bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG–TERM OUTCOMES FOLLOWING TRANSVENOUS LEAD EXTRACTION: DATA FROM A TERTIARY REFERRAL CENTER
Authors: Calvi E , Arabia G , Cerini M , Falco R , Bellicini M , Curnis A 
Published: May 2024

Abstract
Transvenous lead extraction (TLE) has been established as a procedure with a satisfactory safety and efficacy profile in both intraoperative and short–term postoperative setting. However, data on long–term outcomes are limited.
The purpose of this study was to evaluate long–term outcomes and prognostic factors in patients who underwent TLE. Patients with a cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were included in a retrospective analysis. The primary outcome was a composite of all–cause mortality and repeated TLE procedure, stratified based on the indication for CIED infection or reasons other than infection. Secondary outcomes included the individual components of the primary outcome. A total of 191 patients were included in the analysis, with 50% (n=96) undergoing TLE due to CIED–related infection. Complete procedural success was achieved in 189 patients (99%), with no major acute complications.
After a median follow–up of 6.5 years, the presence of infection at the time of TLE was associated with significantly lower event–free survival (67% vs. 83% in the non–infection group, adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02–3.81, p = 0.04). The all–cause mortality rate was higher in the infected group (30% vs. 10%, p &lt; 0.01). Conversely, the rate of repeated TLE did not differ significantly between the two groups (4% vs. 7%, p = 0.62). Among patients undergoing TLE due to infection, the presence of vegetations on leads or valvular apparatus (aHR 2.56; 95%CI 1.17–5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04–6.70, p = 0.04) were independently correlated with the primary outcome. Subgroup analysis based on gender revealed that female patients had a higher risk of minor intraprocedural and periprocedural complications (17.2% vs. 2.5%, p &lt; 0.01), but no differences in long–term outcomes. Patients undergoing TLE for CIED–related infection demonstrate a high risk of long–term mortality. Systemic infection, indicated by vegetations and positive blood cultures, is associated with a worse prognosis, independent of the procedural complexity and success. Female patients exhibit an increased risk of minor intraprocedural and periprocedural complications.
FEASIBILITY AND MICRO–COSTING ANALYSIS OF A SAME–DAY DISCHARGE PROTOCOL FOR CATHETER ABLATION OF ATRIAL FIBRILLATION: A PILOT STUDY USING CRYOBALLOON ABLATION
Authors: Sgarito G , Conti S 
Published: May 2024

Abstract

Background
Catheter ablation (CA) is a well–established treatment for atrial fibrillation (AF). Due to the ageing population, increasing prevalence of AF risk factors, improving detection methods for AF, and broadening indications for ablation, CA for AF is the most common resource–consuming ablation procedure, strongly impacting waiting list times and healthcare costs. The combination of these factors and limited bed availability led to development of a same–day discharge (SDD) protocol with acceptable efficacy and safety outcomes. Due to the COVID–19 outbreak, we started the SDD pilot project to reduce patient hospital stays and time spent on the waiting list.

Objective
We aimed to assess our day–case service‘s overall effectiveness and safety. Furthermore, we aimed to evaluate the health–economic impact of a routine adoption of day–case AF ablation.

Methods
Patients with symptomatic and drug–refractory PAF or early Pe–AF scheduled for de–novo ablation were included in the study protocol if they had the following clinical and non–clinical criteria for an SDD protocol: 1–Clinical factors: a) stable anticoagulation, b) No history of bleeding, c) No systolic heart failure, d) No history of pulmonary disease, e) No interventional procedure within 60 days, f) BMI &lt;35, g) CHA DS –VASc ≤3, h) non–severely dilated left atrium, i) age &lt;65 years old; 2–Non–clinical factors: a) home residence within 50 km, or if more, with an emergency department (ER) reachable within 30 minutes, b) home assistance to the patients the same day of the procedure.

Results
Fifty–two patients were included in the SDD protocol and underwent PVI with the Arctic Front Advance cryoballoon ablation catheter. Patients were admitted to a cardiac short–stay unit on the day of ablation at 7 am. SDD procedures were carried out in conscious sedation without the presence of an anesthesiologist. After ablation, the patient was admitted to the recovery area for at least 6 hours. Postprocedural echocardiography was performed to rule out pericardial effusion. The bed occupancy cost reduction was 493€/procedure with the SDD protocol (2415€ vs. 1921€). No minor or major complications were observed in the SDD protocol.

