bluuebunny/crossref_metadata_2025_split huggingface dataset:
10 Pharmacodynamic profiles of aspirin versus dual-pathway inhibition with either aspirin or clopidogrel among patients with stable atherosclerotic disease
Authors: Galli Mattia , Franchi Francesco , Rollini Fabiana , Been Latonya , Jaoude Patrick , Rivas Andrea , Zhou Xuan , Jia Sida , Maaliki Naji , Lee Chang , Pineda Andres , Suryadevara Siva , Soffer Daniel , Zenni Martin , Jennings Lisa , Bass Theodore , Angiolillo Dominick J 
Published: December 2021

Abstract

Aims
Inhibition of thrombin-mediated signalling processes using a vascular dose of rivaroxaban in adjunct to single antiplatelet therapy, known as dual-pathway inhibition (DPI), reduces atherothrombotic events in patients with stable atherosclerotic disease. However, there is limited data on the pharmacodynamic (PD) effects of this strategy.

Methods
This investigation was conducted in selected cohorts of patients (n = 40) with stable atherosclerotic disease enrolled from a larger prospective, open-label, parallel-group PD study who were treated with either aspirin, aspirin plus rivaroxaban 2.5 mg/bid or clopidogrel plus rivaroxaban 2.5 mg/bid. Multiple PD assays providing a comprehensive assessment of markers of thrombosis were used. The primary endpoint was the comparison between groups of platelet-mediated global thrombogenicity by light transmittance aggregometry (LTA) following stimuli with collagen-related peptide + adenosine diphosphate + tissue factor (CATF).

Results
There were no differences in the primary endpoint between aspirin vs. aspirin plus rivaroxaban 2.5 mg/bid (P = 0.110), aspirin vs. clopidogrel plus rivaroxaban 2.5 mg/bid (P = 0.611) or aspirin plus rivaroxaban 2.5 mg/bid vs. clopidogrel plus rivaroxaban 2.5 mg/bid (P = 0.315). Rivaroxaban-based treatments significantly reduced markers of thrombin generation (peak thrombin and thrombin velocity index). Clopidogrel-based treatments reduced markers of P2Y12 signalling (LTA ADP 20 max and VerifyNow). Aspirin-based treatments reduced markers of markers of cyclooxygenase-1 activity (LTA collagen).

Conclusions
Compared with aspirin alone, DPI with either aspirin or clopidogrel might provide superior ischaemic protection by targeting pathways alternative to those affected by antiplatelet agents with only a moderate trade-off in bleeding as supported by similar platelet-mediated global thrombogenicity between treatments.
167 Right ventricular involvement in breast cancer patients undergoing chemotherapy
Authors: Ferri Luisa , Bergamini Corinna , Springhetti Paolo , Niro Lorenzo , Cerrito Luca Felice , Schiavone Arianna , Porto Marta Dal , Setti Elisa , Benfari Giovanni , Rossi Andrea , Fiorio Elena , Ribichini Flavio Luciano 
Published: December 2021

Abstract

Aims
Trastuzumab (TZ) and Anthracyclines (AC) are widely used for their key role in breast cancer. However, they may have different side effects on the cardiovascular system. One of the most concerning complications is myocardial dysfunction. Many studies have highlighted the importance of the screening for cardiotoxicity using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Nevertheless, there is little data about the right ventricular (RV) involvement. Aim of this study is to analyse the modification of RV systolic function in this setting.

Methods
One hundred and five women affected by HER-2 positive breast cancer treated with TZ referring to our echo-lab were enrolled in our single centre prospective study. Three patients were excluded due to an early TZ suspension not related to cardiovascular complications, thus 102 patients (97.1%) were eligible for analyses. Eighty-six of these (84.3%) were treated also with AC. All patients underwent consecutive transthoracic echocardiography (TTE) before starting TZ and then every 3 months up to 12 months. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software. A complete clinical evaluation was also performed at each Follow-up. LV systolic dysfunction was defined as an absolute reduction of LVEF &gt;10% from baseline to LVEF &lt; 53% or a relative reduction of GLS &gt;15% from baseline and an absolute reduction of LVEF &gt;10% from baseline. RV systolic dysfunction was defined as TAPSE &lt;17 mm, pulsed doppler S wave &lt;9.5 cm/s and/or RV free wall strain &lt;20%.

Results
LV systolic dysfunction occurred in 11 patients (10.8%). TAPSE and pulsed doppler S wave remained within the normal limits in all patients at Follow-up. On the contrary, RV free wall strain was reduced in 11 patients (10.8%), none of whom reported symptoms or signs of right-sided heart failure; 5 of these (45.5%) also presented LV dysfunction. LV and RV systolic dysfunction occurred mainly at the same time.

