bluuebunny/crossref_metadata_2025_split huggingface dataset:
MACHINE LEARNING APPROACH FOR PREDICTION OF CLINICAL OUTCOMES IN ANTICOAGULATED PATIENTS WITH ATRIAL FIBRILLATION
Authors: Bernardini A , Bindini L , Antonucci E , Berteotti M , Giusti B , Testa S , Palareti G , Milli M , Frasconi P , Marcucci R 
Published: May 2024

Abstract

Background
Despite the availability of different risk scores, the accuracy of actual prediction tools for outcomes in patients with atrial fibrillation (AF) remains modest. Although Machine Learning (ML) has been used to predict outcomes in the AF population, evidences about outcome prediction in a population entirely on oral anticoagulation is lacking.
The aim of this study is to use ML to predict outcomes in anticoagulated patients with atrial fibrillation, processing data from the Italian AF START–2 Register.

Methods and aims
Different ML models were applied to predict all–cause death, cardiovascular (CV) death, major bleeding and stroke in anticoagulated patients with nonvalvular AF. Overall population, Vitamin K Antagonists (VKA) and Direct Oral Anticoagulants (DOACs) populations were considered for the analyses.

Results
11078 AF patients (male n=6029, 54.3%) were enrolled with a median follow–up period of 1.5 years [IQR 1.0–2.6]. Patients on VKA were 5135 (46.4%), while 5943 (53.6%) were on DOACs. During the follow–up, 785 patients died, of which 169 (21.6%) due to CV causes; 240 major bleeding events were recorded, and 50 strokes occurred. Using Multi–Gate Mixture of Experts (MmoE), a cross–validated AUC of 0.779 ± 0.016 and 0.745 ± 0.022 were obtained, respectively, for the prediction of all–cause death and CV death in the overall population. The best ML model outperformed CHA2DSVA2SC and HAS–BLED for all–cause death prediction (p&lt;0.001 for both). When compared to HAS–BLED, Gradient Boosting improved major bleeding prediction in DOACs patients compared to HAS–BLED score (0.711 vs. 0.586, p&lt;0.001). Body mass index, age, glomerular filtration rate, platelet count and hemoglobin levels resulted the most important variables for ML prediction.

Conclusions
In patients with AF, ML models showed good discriminative ability to predict all–cause death, regardless of the type of anticoagulation strategy, and major bleeding on DOAC therapy, outperforming CHA2DS2VASC and the HAS–BLED scores for risk prediction in these populations. Anemia, platelet count, and BMI emerged as new potential risk predictors in anticoagulated AF patients. The applications of ML prediction models in clinical practice could improve the risk assessment and subsequent management of anticoagulated patients with AF.
COMBINED ENDOSCOPIC MITRAL REPAIR AND DIRECT CORONARY ARTERY BYPASS VIA BILATERAL MINI–THORACOTOMY
Authors: Squiccimarro E , Margari V , Kounakis G , Visicchio G , Pascarella C , Carbone C , Paparella D 
Published: May 2024

