bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPLANTABLE MEDICAL DEVICES: A NON INVASIVE AND COSMETIC FRONTIER FOR WOUND CLOSURE
Authors: Lacquaniti A , Coroselli C , Russo A , Marcheselli A , Ficili S 
Published: May 2024

Abstract
Cardiovascular implantable electronic devices (CIEDs) implantation procedures have undergone continuous improvement. Every aspect of the procedure can contribute to these improvements, including incision closure.
The aim of this study was to assess the accuracy and validity of a non–invasive method using adhesive skin closure strips for wound closure of CIEDs in older adults, instead of surgical suture, evaluating parameters such as infection, erythema, skin reaction, itching, pain, oedema, time for closure, cosmetic outcomes and patients’ satisfaction.
A retrospective study was carried out in 152 subjects (mean age 81 +9.3 years).undergoing application of adhesive strips after CIEDs substitution/implant and 132 usual care control subjects (mean age 76.6+8.9). Variables considered were: age, gender, risk factors for wound complications. Wound evaluation was conducted by using the Visual Analogue Scale (VAS) and the Patient and Observer Scar Assessment Scale (POSAS). Operative time for closing the incision and for removing sutures or strips were significantly lower in both application and removal in the adhesive strip group. At follow–up evaluations, each parameter considered by evaluation of the patients and staff was significantly better than in the control group. Fewer complications were observed in the patients undergoing wound closure wit adhesive strips. Previoulsy, to the best of our knowledge, the use of adhesive strips in closing surgical wounds of patients undergoing CIEDs implant/replacement has never been considered. Adhesive strips for wound closure of CIEDs incision are characterized by shorter procedural time, optimal early and late cosmetic results, fewer complications in older patients and is cheaper. Its use for CIEDs wound closure is reasonably supported.
SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD) WITH CARDIAC ARREST AT PRESENTATION: A SUBANALYSIS FROM THE DISCO REGISTRY
Authors: Giacobbe F , Bruno F , Brero M , Fernando M , Rolfo C , Benenati S , Quadri G , Chiara C , Infantino V , Buccheri D , Bernelli C , Bettari L , Gonzalo N , Pavani M , Scappaticci M , De Filippo O , Boi A , Erriquez A , Musumeci G , Chinaglia A , Patti G , Porto I , Escaned J , De Ferrari G , Varbella F , D‘Ascenzo F , Cerrato E 
Published: May 2024

Abstract

Introduction
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI), which primarily affects young women without traditional cardiovascular risk factors, often presenting as sudden cardiac death. This study aims to investigate the prevalence, characteristics, predictors, and outcomes of cardiac arrest in SCAD patients.

Methods
The DISCO IT/SPA registry, an international retrospective multicenter study, enrolled 375 SCAD patients from 26 centers in Italy and Spain. Patients were categorized based on the presence or absence of cardiac arrest at admission. Data on demographics, clinical presentation, treatment, angiographic findings, and outcomes were collected. Angiograms were independently reviewed, and outcomes included major adverse cardiovascular events (MACE) and in–hospital bleeding.

Results
Among 375 SCAD patients, 20 (5.3%) presented with cardiac arrest. Both groups were similar in age, gender distribution, and conventional risk factors, except for a lower prevalence of dyslipidemia in the cardiac arrest group. ST–segment elevation myocardial infarction (STEMI) presentation and angiographic type 2b were independent predictors of cardiac arrest. Revascularization was more frequent in the cardiac arrest group. In–hospital outcomes, except for longer hospitalization, did not differ. On follow–up (average 21 months), MACE rates were similar between groups.

Conclusions
Cardiac arrest is a notable complication in SCAD, mostly presenting with ventricular fibrillation. The prognosis of SCAD patients presenting with cardiac arrest did not differ from those without, reporting a similar rate of events both in–hospital and during long–term follow–up. STEMI presentation and angiographic type 2b were identified as independent predictors of cardiac arrest in SCAD.
THE INTELLIGENT USE OF ADRENALINE
Authors: Ortello A , Comparato F , Puccio D , Corrado E 
Published: May 2024

