bluuebunny/crossref_metadata_2025_split huggingface dataset:
NUTRITIONAL STATUS IN PATIENTS WITH ACS: PRESENTATION OF THE DIET–ACS PILOT PROJECT
Authors: Sammartino A , Dainotto E , Pelli S , Gianni E , Gori P , Valenziano A , Toso A 
Published: May 2024

Abstract

Background and Aims
Recent evidence showed that malnutrition is an important poor prognostic factor for cardiovascular (CV) disease. Malnutrition is often considered a consequence of a state of undernutrition and, therefore, is believed to only affect underweight people. In fact, a major malnutrition problem affects the overweight and obese population due to inadequate consumption of micronutrients and poor food quality. This study sought to report the prevalence, clinical associations, and short–term prognostic consequences of malnutrition in patients with acute coronary syndrome (ACS).

Methods
This is a prospective observational pilot study that includes patients with a final diagnosis of ACS admitted consecutively to the UTIC of the Santo Stefano hospital in Prato. All patients (all spectrum ACS) are subjected to an early invasive strategy and treated with routine pharmacological therapy. In all cases the standard prevention protocol against contrast–induced acute kidney injury is applied. On admission, we measure: anthropometric parameters, indirect measurement of lipid and protein reserve; body composition with BIVA method; routine blood tests. The following nutritional indices are calculated: the Controlling Nutritional Status score (CONUT), the Nutritional Risk Index (NRI) and the Prognostic Nutritional Index score (PNI). Clinical end–points are: incidence of acute kidney injury (defined as an increase in serum creatinine ≥ 0.3 mg/dl within 48 hours of the invasive procedure); maximum increase in high sensitivity C reactive protein value; maximum decrease in hemoglobin value. During hospitalization, death, re–infarction, acute heart failure are recorded as major adverse clinical events.

Results
The study, which began on November 1, 2023, plans to enroll 120 consecutive patients. The prevalence of the state of malnutrition will be evaluated according to the various indices and its association with the pre–established clinical end–points will be analyzed.

Conclusions
The results will allow us to establish whether the evaluation of malnutrition in patients with ACS is decisive in quantifying the risk of complications, evaluating the response to therapy and impacting the prognosis. The results of this study will be presented and discussed at the congress.
LIFETIME MANAGEMENT OF AORTIC STENOSIS IN EXTREME SETTING
Authors: Esposito R 
Published: May 2024

Abstract
A 51–year–old male patient returned to our attention due to symptomatic severe aortic stenosis. Despite the severity of the aortic valve disease, he had been previously turned down from aortic valve replacement by us because of lack of symptoms and very unfavorable anatomy. Indeed he had been irradiated at the age of 3 due to Hodgkin’s Lymphoma and presented with porcelain aorta, small ascending aorta and aortic annulus. The patient returned to us with a 3–month history of progressive dyspnea (NYHA class IIa) and one episode of lipothymia during physical exercise. Physical examination, hematologic and biochemical investigations at admission were normal. Our trans–thoracic echocardiogram confirmed a trileaflet aortic valve (AV) that was severely stenotic and calcified with a mean gradient of 60 mmHg and an AV area of 0.5 cm2 (0.3 cm2/m2), in presence of good left ventricular systolic function with an ejection fraction (EF) of 60%. CT excluded coronary disease but, confirmed severe calcified aortic stenosis and porcelain aorta with small calcific sino–tubular junction and ascending aorta and protruding LVOT calcium. (Ascending aorta 19 mm; STJ 19 mm). The heart–team judged the patient not suitable for AVR and decided to perform a high–risk TAVI, leaving apical conduit as the last resort. From a technical standpoint, the LVOT calcium and the short and narrow STJ were high risk features for rupture with balloon expandable devices. On the other hand the short and narrow STJ with the narrow ascending aorta would represent a serious issue for the expansion of self–expanding devices and an even more troublesome feature for future coronary access and coronary occlusion in the setting of TAVI–in–TAVI down the road. Given the patient’s young age, a balloon expandable SAPIEN ultra 23 mm was chosen to be implanted with a two–step inflation to minimize the risk of STJ rupture. The prosthesis was partially expanded until anchoring was achieved on the aortic leaflets then, on continuous pacing, the balloon was rapidly collapsed, pushed down deeper under the STJ and fully inflated to achieve prosthesis’ inflow expansion. Intra–procedural and post–procedural course were uneventful and the patient was discharged home in 5th Day. Transthoracic echocardiogram at the dismission reveal a trans–aortic mean gradient of 18 mmhg, the absence of significant paravalvular leaks and a preserved ejection fraction. Pre–discharge CT scan confirmed feasibility of future TAVI–in–TAVI in case of need.
THE IMPACT OF HEART FAILURE ON QUALITY OF LIFE: A MIXED METHOD STUDY
Authors: Li Vigni M , Ghiadoni L , Pugliese N 
Published: May 2024

