bluuebunny/crossref_metadata_2025_split huggingface dataset:
TEN YEARS OF TRANSESOPHAGEAL ELECTROPHYSIOLOGICAL STUDIES IN YOUNGER THAN 40 YEARS PEOPLE WITH A WOLFF–PARKINSON–WHITE SYNDROME
Authors: Toniolo M , Muser D , Rebellato L , Daleffe E , Imazio M 
Published: May 2024

Abstract

Background
The electrophysiological evaluation of Wolff–Parkinson–White syndrome (WPW) is recommended in people older than five–years to detect the risk of life–threatening arrhythmias. The purpose of this retrospective single–center study was to determine the feasibility of transesophageal electrophysiological study (EPS) in an outpatient setting among young people between 10 and 37 years old and to evaluate its prognostic role.

Methods
Electrophysiological study (EPS) was indicated in 60 consecutive people (48 males, 81%; mean age 19 ± 7 years) between january 2012 and october 2023. The test was indicated for manifest WPW, either for palpitations (n=11, 18.6%), unexplained dizziness (n=1, 1.7%), or for sport eligibility in asymptomatic people (n=47, 79.6%). An accessory pathway (AP) was considered to have a short refractory period and carry an increased risk for sudden cardiac death when the effective refractory period (ERP) was ≤240 ms, or if an atrioventricular (AV) reentrant tachycardia precipitating pre–excited atrial fibrillation was induced.

Results
EPS was performed in all but one person, without sedation. The main difficulty lied in passing the catheter through the nose. Programmed atrial stimulation at cycle length of 500 ms with one decremental extrastimulus was performed in all people to determinate the refractory period of the AP and the AV node. Physical activity during the test, or isoproterenol infusion was performed in 45 out of 59 people. The AP ERP was determined in the majority of case (54 out 59 people) and was between 200 and 360 ms (mean 270 ± 34 ms). Orthodromic reentrant tachycardia was induced in 10 (16.9%) cases, in 5 asymptomatic people and 5 patients with palpitations. Atrial fibrillation was induced in 13 cases. Antidromic tachycardia was never induced. Ten people (16.9%) were deemed at increased risk of life–threatening arrhythmias while 49 (83.1%) patients were deemedat low risk. Eight out of 10 (80%) high risk pts and only 5 out of 49 low risk patientss underwent catheter ablation of the AP. After a median follow–up of 57 months, all 49 patients defined at low risk were alive, without syncope or sudden cardiac arrest events.

Conclusions
In young patients with WPW syndrome, transesophageal EPS can be performed in an outpatient setting with an excellent tolerability and shows a high specificity (negative predictive value of 100%) to role out patients at increased risk of life–threatening arrhythmias.
A HEART–POUNDING RECOVERY PHASE
Authors: Paffoni P , Maffè S , Bergamasco L , Facchini E , Prenna E , Ariotti S , Ticozzi S , Franchetti Pardo N , Paino A , Dellavesa P 
Published: May 2024

Abstract

Background
Bidirectional ventricular tachycardia is a rare form of ventricular tachycardia that shows dual QRS morphologies alternating beat–to–beat. First reported as a complication of digoxin treatment, then in other conditions including myocarditis, sarcoidosis, catecholaminergic tachycardia, and Andersen–Tawil syndrome, rare are the cases in acute myocardial ischemia.
We present a case of 69 years old men, dyslipidemic, with an acute coronary syndrome in 2020, treated with PTCA and stent on left anterior descending artery, coronary angiography showed residual subcritical stenosis of left main. At electrocardiogram presence of left bunble brabch block (LBBB). After one year a stress myocardial scintigraphy was performed, stopped at 90% of maximal heart rate, without symptoms; during recovery phase after 22 seconds a wide QRS (170ms) tachycardia with morphology LBBB began (Figure 1), without symptoms, spontaneously interrupted after 50 s. After one minute another wide QRS tachycardia started, bidirectional (Figure 2), with interruption after 40 s. The patient did not present troponin elevation, not alteration in blood tests. No other arrhythmias were recorded, only bradycardia without pauses, shorts episodes of atrial fibrillation. Echocardiography confirmed left ventricular ejection fraction 40%.
The results of myocardial scintigraphy was only fixed basal septal ipoperfusion, confirmed by the presence of late enhancement on cardiac MRI. Coronary angiography showed distal left main stenosis involving interventricolar anterior artery origin, treated with PTCA + stent. In the following months, given reduction in NYHA class, brady–tachy atrial arrhythmic disease, left ventricular ejection fraction 35% and poor chances of drug therapy, ICD CRT was implanted. At 2–year follow–up no more ventricular arrhythmias were recorded.

