bluuebunny/crossref_metadata_2025_split huggingface dataset:
HYBRID STAGED REVASCULARIZATION OF SEVERE THREE–VESSEL DISEASE ENSURED SAFE MAJOR ONCOLOGIC GASTRIC SURGERY
Authors: Biolcati M , Bassi I , Cannata A 
Published: May 2024

Abstract
A 71–years–old man with multiple cardiovascular risk factors and an old history of paroxysmal AF (non–anticoagulated due to a single episode in youth) was diagnosed with a non–metastatic adenocarcinoma of gastric fundus judged resectable. During infusion of the third cycle of pre–operative CT with FLOT he experienced transitory chest pain with the development of sharpened T waves with a high J point in antero–lateral leads at the EKG during the symptom (fig. 1). The episode was at first considered compatible with vasospasm induced by 5–FU, but a CT scan was nonetheless performed showing a severe three–vessel CAD involving the left main coronary artery (fig. 2), confirmed by the coronary angiography. A normal systolic function was found at the cardiac ultrasound. After the multidisciplinary team including cardiologists, cardiac surgeons, anaesthesiologists, oncologists and gastric surgeons discussed the case, the patient was referred to an urgent off–pump single CABG of the LAD coronary artery with LIMA. That allowed the non–delayable program of total gastrectomy – which was conducted for weeks later – in a safe setting by revascularizing the prognostic vessel and avoiding the DAPT related to a PCI (an eventual bridge therapy with intravenous P2Y12 inhibitors during the first month of stenting of a critical coronary artery was considered at high risk); in addition, the choice of OPCAB prevented the augmented risk of complications of extracorporeal circulation described in oncologic patients such as bleeding and higher mortality (Vieira et al, 2012). Once no residual local or metastatic disease was established, a complete revascularization was performed in election few weeks later by PCI of the residual vessels, which avoided the problems related to a re–sternotomy of a possible second CABG with venous grafts. After six months, the patient was still alive and concluded the remaining two cycles of adjuvant CT safely.
LEAD–REVERSAL OF AN ICD: A RARE BUT POSSIBLE CAUSE OF INAPPROPRIATE SHOCKS AND FAILURE TO TREAT LIFE–THREATENING VENTRICULAR ARRHYTHMIAS
Authors: Freschini M , Notaristefano F , D‘Ammando M , Zingarini G , Barengo A , Giuranna M , Russo G , Della Torre M , Cavallini C 
Published: May 2024

Abstract

Introduction
Lead reversal of a dual–chamber (D–C) ICD is a rare but possible event that can occur during device implantation or at the time of generator replacement. The presence of DF–1 connector is a prerequisite for the switch between atrial and pace/sense ventricular lead. The effects may be deleterious for the patient.

Clinical Case
A 86 y–o man was admitted to the hospital for fatigue; ICD malfunction was suspected. Medical history included paroxysmal AF, ICD implantation for ischemic cardiomyopathy, generator replacement one year ago and access to ED for ICD–shock 3 months before: the device check showed an appropriate intervention on VT. Device was programmed in DDD–70 bpm and at the admission the surface ECG showed: a first spike not followed by electrical activity and a subsequent spike after the programmed AV which resulted in atrial depolarization; the latter was followed by spontaneous narrow QRS. Subsequently the ECG showed a paced QRS complex with another spike 80ms later inside the QRS (Fig.1a). The EGMs at device check are represented in Fig.1b. Impedance, threshold and lead sensing parameters were normal except for atrial threshold close to the programmed output. During sensing test the atrial EGM followed the ventricular EGM (Fig.2) and raised the suspicion of 1) atrial undersensing with T–wave oversensing, ruled out by testing different PVARP and atrial sensitivity; 2) Atrial lead dislodgement in the ventricle 3) atrial and ventricular lead connection switch. To better define the problem the threshold test was combined with the surface ECG recording: threshold tests in VVI and AAI showed respectively atrial and ventricular capture on the surface ECG (Fig.3a,3b), which confirmed the inversion of atrial and ventricular pace/sense connections. Subsequent surgical repositioning of the correct lead to the IS1 sensing/pacing RA and RV ports allowed resolution of this problem.

Discussion
Atrial and ventricular lead connection switch is only possible in DF–1 D–C ICD. Diagnosis can easily be missed if the device check is not combined with surface ECG. In this case once the diagnosis was made, it was possible to understand that the ICD–shock occurred 3 months before was inappropriately delivered on a SVT.