Conclusions
Cancer treatment also appears to impact on right chamber myocardium. RV free wall strain analysis seems more reliable in detecting RV systolic dysfunction rather than clinical examination or common echocardiographic parameters, such as TAPSE or pulsed doppler S wave, in the setting of patients with breast cancer treated with chemotherapy. However, further studies are needed to investigate its prognostic role.
7 DOACs: a new skyline in cancer-associated thrombosis resistant to heparin. A clinical case of seminoma in BEP chemotherapy protocol solved with edoxaban
Authors: Fioretti Agnese Maria , Leopizzi Tiziana , Sarcinella Gianvito , Giotta Francesco , Lorusso Vito , Oliva Stefano 
Published: December 2021

Abstract

Aims
TEV is a common cancer complication with 20% incidence. LMWH is the standard therapy for efficacy, safety and ease of use. However, some scenarios are deeply challenging for intercurrent prothrombotic anticancer drugs.

Methods
A 35-year-old man reported dysphagia, EGDS: oesophagus ulcers, thyroid echography: thoracic mass compressing proximal borders. Vascular ultrasound: thrombosis of left internal giugular, subclavian, axillary and brachial veins; he began enoxaparin 6000 IU ×2/die (65 kg). CT-scan: solid anterior–superior mediastinum vascularized mass (16 × 13 cm) incorporating great thoracic vessels with 20 cm cranio-caudal longitudinal extension with trachea dislocation. PET-CT: massive superior-anterior mediastinum pathological 18F-FDG accumulation suggestive for malignancy. Lung perfusion scan: absence of left lung perfusion. Angio-CT: showed compression of pulmonary artery trunk and of branches. He presented marked asthenia, sweating and presyncope. D-dimer: 6026 µg/L, NT-proBNP: 1417 pg/mL. Mediastinum biopsy exhibited seminoma (ki67+: 65%), he started BEP Protocol (etoposide, cisplatin, bleomycin). TTE: periaortic cuff from mediastinum mass which ab extrinseco compressed pulmonary artery trunk and branches with occlusion of left one, right chambers dilatation, sovra-epatic veins and inferior vena cava (21 mm) ectasia, decreased inspiratory collapse, pulmonary hypertension (SPAP: 52 mmHg), EF: 55%. After 2 months of enoxaparin, vein ultrasound: persistent DVT and positive CUS. So, we replaced enoxaparin with edoxaban 60 mg/die. After 2 months of edoxaban, overall regression of vein thrombosis with minimal residual thrombosis of left internal giugular vein; D-dimer: 1554 µg/L.

Results
After 2 months of BEP Protocol, CT-scan: decrease mediastinum mass (6 × 12 cm) dimensions.

Conclusions
Cancer associated thrombosis is a frequent complication, worsening mortality, morbidity and decision-making. Cancer stage and drugs favour development of severe thrombosis, not solvable with LMWH, the cornerstone of anticoagulant therapy in cancer-related thrombosis. DOACs appear as a new and successful therapeutical option, especially in the most challenging cases of highly thrombotic profile after ‘heparin failure’.
785 Sodium–glucose cotransporter 2 inhibitors in real-life patients at high cardiovascular risk
Authors: Cesaro Arturo , Fimiani Fabio , Gragnano Felice , Moscarella Elisabetta , Signore Giovanni , Maratea Anna Chiara , Rotolo Francesco Paolo , Vergara Andrea , Schiavo Alessandra , Calabrò Paolo 
Published: December 2021

Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), were recently approved in the USA and the EU for the treatment of adults with symptomatic heart failure with reduced ejection fraction (HFrEF). These drugs currently play a prominent role in the treatment algorithm for HFrEF [ejection fraction ≤40%], and international guidelines considered they as first-line drugs. However, data on the use of SGLT2i in real-world practice lack. We aim at providing data on SGLT2i in high cardiovascular risk patients in the real-world setting.
We have retrospectively evaluated high cardiovascular risk patients treated with SGLT2i according to Italian national regulation, and collected 1-year outcomes. The primary objective of the study is to generate real-world data about clinical characteristics, major adverse cardiovascular events (MACE), hospitalizations for heart failure, and adverse event in patients receiving canagliflozin, empagliflozin, dapagliflozin, ertugliflozin from our cohort. Ninety-three patients with diabetes treated with SGLT2i were retrospectively enrolled. At 1-year follow-up, the rate of hospitalization was 10.7%, the MACE events occurred in 6.4% of patients; of these, 4.3% had a myocardial infarction, and 2.1% had a stroke/TIA, the rate of urinary tract infections was 5.3% while no major adverse event occurred.
In conclusion, in a real-world study including patients with high and very high cardiovascular risk, SGLT2i showed to be safe, with no major adverse events occurring at follow-up.
21 Direct oral anticoagulants vs. vitamin K antagonists in the treatment of left ventricular thrombosis: a systematic review and meta-analysis
Authors: Condello Francesco , Maurina Matteo , Chiarito Mauro , Sturla Matteo , Terzi Riccardo , Fazzari Fabio , Sanz-Sanchez Jorge , Cannata Francesco , Condorelli Gianluigi , Stefanini Giulio 
Published: December 2021