Conclusion
The adoption of an optimized path would lead to a reduction in the length of hospital stays, optimization of beds, a reduction in waiting lists, an accelerating patient access to care and a reduction in patient management costs by optimizing the consumption of resources.
RELATIVE SURVIVAL AFTER ADULT CARDIAC SURGERY IN ITALY
Authors: Rosato S , Biancari F , D‘Errigo P , Manno V , Cuomo M , Duranti G , Baglio G 
Published: May 2024

Abstract

Background
Although adult cardiac surgery maintains an important role in the management of severe heart diseases also in the current era of constant technological advancements of transcatheter procedures, data on life expectancy of cardiac surgery patients is scarce.in particular, there is a lack of data on relative survival of frequently performed isolated cardiac surgery procedures.
In this study we estimated the observed 10–year survival in cardiac surgery patients, the expected survival from age– and sex–adjusted general population and the relative survival from a nationwide administrative registry.

Methods
This is an observational study from a nationwide administrative registry including all adult patients who underwent cardiac surgery from January 2010 to December 2020, in Italy.
Patients died within 90 days from the procedure have been excluded from this analysis. Age and sex adjusted relative survival of 90–day survivors was estimated using the Hakulinen and Tenkkanen’s method. A relative survival of 1.0 implies that the observed survival is the same as the expected survival in the age– and sex– matched general population.

Results
Data on 394445 consecutive adult patients survived 90 days after cardiac surgery have been analyzed. 10–year survival was 58.0% (95%CI 57.8–58.3), the expected survival was 70.1%, and the relative survival was 0.83 (95%CI 0.82–0.83). Patients who underwent surgical repair of the mitral valve and aortic valve had relative survival of 0.96 and 0.92, respectively, which means that the observed survival was close to the expected survival of the matched general population. Isolated coronary artery bypass grafting had a relative survival of 0.88. Surgical replacement of the heart valves had a relative survival below 0.80. Poor results with relative survival &lt;0.70 were observed after complex cardiac surgery. Relative survival was below 0.60 in patients who underwent double or triple valve surgery combined with coronary surgery.

Conclusions
The present findings provide a picture of the real expectation in terms of late survival of patients after adult cardiac surgery. This information can be useful for a throughout discussion with patients and their relatives on the benefits and risks associated with surgery, and it may be relevant in the decision–making process and in planning tertiary prevention.
MINIMALLY INVASIVE TRANS–AXILLARY VERSUS FULL STERNOTOMY MITRAL VALVE REPAIR: A PROPENSITY SCORE–MATCHED ANALYSIS ON MID–TERM OUTCOMES
Authors: Bifulco O , Malvindi P , Berretta P , Brugiatelli L , Cefarelli M , Alfonsi J , D‘Alfonso A , Zingaro C , Di Eusanio M 
Published: May 2024

Abstract
Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium– and long–term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid–term results in patients who underwent TAxA MVr. Prospectively collected data of patients who underwent first–time MVr for MV regurgitation between 2017 and 2022, were reviewed. A total of 308 patients received TAxA, while in 220 cases, traditional full sternotomy (FS) was performed. Concomitant aortic and coronary artery bypass grafting (CABG) procedures, infective endocarditis or urgent operations were excluded. A propensity match (PS) analysis was used to overcome preoperative differences between the populations. Follow–up data were retrieved from outpatients’ clinic, telephone calls and municipal administration records. After PS–matching, two well–balanced cohorts of 171 patients were analysed. The overall 30–day mortality rate was 0.6% in both cohorts. No statistical difference in postoperative complications was reported. TAxA cohort experienced earlier postoperative extubation (p &lt; 0.001) with a higher rate of extubation performed in the operating theatre (p &lt; 0.001), shorter intensive care unit (ICU) stay (p &lt; 0.001), and reduced hospitalization with 51% of patients discharged home (p &lt; 0.001). Estimated survival at 5 years was 98.8% in TAxA vs. 93.6% in FS cohort (Log rank p = 0.15). The cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts (Gray test p = 0.49). TAxA approach for MVr was associated with low rates of in–hospital mortality and major postoperative complications being furthermore associated with shorter mechanical ventilation time, shorter ICU stay and reduced hospitalization with a higher rate of patients able to be discharged home. At mid–term, TAxA was associated with excellent survival and low rate of MV reoperation.
NOVEL INTEGRATED IMAGING PARAMETERS FOR RISK STRATIFICATION OF ATRIAL FIBRILLATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
Authors: Parisi F , La Franca E , Giovanni G , Bellavia D , Pistelli L , Zito C , Carerj S , Cipriani M 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) impacts prognosis of hypertrophic cardiomyopathy (HCM) by promoting progressive heart failure (HF) and increasing risk of stroke. Over the past years, several indexes and methods to predict AF among HCM patients have been proposed. However, they are limited by a lack of accuracy. Aims of our study was to evaluate the role of new echocardiographic parameters in predicting new onset of AF and to validate them by cardiac magnetic resonance (CMR).