Abstract

Introduction
Heart failure (HF) is a significant global health problem, affecting over 64,000 people annually and resulting in high mortality rates (Savarese et al., 2023). However, for those receiving follow–up care, there is a 20% increase in 5–year survival (Braunwald, 2013). Globally, heart failure affects 1–3% of the population in developed countries, with 15 million patients in Europe and a 2% prevalence in Italy, accompanied by a 20% mortality rate (Heidenreich et al., 2022). Patients with heart failure often experience a reduction in quality of life (QoL), impacting their psychosocial well–being (Lupón, 2013). Indeed, those with lower QoL tend to experience more adverse events, such as rehospitalization and mortality (Ly et al., 2023). Therefore, it becomes crucial to assess QoL over time, utilizing new technologies for home monitoring. Continuous evaluation of QoL and the use of home monitoring technologies, such as telemedicine and telemonitoring, are essential and can have a positive impact on promoting QoL (Morken et al., 2022). OBJECTIVE: Investigate the perceived quality of life in geriatric patients with heart failure, describing the impact of the condition on QoL.

Materials and Methods
This mixed–methods study aims to explore QoL perception in a cohort of real–life outpatient geriatric patients with HF based on different stages of the disease. The study consists of two phases: a quantitative survey and a qualitative investigation. The KCCQ 23 scale was used to quantitatively assess self–reported QoL during in–person follow–up appointments and subsequently through phone follow–ups at 6 and/or 12 months. Additionally, the qualitative phase involved conducting semi–structured interviews via video calls.

Results, Discussion and Conclusions
The study involved 478 patients with heart failure, with women, who were underrepresented, reporting lower QoL than men. Analysis of interviews and subsequent triangulation of quantitative and qualitative data revealed that the QoL of HF patients is influenced by six identified themes: future perspectives, self–care, social interactions, emotional state, functional status, awareness of the disease, and awareness of one‘s health status. Furthermore, it was observed that deceased patients who received follow–up care reported significantly worse QoL scores compared to those who did not receive follow–up.
SAFETY AND EFFICACY OF EVOLOCUMAB IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERWENT TO CORONARY ARTERY BYPASS GRAFT: A COMPARATIVE RETROSPECTIVE ANALYSIS
Authors: Nasso G , La Rosa C , Bartolomucci F , Brigiani M , De Mola M , Valenti G , Amodeo V , Contegiacomo G , Hila D , Condello I , Speziale G , Santarpino G 
Published: May 2024

Abstract

Background
In–hospital reduction of low–density lipoprotein cholesterol (LDL–C) levels following the acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors (Evolocumab) in these patients undergoing surgical coronary revascularization has not been demonstrated.

Methods
From January 2022 to June 2023, we analyzed 74 patients presenting with ACS whose LDL–C levels were higher than guideline–recommended targets and underwent coronary bypass surgery. In the first period (January 2022– January 2023), the patients increased the Statin dosage and/or added Ezetimibe (Group STEZE 43 patients). At a later time (February 2023 – July 2023), the patients received not only Statin and ezetimibe but also evolocumab 140 mg every 2 weeks started as early as possible (Group STEVO 31 patients). One and three months after discharge the patients underwent a clinical and laboratory control with evaluation of the efficacy lipid measurements and every adverse event.

Results
The two groups not differ in terms of risk factors as mean age (STEVO: 68.5±6.8 y.o. vs. STEZE 70±7.4 y.o. p=0.38), Diabetes (STEVO: 12–38.7% vs. STEZE 18–41.8%, p=0.79), previous myocardial infarction (STEVO: 7–22.6% vs. STEZE 10–23.2%, p=0.91) and Euroscore II (STEVO: 2.14±0.75 vs. STEZE 2.05±0.6, p=0.29). Also in terms of ACS (ST–, Instable angina or NSTE) and time of symptom onset, there is no difference between groups. Most patients (74.4% in STEZE and 71% in STEVO, p=0.88) were on no statin at baseline. Cholesterol, LDL–C and HDL trends from preprocedural to 3 months follow up in both groups demonstrating a more significative reduction in LDL–C and Cholesterol in STEVO group and no difference in HDL–C raising. No deaths were reported. In 3 STEZE group a recurrence of angina poses the need of re–revascularization. No of STEVO patients occur one major adverse event. The statistic difference in terms of these serious events 7% in STEZE vs. 0% in STEVO was not significant (p=0.26).

