bluuebunny/crossref_metadata_2025_split huggingface dataset:
191 Prognostic value of amyloid beta (1–40) in patients with acute myocardial infarction
Authors: Gagno Giulia , Janjusevic Milijana , Fluca Alessandra Lucia , Beltrami Antonio Paolo , Sinagra Gianfranco , Aleksova Aneta 
Published: December 2021

Abstract

Aims
Patients who have survived acute myocardial infarction (AMI) are at higher risk of developing several cardiovascular complications during follow-up and, unfortunately, appropriate risk stratification remains a major challenge. Amyloid-β 1–40 [Aβ (1–40)] has already emerged as a prognostic biomarker of cardiovascular mortality among patients with stable coronary heart disease due to its pathophysiological vascular inflammation properties.

Methods and results
The relationship between plasma Aβ (1–40) concentrations and follow-up outcome was examined in a large prospective cohort of patients hospitalized for AMI (NSTEMI or STEMI). Total RNA was extracted from peripheral blood mononuclear cells (PBMC) to assess the expression levels of BACE1 and BACE1-AS. A total of 894 subjects (607 patients with STEMI and 287 patients with NSTEMI) were included in this study. The median plasma Aβ (1–40) concentration at admission was 96.59 (60.94–134.5) pg/ml. During the 83 month follow-up, 123 patients died and 78 patients developed HF. Higher Aβ (1–40) concentrations were able to predict an increased mortality risk during follow-up. In addition, in the cohort of patients older than 67 years, the plasma concentration of Aβ (1–40) strongly correlated with an unfavourable outcome, whereas in the cohort younger than 67 years did not.

Conclusions
This is the largest single centre study investigating the role of plasma Aβ (1–40) concentration in predicting patient outcomes after AMI both STEMI and NSTEMI. Our data show a strong correlation between plasma Aβ (1–40) levels and mortality risk during follow-up. In addition, we confirmed a correlation between age and plasma Aβ (1–40) concentration, noting that Aβ (1–40) values are an incremental risk factor in relation to age for adverse outcomes.
686 Coronary lesion distribution in young patient presenting with acute coronary syndrome
Authors: Franzino Marco , Pistelli Lorenzo , Parisi Francesca , De Santis Giulia Azzurra , Nicolò Claudio , Andò Giuseppe , Virga Vittorio , Vizzari Giampiero , Saporito Francesco , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Costa Francesco 
Published: December 2021

Abstract

Aims
The distribution of coronary lesions in young patients presenting with acute coronary syndrome (ACS) is not known.

Methods and results
We included 82 consecutive young patients (≤45 years at presentation) with ACS and obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Significant coronary lesions (&gt;50%) at each segment during coronary angiography were evaluated. A total of 158 lesions have been evaluated. Multivessel disease was observed in 37% of patients. Lesions at proximal and mid left anterior descending (LAD) coronary artery were the most common observation (Figure A). Roughly one in three lesions affected a proximal coronary segment (i.e. segment 1, 5, 6, or 11), and 45.1% of patients presented at least one lesion in these segments. Within each segment, lesions affected the ostium in 15.8%, proximal third in 26.8%, mid-third in 32.9%, and distal-third in 15.9% of cases. Among those presenting with ST-segment elevated myocardial infarction, culprit lesion distribution is presented in Figure B. Proximal segments were affected in 33.9%, while culprit lesion of the LAD, left circumflex, and right coronary artery was observed in 51.8%, 16.1%, and 32.1% respectively.

Conclusions
In conclusion, coronary artery disease in patients presenting with ACS occur more often in the LAD and in proximal coronary segments. A significant lesion in a proximal coronary segment affected roughly half of young patients presenting with ACS.
634 Long term prognostic effect of lipoprotein in patients with and without diabetes mellitus after myocardial infarction
Authors: Tedeschi Michele , Cancro Francesco Paolo , Busiello Marco Maria , Butrico Valentina , Torre Marco , Cristiano Mario , Sabatino Mariano , Romei Stefano , Settembre Emanuela , Alfano Antonia , Vecchione Carmine , Galasso Gennaro 
Published: December 2021

Abstract

Aims
The aim is to describe the baseline clinical, laboratory, and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoproteina [Lpa] serum level on long-term outcome in this very high-risk population.

