bluuebunny/crossref_metadata_2025_split huggingface dataset:
358 Clinical characteristic and natural history of chemotherapy induced dilated cardiomyopathy
Authors: Lalario Andrea , Del Mestre Eva , Lo Casto Michele , Nuzzi Vincenzo , Cannatà Antonio 
Published: December 2021

Abstract
Chemotherapy can lead to chemotherapy-induced dilated cardiomyopathy (CI-DCM), recognized as one of the Non-ischaemic Dilated Cardiomyopathy (DCM) phenotypes characterized by worse outcome. Evidences on a direct comparison between idiopathic-DCM (iDCM) and CI-DCM still lack. We included all the consecutive patients enrolled in the Trieste Muscle Heart Disease Registry. C-DCM was defined according to current recommendations. Uni- and multivariable analysis and Kaplan-Meier were performed. The primary outcome was all-cause death and the secondary outcomes were cardiac death and a composite of heart failure hospitalization, heart transplantation, ventricular assist-device implantation and major ventricular arrhythmias. The study included 511 patients (499 patients affected by iDCM and 52 patients affected by CI-DCM). Compared to iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years respectively, P &lt; 0.001) and had a higher LVEF (35%±10 vs. 32%±9, P = 0.03). CI-DCM patients had a higher incidence of all-cause of death compared to iDCM (36.5% vs. 8.4%, P &lt; 0.001), while the incidence of cardiac death (7% in the CI-DCM group vs. 4% in the iDCM group, P = 0. 232) and of the composite secondary outcome was comparable amongst the two groups. At multivariable analysis, the diagnosis of CI-DCM was an independent predictor of primary outcome incidence (HR: 5.79, 95% CI: 1.83–18.27), P = 0.003, together atrial fibrillation. In a well-selected DCM cohort, patients with a chemotherapic etiology had a higher incidence of all-cause mortality compared to iDCM, while the incidence of cardiac adverse events was comparable among CI-DCM and iDCM.
334 Hereditary transthyretin amyloidosis: main features and profiles of different clinical phenotypes
Authors: Massa Paolo , Caponetti Angelo Giuseppe , Saturi Giulia , Ponziani Albero , Sguazzotti Maurizio , Accietto Antonella , Dal Passo Beatrice , Longhi Simone , Bonfiglioli Rachele , Mattana Francesco , Guaraldi Pietro , Cortelli Pietro , Galié Nazzareno , Biagini Elena , Gagliardi Christian 
Published: December 2021

Abstract

Aims
Hereditary transthyretin-related amyloidosis (h-ATTR) is a systemic infiltrative disease caused by a single amino acid mutation on the transthyretin (TTR) gene, which destabilizes the protein and can determine its deposition on multiple organs, including heart and peripheral nervous system. We aimed to characterize and compare clinical, instrumental, and prognostic features of patients affected by h-ATTR by dividing the population into the disease’s main phenotypes (unaffected carriers, cardiac, neurological or mixed phenotype).

Methods and results
Two hundred and eighty-five subjects of a single-centre cohort with a recognized pathogenic mutation on TTR gene were retrospectively included in the analysis. Phenotypes of disease were defined at baseline. Neurological phenotype (NP) was defined according to sensorimotor and/or autonomic dysfunction, while cardiac phenotype (CP) was defined in the presence of unexplained maximum wall thickness &gt;12 mm and other typical echocardiographic findings. Unaffected carriers (UC) and mixed phenotypes (MP) presented none or both of the above-mentioned features, respectively. Two hundred and ten patients showed clinical signs of the disease, 37 (13%) with CP, 65 (23%) with NP and 108 (38%) with MP, while 75 subjects (26%) were UC. Ile68Leu was the most represented mutation (96 subjects, 34%), followed by Val30Met (21%) and Glu89Gln (13%). NP patients (mostly Val30Met) had mPND score &gt;1 in 45% of patients, were younger at diagnosis (mean 47 years, P &lt; 0.001 vs. CP/MP), and sex was equally distributed. In contrast, CP patients were older at diagnosis (mean 70 years, P &lt; 0.001 vs. CP/MP), predominantly male (as well as in MP) with a higher incidence of tunnel carpal syndrome and a shorter time interval between onset of symptoms and diagnosis (mean 17 months, P &lt; 0.001 vs. CP/MP). NYHA class, ECG findings, left ventricular wall thickness, and ejection fraction did not significantly differ between CP and MP. After a mean follow-up of 59 months, 98 (34%) patients died. On a Kaplan–Meier survival analysis, mean survival times were 208, 123, 150, and 95 months for UC, CP, NP, and MP, respectively, with a statistically significant difference in affected patients between NP and MP (P = 0.012).

