bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREDICTION OF ACUTE AORTIC SYNDROMES IN PATIENTS WITH DILATATION OF ASCENDING AORTA: IS IT THE HOLY GRAIL OF CONTEMPORARY CARDIAC SURGERY?
Authors: Totaro P , Amoroso F , Kushta E , Musto M , Pelenghi S 
Published: May 2024

Abstract

Objective
Acute aortic syndromes (AAS) represent the most frequent emergency situation in cardiac surgery. Despite improvements in surgical outcomes in recent decades, postoperative mortality in these situations is still significant (5–20%). The study of potential markers able of identifying patients at high–risk for AAS has been widely evaluated for many years. Although many potential markers have been identified, current guidelines are based, in the absence of morphological signs, on two keys: maximum dilation and its evolution over time. In this work we have reviewed our twenty–year experience to better elucidate the clinical history that led to AAS in the current era. We also evaluated the real role of monitoring a known dilatation of the ascending aorta over time in the prevention of AAS.

Materials and Methods
Data from 267 patients undergoing emergency surgery for AAS (acute dissection, intraparietal hematoma, ulcerated plaque rupture) were examined. For each patients, the past medical history was reviewed including the diagnostic / instrumental evaluations carried out before the acute event.

Results
As Summarized in Figure 1A, despite history of hypertension was common, only a minority of patients had underwent adequate diagnostic evaluation of the thoracic aorta before AAS. Furthermore, out of 267 patients, only 3 patients had a known AAA &gt; 50mm and all had previously refused surgery. The remaining patients (Fig 1B) presented dilatation without surgical indication according current international guidelines. In 1 patient a CT Scan was performed 1 week before AAS and maximum dilatation was 43mm (Fig 1C) with no sign of increased risk of dissection. At the time of dissection dilatation reached 52 mm (Fig 1D).

Conclusion
Our analysis, based on twenty years of experience, has clearly shown that only a minimal part of patients experiencing an AAS have a clear history of progressive aortic dilatation, amenable to analysis and risk weighting. In our series, the minority of patients with previous history of aortic dilatation, however, did not have aortic dilations at high risk of AAS according to international guidelines. The "real life" in contemporary cardiac surgery, therefore, seems to confirm the substantial unpredictability of an acute aortic event in the absence of systematic surveillance protocols to be adopted on the entire population at risk.
IMPROVED EARLY OUTCOMES IN WOMEN UNDERGOING AORTIC VALVE INTERVENTIONS
Authors: Bifulco O , Malvindi P , Berretta P , Alfonsi J , Cefarelli M , Zingaro C , Capestro F , D‘Alfonso A , Di Eusanio M 
Published: May 2024

Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3–8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018–2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis–patient mismatch. Nine hundred and fifty–five consecutive patients—514 women and 441 men—were included. Among them, 480 patients—276 female and 204 male—received a transcatheter procedure, and 475—238 women and 237 men—had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
A RARE COMPLICATION OF MITRAL TEER PROCEDURE: CLIP LATE DETACHMENT AND EMBOLIZATION
Authors: Pallotta R , Saccocci M , Denti P , Buzzatti N , Agricola E , Maisano F 
Published: May 2024