Abstract

Case Report
A 52–year–old patient experienced anterior and inferior ST–elevation myocardial infarction, leading to cardiogenic shock necessitating invasive hemodynamic and pharmacological support. During angiography, an intra–aortic balloon pump (IABP) was inserted, and a norepinephrine infusion along with dobutamine was initiated, showing partial clinical and laboratory improvement. Critical disease in all three vessels was detected, prompting angioplasty with stenting of the right coronary artery and left anterior descending artery. Echocardiography revealed severe reduction in left ventricular systolic function (ejection fraction 10%). Despite revascularization and intensive support, the patient‘s hemodynamic status deteriorated (SCAI D), necessitating the addition of adrenaline (0.03 μg/kg/min) to the ongoing dobutamine infusion, suspending noradrenaline. Subsequent days showed gradual improvement, allowing for withdrawal from amine support and discontinuation of the IABP. Follow–up included a cardiac MRI displaying severe systolic dysfunction (EF 21%), extensive ischemic–pattern delayed enhancement across three–vessel distribution. Given the persistent severe left ventricular dysfunction, the patient underwent subcutaneous defibrillator implantation for primary prevention after optimizing anti–remodeling therapy. Despite optimized medical therapy and cycles of levosimendan, the patient experienced heart failure exacerbation, requiring hospitalization (INTERMACS 3). Considering the clinical condition and absence of contraindications, the patient was listed for heart transplantation. Due to refractory hemodynamic instability despite inotropic agents, a left ventricular assist device was implanted as a bridge to transplantation. Roughly 6 months later, the patient successfully underwent heart transplantation without acute complications.

Conclusions
Very low doses of adrenaline demonstrate increased sensitivity to β2 receptors over α receptors, thereby enhancing mean arterial pressure and peripheral perfusion. At the cardiac level, it induces an increase in both heart rate and coronary blood flow, while peripherally reducing resistances, predominantly due to the prevalence of β2 receptors in skeletal muscle. This improvement contributes to the enhancement of ventricular–arterial coupling. In conditions characterized by a primary pump deficit, such as cardiogenic shock, the use of low–dose adrenaline emerges as a valid therapeutic option.
CASE REPORT: SELF–EXPANDING TRANSCATHETER VALVE IMPLANTATION (ACURATE NEO 2) IN A VERY SMALL NATIVE AORTIC ANNULUS
Authors: Casilli F , Medda M , Trovati L , Marchese G , Donatelli F 
Published: May 2024

Abstract
We present the case of a 74–year–old female, symptomatic for dyspnea on exertion, evaluated by our Cardiac Team for severe aortic valve (AV) stenosis. The transesophageal echocardiography showed a stenotic tricuspid AV (valve area of 0.51 cm2, peak and mean gradients of 75 mmHg and 43 mmHg respectively), normal left ventricle (LV) ejection fraction without significant intraventricular gradient. Pre–operative thoraco–abdominal computed tomography angiography showed an AV without significant calcifications, an aortic annulus perimeter of 51.7 mm (area of 207,8 mm2) and a left ventricular outflow tract (LVOT) perimeter of 45.3 mm with elliptical shape (area of 149,9 mm2). The TAVR procedure was performed with an ‘off–label’ implantation of a SE THV with supra–annular location of leaflets (Acurate Neo 2 23 mm), without any predilation. The post–procedural transthoracic echocardiographic study highlighted the correct positioning of the bioprosthesis without significant protrusion in the LVOT and without any interference with the mitral valve apparatus. The main clinical, technical and procedural considerations have been: According to recommendations, the minimum perimeter of 56.5 mm and the minimum area of 254 mm2 represent the lower limits of the sizing guidelines for THV currently available. We used a SE valve with supra–annular location of the leaflets that offers a potential advantage over BE valves and intra annular SE valves, ensuring a larger effective orifice area. We avoided pre– and post–dilatation to reduce the risk of annular damage and/or rupture The precision of THV implantation (with minimal protrusion in LVOT) was maximized when the rapid pacing during phase 2 of the valve deployment was utilized. A short period of DAPT can be considered in order to prevent a potential increase of thromboembolic events secondary to small aortic valve area. In our opinion the main goal is to prevent high implantation and commissural misalignment in order to facilitate the subsequent coronary percutaneous interventions if needed. Even prophylactic coronary stenting (‘chimney fashion‘) should be avoided unless absolutely necessary. These technical considerations applies also to allow a subsequent valve–in–valve (VIV) procedure, if indicated. To our knowledge, this is among the smallest native aortic annulus so far described and treated percutaneously in a tricuspid stenotic aortic valve with a self–expanding (SE) THV Acurate Neo 2.
SEVERE MITRAL INSUFFICIENCY FROM RHEUMATIC DISEASE: A CASE REPORT
Authors: Testa S , Ricci M , Gallina S , Renda G , Ricci F 
Published: May 2024

