bluuebunny/crossref_metadata_2025_split huggingface dataset:
USE OF SGLT2-i IN ELDERLY PATIENTS WITH HFrEF- REAL WORD DATA
Authors: Verga F , Orso F , Salucci C , Corti G , Graziani M , Alfano F , Poletti E , Cagnoni C , Ungar A , Baldasseroni S 
Published: May 2024

Abstract

Introduction
SGLT2-i have been shown to improve prognosis in patients with reduced ejection fraction heart failure (HFrEF) in randomized clinical trials (RCTs). However, we have little data on the use of these drugs in clinical practice, both in terms of safety and efficacy profile, especially in elderly patients.

Objectives
To describe the characteristics of HFrEF outpatients who started SGLT2-I and evaluate tolerability and effect of therapy.

Results
We evaluated 42 patients, 32 M and 10 F, with a mean age of 78±8.2 years (62.1% over 75). At baseline, the mean EF was 34.5%± 6.0 and the patients' renal function calculated with CKD-EPI was 56.3±18.6 ml/min/m2.
We followed at 6 months 36 patients. After 6 months of SGLT2i therapy, there was a significant reduction in NYHA class (NYHA I 30.6% vs 9.8%, NYHA III 13.9% vs 31.7%), a slight recovery in EF (38% vs 33% p-value = 0.039) and a decrease in diuretic dose (34 mg/day vs 64 mg/day, p-value 0.033). Despite a slight initial reduction in eGFR, like RCTs, there was recovery of renal function at 6 months. At 6 months, only 2 patients discontinued SGLT2i therapy due to urinary infection.

Conclusions
In our analysis after 6 months of SGLT2-i therapy in elderly patients, there was clinical improvement as evidenced by improvement in NYHA class and reduction in diuretic therapy. SGLT2-i have been shown to be relatively safe, with no adverse effects occurring and no significant worsening of renal function.
QUALITY OF CARE FOR PATIENTS WITH ACUTE HEART FAILURE: RESULTS OF THE FIRST 3 MONTHS OF THE QUALITY IN CARDIOLOGY (QIC) PROJECT
Authors: Corticelli A , Avanzini F , Conti A , Anguilano M , Bersano C , Bertocchi P , Bova C , Carbone S , Di Giulio P , Loffreno A , Paone M , Rigamonti A , Russo G , Santambrogio M , Scifo C , Serpato E , Spinelli M , Achilli F 
Published: May 2024

Abstract

Background
Assessing the quality of care is the first step for improve the management of patients with acute heart failure (AHF). The European Society of Cardiology (ESC) recently defined a set of quality indicators (QI) of care for AHF. Aim: To evaluate the quality of care of patients admitted to the Cardiology ward of our first level hospital for an AHF using the ESC QI.

Methods
QiC project is a prospective quality improvement study in real–world practice on all patients admitted in our ward for an AHF from 1.5.2023 to 30.4.25 with six–monthly audit activities. Case record forms were filled in by doctors during admission and were attached to the patient’s discharge letter. The ESC QI include 12 main and 4 secondary QI on structural framework, patient assessment, initial treatment, and assessment of patient health–related quality of life. For each QI was evaluated the percentage of QI assessable and attained.

Results
A total of 39 patients were admitted for AHF in our Cardiology Department in the first 3 months. One patient denied consent, one died during hospitalization, 5 patients had to be transferred to another hospital, and 7 did not have their record form filled in. The median age of the 25 patients discharged alive was 76 (IQR 64–83) years, 17 (68.0%) were males, 3 (12.0%) had a preserved, 1 (4.0%) mildly reduced, and 21 (84.0%) reduced ejection fraction. The percentages of non–assessment, non–attainment and attainment for each QI are reported in the Figure: the degree of non–assessment of the 16 QI ranged from 0 to 16% and the degree of QI attainment from 12 to 100%.

