bluuebunny/crossref_metadata_2025_split huggingface dataset:
YOUNG WOMAN WITH LEFT VENTRICULAR DYSFUNCTION AND MITRAL LAMBL EXCRESCENCE: WHAT TO DO WHEN ISCHEMIC STROKE IS RECURRENT?
Authors: Facchini E , Maffè S , Ticozzi S , Paffoni P , Prenna E , Ariotti S , Bergamasco L , Franchetti Pardo N , Paino A , Dellavesa P 
Published: May 2024

Abstract
Lambl excrescence describing rare cardiac growths that develop at the valvular coaptation sites of the heart which are seen as a thin, hypermobile and filiform strand on an echocardiogram. These filiform strands can be noted in association with embolic stroke. Also heart failure (HF) and stroke frequently coexist because of an overlap of shared risk factors and subsequent mechanisms and a higher risk of stroke is present also in HF patients in sinus rythm (SR). The clinical case concerns a 54–year–old woman. In March 2020 she was admitted for ischemic stroke by occlusion of middle cerebral artery subjected to thrombolysis and mechanical thromboctomy. Electrocardiogram showed SR and left branch block. Echocardiogram and echocardiogram transesophageal showed left ventricular (LV) dysfunction (EF 40%) withouth clear presence of emboligen sources. Thrombophilic screening and neurological checks were negative. Single antiaggregant therapy has been started. New hospitalization in October 2023 for recurrent ischemic stroke. Echocardiogram showed worsening of LV dysfunction (EF 20%). Transesophageal echocardiogram showed the presence of a filiform filament on the mitral leaflets on the atrial side (Fig 1) without the presence of intracavitary thrombi. Coronary TC angiography (Fig 2) was negative. Cardiac magnetic resonance (Fig 3) confirmed reduced ejection fraction and showed subepicardial late gadolinium enhancement in lateral wall. There are no clear evidence–based guidelines for the treatment of Lambl excrescences. When associated with stroke, an exhaustive stroke workup to identify the potential cause of stroke should always be undertaken. If the workup remains negative without any identifiable cause, then the patients can be treated with antiplatelet agents such as aspirin and clopidogrel or anticoagulation with warfarin. Also the indication to antithrombotic strategies in patients with HF, SR and stroke is controversial. There are no data to support a routine strategy of anticoagulation in patients with HF with LV dysfuncion in SR who do not have history of paroxysmal atrial fibrillation (ESC 2022 HF guidelines). So which therapy to start in young patient, with recurrent strokes, heart failure /severe LV dysfunction and mitral lambl excrescence? Oral anticoagulant? Double platelet antiaggregation? Oral anticoagulant and single platelet antiaggregation? Definitely the choice is not simple but we decided to start warfarin and continue follow–up.
CLINICAL BENEFITS OF ADVANCED ALGORITHMS IN HEART FAILURE MANAGEMENT IN PATIENTS UNDERGOING CARDIAC CONTRACTILITY MODULATION DEVICE IMPLANTATION
Authors: Floris R , Demontis M , Orru F , Marongiu M , Casula M , Sirigu F , Pippia V , Mule M , Delogu G 
Published: May 2024

Abstract

Introduction
A 71–year–old man, diagnosed with primary dilated cardiomyopathy and severe left ventricular dysfunction (LVDTD 60 mm, LVEF 20%), exhibited normal right ventricular function (RVDTD 36 mm, TAPSE 21 mm, RV S’ TDI 11 cm/s), and moderate mitral regurgitation. In early 2019, he was hospitalized for heart failure and underwent the implantation of a biventricular defibrillator for primary prevention, activating a multiparametric algorithm for heart failure management. At discharge, maximal pharmacological therapy was confirmed. Since September 2022, the heart failure synthetic index exceeded the critical threshold, reaching a value of 17, triggering a remote monitoring alert necessitating an increase in diuretic therapy. Despite a few months of clinical stability, in December 2022, he reported a progressive reduction in functional capacity, confirmed by an increase in the heart failure index.

Diagnosis and Management
Due to the onset of NYHA class III symptoms in February 2023, the patient was hospitalized. An echocardiogram revealed a continuous decline in right ventricular function (TAPSE 12 mm, RV S’ TDI 6 m/s). He underwent four biweekly infusions of Levosimendan, resulting in a transient clinical improvement. In March 2023, a device for modulating cardiac contractility was implanted without acute complications (Fig.1). Two months post–implantation, a progressive improvement in clinical conditions was observed, accompanied by a gradual decline in the heart failure index returning to baseline values (Fig.2). The echocardiogram showed stable left systolic function and a significant improvement in right ventricular functional indices (Fig.3). Since May 2023, the patient has not required Levosimendan infusion, maintaining a stable NYHA class II.