Abstract
Acute rheumatic fever continues to be a major health problem in many parts of thw world. It’s more common in low–income or developing parts of the world. Antibiotics for bacterial infections may not be available in these areas. In developed countries, cardiac involvement is quite rare. Although traditionally considered to be a disease associated with poverty, rheumatic fever continues to persist even among the middle–class population in developed countries. Children and teenagers with intreated strep infections are the most likely to get rheumatic fever. Signs of heart damage can develop years after the infection. Rheumatic heart disease is the result of valvular damage caused by an abnormal immune response to Streptococcus pyogenes infection. After multiple episodes of rheumatic fever, progressive fibrosis of the heart valves can occur: mitral regurgitation is the most common valvular lesion. We report the case of a 13–year–old, Italian, middle–class girl with rheumatic mitral valve involvement. A 13–years–old comes to the clinic for onset of worsening dyspnea ad easy fatigability. History turns out to be negative for cardiovascular disease and history of recent infections. Echocardiographic examination showed a dilated left ventricle (VTD 148ml, 98 m/mq) with preserved chinese. Severe dilatation of the left atrium with atrio–aortic ratio 2.3 and atrial volume 91 ml/mq. The mitral valve presented a myxomatous, thickened leaflets, predominantly the posterior which appeared retracted and hypomobile with thickening of the subvalvular apparatus with coaptation deficit along the entire coaptation rhyme realizing severe degree insufficiency (CV 7mm, ERO 0.8 cm2, CO 39 l/min). A small cleft at the level of A1, main lesion jet (A1–P3–P2) was also visible. The Echocardiographic appearance suggested outcomes from rheumatic disease so antistreptolysin titer and anti–DNase B antibodies were assayed with high levels found. Penicillin prophylaxis was therefore initiated. For the continuation of the therapeutic course, the case was discussed collegially and a valve replacement rather tan repair was advocated because the valvular and subvalvular apparatus were far too damaged.
CLINICAL CHALLENGE: AORTITIS IN THE EMERGENCY DEPARTMENT
Authors: Renon F , Depaoli A , Quaglia P , Carignola R , Cingolani M , Suppo U , Cannillo M , Grosso Marra W 
Published: May 2024

Abstract
A 67 yo woman presented to the ED for a sustained episode of palpitations and acute chest pain. Past medical history: suspected psoriatic arthritis previously treated with steroids and hydroxychloroquine; previous suspicion of rheumatic polymyalgia and Horton arteritis, regressed with steroids; gastroesophageal reflux disease; mild hypercholesterolemia and a family history of premature coronary artery disease. In the ED the patient was hemodynamically stable. On physical examination: tachyarrhythmic heart sounds with no murmurs. The peripheral arterial pulses were preserved and symmetrical. The remaining physical examination was unremarkable. ECG: atrial fibrillation at 150 bpm. The D–dimer was increased, normal hs–troponin and normal haemoglobin. On echocardiography: normal biventricular structure and function; normal aortic root with dilatation of proximal ascending aorta (47 mm), without visible intimal flaps. The anterior wall of the proximal ascending aorta was thickened. A moderate circumferential pericardial effusion was present, without signs of hemodynamic impact. On suspicion of an acute aortic syndrome with possible intramural haematoma of an ascending aortic aneurism, an urgent CT scan was ordered. It showed a severe dilatation of ascending aorta (52 mm) involving of the proximal aortic arch. The anterior aortic wall was thickened (5 mm), without clear images of IMH, aortic dissection or penetrating ulcer. The pericardial effusion had a supra–fluid density without blood density. A repeated CT at 6 hours showed no changes. The case was suggestive of an inflammatory aetiology. The patient was admitted to the cardiac intensive care unit. A PET–CT scan showed signs of an inflammatory disease of the great vessels. A serological autoimmunity screening was negative. The patient was diagnosed with inflammatory aortitis (giant cell vs Takayasu arteritis) and started on high dose iv glucocorticoid therapy. Given the high risk of severe aortic complications, adjunctive therapy with tocilizumab was prescribed. The therapy was gradually tapered, with subsequent switch to oral steroids plus tocilizumab. At one and a half month of follow–up, a CT scan was repeated, documenting stable aortic diameters and the disappearance of the abnormal thickness and of the enhancement of the aortic wall. A follow–up PET–CT scan has been scheduled at 6 months time. An elective aortic intervention has been indicated after remission of the inflammatory phase.
CLINICAL CASE OF A VERY YOUNG PATIENT AFFECTED BY CAD
Authors: Di Liberto I , Geraci S , Pilato G , Vaccaro G , Milazzo D , Caramanno G 
Published: May 2024