Conclusions
The quality of care for acute heart failure can be measured in the majority of patients admitted to our Cardiology Department using the ESC quality indicators. Although the majority of quality indicators are met in our patients, a large room for improvement is present in the domain of the patient assessment (mainly in completeness of blood tests and cardiac rehabilitation programme), of the initial treatment (SGLT2 inhibitor prescription), and of the assessment of patient health–related quality of life.
HEART FAILURE PATIENTS WITH IMPROVED EJECTION FRACTION: INSIGHTS FROM THE MECKI SCORE DATABASE
Authors: Mapelli M 
Published: May 2024

Abstract

Aims
Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF).

Methods
7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow–up of 1490 days). We analyzed clinical, laboratory, ECG, echocardiographic, exercise, and survival data from HFimpEF (n=1504) and pHFrEF (n=6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation.

Results
Main results are shown in Figure 1. HFimpEF patients had lower HF severity: LVEF 44.0[41.0–47.0] vs. 29.7[24.1–34.5]%, BNP 122[65–296] vs. 373[152–888] pg/mL, hemoglobin 13.5[12.2–14.6] vs. 13.7[12.5–14.7] g/dL, renal function by MDRD 72.0[56.7– 89.3] vs. 70.4[54.5–85.3] mL/min, peakVO2 62.2[50.7–74.1] vs. 52.6[41.8–64.3]%pred, VE/VCO2 slope 30.0[26.9–34.4] vs. 32.1[28.0–38.0] in HFimpEF and pHFrEF, respectively (p&lt;0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person–years for HFimpEF and pHFrEF, respectively (p&lt;0.001). Kaplan–Meier analysis (Fig.2) showed that HFimpEF had better a long–term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan–Meier curves showed the same prognosis.

Conclusions
HFimpEF represents a peculiar group of HF patients whose clinical, laboratory, ECG, echocardiographic, and exercise characteristics parallel the recovery of systolic function. Nonetheless, these patients remain at risk for adverse outcome.
CHRONIC THROMBOEMBOLIC PULMONARY DISEASE: ASSOCIATION WITH EXERCISE–INDUCED PULMONARY HYPERTENSION AND RIGHT VENTRICLE ADAPTATION OVER TIME
Authors: Alberti M , Madonna R , Biondi F , Morganti R , Badagliacca R , Vizza C , De Caterina R 
Published: May 2024

Abstract

Background and Aim
Chronic thromboembolic pulmonary disease (CTEPD) is a progressive condition caused by fibrotic thrombi and vascular remodeling in the pulmonary circulation despite prolonged anticoagulation. We evaluated clinical factors associated with CTEPD, as well as its impact on functional capacity, pulmonary haemodynamics at rest and after exercise, and right ventricle (RV) morphology and function.

Methods
We compared 33 consecutive patients with a history of acute pulmonary embolism and either normal pulmonary vascular imaging (negative Q–scan, group 1, n = 16) or persistent defects on lung perfusion scan (positive Q–scan) despite oral anticoagulation at 4 months (group 2, n = 17). Investigations included thrombotic load, the Pulmonary Embolism Severity Index (PESI) score, functional class, N–terminal prohormone of brain natriuretic peptide (NT–proBNP), cardiopulmonary exercise test (CPET) and echocardiographic parameters at rest and after exercise (ESE), at 4 and at 24 months.

Results
Compared with group 1, group 2 featured a higher PESI score (p = 0.02) and a higher thrombotic load (p = 0.004) at hospital admission. At 4 months, group 2 developed exercise–induced pulmonary hypertension (Ex–PH) at CPET (p &lt; 0.001) and ESE (p &lt; 0.001). At 24 months group 2 showed higher NT–proBNP (p &lt; 0.001), WHO–FC (p &lt; 0.001), systolic (p&lt;0.001) and diastolic (p = 0.037) RV dysfunction and worse RV–arterial coupling (p &lt; 0.001) despite maintaining a low or intermediate echocardiographic probability of PH.

