bluuebunny/crossref_metadata_2025_split huggingface dataset:
589 External validation of the increased wall thickness score for the diagnosis of cardiac amyloidosis
Authors: Monda Emanuele , Palmiero Giuseppe , Lioncino Michele , Rubino Marta , Caiazza Martina , Vetrano Erica , Di Fraia Francesco , Mauriello Alfredo , Cirillo Annapaola , Verrillo Federica , Fusco Adelaide , Dongiglio Francesca , Calabrò Paolo , Golino Paolo , Limongelli Giuseppe 
Published: December 2021

Abstract

Aims
This study aimed to validate the increased wall thickness (IWT) score, a multiparametric echocardiographic score to facilitate diagnosis of cardiac amyloidosis (CA), in an independent population of patients with increased LV wall thickness suspicious for CA.

Methods and results
Between January 2019 and December 2020, 152 consecutive patients with increased LV wall thickness suspicious for CA were included. For all patient, the multiparametric echocardiographic score (IWT score) was calculated. To validate the diagnostic accuracy of an IWT score ≥8 to predict the diagnosis of CA, sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) were calculated. Among the 152 patients included in the study, 50 (33%) were diagnosed as CA, 25 (16%) had severe aortic stenosis, 25 (16%) had hypertensive remodelling, and 52 (34%) had hypertrophic cardiomyopathy. Among the 50 and 102 patients with and without CA, 19 (38%) and 1 (1%) showed an IWT score ≥8, respectively. Overall, the diagnostic accuracy of an IWT score ≥8 for the diagnosis of CA in our population was the following: Se 38% (95% CI: 25–53%); Sp 99% (95% CI: 95–100%); PPV 95% (95% CI: 72–99%); NPV 77% (95% CI: 73–80%); PA 79% (95% CI: 72–85%).

Conclusions
This study reports the first external validation of the IWT score for the diagnosis of CA in patients with increased LV wall thickness. A score ≥8 showed a high Sp, PPV and PA, suggesting that the IWT score can be used to identify CA patients in those with increased LV wall thickness.
118 Undefined left ventricular arrhythmogenic cardiomyopathy: the value of genotyping and histological characterization
Authors: Peretto Giovanni , Casella Michela , Merlo Marco , Rizzo Stefania , Cappelletto Chiara , Russo Antonio Dello , Basso Cristina , Bella Paolo Della , Sinagra Gianfranco , Sala Simone 
Published: December 2021

Abstract

Aims
Etiology identification and risk stratification represent major issues for patients presenting with undefined left ventricular arrhythmogenic cardiomyopathy (ULVACM). To investigate the role of genotyping and histology for ULVACM classification, management, and risk assessment.

Methods and results
We retrospectively analysed a multicentre cohort of patients (screened n = 1037) with ULVACM defined by ventricular arrhythmia (VA) onset, nonischaemic late gadolinium enhancement (LGE) limited to the LV, and no manifest dilated cardiomyopathy (LVEF ≥ 40%). We selected patients undergoing both next generation sequencing (NGS) genotyping and endomyocardial biopsy (EMB) for etiology definition. When feasible, immunosuppressive therapy (IST) was used to target active myocardial inflammation (AMI). The study endpoint was a composite of cardiac death, heart transplantation and malignant VAs (VT, VF, appropriate ICD treatment). The study cohort is composed by 135 ULVACM patients (age 43 ± 14 years, 63% males, LVEF 55 ± 7%). NGS identified pathogenic or likely-pathogenic variants (PVs/LPVs) consistent with ACM in 21 cases (16%), whereas EMB showed AMI in 78 patients (58%), including 13/21 PVs/LPVs + (62%). IST was started in 41/78 AMI patients (53%), including 9/13 PVs/LPVs + (69%). Twenty patients (15%) met the study endpoint by 12 months, and 36 (27%) by the end of the study (60 ± 27 months). Beyond malignant VT onset, AMI was the only predictor of events by 12 months (HR: 5.0, 95% CI: 1.4–18.1, P = 0.007). No prognostic role was found for PVs/LPVs, except for the subgroup (n = 77) with nonsustained VT onset. Among AMI patients, those treated by IST had a significantly lower occurrence of events, both by 12-months (1/41 vs. 16/37, P &lt; 0.001) and later (HR: 0.05, 95% CI: 0.01–0.21, P &lt; 0.001). Results were independently confirmed in PVs/LPVs+ and PVs/LPVs- cases. Excluding the IST population, the association of multiple factors among VT onset, PVs/LPVs, and AMI, resulted in an improved discrimination of arrhythmic risk profiles.

