bluuebunny/crossref_metadata_2025_split huggingface dataset:
FOLATES–RELATED AND BONE MARROW DISORDERS PROMOTE ATRIAL CARDIOMYOPATHY INPATIENTS AFFECTED BY PAROXYSMAL ATRIAL FIBRILLATION VIA BOTH EPCS AND ENDOTHELIAL DYSFUNCTION
Authors: Sgarra L , Grimaldi M , Caccavo V , Troisi F , Katsouras G , De Santis V , Potenza A , Montagnani M 
Published: May 2024

Abstract

Background
Atrial Cardiomyopathy (AC) has been recently postulated to explain those embolic strokes not due to atrial fibrillation (AF) and paradoxical embolism. Pathogenic mechanisms underlying AC are still largely unknown. Folate cycle disorders (FD) are a yet underrated pro–thrombotic dysmetabolism. FD could hinder both endothelial and circulating endothelial progenitor cell (EPCs) functioning, therefore providing one–shot explanation to both atrial fibrosis and endothelial dysfunction (ED).

Purpose
This study aims to enquire for the hypothesis that: 1) atrial fibrosis (AFib) would relate to FD (intended as both: a)MTHFR C677T inherited mutations and b)bone–marrow function disorders, here referring to erythropoiesis diversions) and 2) AF patients would show dysfunctional EPCs.

Methods
We studied 59 consecutive patients admitted to the cardiology Unit of the General Hospital“F.Miulli”, with preserved EF, subjected to AF ablation. AFib was quantified in term of percentage of bipolar peak–to–peak voltage points below 0,5mV with respect to the wholeness of picked points. Blood count cell was evaluated at the admission. MTHFR C677T genotypes and serum folate were assessed. EPCs isolation and characterization were performed by cytometry analysis (CD45, CD34, CD133, VEGFR2 and KDR). EPCs functional wound healing assay was performed to determine the percentage of EPCs able to "fix the wound” and compared with matched–controls.

Results
Baseline characteristics did not differ between Sample and Control groups (Fig. 1 – Left Table). % of Afib significantly differs between C677T MTHFR homozigosis patients (n=15) with respect to non–C677TMTHFR homozygosis patients (n=44) (Fig.1 – Right graph. – p &lt; 0,02). Once univariate analysis was performed, subsequent multivariate analysis highlight highest fit, once merged RBC, RDW–SD and folates values were inputed (Fig.2 – superior graph. – R2=0,39;p=0,0001). Either RBC, RDW–SD and folates coefficient reached significance (p &lt; 0,0001; p &lt; 0,01; p &lt; 0,05 respectively). Number of EPCs signifi cantly differs between AF patients and matched controls (Fig 2 – inferior graph. –p &lt; 0,001).

Conclusions
Our findings support the hypothesis that genetically determined folates dysmetabolism (MTHFR dysfunction) promotes AFib via a complex cardiac–bone marrow networking involving circulatingEPCs and unraveled by erythropoiesis diversions. Such results suggest a pathogenic role of folate cycle disorders in the AC development.
HEART FAILURE WITH RELAPSING ATRIAL FIBRILLATION: BELOW THE SURFACE
Authors: Trifirò S , Ghiadoni L 
Published: May 2024