Conclusions
This is the first "proof of concept" study showing that patients with a positive Q–scan frequently develop Ex–PH and RV functional deterioration as well as reduced functional capacity, generating the hypothesis that Ex–PH could help detect the progression to CTEPD.
IS IT REALLY A CASE OF TAKOTSUBO? SOMETIMES APPEARENCES CAN BE DECEPTIVE
Authors: De Donno F , Gidiucci R , Tosi C , Verde A , Masciocco G , Garascia A 
Published: May 2024

Abstract
We report the case of a 22–year–old female with a history of David procedure and mechanical valve replacement (ATS 22 mm) due to bicuspid aortic valve and severe AR with ascending aorta aneurysm in 2015. Regular annual clinical follow–up (EKG and ultrasound) was always normal. Since 2022 the patient suffered from episodes of dyspnea, chest pain and sadness diagnosed as Panic Disorder. Home–therapy: Warfarin, estroprogestinic pill. At the latest outpatient visit she was asymptomatic and in good overall condition, but her EKG showed novel alterations (T wave inversion in antero–lateral leads and QT prolongation). She was then sent to the ED. LAB: troponin levels were normal (6.8 ng/ml) with an elevated Nt–proBNP (425 ng/ml) and a low INR (1.53). Questioned about recent events she reported a road trauma which occurred two weeks prior. She was then admitted to Cardiology clinic. Ultrasound: apical akinesia with reduced wall thickness, EF 48%, E/E‘ 10, and normal right ventricular function. The aortic valve prosthesis was functional without pathological regurgitation, and other echocardiographic parameters were within normal limits. EKG and ultrasound abnormalities along with a recent history of trauma supported Takotsubo Syndrome diagnosis (InterTAK score = 79.8% – 67pt), even though troponin levels were normal. Throughout hospitalization there were no changes in the EKG or pathological increases in troponin, and the patient remained asymptomatic. The patient was treated with LMWH to achieve adequate INR levels and initiated on B–blocker, ACEi, and SGLT2i for HFmrEF. Cardiac MRI revealed apical segment akinesia with dilation and reduced wall thickness (EDV 97 ml/m²), EF 41%, transmural ischemic LGE in the apical region and a ventricular thrombus (16x4 mm). The patient underwent coronary angiography which showed normal epicardial coronary arteries. Upon careful history–taking, the patient admitted irregular intake of VKA in the previous months. Given this information, the MRI and angiographic findings the diagnosis of unrecognized prior acute coronary syndrome, likely due to coronary thromboembolism in a patient with PHV and suboptimal compliance with VKA, was established. The patient was discharged home upon achieving a persistently therapeutic INR, with instructions to discontinue contraceptive therapy. Conclusion: coronary thromboembolism is a rare complication of PHV with inadequate anticoagulation leading, in this case, to an unrecognized MI.
ACUTE PULMONARY EMBOLISM: NEW HORIZONS IN CAT LAB
Authors: Valenti G , Monello A , Rusticali G , Losi L , Bolognesi G , Aschieri D 
Published: May 2024

Abstract

Pulmonary embolism (PE) has an incidence of 30–100 cases per 100,000 inhabitants per year and is one of the main causes of cardiovascular mortality.The 2019 ESC guidelines suggest treating patients at intermediate–high risk with heparin, discouraging thrombolysis and leaving embolectomy to the clinician‘s judgment in case of impending hemodynamic instability. The case involves a patient with intermediate–high risk PE,and how the cardiologist‘s intuition was supported by the multidisciplinary team‘s work to ensure timely treatment.