Conclusion
Atrial and ventricular lead switch diagnosis is complex and often requires additional manoeuvers. The confirmation is crucial to avoid both inappropriate shocks and the failure to treat life–threatening ventricular arrhythmias.
RIGHT VENTRICULAR DYSFUNCTION AND TRICUSPID VALVE SURGICAL CORRECTION: ROOM FOR STRESS ECHOCARDIOGRAPHY?
Authors: Pasquero M , Bocchino P , Gravinese C , Boretto P , Bellettini M , Angelini F , De Ferrari G 
Published: May 2024

Abstract
We report the case of a 50–years–old young woman with multi–operated rheumatic valvular heart disease; aortic, mitral, and tricuspid commissurotomy (1994); aortic valve replacement with bioprosthesis for endocarditis (1998); mitro–aortic replacement with mechanical prosthesis and tricuspid valve plastic repair (1999); mitral valve replacement and re–do of tricuspid plastic repair (2003). Concomitant conduction pathway disease (BAV II type 1 and RBB). The patient was admitted in June 2023 for wet & warm NYHA IV right heart failure with severe peripheral congestion and ascites. On echocardiography: LV with systo–diastolic compression, EF 51%; normo–functioning aortic prosthesis; dilated (TDA 24 cm2), hypokinetic (TAPSE 9mm,S‘ 4 cm/s,FAC 25%) right ventricole (RV), with poor load adaptation (load adaptation index 16, RVCPI 108 mm*mmHg, ePAPI 1.1); torrential IT, caval plethora with systolization of hepatic venous flow. Medical therapy was initiated with intravenous bolus diuretics, nitroglycerin and inotropic support (dobutamine 2.5 y). In order to define the best therapeutic strategy in the persistence of torrential IT and RV dysfunction we performed: trans–oesophageal echocardiography, showed massive IT from ring dilatation and wide flail of the septal flap not suitable for edge–to–edge correction, total–body angioTC, with no relevant findings, right cardiac catheterization, which documented pulmonary pressure and arteriolar resistances within limits (wedge 12 mmHg,PAP25/15/18 mmHg,RAP 11 mmHg,PAPI 0. 9,RVSWI 4.8) with reduced cardiac index (2.14 l/min/cm2) and stress–echocardiography with dobutamine that showed presence of RV contractile reserve (FAC 28%&gt;39%). In consideration of the functional properties of the tricuspid valve, absence of pulmonary hypertension and given the presence of RV contractile reserve, patient underwent tricuspid valve replacement surgery with a bioprosthesis (SJ Epic 27 mm) in mini–thoracotomy with smooth postoperative course. At 3 months follow–up showed functional recovery (NYHA II), with good prosthetic function and partial reverse remodeling of the RV (TDA 14 cm2, FAC of 30%). In conclusion, by documenting right ventricular contractile reserve, stress echocardiography proved to be an important aid in predicting absence of RV failure in the immediate post–surgical period, presenting attractive prospects in the assessment of RV functional reserve in patients undergoing to corrective tricuspidal surgery.
ENOXIMONE AS A THERAPEUTIC OPTION IN STATUS ASTHMATICUS: A CASE REPORT
Authors: Michele C , Vera–Mondazzi L , Trunfio D , Giovanella E , Mohmed Ahmed Ibrahem H , Abd Almhmoid Sidiq M , Salah Ali Gubara H , Portella G , Masini F 
Published: May 2024

