bluuebunny/crossref_metadata_2025_split huggingface dataset:
765 Is acute response to calcium sensitizers drugs predictive of response to cardiac contractility modulation in NYHA IV patients?
Authors: Esposito Francesca , Vitillo Paolo , Urraro Francesco , Nappi Felice , Rotondi Francesco , Nicastro Federico , Amato Luca , Laurino Angela , Russo Anna , Lorenzo Emilio Di 
Published: December 2021

Abstract
A 53-years old man presented to our institution with a diagnosis of decompensated heart failure NYHA Class IV. He had a history of ischaemic heart disease with severe biventricular dysfunction, diabetes, hypertension, dyslipidaemia, advanced chronic kidney disease, previous explanation of dual-chamber implantable electronic device (ICD) due to endocarditis and subsequent implantation of subcutaneous ICD in primary prevention. Home therapy included uptitrated angiotensin-converting enzyme inhibitor, β-blocker, loop-diuretic, spironolactone, acetylsalicylic acid, and oral hypoglycemics. Clinical examination showed signs and symptoms of systemic and pulmonary congestion with pleural effusion and ascites. Echocardiography revealed diffuse left ventricular (LV) hypokinesis with an ejection fraction (EF) of 25%, severe right ventricular dysfunction and increased filling pressures. He was treated with high dose of i.v. diuretics with mild improvement of dyspnoea. However, haemodynamic stability was labile with worsening of symptoms as soon as mild down-titration of iv diuretics was attempted. Levosimendan, a calcium-sensitizer inodilator, indicated for short-term treatment of acutely decompensated severe chronic heart failure (HF), was administered with good clinical response. Thus, we thought that the patient could have benefited from contractility modulation therapy (CCM) which acts on intramyocardial calcium handling. CCM is a novel therapeutic option for patients with classes III–IV HF with EF ≥ 25% to ≤ 45% and narrow QRS complex that acts on intramyocardial calcium-handling. CCM proved effective in alleviating symptoms, improving exercise tolerance and quality of life, and reducing hospitalization rates in HF. It improves myocardial contractility, reverses the foetal myocyte gene program associated with HF and facilitates cardiac reverse remodelling. Therefore, an Optimizer Smart System (Impulse Dynamics) was implanted. Two pacing electrodes were placed on the interventricular septum in apical and mid-septal position, respectively. The leads were connected to a pulse-generator in a right pectoral pocket. In the following days, we observed a progressive improvement in clinical status, with gradual resolution of peripheral oedema, dyspnoea and fatigue and significant weight loss. Six-month echocardiography showed a stable value of EF and significant improvement in stroke volume (35.2 ml from 24.8 ml at baseline). The patient did not undergo further hospitalization for decompensated HF and was in stable ambulatory NYHA Class IV. We believe CCM is an option in patients with advanced HF in which avoiding recurrent hospitalizations, with their overt increase mortality, is often a challenging therapeutic goal. 765 Figure
735 Myocardial ischaemia: not just about obstructive coronary arteries
Authors: Agnello Federica , Catellana Carmelo , Francaciglia Bruno , Capodanno Davide , Tamburino Corrado 
Published: December 2021

Abstract

Aims
A vast proportion of subjects with anginal symptoms undergoing invasive coronary angiography (ICA) suffer from ischaemia with non-obstructive coronary arteries (INOCA). This condition has many contributing mechanisms, including epicardial vasospasm caused by vasomotor disorder, which is characterized by ST-segment changes during the self-limiting chest pain episodes. The diagnosis of this condition is challenging. Although different provocative test could performed during ICA (e.g. intracoronary administration of acetylcholine or ergonovine), their use is uncommon.

Methods and results Clinical case
A 39-years old man, smoker, hypertensive and dyslipidemic, presented to the emergency department after a Holter dynamic ECG detecting transient ST-segment elevation in the D1 lead. He had recurrent rest angina despite medical therapy and a prior ICA performed one year before the current presentation documented a mild stenosis of the posterior descending artery, a moderate stenosis of a duplicated left anterior descending artery, and a chronic total occlusion of the left obtuse marginal, which was not revascularized because of the absence of inducible ischaemia on single-photon emission computed tomography. The new ICA performed at presentation revealed a significant progression of coronary artery disease at the level of the posterior descending artery, which was treated through percutaneous coronary intervention, while the other vessels were unchanged. During the procedure, the patient experienced severe angina with ST-segment elevation and angiographically evident vasospasm of left coronary artery. The instantaneous wave-free ratio measurement performed on the medial branch of the duplicated left anterior descending artery was 0.86, which quickly resolved after administration of nitrate (0.93). Calcium channel blockers were added to medical therapy and the patient was discharged asymptomatic.

