bluuebunny/crossref_metadata_2025_split huggingface dataset:
DISCONTINUING DAPT: NOT JUST A MATTER OF SCORES BUT OF INTEGRATED EVALUATION? A KEY ROLE OF IMAGING IN A COMPLEX SCENARIO
Authors: Tamborrino P , Vitale C , Angelillis M , Galeotti G , Carluccio M 
Published: May 2024

Abstract
The duration of the dual antiplatelet therapy (DAPT) is a widely debated topic within the scientific community. The latest guidelines on acute coronary syndromes have supported the possibility of different therapeutic approaches tailored to patient characteristics. However, the clinical cardiologist‘s decisions are not always based on certain principles. The following case report is a practical example. Discussion: A 31–years–old man came to our attention after a resuscitated cardiac arrest due to ventricular fibrillation during a motorcycle race. His history was characterized by a previous acute myocardial infarction at the age of thirteen due to a traumatic dissection of the proximal left anterior descending (LAD) coronary artery and ascending aorta treated conservatively, with residual transmural necrosis of the mid and subendocardial anterior wall on cardiac MRI. At the admission, ECG showed ST–segment elevation in the anterior leads. Coronary angiography revealed occlusion of the proximal LAD coronary artery, treated with drug–eluting stent (ONYX 5.0 mm), with evidence of dissection and aneurysmal wall of that segment. The patient started a DAPT with aspirin and prasugrel. At discharge, echocardiogram evidenced a moderate left ventricular dysfunction (ejection fraction 34%) with signs of anterior and apical necrosis. Later, the patient was admitted for a subcutaneous defibrillator implantation, due to persistent moderate ventricular dysfunction. One year after revascularization, a lifelong DAPT strategy with downgrading to clopidogrel was considered the best choice for the following considerations: the young age of the patient, the low bleeding risk (PRECISE DAPT score 8), a not elevated DAPT score (value 2), the revascularization in the aneurysmal segment without an appropriate stent apposition (due to absence of a right sizing) and the previous dissection with sign of partial thrombosis at coronary CT. Conclusions: The anatomical complexity of angioplasty procedures and the delicate balance between ischemic and thrombotic risks have led to continuously evolving therapeutic strategies. The clinical scores currently available cannot often account for complex coronary anatomy. Thus, it‘s essential to consider a personalized approach, individualized on clinical and imaging characteristics, that encompasses ischemic and bleeding risk and procedural data for the appropriate treatment for each patient.
ICCU – ACQUIRED WEAKNESS IN ELDERLY PATIENT ADMITTED FOR ACUTE CARDIAC CRITICAL ILLNESS
Authors: Trotta M , Brunori L , Cestelli J , Chiocci E , Del Pinto M , Falchetti D 
Published: May 2024

Abstract
Over the last thirty years there has been a profound change in the demographic and epidemiological (1) profile of patients admitted to Intensive Cardiac Care Units (ICCU). Patients with multi–comorbidity and multi–organ failure have significantly increased; this resulted in an exponential extension of the ICCU stay. As related to what was said above, there has been an increase in weakness with consequent growth in medical–care complexity. In addition to these aspects, the increase in manifestations such as disorientation syndrome and delirium in these patients during hospitalization is of great importance. The pathophysiological characteristics of weakness acquired in ICCU are well known, while it is difficult in clinical practice to use neuro–pathophysiological diagnostics to describe its etiology (reduced peripheral nerve conduction velocity, reduced CMAP–compound muscle action potential, reduced muscle excitability, etc.). Given the complexity described, in our opinion it is essential to include the figure of a dedicated physiotherapist in medical nursing care in the ICCU. It would thus finally be possible to structure a multidisciplinary approach useful for the early rehabilitation of elderly and multi–morbid patients in order to reduce hospital stay (2), clinical complications and possible improvement in terms of clinical outcomes. Our group therefore has attempted to define a multidisciplinary intervention protocol through the use of rehabilitation assessment tools validated in patients admitted to ICCU aged 65 years and over. The protocol will provide for a randomization of patients consecutively admitted to our ICCU for an early structured multidisciplinary treatment vs usual care. A series of clinical–laboratory parameters will also be evaluated to define the incidence of the following complications: hyper–catabolic state, development of Acute Renal Failure with increase in creatinine &gt;40% compared to baseline, infectious complications, clinically evident Congestive Heart Failure or episodes of left ventricular failure and NTproBNP trend during hospitalization. With the definition of this protocol, we would like to elaborate the numerous evidence in the literature on early rehabilitation intervention models (3), as there is no certain data in patients admitted to ICCU.
IRON DEFICIENCY ANEMIA AFTER CARDIAC SURGERY: IS THERE AN ADDED VALUE OF THERAPY WITH SUCROSOMIAL IRON ON TOP ON FERRIC CARBOXYMALTOSE? PRELIMINARY DATA
Authors: Venturini E , Giallauria F 
Published: May 2024

Abstract

Background
IDA after CS increases mortality, serious adverse events and length of stay; it also has a negative impact on the cardiac rehabilitation (CR) program. The FCM is the gold standard for IDA patients (P). However short–term treatment of IDA after CS using FMC or SI showed a significant similar improvement of key hematological parameters (HP) and in functional capacity . The aim of the study was to evaluate whether the use of both therapies had an additional positive effect.