Conclusions
Despite its limited diagnostic yield, the combined genetic and histological workup substantially contributed into ULVACM prognostic assessment. Furthermore, EMB identified suitable candidates for IST, who showed better outcomes irrespectively of their genotype.
23 Psycho-emotional aspects in patients with takotsubo syndrome compared with a control group
Authors: Matera Annalisa , Santoro Francesco , Mallardi Adriana , Leopizzi Alessandra , Vitale Enrica , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
Takotsubo syndrome (TTS), also called stress cardiomyopathy, is an acute and transient left ventricular systolic dysfunction. Patients affected are usually postmenopausal woman with symptoms similar to myocardial infarction (angina pectoris, shortness of breath, palpitations, etc.) who experienced sudden emotional or physical stress. Emotional stressors are the mayor trigger in about 40% of cases, therefore an evaluation of psychological profile of these patients may have clinical relevance. Evaluate the quality of life, the level of anxiety and depression, the activities of daily life in patients with TTS in comparison with a control group with similar characteristics who haven’t developed this pathology.

Methods and results
44 patients were recruited: 22 patients with TTS and 22 patients included in the control-group who didn’t develop the syndrome. Patients answered to three questionnaires for the evaluation of daily living activities, (Activities of daily living and Instrumental activities of daily living—ADL and IADL), levels of anxiety and depression (hospital anxiety and depression scale—HADS), and quality of life (36-Item Short Form Health Survey-SF—36). Mean age of the study population was 69 ± 9 years and patients were all female. No differences in term of cardiovascular and no risk factor were found between the two groups. Concerning daily living activities, no differences were present. However, when comparing levels of anxiety and depression, TTS patients had higher levels of anxiety (9.4 ± 5.3 vs. 7.7 ± 4.3; P = 0.3; HADS), meanwhile levels of depression were higher in patients of the control group (6.1 ± 3.4 vs. 6.7 ± 4.7; P = 0.7; HADS). Regarding the quality of life, patients with TTS reported to have reduced energy and had fewer social activities (respectively, 51.2 ± 15.7 vs. 62.8 ± 16.5; P = 0.03; 60.4 ± 29.1 vs. 66.6 ± 30.2 con P = 0.7; SF-36).

Conclusions
Patients with Takotsubo syndrome have typical psycho-emotional aspects including higher levels of anxiety and impaired quality of life (as reduced energy and fewer social activities). Further research is needed to better stratify these aspects.
322 Atrial morphological and functional parameters in hypertrophic cardiomyopathy: cardiovascular outcome implication
Authors: Setti Martina , Rizzetto Francesca , Benfari Giovanni , Cavazza Beatrice , Dal Porto Marta , Ribichini Flavio , Rossi Andrea , Cicoira Mariantonietta 
Published: December 2021

Abstract

Aims
The impact of atrial function measured by standard and advanced echocardiographic techniques is emerging in various clinical settings but remains poorly explored in patients with hypertrophic cardiomyopathy (HCM).