Conclusions
Vasospastic angina can cause ischaemia both in the presence and in the absence of visible atherosclerosis. This cause of INOCA often remains undetected but it is relatively frequent especially among younger patients who continue experiencing angina leading to repeated hospitalizations. The chance of this condition should be always taken into account, and the correct diagnosis should be obtained not incidentally like in the present case, but following standardized intracoronary test in a proper setting.
231 In-hospital outcomes following an acute coronary syndrome in patients with liver fibrosis: results from the real-world observational registry of acute coronary syndromes (REALE-ACS)
Authors: Biccirè Flavio Giuseppe , Sammartini Emanuele , Dacierno Edoardo Maria , Sajeva Riccardo , Pignatelli Pasquale , Barillà Francesco , Tanzilli Gaetano , Pastori Daniele 
Published: December 2021

Abstract

Aims
The prognostic role of liver fibrosis (LF) in acute coronary syndrome (ACS) patients is unclear. Biochemical markers and scoring systems, such as the APRI score and the FIB-4 score, have recently been shown to be reliable in predicting LF. We aimed to investigate the relationship between LF and in-hospital outcomes in consecutive ACS patients.

Methods and results
The REALE-ACS is a real-world monocentric observational study to investigate characteristics, management and outcomes of patients admitted for ACS from January 2016 to January 2020. LF was defined by an APRI score &gt;0.70 and FIB-4 score &gt;3.25. We investigated the association of APRI and FIB-4 with in-hospital adverse events (AEs) defined as cardiogenic shock and death. 469 consecutive ACS patients were included. Mean age was 65.7 ± 13.0 years and 108 (23%) were women. Overall, 7.9% of patients had LF. STEMI was more common in LF patients (86.5% vs. 40.8%, P &lt; 0.001). Patients with LF had lower hypertension (64.9% vs. 81.7%, P = 0.015), and higher GRACE score upon admission (155.3 ± 48.4 vs. 131.6 ± 38.9, P = 0.001). Higher serum levels of aspartate aminotransferase [242 (184.5–363) vs. 22 (17–34), P &lt; 0.001], alanine aminotransferase [67 (51.5–115) vs. 20 (15–29), P &lt; 0.001], white blood cells [12 000 (10 145–14 350) vs. 8935 (7262.5–11 267), P &lt; 0.001], percentage of neutrophils (97.3 ± 104.5 vs. 68.5 ± 13.7, P &lt; 0.001), D-dimer [1039 (435.5–2100) vs. 436 (275–894), P &lt; 0.001], and lower percentage of lymphocytes (12.3 ± 6.0 vs. 21.7 ± 11.21, P &lt; 0.001) were reported in LF patients. Globally, 49 AEs were recorded. At stepwise multivariable logistic regression analysis including clinical and biochemical factors, COPD [odds ratio (OR): 2.47, 95% confidence interval (CI): 1.15–5.29, P = 0.020], HS-troponin levels (OR: 2.05, 95% CI: 1.02–4.10, P = 0.043), and APRI &gt; 0.70 (OR: 2.58, 95% CI: 1.07–6.22, P = 0.035) were associated with AEs.

Conclusions
ACS patients with LF have a high STEMI rate and are at higher risk of worse in-hospital AEs. Our findings suggest that LF may contribute to the identify ACS patients at high-risk for adverse events and mortality.
666 Complete vs. culprit-only strategy in older MI patients with multi-vessel disease
Authors: Caglioni Serena , Mele Daniela , Verardi Filippo Maria , Campana Roberta , Erriquez Andrea , Pompei Graziella , Biscaglia Simone 
Published: December 2021

Abstract

Aims
The revascularization strategy to pursue in older myocardial infarction (MI) patients with multivessel disease (MVD) is currently unknown. For this reason, while waiting for the results of dedicated trials, we sought to compare a complete vs. a culprit-only strategy in older MI patients by merging data from four registries.