Conclusions
Evolocumab initiated “as soon as possible” in ACS submitted to CABG with high–intensity statin therapy and ezetimibe was well tolerated and resulted in a substantial reduction in LDL–C levels at dismission, 1 and 3 months. This laboratory result is associated with a reduction in repeated–revascularization.
MULTIDISCIPLINARY PROJECT FOR DELIRIUM IN CICU
Authors: Lauretani F , Maggio M , Ardissino D , Paoli G , Bonura R , Dicembrino R , La Sala R , Baio A , Delsanto R , Gavagni S 
Published: May 2024

Abstract

Background
Delirium could be considered a geriatric syndrome encompassing an array of neuropsychiatric symptoms, which represents a disarrangement of the cerebral function in response to one or more pathophysiological stressors. The prevalence of delirium is high even in Intensive Care Units, where this condition may reach 80% in patients undergoing invasive technique. An estimated 30–40% of cases of delirium are preventable, and prevention is the most effective strategy to minimize the manifestation of delirium and its adverse outcomes. However, predictable episodes of delirium do not seem to be managed effectively.

Aim and Methods of the Study
Between May 2022 and June 2023, all patients aged 65 years or older admitted to the cardiac intensive care unit (CICU) were enrolled and followed for 1 year. This study is prospective observational cohort study aimed at evaluating the incidence of delirium in CICU patients and the relationship between delirium and predisposing and precipitating risk factors for example restraints, comorbidities. Multidisciplinary evaluation was realized for all patients who admitted in cardiac intensive care unit (CICU). The study was approved by the local ethics committee and was carried out in accordance with the Helsinki declaration. All patients provided written informed consent. Exclusion criteria were terminal status and patient refusal to participate in the study. A physician specialist in cardiology recorded all relevant information related to the patient‘s acute clinical conditions, baseline medical history mental, sociodemographic status and comorbidity through Cumulative Illness Rating Scale. Functional, nutritional and risk for delirium was assessed by a nurse.

Results
During the study period, 105 patients aged 65 years or older were assessed in CICU. The majority (n. 56, 53,33%) was male, the delirium incidence rate was 15 (14,29%). In the multivariable model, age (p 0.004), CIRS_ severity index (p 0.008), ADL (p 0.007), BMI ≥ 35 (p 0.01), BDZ (p 0.001), SSRI (p 0.05) were significantly associated with 4AT.

Discussion
In our study, CICU patients with delirium showed worse short and long–term clinical outcomes; similar data were shown in other studies (Falsini et al., 2018; Zipser et al., 2021). The presence of delirium itself had a strong clinical impact.

Conclusion
The results of the study allowed us to prepare a quality improvement plan for elderly CICU patients at risk of delirium.
WHEN CLINICAL FINDINGS TAKE YOU DOWN THE WRONG PATH: PERSISTENT FEVER IN A PATIENT WITH PREVIOUS CARDIAC SURGERY
Authors: Pedio E , Savino L , Giovannico L , Gentile M , Nucci G , Zaccaro S , Parigino D , Ostuni V , Bottio T 
Published: May 2024

Abstract

Introduction
In a patient who underwent previous cardiac surgery, persistent fever may be related to endocarditis. Symptoms and cardiovascular imaging, such as echocardiogram and PET/CT, may guide clinicians and surgeons to the correct diagnosis.

