bluuebunny/crossref_metadata_2025_split huggingface dataset:
POST–ENDOCARDITIS MOBILE THROMBUS IN PULMONARY VALVE: A UNIQUE CASE REPORT OF ACUTE PULMONARY EMBOLISM
Authors: Ciampi C , Ossola P , Massaro S , Tavasci E , Lobiati E , Riva B , Bianchi A , Lenatti L , Triggiani M , Farina A 
Published: May 2024

Abstract

Background
Infective endocarditis results from a complex interplay among bacterial virulence factors, coagulation, and hemodynamics.Native pulmonary valve endocarditis is a very rare phenomenon. Similarly, the development of a thrombus on the pulmonary valve is uncommon. In the following clinical case, these two rare events appear interconnected.

Clinical Case
A 66–year–old male presented to the emergency department with a history of weight loss, asthenia, and fever lasting two months, partially relieved by empirical antibiotic therapy. Initial diagnostic tests revealed sinus tachycardia and a slight increase in inflammation markers. A chest radiograph showed pulmonary consolidation, leading to further investigation with a CT pulmonary angiogram. This identified a large mass at the pulmonary valve, with a suspicion of thrombosis, accompanied by right segmental pulmonary embolism and associated pulmonary infarction. A transthoracic echocardiogram confirmed the presence of two iso–anechoic masses adherent to the pulmonary valve, predominantly on the anterior and left cusps, as seen in 3D reconstruction. Dysfunction or dilation of the right ventricle, as well as vegetations on the other valves, were ruled out. The patient was urgently admitted to the cardiac intensive care unit. Empirical antibiotic therapy was initiated due to suspected endocarditis, and blood cultures were performed, which resulted negative. Despite being classified as intermediate–low risk for pulmonary embolism severity, considering the imminent risk of embolization from the identified mass, cardiothoracic surgery was performed. The procedure involved replacing the pulmonary valve with a bioprosthesis and removing the two neoformations. Pathological analysis indicated endocarditis of the pulmonary valve with transmural ulcerative inflammation and a thrombotic nature of the two masses. The culture of the valve was negative, suggesting a possible resolution of the infectious process. The postoperative period was stable, and the patient was subsequently enrolled in a cardiac rehabilitation program, with indications to continue anticoagulant therapy until reevaluation and antibiotic therapy with ceftriaxone and vancomycin for up to six weeks post–surgery. As far as we know, this is the first time in the literature that thrombus formation on a native pulmonary valve following endocarditis has been documented.
FIRST ITALIAN CASE OF TRANSCATHETER TREATMENT OF AORTIC REGURGITATION IN L–VAD PATIENT WITH A DEDICATED DEVICE
Authors: Tavana K , Buzzatti N , Saccocci M , Monaco F , Longoni M , Maisano F 
Published: May 2024

Abstract
In patients with L–VADs, aortic valve regurgitation is a relatively frequent complication often associated with high mortality. Surgical approaches are extremely complex and often lead to poor outcomes. TAVI can be a feasible solution but it is usually extremely challenging due to the absence of calcification and stenosis. We report the case of a 56–year–old man who underwent LVAD implantation 4years ago as destination therapy for dilated myocardiopathy and chronic multiple myeloma. During the last year, he progressively developed severe pure aortic regurgitation. Last month, he was admitted to our center for heart failure symptoms and recurrent ventricular arrhythmias (VT/VF). The patient was considered at high risk for surgery and evaluated for a transcatheter approach. Due to the absence of calcification and a relatively large annulus, we decided to use the JenaValve Trilogy prosthesis, the only THV CE approved for aortic regurgitation treatment. Unlike other types of THV (self– or balloon expandable), this is specifically designed for AR and does not require significant oversizing to allow correct anchoring. Another advantage in this setting is the possibility of avoiding the reduction of the LVAD flow due to the reduced risk of embolization and the possibility of proceeding to direct implantation without ventricular rapid pacing thanks to the direct anchoring method onto the native aortic leaflets. In this patient, a JenaValve size L bioprosthesis was implanted transfemorally under general anesthesia with an excellent result. The post–operative echocardiography showed a perfectly implanted prosthesis with no intraprosthesis regurgitation and only a mild anterior paravalvular leak with a subsequent improvement of all hemodynamic parameters. In our opinion, when feasible, the JenaValve implant can be a safe and effective therapeutic option in patients with active LVAD devices at high operative risk.
LEFT BUNDLE BRANCH PACING AND IMPROVEMENT OF AORTIC STENOSIS: A SUCCESSFUL AND UNUSUAL CLINICAL CASE
Authors: Astuti G , Mingoia G , Comparato F , Leggio G , D’Angelo F , De Michele G , Ciaramitaro G , Puccio D , Coppola G , Corrado E 
Published: May 2024

Abstract

Introduction
The dyssynchronous electrical activation of the ventricles may worsen underlying aortic stenosis. Left bundle branch pacing (LBBP) via a transventricular septal approach could be an alternative physiological pacing modality for patients with atrioventricular block (AVB), allowing the preservation of left ventricle synchronization and a decrease in left ventricular end–systolic volume.