Abstract
Emerging evidence upholds minimally invasive approaches as the foremost surgical intervention for heart valve diseases, addressing detriments associated with traditional cardiac surgery. Yet, the comprehensive adoption of minimally invasive coronary surgery is disproportionately low, not to mention concurrent coronary and valve procedures. Bilateral mini–thoracotomy (MT) has been suggested as a feasible and safe technique for diverse isolated cardiac procedures. In 2021–2023, 7 patients were treated with minimally invasive mitral repair (MVr) and direct coronary artery bypass (MIDCAB): age was 66±4 years, 5 were males, and EuroSCORE II (%) was 2.6±1.2. For the procedure, a double–lumen endotracheal tube was employed, and heparin was administered. The right internal jugular vein was cannulated percutaneously. The MIDCAB involved a anterolateral left MT at the fifth intercostal space (IS). The left internal thoracic artery (LITA) was harvested under direct vision using a retractor. Mini–pericardiectomy was performed to facilitate off–pump anastomoses on the left anterior descending artery using a stabilizer, along with intracoronary shunts. Transit time flowmetry was performed. A right groin incision exposed the femoral vessels for echo–guided cannulation as per Seldinger. Endoscopic MVr was accomplished via a right MT above the nipple, at the fourth IS. A soft–tissue retractor and trocars at the fourth and sixth IS enabled 3D thoracoscopy and CO2 insufflation. After adjusting for selective ventilation, the chest was accessed for pericardiectomy. An aortic needle inserted via the main incision facilitated cardioplegia delivery and aortic venting. Cardiopulmonary bypass was established and aortic clamping achieved by Chitwood clamp at the second IS. Cardioplegia was delivered with the LITA graft temporarily closed. All patients received ring annuloplasty, 4 had posterior leaflet resection, 3 neochordal repair, and 2 had concomitant monopolar ablation and linear left atrial appendage closure. All patients were discharged healthy, after graft evaluation via computerized tomography. We report favorable outcome, satisfactory surgical times, early mechanical ventilation discontinuation (4±2 hours) and discharge from intensive care unit (3±1 days). No patient died at follow–up (maximum 2 years). In conclusion, minimally invasiveness should be embraced to ensure acceptance among patients and favorable long–term results, even when facing multifactorial pathology.
PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS TREATED WITH ORAL ANTICOAGULANT THERAPY: BASELINE CLINICAL CHARACTERISTICS OF THE PERSEO REGISTRY
Authors: Sciahbasi A , Gargiulo G , Giacoppo D , Talarico G , Calabrò P , Zilio F , De Rosa S , Talanas G , Tebaldi M , Andò G , Rigattieri S , Misuraca L , Cortese B , Musuraca G , Lucci V , Guiducci V , Renda G , Zezza L , Versaci F , Giannico M , Caruso M , Fischetti D , Colletta M , Santarelli A , Larosa C , Iannone A , Esposito G , Tarantini G , Musumeci G , Rubboli A 
Published: May 2024

Abstract

Background
International guidelines recommend a dual antithrombotic therapy (DAT) with direct oral anticoagulant (DOAC) for patients on chronic oral anticoagulant therapy (OAT) undergoing percutaneous coronary intervention with stent implantation (PCI–S). However, the implementation of practice Guidelines in the “real world” is often a complex exercise. Aim of the multicenter prospective observational PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) registry was to evaluate the management of the different antithrombotic regimens strategies in patients with an indication for OAT undergoing PCI–S in a “real world” setting and its association with clinical outcomes.

Methods
The PERSEO registry has been designed to enrol patients requiring OAT and treated by PCI–S in 25 Italian Cardiology Centres. No exclusion criteria have been defined. The primary end–point was a combined measure of efficacy and safety outcome (NACE), including major bleeding events + major adverse cardiac and cerebral events at one year follow up in patients treated with DOAC compared to vitamin K antagonists.

Results
From February 2018 to February 2022, a total of 1233 patients were enrolled: mean age 74±9 years, 900 males and 333 females. The primary indication for OAT was atrial fibrillation (1066 patients, 87%) while an acute coronary syndrome was the leading reason for PCI–S (789 patients, 64%). Of those, 271 patients had an ST elevation myocardial infarction at admission. Mean CHA2DVAS2C score and HASBLED score were respectively 4±2 and 4±1. Six patients died during hospitalization and 1227 were discharged alive: 1027 on triple antithrombotic therapy (oral anticoagulant and dual antiplatelet therapy), 196 patients on DAT (oral anticoagulant and single antiplatelet therapy) and 4 patients on oral anticoagulant alone. The majority of patients enrolled were discharged on DOAC (1006 patients, 82%), whereas only a minority received vitamin K antagonists (221 patients, 18%).

