bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSESSMENT MANAGER A NEW DIGITAL PLATFORM FOR REHABILITATION CARDIOLOGY: PRACTICAL, EVALUATIVE AND PRESCRIPTIVE ASPECTS
Authors: Camera F , Caligari M , Marconi M , Monina E , Mazza A 
Published: May 2024

Abstract

Physical activity is a real medicine for preventing and treating a wide range of diseases, its prescription must have the same precision and accuracy in order to optimize the effects avoiding at the same time clinical risks since patients are often frail. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of the" Internet of Things (IoT),"is based on the idea of "smart" objects interconnected with each other to exchange the information possessed, collected and/or processed. All this will allow real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine, and cloud computing begin to enable an integration of people, equipment and data.

Aims
To evaluate whether an assessment procedure with digital Assessment Manager® (AM) support, can optimize the execution and writing time of the physiotherapy assessment.

Materials and Methods
We evaluated 751 patients admitted to the Cardiology Rehabilitation Unit using a Tablet with AM® software exclusively from the following integrated care pathways: Chronic Heart Failure, Acute Coronary Syndrome and Post Cardiac Surgery Syndrome. Discussion on the use of Assessment Manager. In the hospital setting, patient assessment is a crucial moment, and in this context AM® is a tool that allows the easy collection of a series of assessment data through questionnaires, tests, and validated clinical scales, and the instant compilation of a complete physiotherapy assessment. The other key aspect is that the system sends all data and findings in real time to the Health Information System called Galileo for immediate consultation accessible to all ward staff. This facilitates communication in the hospital environment, helping to reduce errors and reporting times.

Results
Among the practical considerations, analysing the timing of the ‘standard‘ CRP evaluation and comparing 20 patients divided into two groups (group evaluated with AM and group evaluated with paper), a time saving assessable around 30% is noted, but what is the added value is the standardisation of the evaluation procedures, as tools that make the performance of the activities as objective, systematic and verifiable as possible, especially in cases of high rehabilitation complexity, ultimately a higher ‘quality‘ of the results, obviously important for scientific research.
EVALUATION OF THE EFFECTIVENESS OF VIDEO SUPPORT FOR HOME PHYSICAL ACTIVITY MAINTENANCE IN CARDIAC SURGERY PATIENTS POST–DISCHARGE
Authors: Scalabrino N , Crespi L , Lazzarini E , Cavalleri N , Rossi M , Saporiti L , Picozzi A 
Published: May 2024

Abstract

Introduction
A difficulty in maintaining a regular post–hospitalization physical activity program by cardiac surgery patients is reported in the literature. This reduces the long–term benefit that a cardiac rehabilitation program can provide, and therefore it has become increasingly relevant to understand how to maintain high compliance in these patients.

Purpose
To evaluate whether a video support containing specific exercises can be more effective in maintaining adherence to physical activity, compared with the paper–only support in use at the specialist cardiac rehabilitation department of Multimedica, Castellanza.

Materials and methods
patients &lt;65 years old, after cardiac surgery, with preserved left ventricular ejection fraction (LVEF), without orthopedic neurological and oncological comorbidities. All subjects at discharge were divided into two groups by simple randomization. GC (control group): 15 patients who were given a paper discharge program containing examples of exercises to be performed at home. GS (study group): 15 patients, also given the paper discharge program containing exercises to be performed at home plus a video support representing the same exercises.

Outcome Measures
6MWT (6–minute walking test), SPPB (short physical performance battery), 30"STS (sit to stand), 10m GST (Gait speed test), carried out upon discharge (T0) and 2 months after discharge (T2). In addition, an Adherence Questionnaire was given at 1 month after discharge T1 and 2 months after discharge (T2).

Results
At 2 months after discharge (T2), both groups maintained the functional autonomy obtained during hospitalization. In the GS, a statistically significant increase (p&lt;0.05) was observed in meters walked at 6MWT, walking speed over 10 m, sit to stand (STS) and adherence to the home program (questionnaire).