Case Report
We report the case of a 77–year–old woman admitted for lower limb edema, easy fatigue and orthopnea. Her cardiological history included chronic heart failure with preserved ejection fraction, chronic coronary syndrome and severe aortic stenosis treated with coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). Subsequently, transcatheter valve–in–valve aortic valve implantation (TAVI) was performed due to prosthetic aortic valve stenosis. The admission EKG revealed bigeminal sinus rhythm, first–degree AVB and left bundle branch block (LBBB). Close EKG monitoring during hospitalization revealed 2:1 AVB. The color–Doppler echocardiogram revealed preserved ejection fraction (EF 55%) and mild to moderate mitral steno–insufficiency. Doppler study indicated variability in the transvalvular aortic gradient. When evaluated on the beat following atrioventricular block, a pattern of severe aortic stenosis emerged (Vmax 4.15 m/s; Gmax/Gmed 68/41 mmHg), while the subsequent conducted beat exhibited a spectrum consistent with moderate aortic stenosis (Vmax 3.91 m/s; Gmax/Gmed 61/33 mmHg). Considering the conduction disorder and the history of left bundle branch block, it was decided to perform cardiac resynchronization therapy using left bundle branch pacing with a dual–chamber pacemaker (Biotronik Edora 8 DR). After device implantation, the EKG revealed an electrically induced rhythm with left anterior hemiblock–like (LAHB) morphology. A follow–up echocardiogram showed a reduction in transvalvular aortic gradient (Vmax 3.52 m/s; Gmax/Gmed 49/25 mmHg), indicating improvement of the aortic stenosis.

Conclusion
In atrioventricular block, anomalous electrical conduction causes an increase in left ventricular end–systolic volume, resulting in a condition of hyperflow through the ventricular outflow tract. Left bundle branch pacing, by resynchronizing atrioventricular and biventricular activity, ensures adequate diastolic filling and reduces the aortic transvalvular gradient, thereby improving aortic stenosis and clinical conditions.
HUGE EPICARDIAL LIPOMATOSIS AND BUTTERFLY APEX OF THE RIGHT VENTRICLE: DIAGNOSITC PITFALLS IN A PATIENT REFERRED FOR SUSPECTED ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
Authors: Brugiatelli L , Lofiego C , Vagnarelli F , Capodaglio I , Patani F , Maurizi K , Tofoni P , Pietrucci F , Silenzi M , Tassetti L , Dello Russo A , Perna G 
Published: May 2024

Abstract
A 68–year–old woman affected by dyslipidemia had a clinical history notable for T wave inversion (TWI) in the lateral and precordial leads from 2008, with a normal echocardiogram (TTE) and a normal coronary angiogram in 2009. No family history of cardiomyopathy or sudden cardiac death. Given the persistence of these alterations (TWI extending from V1–V6 and in lateral leads), in 2019 TTE was repeated, but did not show any significant findings. Consecutive Holter ECG were performed and no significant arrhythmias or ventricular ectopics were recorded. Therefore, a cardiac magnetic resonance (CMR) was performed elsewhere in 2019 and reported the presence of a dyskinetic segment close to right ventricular (RV) apex, epicardial lipomatosis extending from the right ventricle to the left ventricular (LV). No wall motion abnormalities nor late gadolinium enhancement (LGE) area were noted. This MRi findings together with ECG repolarization abnormalities raised the suspiscion of arrhythmogenic right ventricular cardiomyopathy (ARVC). Therefore, the patient was referred to our Center. ECG was repeated and showed TWI in the precordial and lateral leads (Fig.1). TTE showed normal left and right ventricular function/ mass and normal RV dimensions. The patient underwent Coronary angiography that confirmed the absence of CAD. Cardiac MRI was repeated and showed massive epicardial lipomatosis surrounding right and left ventricle (Fig 2a, red arrows). In this T1–weighted DIR image there is hyperintense tissue that surrounds the left and right ventricle, which is more evident when compared with normal myocardium. The adipose nature of this finding was further confirmed with T1–mapping sequences (Fig 2b, yellow arrow). T1 mapping showed low T1 values (300–500 ms) near the right ventricle, compatible with adipose tissue. What seemed to be a dyskinetic apical segment was re–interpreted as “butterfly apex” (Fig 3, red arrow), a little–known anatomic variant that could be mistaken for a RV wall abnormality. Moreover, this segment is not usually involved in isolation in ARVC. Genetic testing for ARVC resulted negative.
The final diagnosis was that of epicardial lipomatosis and butterfly apex presenting with T wave inversion in the precordial leads. No further criteria suggesting ARVC was present. We chose this case because it is emblematic of many potential pitfalls that might occur in the diagnostic pathway of ARVC.
ROLE OF ENDOMYOCARDIAL BIOPSY IN ASYMPTOMATIC CARRIERS OF TRANSTHYRETIN MUTATION: A CASE REPORT
Authors: Costantino J , Ballatore F , Marchionni G , Alfarano M , Frustaci A , Vizza C , Chimenti C 
Published: May 2024