Methods and results
This was a retrospective, single-centre, study including consecutive patients admitted with MI diagnosis between 1 January 2017 and 31 December 2020. The availability of data on baseline Lpa serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lpa value of 50 mg/dl was used to test the hypothesis of a different effect of Lpa on the clinical outcome of patients with or without DM. The primary study outcome was all-cause death at 3-year follow-up. The study population included 997 patients (mean age 63.7 ± 13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8 ± 12.1 vs. 62.0 ± 13.7 years, P &lt; 0.001) and showed a significantly higher prevalence of dyslipidaemia, hypertension, obesity, prior MI, and prior coronary revascularization (P &lt; 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, P &lt; 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, P = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lpa ≥ 50 mg/dl showed a significantly lower long-term survival compared with those with Lpa &lt; 50 mg/dl (Log-Rank = 0.004). In DM patients, conversely, no survival difference was found between patients with Lpa ≥ 50 mg/dl vs. those with Lpa &lt; 50 mg/dl. At multivariable Cox regression analysis, in patients without DM, Lpa serum level (HR: 2.68, 95% CI: 1.23–5.83; P = 0.013) and age (HR: 1.06, 95% CI: 1.04–1.09; P &lt; 0.001) were independent predictors of mortality at 3-year follow-up. Among DM patients, only age was independently associated with 3-year mortality (HR: 1.07, 95% CI: 1.03–1.10; P &lt; 0.001) (Table).

Conclusions
In this MI population, Lpa was independently associated with long-term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lpa on clinical outcome after MI requires confirmation by larger prospective studies.
189 Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease
Authors: Magnani Giulia , Bricoli Serena , Ardissino Maddalena , Maglietta Giuseppe , Nelson Adam , Tagliazzuccchi Guidoantonio Malagoli , Disisto Caterina , Celli Patrizia , Ferrario Maurizio , Canosi Umberto , Cernetti Carlo , Negri Francesco , Merlini Piera Angelica , Tubaro Marco , Berzuini Carlo , Manzalini Chiara , Ignone Giancarlo , Campana Carlo , Moschini Luigi , Ponte Elisabetta , Pozzi Roberto , Fetiveau Raffaella , Buratti Silvia , Paraboschi Elvezia , Asselta Rosanna , Botti Andrea , Tuttolomondo Domenico , Barocelli Federico , Biagi Andrea , Bonura Rosario , Moccetti Tiziano , Crocamo Antonio , Benatti Giorgio , Paoli Giorgia , Solinas Emilia , Notarangelo Maria Francesca , Moscarella Elisabetta , Calabrò Paolo , Duga Stefano , Niccoli Giampoalo , Ardissino Diego 
Published: December 2021

Abstract

Aims
Data regarding long-term prognosis of MINOCA are very limited and conflicting.

Methods and results
The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26), but the rates of CV death (6.2% vs. 8.4%; adj. HR: 0.26, 95% CI: 0.08–0.86; P = 0.03) and coronary revascularization (6.7% vs. 27.7%; HR: 0.27, 95% CI: 0.15–0.47; P &lt; 0.001) were lower in the MINOCA group.

Conclusions
MINOCA is frequent in early-onset MI patients and is not benign with a long-term risk of MACE and overall mortality not significantly different from that of the MICAD patients.

189 Figure 1 Composite primary endpoint of CV death, non-fatal MI, and non-fatal stroke
232 A multidisciplinary case of multiple myeloma with cardiac and renal involvement: a look beyond amyloidosis
Authors: Bacchi Beatrice , Cappelli Francesco , Perfetto Federico , Allinovi Marco , Innocenti Samantha , Antonioli Elisabetta , Marchionni Niccolò , Di Mario Carlo , Stefano Pier Luigi 
Published: December 2021

Abstract

Aims
Multiple myeloma (MM) is a malignant neoplasm with a frequent cardiac involvement characterized by restrictive cardiomyopathy. Kidney and thromboembolic complications are also described.

Methods and results
A 52-year-old woman with a history of kidney disease was admitted to nephrology department due to worsening of renal function and refractory hypertension. A bone marrow biopsy revealed the diagnosis of MM. A renal and fat pad biopsy with Congo red staining was performed but amyloid deposition was not observed. Increased cardiac enzymes suggested a cardiac involvement. Indeed, two intracardiac right-sided masses and massive pulmonary embolism were detected. Surgical cardiac intervention was promptly performed and a chemotherapy regimen was started. Meantime, a kidney biopsy revealed a light-chain deposition disease.

Conclusions
This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, in patients with not acute massive pulmonary embolism and intracardiac right masses, surgical pulmonary embolectomy should be promptly performed to preserve RV function and to avoid prevent pulmonary hypertension development.
274 Cerebrovascular events in takotsubo syndrome: short- and long-term outcome. Results from a multicentre-prospective registry
Authors: Leopizzi Alessandra , Santoro Francesco , Mallardi Adriana , Vitale Enrica , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients. The aim of the study is to evaluate rates of in hospital and long-term Follow-up events in TTS patients with history or acute cerebrovascular events (CVE).