Conclusions
Video support was found to be effective in maintaining adherence to the proposed home physical activity program. All patients in possession of the video continued their home exercise consistently, keeping the benefits, which were visible in follow–up evaluations with statistically significant results (p&lt;0.05).
LONG–TERM FOLLOW–UP IN PATIENTS ON PCSK9 INHIBITOR THERAPY: COMBINING FAST TRACK STRATEGY AND OUTPATIENT MANAGEMENT
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

Background
Dyslipidemia is a significant risk factor for cardiovascular diseases, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as an effective treatment option. This study aims to investigate the lipid profile in the long–term follow–up of dyslipidemic patients receiving PCSK9 inhibitor therapy in an entirely outpatient setting.

Methods
We enrolled 381 patients from our dyslipidemia outpatient clinic. Study population included both patients with a first dyslipidemia visit and those discharged from a cardiology unit with fast fast–track protocol. Patients were followed up at 6 (n = 252), 12 (n = 191), and 36 months (n = 77) to assess the effects of PCSK9 inhibitor therapy on lipid profile.

Results
At the 6–month follow–up, the total cholesterol levels decreased significantly (223.1±35.2 mg/dL vs 129.6±31.9 mg/dL p &lt; 0.001) as LDL cholesterol levels (148±45 vs 72.6±46 mg/dL p &lt; 0.001). The 12–month follow–up maintained similar levels of lowering (total cholesterol 123.6±39 mg/dL LDL 67.5±41 mg/dL p &lt; 0.001) as well as the 36–month follow–up (total cholesterol 138.1±43 mg/dL LDL 71.6±44 mg/dL p &lt; 0.001). No significant reductions in triglycerides and HDL levels were observed during follow–up.

Conclusion
The study highlights the feasibility and effectiveness of the long–term management of dyslipidemic patients with PCSK9 hypercholesterolemia in an entirely outpatient setting, including patients referred through the fast–track protocol.
CARDIOVASCULAR INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: De Carlini C , Loffreno A , Chiappa L , Achilli F 
Published: May 2024

Abstract

Background
Cardiovascular involvement is frequent in systemic lupus erythematosus (SLE). Aortic insufficiency is a common valvular abnormality seen in patients with systemic lupus erythematosus (SLE), it may be caused by a primary valve pathology or by an aortitis One of the cardiac manifestations associated with SLE and antiphospholipid syndrome (APLS) is Libman–Sacks endocarditis, also known as non–bacterial thrombotic endocarditis Although rare, there are reported cases of lupus aortitis which has also been associated with dissection, aneurysm and thrombus.

Case Report
We present a case of a 40 –years–old lady with lupus glomerulonephritis requiring immunosuppression and dialysis, who presented to the emergency department with fever and dyspnea. She was first treated with dialysis. Blood cultures drawn from central venous catheter peripheral were positive for staphylococcus epidermidis, the cultures from peripheral blood was negative instead.Transthoracic and transesophageal Echocardiography showed severe aortic regurgitation (not present three month earlier) with doubt valvular vegetations and with a focal enlargement of the aortic root (figure 1, 2).The patient met one major criterion (blood culture) and two minor criteria (high risk and fever), implying possible infective endocarditis. The patient was then started on intravenous antibiotics (vancomycin) and immunosuppression was reduced. Given the hemodynamic instability due to the severe aortic insufficiency, an Heart CT scan was performed to planned the surgical intervention. The CT scan confirmed the presence of small, multiple vegetation attached to the aortic leaflet and an aortic dissection on the right coronary cusp (figure 3). She proceeded to urgent surgery with aortic valve and aortic root replacement, the histology revealed evidence of Libman–Sacks endocarditis and aortitis.