Abstract

Introduction
There are two forms of cardiac amyloidosis (ATTR–CM) from Transthyretin, one wild–type (ATTRwt) and one hereditary (ATTRv), with autosomal dominant transmission. The introduction of new specific therapies has made it possible to block the progression of the disease. The success of these therapies is mainly linked to the early treatment. For this reason, early diagnosis represents a fundamental objective.

Case Report
A 56–year–old man came to our attention due to a mutation of pathogenetic significance in the gene coding for TTR (Ile68Leu). The genetic test was performed following the diagnosis of ATTRv in a first–degree relative (brother aged 58, with onset of symptoms at around 55 years). In medical history he reported a history of bilateral carpal tunnel confirmed by electroneurography and trigger finger. Blood tests showed normal levels of NT–proBNP and TroponinThs (74 pg/mL and 0.005 mcg/L). The ECG showed RS at 60 bpm with normal AV and IV conduction, normal voltages and no changes in ventricular repolarization. The echocardiogram and MRI showed no signs suggestive of amyloidosis. The scintigraphy with bone tracers did not highlight partological hyperfixation in the heart (Perugini score 0). In consideration of the similar age of onset of the disease in the affected brother (predicted time of disease onset, PADO) and the presence of carpal tunnel, which typically precedes the onset of cardiac amyloidosis by a few years, after informed consent, the patient underwent endomyocardial biopsy. Unexpectedly, histological and immunohistochemical analysis revealed the presence of initial transthyretin amyloid deposits. The patient underwent therapy with Tafamidis and after two years of follow–up he did not show disease progression.

Conclusions
The experience of this case underlines how the most used methods for the evaluation of ATTRv carriers do not always allow an effective evaluation of cardiac involvement, now widely recognized as the prognostic factor with the greatest impact on survival. In carriers reaching PADO age, endomyocardial biopsy could be considered an option for identifying subclinical cardiac involvement by starting therapy early and improving quality of life and the prospect of long–term survival.
TO CUT OR NOT TO CUT: CUTTING BALLOON FOR LESION PREPARATION BEFORE DRUG COATED BALLOON ANGIOPLASTY
Authors: Facci G , Bottardi A , Venturi G , Mugnolo A , Zamboni A , Bacchion F , Morando G 
Published: May 2024

Abstract

Background
There are limited data on the use of DCB in calcified lesions. In particular, evidence regarding the use of cutting balloon before DCB angioplasty is scarce.

Methods
We retrospectively analyzed our internal registry between May 2017 and May 2023 to retrieve intrastent restenosis angioplasty performed with DCB. We divided our population according to the use of cutting balloon as debulking technique before DCB. The objective of the study was to compare the two population in term of procedural success (primary endpoint defined as absence of flow–limiting dissection or residual stenosis&gt;30% or bail–out to stent strategy) and 6 months target lesion revascularization (secondary endpoint).

Results
Between May 2017 and May 2023 one hundred and six (106) ISR were treated with DCB–angioplasty at our center: twenty–four were prepared with cutting–balloon, mostly because of high calcification burden, while eighty–two only with conventional NC balloon before DCB strategy. Procedural success was achieved in all patients analyzed (100%). Therefore, there were no differences in procedural success between the two groups. In the cutting balloon group, mainly for unstable angina, a new angiography was performed for 4 patients: one underwent target vessel revascularization (4.1%) while three target lesion revascularizations (12.5%). In the second group, seven out of 82 presented stable angina and needed new angiography resulting in target lesion revascularization (9,1%) due to severe ISR (two underwent surgical revascularization, five percutaneous with DCB). Therefore, cutting balloon was not associated with increased TLR (HR 2.7; 95% CI 0.70–10.52; p 0.147).

