bluuebunny/crossref_metadata_2025_split huggingface dataset:
106 The effective study: development and application of a question-driven, time-effective cardiac magnetic resonance scanning protocol
Authors: Torlasco Camilla , Castelletti Silvia , Soranna Davide , Volpato Valentina , Figliozzi Stefano , Menacho Katia , Cernigliaro Franco , Zambon Antonella , Kellman Peter , Moon James C , Badano Luigi Paolo , Parati Gianfranco 
Published: December 2021

Abstract

Aims
Long scanning times impede cardiac magnetic resonance (CMR) clinical uptake. A ‘one-size-fits-all’ shortened, focused protocol [e.g. only function and late-gadolinium enhancement (LGE)] reduces scanning time and costs, but provide less information. We developed two question-driven CMR and stress-CMR protocols, including tailored advanced tissue characterization, and tested their effectiveness in reducing scanning time while retaining the diagnostic performances of standard protocols.

Methods and results
Eighty-three consecutive patients with cardiomyopathy or ischaemic heart disease underwent the tailored CMR. Each scan consisted of standard cines, LGE imaging, native T1-mapping, and extracellular volume. Fat/oedema modules, right ventricle cine, and in-line quantitative perfusion mapping were performed as clinically required. Workflow was optimized to avoid gaps. See Figure 1 for protocol details. Time target was &lt;30 min for a CMR and &lt;35 min for a stress-CMR. CMR was considered impactful when its results drove changes in diagnosis or management. Advanced tissue characterization was considered impactful when it changed the confidence level in the diagnosis. Images’ quality was assessed. A ‘control group’ of 137 patients was identified among scans performed before February 2020. Compared to standard protocols, the average scan duration dropped by &gt; 30% (CMR: from 42 ± 8 to 28 ± 6min; stress-CMR: from 50 ± 10 to 34 ± 6min, both P &lt; 0.0001). Independent on the protocol, CMR was impactful in ∼60% cases, and advanced tissue characterization was impactful in &gt; 45% of cases. Quality grading was similar between the two protocols. Tailored protocols did not require additional staff.

Conclusions
Tailored CMR and stress-CMR protocols including advanced tissue characterization are accurate and time-effective for cardiomyopathies and ischaemic heart disease.
654 Fragility of functional/symptomatic endpoints to assess the efficacy of drugs for pulmonary arterial hypertension
Authors: Barca Luca , De Marzo Vincenzo , Toma Matteo , Guglielmi Giulia , Crimi Gabriele , Porto Italo , Ameri Pietro 
Published: December 2021

Abstract

Aims
Drugs for pulmonary arterial hypertension (PAH) have historically been evaluated for their efficacy in improving functional capacity and decreasing symptoms. However, these measures of treatment effect are approximate and subject to substantial variability, and therapeutic choices based on them may be aleatory.

Methods and results
We reviewed the articles reporting the results of phase 3 PAH randomized controlled trials (RCTs) and calculated the fragility index (FI) for the outcomes exploring functional capacity and symptoms. The FI corresponds to the number of events that need to be added to the arm with the smallest number of events to make a significant result non-significant: the lower the FI, the fragile the trial with respect to the endpoint examined. For RCTs with non-significant results, we calculated the FI as the number of events that need to be removed from the investigational drug (ID) group to reach a P-value &lt;0.05. When possible, we also computed the FI for PAH hospitalization. Data about the rate of functional/symptomatic improvement were available for 22 (63%) of 35 RCTs (Table). The ID was superior to placebo or comparator with P &lt; 0.05 in 10 (45%) of these 22 studies. The median FI was 2 [interquartile range (IQR): 6.5], with 4 RCTs having a FI = 1 and only 2 &gt; 10 (Table). For the 12 RCTs in which the effect of the ID was neutral (P &gt; 0.05), the median FI was 6 (IQR 4.25) (Table). The hospitalization FI was determined for 17 (77%) of the 22 RCTs and was overall higher than the one for the functional/symptomatic outcome (median 6, IQR 8).

Conclusions
Accessible information about the effects of PAH drugs on functional capacity and/or symptoms is published for 6 in 10 RCTs, in which very few events in one arm could have flipped the results from non-significant to significant or, more remarkably, from significant to non-significant. The evidence supporting the reduction of PAH hospitalizations as a treatment goal appears to be more robust.
253 Imaging of congenital AV block caused by maternal autoantibodies: a single-centre experience
Authors: Basso Alessia , Maluta Nicole , Biffanti Roberta , Reffo Elena , Leoni Loira , Tonello Marta , Sabatino Jolanda , Vida Vladimiro , Cerutti Alessia , Di Salvo Giovanni 
Published: December 2021

Abstract

Aims
Autoimmune congenital heart block (CHB) is a severe manifestation of neonatal lupus syndrome. There is lack of consensus regarding treatment of pregnant women with anti-SSA/SSB autoantibodies. To evaluate the effectiveness of the combined protocol therapy (oral steroid, plasmapheresis, and IVIG) for the CHB treatment.