Discussion
Our patient showed two different cardiovascular complications of SLE: the more frequent Libman –Sack endocarditis and the rare lupus aortitis associated to aortic dissection.The patient had risk factors for infective endocarditis and she did fulfil the modified Duke’s criteria for infective endocarditis and was treated with antibiotics and with a reduction of immunosuppression therapy. In fact, it can be difficult to distinguish between infective endocarditis and Libman–Sacks endocarditis especially in the setting of risk factors for both. Antibiotics and immunosuppressants should be used both.
A RARE CASE OF LATE RUPTURE OF POSTINFARCT PSEUDOANEURYSM (PA) OF THE INTERVENTRICULAR SEPTUM (IVS)
Authors: Rossini D , Gianfaldoni M , Amati R , Stroppa S 
Published: May 2024

Abstract
Rupture of the IVS is a mechanical complication of acute myocardial infarction (AMI), rare since the spread of percutaneous coronary revascularisation techniques. In a recent US case study, it was documented in 0.25% of cases. However, it is something to think about in the event of unexpected, rapid haemodynamic deterioration. We report the case of a 73–year–old man with a clinical history of COPD in heavy smoker, who was admitted on 04/14/2022 for a sub–acute inferior MI. After percutaneous revascularisation of the circumflex artery, the patient (pt) was discharged clinically stable. On transthoracic echocardiogram (TTE), the left ventricle (LV) appeared normal in size, with a large proximal inferior wall aneurysm (A) and slightly reduced global systolic function (EF = 45%). On 09/16/2022 admission to surgery for gastric perforation peritonitis from abuse of non–steroidal anti–inflammatory drugs. The pt survived the surgery without cardiac complications and remained well–compensated and asymptomatic in the following months. On 06/23/2023 new admission for heart failure: worsening dyspnoea and pulmonary and systemic congestion. The TTE showed a dilated LV (TDV = 162 ml), infero–lateral akinesia, a mid–basal inferior wall A and moderate global systolic dysfunction (EF = 40%). High velocity systolic flow was also documented in the right ventricle, which appeared to originate from an aneurysmal portion of the posterior IVS in continuity with the inferior wall A (Fig.1–2). Cardiac MRI confirmed the presence of a postinfarct PA involving the inferior wall and the basal and middle IVS with multiple jets responsible for significant left–right shunt (Qp/Qs = 2.9). Once clinical stabilisation was achieved, the pt was referred for cardiac surgery for direct closure of the interatrial defect and endoventriculoplasty. After the early postoperative phase, characterised by the need for pharmacological and mechanical haemodynamic support, there was a progressive clinical improvement. PA is most frequently localised infero–posteriorly, and is distinguished from A by its narrow collar (ratio of collar diameter to aneurysm diameter ≤ 0.5) and the absence of muscle tissue in the wall. 55% of PA are postischemic. They are classified, according to the distance from AMI, into acute (within 2 wks), subacute (between 2 wks and 3 mth) and chronic (after 3 mth); chronic PA are often large and asymptomatic but easily rupture, causing, as in our case, a late complication of the AMI.
CONTEMPORARY CLINICAL PRESENTATION, MANAGEMENT AND OUTCOMES OF SPONTANEOUS CORONARY ARTERY DISSECTION: DATA FROM A SINGLE SECONDARY CENTRE
Authors: Bosi D , Guiducci V , Ferretti M , Pignatelli G , Musto D‘Amore S , Demola P , Solinas E , Pergola V , Zedde M , Pascarella R , Navazio A , Mantovani F 
Published: May 2024

Abstract

Background
Extra–coronary involvement is identified in more than 50% of patients presenting with SCAD, mainly as fibromuscular dysplasia (FMD) pattern. This association might suggest that they share at least partially some pathomechanisms. However, no recommendations on FMD screening in SCAD patients exist to date in international consensus documents, and this is therefore left at clinician discretion.

Aim
We sought to determine the rate of FMD screening in historical cohort of patients with SCAD at our institution.

Methods
Observational retrospective study of all consecutive SCAD patients admitted to catheterization laboratory.