Conclusion
Lesion preparation with cutting balloon represent a valid strategy in the setting of in stent restenosis before DCB angioplasty in term of procedural success and 6 months risk for target lesion revascularization. Our monocentric registry presents the limitation of a small number which did not allow for any adjustment and a short follow up period but provides an overview of a real–world experience.
REAL WORLD USAGE OF RANOLAZINE FOR ANTIARRHYTHMIC PURPOSES: SINGLE CENTER EXPERIENCE
Authors: Braia V , Manai R , Bocchino P , Angelini F , Gallone G , De Lio G , Pidello S , Saglietto A , Boretto P , Marcelli G , Melis D , Giannino G , Gravinese C , Frea S , Raineri C , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Introduction
Ranolazine is a late sodium current blocking drug developed as an antianginal agent, with good preliminary efficacy data even for antiarrhythmic purposes (both at atrial and at ventricular level).

Objectives
To evaluate patients’ clinical characteristics and antiarrhythmic efficacy of ranolazine in subjects with a history of atrial and/or ventricular arrhythmias, isolated or repetitive.

Patients and methods
we included patients who received a first prescription of ranolazine for antiarrhythmic purposes in our center from 1/2022 to 11/2023 and evaluated the survival free from major arrhythmic relapses/ablation.

Results
93 patients were enrolled (66±13 years, 15% women): 59% with arterial hypertension, 26% diabetics, 46% with post–ischemic dilated heart disease, 32% with primary cardiomyopathy (including 11% with hypertrophic cardiomyopathy, 10% with LMNA, 14% with TTN), 46% with implantable cardioverter defibrillator, 9% with pacemaker. The mean LV ejection fraction was 42 ± 15%, the mean serum creatinine 1 ± 0.3 mg/dL. Half (50%) had a history of atrial arrhythmias in the 6 months before starting the drug, mainly paroxysmal atrial fibrillation (AF), 67% of ventricular arrhythmias (VAs), mainly isolated and repetitive premature ventricular beats (PVB, 47% of the total), but also sustained or treated VAs (n=18, 19%). Overall, 18% of patients had already undergone AF ablation, 13% ventricular tachycardia ablation, 3% cardiac sympathetic denervation. Finally, 95% of patients were on beta–blocker therapy and 28% were on amiodarone. Ranolazine was prescribed at an average initial dose of 535± 150 mg. The majority (54%) of patients (n=50) had a follow–up longer than 3 months (median 9 months, IQR 6–14); in 6% the drug was stopped due to intolerance and the average dose at the last FU was 641 ± 150 mg. Twenty–eight percent of patients with paroxysmal/persistent atrial arrhythmias had relapses, requiring ablation in 6%. Among patients with major VAs, 57% suffered recurrences, but only 19% required ablation (invasive in 2 cases, non–invasive in 1 case). Finally, among the patients with PVBs, none suffered major VAs or required PVB/VA ablation.

Conclusions
This is the largest available case–series reporting about the real–world usage of ranolazine for antiarrhythmic purposes. Our single center experience supports ranolazine’s good safety and tolerability and shows encouraging efficacy results in terms of clinical stabilization of complex patients.
THE HEART‘S ABILITY TO "SELF–DEFIBRILLATE": A SPECIAL CASE OF IDIOPATHIC VENTRICULAR TACHYCARDIA
Authors: De Luca P , Sollazzo V , Benvenuto A , De Luca A 
Published: May 2024

Abstract

Background
In ventricular tachycardia the heart rate is significantly increased. The main cause is an underlying heart disease (previous myocardial infarction or cardiomyopathy). Dysionia (hypokalemia and hypomagnesemia), acidemia, hypoxia, side effects of drugs contribute; Long QT syndrome is associated with torsade de pointes. Idiopathic ventricular tachycardia is not linked to a heart disease that can be diagnosed with currently available tests. A protection mechanism that the heart applies in the presence of ventricular tachycardia has been discovered: a sort of self–defibrillation.