Abstract
Status asthmaticus is an acute exacerbation of asthma that is unresponsive to initial treatment with bronchodilators and can rapidly escalate into acute ventilatory failure. The clinical picture of severe asthma include agitation, drowsiness or confusion, breathlessness at rest, tachypnea, use of accessory respiratory muscles, tachycardia, and pulsus paradoxus. Pharmacological treatments include but are not limited to beta–2–mimetics, anticholinergic agents, magnesium sulphate, steroids and aminophylline. Asthma exacerbations can be triggered by interrupting chronic treatment: in war torn areas as Sudan it is mainly due to the abrupt lack of availability of drugs. A 58 years old 80 kg man with history of severe asthma presented to our triage complaining of severe dyspnea in the last 3 days, unresponsive to treatment with bronchodilators and systemic corticosteroids. He stopped his chronic therapy with budesonide/formeterol due to the unavailability of the drug. At the arrival he showed orthopnea, severe tachypnoea (60 breaths/min) and sinus tachicardia (130 bpm), silent chest and SpO2 86% on reservoir mask 15 l O2/min. The ABG showed pH7.27, pO2 47, pCO2 60. The chest Xray and the transthoracic echo were unremarkable. After receiving repeated nebulizers (salbutamol 5 mg + adrenaline 1 mg every 20’ for 2 h), iv hydrocortisone high dose (1 g), iv aminophylline 240 mg, iv magnesium sulphate 2 g, iv ketamine 100 mg there were neither clinical nor ABG improvement. Given the unavailability of drugs as ipratropium and sevofluorane and of treatments like V–V ECMO, a rescue trial with iv enoximone was performed, administrating 0.3 mg/kg iv bolus followed by 3 mg/kg/min continuous infusion, conbined with NIV to decrease the respiratory workload and salbutamol nebulizers. Improvement of the respiratory mechanics and of the gas exhange were immediate, leading to normal ABG, mild tachypnoea and mild chest wheezes after the administration of 200 mg of enoximone, with no cardiovascular side effects. The patient was discharged home on the 6th day, without respiratory symptoms. Enoximone acts as an inotrope by inhibiting PDE–3 activity and increasing intracellular cAMP levels in cardiac myocytes. Increasing intracellular cAMP is also the main mechanism of β2–agonists bronchodilators, and both experimental models and clinical experience suggest that enoximone can overcome the asthma–related β–receptors downregulation, providing a therapeutic role in status asthmaticus.
URIC ACID SIGNIFICANTLY CORRELATES WITH THE PRESENCE OF LOW–VOLTAGE AREAS AT THE ENDOCARDIAL MAPPING IN PATIENTS WITH NON–VALVULAR ATRIAL FIBRILLATION
Authors: Baroni M , Fortuna M , Maloberti A , Tognola C , Algeri M , Intravaia R , Leidi F , Colombo V , Ciampi C , Carbonaro M , Gigli L , Mazzone P , Giannattasio C 
Published: May 2024

Abstract

Background
Interest in the role of atrial substrate in maintaining Atrial Fibrillation (AF) is growing. Fibrosis is the culprit in the electrical derangement of the myocites. Many cardiovascular risk factors are known to be linked to atrial scarring; among them Uric Acid (UA) is emerging. The purpose of our study is to evaluate whether UA is associated with atrial fibrosis in AF patients.

Methods
81 patients who underwent radiofrequency transcatheter ablation for nonvalvular AF at the cardiological department of the Niguarda Hospital were enrolled. UA levels were analysed before the procedure as well as known predictors of atrial fibrosis. High density electroanatomic mapping of the left atrium was performed and patients were divided according to the presence or not of areas of pathological substrate (bipolar voltage &lt; 0.5mV in sinus rhythm).

Results
19 patients showed a pathological atrial substrate. The population of patients with pathological atrial substrate was older (64.7±1.6 vs 58.2±10.9 years, p=0.032) and had more often a persistent phenotype of AF (84.3 vs 35.8%, p&lt;0.001). UA levels were significantly higher in the pathological group (6.8±1.9 vs 5.3±1.4, p&lt;0.001) as well as the prevalence of hyperuricemia (26.5 vs 6.5%, p=0.021). The association between uric acid and pathological atrial substrate remains significant even after correction for confounding factors (age, left ventricular dysfunction, valvular disease, AF phenotype and furosemide use).

Conclusions
In a population of patients who underwent atrial fibrillation’s ablation, higher uric acid’s levels were significantly associated with pathological left atrium’s substrate at electro–anatomical mapping.
ADDITION OF GLIFOZINE IN THE CARDIOLOGY OUTPATIENT SETTING: FOCUS ON BODY WEIGHT REDUCTION
Authors: Formigli D , Cocozza S , Parente A , Coppola G , Di Donato M , De Fortuna E , Franco V , Moscato F , Scherillo M 
Published: May 2024

Abstract

Rationale
Glyphozines (dapaglifozin and empaglifozin) have recently been made prescribable also for cardiologists in the setting of heart failure, diabetes mellitus and chronic renal failure. In clinical validation trials their use is associated with a poor reduction in body weight of between 1 and 2.5%.

Aim of the Work
To identify the benefit in terms of body weight reduction in outpatients after the addition of glyphozines.

Results
N=59 patients (69% male) who received a new prescription for glifozine at the outpatient cardiology visit in January 2023 according to AIFA indications were included in the analysis. The average age was 73 ± 8 years, with average weight and BMI of 78.9 ± 13.2 Kg and 28.7 ± 3.9 Kg/m2. The anamnesis shows a history of: previous ACS in 66%, AF in 19%, CCS in 10% and VHD in 8%. The AIFA indications for prescription were: T2DM 47%, HFpEF 25%, HFrEF 20%, CKD 7%. Concomitant therapies were: BB 76%, Diuretics 61%, ARB 46%, MRA and CCB 20%, ACEIs 19%, ARNI 8%, Ivabradine 8%, Ranolazine 7%. At an average FU of 8.7 ± 2.9 months there was an overall average weight and BMI reduction of 4.7%. On univariate analysis there was no significant difference in weight reduction between HFrEF, HFpEF, T2DM and CKD. Patients in concomitant therapy with loop or thiazide diuretics (n=36) to which glyfozine was associated instead presented a greater reduction in weight and BMI compared to patients without diuretics (n=23): - 5.6 ± 3 .8% vs - 3.3 ± 4.8% (p=0.027).