Conclusions
Point of interest of this case is appearance of two complex different ventricular arrhythmias in the recovery phase of the stress test with paucisymptomatic patient and no arrhythmias during exercise test. The origin mechanism probably involves triggered activity from after–depolarizations, abnormal automaticity, and reentry. The fixed hypoperfusion area on myocardial scintigraphy and septal scar on cardiac MRI can be involved in the genesis of the bidirectional ventricular tachycardia; complete resolution of the arrhythmias after coronary revascularization, support ischemic hypothesis for the origin of arrhythmias.
VENTRICULAR ARRHYTHMIAS IN A UNEXPECTED CARDIAC MAGNETIC RESONANCE
Authors: Tansella D , Pittorru R , Perazzolo Marra M 
Published: May 2024

Abstract

Background
Electrical storm in a widespread inflammation of the myocardium represent a very challenge condition and recognizes a broad spectrum of etiology.

Case Presentation
A 59–year–old man, without significant prior medical history, came to our attention because, following an emergent hernioplasty procedure, he displayed anterior ST–segment elevation and elevated troponin levels (150.000 ng/L). An echocardiogram revealed an estimated left ventricular ejection fraction (EF) of 39% with anterior hypokinesia. Coronary angiography showed no abnormalities. Cardiac magnetic resonance imaging demonstrated ring–like edema and ring–like late gadolinium enhancement in the left ventricle on T2–weighted and PSIR sequences, with no involvement of the right ventricle. Additionally, there was an increase in extracellular volume. Despite several laboratory tests to investigate infectious or autoimmune causes, the etiology remained inconclusive. To further explore the cause, an endomyocardial biopsy was performed. However, the patient experienced an unstable electrical storm three days later.

Management
Recurrent ventricular tachycardia (VT) was initially treated with esmolol, amiodarone, and procainamide, but with limited success. Due to VT–induced hemodynamic instability, the patient was sedated with propofol and intubated. Endomyocardial biopsy (EMB) confirmed lymphocytic myocarditis. In light of the hemodynamic instability and refractory electrical storm, the patient was promptly cannulated for veno–arterial extracorporeal membrane oxygenation (VA–ECMO) and started on methylprednisolone. Although there was an apparent resolution of VT, the patient experienced new episodes, necessitating percutaneous stellate ganglion block and an upgraded treatment plan that included mycophenolate mofetil. Given the high burden of arrhythmias, severe ventricular dysfunction, and the lack of response to medications, the patient is now awaiting cardiac transplantation.

Conclusion
Transmural edema and ring–like late gadolinium enhancement (LGE) in the early phase are predictors of a poor prognosis. In cases of hemodynamic deterioration and refractory electrical storms, it is crucial to promptly initiate mechanical support. Cardiac transplantation remains the sole treatment option for individuals who do not respond to antiarrhythmic and immunosuppressive drugs.
MYOCARDITIS: VIRUS OR DESMOSOME?
Authors: Dei L , Re F , Gabrielli D , Sciarra L , Romano S 
Published: May 2024

Abstract

Patient Profile
Female, 56 yo, arterial hypertension, FH of autoimmune diseases, no history of sudden death. Medical History: • At the age of 46: Hospitalized for chest pain. Coronary angiography: negative. Diagnosis: myocardial ischemia with normal coronary arteries. • 2018: Hospitalized again for angina. ECG showed low voltages, flat T–waves in the inf–lat. leads. Coronary angiography: negative.

Biopsy
Mild hypertrophy and cytoplasmic vacuolization, minimal increase in interstitial fibrosis, no necrosis or inflammatory infiltrates. Mild nonspecific cardiomyopathy. Viral DNA test positive for HHV–6. Serology: HHV–6 in blood (neg), IgG HHV–6 (pos), IgM (neg). Diagnosis: myocarditis due to HHV–6. • San Camillo Cardiomyopathy Center: Echocardiogram: basal ant–lat. hypokinesia, EF 60%. Therapy: Bisoprolol 3.75 mg, Ramipril 5 mg, Ranolazine 1000 mg. MRI: basal transmural ant–lat. and subepicardial lateral LGE. Oedema and hypokinesia coexists. Subacute myocarditis. MRI at 1 year: mild left ventricular dilation, EF 60%, meso–subepicardial LGE in the ant–lat and inf mid–basal regions without oedema. Serial Holter ECGs: frequent polymorphic ventricular ectopics, couplets, and runs. CPET: normal exercise capacity, pVO2 19.4 (ml/min)/kg (90%).