Conclusions
H-ATTR is a rare systemic disorder whose natural history, including age of onset, clinical characteristics, and instrumental findings, is strongly influenced by primary phenotypes, ranging from the excellent prognosis of unaffected carriers to the inauspicious outcome of mixed phenotypes.
577 Bisoprolol for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy
Authors: Monda Emanuele , Lioncino Michele , Palmiero Giuseppe , Rubino Marta , Cirillo Annapaola , Verrillo Federica , Fusco Adelaide , Caiazza Martina , Mazzella Marialuisa , Moscarella Elisabetta , Dongiglio Francesca , Sepe Joseph , Russo Maria Giovanna , Pacileo Giuseppe , Limongelli Giuseppe 
Published: December 2021

Abstract

Aims
To evaluate to role of bisoprolol to control symptoms and left ventricular outflow tract obstruction (LVOTO) in a consecutive cohort of adults with hypertrophic cardiomyopathy (HCM).

Methods and results
In this retrospective study, patients with HCM with an LVOT gradient ≥50mmHg after Valsalva manoeuvre and New York Heart Association (NYHA) class II-III symptoms were assigned to receive bisoprolol (starting at 1.25 mg daily). The initial dose was increased every two weeks to achieve the target in LVOT gradient &lt;30 mmHg or the maximum tolerated dose. The primary endpoint was the achievement of a LVOT gradient &lt;30 mmHg and ≥1 NYHA class improvement. The secondary endpoints were proportion of patients with LVOT gradient &lt;30 mmHg or &lt; 50 mmHg, proportion of patients with ≥1 NYHA class improvement, and change from baseline in LVOT gradient. Between December 2001 and December 2020, 92 patients were enrolled into the study. Sixteen (17%) patients on bisoprolol met the primary endpoint. Bisoprolol reduced the LVOT gradient to less than 30 mmHg in 33 (36%) patients, to less than 50 mmHg in 57 (62%), and improved NYHA class in 30 (33%). The mean reduction of LVOT gradient on bisoprolol was 28 (±14) mmHg and the percentage reduction was 42 (±21)%. In 35 (39%) patients, bisoprolol did not reduce the gradient to less than 50 mmHg requiring disopyramide and/or myectomy to achieve this goal.

Conclusions
Treatment with bisoprolol was well-tolerated and effective in relieving obstruction and improving symptoms in a significant proportion of patients with symptomatic obstructive HCM.
639 A case of acute transient constrictive pericarditis—an unusual presentation
Authors: Spissu Paolo Marco Pietro , Angius Simone , Marchetti Maria Francesca , Caggiari Ludovica , Gioi Alessandra , Mura Giulia , Mandas Martina , Licciardi Marco , Meloni Luigi , Montisci Roberta 
Published: December 2021

Abstract

Aims
Transient constrictive pericarditis (TCP) is a rare manifestation which can occur in up to 15% of cases of acute pericarditis and most have resolution after 3 months of anti-inflammatory therapy.

Methods and results
We present the case of a young guy who showed up at our emergency department complaining of pericarditic chest pain and fever up to 39 °C degrees since the previous 4 days. After physical examination, electrocardiogram, blood tests, chest X-ray, and echocardiography acute pericarditis with severe pericardial effusion (more than 20 mm of thickness) were diagnosed and an empiric anti-inflammatory therapy with ibuprofen and colchicine was started. After 2 weeks of therapy, patient was not clinically improving with a worsened pericardial effusion and only a mild reduction of inflammatory markers. During an echocardiographic examination, features of constrictive physiology were discovered: respirophasic interventricular septal shift, increased respiratory variation of the mitral and tricuspidal inflow, plethoric inferior vena cava, and ‘annulus reversus’ and ‘annulus paradoxus’ on Tissue Doppler Imaging (TDI). Cardiac magnetic resonance (CMR) was also performed to confirm the diagnosis of acute pericardial constriction: it revealed increased T2-weighted imaging signal and increased Delayed Gadolinium Enhanced (DGE) signal, respectively consistent with oedema and with neovascularization, both suggestive of acute pericardial inflammation. Therefore, oral low doses corticosteroid was started After 2 weeks course of ‘triple therapy’ the patient was clinically improved and the echocardiographic features of constrictive physiology were no longer present thus allowing his discharge and the continuation of therapy at home.