Conclusions
The addition of glifozine in patients who undergo periodic cardiological control is associated with a greater reduction in body weight when associated with concomitant diuretic therapy.
NON–INVASIVE VENTILATION IN HOSPTALIZED ACUTE HEART FAILURE IS ASSOCIATED TO SHORT–TERM MORTALITY
Authors: Livrieri A , Potenza A , Landriscina R , Sanasi M , Piscopo A , Sasanelli P , Demola P , Basile M , Gesualdo M , De Palo M , Caldarola P , Massari F , Scicchitano P 
Published: May 2024

Abstract

Background
Some patients with acute heart failure (AHF) are initially treated with noninvasive ventilation (NIV). Today, it is not full explored the prognosis of subjects hospitalized with AHF and treated with NIV.

Methods
We retrospectively evaluated subjects hospitalized with AHF between 2022 and 2023 in intensive care unit. We determined the association between and mortality at 90–days using Cox proportional hazard and Kaplan–Meier analyses.

Results
We included 191 subjects who were hospitalized with AHF. Ninenty–days mortality occurred in 24% subjects. Seventy–five subjects were treated with NIV (32%) and showed higher mortality when compared with for those without NIV (55% vs 35%, p&lt;0.01). At 90–days, mortality was significantly associated with NIV (hazard ratio 2.3, 95% CI 1.3–4.0; p=0.005). Survival curves for mortality according to NIV use is in figure (logrank p= 0.004; chi–squared = 8.3). After adjustment for sex, age, BNP, renal and left ventricular functions, NIV treatment remained significantly associated to about 2–fold risk increase in mortality.

Conclusions
In subjects hospitalized with AHF the treatment with non–invasive ventilation was associated to short–term mortality independently from clinical parameters. This prognostic information should be weighted against structured trials in order to derive more specific clinical implications.
IMPACT OF DISCHARGE FROM A CARDIOLOGY UNIT ON OUTCOMES IN NON–ST ELEVATION MYOCARDIAL INFARCTION: AN ANALYSIS OF A NATIONWIDE ADMINISTRATIVE DATABASE
Authors: D‘Errigo P , De Luca L , Rosato S , Badoni G , Baglio G 
Published: May 2024

Abstract

Background
Current data on the prognostic impact of a specialist management of patients with acute coronary syndromes are scarce.

Aim
To evaluate the impact of the discharge of revascularized patients with Non–ST elevation myocardial infarction (NSTEMI) from a cardiology unit on their 1–year prognosis and to evaluate the differences in terms of effectiveness between discharge from a cardiology and non–cardiology unit and the whole management of the index hospitalization in a cardiology unit.

Methods
Retrospective nationwide cohort study enrolling consecutive patients older than 18 years admitted in 2019–2020 in Italy for a NSTEMI and undergoing percutaneous coronary intervention (PCI) within 48 hours from the index admission. Patients died within 30 days from the index admission were excluded from the analysis. Enrolled patients were classified based on the management department into: patients not discharged from a cardiology unit (group 1); patients not admitted but discharged from a cardiology unit (group 2); patients completely managed (admitted and discharged) in a cardiology unit (group 3). The outcome of interest was 1–year all–cause mortality. A Cox multivariate regression model was used to evaluate the impact of the management department on 1–year mortality.

Results
The study cohort consisted of 31950 NSTEMI events. Among them, 534 (1.6%) were allocated in group 1, 1160 (3.6%) in group 2 and 30256 (94.7%) in group 3. Patients completely managed by a cardiology unit were younger and less likely to be female than patients in other groups. The 1–year mortality was 14.4%, 8.4% and 3.8% (p&lt;0.001) for group 1, group 2 and group 3, respectively (Figure). After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 1–year mortality was 2.4 (p&lt;0.0001) and 1.7 (p&lt;0.0001), in patients in group 1 and group 2, respectively, as compared with patients completely managed in a cardiology unit (group 3).