Genetic testing
VUS in DSC, probably pathogenic, and VUS in ABCC9, PKP2, DSP (2 mutations) with uncertain clinical significance. • In 2022: Readmitted for angina. Elevated Troponin levels. Coro CT angiography: negative. MRI: EF 45%, akinesia of the apex and apical lat. wall; diffuse LGE and edema. Pericardial effusion. Patient refused biopsy. Discharged after recovery (EF 52%) with the diagnosis of recurrent myocarditis. Empagliflozin added. • Follow up. ECG: progression of repolarization abnormalities (TWI in V1–V3 + inf.–lat. leads). Biopsy: fibroadipose replacement, no necrosis or inflammatory infiltrates. Chronic myocarditis and sequels. Viral tests: negative. CPET and stress echo: VO2peak 20.7 (ml/kg)/min (88%), normal work capacity. Very rare monomorphic PVCs. EF 50%, preserved contractile reserve.

Conclusions
Diagnosis of left dominant arrhythmogenic cardiomyopathy with a typical pattern for hot phases of myocardial inflammation. The first episode could have been triggered by a viral infection on a predisposing genetic substrate. Nadolol 40 mg x2 was introduced. The possibility of ICD implantation was discussed, and patient refused. A six–month follow–up was planned. Family screening results were negative.
POST-HOC STRATIFICATION OF THE RISK OF INFECTION IN EXTRACTED PATIENTS
Authors: Benedetto L , Ferrieri A , Pastore I , Carretta D , D‘Agostino C , Dentico A 
Published: May 2024

Abstract

Introduction
Infection represents one of the most widespread and feared complications of CIED implantation procedures. Most of the time this could even evolve into endocarditis on electrocatheters or septic shock, to the point that the only life-saving therapy becomes the transvenous extraction of electrocatheters. For this reason, the problem often arises of preventing these infectious conditions by carrying out an infectious risk assessment before the implant so as not to incur these complications over time. This study aims to stratify post-hoc the infectious risk of patients extracted in our center to validate the introduction and use of scores for the pre-implantation assessment of infectious risk.

Methodology
We evaluated 163 patients who underwent transvenous extraction of leads, of which 130 due to pocket infection/endocarditis on leads or sepsis. In these patients, a post-hoc assessment of the risk of infection was made according to the UPCM score, a score created by the University of Pittsburgh. A score value greater than or equal to 7 identifies patients who are more likely to develop an infection over time. This score takes into account risk factors such as: early reoperation, type of device implanted (CRTD vs ICD/PM), presence of more than 2 catheters in place, replacement or revision of the device, use of temporary pacing, intake of corticosteroids or anticoagulants oral, renal function, fever within 24 hours before implantation, presence of diabetes or heart failure, male gender. We then paid particular attention to patients who had undergone an upgrade procedure or to those who had undergone an extraction procedure twice.

Results
Of the 130 patients in our center who underwent extraction for infection, 112 had a score greater than or equal to 7; On the other hand, 18 were those with a score lower than 7. The average value was found to be 22.9.

Conclusions
The identification of a score that can be evaluated before the CIED implantation procedure can be an excellent aid in identifying fragile patients who could suffer from infection in the long or short term. By doing this, further alternatives to the transvenous implant could be evaluated, such as the implantation of a leadless pacemaker or subcutaneous ICD in non-PM dependent patients eligible for this.
PREVENTIVE REHABILITATION CARDIOLOGY AS A POSSIBLE SETTING FOR THE MULTIDISCIPLINARY OUTPATIENT CLINIC FOR HEART FAILURE. THE CREATION OF A HEART FAILURE NETWORK BETWEEN THE DIFFERENT LEVELS OF CARE
Authors: Saporiti L , Moroni L , Rizza C , Scalabrino N , Guzon S , Picozzi A , Anzà C 
Published: May 2024