Abstract
Intraprocedural and late complications of MitraClip implantation have already been described. This report highlights the importance of conventional surgical options in the event of percutaneous treatment failure. An 85–year–old woman with a history of chronic anemia, and thalassemia Minor was referred to our clinic for severe mitral regurgitation (MR) due to a P2 flail with significant calcification of the posterior mitral annulus. During the Heart Team discussion, age and comorbidities led to consider the patient eligible for TEER with the MitraClip system (EuroSCORE II 9,34%; STS score 7,47%). TEER procedure was uneventful: one XTW was deployed at the level of the flail (A2–P2), a second XTW was then placed more lateral to treat a separate residual jet, and one NTW was finally placed between them. MR reduction was considered acceptable (moderate MR, mean grad 6 mmHg). After two months, symptoms worsened, and TTE showed severe MR (no device detachment) with increased sPAP and associated moderate TR. A couple of weeks later, the patient was hospitalized. Chest X–ray revealed clip embolization confirmed by coronary angiography that showed an XTW Clip embolized to the Right coronary sinus with partial occlusion of the ostium. Percutaneous clip retrieval is described in the literature, but the embolized device position and the presence of recurrent severe MR led us to prefer an urgent surgical intervention. Under CPB, the embolized XTW was easily retrieved through a small aortotomy; the intervention was completed by mitral valve replacement and tricuspid valve repair. The postoperative course was uneventful. Predischarge TTE showed normal mitral bioprosthesis function, mild AR, mild TR, and preserved LV function. DISCUSSION Clip embolization is a rare but potentially critical complication of TEER and can happen periprocedurally or on early follow–up. Single leaflet detachment is more common, but complete detachment and embolization can occur. Therapeutic options are represented by surgical or transcatheter approaches according to embolization sites and patient comorbidities. In our case, the risk of potential coronary obstruction or thrombosis and the concomitant need for MR treatment have led us to consider surgery as the first option. CONCLUSION TEER can be graved by acute or late complications. The best approach has to be tailored to each patient, and surgery can be an effective and safe option even for initially discarded high–risk patients.
AN INCIDENTAL DIAGNOSIS OF ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA
Authors: Mistrulli R , Dei L , Halasz G , Gebrielli D , Re F 
Published: May 2024

Abstract
72–year–old patient with paroxysmal atrial fibrillation and hypertension. Mother died suddenly at the age of 40 from an unknown cause. The patient worked at a high physical and emotional intensity (firefighter) and denies syncopal episodes. During an hospitalisation for pneumonia, an echocardiogram was performed that showed dilatation of the outflow tract and basal portion of the right ventricle (RV), apical bulging and right ventricular (RV) free wall dyskinesia. Absence of signs of pulmonary hypertension. The left ventricle was of normal size with preserved ejection fraction (EF 60%). the electrocardiogram showed inversion of the T wave from V1 to V4 and in the lower leads. He underwent a coronary CT scan, which was negative. In view of the clinical findings, cardiac MRI was requested, which showed severe dilatation of the free wall of RV, which was dyskinetic and hypertrabeculated and reduced RV EF (38%). At T1 sequences, diffuse and trasmural late gadolinium enahcement of the RV free wall. The Holter ECG recorded 773 monomorphic ventricular extrasystoles. The patient underwent genetic analysis, which is still in progress. This is an established case of arrhythmogenic right ventricular dysplasia that was accidentally diagnosed at an advanced age. This finding is unexpected as such a benign prognosis has rarely been described in the literature and in the natural history of this cardiomyopathy. In this particular situation, it is also very difficult to choose the best management strategy even in light of the recently published new guidelines.
CLASS 1C AGENTS ARE EFFECTIVE AND SAFE IN TERMINATING RECENT–ONSET ATRIAL FIBRILLATION IN ELDER PATIENTS TOO
Authors: Bonora A , Turcato G , Piccoli A , Bampa B , Gabbiani D , Tonelli M , Beltrame F , Maccagnani A 
Published: May 2024

Abstract

Background
Amiodarone is still widely used in recent–onset atrial fibrillation (AF), mainly in elder people, for its presumed safety. Nevertheless the growing experience with class 1c agents could encourage their use in order to improve the management of AF in elderly too. Aim: To assess whether class 1c agents could be considered effective and safe in elder people, as well in younger, in terminating recent–onset AF.

Methods
We retrospectively evaluated a three–years experience in over 75 patients treated in the Emergency Department of University Hospital of Verona for recent–onset AF (&lt; 48 h). We excluded patients submitted to electrical cardioversion and those in whom the choice of treatment was forced by clinical conditions or coronary and structural heart disease. Then we compared the results in terms of effectiveness and safety between the two groups of treatment, class 1c agents vs amiodarone. Statistical analysis was performed using Chi–square test, with significance level set at p&lt;0.05.