Clinical Case
A 75–year–old female with systemic hypertension, recently discharged with a pneumonia diagnosis,presented to the Emergency Department complaining of dyspnea. The CT angiogram showed PE with a saddle thrombus occupying a significant portion of the main pulmonary arterial branches, severe right ventricular dilation (baseline diameter 50 mm, 44 mm RVOT average, TAPSE 16 mm),dilated vena cava; stable hemodynamics (BP 120/90 mmHg), slightly elevated troponin I (73.4 ng/L, normal range &lt;12 ng/L), placing the patient in the intermediate–high–risk category, for which intravenous heparin was administered according to European guidelines. A follow–up CT angiogram on the fourth day showed no improvement in the radiological picture. With stable hemodynamics, indicating no systemic thrombolysis, and hypoxemia with peripheral desaturation (pO2 60 mmHg, SaO2 &lt;90%), the possibility of using pulmonary thromboaspiration was requested. On the fifth day, a pulmonary embolectomy procedure was performed via transfemoral vein (Flowtriever device).Thrombus aspiration (6 cm in length) immediately improved the baseline hemodynamic profile: PAPs pre–procedure 67 mmHg, post–procedure 43 mmHg.The follow–up CT angiogram no longer showed thrombus in the main arterial branches (remaining thrombi in segmental and subsegmental pulmonary arteries). In the pre–discharge echocardiogram, estimated PAPs was 30 mmHg, TAPSE 19 mm.

Conclusions
Acute pulmonary embolism still represents a clinical reality for which effective therapeutic strategies are not universally available, both for acute treatment and preventing chronic thromboembolic pulmonary hypertension.The Flowtriever device we used proved to be easy and safe to use, with immediate therapeutic results, both clinically and instrumentally.Further studies are needed to consolidate the role of percutaneous pulmonary thrombectomy in the routine treatment of patients with pulmonary embolism.
REMOTE CARDIAC DEVICE MANAGEMENT: REAL–WORLD INSIGHTS AND CHALLENGES
Authors: Veneziano F , Toniolo S , Cavedon S , Zimelli E , Mecenero A , Volpiana A , Fortuna G , Dalla Valle C , Battisti V , Dolci G , Tenaglia R , Loddo I , Verlato R , Bilato C 
Published: May 2024

Abstract

Background
telemedicine plays a crucial role in managing patients with Cardiac Implantable Electronic Devices (CIEDs), offering unique technical and clinical benefits. This study explores the characteristics of a real–world population of CIED recipients undergoing entirely remote follow–up.

Methods and Results
in a prospective evaluation of 808 consecutive CIED patients from two Italian Cardiology Centers (2021–2023), initial on–site assessments were followed by remote evaluations, either scheduled or alert–triggered. The majority received pacemakers (68.8%), with others having Implantable Defibrillators (19.3%) or Implantable Loop Recorders (11.9%). The average age was 75.6±12.6 years, and 42% were female. Most of the patients were retired (83.3%), and 73% required at least one caregiver. The EQ–5D score indicated a lower quality of life (8.9±4.3) compared to the Italian general population. During the observation period (20.6 months), 34.9% of patients were admitted to the hospital, with 50% of cases being cardiovascular–related. Heart failure was the most common cause (13.2%). Device–related issues prompted outpatients’ cardiology clinic Department evaluations in 13.4% of cases. The telemedicine program produced 2780 remote transmissions, with 23% being automatic alerts. In–clinic evaluations were 1313, with a mean duration of 19.2 minutes. Atrial fibrillation (AF) history was prevalent (40.2%), and 719 AF episodes occurred during the observation period.

Conclusions
Managing CIED patients via telemedicine is feasible but requires structured organization considering patient characteristics and possible outcomes. AF management is crucial, given its high prevalence. Older age and compromised quality of life are significant factors, partly mitigated by the widespread presence of caregivers. Despite remote follow–up, many patients access healthcare structures for cardiovascular reasons, emphasizing the need for distinct pathways for device–related and general care necessities.
HYPERTENSIVE EMERGENCIES AND URGENCIES: ADHERENCE TO GUIDELINES AND RELATIONSHIP BETWEEN BLOOD PRESSURE MANAGEMENT AND IN–HOSPITAL MORTALITY
Authors: Maloberti A , Valobra T , Giani V , Garofani I , De Censi L , Galasso M , Colombo V , Menna A , Giacalone A , Ferretti C , Sultana A , Gheda S , Capsoni N , Galbiati F , Bombelli M , Giannattasio C 
Published: May 2024