Abstract
Preventive Rehabilitative Cardiology (CPR) is a possible ideal setting for a Heart Failure (HF) Outpatient Clinic because it allows a specialized multidisciplinary team to be involved in the follow–up of the patient with Chronic Heart Failure (CHF). In the ESC 2021 Heart Failure Guidelines, two cornerstones in the management of patients with CHF are multidisciplinarity (meant as taking charge of the patient not only by the cardiologist but by several health figures, medical and non–medical, through the creation of a team) and the precocity and completeness of therapeutic optimization interventions. These two aspects of the process of taking care of patients with CHF are prerogatives widely developed in CPR. Outpatient cardiac rehabilitation pathways have developed effectively, albeit marginally, in CPR. In an increasingly clear differentiation of roles and in the perspective of the creation of a HF network, in order to optimize paths and resources, it therefore seems useful that CPR takes charge of the chronicity of the HF patient also through its continued outpatient management in the context of a HF Outpatient Clinic. The CPR of Castellanza–Multimedica has adopted a PDTA that aims to guarantee a multidisciplinary management for the patient suffering heart failure. Educational materials and working documents have been produced to encourage an exchange among professionals, and a framework of multidisciplinarity. Future work objectives include the structuring of an increasingly effective and two–way network with level II and III centres not belonging to Multimedica Group and direct access to the clinic not only upon referral from the GP, with whom active collaboration projects are underway, but also directly from the local DEAs, as well as the activation of televisit and teleconsultation programs. A first pilot study was performed to compare endurance versus interval physical training cycles in outpatients with HFrEF. RESULTS: in 5 years of activity, 196 patients were treated: 33 patients (16,8%) were sent to other centres or lost to follow–up, 16 (8,1%) were discharged with re–referral to the GP and Level I outpatient clinics or to the chronic disease programme (PAI), 29 (14,7%) died. Of the 119 patients with active follow–up as of 31/12/2023, 109 (91,5%) are on beta–blocker therapy, 70 (58,8%) on ARNI, 32 (26,8%) on ACEI–sartane for a total of 102 (85,7%) on RAASI, 106 (89,0%) patients on MRA, 87 (73,1%) on glyphozine, 73 (61,3%) on quadruple therapy.
EARLY USE OF SACUBITRIL/VALSARTAN FOLLOWING ACUTE DECOMPENSATED HEART FAILURE WITH REDUCED EJECTION FRACTION: FEASIBILITY AND UNVEILING FACTORS
Authors: Alonzo A , Matteucci A , Castello L , Marino G , Spinelli A , Di Fusco S A , Colivicchi F 
Published: May 2024

Abstract

Introduction
Sacubitril/Valsartan plays a pivotal role in treating heart failure with reduced ejection fraction (HFrEF), reducing cardiovascular mortality and hospitalizations. Despite its effectiveness, real-world data indicate persistent underprescription due to management complexity, modest tolerability, therapeutic inertia and regulatory constraints. The TRANSITION study in acute decompensated heart failure (ADHF) demonstrated the feasibility of initiating Sacubitril/Valsartan in hospitalized patients with HFrEF. Our study aims to establish the safety and tolerability of early Sacubitril/Valsartan prescription during ADHF hospitalization and investigate reasons of its underprescription. We present preliminary data from 20 consecutive ADHF patients admitted to our department between August and October 2023.

Methods
We collected data from patients with HFrEF diagnosis according to current guidelines. Patient data were documented during hospitalizations, and therapeutic regimens at admission were compared with those at discharge. We also reported systolic arterial pressure, creatinine levels, glomerular filtration rate and kaliemia values.

Results
Patients had a mean age of 75±12.8, and 80% were men. The mean ejection fraction was 30.7% ± 5.6. BMI was 26.9±4.3, and 40% of the patients had diabetes. The mean hospital stay was 5.4 ± 4.1 days. The utilization of Sacubitril/Valsartan at admission was 25% up to 75% at discharge (p = 0.001). Concurrently, beta-blocker usage increased from 55% to 90% (p = 0.013), SGLT2 inhibitors from 55% to 75% (p = 0.001), and MRAs from 30% to 80% (p = 0.001). Systolic arterial pressure decreased not significantly (p = 0.189) as well as the glomerular filtration rate (p = 0.51). Kaliemia remained stable from 4.09±0.45 mEq/l to 4.14±0.45 mEq/l (p = 0.72). The prescribed dosage of Sacubitril/Valsartan was 50 mg bid in 80% of patients, 100 mg bid in 13,3% and 200 mg in 6,6%. Among patients who didn’t receive Sacubitril/Valsartan, four patients had an absolute contraindication represented by a GFR &lt; 30 ml/min and one patient didn’t receive the drug due to an episode of cardiogenic shock.