Methods and results
All cases of CHB from 2000 to 2020 were retrospectively enrolled. All the patients underwent foetal echocardiography for the evaluation of CHB, ventricular rate and main related foetal complications: cardiomegaly, pericardial and pleural effusion, foetal hydrops, dilated cardiomyopathy, and heart failure. Moreover, postnatal major adverse cardiovascular, such as death and pacemaker implantation, were recorded. For statistical analysis, the population was divided into two cohorts: a protocol group receiving in utero combined therapy and a control group receiving other therapies or not treated. Among 252 pregnancies with anti-SSA/SSB antibodies, 36 developed CHB. At birth, complete CHB treated with protocol therapies showed a significantly higher ventricular rate (P = 0.042), a significant reduction in intrauterine or postnatal mortality (P = 0.018), and a lower rate of pacemaker implantation (P = 0.049).

Conclusions
The combined treatment protocol has proven effective in improving foetal and neonatal short- and long-term survival.
83 The predictive role of neutrophil-to-lymphocyte ratio in post-operative cardiopulmonary bypass surgery
Authors: Bucciarelli Valentina , Bianco Francesco , Blasi Annaclara , Primavera Martina , Alessandra Baldinelli , Colaneri Massimo , Gallina Sabina , Pozzi Marco 
Published: December 2021

Abstract

Aims
Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality, and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes, and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery. To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB.

Methods and results
We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27 ± 10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 h from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed. Diagnoses of 146 patients included atrial septal defect (n = 36), ventricular septal defect (n = 20), pulmonary atresia/stenosis (n = 10), tetralogy of Fallot (n = 20), endocardial cushion defect (n = 8), left ventricular outflow tract obstruction (n = 14), anomalous origin of coronary artery (n = 6), complex CHD (n = 13), interrupted/hypoplastic aortic arch (n = 12), anomalous pulmonary venous return (n = 3). The mean CPB time was 121.6 ± 84.6 min. The median ICU hospitalization was 48 h [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P = 0.034 and P = 0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (log-rank, P = 0.029), especially when associated with POA (log-rank, P = 0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P = 0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P = 0.012, respectively], but not with JET.

Conclusions
24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.
111 Extravalvular cardiac damage and renal function following TAVI for severe aortic stenosis
Authors: Fezzi Simone , Pesarini Gabriele , Mammone Concetta , Flaim Massimo , Castaldi Gianluca , Tavella Domenico , Scarsini Roberto , Ribichini Flavio , Pighi Michele 
Published: December 2021

Abstract

Aims
Acute kidney injury (AKI) represents a common complication following TAVI, that correlates strictly with in-hospital, short, and long-term mortality. Extra-valvular cardiac damage (EVCD) showed to affect long-term outcomes in patients with severe aortic stenosis (AS). We sought to determine the differences in the incidence of AKI and acute kidney recovery (AKR) among patients undergoing TAVI and their impact on clinical outcomes according to EVCD.

Methods and results
706 symptomatic severe AS patients were selected and retrospectively analysed. Based on echocardiography findings, patients were classified based on the degree of EVCD. AKI was defined as a relative increase at 24–72H in sCr concentration of at least 0.3 mg/dl, and was classified according to AKIN stages. AKR was defined either as an increase of GFR of 25% or a decrease in sCr of at least 0.3 mg/dl, both measured at 24–72H after the procedure. After dichotomized analysis, patients in EVCD stage 3–4 reported a significantly higher rate of AKI (27.4% vs. 11.3%; P &lt; 0.001), significant AKI (5.3% vs. 1.5%; P &lt; 0.010) and the need for continuous renal replacement therapy (CRRT) after TAVI (2.7% vs. 0.7%; P = 0.052), whereas a lower incidence of AKR was reported (11.6% vs. 6.2%; P = 0.087). At the multivariate model higher EVCD stage, lower GFR and the amount of contrast used were found to be independent predictors of AKI, while early stages of cardiac damage (HR: 0.420; 95% CI: 0.224–0.785; P = 0.007) and lower GFR were found to be independent predictors of AKR. In the overall population, at a median 24-months follow-up, after multivariate analysis AKI was associated with a higher incidence of all-cause mortality [HR: 2.636; 95% CI: (1.360–5.108); P = 0.004] and MACEs [HR: 2.122; 95% CI: (1.170–3.849); P = 0.013]. Notably, at the multivariate analysis, AKI significantly impacted on survival in patients in stages 3–4 [HR: 2.461; 95% CI: (1.017–6.067); P = 0.046], but not in patients in stages 0–2 [HR: 1.301; 95% CI: (0.380–4.457); P = 0.675], with an interaction that achieved statistical significance (p for interaction 0.006). AKR did not reduce adverse clinical outcomes [HR: 0.742; 95% CI: (0.339–1.623); P = 0.455 for all-cause mortality; HR: 0.701; 95% CI: (0.351–1.397); P = 0.312 for MACEs] but was associated with an improvement of renal function at 12 months.