Abstract

Introduction
Data regarding prevalence and clinical management of hypertensive emergencies and urgencies are lacking and heterogeneous. Our goal is to characterize patients with hypertensive emergencies and urgencies admitted to the Emergency Department (ED) of Niguarda hospital and Pio XI Hospital of Desio. In this population we also want to evaluate factors associated with organ damage, adherence to guidelines and the impact of Blood Pressure (BP) management on in–hospital mortality.

Method
We performed a multi–centre retrospective study collecting data about all adult patients with systolic BP ≥ 180 mmHg and/or diastolic BP ≥120 mmHg admitted to our hospitals‘ ED during 2017 and 2019.

Results
Admission to ED for BP elevation were 1838 (0.95% of total admission to ED), of whom 38% were hypertensive emergencies and 62% were hypertensive urgencies. Patients with hypertensive emergencies were older, mainly male, with more comorbidities and more symptomatic at ED admission. In the emergencies group, we observe a SBP mean reduction of 39.50 mmHg (±26.35) and a DBP mean lowering of 16.28 mmHg (±17.57); the most used drugs were furosemide, nitroglycerin and parenteral labetalol. In the urgencies group, the mean reduction was 39.09 mmHg (±22.46) for SBP and 15.34 mmHg (±16.07) for DBP. The most used drug was short–acting nifedipine benzodiazepine and amlodipine in this group. Age, sex, clinical history of heart failure and chronic obstructive pulmonary disease, symptoms at ED admission ad eGFR have been recognised as factors associated with organ damage. Instead, BP at ED admission and its management didn’t appear to have a significant impact on outcomes.

Conclusions
Our study demonstrated better adherence to guidelines in the treatment of hypertensive emergency than of hypertensive urgencies. Furthermore, no significant association were found between the BP management in the ED and in–hospital mortality.
CHOLESTEROL–LOWERING THERAPIES IN ACUTE CORONARY SYNDROME: A SINGLE–CENTER OBSERVATIONAL STUDY
Authors: Marino G , Spinelli A , Macchiusi A , Altamura V , Di Fusco S , Aquilani S , Aiello A , Colivicchi F 
Published: May 2024

Abstract

Background
LDL–cholesterol (LDL–C) is a key target of atherosclerotic cardiovascular disease secondary prevention. We report a cohort study aimed at assessing lipid–lowering drug use in patients hospitalized for acute coronary syndrome (ACS).

Methods and Results
In this single–center observational study we enrolled 81 patients hospitalized from September to October 2023 at the Clinical and Rehabilitation Cardiology of the San Filippo Neri Hospital with diagnosis of ACS treated with angioplasty. Thirteen (16.05%) of these patients had no history of ASCVD, 68 (83.95%) patients had a history of ASCVD. Among the latter, 12 (17.65%) experienced a second vascular event within two years. At enrolment, LDL–C mean values in the total population were 86,31 mg/dl. LDL–C levels were higher in the group without a history of ASCVD than in the group with a history of ASCVD (109,30 mg/dl vs 82,31 mg/dl). In the subgroup of patients with a history of ASCVD and two cardiovascular events in the last two years, the mean level of LDL–C was 93.60 mg/dl. According to the most recent 2019 ESC/EAS guidelines, for patients with ASCVD (very high risk) the recommended therapeutic LDL–C goal is &lt;55 mg/dl and for patients with ASCVD who experience a second vascular event within two years, an LDL–C goal of &lt;40 mg/dl may be considered. In our study only 16,17% of patients with a history of ASCVD achieved such goals. At admission about half of patients included in this study (49,38%) were not prescribed any therapy, 16,05% received monotherapy (statins or ezetimibe or nutraceuticals), 28,40% were taking combination therapy (statin + ezetimibe) and 6,17% other combinations of statins, ezetimibe, nutraceuticals, and Proprotein Convertase Subtilisin/Kexin–type 9 inhibitors (PCSK9i) (Figure 1). At discharge 80,25% of all patients received combination therapy (statin + ezetimibe), 13,58% received other combinations (statin + ezetimibe + PCSK9i; statin + ezetimibe + bempedoic acid; statin + ezetimibe + inclisiran; statin + ezetimibe + omega–3 fatty acids; ezetimibe + inclisiran), 6,17% received monotherapy (PCSK9i or statin) (Figure 2).