Conclusion
Cardiac contractility modulation proves to be an effective method in managing heart failure, reducing symptoms, and preventing hospitalizations. Improved patient management is evident with reduced volumes and enhanced contractile capacity of the right ventricle. The use of advanced algorithms integrated with defibrillation devices allows for the assessment of the method‘s efficacy even remotely
SGLT2i IN THE REAL WORLD: DATA FROM THE PONTE (bridge) HF PROJECT (PDTA FOR INTEGRATED TERRITORY HOSPITAL FOLLOW-UP OF PATIENTS WITH HEART FAILURE)
Authors: De Gennaro L , Grande D , Bulzis G , Carbonara R , Cataneo L , Correale M , De Masi De Luca G , Di Stolfo G , Ferraretti A , Galgano G , Gioia M , Leone M , Malerba L , Marazia S , Minielli V , Petruzzi P , Potenza A , Lamacchia O , Iacoviello M , Caldarola P 
Published: May 2024

Abstract

Background
Over the last few years, treatment with sodium glucose cotransporter 2 inhibitors (SGLT2i) dapaglifozin and empaglifozin was shown to reduce the combined risk of cardiovascular death and/or hospitalization for heart failure (HF) among patients with heart failure with reduced ejection fraction. Subsequent RCTs have demonstrated similar reduction in the combined endpoint also in patients with left ventricular ejection fraction (LVEF) &gt;40%. Nevertheless, real world data on the current state of implementation of SGLT2i therapy in HF clinical practice are scarce.
The aim of the study was therefore to evaluate the impact of SGLT2i treatment in a real world population of HF patients.

Methods
527 consecutive patients with HF, treated with SGLT2i and with 6 months of follow-up already enrolled in the PONTE (PDTA FOR THE INTEGRATED FOLLOW-UP IN THE HOSPITAL TERRITORY OF THE PATIENT WITH HEART FAILURE) HF project, a care model implemented in Puglia region (Italy) based on hospital-territory integration aimed at the optimized management of patient with HF after hospitalization, were considered for the study.
Demographic, clinical, laboratory and instrumental characteristics, changes in NYHA class, creatinine, NT-proBNP, medications, LVEF after initiation of therapy with SGLT2i were evaluated.

Results
The 527 enrolled patients (mean age of 67,40 years, 75% hypertensive, 39% diabetic, 51% ischemic heart disease, 52% with ICD, 35% with atrial fibrillation) were in NYHA class I in 3,2% of cases, class II in 56,6%, class III in 38,5%, class IV in 1,7%. Mean LVEF was 34,20% (63% of patients had LVEF &lt;35%), NT-proBNP 2606,86 pg/ml, creatinine 1,19 mg/dl. 95,1% of patients was on treatment with beta-blockers, 52,7% with ACE inhibitors, 55,1% with ARNI.
After a follow-up of 6 months, a reduction of patients in NYHA classes III+IV from 40,2 to 19,0% as well as an increase in patients in classes I+II from 59,8 to 81,0% (NYHA I increasing from 3,2 to 14,6%) were observed. Furthermore, mean LVEF increased from 34,20 to 37,68% and patients taking loop diuretics reduced from 83,9 to 77,4%. Creatinine remained stable (1,19 vs 1,21 mg/dl), while NT-proBNP lowered from 2606,86 to 1603,32 pg/ml.

Conclusions
Our real world data on SGLT2i in HF patients seem to confirm the efficacy of this class of drugs in a short term follow-up, with a positive effect on symptoms (improvement in NYHA class and fewer patients taking loop diuretics), NT-proBNP and LVEF.
IMPROVE THE EFFECTIVENESS OF PREDICTIVE MODELS FOR LENGTH OF HOSPITAL STAY (LOS) BY ADDING ELECTRONIC HEALTH RECORDS DATA: A RETROSPECTIVE STUDY IN PATIENTS WITH HEART FAILURE
Authors: Cocchieri A , Cesare M , Magliozzi E , Damiani G 
Published: May 2024

Abstract

Background
Length of hospital stay (LOS) is considered a key process that has a clinical, economic, and organizational impact representative of the quality of care. In particular, in patients with heart failure (HF), which is a life–threatening multifactorial syndrome and a major public health problem, when a prolonged LOS (PLOS) occurs, frequent readmission and high mortality are common, with worrying consequences for health systems. Although the LOS is often explained by standard medical data (e.g., comorbidities), it may depend on many other patient characteristics. Therefore, considering additional elements collected in electronic health records (EHRs) could be crucial to predict the occurrence of a LOS and correctly estimating this risk. The aim of this study is to demonstrate the predictive power of clinical and organizational data collected through an EHR on LOS in HF patients.