Methods and results
The inclusion criteria for the target population of the present study were: (i) age ≥75 years; (ii) MI (STE or NSTE); (iii) MVD; and (iv) successful treatment of culprit lesion. Propensity scores (PS) were derived using logistic regression (backwards stepwise selection, P &lt; 0.2. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) death, MI, major bleeding. Multivariable adjustment included the PS and inverse probability of treatment weighting (IPTW). The Kaplan–Meier plots were weighted for IPT. Among 2087 patients included, 1362 (65%) received culprit-only treatment whereas 725 (35%) complete revascularization. The mean age was 81.5 years, while mean Follow-up was 419 ± 284 days. Seventy-four patients (10%) died in the complete group and 223 in the culprit-only one (16%). The adjusted cumulative 1-year mortality was 9.7% in the complete and 12.9% in the culprit-only group (adjusted HR: 0.67, 95% CI: 0.50–0.89). Complete revascularization was associated with lower incidence of CV death (adjusted HR: 0.68, 95% CI: 0.48–0.95) and MI (adjusted HR: 0.67, 95% CI: 0.48–0.95).

Conclusions
Culprit-only is the default strategy in older MI patients with MVD. In our analysis, complete revascularization was associated with lower all-cause and CV mortality and with a lower MI rate.
6 The role of speckle tracking echocardiography in the identification of culprit lesion in patients with non-ST-segment elevation acute coronary syndrome
Authors: Chiarello Giuseppina , Gherbesi Elisa , Ursi Raffaella , Pontone Gianluca , Fusini Laura , Favale Stefano , Guaricci Andrea Igoren 
Published: December 2021

Abstract

Aims
An early evaluation of patients with non-ST elevation acute coronary syndrome patients (NSTE-ACS) is important to choose the appropriate treatment strategy. In this setting of patients, conventional echocardiographic assessment may reveal normal myocardial kinesis in 25–76% of cases. Global and territorial longitudinal strain (GLS and TLS, respectively) may be an early and accurate non-invasive tool for prediction of multivessel CAD in patients with NSTE-ACS. To evaluate the ability of TLS to predict culprit lesions in patients with NSTE-ACS.

Methods and results
We studied 183 patients diagnosed with NSTE-ACS, in our Institution over 2 years of time. Conventional echocardiography and 2 D speckle tracking echocardiography (STE) imaging were performed by two experienced echocardiographers, who were blinded to patient characteristics. The TLS was identified as the mean value of the segments’ strain as respect to each vessel territory. Coronary angiography was performed in all patients. Significant CAD (luminal stenosis more than 70% in a major epicardial coronary vessel) and culprit lesion were identified and threated by PTCA when appropriate. A significant difference between mono- and tri-vessel CAD in the variation of WMSI has been demonstrated. There was a statistically significant difference between both 3-vessels vs. 1-vessel disease and 2-vessels vs. 1-vessel disease in changing of TLS-LAD, TLS-RCA, and TLS-Cx values (P-value &lt;0.001). There was a significant difference between 3-vessels vs. 2-vessels disease for TLS-RCA values. There was a statistically significant difference for WMSI-LAD, WMSI-CX, and WMSI-RCA values whether the respective artery was involved or not. Variations of TLS were statistically significant both when the territorial tributary artery was involved and also if the artery represented the culprit lesion (P-value TLS-LAD &lt;0.001, TLS-LAD culprit &lt;0.001, TLS-CX &lt; 0.001, TLS-cx culprit &lt;0.001, TLS-RCA &lt;0.001, P-value TLS-RCA culprit 0.022). A regression model was performed comparing the variation of WMSI as respect to the variation of WMSI+TLS in the territory of culprit lesions. For WMSI-LAD the OR was 0.94 and for TLS-LAD the OR was 1.19 and the P-value of the addition was 0.001. The OR of WMSI-CX was 1.76 and for TLS-CX the OR was 1.40 and the P-value of the addition was 0.001. The OR of WMSI-RCA was 0.71 and for TLS-RCA the OR was 1.17, the P-value of the addition was 0.019.

