bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE OUTPATIENT CLINIC FOR PATIENTS WITH HEART FAILURE: A PROPOSAL FOR ADVANCED NURSING
Authors: Gastaldello C 
Published: May 2024

Abstract
In Italy, Heart Failure represents the leading cause of hospitalization in people over the age of sixty–five and is considered a public health problem of enormous importance, as it entails disabling consequences for the person, such as a significant reduction in the quality of life and the degree of self–sufficiency. Therefore, the person with heart failure requires adequate nursing care in each phase of transition from one care setting to another, as well as in the phase that goes from hospital discharge to the patient‘s return to the home. In the European Guidelines dedicated to Heart Failure it is not specified whether there is a nursing management assistance program dedicated to patients, and if present as it is declined in the various healthcare contexts. The aim of the thesis was to explore in the literature and in the national territory if there are advanced nursing care programs aimed at patients with heart failure and to develop the idea of ​​a nursing–managed clinic, where advanced nursing, which can be introduced into the integrated hospital–community care network for heart failure. For this purpose, a qualitative exploratory survey was developed, divided into two phases: a telephone exploratory survey which considered the cardiological clinics of all the Health Authorities of the Veneto Region and two other Italian Regions; a semi–structured interview addressed to a group of nurses who in the past managed a nursing clinic dedicated to patients with heart failure in a healthcare company in the Veneto Region. The results, especially from the literature review, showed a significant reduction in the risk of hospital readmission and in the mortality rate, an increase in the quality of life. However, differences emerged in the local context regarding the objectives, organization and activity of a Nursing Clinic dedicated to patients with heart failure. The challenge still remains open.
THE HF–ABCDE+FG APPROACH IN HEART FAILURE: A SIMPLIFIED DECISION– MAKING ALGORITHM FOR MANAGEMENT IN EMERGENCY DEPARTMENT
Authors: Pepe G , Vignani M , Casolo G , Sanna M , Ghiadoni L 
Published: May 2024

Abstract
The–HF– ABCDE+FG protocol is an easy to memorize algorithm for diagnosis and treatment of Heart failure (HF) in the setting of Emergency Department (ED). The acronym “ABCDE” recalls the more famous ABCDE sequence proposed in Advanced Life Support (ALS), the most widely used and standardized approach to critical patients in the ED. Using a similar approach, the algorithm here proposed can help to recall the main elements of the patient’s assessment presenting acute heart failure (AHF) concerning diagnosis and early therapy. It should be interpreted as a continuum since each step is partially overlapped and mnemonically linked to the previous and to the next one. As Acute heart failure can present with a variable pattern of signs and symptoms, diagnosis in the Emergency Department can be supported by a rapid and easy to memorize pathway made up of 5 steps: A (history assessment), B (blood exams/ blood gas analysis), C (Chest X–Ray), D (Dysfunction– lung anch heart ultrasound), E (Electricity– verify ICD or PM when implanted). On the other hand, with reference to the therapeutic algorithm, we suggest an extended protocol ABCDE+FG: each word of the acronym stands for a Class I recommendation coming from 2021 ESC Guidelines: A (ACE–i/ ARBs/ARNI), B (standing for Beta–Blockers), C (anti–choagulation) and D (Diuretics) which represent the standard desease–controlling therapy. In addiction, attention must be paid to associated conditions, like underlying electrical instability requiring PM or ICD (E standing for Electrical Therapy), iron deficiency (F standing for Ferric Carboxymaltose) and poor glycemic control (G standing for Glyfozines). In fact, it has been demonstrated that an optimyzed therapy from a very early stage can deeply impact on the evolution of desease and remarkably reduce further accesses for AHF. Thus, once the patient has been stabilyzed in the ED, we suggest to initiate the most appropriate therapy as soon as possible and eventually send the patient to the best setting of care (discharge, short observation, non intensive/intensive care).
A CASE OF DUAL–SITE LEFT VENTRICULAR PACING PERFORMED VIA A PERSISTENT LEFT SUPERIOR VENA CAVA IN A PATIENT WITH COMPLETE ATRIO–VENTRICULAR BLOCK AND RIGHT SUPERIOR VENA CAVA OCCLUSION
Authors: Quilico F , Sanzo A , Vicentini A , Vicini Scajola L , Savastano S , Baldi E , Petracci B , Rordorf R 
Published: May 2024