Methods
A descriptive, retrospective study was conducted in an Italian university hospital. Data related to HF inpatients consecutively admitted across 1 year were collected from the hospital’s HER. PLOS was defined as a stay ≥ 14 days. Sociodemographic data, administrative data, and clinical data (such as the number of active medical problems, the number of medications, frailty, and nursing dependency), were tested in a predictive model as potential determinants of LOS.

Results
A total of 608 HF patients were included. The mean age of patients was 76 ± 13.06 years (range: 23–102); 61.5% were male. Prolonged LOS was found in 25.2% of patients. The univariable linear regression model explained 10.2% of LOS variance. Being female, living without social support, having an increased number of previous admissions and nursing dependency, being dependent on functional status, having a worse behavior pattern and mobility, and experiencing a sensory deficit were significant determinants (p &lt; .05) of LOS.

Conclusion
The inclusion of EHRs data in addition to clinical variables, can help clinicians and researchers to improve the predictive ability on LOS, ensuring its early identification and ultimately enhancing the patients’ health outcomes through the implementation of targeted interventions.
SARS–COV2 INFECTIONS IN HEART TRANSPLANT RECIPIENTS: VACCINES STILL ARE OUR GREATEST WEAPON
Authors: Tedeschi A , Ammirati E , Garascia A , Palazzini M , Masciocco G , Gentile P , Monticelli M , Leidi F 
Published: May 2024

Abstract
Long–term clinical follow–ups are needed to assess the effectiveness of vaccine and booster doses against severe acute respiratory syndrome coronavirus 2 (SARS–CoV2) infection for heart transplant (HT) recipients, particularly in an epidemiological landscape characterized by rapidly changing viral variants. Among patients who received HT at Niguarda Hospital from January 2008 to March 2022, we compared the clinical outcomes of those who developed SARS–CoV2 infection between March 2020 and January 2023, according to their vaccination status (vaccinated Vs unvaccinated). Of 377 patients, 98 (25,9%) developed SARS–CoV2 infection during the study period. 24 (27.5 %) developed infection before receiving the vaccination, whilst 74 (75,5%) almost after 2 weeks from receiving the first dose. The unvaccinated cohort demonstrated a higher incidence of death, pneumonia, requiring of oxygen supplementation, non–invasive and invasive ventilation therapy. Furthermore, we assess an additional protective effect against mortality offered from booster doses. Vaccine administration in HT patients is associated with a lower rate of death and severe disease, particularly in those patients who received one or two booster doses.
POOR IN–HOSPITAL CONGESTION IMPROVEMENT IN ACUTE HEART FAILURE PATIENTS CLASSIFIED ACCORDING TO LEFT VENTRICULAR EJECTION FRACTION: PROGNOSTIC IMPLICATIONS
Authors: Ruocco G , Girerd N , Rastogi T , Lamiral Z , Palazzuoli A 
Published: May 2024

Abstract

Background
Residual congestion in acute heart failure (AHF) is related to poor prognosis. However, we lack data on the prognostic value of changes in a combined assessment of in–hospital congestion. We sought evaluated the association of in–hospital congestion changes with subsequent prognosis according to LVEF classification.

Methods
Patients (N=244, 80.3±7.6 years, 50.8% male) admitted for acute HF in 2 European tertiary care centers underwent clinical assessment, echocardiography, lung ultrasound (LUS) ultrasound and natriuretic peptides (NP) measurement at admission and discharge. The primary outcome was the composite of All–cause mortality and/or HF re–hospitalization.

Results
In the 244 considered patients (95 HfrEF, 57 HFmrEF and 92 HFpEF), limited improvement in clinical congestion score (Hazard ratio 2.33, 1.51 to 3.61, p=0.0001), NP levels (2.29, 1.55 to 3.38, p&lt;0.0001) and B–lines count (6.44, 4.19 to 9.89, p&lt;0.001), had significnatly higher risk of outcome compared to patients experiencing more sizeable decongestion. The same pattern of association was observed when adjusting on confounding factors. A limited improvement in clinical congestion score and B–lines count was related to poor prognosis in all LVEF categories.