Abstract
Young patient of 24 years old, smoker, dyslipidemic and family history of coronary artery disease (CAD). He was admitted to emergency room for chest pain after moderate effort in December. EKG was normal, troponin was negative and echocardiography showed left ventricle with normal contractility. Blood chemistry test showed LDL 130 mg/dL, Triglycerides 200 mg/dL e Lipoprotein (a) 16 nmol/L. Elective cardiovascular exercise test resulted positive for signs and symptoms of cardiovascular ischemia (Figure 1). Coronary angio–TC showed 60% stenosis of proximal LAD and intramyocardial bridging of mid LAD. Subsequently elective coronary angiography confirmed the description of coronary angio–TC; contextually optical coherence tomography (OCT) was performed and showed fibrous cap rupture of proximal LAD (Figure 2 – 3). The patient was discharged with indication of medical therapy (Cardioaspirina 100 mg, Atorvastatina 40 mg, Bisoprololo 1,25 mg). CAD is a chronic condition usually occurring after the sixth decade of life. However, some populations experience this disease prematurely. In the last few decades, different studies have shown an increased incidence of CAD in very young people. The prevalence of CAD reported in very young people is 1–16%. Clinical and interventional management of CAD in very young people is still subject of discussion today. The literature showed how risk factors such us current smokers, dyslipidemia, and family history of CAD are significantly associated with the existence of severe CAD in patients of ≤40 years. The above risk factors are present in this patient, therefore we opted for correct them by medical therapy and follow–up by OCT at 6 months. The patient was stable and asyntomatic for chest pain at 1 month telephone follow–up.Figure 1.Figure 2.Figure 3.
ST SEGMENT DEPRESSION: MUCH ADO ABOUT NOTHING
Authors: Cherubini S , Gioffrè L , De Luca L , Casteli F , Ciolli A 
Published: May 2024

Abstract

Introduction
ST depression in ECG trace is classically used to assess the cardiac ischaemia. Several other causes of ST depression, like hypokalaemia, digoxin therapy, left ventricular hypertrophy, left bundle branch block can be easily excluded. Sometimes the ST segment depression during tachycardia is observed in young healthy people where ischemic background is rare.

Case Report
We present the case of an asymptomatic and without cardiovascular risk factors 29–years–old man who performed, during occasional sport visit, an ECG showing sinus tachycardia with diffuse ST segment depression. The ECG obtained at the presentation in Emergency Department of our hospital confirmed sinus tachycardia at 140 beats per minute and diffuse ST segment depression. This finding persisted during the following six hours and slowly regressed with normalization of the heart rate. The same ECG alteration was founded during an exercise test when the heart rate rised up to 90 bpm. A coronary angiography showed anatomically normal and angiographically free of stenosis coronaries; the functional study, using Fractional Flow Reserve (FFR), Coronary Flow Reserve (CFR) and Index of Microcirculatory Resistance (IMR), currently gold standard for the functional study of microcirculation, was normal. No alterations were founded at the cardiac magnetic resonance. Due to a previous resting ECG suspected of ventricular preexcitation, an electrophysiological study was performed and showed neither accessory pathways nor inducibility arrhythmias. The asymptomatic and hemodynamically stable patient was discharged and an ambulatorial follow–up was planned.

Conclusion
This case emphasizes the ever–present difficulty of attributing unequivocal etiological meanings to electrocardiographic alterations.
A CASE REPORT OF AN ASYMPTOMATIC PATIENT WITH TYPE 2 WELLENS’ SYNDROME AND RENAL CARCINOMA
Authors: Floris R , Demontis M , Carboni G , Palmas S , Boi A , Delogu G 
Published: May 2024