Conclusions
This case was remarkable because it showed that constrictive pericarditis may present in a reversible form with medical therapy, this meaning it is due to pericardial oedema, inflammation and fibrin deposition similar to acute pericarditis rather than the pericardial fibrosis and calcification more commonly seen in chronic pericardial constriction.
566 Transthyretin and light-chain cardiac amyloidosis: clinical characteristics, echocardiographic findings, and outcomes of a large cohort of patients in Northern Italy
Authors: De Angelis Maria Grazia , Tomasoni Daniela , Pancaldi Edoardo , Pezzola Elisa , Saccani Nicola , Nardi Matilde , Cani Dario Salvatore , Lombardi Carlo Mario , Metra Marco 
Published: December 2021

Abstract

Aims
To describe the characteristics of a cohort of patients with cardiac amyloidosis (CA) and to compare the two most common phenotypes of CA, transthyretin (ATTR) and immunoglobulin light-chain (AL).

Methods and results
One-hundred and eighty patients [n = 115 (64%) men, 74 ± 11 years] were retrospectively included from January 2013 to April 2021 in a single centre in Northern Italy. The majority [n = 102 (57%)] had ATTR-CA, whereas 78 patients (43%) had AL-CA. ATTR-CA patients were older (79 ± 7 vs. 66 ± 10 years, P &lt; 0.001) and with higher prevalence of cardiovascular comorbidities, compared to those with AL-CA. ATTR-CA patients had higher N-terminal pro-B-type natriuretic peptide (Nt-proBNP) and troponin levels, and lower haemoglobin and estimated glomerular filtration rate. Echocardiographic findings suggested a more advanced stage of the disease in the ATTR-CA subgroup [left ventricular ejection fraction (LVEF), 51 ± 10% vs. 60 ± 9%; global longitudinal strain (GLS), −11 ± 3% vs. −13 ± 4%; peak systolic wall motion velocity, 4.9 ± 1.7 vs. 6.4 ± 1.9; left ventricular mass index (LVMI) 316 ± 133 g/m2 vs. 157 ± 72 g/m2; left atrium volume index (LAVI) 48 ± 17 ml vs. 40 ± 16 ml; right ventricular diameter 31 ± 9 mm vs. 22 ± 5 mm; tricuspidal annular plane systolic excursion (TAPSE) 17 ± 5 vs. 19 ± 5; all P &lt; 0.05). During a median follow-up of 15 (6–31) months, 68 (38%) patients died. All-cause death occurred in 31% vs. 46% patients with ATTR- and AL-CA, respectively. AL-CA was an independent predictor of mortality (adjusted hazard ratio 2.62, 95% confidence interval 1.55–4.43; P &lt; 0.001). Other independent predictors of mortality were age, systolic blood pressure, Nt-proBNP, troponin and GLS. When cardiovascular (CV) death was considered, there was no significant difference between the two phenotypes (log rank P = 0.384).

Conclusions
Despite ATTR-CA patients showed worse baseline characteristics, suggesting a more advanced disease at presentation, AL-CA phenotype was associated with a higher risk of all-cause death. Of note, CV mortality was comparable between the two groups.
285 A rare case of atypical, non-triggered takotsubo recurrence
Authors: Widmann Maddalena , Lia Micaela , Rizzetto Francesca , Tavella Domenico , Prati Daniele , Ribichini Flavio Luciano 
Published: December 2021

Abstract

Aims
Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome that, at presentation, mimics acute myocardial infarction. The most common echocardiographic manifestation is the so-called ‘apical ballooning’, but other much less common wall motion patterns have been described. The pathophysiology of the syndrome is not fully understood, but there is considerable evidence that sympathetic stimulation plays a central role. The prevalence of this syndrome is higher in post-menopausal women and in most cases, but not invariably, precipitated by an emotional or physical triggering event. A close relation between brain and circulatory system has been observed and for this reason psychiatric and neurologic disorders are often recognized as precipitating conditions. Although many risk factor persist after the acute manifestation, Takotsubo recurrences do represent an exception, especially in the absence of a clear precipitating event.