Methods and Results
We analyzed clinical and imaging data of 141 HCM patients in sinus rhythm who underwent first evaluation at our center (51.2 ± 17.3 years, mean follow up 5.3 ± 3 years). Main parameters analyzed were left atrium (LA) end–diastolic volume (LAV min), end–systolic volume (LAVmax), LA ejection fraction (LAEF), left atrioventricular coupling index (LACI), and LA diameter (LAD). LACI was defined by the LAVmin divided by the LV end–diastolic volume (LVEDV); this parameter was assessed in previous studies as a good detector of early atrial remodeling and impaired LV compliance. 35 patients developed new–onset AF (after a mean period of 4 ± 3.2 years). At the baseline evaluation, LACI, LAD, and LAVmin showed to be significantly greater in patients who developed AF compared to patients who did not. At CMR, LACI &gt;44% accurately predicted new–onset AF (sensitivity 85%, specificity 70%; AUC 0.81). LACI by ETT showed similar accuracy (AUC 0.75) and was superior to that shown by LAD (AUC 0.71) (Figure 1). Patients who did not develop AF had significantly higher LAEF at ETT (49.3 ± 11% vs 37 ± 9.6%; p &lt; 0.0001). CMR analysis confirmed this result. LAEF &gt;43% was a good predictor of AF free survival (log rank&lt;0.001). Conversely, at a multivariate analysis, LAFE &lt;43% by ETT was independently associated with AF occurrence (OR 4.5, 95% CI 1.4–13.7) (Figure 2). 11 patients experienced death or heart transplant (HTx). Higher values of LACI and LAVmin and lower values of LAEF were found to be associated the composite outcome of death or HTx. LACI&gt;60% predicted the composite of death or HTx with good accuracy (AUC 0.74) (Figure 3).

Conclusions
LACI and LAEF showed to improve accuracy in predicting the new onset of AF in HCM patients without severe LA dilatation (LAD&gt;45mm). Higher LACI and Lower LAEF (namely &lt;43%) identify patients at higher risk of new onset AF, and, therefore, worthy of a more strict follow–up.
CORONARY FLOW AT REST AND CLINICAL OUTCOMES IN DILATED CARDIOMYOPATHY
Authors: Roccabruna A , Portolan L , Bonvicini E , Ciceri L , Pilan M , Springhetti P , Fabroni M , Piccoli A , Setti M , Benfari G , Scarsini R , Ribichini F 
Published: May 2024

Abstract

Background/Objectives
Reduced coronary flow reserve (CFR) was described in dilated cardiomyopathy (DCM). To match increased metabolic demand from the myocardium, resting coronary flow (rCF) increases with CFR consumption. Whether an increased rCF causing a reduction of CFR is associated with worse clinical outcomes in DCM remains debated. RCF is inversely correlated to the resting mean transit time (mtt) required for blood to pass through the coronary artery (rCF=1/mtt). A reliable surrogate of mtt is the ratio n frames/frame rate where n frames are the number of frames required for the dye to reach standard distal landmarks of coronary arteries during invasive coronary angiography (ICA) and frame rate is the frame rate acquisition. We aim to assess the prognostic role of rCF evaluated at the ICA performed as standard clinical practice at the time of diagnosis at long–term follow–up in DCM.