Conclusions
The Italian PERSEO Registry is the largest prospective observational study comparing different antithrombotic strategies in patients with an indication for OAT undergoing PCI–S in a “real world” setting. Baseline characteristics, depicted a population at high thrombotic and haemorrhagic risk. In agreement with current guidelines the majority of patients were discharged on DOAC, yet the use of a DAT was still limited to a minority of the patients included.
SAFETY AND EFFICACY OF A LIGHT ANTITHROMBOTIC REGIMEN AFTER LEFT ATRIAL APPENDAGE OCCLUSION: INSIGHTS FROM THE LOGIC (LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH GASTROINTESTINAL OR INTRACRANIAL BLEEDING) INTERNATIONAL MULTICENTER REGISTRY
Authors: Gallo F , D‘Amico G , Della Rocca D , Mazzone P , D‘Angelo G , Bordignon S , Casu G , Giannini F , Berti S , Barbierato M , Natale A , Themistoclakis S , Ronco F 
Published: May 2024

Abstract

Background
Antithrombotic therapy (AT) after left atrial appendage occlusion (LAAO) in patients with non–valvular atrial fibrillation (NVAF) has the purpose of preventing device related thrombosis (DRT), avoiding embolic events; nevertheless, the correct antithrombotic regimen after LAAO is still under debate.

Aims
Aim of this substudy of the observational LOGIC registry was to describe the efficacy and safety of a light antithrombotic regimen, comprising single antiplatelet therapy or none, compared to a standard antithrombotic regimen, after a successful LAAO.

Methods
Patients with NVAF that underwent LAAO were previously included in the LOGIC registry. Patients receiving single or no AT were considered as light therapy group, while other regimen were considered as standard regimen group. Outcomes of interest were: death from any causes and cardiovascular death, ischemic stroke, transient ischemic attack and systemic embolization, any bleeding and major bleeding at 12 months. Results. Six hundred and twenty–eight patients were considered in the analysis, 31.4% received a light antithrombotic regimen. There were no differences in overall and cardiovascular mortality (5.1% Vs 6.7%, p=0.426 and 2.0% Vs 1.4%, p=0.553 respectively). Cerebrovascular stroke and transient ischemic attack were similar between the two groups (1.5% Vs 1.4%, p=0.898 and 1.5% Vs 1.3%, p=0.847). Light regimen was not associated with an increased rate of systemic embolism (1.0% Vs 0.7%, p=0.447 and HR 0.88 [95% CI: 0.34 – 2.27; p=0.79]).

Conclusions
An AT regimen based on single or no antithrombotic therapy after LAAO seems to be safe in patients with high–bleeding risk, without increasing cerebrovascular or peripheral ischemic events.
CORONARY INFLAMMATION ON CHEST COMPUTED TOMOGRAPHY AND COVID–19 MORTALITY
Authors: Tuttolomondo D , Gaibazzi N 
Published: May 2024

Abstract

Aims
The main factors associated with coronavirus disease–19 (COVID–19) mortality are age, comorbidities, pattern of inflammatory response and SARS–CoV–2 lineage involved in infection. However, the clinical course of the disease is extremely heterogeneous, and reliable biomarkers predicting adverse prognosis are lacking. Our aim was to elucidate the prognostic role of a novel marker of coronary artery disease inflammation, peri–coronary adipose tissue attenuation (PCAT), available from high–resolution chest computed tomography (HRCT), in COVID–19 patients with severe disease requiring hospitalization.

Methods and Results
Two distinct groups of patients, admitted to Parma University Hospital in Italy with COVID–19 in March 2020 and March 2021 (first and third wave peaks of COVID–19 pandemic in Italy, with prevalence of wild–type and B.1.1.7 SARS–CoV–2 lineage, respectively) were retrospectively enrolled. The primary endpoint was in–hospital mortality. Demographic, clinical, laboratory, HRCT data and coronary artery HRCT features (coronary calcium score and PCAT attenuation) were collected to establish which variables were associated with mortality. Among the 769 patients enrolled, 555 (72%) were discharged alive and 214 (28%) died. In multivariable logistic regression analysis age (p&lt;0.001), number of chronic illnesses (p&lt;0.001), smoking habit (p=0.006), P/F ratio (p=0.001), platelet count (p=0.002), blood creatinine (p&lt;0.001), non–invasive mechanical ventilation (p&lt;0.001), HRCT visual score (p&lt;0.001) and PCAT (p&lt;0.001), but not the calcium score, were independently associated with in–hospital mortality.