Methods
26 consecutive IDA P, (normal ventricular function, mean age 71,5 ± 8y), after the admission in in in–patient Cardiac Rehabilitation were all treated with FCM (group A) and a part (group B, n 13) also with SI. The study design included a single dose of 1000 mg of FCM at T1 (at 8–10 days from CS) and after a dose of 60 mg of SI per day from T1 to T2 (the day of discharge 10 days after) until T3, 15 days after. Measures of efficacy included changes from baseline in HP and natriuretic peptides (NP).

Results
The data are shown in the Table. The statistical analysis was conducted with the Mann Whitney test (non–parametric). At baseline there were no differences in Vit B12, folate and reticulocytes. No P had a deficiency of Vit.B12 or of reticulocytes; 57% had a folate deficiency (higher prevalence in the group B, 4.0 ±2.1 vs. 9.5±11.7 ns). Hb and other HP increased significantly, with no differences between the two groups. The increase in Transferrin Saturation (Tsat) was greater (but ns) in group B with lower baseline level. The ferritin (F) level was much higher in group A; the delta is also significant. Iin group B the F remains stable, while in grupo A it doubles (+94%). No significant differences were observed in others parameters. The NP level was lower at T3 in group B; the data does not appear to be clinically relevant, for the different baseline values (the delta was not significant).

Conclusions
It is mandatory to look for folate deficiency, for optimal management of IDA after CS. The SI can mitigate the high levels of F, consequence of the inflammatory state following CS. Furthermore, it is known that FCM can induce a further increase in F may be due to a low–grade pro–inflammatory effect correlated to the high level of iron deposition in macrophages . Also relevant is the positive impact on TSAT with the possibility of reaching the guidelines–level more quickly. The increase in the number of cases will allow us to achieve more certain results.
LIPID–LOWERING THERAPY WITH PCSK9 INHIBITORS: FAMILIAL HYPERCHOLESTEROLEMIA VS GENERAL POPULATION OUTCOMES
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
Dyslipidemic patients, particularly those with familial hypercholesterolemia (FH), are at increased risk of cardiovascular events and require beginning a full treatment. This study aims to compare the long–term effects of PCSK9i treatment in FH and non–FH dyslipidemic patients.

Methods
The study enrolled 381 dyslipidemic patients receiving PCSK9 inhibitors in our dyslipidemia outpatient clinic. FH was defined in accordance with the Dutch Lipid Clinic Network Criteria. The clinical data were collected in both groups and lipid profiles were monitored at 6, 12, and 36 months.

Results
In patients with FH baseline total cholesterol was significantly higher(260±54.8 mg/dL vs 212±51.3 mg/dL p &lt; 0.001) as well as LDL cholesterol (181.4±51.7 mg/dL vs 137±45.1 mg/dL p &lt; 0.001). A lipid reduction was observed in both groups at 6 months (LDL 69±41 mg/dL vs 62±37 mg/dL p = 0.20) at 12 (LDL 66±41 mg/dL vs 66±40 mg/dL p = 0.96) and 36 months (LDL 73±45 mg/dL vs 72±35 mg/dL p = 0.92).

Conclusions
PCSK9i treatment is highly effective in reducing LDL–C levels in both FH and non–FH dyslipidemic patients. The Achievement of similar LDL–C levels between these two groups in long–term follow–up could suggest that PCSK9i therapy is equally efficacious in both populations despite different dyslipidemia settings.
ROLE OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD)
Authors: Dell‘Aversana F , Tedeschi C , Ferrandino G , Tuccillo A , Scotto di Uccio F , Tuccillo B , Liguori C 
Published: May 2024