Abstract

Patient
A 64 year old male admitted for syncope. EKG presented 3rd degree AV block. Attempting to place temporary pacemaker was unsuccessful due to occlusion of the right femoral vein and the presence of a catheter for hemodialysis in the left femoral vein. He also has complete thrombosis of the right internal jugular vein, proximal superior vena cava and right femoral vein. He was referred to ICCU for monitoring, asymptomatic with no signs of congestion or hypoperfusion. Dopamine was started at 4 mcg/kg/min and then isoprenaline 0.06 mcg/kg/min. Initial work up Echocardiography showed depressed LV ejection fraction (LVEF 40%). Chest and abdomen angio–CT showed persistence of a superior left vena cava (PSLVC), which drained in the coronary sinus (CS). Right axillary and subclavian veins were occluded, and also right superior vena cava and right jugular vein. Left jugular, axillary and subclavian veins were pervious. Left femoral and right iliac–femoral veins showed significantly narrowing of the vessel lumen.

Diagnosis and Management
Our indication for this patient was CRT rather than RV pacing. The implant of a leadless AV pacemaker was also considered, but it was considered unfeasible due to limited access from the femoral veins. The presence of a PSLVC cava draining into CS was confirmed with angiography in the EP Lab. At the beginning of the procedure two episodes of asystole occurred. A first bipolar lead was rapidly placed in a postero–lateral branch of the CS, to obtain a stable temporary pacing. We then placed a quadripolar, active fixation, left ventricular pacing lead via the PSLVC into an antero–lateral branch of the CS. Finally, we placed a right atrium active fixation pacing lead in the right atrium again through the PSLVC. Vascular accesses were cephalic left vein and axillary vein. Acceptable sensing and pacing parameters were achieved. The bipolar LV lead was connected to the IS–1 RV port for sensing and the quadripolar lead was connected to the IS–4 LV port for pacing. Programming was DDDR 60–130 with active LV pacing only. Total procedural time was 180 minutes. No complications occurred. At discharge electric parameters were stable. Echocardiography showed an improvement in LVEF (45% vs 40%) and ECG showed atrio–ventricular LV pacing.

Conclusion
As far as we know this is the first reported case of a CRT delivered by two left ventricle pacing leads both placed via a PLSVC, with no need to place a pacing lead in the right ventricle.
RESIDUAL CARDIOVASCULAR RISK AND SEVERITY OF CORONARY DISEASE
Authors: Marino G , Spinelli A , Macchiusi A , Altamura V , Di Fusco S , Aquilani S , Aiello A , Colivicchi F 
Published: May 2024

Abstract

Background
The presence of residual risk in patients with a history of atherosclerotic cardiovascular disease (ASCVD) is a cause of additional cardiovascular events. The aim of this study is to correlate residual cardiovascular risk with the severity of coronary disease.

Methods
We enrolled 52 patients hospitalized with a diagnosis of acute coronary syndrome from September to October 2023 at the Clinical and Rehabilitation Cardiology of the San Filippo Neri Hospital. All patients were treated with percutaneous and/or surgical coronary revascularization and had a history of ASCVD. Thirty of these patients had a single–vessel coronary disease and 22 had a multivessel coronary disease. We analyzed the main cardiovascular risk factors and the received therapies in both groups.

Results
Triglyceride levels were significantly higher in the group with a multivessel coronary disease (132.94 ± 65.41 mg/dl vs 94.06 ± 37.63 mg/dl; p=0.01) as well as the levels of glycated hemoglobin (50.91 ± 15.23 mmol/mol vs 42.92 ± 6.65 mmol/mol; p=0.01) and high–sensitivity C–reactive protein (hs–CRP, 1.25 ± 1.48 mg/dl vs 0.65 ± 0.46 mg/dl; p=0.04). We found no significant differences between the two groups for the other main cardiovascular risk factors and the therapies.

Conclusions
Our data show that higher levels of triglycerides, glycated hemoglobin and hs–CRP, an inflammatory biomarker, are associated with a more extensive coronary disease. This finding suggests that a better metabolic control, in terms of glycated hemoglobin and triglyceride levels, and inflammation could contribute to the reduction of coronary disease extension.
TREATMENT OF OBESITY WITH SGLT–2: OUR RESULTS
Authors: Fazio G 
Published: May 2024

Abstract

SGLT–2 inhibitors were indicated to be able to reduce the weight of diabetic patients for around 4 kilograms. We investigated the possibility to reduce the weight of non–diabetic patients using SGLT–2.