Abstract
Advances in pharmacologic and device therapy have greatly improved prognosis of patients with HFrEF. However, the typical clinical course is still characterized by recurring symptoms, worsening functional status and risk of frequent hospitalizations. A 72–years–old male patient with arterial hypertension, poorly controlled T2DM, TIA and chronic kidney disease presented to Cardiology service in 2018 with dyspnoea on effort and first evidence of EF 35% at echocardiography. He was admitted for elective coronary angiography, which demonstrated limited coronary heart disease of circumflex artery and its first marginal branch, treated by PTCA and stenting. CMR confirmed severe LV dysfunction, but also revealed extensive fibrotic areas with ischaemic and non–ischaemic patterns beyond revascularized regions. With such evidences, HF treatments were intensified, with titration of disease– modifying therapies and DOAC was added for asymptomatic paroxysmal AF. CRT–D was implanted for QRS of 160 msec, which was narrowed to 130 msec. Nevertheless, in one–year time the patient presented worsening of symptoms with several hospital admissions for acute HF and AF with fast rate. A switch to rhythm–control strategy was hence chosen. DCCV was performed, after an initial deferral for thrombosis of LAA due to poor adherence to DOAC. However, three–days after DCCV, the patient presented again to emergency services for dyspnoea, left upper flank pain and AF with fast rate. He was admitted to Acute Medicine Unit and treated with high flow O2, iv Furosemide and Digoxin, analgesics. CT chest and abdomen with contrast was performed in the suspicion of systemic venous thromboembolism for persistent type 1 respiratory failure, raised D–dimer and elevated liver function tests, despite appropriate anticoagulation. CT revealed an unexpected left superior pulmonary vein thrombosis, splenic and small left renal infarcts. The patient was discharged after recovery on subcutaneous heparin. At 15–day review, the patient was in stable conditions and awaiting completion of coagulation screening tests. This case study addresses some important aspects in the care of HF. An accurate assessment of HF aetiology and recurrent triggers, a timely planning of pharmacologic and device treatments, alongside with management of co–morbidities, therapeutic adherence and appropriate anticoagulation, can provide the clinician powerful tools to accomplish the difficult task of managing HF below the surface.
USE OF DAPAGLIFLOZIN FOR HEART FAILURE WITH REDUCED EJECTION FRACTION IN ITALIAN CLINICAL PRACTICE (EVOLUTION–HF ITALY): INTERIM ANALYSIS AT 6 MONTHS OF FOLLOW–UP
Authors: Orso F , Carugo S , Ameri P , Di Lenarda A , Iacoviello M , Indolfi C , Mortara A , Perrone Filardi P , Ungar A , Volpe M , Volterrani M , Granelli V , Ceracchi M , Pluchinotta F , Mastromauro F , Merlo A , Cosentino N , Gnesi M , Metra M , Rosano G 
Published: May 2024

Abstract

Background
Dapagliflozin is a sodium–glucose cotransporter–2 inhibitor (SGLT2i) approved for the treatment of Heart Failure (HF); however, real–world data on the use of dapagliflozin in the setting of HF with reduced Ejection Fraction (HFrEF) are scarce. EVOLUTION–HF Italy is part of a wider initiative aimed at filling these gaps with Real–World Evidence studies in 13 European countries.

Aims
The primary aim of the study is to describe characteristics of patients starting dapagliflozin for HFrEF and treatment patterns including discontinuation of dapagliflozin. Patient Reported Outcomes (PROs) are investigated as secondary aims, including Kansas City Cardiomyopathy Questionnaire (KCCQ), Medication Adherence Report Scale (MARS–5), and 6–Minutes Walking Test (6MWT). This abstract reports interim analysis (IA) results after 6 months of follow–up.

Methods
EVOLUTION–HF is a descriptive, observational, longitudinal study, which enrolled patients ≥18 years of age initiating dapagliflozin according to the approved HFrEF label; those with previous SGLT2i treatment were excluded. The enrollment window was 14–45 days after dapagliflozin initiation, and follow–up lasts up to 1 year.

Results
256 participants (mean age 68.5±11.6 years, 75.8% males) were enrolled in 11 Italian sites between April 2022 and April 2023; baseline clinical characteristics are reported in Figure 1. On average, Left Ventricular Ejection Fraction (LVEF) was 31.9%. Most participants had HF in NYHA class II (69.1%) and with ischaemic aetiology (55.7%); 31.7% were hospitalised for HF in the previous year. Cardiovascular treatments at baseline are detailed in Figure 2: 66.4% of patients were treated according to guideline–directed medical therapy for HFrEF (ARNI or ARB or ACEi + BB + MRA + SGLT2i). Follow–up visits at Month 6 were completed by 99 patients at the time of the IA (Figure 3). At 6 months, when compared with baseline, NTproBNP values lower and clinical status (as assessed by KCCQ score) improved, with patients being highly adherent to HF therapies.