Methods and results
395 consecutive patients were enrolled in a multicentre prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow-up events of all patients were evaluated. Prevalence of cerebrovascular events among TTS patients was 9.4% (num = 37). Compared to the control group, these patients were older (80 ± 7 vs. 71 ± 12, P = 0.01) and predominantly men (24% vs. 9%, P = 0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups. The prevalence of physical stressor was higher in the CVE group (67% vs. 44% P = 0.01). The incidence of in-hospital adverse events was higher in the CVE than in the control one (70% vs. 29%), mainly driven by higher rate of Cardiogenic shock (19 vs. 8% P = 0.01) and in-hospital death (19 vs. 4%, P = 0.01). At long-term follow-up, patients in CVE group hat higher mortality rate (38% vs. 20% P = 0.01)). Patients presenting with acute CVE, 10 out of 37 patients (27%) when compared with chronic CVE had higher in-hospital mortality (40% vs. 11% P = 0.01).

Conclusions
TTS patients with history or acute cerebrovascular events had higher rate of in-hospital events and death at long-term follow-up. Acute cerebrovascular events in the setting of TTS are featured with worst prognosis.
516 Prevalence of carpal tunnel syndrome in patients with transthyretin cardiac amyloidosis
Authors: Trimarchi Giancarlo , Perna Alessia , Zampieri Mattia , Argirò Alessia , Runinski Robert , Cappelli Francesco , Di Bella Gianluca 
Published: December 2021

Abstract

Aims
Carpal tunnel syndrome (CTS) represents an important red flag for transthyretin (ATTR) cardiac amyloidosis (CA). However, no large studies have investigated the prevalence of CTS in wild type ATTR (wtATTR) and hereditary ATTR (hATTR). To investigate the prevalence of CTS in patients with ATTR-CA, both wild type and hereditary, differentiating between monolateral and bilateral carpal tunnel syndrome.

Methods and results
381 patients, 308 male and 73 female, with a definite diagnosis of ATTR CA have been evaluated. Among these, 230 patients with diagnosis of wild-type ATTR (wtATTR) and 151 patients with hereditary ATTR (hATTR) were identified. Patients with diagnosis of hATTR are sorted according to phenotype in cardiologic (43 patients) and mixed when both cardiologic and neurologic phenotype are observed (108 patients). Patients with neurological phenotype without CA were excluded. Overall, CTS is present in 57.6% of ATTR patients; A higher prevalence (P &lt; 0.05) of CTS was observed in wtATTR (61.6%) respect to hATTR (51.7%). Monolateral isolated CTS is significantly frequent (P &lt; 0.05) in patients with hATTR (35.1%) than in wtATTR (12.7%), on the contrary bilateral CTS is significantly more frequent (P &lt; 0.05) in patients with wtATTR (48.5%) than in hATTR (16.6%). Among patients with hATTR, of the 43 patients with cardiologic phenotype, 18 patients (41.9%) have diagnosis of CTS, subdivided in 28% with monolateral CTS and 72% with bilateral CTS. Among hATTR patients with mixed phenotype, 55.6% have diagnosis of CTS, subdivided in 80% with monolateral isolated CTS and 20% with bilateral CTS. Among 151 patients with hATTR, monolateral isolated CTS is significantly more present in patients with mixed phenotype (80% vs. 27%, P &lt; 0.001) while bilateral CTS is significantly more frequent in patients with cardiologic phenotype (72.2% vs. 20%, P &lt; 0.001).

Conclusions
CTS particularly with bilateral involvement is a common finding in wtATTR patients than in hATTR patients. On the contrary, monolateral isolated CTS is significantly more frequent in patients with hATTR than in wtATTR. Among patients with hATTR, bilateral CTS is significantly more frequent in patients with cardiologic phenotype than mixed phenotype while monolateral isolated CTS is significantly more present in patients with mixed phenotype.
280 Role of the electrocardiogram in differentiating genotype positive dilated cardiomyopathy from cardiac remodelling in athletes
Authors: Zaffalon Denise , Papatheodorou Efstathios , Merghani Ahmed , Dhutia Harshil , Moccia Eleonora , Malhotra Aneil , Miles Christopher J. , Attard Virginia , Homfray Tessa , Sharma Rajan , Gigli Marta , Dal Ferro Matteo , Merlo Marco , Papadakis Michael , Sinagra Gianfranco , Sharma Sanjay , Finocchiaro Gherardo 
Published: December 2021

Abstract

Aims
Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). The aim of this study was to investigate the role of the ECG in differentiating between physiological and pathological remodelling.

Methods and results
The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter &gt; 62 mm and/or LV ejection fraction between 45% and 50%. The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n = 14, 47%), lateral TWI (n = 6, 20%), ventricular ectopic beats (n = 5, 17%) and anterior TWI (n = 4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% [confidence interval (CI: 54–88%), 93% (CI: 78–99%), and 0.83 (CI: 0.71–0.92), respectively.