Clinical Case
A forty–year–old smoker comes to the emergency room suffering from heart palpitations, dizziness and syncope. Physical examination: hypotension and asthenia. ECG: sinus rhythm with single and paired ventricular extrasystoles, monomorphic. Blood tests normal. Echocardiogram: mitral prolapse. Admitted to Internal Medicine, the patient presents a brief loss of consciousness; ECG: non–sustained ventricular tachycardia treated effectively with beta–blockers and amiodarone. Transferred to Cardiology: negative instrumental investigations for structural heart disease; on the Holter ECG, runs of non–sustained ventricular tachycardia. Discharged with beta–blockers. Asymptomatic at follow–up.

Conclusions
By studying the electrical dynamics underlying ventricular tachycardia, it was found that in the presence of rapid cardiac rhythms, complex electrical oscillations are established which lead to a sort of "self–defibrillation" of the heart. The electrical signals that precede the spontaneous termination of a ventricular tachycardia are characterized by an oscillatory dynamic of impulses with different durations from one beat to the next called alternans; when alternans increase, there is a greater susceptibility on the part of the heart to self–termination of the arrhythmic event, highlighting its cardio–protective effect as a defense mechanism triggered by the heart to resynchronize. It is therefore possible to develop new drugs and devices that exploit as a mechanism of action the increase in alternans during arrhythmic events and therefore the cardioprotective mechanism of the heart itself. A possible future clinical application could be the design of a low–energy implantable cardiac defibrillator, compared to current ones whose effectiveness is limited by the painful electric shocks that characterize them.
TRIPTANS: HOPE FOR THE BEST, PREPARE FOR THE WORST
Authors: Polito D , Piscione M , Bianco S , Segreti A , Ussai G , Grigioni F 
Published: May 2024

Abstract
The estimated prevalence of headaches in the population is 66%. According to recent guidelines, basic analgesics, nonsteroidal anti–inflammatory drugs (NSAIDs), or acetaminophen are frequently used as first–line treatment for mild migraine attacks. A triptan is added when analgesic–resistant attacks occur. So these drugs are used as a second–line medication for mild migraines and a first–line medication for moderate to severe headaches. A correlation between spontaneous coronary artery dissection (SCAD) and triptans has already been reported in the literature. If myocardial infarction is more common in patients with cardiovascular risk factors, SCAD seems more frequent in young and smoker females. What is interesting is the speculation of the pathophysiological mechanisms of SCAD after triptans use. A possible option may consist in the fact that the dissection of the anterior descending artery is due to circumferential shear stress caused by these drugs, combined with smoking habits and estrogen deprivation. These latters influence the immune system and the circulating progenitor cells, which are reduced and less active to replace senescent endothelial cells. That is why an intimal flap is formed so that the blood would enter the media and the dissection would be perpetuated. The suspension of the drug is necessary to prevent the vasoconstriction of the vessel from exacerbating the wall stress caused by smoke and sexual hormones deficiency.
THE ENIGMA OF THE ‘SMOKER‘S PARADOX‘ : RESULTS FROM A SINGLE–CENTER REGISTRY OF PATIENTS WITH STEMI UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Paradossi U , De Caterina A , Raccis M , Dossi F , Bianchi G , Palmieri C , Berti S 
Published: May 2024

Abstract

Background
Smoker’s paradox usually refers to the common observation of a favourable outcome of smoker patients in acute myocardial infarction. The interpretation of this phenomenon is still controversial and not fully explained. We aimed at assessing whether smoking could be associated with mortality in a large cohort of prospectively enrolled patients with ST segment elevation myocardial infarction (STEMI) referred to primary percutaneous coronary intervention (PCI).

Methods
From April 2006 to December 2018 a population of 2456 STEMI patients treated with primary PCI were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data and 1–year follow–up were collected.

Results
Among 2546 patients admitted with STEMI 1007 (41%) were current smokers. Smokers were 10 years younger and had lower crude in–hospital and 1–year mortality (1.5% vs 6%, p&lt;0.0001 and 5% vs 11%, p&lt;0.0001), shorter ischemic time (203 [147–299] vs 220 [154–334] minutes, p=0.002) and shorter decision time (60 [30–135] vs 70 [36–170] minutes, p=0.0063). After propensity–matching, age, cardiogenic shock and low TIMI score were associated with in–hospital mortality, while smoking habit was still associated with reduced mortality. Smoking was also associated with reduced death rate at 1–year follow–up (HR 0.54, 95% CI [0.37 – 0.78]; p&lt;0.001).

Conclusions
Our data show a protective link between smoking status and mortality in patients with STEMI, the so called “smoker’s paradox”. This could be explained not only by the shorter ischemic time and younger age of the smoking population but also by a specific pathogenetic effect of smoking underlying the onset of STEMI and response to therapies.