Results
We attempted at restoration of sinus rhythm in 264 patients older than 75 years observed for recent–onset AF from January 2018 to December 2020. According to exclusion criteria, the study population was restricted to 147 patients (53 males, 94 females; mean age 80 years, range 75–95) where the treatment depended on the physician‘s choice only. Most of these patients (61.2%) was treated with amiodarone, while in 38.8% class 1c agents were administered. Mean age was not significantly different between the groups (81 vs 78.5). After treatment, stable restoration of sinus rhythm was reported in 43 patients (47.7%) in amiodarone and in 47 (82.4%) in class 1c group (p&lt;0.01). Median time of conversion was 240 minutes (range 30–680) in amiodarone while 60 (range 15–530) in class 1c group (p&lt;0.01), as shown in fig. 1. Surprisingly, even the narrow sample did not allow any significance, the incidence of adverse events was notably superior in amiodarone patients, both in number (5 cases) and seriousness (2 cases). Whereas in class 1c group we reported only one mild adverse event. At the end of observation, 43 patients (75.4%) in class 1c but only 38 (42.2%) in amiodarone group were discharged with stable sinus rhythm (p&lt;0.02).

Conclusions
Class 1c agents appear to be more effective and as safe as amiodarone in terminating recent–onset AF even in selected elder people. However these preliminary results need to be confirmed in a larger and prospective study.
CLINICAL AND GENETIC FEATURES OF JUVENILE ONSET LONE ATRIAL FIBRILLATION
Authors: Bertello E , Berruquier P , Dusi V , Saglietto A , Vallino C , Tallone L , Solano A , Giannino G , Vairo A , Angelini F , Del Prever G Brach , Pidello S , Raineri C , Giustetto C , Matta M , Castagno D , Ferraris F , Deaglio S , De Ferrari G , Anselmino M 
Published: May 2024

Abstract

Background
Juvenile–onset lone atrial fibrillation (LAF) may be the initial manifestation of an othrewise concealed channelopathy or cardiomyopathy (CMP). Clinical characteristics, genetic background and proper management are still largely unknown.

Purpose
Describe the clinical and genetic characteristics of patients with juvenile–onset LAF.

Methods
We enrolled patients referred to our center for ablation between 1/2018 and 11/2023 with a first diagnosis of LAF below 60 years, absence of CMP, ischemic, valvular, congenital heart disease, and no overt channelopathy. A concealed Brugada syndrome was systematically excluded. Genetic testing was performed using Next Genome Sequencing and a dedicated gene panel.

Results
89 patients were included (84% male, LAF onset 43 ± 8 years, BMI 25 ± 7 kg/m2): 32% had a first–degree family history of AF (including 15% below 60 years), 18% of sudden death, 8% of cardiac conduction disorders and 2% of CMP. Arterial hypertension was present in 24%, smoking in 47% and obstructive sleep apnea in 4%; 20% were competitive athletes. Most patients (89%) presented with symptomatic paroxysmal AF (palpitations); LVEF was 61 5% and LAVI 35 14 ml/m2. Median follow–up time after the first AF was 6 years (IQR 4–10). Most patients (81, 91%) underwent ≥1 ablation after failed anti–arrhythmic drug (AAD) therapy (mostly IC). The first procedure (73% radiofrequency, 27% cryoablation) included pulmonary veins isolation (PVI) in all and additional lesions in 5%; the second (n=18, 22% of the ablation group) included PV re–isolation in all and additional lesions in 17%; the third (n=8, 10% of the ablation group) included PV re–isolation in 25% and additional lesions in 75%. The remaining 8 patients were treated with AAD only (mostly IC). By the last follow–up, 7% of patients in the ablation group and 25% in the AAD group had documented recurrences (even though 50% of those who received ablation were still on AAD). Among the 35 patients subjected to genetic investigation, 10 have available results: 30% tested positive for C4–C5 variants (2 for KCNQ1, 1 for TTN), 50% for C3 variants (RYR2, ABCC9, LMNA, KCNH2 and RMB20) and 20% were negative.

Conclusions
In the present cohort of patients with juvenile–onset LAF, a positive family history was found in almost one third of patients. Despite prompt diagnosis and treatment, recurrences rate is not trivial. The yield of genetic test so far is high, supporting its use in this population.
A COMPLEX CASE OF EARLY ONSET ATRIAL FIBRILLATION IN AN ENDURANCE ATHLETE: THE IMPORTANCE OF FAMILY HISTORY
Authors: Solano A , Tallone L , Bertello E , Berruquier P , Saglietto A , Brach G , Angelini F , Vairo A , D‘ Ascenzo F , Giustetto C , Raineri C , Deaglio S , Anselmino M , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Introduction
Early onset atrial fibrillation (AF) in an endurance athlete represents a challenge for the cardiologist, especially in apparent absence of an overt structural heart disease. Different genetic variants have been associated with early onset AF but indications to genetic testing are still under definition.