Conclusions
The interim analysis presented in this abstract indicates signs of clinical improvement 6 months after initiation of dapagliflozin. At study completion (April 2024), EVOLUTION–HF Italy will generate robust evidence on real–world use of dapagliflozin among Italian patients with HFrEF, including relevant information on treatment pattern, clinical parameters, and quality of life.
PSYCHOMETRIC PROPERTIES OF THE KCCQ–12 IN A EUROPEAN COHORT OF PATIENTS WITH HEART FAILURE
Authors: Iovino P , Dollaku H , Alvaro R , Pucciarelli G , Rasero L , Vellone E 
Published: May 2024

Abstract

Background
Despite medical advances, patients with heart failure continue to suffer from poor quality of life due to worsening symptoms and functional limitations. Therefore, it is important to understand the multidimensional facets of quality of life in these patients. The Kansas City Cardiomyopathy Questionnaire is a commonly used quality of life assessment tool worldwide. However, However, there is still a lack of knowledge about its psychometric properties.

Purpose
The aim of this study was to investigate the psychometric properties of the KCCQ–12 and its measurement invariance in a cohort of European patients with heart failure.

Methods
Participants (n=510, median age=72, IQR=18, 58% males) completed the KCCQ–12 alongside measures of clinical psychosocial severity. A confirmatory factor analysis was used to establish factorial validity; internal consistency was determined using the Omega coefficient and the model–based internal consistency coefficient. Zero–order correlations between the KCCQ–12 scores and clinical and psychosocial measures were performed to test convergent validity. Multigroup confirmatory factor analysis was conducted to test measurement invariance across patients with preserved vs reduced ejection fraction.

Results
Confirmatory factor analysis confirmed a four–factor solution, with the domains of physical limitations, symptom frequency, quality of life, and social interference. Internal consistency was excellent (Omega coefficients ranging from 0.83 and 0.90, and internal consistency index of 0.94). The KCCQ–12 scores significantly correlated with ejection fraction, New York Heart Association class, quality of life, anxiety, depression, symptom burden, and the KCCQ–23 Overall Summary score, which adequately supported the convergent validity of the KCCQ–12. Measurement invariance was confirmed at the partial scalar and strict level.

Conclusions
These findings support the validity and reliability of the KCCQ–12, both in patients with reduced and preserved ejection fraction. Hence, this version can be confidently used both in research and clinical practice to measure quality of life of heart failure patients.
THE CHALLENGING SCENARIO OF DYSPNEA IN THE ELDERLY: DUE MORE TO CONGESTION OR INFLAMMATION?
Authors: Cosmi D , Tarquini B , Mariottoni B , Cosmi F 
Published: May 2024

Abstract

Introduction
Elderly patients hospitalized due to acute heart failure often have a concomitant acute lung disease. Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis.

Purpose
We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and strong inflammatory response.

Materials and Methods
We evaluated 302 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT–proBNP ≥3,000 pg/ml, and a finding X–ray of lung congestion with or without a consolidation. Reactive C Protein (CRP) was measured. Patients with SARS–CoV–2, indication to corticosteroids for other clinical conditions or need for mechanical ventilation were excluded. The 112 patients with CRP&gt;20 mg/dl were randomized into 2 groups: 56 patients were treated open–label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies, while the same number of patients were treated with the usual therapy. In both groups antibiotics were administered based on procalcitonin guided protocl. Clinical recovery time, length of hospitalization, in–hospital mortality, need for a new hospitalization and mortality at one month were evaluated.

Results
The mean age of patients was 89±5 years in the dexamethasone group and 88±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in–hospital mortality or need for rehospitalization and mortality at 30 days. Notably, PCT guided treatment led to an average reduction in duration of antibiotic therapy from 8 to 5 days.