Methods and results
Consecutive patients with HCM referred to the heart failure outpatient clinic were prospectively enrolled. Complete clinical and echocardiographic evaluation was performed, including fully automated 2D speckle tracking analysis software (AutoStrain, TomTec). Atrial function was assessed by means of left atrial (LA) volume, LA diameter, a’-TDI, and global peak atrial longitudinal strain (PALS). The primary endpoint was a composite of cardiovascular (CV) events (cardiovascular death or hospitalization, new-onset atrial fibrillation, surgical myectomy, sustained ventricular tachycardia or ventricular fibrillation) during the follow-up. A total of 40 patients with confirmed HCM diagnoses and complete follow-up were included, mean age was 61 ± 14 years, 62% male, ejection fraction 64 ± 8%. LA was frequently enlarged (indexed LA volume 43 ± 14 ml/m2, LA diameter 39 ± 7 mm), and dysfunctional (a’-TDI 7.1 ± 2.2 cm/s, PALS 21 ± 7%). During a mean follow-up of 460 ± 300 days, seven patients had a CV event. Among LA parameters, septal a’-TDI seems to characterize patients with events the most (5.5 ± 2.1 vs. 7.5 ± 2.3, P = 0.03). This was confirmed in an age-adjusted survival model [HR: 0.62 (0.39–0.92), P = 0.03]. The spline curve in the Figure illustrates the relationship between a’-TDI and the age-adjusted probability of CV events; the association began at about 7 cm/s and increased steeply for lower values. Of note, the association between PALS and CV events was highly significant in younger patients (&lt;70 years, P &lt; 0.001).

Conclusions
According to our pilot study, a’-TDI can be considered a simple, feasible, and routinely available parameter of left atrial function, which can help to identify HCM patients at higher risk of CV events.
110 Sex-related differences in clinical presentation and outcome of patients with cardiac transthyretin amyloidosis and light chain amyloidosis
Authors: Zampieri Mattia , Argirò Alessia , Allinovi Marco , Tassetti Luigi , Zocchi Chiara , Gabriele Martina , Andrei Valentina , Fumagalli Carlo , Di Mario Carlo , Tomberli Alessia , Olivotto Iacopo , Perfetto Federico , Cappelli Francesco 
Published: December 2021

Abstract

Aims
We aimed to ascertain whether sex-related differences are relevant to the pathophysiology, presentation, and outcomes in different types of cardiac amyloidosis—a field still poorly investigated. Medical files from consecutive patients diagnosed with cardiac amyloidosis between 2000 and 2020, at Careggi University Hospital, were retrospectively evaluated.

Methods and results
Over this period, 259 patients (12% females) were diagnosed with wild type transthyretin amyloidosis (wtATTR), 52 (25% females) with hereditary transthyretin amyloidosis (hATTR) and 143 (47% females) with light chain amyloidosis (AL). Wt-ATTR women, compared to men, were significantly older at the time of diagnosis and showed higher National Amyloidosis Centre score, thicker normalized interventricular septum, higher diastolic dysfunction and worse right ventricular function. Females with hATTR and AL had lower normalized cardiac mass compared to men. Otherwise, bio-humoural parameters, NYHA class, and ECG characteristics were similar. No differences in outcome were observed with regard to sex.

Conclusions
In conclusion, we did not observe major differences in clinical expression related to sex in different types of cardiac amyloidosis: specifically, outcome was not affected. Nevertheless, women with wtATTR showed a worse profile at diagnosis and evidence suggesting a later recognition of disease compared to men, highlighting the need for a higher index of suspicion in female patients.
271 Treatment of thrombophlebitic necrotic lesions in a patient with syncardia—a case report
Authors: Artiola Gaetano , Pettillo Vincenzo 
Published: December 2021

Abstract

Aims
The 58 years old male patient with an important dilated cardiomyopathy, carrier of ICD, numerous malignant arrhythmias (VT) and without the possibility of a timely heart transplant, underwent emergency surgery by implanting a total artificial heart syncardia. Necrotic tissue was already present on the forearm and in the antecubital region before the surgery; it was caused by extravasation and thrombophlebitis due to continuous intravenous therapies and the lesions were deep down to tendons and bones after a surgical toilet. Years of unstable haemodynamics caused by dilated cardiomyopathy and low cardiac output led to poor peripheral vascularization giving priority to noble structures. Restoration of the tissue using advanced dressings without the use of skin grafts avoiding bacterial infections in a fragile patient.