Conclusions
While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.
342 Cardiorespiratory fitness and systemic vascular resistance: oxygen pressure as a novel marker of peripheral vascular response during cardiopulmonary exercise testing
Authors: Centorbi Claudio Stefano , Lazzeroni Davide , Moderato Luca , Bini Matteo , Brambilla Lorenzo , Brambilla Valerio , Camaiora Umberto , Geroldi Simone , Meloni Luigi , Coruzzi Paolo , Piepoli Massimo , Ardissino Diego , Niccoli Giampaolo 
Published: December 2021

Abstract

Aims
The key role of systemic vascular resistance (SVR) in cardiovascular performance during exercise has been invasively demonstrated, however no data have been non-invasively obtained by analysing SVR response using cardiopulmonary exercise testing (CPET). To investigate the relationship between SVR at peak, maximum oxygen uptake (VO2 peak), and its determinants using CPET.

Methods and results
1130 consecutive subjects were enrolled; according to physiology, SVR was determined as the ratio between mean arterial pressure (MAP) and cardiac output (CO). A novel parameter, named oxygen pressure (MAP peak/VO2 peak) was also created. Mean age was 61 ± 12 years and male gender was prevalent (61%); 66% of patients had arterial hypertension, 74% dyslipidaemia, 19% diabetes, 20% had smoking habit, and 26% previous history of cardiovascular (CV) disease. Significant inverse correlations between SVR peak and VO2/kg peak (P &lt; 0.001), oxygen pulse (P &lt; 0.001), CV efficiency (P &lt; 0.001), chronotropic response (P &lt; 0.001), and oxygen uptake exaction slope (P &lt; 0.001) were found. Moreover, positive correlation between SVR peak and VE/VCO2 slope (P &lt; 0.001) was observed. After multivariate analysis, the inverse correlation between peak SVR and peak VO2 remained significant (P &lt; 0.001). Similar results were found considering oxygen pressure.

Conclusions
Low values of SVR at peak exercise, non-invasively evaluated with CPET, are associated with high levels of cardiorespiratory fitness. Oxygen pressure may represent a novel and simple CPET marker of peripheral vascular response to exercise, thereby representing a promising field of research in exercise medicine.
5 Early diagnosis of coronary artery disease in postmenopausal women by arterial stiffness assessment
Authors: Maiello Maria , Zito Annapaola , Ciccone Marco Matteo , Palmiero Pasquale 
Published: December 2021

Abstract

Aims
Arterial stiffness is a marker of cardiovascular disease useful to identify, at an early stage, subjects with increased risk of cardiovascular artery diseases (CADs). Nevertheless, studies on gender-specific interactions of PWV and CAD are lacking. Therefore, the aim of this study is to investigate, in a population of postmenopausal women, the role of PWV in relation to CAD. The goal of our study was to assess the prevalence of CAD, among postmenopausal women affected by increased arterial stiffness, assessed by global pulse wave velocity (gPWV), and with diabetes and/or hypertension on target, distinguishing the different phenotypes.

Methods and results
We enrolled 632 consecutive women with an increased gPWV, 300 consecutive postmenopausal women with normal gPWV were included as control group (CG). We assessed arterial stiffness by gPWV, performed by pulsed Doppler (3.5 MHz probe) using two-dimensional guidance and ECG trigger. Philips Epiq 7 was used which is an echo-Doppler system equipped with a multifrequency transducer. The gPWV was assessed as normal for a velocity equal or lower than 7.1 m/s. CAD diagnosis was accepted when confirmed by exercise or nuclear stress test, cardiac catheterization, and angiogram or cardiac CT scan. All women were on therapy, with blood pressure &lt; 130/80 mmHg and HbA1c &lt; 7%. 55 (8.8%) women were affected by CAD among 632 with increased gPMW, and 15 (5%) among 300 women of CG, P &lt; 0.04. There was no difference for mean age between the two groups: 58 ± 11 and 56 ± 8, respectively, P = 0.2. 29 (4.5%) women were affected by CAD and hypertensive cardiomyopathy among 632 with increased gPMW, and 6 (2%) among 300 women of CG, P &lt; 0.05. 16 (2.6%) women were affected by CAD and metabolic cardiomyopathy among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P &lt; 0.05. Seventeen (2.7%) women were affected by CAD alone among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P &lt; 0.04.

Conclusions
We found a higher prevalence of CAD among postmenopausal women with increased gPWV when affected by hypertension and/or diabetes, also if on target therapy; the statistically significant correlation is confirmed also when women are affected by hypertensive or metabolic cardiomyopathy. We conclude that early detection increased gPWV may identify women with higher risk to develop CAD also before they become symptomatic.