Conclusions
Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state have a favorable response to dexamethasone therapy added to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double–blind randomized controlled trials.
SERUM OSMOLARITY ON ADMISSION ACUTE HEART FAILURE AND SHORT–TERM MORTALITY
Authors: Livrieri A , Scicchitano P , Pinto M , Abruzzese S , Tangorra M , Trotta F , Cannito A , Caldarola P , Massari F 
Published: May 2024

Abstract

Background
Serum osmolality has been reported to be infuenced by well–known prognostic factors such as arginine vasopressin, the renin–angiotensin–aldosterone system, and natriuretic peptides, which suggest that osmolality itself could be also associated with the prognosis of heart failure. However, previous studies in acute heart failure (AHF) reported conflicting results on the prognostic role of serum osmolality.

Methods
We conducted a retrospective cohort study in subjects hospitalized with AHF between 2022 and 2023 in order to determine the association between serum osmolality at admission and 90–days mortality using Cox proportional hazard and Kaplen–Meier models.

Results
The study group consisted of 166 AHF patients (male 51%), mean age of 80 ± 9 years) with serum osmolarity 282± 11 mOsm/L and 90–days mortality equal to 23%. At univariate analysis, osmolality was significantly associated with mortality (HR 0.96, 95% CI 0.94–0.96). The optimal cut–off values for mortality was &lt;280 mOsm/L (AUC 0.61; VPV 33 VPN 84). After adjustment for sex, age, BNP, renal and left ventricular functions, osmolality remained significantly and independently associated with mortality (HR 0.97, 95% CI 0.95–0.99).

Conclusions
Lower levels of serum osmolality on admission were related to short–term mortality in patients with AHF, suggesting that this could help stratify the risk of early mortality.
A CASE OF PULMONARY HYPERTENSION ASSOCIATED WITH MYELOFIBROSIS: THERAPEUTICAL CHALLENGES FROM ACUTE TO CHRONIC SETTING
Authors: Bignami L , Picariello C , Diaferio A , Porcelli G , Deluca F , Marcantoni L , Maddalozzo A , Ribichini F , Zanon F 
Published: May 2024

Abstract
A 85–year–old female was transferred to our ICCU for acute heart failure from one of our spoke hospitals. The patient had a long history of chronic myelofibrosis, treated with fedratinib as a second–line agent after ruxolitinib failure. During a recent hospital admission, transthoracic echocardiography already showed signs of severe pulmonary hypertension (PH) with right ventricular (RV) dysfunction, so diuretic was started. On admission the patient presented showed consistent with acute on chronic kidney injury (serum Cr 3.2 mg/dl), stable anemia (Hb 9.2 mg/dl) and markedly elevated Nt–proBNP. A pulmonary CT–scan excluded acute pulmonary embolism and lung parenchymal alterations, with a clear dilation of main pulmonary artery. Transthoracic echocardiography (figure 1) confirmed precapillary PH phenotype diagnosis. Electrocardiogram (figure 2) showed sinus rhythm; incomplete RBBB, T wave inversion in V2 to V4. The patient was initially treated with high dose furosemide, low flow oxygen; but later she needed multiple cycles of inotropes, vasopressors and combined diuretic therapy (metolazone and acetazolamide) to stabilize the clinical setting. The patient also experienced episodes of paroxysmal high ventricular rate atrial flutter. After resolution of volume overload, a right heart catheterization was performed and findings were consistent with severe precapillary pulmonary hypertension: PA pressure 90/58/40 mmHg, normal PCWP, high PVR, mild cardiac index reduction. Due to critical clinical situation, Sildenafil 20 mg was started as an off–label therapy for PH (group 5). Subsequently, the patient experienced gradual but constant hemodynamic and clinical improvement and was discharged in NYHA class II. At 1 month control, patient was stable, echocardiogram revealed improvement in right ventricle dimension, systolic function and right atrial enlargement. At three months, patient is still in an intermediate risk class for PH, so we are evaluating a combination therapy (either endothelin receptor antagonist or prostanoids), taking into account anemia and thrombocytopenia. Take home message: PH can be a complication of hematological disorders as myelofibrosis, included in “mixed” forms (group 5) of PH. In our patient, after a challenging management for acute right heart failure, an off–label PDE–5 inhibitor stabilized the clinical scenario: more data are needed on PH drugs use in this setting where up to now therapeutic strategies are lacking.
HOW TO IMPLEMENT TELEMEDICINE IN A HEALTHCARE TRUST: THE "TEELEMEBII" STRATEGY
Authors: Rocca P , Marta B 
Published: May 2024