Methods and results
A Pubmed search for advanced dressings was performed and a Webinar on the Wound Hygiene technique was attended. In the first instance, a polyurethane foam dressing was used and the wound on the forearm showed major improvements, subsequently with the synergistic help of the ‘Wound Hygiene’ technique and dressings based on connectivine, the tissue healed. The wound located in the antecubital region had continuous biofilm formation and a VacTherapy was planned for this. After 7 days, the conditions worsened and for this reason it was decided to use the Aqua Cell Ag +. This dressing with the silver helps in the formation of granulation tissue and it also prevents infections ‘trapping’ bacteria inside it.

Conclusions
The use of dressings with the Wound Hygiene technique led to the formation of new tissue without the need to perform a skin graft in a patient with a total artificial heart and without bacterial infections.
35 Electrophysiology and electrostimulation: experience
Authors: Santucci Stefano , Negossi Davide , Emanuelli David , Paoloni Valentina , Biondi Federico , Santucci Matteo , Marzuolo Cinzia 
Published: December 2021

Abstract
In the last 50 years, cardiac electrophysiology has undergone rapid technological development which has led to a numerical increase in both patients who have been able to benefit from the therapies of rediscovery and rhythm control, and of the devices. The activity of an electrophysiology and electrostimulation room is based on the intensive use of ionizing radiation even if electrophysiology studies, ablation, and cryoablation techniques have benefited from the support of computerized electroanatomical mapping systems with consequent dose reduction. Over the years, the instruments to be managed inside the room have increased both in complexity and numerically. Starting from the biventricular PM, we go through the implantation of subcutaneous defibrillators up to the transseptal ablations. Patient management requires additional skills that each member of the team must possess. Continuous training and updates are of fundamental importance. The purpose of this work is our experience based on the activity now more 10 years.
162 Whole-body cryotherapy treatment modulates the innate immune response in non-professional football players
Authors: Selleri Valentina , De Gaetano Anna , Zanini Giada , Malerba Mara , Pinti Marcello , Tripi Ferdinando , Mattioli Anna Vittoria , Savino Gustavo , Nasi Milena 
Published: December 2021

Abstract

Aims
Whole-body cryotherapy (WBC) is a recently widely strategy used for muscle recovery after injury that can to activate inflammatory response. WBC consists of short exposure, of about 2-3 minutes, to dry air at cryogenic temperatures up to -190 °C. The aim of our study is to analyze WBC effects on metabolic, hormonal, and immunological responses of non-professional football players (NPFPs).

Methods and results
Nine male NPFPs (age: 20 ± 2 years) on the same team are recruited and, in particular, they played and trained each day before, during, and after WBC treatment. We collected NPFPs blood samples immediately before WBC and after 5 once-day sessions, then we evaluated a set consisting of 50 analytes, including hormones profile, haematologic parameters, and serum chemistry. We proceeded with monocytes (Mo) phenotyping and then we investigated the concentration of some plasmatic markers with anti-inflammatory effects (IL2RA, IL1RN) or typically increased during inflammation [CCL2, IL-18, free mitochondrial DNA (mtDNA)]. WBC treatment (WBC-t) lead to a decrease not only in mean platelet volume, mean corpuscular haemoglobin, and ferritin levels, but also in testosterone and estradiol levels, even if they remain within the normal ranges. This treatment is also responsible for total Mo increased and, in particular, a reduction of classical Mo has been demonstrated in parallel with an increase of non-classical ones. Moreover, each Mo subset shows lower expression of CXCR4. Considering pro-inflammatory molecules, IL1RA showed a tendency to decrease, while IL1RN and IL18 decreased in plasma after WBC-t. Conversely, circulating mtDNA levels appeared unaltered by treatment.