Conclusions
TLS allows an accurate identification of the culprit lesion in patients presenting with NSTE-ACS. TLS can be considered as part of routine echocardiography on top of WMSI in early evaluation for a better clinical assessment in this subset of patients.
451 Deferral of coronary revascularization in patients with reduced ejection fraction based on physiological assessment: impact on long-term survival
Authors: Gallinoro Emanuele , Paolisso Pasquale , Di Gioia Giuseppe , Bermpeis Kostantinos , Fernandez-peregrina Estefania , Candreva Alessandro , Esposito Giuseppe , Fabbricatore Davide , Bartunek Jozef , Vanderheyden Marc , Wyffels Eric , Sonck Jeroen , Collet Carlos , De Bruyne Bernard , Barbato Emanuele 
Published: December 2021

Abstract

Aims
Deferring percutaneous coronary intervention (PCI) in patients with non-significant stenoses based on fractional flow reserve (FFR) is associated with favourable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction (LVEF) is unclear. To investigate whether FFR provides adjunctive clinical benefit compared to coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced LVEF.

Methods and results
Consecutive patients (n = 4577) with reduced LVEF (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We eventually included patients with at least one intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR-guided) or angiography alone (angiography-guided). The primary endpoint of the study was the cumulative incidence of all-cause death at 10 years. The secondary endpoint [the incidence of major adverse cardiovascular and cerebrovascular events (MACCE)], was a composite of all-cause death, myocardial infarction, any revascularization and stroke. A total of 840 patients were included (206 in the FFR-guided and 634 in the angiography-guided group). Median clinical follow-up was 7 years [IQR: (3.22–11.08)]. After 1:1 propensity score matching, baseline characteristics between the two groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group [94 (45.6%) vs. 119 (57.8%), HR: 0.65 (95% CI: 0.49–0.85), P &lt; 0.01]. The rate of major adverse cardiovascular and cerebrovascular events [(MACCE), a composite of all-cause death, myocardial infarction, any revascularization, and stroke) was lower in the FFR-guided group [123 (59.7%) vs. 139 (67.5%), HR: 0.75 (95% CI: 0.59–0.95), P = 0.02].

Conclusions
In patients with reduced LVEF, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and MACCE at 10 years.
103 Coronary plaque healing and diabetes: insights from optical coherence tomography imaging
Authors: Vergallo Rocco , Lombardi Marco , Betti Matteo , Ricchiuto Alfredo , Maino Alessandro , Buonpane Angela , Bianchini Emiliano , Galli Mattia , D’Amario Domenico , Montone Rocco Antonio , Leone Antonio Maria , Aurigemma Cristina , Romagnoli Enrico , Buffon Antonino , Burzotta Francesco , Trani Carlo , Crea Filippo 
Published: December 2021

Abstract

Aims
Atherosclerotic plaque healing is a dynamic process developing after plaque rupture or erosion, which aims to prevent lasting occlusive thrombus formation and to promote plaque repair. We hypothesized that diabetes mellitus, one of the major conventional cardiovascular risk factors, may influence the healing capacity after plaque destabilization.

Methods and results
In this single-centre observational cohort study, patients with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) who underwent optical coherence tomography (OCT) imaging at Fondazione Policlinico A. Gemelli–IRCCS, Rome, were included. Patients were divided into two groups (i.e. diabetes vs. no diabetes), and stratified based on diabetes medications (i.e. insulin, vs. oral antidiabetic drugs). OCT analysis of non-culprit coronary segments was performed. 105 patients were included (44 diabetes, 61 no diabetes). Prevalence of HCPs was not significantly different between patients with and without diabetes (3.6% vs. 3.8%, P = 0.854). However, patients with diabetes on insulin showed a lower prevalence of HCPs both at patient-based (7.1% vs. 26.4%, P = 0.116) and at segment-based analysis (1.2% vs. 4.2%, P = 0.020). When comparing HbA1c levels based on the presence or absence of healed plaque at the non-culprit lesions, patients with healed plaque showed significantly lower levels of HbA1c compared to patients without healed plaques (43.5 ± 12.1% vs. 61.2 ± 10.4%, P &lt; 0.001). At segment-based analysis, normal vessel structure, pathological intimal thickening (PIT), and spotty calcifications were significantly less prevalent in diabetic patients (2.1% vs. 5.1%, P = 0.001; 7.2% vs. 9.5%, P = 0.05; 9.9% vs. 13.6%, P = 0.02, respectively), whereas neovascularization was significantly higher (19.2% vs. 15.6%, P = 0.035).