Conclusions
In AHF, the degree of congestion reduction assessed over the in–hospital stay period, can stratify the subsequent event risk. Limited improvement in both clinical congestion and B–lines count are related to poor prognosis irrespectively of LVEF.
QRS INDEX TO PREDICT CARDIAC RESYNCHRONIZATION THERAPY RESPONSE: A TRICENTRIC STUDY
Authors: Madaudo C , Coppola G , Mascioli G , D‘Ardia G , La Greca C , Prezioso A , Corrado E 
Published: May 2024

Abstract

Background
Several studies have evaluated the role of QRS duration (QRSd) or QRS narrowing as a predictor of response to cardiac resynchronization therapy (CRT) to reduce non–responders.

Purpose
The aim of our study was to determine the correlation between the relative change in QRS narrowing index (QI) compared to clinical outcome and prognosis in patients who underwent CRT implantation.

Methods
A three–center study involving 398 patients with a CRT device was conducted. Clinical variables, echocardiographic parameters and drug therapies, QRS duration before and after CRT implantation, and QRS index (QI) were measured.

Results
In a six–month follow–up, a significant improvement in left ventricle ejection fraction (EF), left ventricle end–diastolic and systolic volumes (LVEDV and LVESV) were observed. QI was significantly related to reverse remodelling (r = +0.22; 95% CI: 0.11 to 0.32, p= 0.001) and the cut–off value that best predicted LV reverse remodelling was 12.25% (AUC 0.7, p=0.001). At 24 months, a statistically significant difference was found between patients with a QI &lt; 12.25% and those with a QI &gt; 12.25%, regarding NYHA class worsening (p= 0,04). The mean of the QI of patients who died from cardiovascular causes was lower than patients who died of other causes (p=0,0179). A correlation between pre–CRT QRSd/LVEDV and QI was observed (r = +0.20; 95% CI: 0.09 to 0.30, p=0.0003). A higher QRSd/LVEDV ratio was associated with an improved LVEF, LVEDV, LVESV (p &lt;0.0001) at follow–up.

Conclusions
QI narrowing after CRT was related to greater echocardiographic reverse remodelling and lower rate of adverse events. The QI can improve adverse events’ prediction in a population with CRT regardless of comorbidities according to the Charlson Comorbidity index. QI could be used to predict CRT response.
THE NURSING MANAGEMENT OF THE PATIENT WHO HAS UNDERGONE CORONARY ANTIOPLASTY
Authors: Lazzerini C 
Published: May 2024

Abstract
Coronary angiography consists of selective angiography of the coronary arteries obtained invasively. Coronary angioplasty (PTCA) consists of the mechanical reperfusion of the coronary arteries via a stent in patients with acute myocardial infarction (AMI). How is a patient who has undergone angioplasty surgery managed from a nursing point of view? In the immediate post–operative period the patient is transferred from the operating room to the inpatient department, subsequently the electrocardiogram is performed and the vital parameters are recorded, immediately afterwards the patient will be subjected to cardiac monitoring and must maintain bed rest. The patient undergoing angioplasty has mechanical compression on the right radial artery (in most cases) which will need to be managed by the nurse. Radial compression is necessary to allow the radial artery to heal the wound caused during the angioplasty procedure. The nurse will have to manage the compression of the radial artery by loosening it two hours after the end of the operation; subsequently, after two hours have passed since the compression has been loosened, it can be removed, after the wound has been carefully assessed by the nurse, there must therefore be no moaning present and the radial pulse must be appreciable. After 6/8 hours the post–PTCA blood sample must be performed, which includes the following blood tests: creatinine and troponin. The patient will have to maintain cardiac monitoring for a few days, he will begin to mobilize, and control blood tests will be performed in the following days. The role of the nurse has a great importance in terms of educating the patient on a healthy lifestyle once discharged. It is important to correctly explain to the patient what interventions to adopt to achieve a healthy lifestyle.
THE EFFICACY OF VERY LOW CALORIE KETOGENIC DIET (VLCKD) ON CARDIO–METABOLIC PROFILE IN PATIENTS WITH OBESITY
Authors: Trapanese V , Natale M , Vatalaro C , Giofrè F , Melina M , Cosentino F , Donato U , Armentaro G , Sciacqua A , Cloro C , Arturi F 
Published: May 2024

Abstract

Background
Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention to achieve a significant weight loss in obese patients in a short time period. Furthermore, hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. In addition, ketogenic diet is able to prevent mitochondrial fission, improve mitochondrial function, suppress oxidative stress and attenuate cardiac myocytes apoptosis in the heart of mice.