Abstract

A 65–year–old male with renal cell carcinoma, previously treated with nephrectomy and recently diagnosed with lung metastases, presented to the cardiology clinic for investigations before starting chemotherapy. He reported a history of ischemic heart disease, a non–ST–elevation myocardial infarction for which he refused coronary angiography in 2005, and a negative maximal stress test for ischemia in 2017. Additionally, the patient reported insulin–dependent type 2 diabetes mellitus and well–controlled arterial hypertension. The patient was referred for a cardiological evaluation due to a reported short–term rhythmic heartbeat without other cardiological symptoms. Cardiological parameters were stable (blood pressure: 140/95 mmHg; heart rate: 42 bpm, and oxygen saturation without oxygen supplementation: 98%). Physical examination was normal. Laboratory investigations did not show elevated levels of high–sensitivity troponin I, and only signs of mild chronic kidney disease were observed. The initial ECG showed sinus bradycardia with deeply inverted T–waves in the extended anterior area (Fig. 1), which were not present in an ECG performed one month earlier. There was no reported chest pain. An echocardiogram examination demonstrated hypertensive heart disease with marked hypokinesia of the mid–apical portion of the anterior wall and anterior interventricular septum, together with a moderate reduction in global systolic function (LV ejection fraction: 40%). The patient was hospitalized, and underwent coronary angiography the following day. He had a low–risk score (GRACE: 95 pts) As shown in Fig. 2, there was evidence of long sub–occlusive stenosis of the proximal part of the anterior descending coronary artery that was treated with angioplasty and a single drug–eluted stent placement, resulting in a good angiographic result. After the procedure, there was a rapid recovery of regional kinetics but a slower normalization of the electrocardiographic morphology (Fig. 3).

Comment
Wellens‘ syndrome identifies a particular subtype of unstable angina characterized by the appearance of ischemic changes on the ECG,. The clinical risk assessment of this subgroup of patients with ACS, apparently having a more benign prognosis due to their definition as unstable angina with a low GRACE risk score, potentially has an evolution toward a large myocardial infarction if not promptly diagnosed.
A (NOT SO) RARE CASE OF ACS IN A YOUNG WOMAN
Authors: Loffreno A , De Carlini C , Bersano C , Saltafossi D , Chiappa L , Rogacka R , Aurino L , Spinelli M , Ajello S , Scandroglio M , Calvo F , Achilli F 
Published: May 2024

Abstract
A 39 yo Caucasian woman, former smoker, with a previous history of gestational hypertension requiring therapy for several months, presented to the ED with persistent oppressive chest pain. No prior ischemic, constitutional or inflammatory symptoms emerged. Physical examination revealed a left carotid bruit and a continuous murmur at the base, Killip I. The ECG showed negative T waves in the inferior leads, the echo “point of care” normal systolic function, akinesia of the inferior wall, moderate aortic insufficiency, normal dimensions of the ascending aorta. HS T troponin rose to 188 ng/L and NT–proBNP 1621 pg/mL, CPR was normal. Coronary angiography revealed a tight subocclusive stenosis of the proximal right coronary artery trated by angioplasty with drug–eluting stent placement. In the ICU diminished pedal pulses were noticed, along with a significant discrepancy in blood pressure values between the four limbs (right upper 150/60 mmHg, left 140/60 mmHg, lower right 70/40 mmHg, left 60/40 mmHg). The echocardiogram showed normalized LV kinesis, moderate aortic insufficiency, normal dimensions of the ascending aorta and arch, flow acceleration at the isthmus (Vmax 4.6 m/s, Gmax 86 mmHg). CT angiography revealed thickening of the walls of the epiaortic vessels (with a non critical stenosis of the left carotid), of the thoracic and the abdominal aorta with complete occlusion of the subrenal segment and the inferior mesenteric artery (reconstituted by the Riolano artery and distal rectal arteries); the distal iliac arteries at the carrefour were separately reconstituted. 18F–FDG PET/CT confirmed diffuse hypercaptation along the ascending aorta, isthmus and proximal descending portion indicative of active vasculitis. Elevation of ESR 110 mm/h and CRP 21 mg/L was observed. The diagnosis of Takayasu‘s arteritis (TA) was estabilished and treatment with prednisone and methotrexate was started, resulting in the normalization of acute phase markers and clinical stability at 3 months. TA is a vasculitis that primarily involves the aorta and its main branches. The diagnosis can be challenging due to the heterogeneous clinical course and lack of specific laboratory markers. Diagnostic delay and persisting inflammation can lead to catastrophic consequences. Despite its rarity, TA can account for a notable proportion of young women with documented myocardial ischemia; hence, cardiologists must be sensitive to this pathology particularly in high–risk populations.