Gagno Giulia , Maione Davide , Porcari Aldostefano , Barbati Giulia , Adamo Luigi , Mestroni Luisa , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
The role of sex in determining the profile and the outcomes of patients with myocarditis is widely unexplored. Our study seeks to evaluate the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis.

Methods and results
We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis (i.e., endomyocardial biopsy or cardiac magnetic resonance proven) of myocarditis. A sub-analysis was performed after division of population according to the main symptom of presentation (i.e., chest pain, ventricular arrhythmias, and heart failure). Clinical and echocardiographic data were evaluated at diagnosis and at last available evaluation (i.e., median of 30 months). The study outcome measure was a composite of all-cause mortality or heart transplantation. We enrolled 312 patients (187; 60% presenting with chest pain; 19; 6% with ventricular arrhythmias; 106; 34% with heart failure). Most of patients (211, 68% of the whole population) were males, consistently in the three modes of presentation. Despite no clinically relevant differences were found at baseline presentation, males presented a larger indexed left ventricular end-diastolic volume (LVEDVi) (62 ± 23 vs. 52 ± 20, P = 0.011 in males vs. females respectively) at follow-up evaluation. At a median follow-up of 62 months, 36 (17%) males vs. females experienced death or heart transplantation (Log-rank P = 0.037). At multivariable Cox analysis, male sex emerged as a predictor of mortality (HR: 2.358; 1.044–5.322; P = 0.039 and left ventricular ejection fraction (LVEF) &lt; 50% (HR: 8.169; 1.226–54.425; P = 0.030)]. Results were consistent in patients presenting with heart failure and chest pain, while arrhythmic group was too small to be reliably interpreted.

Conclusions
In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favorable long-term prognosis than male, despite a similar clinical profile at baseline.
303 Longitudinal arrhythmic risk assessment based on ejection fraction in patients with recent-onset non-ischaemic dilated cardiomyopathy
Authors: De Angelis Giulia , Merlo Marco , Barbati Giulia , Bertolo Silvia , De Luca Antonio , Ramani Federica , Adamo Luigi , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Practice guidelines suggest implantable cardioverter defibrillators (ICD) in patients with left ventricular ejection fraction (LVEF) ≤35% despite 3–6 months of guideline-directed medical therapy (GDMT). It remains unclear whether this strategy is appropriate for patients with dilated cardiomyopathy (DCM), who can experience reverse ventricular remodelling for up to 24 months after initiation of GDMT. We sought to assess the longitudinal dynamic relationship between LVEF ≤35% and arrhythmic risk in patients with recent onset non-ischaemic DCM under GDMT.

Methods and results
We performed a competitive risk analysis on patients with recent onset DCM (≤6 months) and recent initiation of GDMT (≤3 months), consecutively enrolled in a longitudinal registry. We assessed risk of major ventricular arrhythmic events or sudden cardiac death (MVAs/SCD) in relationship to LVEF ≤35% at enrollment, 6-months and 24-months post initiation of GDMT. 544 patients met inclusion criteria. LVEF ≤35% identified patients with increased risk of MVAs/SCD starting from 24-months after initiation of GDMT (hazards ratio: 2.126, 95% confidence interval: 1.065–4.245, P = 0.03). However, LVEF ≤35% at presentation or at 6 months post enrollment did not have prognostic significance. 67% of patients with LVEF ≤35% at 6 months after initiation of GDMT improved their LVEF to &gt; 35% by 24 months. This late LVEF improvement correlated with a lower arrhythmic risk (P = 0.012) and was preceded by a reduction of LV dimensions in the first 6 months of GDMT.

Conclusions
In patients with DCM, risk stratification based on LVEF ≤35% is effective after 2 years of GDMT, but not after 6 months.