Conclusions
AKI demonstrated to negatively impact on 24-month all-cause mortality only when occurring in advanced stages of EVCD, but not in early stages. Conversely, early EVCD was associated with a higher incidence of AKR, which not significantly improved clinical outcomes but was associated with an improvement of renal function at 12-months. The application of this staging system may provide an additional tool for the decision-making process in patients with severe AS. 111 Figure
600 Validation of the academic research consortium high bleeding risk criteria in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of 10 studies and 67 862 patients
Authors: Silverio Angelo , Maio Marco Di , Buccheri Sergio , Luca Giuseppe De , Esposito Luca , Sarno Giovanna , Bellino Michele , Cancro Francesco Paolo , Centore Mario , Verdoia Monica , Vecchione Carmine , Galasso Gennaro 
Published: December 2021

Abstract

Aims
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) has recently proposed, by consensus, 20 clinical criteria for the assessment of the bleeding risk after percutaneous coronary intervention (PCI). A major criterion was defined as any individual clinical condition conferring in isolation a risk for major bleeding ≥4% up to 1 year after PCI; instead, a minor criterion was considered to confer a bleeding risk of &lt; 4%. The aim of this meta-analysis was to assess the performance of the ARC-HBR criteria in stratifying the risk of bleeding and ischaemic events after PCI.

Methods and results
MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC-HBR criteria in patients treated with PCI. The primary outcome measure of this meta-analysis was major bleeding. The analysis included 10 studies encompassing 67 862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non-HBR group (RR: 2.56, 95% CI: 2.28–2.89). The average C-statistic was 0.64 (95% CI: 0.60–0.68), indicating modest discrimination. The risk of intracranial haemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all-cause death was higher in HBR vs. Non-HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI: 0.88–1.16). When assessed in isolation, the mean cumulative incidence of major bleeding at 1 year exceeded the cut-off value of 4% for all the major criteria and for two out of six minor criteria, including age ≥75 years and moderate chronic kidney disease (CKD) (Figure).

Conclusions
The ARC-HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. These findings corroborate the ability of ARC-HBR major criteria in identifying PCI patients who are more likely to develop adverse events, but also suggest caution in the decision making of patients with isolated minor criteria, including age ≥ 75 years and moderate CKD.
774 Young adults with acute coronary syndrome: still a long road ahead
Authors: Ielapi Jessica , Rosa Salvatore De , Deietti Giuseppe , Critelli Claudia , Panuccio Giuseppe , Cacia Michele Antonio , Luca Emilia De , Strangio Antonio , Sorrentino Sabato , Polimeni Alberto , Sabatino Jolanda , Pilò Antonio , Spaccarotella Carmen , Mongiardo Annalisa , Indolfi Ciro 
Published: December 2021

Abstract

Aims
Acute coronary syndrome (ACS) are a leading cause for mortality and morbility worldwide. Despite ACS usually affects the older population, it also occurs in younger individuals. Young ACS patients (YACS) have a significantly worse prognosis compared to their age-mates in the general population. Despite YACS are characterized by a different risk profiles compared to their older mates, many aspects still remain elusive. Aim of this study was to describe the clinical profile of young adults with Acute Coronary Syndrome.

Methods and results
Young patients (≤50 years) with the first diagnose of Acute Coronary Syndrome admitted to the Magna Graecia University Hospital were enrolled in the ongoing GENEPAMY registry. Over 7 years, a total of 675 eligible patients with Acute Coronary Syndrome aged 44 ± 8 years were included. Men accounted for 84.9% of all patients. Overall, 11.9% of patients had diabetes, 69.1% hypertension, 17.6% obesity, 93.6% dyslipidemia, while 75.5% were smokers. In the overall cohort, 44.1% were first diagnosed with STEMI, 45.9% with NSTEMI, while the remaining had been admitted for Unstable Angina. Cardiogenic shock was present at admission in 2.7% of cases. Multivessel disease was present in 39% of cases and was significantly less frequent in women (P &lt; 0.001). Thrombolysis was administered as the initial treatment in 15.1% of cases but was ineffective in 66.7% of patients. Percutaneous coronary angioplasty was performed in 79.1% of patients, while 1.9% of patients underwent surgical myocardial revascularization. Spontaneous coronary dissection was present in 0.7% of men and 17.2% of women (P &lt; 0.001). At admission, 98.9% of patients had been treated with ASA, 17.9% with clopidogrel, 49.1% with ticagrelor and 28.4% with prasugrel. A complete revascularization was achieved in 81.6% during the index hospitalization but was significantly more frequent in women compared to men (86.3% vs. 80.8; P &lt; 0.001).