Abstract

Aims
Evidence about the use of direct oral anticoagulants (DOACs) in patients with left ventricular thrombosis (LVT) are emerging. The aim of our study was to provide a comprehensive synthesis of the available evidence concerning the clinical effects of DOACs vs. vitamin K antagonists (VKAs) in LVT treatment.

Methods
Systematic search of studies evaluating DOACs vs. VKAs use in patients with LVT was performed on 11 May 2021. Data were pooled by meta-analysis using a random-effects model. Odds ratios (OR) with relative 95% confidence intervals (CI) were used as measures of effect estimates. The primary efficacy and safety endpoint were ischaemic stroke and any bleeding, respectively. Secondary endpoints were LVT resolution, systemic embolism, major bleeding, haemorrhagic stroke, and all cause death.

Results
Twenty studies were included in the meta-analysis: 1391 patients were treated with DOACs and 1534 with VKAs. A significant reduction in the risk of ischaemic stroke [OR 0.67, 95% CI 0.45–0.98, P = 0.048, number needed to treat to benefit (NNTB) 22 (95% CI 15–43)] and any bleeding [OR 0.64, 95% CI 0.46–0.89, P = 0.009, NNTB 26 (95% CI 16–80)] was observed with DOACs compared to VKAs. No statistically significant difference was observed among the two treatment arms for the secondary endpoints.

Conclusion
Compared to VKAs, DOACs are associated with a reduced risk of ischaemic stroke and bleeding. In light of these findings, and the practical advantages of DOACs, additional large scale randomized controlled trials are needed to confirm the benefits of DOACs in patients with LVT.
398 Right ventricular cardiogenic shock induced by propafenone intoxication: a case report
Authors: Maurina Matteo , Bertoldi Letizia , Briani Martina , Chiarito Mauro , Reimers Bernhard , Corrada Elena 
Published: December 2021

Abstract

Aims
Propafenone is a Class 1C antiarrhythmic drug recommended in the treatment of supraventricular or ventricular tachycardia and paroxysmal atrial fibrillation (AF). Most common cardiological features associated with propafenone intoxication include heart failure and conduction disturbances while other clinical findings range from nausea and vomiting to seizures and coma.

Methods
We report a case of atypical presentation of propafenone intoxication occurred in 88-year-old woman who presented at Emergency Department with severe ECG abnormalities and prevalent acute right ventricular with massive tricuspidalic regurgitation and cardiogenic shock. The patient underwent urgent coronary angiography that revealed a stable 90% coronary plaque that was treated with a single stent and then brought to Intensive Care Unit where she was successfully treated with inotropic and mechanical circulatory support (intra-aortic balloon pump, IABP).

Results
The patient progressively achieved hemodynamic stability with complete ECG normalization and biventricular function recovery.

Conclusions
Our case further expands the vast spectrum of presentations of Class 1c antiarrhythmic drugs overdose. In an emergency setting it is difficult to rule out other causes of cardiogenic shock but propafenone toxicity needs to be suspected in every case of hemodynamic instability in patients in chronical treatment. Patients in chronical treatment with propafenone who have kidney or liver dysfunction might be at higher risk of drug accumulation: in such cases, the real utility of propafenone must be evaluated before therapy initiation.
136 Blood vortices analysis in children with Wolff–Parkinson–White syndrome
Authors: Borrelli Nunzia , Di Salvo Giovanni , Ciriello Giovanni Domenico , Grimaldi Nicola , Barracano Rosaria , Fusco Flavia , Merola Assunta , Correra Anna , Colonna Diego , Romeo Emanuele , Palma Michela , Scognamiglio Giancarlo , Russo Maria Giovanna , Sarubbi Berardo 
Published: December 2021

Abstract

Aims
Wolff–Parkinson–White syndrome (WPW) is a clinical condition characterized by pre-excitation on electrocardiogram (ECG) and symptoms of arrhythmias. It has been described that premature ventricular activation induces septal wall motion abnormalities and ventricular dyssynchrony, causing detrimental effects on cardiac performance. The new speckle-tracking-based technique, blood speckle imaging (BSI), has been previously used to evaluate blood flow characteristics in normal and dysfunctional hearts in patients with normal atrio-ventricular (AV) conduction. We aimed to study the features of left ventricle blood vortices in patients with WPW and short AV conduction by using BSI.