Results
From January 2015 to June 2021, 41 patients received a SCAD diagnosis and represented our study cohort. Mean age was 55 ± 11 years with a high prevalence of female gender (34 patients, 83%). Traditional risk factors showed a marked prevalence especially regarding smoke habits (12 patient, 30%) and dyslipidaemia (21 patients, 51%). Left anterior descending artery was the vessel more frequently involved (49%) followed by circumflex artery (41%) and right coronary artery (10%). SCAD was more frequently classified as type II (68%) followed by type IV (17%), type I (10%) and type III (5%) according to Saw classification. Screening for FMD was performed in 6 patients (12%) among the most recent SCAD diagnoses; of these 1 patients received a diagnosis of FMD, with involvement of carotid and mesenteric arteries. Table.

Conclusion
In our single centre experience, screening for FMD was historically performed in a minority of patients with a perceived trend for a systematic screening in more recent years.
THE ROLE OF MULTIPARAMETRIC EVALUATION PRIOR TO L–VAD IMPLANT IN RIGHT VENTRICLE DISFUNCTION: A CASE REPORT
Authors: Caputo A , Loffredo F , Liccardo B , Amarelli C , Marra C , Del Giudice C , Golino P 
Published: May 2024

Abstract

Background
Right ventricular failure is the most common post–operative complication after L–VAD implant and it represents an important cause of mortality in these patients. Pre–existing right ventricular disfunction is considered an absolute contraindication to L–VAD implant, though in some cases right ventricular hypokinesia could be the expression of elevated pressure in the pulmonary circulation secondary to high left heart filling pressures. Numerous clinical, echocardiographic and hemodynamic parameters have been proposed for the evaluation of L–VAD eligibility. Among these Michigan right ventricle failure score, rest and dobutamine stress echocardiography (TAPSE, S wave peak, right wall longitudinal strain) and right heart catheterization parameters showed an adequate correlation with L–VAD implant outcome.

Case Report
A 67 yo patient affected by advanced heart failure secondary to ischemic dilatative cardiomyopathy was referred to our unit for frequent exacerbations of heart failure despite optimal medical therapy. Echocardiography detected severe left ventricle disfunction, severe mitral regurgitation and a hypokinetic right ventricle that was not present at a previous evaluation showing only a mild disfunction. We therefore performed a dobutamine stress echocardiography to assess right ventricular contractile reserve, which demonstrated an adequate systolic response at hight dose of dobutamine (20 y/Kg/min). These data were confirmed by right heart catheterization, which allowed the evaluation of hemodynamic predictors of post L–VAD RV failure. After Heart Team discussion the L–VAD was successfully implanted. The patient was extubated at day 1 PO and weaned from inotropes at day 4, he did not present any clinical and hemodynamic signs of RV failure and is currently undergoing post–surgical rehabilitative care.

Conclusions
Our experience strengthen the importance of a standardized multiparametric assessment in patients affected by advanced heart failure proposed for L–VAD and showing right ventricle contractile impairment.
MONOCENTRIC EXPERIENCE FROM A CARDIOGENIC SHOCK NETWORK: ROLE OF ECLS IN REFRACTORY CARDIOGENIC SHOCK, KEY TO SURVIVAL OR BRIDGE TO ADVANCED HEART FAILURE THERAPIES
Authors: Fusi C , Marchese A , Sorini Dini C , Righini F , Cesareo F , Gentilini R , Bernazzali S , Maccherini M , Valente S 
Published: May 2024

Abstract

Background
Extra–Circulatory Life Support (ECLS) is a vital therapeutic option in patients (pts) with refractory cardiogenic shock (CS). Few centers can assure optimal assistance to these delicate pts and early centralization in the context of regional networks is essential.

Methods
We enrolled all consecutive pts with ECLS for refractory CS admitted to our Intensive Cardiac Care Unit (ICCU) from January 2021 to November 2023. The primary endpoints evaluated were weaning from ECLS and in–hospital mortality. The secondary endpoints included neurological outcomes and major complications.