Conclusion
Coronary inflammation, measured with PCAT on HRCT, was independently associated with higher mortality in patients with severe COVID–19, while the pre–existent coronary atherosclerotic burden was not associated with adverse outcomes after adjustment for covariates.
HFPEF AND GLYCEMIC VARIABILITY: GHIDD TRIAL
Authors: Fazio G 
Published: May 2024

Abstract

Background
Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%.

Purpose
In our study we evaluated the non diabetic patients with HFpEF with Glunovo® to evaluate the glycaemic variability in this population.

Methods
100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days, At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39–87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay.

Results
In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value &lt;59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were&gt; 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%).

Conclusions
Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT–2 inhibitor and GLP–1 Agonist in this class of patients.
SUDDEN DEATH IN THE WOMEN: EPIDEMIOLOGICAL DIFFERENCES IN THE BOLOGNA METROPOLITAN AREA
Authors: Carinci V , Cardelli L , Gamberini L , Semeraro F , Bugani G , Casella G 
Published: May 2024

Abstract

Bakground
It is a well known fact that men (M) are more likely to suffer of out of hospital cardiac arrest (OHCA) than women (W). Women account for 20–40 % of all OHCA, probably due to a minor prevalence of coronaric disease.

Methods
Our retrospective study considered all OHCA occurred in the Bologna metropolitan area (456.200 inhabitants) between 2009 and 2019. We considered all Pts, admitted alive at the hospital, presenting a NON STEMI ECG or a nondiagnostic ECG. We excluded Pts with STEMI ECG and extra cardiac causes of cardiac arrest or missing follow up. For each patient demographic informations, initial cardiac rhythm (ventricular fibrillation/ventricular tachycardia (VF/VT), asystole, or pulseless acticity (PEA)) and in hospital mortality, have been collected

Results
We evaluated 2072 OHCA, 1394 m (67%, age 66±13 yrs) and 678 w (33%, age 72±17 yrs, p&lt; 0.04). The prevalent initial rhythm was VF/VT in m (38% m vs 19% w), and PEA in w (35% m vs 49% w). Survival at hospital discharge has been 13,8% in m and 11,5% w We analyzed data of 146 pts presenting with non STEMI ECG or non diagnostic ECG: 46 w (31,5%) and 100 m (68,5%). Mean age was 60±18 yrs in w and 62 ±17 yrs in m (p = 0,552). The initial rhythm was VF/VT in 54,5% of w and 75,5% of m (p = 0,01), PEA in 25% w and 16,5% m (p = 0,192) and asystole in 20,5% w and 8,5% m (p = 0.054) 30 over 46 w (65%) underwent a coronaric study against 83 m over 100 (83%) (p = 0,021); between these pts, 6 w (13,6%) underwent percutaneous angioplasty against 30 m (30,0%) (p = 0,037). In the pts underwent to invasive study, mortality has been 40% for the w and 23% for the m (p = 0,095). In the conservative arm mortality was 62,5% for the w and 47% for the m (p = 0,49). Total mortality has been 47,8% for the w and 27 % for the m (p = 0,015) A multiparametric analysis matching mortality versus age, sex, initial rhythm VF/VT and witnessed cardiac arrest (Tab 1) showed that male sex has been indipendently associated to lower mortality OR 0.37 (95% CI 0.16 – 0.86).

Conclusions
In the Bologna metropolitan area, women represent 37% of OHCA. In the group of pts without ST elevation ECG, women represent equally only 31%, but show mean age and prevalence of initial rhythm VF/VT similar to men. Men and women had different access to coronaric study and present different mortality rate. This topic of research has great scientific relevance and its results deserve further studies to investigate the differences pointed out
EVALUATING PRO–ATHEROSCLEROTIC ACTIVITIES IN EPICARDIAL AND PERICARDIAL ADIPOSE TISSUE AND EXPLORING THEIR POTENTIAL AS CELLULAR MODELS FOR ASSESSING PATIENT RESPONSIVENESS TO THERAPEUTICS
Authors: Quarta S , Massaro M , Calabriso N , Scoditti E , Carluccio M , Cardetta F , Santarpino G 
Published: May 2024

Abstract

Background
Hypertrophy of epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) as in obesity is associated with several cardiac risk factors and higher carotid intima–media thickness, suggesting a pathogenic role of both cardiac fat tissue in the development of atherosclerosis. Curbing epicardial and pericardial adipose tissue dysmetabolism and associated inflammation may represent a novel therapeutic target to prevent coronary atherosclerosis.