Materials and Methods
A continuous series of 402 patients were enrolled in a prospective analysis. All patients started a therapy with SGLT–2 inhibitor for a cardiological (80%) or nephrological disease (20%). The 54% used dapagliflozin while the 46% used empagliflozin. In all patients affected by chronic heart failure the SGLT–2 – Inhibitor was added to optimal medical therapy without new symptoms in ambulatory. In nephrological patients the drug was added after a complete stabilization of disease. The recruitment period was long 6 months. After the recruitment the patient was follow for other 6 month. At the end of the follow–up, we evaluated the weight lost. The result was evaluated by an electrical balance, that was the same for all evaluations. The data was collected in excel and analysed by the Q–R–Calc program.

Results
The mean age of patients was 63 age, 54% female. None was diabetic patients. Hypertension was present in 73%, hypercholesterolemia in 43%. 11% was smokers. 94% were Caucasian patients. The mean of Weight was 75 kg at the first control. The mean height 174 cm. All patients performed a cardiological o nephrological control in which the medical doctor prescribed SGLT–2 inhibitor on top the optical medical therapy. All patients that presented during this control some causes of instability were excluded from the analysis. 90% of patients assumed RAAS inhibitors (ARNI 23%), 81% betablockers, 54% diuretics, 68% MRA. About the subtype of heart failure 60% was HFpEF and 40% HFrEF. The mean GFR of nephrological patients was 31 l/min. After 6 month the mean weight loss was 5,2 kgs with a standard deviation of 3,1 kgs. The reduction of weight was 6.6% of the initial weight. No statistical differences were evaluated comparing empagliflozin and dapagliflozin.

Conclusion
The SGLT–2 inhibitor in non–diabetic patients was. able to determinate a weight lost of 6.6% (mean 5,2).
ROLE OF VERY LOW DOSE STATIN THERAPY IN PCSK9 INIB. TREATED PATIENTS
Authors: Gentile G , Bentivoglio F , De Carlini C , Meles E , Gorgoglione M , Bucalo R , Bruni F , Masiello L , Maggiolini S 
Published: May 2024

Abstract
Female patient 62 years old Cardiovascular risk factors: Arterial hypertension, smoking, obesity, dyslipidemia, hypercholesterolemia, family history of cardiovascular diseases (father who died from miocardial infarction (MI) and brother with 3 MI). Intolerance to various statins (myalgia) Non–critical atherosclerosis of the supra–aortic trunks. Therapy with PCSK9 inib. started. (evolocumab 140 mg every 2 weeks). Subsequently the patient suffers from acute coronary syndrome (NSTEMI). CACG: fusiform aneurysm of proximal left anterior descending artery (LAD) The new LDL target to be reached &lt; 55 mg/dl is far from the value achieved with the co–administration of PCSK9 inib. and ezetimibe (minimum LDL value reached with this therapy 123 mg/dl) Even with a certain time delay it was decided to introduce a statin at an extremely low dose (rosuvastatin 5 mg 3 times a week). The effect of this strategy is very effective, allowing a reduction in LDL by over 50% and up to a value of 60 (only slightly higher than the target value). However, the patient again suffers from myalgia (without an increase in CPK) and decides to suspend treatment with a new increase in LDL values to 112 mg/dl. The case emphasizes: 1) the synergistic effect of statin with PCSK9 inhibitor therapy. This synergy is already evident with extremely low doses of statin and should always be sought 2) the usefulness of an aggressive drug therapy that tends to bring LDL values within the therapeutic targets in the shortest possible time. Moreover this could highlight intolerances that make it impossible to continue with a specific therapeutic scheme so as to allow the study of new options.
PROGNOSTIC VALUE OF FOLLOW–UP MEAN PULMONARY ARTERIAL PRESSURE AND PULMONARY VASCULAR RESISTANCE IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION REACHING A LOW–RISK PROFILE
Authors: Dardi F , Cennerazzo F , Guarino D , Ballerini A , Donato F , Bertozzi R , Manes A , Palazzini M , Galiè N 
Published: May 2024

Abstract

Background
Hemodynamic variables such as right atrial pressure, cardiac index (CI), stroke volume index (SVI), and mixed venous oxygen saturation have consistently been associated with survival in pulmonary arterial hypertension (PAH). New PAH treatments are, however, able to improve short–term outcome reducing mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) without increasing CI or SVI. The prognostic role of a mPAP &lt;35 mmHg at follow–up and PVR values &lt;5 WU in prevalent patients have been described.