Abstract
Spontaneous Coronary Artery Dissection (SCAD) is a rare but insidious cause of myocardial infarction and sudden cardiac death especially in those who lacks of traditional cardiovascular risk factors. Although the most appropriate management of patients with SCAD is not clearly defined, it‘s essential to make an early diagnosis in order to follow a conservative approach. Nowadays, the role of Coronary Computed Tomography Angiography (CCTA) is consolidated in the study of atherosclerotic coronary pathology but its contribution in the diagnosis and follow–up of patients with SCAD does not apperar to be defined. The purpose of this study was to retrospectively investigate the diagnostic performance of CCTA and its role in the follow–up of patients with diagnosis of SCAD. We examined 307 patients admitted to emergency department for acute chest pain and an ECG diagnosis of STEMI from March 2021 to July 2023. 1 patient was diagnosed with type 2 SCAD on invasive coronary angiography (ICA) and 2 patients received a suspected diagnosis of SCAD at ICA and CCTA examination was performed to confirm the suspicion. CCTA examination showed the acute presence of Intramural hematoma (IMH) of the wall of left anterior descending artery (LAD) in 2 patients, confirming the angiographic suspect of SCAD type 2. All 3 patients were treated with conservatie therapy and subsequentely underwent CCTA of follow–up. The examination performed respectively 3 months, 45 days and 1 month after the acute event demonstrated the complete resolution of IMH in all patients and the patency of the vessel lumens. CCTA seems to be a feasible and effective imaging modality to detect the main findings of SCAD. It may play a crucial role in the management of patients with acute chest pain at low–intermediate risk of ACS in order to reduce the number of misdiagnoses. Furthermore, CCTA could facilitate follow–up of patients with diagnosis of SCAD given the high recurrency rate of this pathology. However, further large prospective studies are needed to clarify the role of CCTA in the diagnosis and in the follow–up of SCAD.
PREVALENCE OF FIBROMUSCULAR DYSPLASIA SCREENING IN SPONTANEOUS CORONARY ARTERY DISSECTION: DATA FROM A SINGLE SECONDARY CENTRE
Authors: Ferretti M , Guiducci V , Bosi D , Musto D‘Amore S , Pignatelli G , 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, accordingly with the literature suggestions.
ROLE OF THE NURSE IN MANAGING INVASIVE BLOOD PRESSURE MONITORING
Authors: Rondo A 
Published: May 2024

Abstract

Introduction
Arterial blood pressure (BP) monitoring is an invasive system for directly tracking and measuring BP and finds its use in critically ill patients who require continuous hemodynamic monitoring and frequent arterial blood test. [1] Invasive monitoring requires the use of sophisticated equipment and specific skills for its management, which influence the quality of care, including the introduction of a catheter inside the arterial vessel. [2] Intra–arterial catheterization is considered the Gold Standard for a direct measurement of BP. [3] Therefore, the objective of this work is to outline the role of the nurse in the management of invasive BP monitoring, with particular attention to the possibility of independently managing the positioning of the arterial cannula itself.

Materials and Methods
A review was performed on the management of invasive BP monitoring, with a particular focus on the role of the nurse in arterial cannula positioning. The Pubmed database was consulted. The search strategy involved the use of Mesh terms and free terms, including "Hemodynamic Monitoring" “Vascular Access Devices” “Critical Care Nursing” “Arterial cannulation”. The terms used were combined together using the Boolean operator “AND”. The Code of Conduct for the Nursing ProfessionsMand the National Collective Labor Agreement were also examinatedand, along with everyday practice of professionals in this field of action.

Results
There are no studies in literature that clearly outline the role of the different professional figures in the management of invasive BP monitoring and there are no clear references regarding who is responsible for positioning the arterial cannula. The development of continuing education programs in the area of clinical reasoning skills for hemodynamic monitoring should be more emphasized. Furthermore, we should focus more on improving practical skills for hemodynamic monitoring. [4]

Conclusions
Advanced skills need to be officially acknowledge to the expert professional by the institutions they belong to, which should contribute to training by creating accredited company courses. Not only to protect assisted people and the professional, but also in order to enhance their work and give it the right recognition. Subsequently, studies could be carried out to evaluate the effective reduction in latency times between non–invasive monitoring and invasive monitoring on critically ill patients, if managed by the nurse.
LEAFLETS AND EXTRA–LEAFLETS HYPOATTENUATED LESIONS FOLLOWING TAVR
Authors: Lentini E , Moscarelli M , Sollami G , Fattouch K 
Published: May 2024

Abstract

Introduction
Subclinical leaflets thrombosis is a condition diagnosed with multi–detector computer tomography (MDCT) characterized by a meniscal–shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self–expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms the leaflets and the extra–leaflets components, such as the valve skirt. Little is known about extra–leaflets hypoattenuated lesions localization, including the anatomic sinus level.

Methods
This was an ambi–directional study. Fifty patients underwent MDCT at follow–up.