Conclusions
Patients with diabetes have a distinct coronary non-culprit plaque phenotype. Healing capacity may be impaired in patients with advanced diabetes on insulin therapy and in those with a suboptimal control of the disease. Further prospective, larger scale studies are warranted to confirm these findings.
86 STEMI and multivessel disease: medical therapy amplifies the benefit of complete myocardial revascularization
Authors: Fabris Enrico , Pezzato Andrea , Gregorio Caterina , Barbati Giulia , Falco Luca , Stolfo Davide , Vitrella Giancarlo , Rakar Serena , Perkan Andrea , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularization strategies. However, the potential predictors of outcomes on top of different revascularization strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularization strategies and the potential impact of medical therapy.

Methods and results
Using a propensity score approach, the impact of two treatment strategies was analysed—staged non-culprit revascularization group vs. culprit-lesion-only percutaneous coronary intervention (PCI) group—on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularization. Moreover, models were further adjusted for medication at discharge. Among 1385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularization group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; P = 0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; P = 0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; P = 0.02). Use of renin–angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; P = 0.03), and both renin–angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; P = 0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; P = 0.01) were associated with lower all-cause death.

Conclusions
In a real-word STEMI population with multivessel disease, staged non-culprit revascularization was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularization and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularization.
649 Clinicians miss diagnosis: it wasn’t a tako-tsubo syndrome, nowadays it is a recurrent tako-tsubo syndrome
Authors: Angius Simone , Fazzini Luca , Balata Federico , Gioi Alessandra , Contini Francesca Valeria , Leoni Laura , Spissu Paolo Marco Pietro , De Angelis Alessandro , Meloni Luigi , Montisci Roberta 
Published: December 2021

Abstract

Aims
Tako-Tsubo syndrome is an usual form of acute cardiomyopathy characterized by reversible left ventricle apical ballooning which occurs in the absence of significant coronary artery disease. Rarely an increase in catecholamines due to pheochromocytoma could lead to Tako-Tsubo syndrome. Here we report a clinical case of undetected pheochromocytoma which led to Tako-Tsubo syndrome in an adult female patient.

Methods and results
A 60 years old female presented at our emergency department with chest pain, increase in cardiac troponin levels and hypo-akinesia of the apical segments at the echocardiography. She was admitted with acute coronary syndrome suspicious. He had history of acute coronary syndrome with non-obstructive coronary arteries (MINOCA) in the 2017. Coronary angiography performed at 24 h from admission, again showed non-obstructive coronary disease, whereby we reviewed the previous MINOCA diagnosis into recurrence Tako-Tsubo syndrome diagnosis. During hospitalization she presented parossistic sinus tachycardia refractory to beta-blocker and ivabradine combined therapy. Cardiac magnetic resonance was performed and confirmed Tako-Tsubo syndrome, furthermore showed a surrenalic mass. Contrast-enhanced abdomen computed tomography and high levels of metanephrines suggested pheochromocytoma diagnosis. One month later she underwent left surrenectomy surgery. Histological examination confirmed pheochromocytoma. The last echocardiography didn’t show kinesia abnormalities with normal left ventricular function.

Conclusions
Our case illustrates the importance of understanding the correlation between Tako-tsubo syndrome and pheochromocytoma, especially in patients with increased activity of the sympathetic nervous system. Until recently, according to Tako-Tsubo syndrome Mayo Clinic criteria, our patient wouldn’t had receive a Tako-Tsubo syndrome diagnosis because pheochromocytoma was an exclusion criteria. Since 2018, Inter-TAK criteria replaced Mayo Clinic criteria including Tako-Tsubo syndrome expression of pheochromocytoma. Referring to our annoying title we always have to consider Tako-Tsubo syndrome into MINOCA differential diagnosis.