Discussion
A 43–years–old man came to our attention because of persistent fever (lasting several months) associated with cough and asthenia. When he was 5 years old, he underwent cardiac surgery for partial atrioventricular canal defect (atrial septal defect was about 4 cm) and mitral valve cleft. 14 years ago he undertook chemotherapy due to Hodgkin‘s lymphoma. Recently a cerebral artery aneurysm, radiologically defined as mycotic but proved to be fusiform, was diagnosed and treated with neurosurgery. During a recent hospitalization, blood culture positive for Streptococcus Mitis and brachial rash were reported and antibiotic therapy was started. Suspecting endocarditis, he was referred to our department. Echocardiogram revealed anterior mitral leaflet fissure, resulting in severe mitral regurgitation. Moreover a periannular cavity of doubtful interpretation (seemingly an abscess) was described. Subsequent 18FDG–PET/CT did not detect any abnormal cardiac metabolic activity. Due to severe valve regurgitation, cardiac surgery was performed: myxomatous degenerative mitral valve leaflets, failure of mitral valve cleft closure and anomalous coronary sinus communication to the left atrium (mimicking echocardiogram findings of suspected empty abscess cavity) were observed. Thus mitral valve replacement using a biological valve prosthesis was performed. Macroscopically there was no evidence of endocarditis, confirming PET/CT scan results. During the post–surgery period, third–degree atrioventricular block episodes were noted. Therefore a bicameral pacemaker was implanted.

Conclusions
This case report demonstrates the importance of not stopping at the first impression, as failure of previous mitral valve repair in a patient presented with persistent fever can mimic endocarditis. Therefore, the results of diagnostic tests should be compared to patients’ medical history and their clinical presentation.
REVASCULARIZATION WITHOUT DES: A CASE REPORT ABOUT METALLIC–LESS REVASCULARIZATION TECHNIQUES
Authors: Maisenti S , Facci G , Rubino F , Agbariah A , Armani I , Fezzi S , Tavella D , Ferrero V , Ribichini F 
Published: May 2024

Abstract

Rational
56 years old patient, admitted to our service for myocardial infarction without ST elevation. In medical history he had dyslipidaemia, hypertension and familiarity for cardiovascular disease, without previous cardiological problems. The patient went to the ER for chest pain, started after his work shift. When admitted to the ER, the patient was still symptomatic for chest pain, with resolution after 3 hours after somministration of analgesics, with normal pressure and heart rate. An ECG was performed, without relevant findings, at the blood exams significative movement of cardiac troponins. At the echocardiogram apical hypokinesia of left ventricle with preserved ejection fraction.

Technical Resolution
Coronarography was performed, with evidence of severe diffuse atheromatic disease of the left anterior descending artery (LAD) at the proximal segment and sub–occlusive stenosis at the middle segment. Due to the diffuseness of the atherosclerotic disease on the LAD, which would have required a complete stenting of the artery, which using classical Drug Eluted Stents would have led to a complete metallization of the artery, in such a young patient who does not have medical history suggesting a progression of the atheromatic disease, metallic–less techniques were chosen. The two lesions were pre–dilatated with a non–compliant (NC) balloon. The proximal lesion was treated with a bioresorbable scaffold (BVS) Magmaris 3x25 mm, post–dilatated with a NC balloon, without complications. The distal segment was treated with a Drug Eluting Balloon (DEB) Pantera Lux 2.5x20 mm, expanded for 90 seconds, with evidence of focal dissection, not flow limiting.At the clinical follow–up performed at one and three months, the patient was asymptomatic for angina, without any cardiovascular event.

Clinical Implications
When facing coronaropathy in a young patient, it is a good option to treat the coronary with techniques that do not leave metallic material in the arteries, which exposes young patients to a higher rate of complications if compared to older patients. When it is preferred to use this kind of techniques, the options can be DEB or BVS. As seen in this case report, often the DEB can lead to complications. It’s well–known that every DEB complication needs a DES to fix it. However, little is proven and studied about the use of BVS on de–novo lesions and on coronary injuries as complications of “conventional” PCI, as well as those derived from DEB delivery.
A CASE OF CHRONIC PERICARDITIS IN A YOUNG PATIENT
Authors: Perfetti S , Zaccaro S , Pedio E , Citarelli G , Greco G , Mandunzio D , Caldarola P 
Published: May 2024