Conclusion
Complete management of index hospitalization or hospital discharge from a specialist unit alone improves the one–year prognosis of patients hospitalized with a diagnosis of NSTEMI in Italy.
A CASE OF ACUTE CORONARY SYNDROME IN DISGUISE
Authors: Pezzi L , Rossi D , Scollo C , Benedetti C , D‘Andria R , D‘Alleva A , Magnano R , Forlani D , Genovesi E , Vitulli P , Gallina S , Di Marco M , Paloscia L 
Published: May 2024

Abstract
A 56–year–old Caucasian woman with a silent cardiac history, a history of smoking, and a previous hip prosthesis surgery presented to the emergency department. She reported oppressive chest pain radiating to the left arm intermittently for about 2 days, precipitated by significant emotional stress at work. The 12–lead ECG revealed sinus bradycardia, symmetrically negative T waves in the anterolateral leads, and prolonged QTc interval (544 ms). The echocardiogram showed apical akinesia, basal hyperkinesia, and moderately depressed global systolic function (ejection fraction 45%). Laboratory tests indicated elevated myocardial necrosis enzyme levels (hs–TnI 549 pg/ml), negative inflammatory markers, normal electrolytes, hemogram within normal limits, and normal renal function. She was admitted with a working diagnosis of NSTEMI–ACS. On admission, the patient was asymptomatic for angina, and had stable vital signs, particularly a blood pressure of 120/70 mmHg and a heart rate of 55 bpm. Clinical examination revealed no abnormalities. The InterTAK score was 67. Coronary angiography revealed severe stenosis of the mid–left anterior descending coronary artery, treated with PTCA–DES. The intracoronary imaging (OCT) showed a plaque with characteristics of stability, leading to the consideration of the diagnosis of Takotsubo syndrome in patient with CAD. Subsequent echocardiography showed nearly complete recovery of systolic function. At the one–month follow–up, the patient exhibited preserved systolic function (EF 60%). This case highlights Takotsubo syndrome with concomitant coronary artery disease (CAD) as a bystander. According to Mayo Clinic criteria, the coexistence of severe CAD would exclude the diagnosis of Takotsubo. However, recent studies suggest the potential for coexistence, prompting the need for additional imaging modalities such as OCT and CMR to differentiate culprit from bystander lesions. Utilizing these techniques may alter the prevalence of Takotsubo syndrome, necessitating a reassessment of cases initially classified as NSTEMI–ACS.
EFFECTS OF VERY LOW CALORIE KETOGENIC DIET VS SLEEVE GASTRECTOMY ON CARDIO–METABOLIC PROFILE IN PATIENTS WITH OBESITY
Authors: Trapanese V , Giofrè F , Natale M , Cosentino F , Vatalaro C , Sergi S , Melina M , Armentaro G , Sciacqua A , Cloro C , Arturi F 
Published: May 2024

Abstract

Background
Obesity is a complex, multifactorial disease with deleterious effects on cardiac function. Currently, the obesity treatment is one of the most difficult challenges. Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention for obesity. Furthermore, hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. On the other hand, sleeve gastrectomy (SG) has been proven to be the most effective long–term weight management treatment. However, to date, it is still unclear whether the positive effects of SG on cardiovascular disease are mediated only by weight loss.

Aim
To evaluate the changes in anthropometric and metabolic parameters and in cardiac structure and function after treatment with SG or VLCKD. The results obtained in the two groups have been compared to verify if, in the short time, there were differences between these two treatments.

Methods
Twenty obese patients were enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. Ten patients have been treated with SG and 10 with VLCKD. The two group were comparable for weight loss: –26 kg (28%) after 3 months in patients treated with VLCKD and –25 kg (27.5%) after 6 months in patients treated with SG.

Results
An improvement in the anthropometric and metabolic profile was observed in all the patients. There were significant improvements in cardiovascular risk factors, including total cholesterol levels, triglyceridis, fasting glycemia, systolic and diastolic blood pressure, serum uric acid and HOMA–IR values. Similarly, the echocardiogram evaluation showed, in both groups of treatment, a reduction of the end–diastolic left ventricular volume, a reduction of the end–systolic left ventricular volume and a reduction of interventricular septal thickness and posterior wall thickness. Furthermore, an increase in the Ejection Fraction has been observed. No significantly differences between two groups were observed. Interestingly, in patients in treatment with VLCKD, a significant change in the global myocardial work efficiency (GWE) was observed.

Conclusion
Our data showed that VLCKD and SG have the potential to protect cardiometabolic health and myocardial remodeling in obese patients. VLCKD is a promising lifestyle intervention that can be used to prevent or treat cardiovascular disease. However, its effectiveness in the medium to long term must be evaluated.