Conclusion
Before hospitalization the use of cholesterol–lowering therapies was not optimal and the majority of patients had LDL–C level higher than recommended targets. Hospitalization allowed us to optimize and personalize the therapy and to prescribe some of the newest cholesterol–lowering drugs.
ROLE OF THE MACHINE LEARNING–DERIVED HYPOTENSION INDEX (HPI) TO CONTAIN INTRAOPERATIVE HYPOTENSION DURING TRANSCATHETER EDGE TO EDGE REPAIR PROCEDURES
Authors: Lombardi F , Lucarelli K , Frassanito L , Casamassima V , Troisi F , Bellomo V , Argentiero A , Mancini G , Casamassima F , Lanza G , Burzotta F , Grimaldi M 
Published: May 2024

Abstract

Introduction
Percutaneous endovascular valvular interventions can result in profound hemodynamic instability, elevated burden of intraoperative hypotension (IOH) and related postoperative complications: ischemic stroke, acute kidney injury and increased mortality. Machine learning(ML),a branch of Artificial intelligence (AI), can analyze large volumes of data, find associations and allowing predictive rather than reactive interventions. The Hypotension Prediction Index (HPI)a ML derived algorithm,provides a unitless number from 0 to 100, that increases accordingly to the risk of developing a hypotensive event (mean arterial pressure – MAP – &lt; 65 mmHg for more than 1 minute) in the following minutes. The aim of this study is to describe IOH in patients undergoing percutaneous valve repair under general anesthesia treated according to an HPI–based hemodynamic guidance (fig.1).

Methods
Eligible adult patients undergoing transcatheter valve repair procedures (MitraclipTM, TriclipTM)were included in the study. When HPI value exceeded 85,a proactive individualized treatment protocol to prevent hypotension was provided according to the following modalities (fig. 2). Primary outcome measure was TWA–MAP (time weighted average mean arterial pressure)under the threshold of 65 mmHg. Secondary outcomes were number of patients with at least one hypotensive event, number of events per patient,depth and duration of hypotensive events and area under MAP threshold of 65 mmHg (AUT–MAP &lt; 65).

Results
Twenty–five consecutive patients were prospectively enrolled and treated. During an average monitoring time per patient of 187 ± 31 minutes, the global burden of hypotension, measured as TWA–MAP &lt; 65 mmHg, was 0.12 [0.02, 0.8] mmHg. Two thirds of the patients(16/25) experienced hypotensive events, with a median number of hypotensive events of 1 [0, 3.25] per patient and about 11% of the time spent &lt; 65 mmHg. Each event lasted 4 [1.7, 8.6] minutes with a MAP of 59 [56, 62] mmHg, leading to a total AUT–MAP &lt; 65 mmHg of 20.3 [3.5, 142.2] mmHg x minutes. The majority of hypotensive events occurred after induction of general anesthesia, while hypotension was rare during the procedure (fig. 3).

Conclusions
HPI algorithm provides accurate and continuous prediction of impending IOH before its occurrence. Machine learning models,as in the case of HPI, could facilitate the physicians to treat IOH which is a potentially modifiable risk factor for major postoperative complications.