Abstract
A 25–year–old woman was admitted to our department with a diagnosis of pericarditis and pericardial effusion. She reported a flu episode 5 months earlier followed by persistent dry cough, dyspnoea on exertion and palpitations. Due to the persistence of symptoms, she consulted a cardiologist and it was observed a mild to moderate pericardial effusion with a raised C reactive protein at lab test. At first she was treated with ibuprofen and colchicine. After 2 months, prednisone was added to the therapy for effusion worsening. During steroids descalation she started complaining of night fever. Few weeks later an echocardiogram revealed increased pericardial effusion (21 mm) with signs of right atrial compression, so she was admitted to our department. No cardiovascular risk factors were reported but overweight and smoking habit. ECG at admission showed a slight depression of PR in inferior leads. Given the history, persistence of elevated inflammatory markers and fever on admission, despite prolonged therapy with NSAIDs, the patient was treated for high–risk pericarditis, with ibuprofen and colchicine. In addition, aetiological research was pursued: autoantibody and viral panel were negative; chest X–ray showed mediastinal enlargement and swelling in the right hilar region. So an urgent chest CT scan was performed and it showed a 8x9 cm mediastinal mass extending to the pectoral muscles and sternum. The mass biopsy revealed a classical Hodgkin lymphoma so she was transferred to Hematology department and chemotherapy was started. During her hospital stay, the effusion remained stable (17 mm). This clinical case demonstrates that pericarditis, even in a young patient, with a lack of response to NSAIDs therapy and with an unremitting course, must raise the suspicion of an occult cancer. In fact, according to the latest guidelines, in case of high–risk pericarditis, i.e. in the presence of at least one negative prognostic predictor between fever higher than 38°C, subacute onset, severe pericardial effusion, tamponade or failure of medical therapy after one week, aetiological research is indicated, in addition to hospitalization. It shouldn‘t be forgotten that pericarditis may be the first manifestation of an occult extracardiac tumor. In particular, the primary tumors associated with pericarditis are breast cancer, lung cancer and lymphomas. Probably better case management would have allowed an earlier diagnosis and treatment of our patient‘s cancer.
A BIZZARE ECG
Authors: Matteucci A , Ujka K 
Published: May 2024

Abstract
Electrocardiographic artifacts are common and may interfere with interpretation. We describe a clinical case where a limb lead electrode was placed near the pulsation of the radial artery, which created an artery pulse tapping artifact also called Aslanger‘s sign or electromechanical association. This is a very unique physiological type of electrocardiogram (ECG) artifact generated by the movement of the electrode placed near the pulsatile artery, particularly in hyperdynamic state such as hyperthyroidism, severe anemia, liver cirrhosis and arteriovenous fistula, including dialysis fistula of end–stage renal disease. These kind of artifacts may imitate primary repolarization changes characteristic for acute coronary syndrome, arrhythmias or electrolyte abnormalities; thus, they have the potential to trigger unnecessary tests. Careful inspection of the ECG in Fig.1 revealed that the coupling interval of the QRS complex and the artifact is identical, which signifies that the artifact is synchronous with cardiac cycle. In the given ECG, bizarre changes were seen in all limb leads except lead III, suggesting that the artifact arose from right arm limb electrode. The repeat ECG in Fig.2 was taken such that the electrode was not directly on the pulse, showed disappearance of the artifact. When ecountering unexpected electrocardiographic findings, inspection of the ECG and lead placement may identify the cause. Recognizing such intimidating ECG artifacts is very important to avoid unnecessary interventions in a benign condition.
Ongoing introgression of a secondary sexual plumage trait in a stable avian hybrid zone
Authors: Long Kira M , Rivera-Colón Angel G , Bennett Kevin F P , Catchen Julian M , Braun Michael J , Brawn Jeffrey D 
Published: May 2024

Abstract
Hybrid zones are dynamic systems where natural selection, sexual selection, and other evolutionary forces can act on reshuffled combinations of distinct genomes. The movement of hybrid zones, individual traits, or both are of particular interest for understanding the interplay between selective processes. In a hybrid zone involving two lek-breeding birds, secondary sexual plumage traits of Manacus vitellinus, including bright yellow collar and olive belly color, have introgressed ~50 km asymmetrically across the genomic center of the zone into populations more genetically similar to Manacus candei. Males with yellow collars are preferred by females and are more aggressive than parental M. candei, suggesting that sexual selection was responsible for the introgression of male traits. We assessed the spatial and temporal dynamics of this hybrid zone using historical (1989–1994) and contemporary (2017–2020) transect samples to survey both morphological and genetic variation. Genome-wide single nucleotide polymorphism data and several male phenotypic traits show that the genomic center of the zone has remained spatially stable, whereas the olive belly color of male M. vitellinus has continued to introgress over this time period. Our data suggest that sexual selection can continue to shape phenotypes dynamically, independent of a stable genomic transition between species.