Conclusions
The differences detected in monocyte subset after WBC-t suggest that, in this condition, Mo could be redistributed into the surrounding tissue. In addition, CXCR4 reduction in Mo subsets could be due to their differentiation process. Hence, WBC could promote Mo differentiation through a mechanism that is still unknown. Since WBC seems to regulate the innate immune system in the enrolled NPFPs, it could have a role in tissue repair beyond a beneficial anti-inflammatory effect.
625 Cluster analysis of weather and pollution features and its role in predicting acute cardiac or cerebrovascular events
Authors: Testa Alberto , Anticoli Sabrina , Pezzella Francesca Romana , Mangiardi Marilena , Di Giosa Alessandro , Marchegiani Giada , Gaspardone Achille , Versaci Benedetta , Versaci Francesco , Zoccai Giuseppe Biondi 
Published: December 2021

Abstract

Aims
The impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised. The aim of this study was to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events.

Methods and results
Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from three tertiary care centre from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for environmental protection, and from the Meteorologic Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rate of acute cardiac and cerebrovascular events with Poisson models. As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated four separate clusters: Cluster 1, including 60 (5.1%) days, Cluster 2 with 419 (35.8%) days, Cluster 3 with 673 (57.6%) days, and Cluster 4 with 17 (1.5%) days, with significant between-cluster differences in weather and pollution features. Notably, Cluster 1 was characterized by low temperatures and high ozone concentrations (P &lt; 0.001). Overall cluster-wise comparisons showed significant overall differences in adverse cardiac and cerebrovascular events (P &lt; 0.001), as well as in cerebrovascular events (P &lt; 0.001) and strokes (P = 0.001). Between-cluster comparisons showed that Cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to Cluster 2, Cluster 3, and Cluster 4 (all P &lt; 0.05), as well as AMI in comparison to Cluster 3 (P = 0.047). In addition, Cluster 2 was associated with a higher risk of strokes in comparison to Cluster 4 (P = 0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events, and strokes for Cluster 1 and Cluster 2.

Conclusions
Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increases risk of acute cardiovascular events, especially cerebrovascular events.
208 Association between cardiovascular data and the development and progression of mild cognitive impairment: results from the retrospective cohort study
Authors: Faggiano Andrea , Difonzo Teresa , Avallone Carlo , Forgione Arianna , Gazzaniga Valentina , Gramegna Chiara , Locatelli Giuseppe , Mallardi Giulio , Nicotra Alessia , Zago Stefano , Carugo Stefano 
Published: December 2021

Abstract

Aims
Mild cognitive impairment (MCI) is characterized by objective evidence of cognitive impairment in one or more cognitive domains in the absence of significant interference in daily-life activities. Anyway, people with MCI are considered to be at heightened risk of further cognitive decline and progression to dementia. To date, few evidence regarding the association between cardiovascular data and MCI are present in the literature. To investigate the association between various cardiovascular data (traditional risk factors and outcomes) and the development and progression of MCI.

Methods and results
The study included 127 patients referred to the Neurological Unit of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan for subjective memory complaints and/or clinical suspect of cognitive impairment. Neuropsychological tests evaluating executive functions and cardiovascular data were collected at baseline and 2-year follow-up. Visit reports and medical records were reviewed to extrapolate the data. The study was conducted between 2012 and 2020. The 51 (40.2%) patients on antiplatelet therapy (94% on aspirin) had a worse baseline degree of cognitive impairment on neuropsychological tests of executive functions and had greater worsening of MCI at 2 years (Table 1). Patients on antiplatelet therapy were significantly older (75.85 vs. 71.7; P = 0.009), more ischaemic (21.6% vs. 1.3%; P &lt; 0.001), hypertensive (90.2% vs. 60.5%; P &lt; 0.001), and dyslipidaemic (62.7% vs. 19.7%; P &lt; 0.001) than patients without antiplatelet therapy. No other single cardiovascular data analysed (presence of hypertension, dyslipidaemia, ischaemic heart disease, diabetes, atrial fibrillation, and anticoagulation therapy) showed a statistical significant association with MCI presence or progression.

Conclusions
The present study suggests that the prevalence and progression of MCI is significantly higher among patients on antiplatelet therapy, who carry a greater cardiovascular burden. Although patients on antiplatelet therapy were older, more ischaemic, hypertensive, and dyslipidaemic than patients without antiplatelet therapy, none of these parameters were associated with MCI presence and/or progression and can therefore be considered a confounding factor.