Objective
The aim of this work was to define the incremental prognostic role of a mPAP &lt;35 mmHg and PVR &lt;5 WU in patients with idiopathic, hereditary, drug–induced PAH (I/H/D–PAH) and PAH associated with connective tissue disease (CTD–PAH) or congenital heart disease (CHD–PAH) reaching a low–risk profile at follow–up after first–line treatment strategy.

Methods
treatment naïve PAH patients were assessed at 1st follow–up (3–6 months after starting PAH–specific therapy; 1st F–UP) with 6–minute walk distance (6MWD), World Health Organization functional class (WHO–FC), brain natriuretic peptide (BNP)/NT–proBNP and right heart catheterization. Risk was assessed according to COMPERA 1.0, FPHR–invasive, Bologna and COMPERA 2.0 risk tools. The primary outcome was all–cause death and a combined endpoint of all cause death + need of treatment escalation. Analyses were performed using Cox regression method in patients reaching a low–risk at 1st F–UP. Data are expressed as median (IQR).

Results
794 patients with PAH were enrolled (54% I/H/D, 28% CTD, 18% CHD) and 706 have a complete re–evaluation 4 (3–6) months after starting first–line treatment. Death occurred in 54% of patients over a median follow–up duration of 5.8 (2.4–11) years. Univariate analyses for all–cause death in patients reaching a low–risk profile at 1st F–UP are shown in Table 1. Univariate analyses for all cause death + need of treatment escalation, together with the initial treatment strategy and the median time from 1st F–UP to death/need of treatment escalation in patients reaching a low–risk profile at 1st F–UP are shown in Table 2.

Conclusion
mPAP &lt;35 mmHg and PVR &lt;5 WU are not of incremental prognostic value for all–cause death in patients reaching a low–risk profile at 1st F–UP after first–line treatment strategy but predict the need of future treatment escalation (after a median time &gt;3 years).
HEART DISEASE IN MICROGRAVITY: THE ROLE OF MICROGRAVITY IN METABOLIC PROCESSES IN MYOCARDIOCYTES
Authors: Giacinto O , Luisini M , Sammartini E , Sammartini D , Minati A , Mastroianni C , Nenna A , Pascarella G , Carassiti M , Chello M , Pelliccia F 
Published: May 2024

Abstract

Objective
Aim of this review is to examine the main molecular patterns alterations during and after exposure to microgravity and find a common molecular stream that may describe the aetiological processes that lead to atrophy of the heart.

Methods
We found 113 articles, and we included 25 studies that investigated physiological effects of weightlessness and artificial gravity in the space flight in animal cardiac muscle cells, in particular the modifications of the protein structure in the absence of gravity.

Result
Microgravity, through methylation on CpG island of the DNA reduces the gene expression of alpha–actinin–1, DNA methyltransferase–1. These molecular values were normal after 12 hours of microgravity suspension, while Histone deacetylase–1 (HDCA–1) resulted up regulated. With regard to cardiogenesis, we noted a reduction in fibronectin, an extracellular matrix glycoprotein that has a role in primordial heart formation to lead to mesodermal migration and differentiation, and in desmosomes which have a particular role in chemical communication between myofibrils; furthermore, an altered displacement of the myofibrils, an alteration of the geometry of these structures and a consequent reduction in cardiac mechanics were noted.Microgravity determines a downregulation of the AC/ cyclic adenosine monophosphate (cAMP) phosphodiesterase system and a secondary dysfunction of the Ca2+ channel; an increase in the levels of the protein Calpain –2 as contributing stressor to myocardial damage is considered an atrophy predisposing risk factor; this protein determines an increase calcium ions and a consequent cardiac remodeling, depression of the ejection fraction and apoptosis of cardiac cells.Another pathological molecular mechanism that leads to alteration of myocardial fibers inotropism is a shift of alpha– Myosin heavy chain to beta– Myosin heavy chain and consequent synthesis of altered titin molecules and a depressed actin/myosin ATPase function.