Results
We enrolled 21 consecutive pts (90% male, 55y median age) with refractory CS and indication for peripheral Veno–Arterial Extracorporeal Membrane Oxygenation (VA–ECMO), percutaneously or surgically positioned, with antegrade perfusion to avoid limb ischemia. Fourteen pts (67%) came from other hospitals, 8 (38%) of which already had been implanted with ECLS. Concerning the CS etiology, we observed 8 (38%) heart failure, 12 (57%) post–myocardial infarction, 1 (5%) adrenergic storm and 10 (48%) cardiac arrests. Six pts (28%) were deemed eligible for heart transplant (HT) list before the CS episode. In all pts we assured left ventricle unloading with IABP (9), Impella CP (3), Impella 5.5 (1). Five pts underwent apical left ventricular venting and escalation of mechanical support. The median duration of ECLS support was 10.1 days. Eleven pts (52%) were successfully weaned from VA–ECMO due to myocardial recovery (n=6; 29%) or HT (n=5; 24%); of the latter, 1 died due to peri–operative complication. Overall in–hospital mortality rate was 52%. Ten pts were discharged: 7 without neurological deficit (CPC 1), 2 with mildly impaired neurological function (CPC 2–3) and 1 with severe disability (CPC 4). During ECLS we observed the following complications: bleeding (28%), AKI (28%), infections (28%), neurological complications as acute ischemic stroke or intracerebral hemorrhage (19%); no limb ischemia occurred.

Conclusions
ECLS provides cardiac and respiratory support and serves as a bridge to recovery or heart replacement therapies (LVAD, HT). Tertiary Shock Centers in a Regional Network assure optimal assistance for this vital support.
INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM
Authors: Mazza A , Paneroni M , Marconi M , Maestri A , Giardini A 
Published: May 2024

Abstract
Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.
THE IMPACT OF NURSE–LED EDUCATION, ON QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A REVIEW OF THE LITERATURE
Authors: Li Vigni M , Meucci B , Gambone F , Giordano V 
Published: May 2024

Abstract

Introduction
The complex mosaic of cardiac rehabilitation (CR) in heart failure (HF) is composed of several "pieces": adherence to the rehabilitation program (Mazza & Paneroni, 2019), therapeutic education, improvement of perceived QoL and self–care (Deek et al., 2017). To improve the patient‘s QoL, however, it is imperative to position them at the focal point of the care process. Several studies, have documented the favorable impact of CR on QoL in HF patients (Conway et al., 2015). Although variations in therapeutic and rehabilitative treatment plans vary according to each stage of the disease, adopting lifestyle changes is a recommended strategy regardless of the stage of HF from which the person is affected (ACC/AHA 2005; Yancy et al., 2005). However, despite the evidence–based benefits of post–discharge interventions combined with patient education in HF patients, the specific impact and benefits of nurse–led patient education alone, independent of the broader health care system, remain still unclear.

Objective
This review aims to investigate the influence of the nurse‘s educational role on the quality of life of patients with HF in the setting of cardiac rehabilitation.

Materials and Methods
A comprehensive literature review was conducted using databases such as PubMed, Scopus, CIHNAL Complete and EMBASE. The review followed the PICO methodology, with the formulation of a research question. MeSH terms and keywords were combined using Boolean operators and inclusion criteria. The primary outcome of interest was improved QoL. Relevant articles were subjected to preliminary analysis on the Rayyan platform. They were first evaluated by title and abstract, then selected for full–text reading, and finally subjected to "quality appraisal".

Results, Discussion and Conclusions
Individuals with HF experience a decline in QoL and are at increased risk of poor prognosis, characterized by exacerbation episodes leading to frequent re–hospitalizations and increased mortality rates (Heo et al., 2009; Rechenberg et al., 2020; Freedland et al., 2021). Therefore, improving QoL in patients with HF is a priority from both care and organizational perspectives (Ades et al., 2013; Darkins et al., 2015). Notably, a tailored CR educational program helps to improve self–care management and, consequently, improve QoL. That highlights the importance of nurse–led CR for HF patients in improving health behaviors and adherence to therapeutic practices.