Methods
This is a retrospective analysis of a prospective cohort of patients with idiopathic DCM under medical management enrolled in the Verona Heart Failure registry between 01/2012 and 12/2022. RCF was evaluated at the ICA performed at the time of diagnosis as 1/(n frames/frame rate). The primary endpoint was a composite of cardiovascular death, rehospitalization for heart failure, resuscitated cardiac arrest, hemodynamically unstable ventricular arrhythmias, implanted cardiac defibrillator intervention and cardiac transplantation due to advanced heart failure.

Results
110 patients were enrolled in the final cohort. 15 patients (13.6%) suffered the primary endpoint at a median follow–up time of 42 months (IQR 18–71). At the ROC curve analysis rCF predicts the primary endpoint at a cut–off of 2.32 with an AUC of 0.728 (0.599–0.858, p=0.005) with sensitivity, specificity, negative and positive predictive value of 73.3%, 69.5%, 94.3% and 27.5% respectively. Patients suffering the primary endpoint tended to be older (66 years [60–74] vs 59 years [51–69], p=0.060) and were characterized by an increased rCF (3 [1.87–3.75] vs 1.87 [1.36–2.5]). Patients with rCF&lt;2.32 suffered the primary endpoint more frequently when compared to those with rCF≥2.32 (27.5% vs 5.7%, log rank test p=0.007).

Conclusions
Increased rCF leading to a consumption of CFR is associated with worse clinical outcomes at long term follow–up in idiopathic DCM. Whether coronary microvascular dysfunction can play a prognostic role in this setting remains to be explored by proper prospective studies.
HYPERTROPHIC CARDIOMYOPATHY AND MYBPC3 VARIANT - A CLINICAL CASE
Authors: Bianco M , Nangeroni G , Biolè C , Garello L , Giachino D , Chinaglia A 
Published: May 2024

Abstract

Introduction
Hypertrophic cardiomyopathy is a primary pathology of the cardiac muscle. Sarcomeric forms of hypertrophic cardiomyopathy (HCM) often have autosomal dominant transmission. A pathogenetic or likely pathogenetic mutation affecting genes encoding sarcomeric proteins is present in 30-60% of cases. In this study, we present a case of a family affected by hypertrophic cardiomyopathy with a mutation classified as of uncertain significance in the MYBPC3 gene.

Clinical Case
Mr. AA, 74 years old, attended the cardiomyopathy outpatient clinic of our hospital in June 2021 due to worsening heart failure with an hypertrophic phenotype. His medical history reported an increase in the thickness of the interventricular septum (IVS) since 1985. In 2015, the patient underwent pacemaker implantation for symptomatic 2:1 atrioventricular block associated with syncope and complete left bundle branch block. Since 2016, he had paroxysmal atrial fibrillation complicated by an ischemic stroke in 2019 with subtherapeutic INR. Cardiac magnetic resonance imaging (MRI) or genetic evaluation had never been performed. During the visit, the patient reported that his sister (AG, 73 years old) had undergone tests due to diffuse negative T waves findings in a previous ECG, revealing the presence of a long myocardial bridge of the left anterior descending artery (LAD). No family history of sudden cardiac death was reported. The echocardiogram of AA showed LV hypertrophy (septal wall thickness/posterior wall thickness 18/15 mm, respectively) with an ejection fraction of 36%. Suspecting sarcomeric HCM, a genetic test (TruSight One Expanded Illumina) was performed, revealing two variants of uncertain significance in heterozygosity in the CACNA1C - Calcium Voltage-Gated Channel Subunit Alpha1 C gene (c.2460G&gt;C p.(Lys820Asn)) and MYBPC3 gene (c.2030C&gt;T p.(Pro677Leu)). After a few months, AG presented MRI results suggestive of HCM apical variant (Figure 1). The genetic consultant recommended family screening, and the pedigree is shown in Figure 2. All carriers of the CACNA1C mutation had a negative phenotype. AG's son, IF, 56 years old, carriers of MYBPC3 mutation, presented an MRI compatible with early-stage HCM (Figure 3). His son, carriers of MYBPC3 mutation as well, is now awaiting a cardiac MRI.