Conclusion
This review showed molecular patterns role in determining a low performance of the heart caused by a reduction on eject fraction and cardiac atrophy especially after long space flight, due to Microgravity as main risk factor. Future studies are needed to find farmacological and/or molecular approaches to treat these biochemical changes in order to interrupt the chain that leads to a flight and post flight cardiovascular syndromes.
SODIUM–GLUCOSE COTRANSPORTER 2 INHIBITOR DAPAGLIFLOZIN REDUCES SYSTEMIC H–FABP AND MONOCYTE–TO–LYMPHOCYTE RATIO IN PRECLINICAL MODELS OF ANTRACYCLINE INDUCED CARDIOTOXICITY
Authors: Quagliariello V , Bisceglia I , Iovine M , Giacobbe I , Maurea F , Giordano V , Barbato M , Arianna R , Izzo F , Canale M , Paccone A , Maurea N 
Published: May 2024

Abstract

Background
Anthracyclines are an effective and widely used chemotherapy agent in the treatment of multiple solid organ tumors and hematologic malignancies. The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. Dapagliflozin exerts several cardiometabolic benefits in patients with and wthout T2DM through SGLT2–NLRP3 mediated pathways.

Purpose
In this study, we highlighted on new beneficial properties of Dapagliflozin in preclinical models of doxorubicin–induced cardiotoxicity.

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO–DAPA, n=6). After treatments, plasma levels of H–FABP and monocyte–to–lymphocyte ratio were determined through selective quantitative methods.

Results
Dapagliflozin associated to Doxorubicin reduces of 48,7% plasma levels of H–FABP compared to DOXO group (p&lt;0.001). Myocardial expression of H–FABP were also reduced, indicating cardioprotective properties of SGLT2i. Moreover, monocyte–to–lymphocyte ratio was strongly enhanced after DOXO therapy, indicating systemic pro–inflammatory properties; notably, Dapagliflozin reduced of 32,8% the monocyte–to–lymphocyte ratio compared to only DOXO treated mice (p&lt;0.005).

Conclusion
For the first time, Dapagliflozin demonstrated a significant reductions of monocyte–to–lymphocyte ratio during doxorubicin therapy, indicating new potential pathways of cardioprotection in cancer patients.
THE ROLE OF ADVANCED NON–INVASIVE CARDIAC IMAGING IN THE DIAGNOSIS AND THE MANAGEMENT OF ACUTE CHEST PAIN IN WOMEN
Authors: Dell‘Aversana F , Tedeschi C , Ferrandino G , Tuccillo A , Scotto di Uccio F , Tuccillo B , Liguori C 
Published: May 2024

Abstract
Over the last years the awareness of gender differences in cardiovascular disease has gradually increased. Gender differences can be highlighted in the spectrum of clinical manifestations of ischemic cardiovascular disease in women and in the higher incidence in female sex of specific pathologies such as Takotsubo Syndrome (TTS), myocardial infarction without significant coronary obstruction (MINOCA) and Spontaneous coronary artery dissection (SCAD). Advanced cardiac imaging is gaining a relevant role also in the acute patient scenario and it can allows the identification of the pathologies that can most frequently cause acute chest pain in women. We included 102 female patients admitted to our emergency department with acute chest pain who underwent advanced cardiac imaging examinations. 72 women had Cardiac Magnetic Resonance Imaging (CMR) for acute myocardial injury after excluding Acute Coronary Syndrome (ACS). 30 women underwent Coronary Computed Tomography Angiography (CCTA) for suspected ACS with low or intermediate risk of Coronary Artery Disease (CAD). In 25/72 patients undergoing CMR was found an ischemic pattern: 19 (26.4%) patients received a diagnosis of myocardial infarction with associated afferent coronary obstruction, in 5 (7%) patients the diagnosis was compatible with MINOCA and in 1 case (4%) the diagnosis of aborted heart attack was made. A non–ischemic pattern was found in 37 patients: 12 (16.7%) patients were diagnosed with Takotsubo Syndrome, 21 (29.2%) patients were affected by myocarditis and 4 (5.5%) patients had signs of pericarditis. In 10 (13.8%) cases CMR was negative. Of the 30 patients who underwent CCTA, 11 (36.7%) had normal coronary arteries, 9 (30%) had non–obstructive CAD (stenosis &lt;50%), 8 (26.6%) had obstructive CAD (stenosis &gt;50%) and 2 (6.6%) patients were diagnosed with SCAD. According to our experience, CMR can play a central role in the diagnosis and management of non–coronary ischemic heart disease which typically affects women. In fact, in females the etiopathogenesis of myocardial ischemia is much more complex and heterogeneous than in males, making non–invasive cardiac imaging decisive to identify the underlying causes of acute chest pain. Furthermore, the use of CCTA as a first–instance diagnostic test in an acute scenario allows us to improve the diagnosis of clinically significant CAD and to adequately direct the therapeutic process.