Conclusions
Our data highlight that YACS present a peculiar clinical profile. In particular, the high cardiovascular risk profile demands attention. Finally, despite most patients were men, young women with ACS present several relevant differences compared to men, needing a more careful clinical management.
197 Angio-based index of microcirculatory resistance for the assessment of the coronary resistance: a proof of concept study
Authors: Marrone Andrea , Gibiino Federico , Scollo Ennio , Tebaldi Matteo , Biscaglia Simone , Erriquez Andrea , Campo Gianluca 
Published: December 2021

Abstract

Aims
The study of coronary microcirculation has gained increasing consideration and importance in cath-lab. Despite the increase of evidence its use still remains very limited. QFR is a novel angio-based approach for the evaluation of coronary stenosis. The aim of our study was to use the QFR assessment in stable patients to recreate the IMR formula and to correlate the result of the two techniques.

Methods and results
From 1 June 2019 to 29 February 2019, 200 patients with CCS and indication of coronary artery angiography and referred to the cath-lab of the University Hospital of Ferrara (Italy) were enrolled. After baseline coronary angiogram, quantitative flow ratio, fractional flow reserve and index of microcirculatory resistance evaluation were performed. Pearson correlation (r) between Angio-based index of microcirculatory resistance (A-IMR) and IMR 0.32 with R2 = 0.098, P = 0.03: McNemar test showed a difference between the two test of 6.82% with 95% CI from −12.05% to 22.89%, which is not significant (P = 0.60). Bland and Altman plot showed a mean difference of 23.3 (from −26.5 to 73.1). Sensitivity, specificity, NPV and PPV were 70%, 83.3%, 75% and 70% for A-IMR value &gt; 44.2. The area under the ROC curve for A-IMR was 0.76 (95% CI: 0.61–0.88, P = 0.0003).

Conclusions
We have validated for the first time the formula of the A-IMR, a tool for the calculation of microvascular resistance which does not require the use of pressure guides and the induction of hyperemia
350 Effect of pre-hospital treatment for STEMI patients undergoing primary PCI
Authors: Fabris Enrico , Menzio Sara , Gregorio Caterina , Pezzato Andrea , Stolfo Davide , Aleksova Aneta , Vitrella Giancarlo , Rakar Serena , Perkan Andrea , Van’t Hof Arnoud W. J , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab.

Methods and results
We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P &lt; 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P &lt; 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P &lt; 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively).

Conclusions
This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
363 Old but fashioned: IVUS and chromaflo guidance for definition of thrombosis mechanism
Authors: Venturi Gabriele , Scarsini Roberto , Pesarini Gabriele , Pighi Michele , Ribichini Flavio 
Published: December 2021

Abstract

Aims
Plaque rupture and plaque erosion are the main causes of coronary thrombosis. While the first one involves fibrous cap disruption, the second one is caused by loss of endothelial continuity. In selected cases with evidence of plaque erosion, antithrombotic therapy without stenting has been suggested as a possible option. OCT is considered the gold standard for definition of thrombosis mechanism and has recently been included in algorithms for evaluation and management of patients with ACS. Also, high definition IVUS was compared with OCT in defining plaque erosion showing promising results. However, the cost and the large amount of contrast medium needed for OCT performance make these diagnostic tools of scarce applicability in daily practice.

Methods and results
We herein describe the case of a young man acceding to the Cath Lab with the diagnosis of NSTEMI. After baseline angiography and IVUS confirmed presence of Thrombus (Figure 1A and B), thromboaspiration was successfully performed (Figure 1D). The definition of thrombosis mechanism, revealing plaque rupture, was then performed with IVUS and ChromaFlo devices (Figure 1C and E). Also, IVUS was used to optimize stent implantation.

Conclusions
Although requiring further confirmations, we believe that in selected cases IVUS and ChromaFlo could provide a more applicable first-line diagnostic tool to define thrombosis mechanism. 363 Figure 1Baseline angiographic and IVUS evaluation confirming presence of coronary thrombus (A, B). After successful performance of thromboaspiration (D), plaque rupture was revealed by IVUS and ChromaFlo (C).