Methods and results
Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest WPW (WPW group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A complete echocardiographic evaluation with 2D, color Doppler, and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristics were analysed during the filling phase of the left ventricle. We focused on the anterior vortex generated by the mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. For each child in the WPW group, Arruda criteria were used to esteem accessory pathway localization from a 12-lead surface ECG. All patients in the WPW group manifested the accessory pathway in the septal region. All patients in the CTR group presented one major anterior vortex along the septal wall during the filling phase (Figure A), while in the WPW group, 10 patients out of 13 (P = 0.009) lacked this main anterior vortex, showing instead fragmented vortices (Figure B). Interestingly, the main differences in blood vortices pattern were showed in the last part of filling phase, when blood flow could be affected by premature activation of the septal wall. There were no differences in terms of left ventricle function (WPWg 59.8 ± 4.02% vs. CTRg 59.0 ± 2.5%, P = 0.6) and global longitudinal strain (WPWg −18.6 ± 1.0% vs. CTRg −19.6 ± 3.1%, P = 0.5) between the two groups. 136 Figure A and B

Conclusions
In our preliminary study, patients with WPW showed a fragmented pattern of diastolic blood vortices that adapted to septal dyssynchrony. We speculate this fragmentation may contribute to impair the performance of the left ventricle.
276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work
Authors: Ciriello Giovanni Domenico , Borrelli Nunzia , Di Salvo Giovanni , Sabatino Jolanda , Bucciarelli Valentina , Avesani Martina , Grimaldi Nicola , Barracano Rosaria , Fusco Flavia , Merola Assunta , Correra Anna , Romeo Emanuele , Colonna Diego , Palma Michela , Scognamiglio Giancarlo , Russo Maria Giovanna , Sarubbi Berardo 
Published: December 2021

Abstract

Aims
Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome.

Methods and results
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls.

Conclusions
WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.
535 Right ventricular dysfunction is independent predictor of in-hospital mortality in patients with low flow low gradient aortic stenosis
Authors: Peluso Angela Pamela , Ferruzzi Germano Junior , Attisano Tiziana , Migliarino Serena , Vigorito Francesco , Bellino Michele , Iuliano Giuseppe , Silverio Angelo , Cristiano Mario , Provenza Gennaro , Baldi Cesare , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Citro Rodolfo 
Published: December 2021

Abstract

Aims
Aim of the study is to assess the prevalence and in-hospital death in patients with low flow low gradient aortic stenosis (LFLG-AS) and right ventricular dysfunction (RVD) hospitalized for heart failure in a single referral centre.

Methods and results
Complete demographic, clinical characteristics, and imaging data were collected. Patients with LFLG AS hospitalized for heart failure were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient &lt; 40 mmHg, and stroke volume index &lt;36 ml/m2. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) &lt; 16 mm at baseline in apical four chamber view according to current guidelines. Patients were divided into two subgroups according to the presence or absence of RVD. In hospitals all cause death has been considered as the primary outcome. A total of 130 patients [78 ± 10 yy; 67 (51%) male] with new diagnosis of LF-LG AS were included in the study. The most frequent comorbidities were hypertension (88.5%; n = 114), dyslipidaemia (74%; n = 96), and diabetes (38%; n = 49). Concomitant coronary artery disease and history of stroke were reported in 19% (n = 24) and 9% (n = 11), respectively. Society of thoracic surgeons score in overall population was 12.6 ± 4.5. Regarding echocardiographic evaluation, the mean transaortic gradient was 25.81 ± 7.42 mmHg and the mean iAVA was 0.42 ± 0.10 cm/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. LFLG AS with a preserved LV EF was detected in 69 patients (53%) and the LFLG AS with a low LV EF was detected in 61 patients (47%). 26 patients (20%) underwent surgical valve replacement, 14 patients (11%) had aortic percutaneous valvuloplasty and 31 patients (24%) underwent TAVI. The remaining patients (45%, n = 59) were maintained under optimized medical therapy. In-hospital death occurred in 16 patients. When compared patients with RVD with those without a higher prevalence of atrial fibrillation/flutter (n = 21, 36%; P = 0.042) and in hospital death was observed (n = 8; 28%; n = 8, 8%; P = 0.026). In the overall population at multivariate regression analysis only RVD was a significant independent predictor of all-cause in-hospital death (P = 0.028; OR: 3.44; CI: 1.146–10.334).

Conclusions
RVD can be detected in more than one quarter of patient with new diagnosis of LFLG AS and is an independent predictor of all-cause in-hospital death. Quantification of right ventricular systolic function in these complex population give important information in identifying patients and higher risk requiring more aggressive therapy.