Purpose
Evaluate pro–atherogenic properties of EAT and PAT, development a feasible method for isolation of adipocytes and evaluate the adipocyte response to therapeutics and micronutrients.

Methods
EAT and PAT were collected from coronary patients undergoing CABG (coronary patients) and from patients undergoing aortic or mitral valve surgery (valvular patients). Basal tissue expression of pro–inflammatory and pro–atherogenic genes was evaluated by rt–PCR. Then adipocytes were isolated and characterized. Finally, we tested the adipocyte ability to challenge vascular endothelium end their responsivity to cytokines and to the cardio–protective nutraceutical docosahexaenoic acid(DHA).

Results
Basal expression of inflammatory genes in adipose samples was higher in coronary patients than in valvular patients. Adipocytes isolated from these fat pads were pure and can be sub–cultured for several days without losing viability and retaining the ability to respond to pro–inflammatory stimuli. Concordantly, their secretome was able to “inflammate” vascular endothelial cells and sustain the recruitment and adhesion of monocyte to endothelial surface. On the other hand, the exposure of adipocytes to DHA resulted in a downregulation of MCP–1, CXCL10, IL–6 and MMP–9 expression(p&lt; 0.05) and in the upregulation of metabolic gene UCP–1 and –2 and PPARγ(p&lt; 0.05) while leaving unaffected the expression of adiponectin.

Conclusion(s)
Our data confirm the proatherogenic role of EAT in determining coronary atherosclerosis and suggests a similar pathogenic role for PAT. Furthermore, we propose a new efficient method for isolating adipocytes from PAT, obtaining cells that can be used as a potential bioreactor to test the response of adipose tissues to drugs and nutraceuticals.
A CLASH OF CHOLESTEROL TITANS: STATIN–INTOLERANT VS. STATIN–TOLERANT PATIENTS ON PCSK9 INHIBITORS IN LONG TERM FOLLOW–UP
Authors: Matteucci A , Alonzo A , Castello L , Spinelli A , Marino G , Schiaffini G , Di Fusco S , Aquilani S , Aiello A , Colivicchi F 
Published: May 2024

Abstract

Introduction
Statin intolerance remains a clinical challenge in the management of dyslipidemia. This study aimed to investigate whether patients with statin intolerance, receiving PCSK9 inhibitors, exhibit lipid profile improvement different from those obtained in those without statin intolerance.

Methods
In this monocentric outpatient study we enrolled 381 dyslipidemic patients receiving PCSK9 inhibitors. Statin intolerance was defined according to ESC criteria. Patients were divided into two groups, clinical data were collected, and lipid profiles were monitored regularly for a total of 36 months.

Results
Among the statin–intolerant patients, there was a higher proportion of women compared to those on statin therapy (38.6% vs 27.2% p = 0.051), although among intolerants the majority were men (69% vs 31% p = 0.023). Statin–intolerant patients had higher baseline total cholesterol (242±29.8 mg/dL vs 221±26.3 mg/dL p &lt; 0.001) and LDL cholesterol (161.4±39.7 mg/dL vs 147±37.1 mg/dL p = 0.010). Interestingly, lipid reduction in both groups became comparable as early as 6 months (LDL 67±37 mg/dL vs 63±39 mg/dL p = 0.42) and continued to be similar at 12 and 36 months of follow–up (LDL 74±44 mg/dL vs 69±29 mg/dL p = 0.62).

Conclusion
PCSK9 inhibitors effectively lower lipid levels in both statin–intolerant and statin–tolerant dyslipidemic patients. Statin–intolerant patients seem to have similar management and can achieve cholesterol levels comparable to patients on statin therapy.