Case
A 54–year–old man (BMI 19 kg/sqm), previous competitive athlete (Nordic running and walking) presented to the Emergency Department with sudden onset palpitations and dyspnea due to high penetrance AF (145 bpm). Family history (FH) was positive for cerebrovascular accidents in both parents and for early onset (&lt;60 years) AF in the father. The man had a recent history of borderline hypertension, of effort related syncope of and of infundibular, isolated, premature ventricular complexes during a maximal exercise stress test (otherwise negative for ischemia) which ultimately led to the denial of competitive sport eligibility. Sinus rhythm (SR) was acutely restored with flecainide and the patient was discharged with low dose nadolol. Cardiac US showed normal left ventricular (LV) dimensions and thicknesses (10 mm), with regular LVEF (60%) and global longitudinal strain (–18%), mildly dilated left atrium (LAVI 36 ml/sqm) and bi–leaflet mitral valve prolapse without significant mitral regurgitation, mitro–anular disjunction nor Pickelhaube sign; 24h Holter ECG showed SR with rare supraventricular (SV) ectopic beats and a 4 beats SV run. Due to the recurrence of short episodes of palpitations, rhythm control with flecainide and antithrombotic prophylaxis were started and AF ablation was planned. Genetic testing for early onset AF identified a nonsense variant (c.84665delG; p.Gly28222fs*2) in TTN gene, classified as likely pathogenic (C4), so far not reported in scientific literature. Also, despite a moderate–low cardiovascular risk as assessed by SCORE2, mostly due to the FH and the desire to engage in high intensity exercise, coronary CT was prescribed, which showed a critical coronary disease leading to stenting on left anterior descending artery and intermediate branch. Cardiac MRI was planned.

Conclusions
Early onset AF in endurance athletes should not be underrated and a thorough examination including a detailed family history should be performed. TTN is the single gene most frequently associated with early onset AF in absence of an overt structural heart disease, but the subsequent clinical evolution is still largely unknown.
ASSOCIATION BETWEEN HEALTH LITERACY AND NURSING DEPENDENCY IN HEART FAILURE PATIENTS: A RETROSPECTIVE STUDY
Authors: Cesare M , Cristofori E , Magliozzi E , Damiani G , Cocchieri A 
Published: May 2024

Abstract

Background
Approximately 6.7 million Americans over 20 years of age have heart failure (HF) and 33% of the US adult population without known symptomatic HF is at–risk for HF. To understand self–care protocols, patients should understand and use health information and literature suggests a positive relation between health literacy (HL) and self–care. Health literacy (HL) is a potential risk factor for health outcomes and can be defined as “personal knowledge and competencies obtained through daily activities, social interactions and across generations”. However, even though HL has gained international relevance, it remains underestimated in most world countries. Moreover, HL is poorly measured in hospitalized HF patients and its relationship with nursing dependency is still poorly studied. We aimed to describe HL levels by analyzing the relationship between HL and nursing dependency.

Methods
A retrospective design was used by selecting 608 adult patients with HF consecutively admitted in cardiovascular and internal medicine units of an Italian university hospital across 1 year. Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on electronic health records; nursing diagnoses were collected from the clinical nursing information system to measure nursing dependency.

Results
The mean age of the sample was 75.50 ± 13.06. HL levels were low (SILS &gt;2) in approximately 26% of the hospitalized patients (n=159; 26.2%). A mean of 4.1 ± 3.4 nursing diagnosis per patient was identified. A significant difference was observed between patients with adequate HL (n=449) and low HL (n=159) in terms of nursing diagnoses (mean 2.76 ± 20.3 VS mean 8.69 ± 2.79; p&lt; .001, respectively). A statistically significant linear association (Spearman’s correlation coefficient) was observed between the HL score and the number of NDs.