Abstract
In this abstract we describe the “TEELEMEBII" strategy adopted by Healthcare Trust Bergamo Est to allow Telemedicine‘s development and to encourage a new healthcare managment model (the results obtained in terms of telemedicine processes activated are riported in a dedicated abstract). The “TEELEMEBII" strategy is composed of 7 steps (Figure 1): T: Top–down The Strategic Management analyses the feasibility of the project. If successful, a Manager with technical skills in the field of telemedicine and managerial competencies is appointed. In some cases, it is possible to set up a small group of professionals. E: Experiences The Manager, or the working group, performs a mapping of existing telemedicine experiences in the company. E: Experts While analysing experiences, the Manager identifies the professionals who already have expertise in the telemedicine field. This phase aims to identify a multidisciplinary Team composed of physicians, nurses, clerks, IT–technicians, management engineer etc., that is proposed to the Strategic Management. LE: LEgitimacy The Strategic Management analyses the proposal and the Constitution of the Telemedicine Team is legitimized through a formal act with the appointment of a Coordinator, the members and the adoption of a regulation. The organizational model of the Team is of a matrix type (Figure 2). ME: MEthod Once established, the Team defines a working method, a common language and specific tools for the organization of activities. B: Bottom–up The Team meets health professionals, explaining the aims of telemedicine and showing fields of application. The Team welcomes proposals from professionals themselves, following a bottom–up logic. For each new emerging project, a Working Group is created (see Figure 2). Adopting the logic of process analysis, the group maps the ordinary process at first, useful to effectively design the activities in telemedicine. It is composed of a member of the Telemedicine Team, with the role of Manager, and professionals who are directly involved in the project to be activated. II: Implementation of the HybrId model The model presented is Hybrid: the Strategic Direction legitimizes the activity of the Telemedicine Team and the Working Groups, while from below the requests made by the Operational Units are evaluated by the Team, which periodically reports them to the Strategic Direction for approval. The Telemedicine Team Coordinator is the interface between the two levels.
CHANGES IN METABOLIC PROFILE, CARDIAC STRUCTURE AND FUNCTION FOLLOWING BARIATRIC SURGERY
Authors: Giofrè F , Trapanese V , Natale M , Melina M , Vatalaro C , Cosentino F , Sciacqua A , Armentaro G , Segura Garcia C , Currò G , Cloro C , Arturi F 
Published: May 2024

Abstract

Background
Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. It is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure. Bariatric surgery has been proven to be the most effective long–term weight management treatment.

Objective
Aim of our study was to investigate the changes in both anthropometric and metabolic parameters and in cardiac structure and function after bariatric surgery.

Methods
Fourty six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The insulin resistance has been assessed by HOMA–IR.

Results
As expected, an improvement in the anthropometric and metabolic profile was observed in all the patients treated with bariatric surgery. Six and 12 months after bariatric surgery, there were significant improvements in cardiovascular risk factors, including reduction in both total and LDL–cholesterol levels, systolic and diastolic blood pressure, serum uric acid levels, fasting glycemia and fasting insulin levels, glycated hemoglobin and HOMA–IR values. Similarly, the echocardiogram evaluation showed a significant reduction of the end–diastolic left ventricular volume (P&lt;0.05 and P&lt;0.005, respectively), a significant reduction of the end–systolic left ventricular volume (P=0.003 and P=0.005, respectively) and a significant reduction of interventricular septal thickness and posterior wall thickness. On the other hand, a significant increase in the Ejection Fraction (P&lt;0.001 and P&lt;0.001, respectively) and in the E/A Ratio (P&lt;0.05 and P&lt;0.05, respectively) after bariatric surgery had been observed. Left ventricular mass decreased significantly after bariatric surgery (P&lt;0.001).

Conclusions
Our data showed an increase of the systol function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.