Discussion
Our analysis highlights the underutilization of ARNi in HFrEF and the feasibility of early Sacubitril/Valsartan use in ADHF. The optimization of the therapy during hospitalization had no significant impact on key parameters. Advanced renal dysfunction represents the major limitation of Sacubitril/Valsartan prescription.
PSYCHOLOGICAL STRESS ALTERATION AND CV MODIFICATION IN CARDIOVASCULAR DISEASE OUTPATIENTS. THE ABC STUDY ON HEART DISEASE
Authors: Berton G , Mahmoud H , Cordiano R , Selvestrel E , Palmieri R , Merotto D , Dariod M , Visentin P 
Published: May 2024

Abstract

Introduction
Psychological stress is one of the most common patient complaints. Its influence on the physiology of the cardiovascular system, and on the aetiology and outcomes of cardiovascular disease (CVD) has been the object of intense investigation. In fact, current knowledge points to a “brain–heart axis” that is especially important in individuals with pre–existing CVD.

Aim
Evaluation of psychological stress reactivity and its cardiovascular effects in CVD outpatients.

Methods
Patients presented to the outpatient cardiology clinic of Conegliano General Hospital in the last 5 years were divided into 2 groups according to the presence or absence of stress symptoms based on the patient’s self–assessment psycho–emotion questionnaire.

Results
415 patients were included in this preliminary analysis. Patients‘ mean age was 66±18 years and 57% were males. Coronary artery diseases were registered in 93(22%) patients and 231 (56%) patients reported stress symptoms. They shared most demographic and clinical characteristics with patients who did not report stress symptoms. However, males were more frequent among patients with no stress. Interestingly, we observed no difference in systolic blood pressure values (SBP) between both groups, (148±21 Vs 145±23 mmHg, p= 0.15) for symptomatic and non–symptomatic patients respectively. Although, symptomatic patients had significantly higher values of diastolic blood pressure (DBP) than non–non–symptomatic patients, (81±10 Vs 77±11 mmHg respectively, p&lt;0.02). Using multivariable linear regression models, age was an independent predictor for higher SBP values (β±SE= 0.5±0.1, p&lt;0.0001), yet male gender and psychological stress were independent predictors for higher DBP values (β±SE were (2.9±1.1, p=0.007) and (4.3±1.1, p&lt;0.0001) respectively). Results Kept true even with repeated BP measurements, Figure 1. Subgroup analysis revealed the same results among non–CAD patients. Yet, for CAD patients stress was not an independent predictor for higher BP values, full–adjusted β±SE were (1.9±5.0, p=0.69) and (3.7±22.3, p=0.10) for SBP and DBP, respectively.

Conclusion
Psychological stress alterations are associated with a significant increase in DBP values, chiefly in non–CAD–outpatients.
EXERCISE PRESCRIPTION IN CARDIOVASCULAR PREVENTION: PRELIMINARY DATA OF A FIVE YEARS ACTIVITY OF SPORTS MEDICINE UNIT –ULSS 2 TREVISO
Authors: Giorgiano F , Vessella T , Merlo L , Pegoraro C , Barra B , Meneguzzo G , Michieletto F , Russo F , Sarto P 
Published: May 2024

Abstract
Physical exercise plays a pivotal role in primary and secondary prevention of non–communicable chronic diseases. Nonetheless, to date, exercise prescription to chronically ill subjects is not yet in line with guidelines indications. In Veneto region, the goal of reducing the gap between guidelines and their actual application has been pursued for several years thanks to a regional “model”of exercise prescription in chronic disease. However, regional data indicative of the real clinical impact of this "model" are lacking. We evaluated the impact of the regional model on a population of chronically ill people visited at our Clinic between 2014 and 2019. In this period, 366 subjects living in the province of Treviso (Veneto region, Italy) with a history of heart disease and/or diabetes have been admitted to our facility and have been provided with precise indications (in the form of prescription) about physical exercise to be practiced in secondary prevention. For each subject, adherence to the exercise prescription was assessed. The study population was therefore divided into 3 classes of activity in accordance with the physical activity practiced during the observation period: 0=not adherent at all at the exercise prescription (no exercise practice phase); 1= practice of unstructured physical activity/ not monitored physical exercise and/or not completely adhering to the exercise prescription in terms of intensity, duration and frequency; 2= practice of structured and monitored physical exercise, completely adherent to exercise prescription provided. By this way, any temporary suspension and subsequent resumption of the activity was considered and the period of cessation of the activity during the monitoring period was taken into account for each subject. Data on “health expenditure”, was collected for each subject at time zero as new hospitalizations and deaths were analyzed following our intervention (exercise prescription letter delivery). According to a preliminary analysis of our data, time spent in practicing exercise in class 1 and 2 lead to a significant improvement in survival and less hospitalizations for considered pathologies. Furthermore, time spent in class 2 exercise practice (structured and monitored physical exercise, at target for intensity, duration and frequency), seems to determine even greater protection compared to unstructured physical activity or structured but not monitored and/or non–targeted physical exercise (class 1).