Aim
To evaluate the role of VLCKD on cardio–metabolic risk factors, cardiac dysfunction and myocardial remodelling in obese patients.

Materials and Methods
Ten obese patients treated with VLCKD were enrolled. All patients were characterized from an anthropometric, cardio–metabolic and echocardiographic point of view at baseline and 8 weeks after VLCKD treatment. In addition, each patient underwent measurement of global myocardial work efficiency (GWE), a novel indicator that accounts for deformation and afterload, which may provide additional value for assessment of myocardial function. The insulin resistance (IR) was evaluated by HOMA–IR.

Results
As expected, all the patients showed a significant reduction in body weight and an overall improvement of body composition parameters after VLCKD. Weight (kg) (from 105.1 ± 18.2 to 83.7 ± 16.7, P &lt;0.05), BMI (kg/m2) (from 40.1 ± 4.7 to 31.8 ± 4.8, P= 0.002) and waist circumference (cm) (from 115 ± 13.6 to 101.8 ± 12.4, p &lt; 0.05) were significantly lower after VLCKD treatment. VLCKD treatment improved also significantly fasting glucose levels (P &lt;0.05), fasting insulin levels (P =0.004), HOMA–IR values (P &lt;0.001), lipid profile and systolic and diastolic blood pressure levels. In addition, the echocardiogram evaluation showed an improved in end–diastolic left ventricular volume, end–systolic left ventricular volume, left ventricular mass and left ventricular mass index. Interestingly, a significantly changes in GWE was observed (P&lt;0.05).

Conclusion
Although preliminary, our data suggest that VLCKD treatment is able to reduce cardio–metabolic risk factors and to improve cardiac dysfunction and myocardial function.
TELECUORE: FEASIBILITY OF A HOSPITAL–TERRITORIAL TELEMEDICINE PROJECT IN CHRONIC HEART FAILURE
Authors: Matrone B , Novara P , Di Spigno F , Tedeschi A , Concetta S , Lisè G , Ballerio N , Auletta T , Pisati M , Aschieri D 
Published: May 2024

Abstract

Background
Since February 2023, Cardiology department of AUSL Piacenza has started a telemedicine project named “TeleCuore,” aimed at exploring the impact of a multiparametric telemonitoring system on the management of patients affected by chronic heart failure (CHF). OBJECTIVES assess organizational sustainability, satisfaction among involved figures, and the clinical impact at 9 months of an extensive telemonitoring project targeting patients with CHF.

Materials and Methods
250 patients with CHF and recent clinical instability were recruited and equipped with the Adilife device to monitor and transmit weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead ECG. These data are managed by case manager (CM), cardiologists, respiratory and perfusion pathophysiology technicians (TFCPC), general practitioner to optimize patient therapy, empowerment, and reduce acute admissions through timely teleconsultations/televisits. Every 6 months, patients are asked to complete a Quality of Life questionnaire (KCCQ–23) and a satisfaction questionnaire regarding the project, which is also administered to healthcare professionals.

Results
Over 9 months, positive patient engagement is confirmed, with over 92,000 total transmitted measurements. The most monitored parameter is heart rate (4 times/week). At questionnaire analysis, 80% of patients believes TeleCuore helps them remember parameter measurements, and 70% adopt a correct lifestyle through phone conversations with CM. For over 50%of them the project contributes improving their relationship with healthcare professionals. For 90%of healthcare professionals there is better team collaboration and patient education. Both clinicians and patients (100%) believe that TeleCuore improves the effectiveness of follow–up visits: patients arrive more prepared (30%), and staff can dedicate more time to patients (30%) and access information before the visit (10%). The patients KCCQ score varies from a medium of 71 at baseline to a medium of 78 at 6 months analisys.

Conclusions
TeleCuore project demonstrates that telemedicine can facilitate patient management and empowerment. Professional figures (CM and TFCPC) are crucial for project execution, working alongside clinical cardiologists for proper alert management, patient education on therapy adherence, and correct lifestyle. An ongoing analysis aims to quantify whether TeleCuore can reduce hospitalizations related to acute heart failure.