Conclusions
In the family presented here, the MYBPC3 variant (c.2030C&gt;T p.(Pro677Leu)) appears to be correlated with the development of sarcomeric hypertrophic cardiomyopathy. Registry studies with a large sample size are desirable to accurately classify variants of uncertain significance, which are becoming more common due to the widespread use of genetic tests.
PROGNOSTIC VALUE MEAN PULMONARY ARTERIAL PRESSURE AND PULMONARY VASCULAR RESISTANCE IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AT FOLLOW–UP
Authors: Dardi F , Salvi M , Guarino D , Ballerini A , Cennerazzo F , Bertozzi R , Donato F , Manes A , Palazzini M , Galiè N 
Published: May 2024

Abstract

Background
Hemodynamic variables related to right ventricular (RV) function have consistently been associated with survival in pulmonary arterial hypertension (PAH). New PAH treatments, however, seems to improve RV coupling reducing RV afterload [e.g. mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR)], but without increasing cardiac output. 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 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) 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 right heart catheterization. The primary outcome was all–cause death. Analyses were performed using Kaplan Meier curves and comparisons were done with Log–rank test. Cox regression analysis was used to find the predictive value of mPAP and PVR at bivariate analysis. 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. Survival curves according to a cut–off value of 35 mmHg for mPAP and 5 WU for PVR are shown in the Figure. Patients with PVR &lt;5 WU and mPAP ≤35 mmHg have a better prognosis than patients with PVR ≥5 WU (independently from mPAP; p–values &lt;0.02) but have the same prognosis of patients with PVR &lt;5 WU and mPAP &gt;35 mmHg (p–value= 0.666). Patients with PVR &lt;5 WU and mPAP &gt;35 mmHg have a better prognosis than patients with PVR ≥5 WU and mPAP &gt;35 mmHg (p–value= 0.031) and a trend toward a better prognosis than patients with PVR ≥5 WU and mPAP ≤35 mmHg (p–value= 0.06). Patients with PVR ≥5 WU have the same prognosis independently from mPAP (p–value= 0.683). In a bivariate Cox regression analysis only PVR &lt;5 WU predict prognosis [HR (95%CI)= 0.61 (0.44–0.84); p–value= 0.002] while a mPAP &lt;35mmHg is not prognostic [HR (95%CI)= 1.00 (0.72–1.40); p–value= 0.991].

Conclusions
mPAP &lt;35 mmHg does not further discriminate the survival over a cut–off value of 5 WU of PVR.
BASELINE SHOCK INDEX–CREATININE CLEARANCE AS A PREDICTOR OF LONG–TERM MORTALITY AFTER ACS. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Palmieri R , Cavuto F , Cordiano R , Merotto D , Dario M , Dal Bo A , Bagato F 
Published: May 2024

Abstract

Background
Shock index (SI), defined as heart rate divided by systolic blood pressure, is a useful simple predictor of long–term mortality after acute myocardial infarction.

Purpose
To assess the utilization of the SI updated version that includes renal function (Shock Index–Creatinine Clearance (SI–C)) to predict long–term mortality after ACS.

Methods
This preliminary analysis included 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization and SI–C was calculated as (SI×100)–estimated CCr. Patients were prospectively followed for 24 years or until death.

Results
Virtually all patients completed the follow–up, representing 7066 person–years. Patients‘ mean age was 66±12 years, 70% were males and 482(82%) had died during follow–up. Compared to those who survived, deceased patients were significantly different in many clinical features. They also showed significantly higher SI–C values ( –11± 25 vs. –36±23, p&lt;0.0001). The predictive value of SI–C for 24–year mortality was very good (area under the curve= 0.783, 95% CI: 0.738–0.827, p&lt;0.001). The cumulative risk was significantly higher in the upper SI–C tertile (log–rank = 162.1, p &lt; 0.001). Unadjusted Cox regression survival analysis showed that the SI–C score was significantly associated with long–term global mortality (HR: 2.1, 95%CI 1.8–2.3, p&lt;0.0001). A fully adjusted model revealed the same results.

Conclusion
Baseline SI–C seems to be an effective independent predictor of long–term global mortality after ACS. It may have potential as a novel and simple early risk stratification tool for ACS patients including long–term outcomes.