Conclusion
HL was associated with the number of NDs in HF patients. Understanding the relationship between HL and nursing dependency can allow the planning of targeted interventions to improve the patient’s health outcomes, representing a key element for public health.
PROGNOSTIC PERFORMANCE OF MECKI SCORE IN HEART FAILURE PATIENTS WITH NON–VALVULAR ATRIAL FIBRILLATION TREATED WITH EDOXABAN
Authors: Mapelli M , Mattavelli I , Salvioni E , Bonomi A , Capra N , Vignati C , Cattadori G , Agostoni P 
Published: May 2024

Abstract

Background
Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated HF model to assess the risk of cardiovascular mortality, urgent heart transplantation and Left Ventricle Assist Device implantation at 2 years. The score integrates cardiopulmonary exercise test (CPET) parameters with hemoglobin, serum sodium, kidney function (MDRD), left ventricle ejection fraction, peak oxygen consumption [% pred] and VE/VCO2 slope. Non–valvular atrial fibrillation (NVAF) is a common feature in HF patients. Recently, direct oral anticoagulants (DOACs) were introduced as an alternative VKAs and have now emerged as the preferred choice. Aim of the study was to assess the reliability of the prognostic evaluation by MECKI score also in HF patients treated with Edoxaban for NVAF.

Methods
We prospectively enrolled consecutive outpatients with HF and NVAF treated with Edoxaban. Each patient underwent a maximal ramp–protocol CPET and a blood sampling for complete blood count, serum electrolytes and renal function. This population was matched for age and sex by propensity score with a retrospective group of HF patients with NVAF treated with VKA belonging to the MECKI score registry.

Results
83 patients with HF and NVAF treated with Edoxaban were enrolled. Median follow up was 814[608–1052] days. A control population was identified in the multicentric MECKI score database (n=7800) by selecting all consecutive patients with HF and NVAF treated with VKA (n=844). The population was propensity score–matched for age and sex. Table 1 compares the main population characteristics. MECKI score performs equally well in predicting the outcome in the two groups (AUC matched population 0.73193, AUC Edoxaban group 0.6557, p=ns) (Figure 1).

Conclusion
MECKI score power was confirmed also in the new population treated with Edoxaban with a slightly higher performance respect to patients treated with VKA.
ICU NURSES AND VAD ADHERENCE TO INS 2021
Authors: Patimo M , Fiorini J , Pezzuto M , Grimaldi M 
Published: May 2024

Abstract

Background
Continuous updates and evidence–based nursing practices are vital for quality patient care. In 2021, the Infusion Nursing Standard (INS) have updated vascular access device (VAD) guidelines. Evaluating nurses’ VAD knowledge according to these guidelines will improve caring quality, particularly for ICU patients that need a functioning VAD.

Aim
To evaluate the knowledge of ICU nurses regarding VADs according to the latest INS 2021 guidelines.

Material and methods
A cross–sectional study was conducted on a sample of nurses providing direct care to ICU patients. A web survey was administered using the “Nurses’ Knowledge and Self–Efficacy on Vascular Access” instrument, which assesses nurses’ knowledge and self–efficacy in relation to short (SPC) and long peripheral canula (LPC), PICC, and PORT, as for INS 2021 guidelines. The survey consisted of 32 items with four closed–answer options, of which only one was correct. Competence and skill levels were calculated by summing the correct responses and standardizing the result to 100.

Results
Some 35 nurses have enrolled, with an average age of 37 years (SD= 10.80), including 16 men and 19 women, working in UTIC, ICU and Stroke Unit. The highest adherence score (97%) has been registered for the PICC flushing technique before and after each use. The lowest result (14%) has been obtained regarding the performing method of blood sampling from a central VAD. Other positive results have been achieved in the selection of the correct placement sites for all VAD types, with score exceeding 90%. The second part of the questionnaire, which focused of nurses’ self–confidence, showed that nurses felt most confident in SPC section, followed by the PORT section, LPC, and lastly, PICC.

Conclusions
ICU nurses have a good level of competence and self–efficacy about the VAD management, adhering to the 2021 INS guidelines, although gaps have been identified in the management of SPC and some techniques and despite the high self–confidence expressed directly by nurses. Healthcare organizations should continuously monitor the ICU nurses’ competencies and skills level to implement targeted intervention and ensure the application of evidence in clinical practice, thereby improving the patients’ quality of care.