Methods and results
A 70-year-old woman was admitted for anginal pain associated with ischaemic electrocardiographic alterations and elevation of cardiac biomarkers. The coronary angiography with left ventriculogram and the echocardiographic findings were consistent with a diagnosis of mid-ventricular Takotsubo. Cardiac magnetic resonance confirmed the absence of an ischaemic pattern or evidence of infectious myocarditis. This case represents a recurrence of TTS, in fact two years earlier the patient was hospitalized to our division for stress cardiomyopathy with typical apical ballooning. Also in the present occasion, she had a favorable clinical course, with a complete recovery of the cardiac function at subsequent evaluations. The unicity of this case lies above all in the absence of a clear trigger event. Although, an altered mental status was present because the patient suffered from anxiety and depression on pharmacological treatment, with periods of exacerbation but not in occasion of the recurrence.

Conclusions
TTS is not a benign condition, with recurrence being possible even in the absence of precipitating events. Based on registry data, annual rate of Takotsubo recurrence is 1.5–1.8% and is estimated to reach 4% in life. A variable TTS pattern at recurrence is common in up to 20% of cases. Our paper reports a unique case of recurrent Takotsubo syndrome with variable patterns of ventricular involvement, with neither physical nor psychological trigger. Nevertheless, for what concerns our case, the psychiatric condition the patient suffered from, could have played a role of permanent status of sympathetic activation, that in the end elicitates the occurrence of the syndrome. A better understanding of the pathophysiology of the syndrome is needed to find evidence-based therapeutic strategies that could prevent recurrence.
34 The diagnostic and therapeutic pathway of the patient with SCA: Nursing&Tech assistance
Authors: Santucci Stefano , Franchetti Domenico , Emanuelli David , Cerulli Martina , Marcotuttli Sara , Santucci Matteo , Gasperini Vittorio 
Published: December 2021

Abstract
Cardiomyopathies to be the first cause of death. The patient who suffers from acute heart disease, after clinical evaluation, is subjected to a diagnostic–therapeutic process that involves several professional figures which include the doctor and the ambulance nurse, the doctor and all the emergency room staff who accept the patient and, if the clinical indication is oriented towards a vascular occlusion disease, the doctor and the technical-nursing team of the haemodynamics service activated in urgency. To diagnose with certainty the presence of vascular disease we make use of diagnostic systems that use ionizing radiation; the haemodynamics team thus finds itself operating not only in urgent conditions but also in dangerous conditions due to the presence of ionizing radiation. Nursing and technical staff need additional skills to be able to take on roles from basic care to emergency electric shock resuscitation. The purpose of this work is to illustrate the phases of the activity that stabilize the treatment in the hemodynamics room from the acute phase to the patient.
161 Biosensor in cardiology. T-care project: a preliminary study on innovative wearable non-invasive telemonitoring system
Authors: Amati Francesca , Ezio Santobuono Vincenzo , Bozza Nicola , Latorre Maria , Memeo Riccardo , Favale Stefano 
Published: December 2021

Abstract

The demographic trend evolution and the modification of health needs highlight the requirement for a novel organization of the healthcare system. Telemedicine is a technological tool that allows a knockdown of geographic barriers being useful in the management of remote patient assistance. Telemedicine is roughly applied in different cardiology’s areas, from telemetric to implantable devices (loop recorders) in order to monitor cardiac rate, cardiac rhythm variations, and the onset of arrhythmic events. The aim of the present study is to assess the validity of wearable devices (T-shirt equipped with biosensors and bands with photopletimographic system) in monitoring EKG, cardiac rate, and pulse oximetry. We enrolled 38 patients, 25 of whom admitted to the Cardiology Unit, University of Bari. Main characteristics of the sample are listed in Table 1.