Results
At mean follow–up was of 12 months, hypoattenuated leaflet lesion with mild to severe restricted movement was detected in 8 individuals (16%); anatomic sinus lesion was identified in 9 patients (18%) with higher prevalence in the non–coronary sinus (16%); subvalvular lesion with a variable extension toward the valve inflow, was diagnosed in 8 patients (16%). In 4 patients (8%) the anatomic sinus thrombus was ‘in overlap’ with the leaflet thrombus; in 3 patients (6%) was in continuity with the subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p=0.02).

Conclusions
This study demonstrated that hypoattenuated lesions could be identified not only at leaflet, but also at subvalvular and anatomic sinus level. The clinical relevance of such lesions remains uncertain.
CARDIOPULMONARY SUPPORT WITH EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) DURING CATHETER ABLATION OF VENTRICULAR FIBRILLATION: A CASE REPORT
Authors: Perniciaro V , Troisi F , Katsouras G , Quadrini F , Di Monaco A , Grimaldi M 
Published: May 2024

Abstract
The clinical case deals with a 46–year–old man, severely obese and suffering from type II diabetes mellitus and arterial hypertension, a smoker. He was admitted to our department for iterative ventricular fibrillation (VF) following a recent acute myocardial infarction with ST–segment elevation treated with percutaneous coronary angioplasty (PTCA) and implantation of drug–eluting stents on the anterior interventricular. Control coronary angiography showed good results of previous PTCA. On the echocardiogram, left ventricular pump function moderately reduced (EF 45%) with district alterations of the kinetics and aneurysmal dilatation of the ascending aorta. During hospitalization, iterative episodes of VF despite maximal antiarrhythmic therapy, promptly treated with DC shock. Continuous telemetry monitoring showed frequent early premature ventricular complex (PVC) triggering VF episodes. A 12–lead Holter ECG was performed to better identify the morphology of these PVC, documenting PVC of morphology compatible with origin from Purkinjie fibres. An electrophysiological study and mapping of the left ventricle were performed with extracorporeal membrane oxygenation (ECMO) support. During mapping of the middle left interventricular septum, VF occurred several times and was promptly treated with DC shock. In this area have been documented Purkinje fibers and low voltage and multifragmented areas; ablation was then performed by delivering radiofrequency in this area until the all potentials were completely eliminated. After ablation, no more ventricular arrhythmias were induced. Cardiac magnetic resonance imaging was performed which showed large areas of late gadolinium enhancement. The patient underwent automatic defibrillator implantation. Ventricular arrhythmias were no longer documented during telemetric monitoring. In this complex case of significant arrhythmic instability in ischemic heart disease with moderate left ventricular pump dysfunction, ECMO assistance allowed us to effectively and safely perform the ablation of the arrhythmic substrate triggering the iterative episodes of VF.
NOT JUST A SIMPLE FEVER: DIAGNOSIS OF COMPLICATED INFECTIVE ENDOCARDITIS ON BICUSPID AORTIC VALVE IN A YOUNG MAN
Authors: Caprio M , Verrengia E , Corazzini A , D‘Alleva A , Gallina S , Di Marco M 
Published: May 2024

Abstract
Bicuspid aortic valve is the most common form of congenital heart disease (prevalence of 0.5 to 2.0%). These patients develop infective endocarditis at significantly higher rates than the general population; furthermore, they are at increased risk of developing infective endocarditis at a younger age owing to intrinsic factors of the aortic valve, but demonstrate better long–term survival after surgical treatment. This case report concerns a 33–year–old caucasian man who presented to the emergency department for persistent fever. He had no significant past medical history, except for a known bicuspid aortic (type 0) valve. The laboratory test demonstrated an active infection and blood cultures were positive, so we performed a transthoracic echocardiogram showing a mobile mass on the aortic valve, associated to a severe aortic regurgitation. Hence, we decided to perform a transesophageal echocardiogram that documented a bicuspid aortic valve with an extensive endocarditic vegetation on anterior leaflet, cusp prolapse and a non–homogenous peri–valvular area, involving the mitral–aortic junction, compatible with abscess. Perivalvular extension of infective endocarditis is the most frequent cause of uncontrolled infection and is associated with a poor prognosis so, as suggested by ESC Guidelines, this clinical case represented an indication for early surgery. The patient was transferred to cardiac surgery department where he underwent surgery. Extensive debridement of the endocarditic lesion was performed; the mitral–aortic junction was reconstructed by suturing a double patch of heterologous pericardium. The defect resulting from the debridement beneath the left coronary ostium was also reconstructed using an additional sutured pericardial patch; then, an Inspiris Resilia size 23 prosthesis was implanted. Transesophageal echocardiography revealed good functioning of the aortic valve prosthesis with mild mitral insufficiency. Meanwhile, blood cultures resulted positive for Staphylococcus Aureus coagulase–negative, so specific antibiotic therapy was started.