The difference between traditional monitoring system and wearable biosensors in not statistically significant as shown in Figure 1; therefore the devices tested in this study show a satisfying level of reliability in monitoring cardiac rate, pulse oximetry, QT interval, QRS complexes, and onset of arrhythmic events. However, alerts produced by arrhythmias different from atrial fibrillation are not completely reliable; moreover, the software and the diagnostic algorithm need to be optimized for motion artefacts. For these reasons, results need to be reproduced on a large cohort of patients.
269 Management of cardiac implantable electronic device follow-up in COVID-19 pandemic: lessons learned during Italian lock down
Authors: Piro Agostino , Magnocavallo Michele , Vetta Giampaolo , Bernardini Alessia , Mariani Marco Valerio , Chimenti Cristina , Giunta Giuseppe , Trivigno Sara , Di Iorio Martina , Mei Maria Chiara , Severino Paolo , Straito Martina , Iannucci Gino , Neccia Matteo , Rocca Domenico Giovanni Della , Manzi Giovanni , Quaglione Raffaele , Natale Andrea , Fedele Francesco , Lavalle Carlo 
Published: December 2021

Abstract

Aims
Remote monitoring (RM) has significantly transformed the standard of care for patients with cardiac electronic implantable devices. It provides easy access to valuable information, such as arrhythmic events, acute decompensation manifestations, and device-related issues, without the need of in-person visits.

Methods and results
Starting 1 March, 332 patients were introduced to an RM programme during the Italian lockdown to limit the risk of in-hospital exposure to severe acute respiratory syndrome-coronavirus-2. Patients were categorized into two groups based on the modality of RM delivery [home (n = 229) vs. office (n = 103) delivered]. The study aimed at assessing the efficacy of the new follow-up protocol, assessed as mean RM activation time (AT), and the need for technical support. In addition, patients’ acceptance and anxiety status were quantified via the Home Monitoring Acceptance and Satisfaction Questionnaire and the Generalized Anxiety Disorder 7-item scale. AT time was less than 48 h in 93% of patients and 7% of them required further technical support. Despite a higher number of trans-telephonic technical support in the home-delivered RM group, mean AT was similar between groups (1.33 ± 0.83 days in home-delivered vs. 1.28 ± 0.81 days in office-delivered patients; P = 0.60). A total of 28 (2.5%) urgent/emergent in-person examinations were required. A high degree of patient satisfaction was reached in both groups whereas anxiety status was higher in the office-delivered group.

Conclusions
The adoption of RM resulted in high patient satisfaction, regardless of the modality of modem delivery; nonetheless, in-office modem delivery was associated with a higher prevalence of anxiety symptoms.
731 Single centre experience tricuspid valve transcatheter edge to edge repair
Authors: Paolucci Luca , Nusca Annunziata , Cammalleri Valeria , Nobile Edoardo , De Filippis Aurelio , Vitez Luka , Carpenito Myriam , Ricottini Elisabetta , Melfi Rosetta , Cocco Nino , Mangiacapra Fabio , Gallo Paolo , Grigioni Francesco , Ussia Gian Paolo 
Published: December 2021

Abstract

Aims
Severe tricuspid valve regurgitation (TVR) is critically associated with an increased risk of morbidity and mortality, surgical treatment is limited by high perioperative risk. In these patients, transcatheter edge to edge valve repair (TEER) is progressively recognized as an effective treatment strategy. The aim of this work is to report the single centre experience procedural results and clinical outcomes in ‘real-world’ patients suffering TVR treated with the TriClip™ device (Abbott Vascular, Santa Clara, California).

Methods
From January up to July 2021, we screened 30 patients with severe TR, among which 8 were treated with TEER. All patients underwent cardiac computerized tomography and both transesophageal and transthoracic echocardiography, with the purpose to identify a dedicated grasping strategy. TEER was performed through right common femoral vein access, advancing a 24 F steerable guiding catheter (SGC) in the right atrium. Following, the TriClip delivery system was advanced and positioned over the valve centroid and, once oriented, the clip was opened. Under fluoroscopic and transesophageal monitoring, the clip was advanced in the right ventricle and pulled back to grasp the target leaflets. Following echocardiographic control, the clip was released.

Results
Procedural success, defined as a significative reduction of the regurgitation’s severity, was achieved in all patients. No procedural or in-hospital adverse events were reported. At 30 days follow-up, all patients were alive and no further hospitalizations occurred.

Conclusions
In our single centre experience, TEER appeared to be a valid and feasible therapeutic option in patients with severe TVR. Multicentre prospective studies are mostly needed to assess the long terms outcomes of TEER in these patients, with the purpose to introduce in the clinical practice a valid alternative to the highly risk surgical option.