bluuebunny/crossref_metadata_2025_split huggingface dataset:
A CASE OF LEFT ACCESSORY PATHWAY ABLATION IN A PATIENT WITH PERSISTENT LEFT SUPERIOR VENA CAVA AND ABSENCE OF RIGHT SUPERIOR VENA CAVA
Authors: Biagi A , Rossi L , Bolognesi M , Aschieri D 
Published: May 2024

Abstract

Introduction
A 31–year old man was admitted in our emergency department for palpitation. A 12–lead electrocardiogram (EKG) showed a well tolerated regular narrow–QRS tachycardia. A bolus of 6mg + 12 mg of adenosine was administered with only temporary resolution of arrhythmia; subsequently an electric cardioversion was performed with restoration of sinus rhythm. A baseline EKG showed no sign of pre–excitation.

Electrophysiological Study
A decapolar magnetic sensor–based catheter integrated with the electroanatomical mapping system was inserted through the right femoral vein and advanced in the right atrium (RA) where geometry reconstruction of this chamber was obtained (Figure 1). The catheter was easily advanced in the coronary sinus that appeared dilatated but failed to progress in the right superior vena cava. A venography was performed and confirmed the diagnosis of persistence left superior vena cava (PLSVC) and absence of right superior vena cava. Two quadripolar catheters were advanced and positioned respectively at His bundle (HIS) and in the right ventricular apex (RVA). During pacing from right ventricular (RV) apex an eccentric retrograde atrial activation was shown. After isoprenaline infusion during atrial programmed stimulation an atrioventricular reentry tachycardia was induced. An intracardiac ecocardiography (ICE) connected with CARTO3 was positioned in the RA. Atrial septal puncture was performed with ICE guidance and an 8.5F sheet was advanced in left atrium. Activation mapping during pacing from RVA showed maximum VA fusion at the postero–lateral localization. An open–irrigate contact force catheter (Smartouch SF; Biosense Webster, Inc., Irvine, California, USA) was inserted; multiple radiofrequency application with 30–35W were applied with resolution of the accessory pathway (Figure 2).

Conclusion
PLSVC is the most frequent congenital abnormality of the thoracic venous system. The prevalence of this condition is variable and range between a 0.2% and a 3% in the general population. This condition is generally asymptomatic and is accidentally found during procedure. In up to 90% of the cases, the right superior vena cava (RSVC) accompanies PLSVC. In a minority of cases RSVC failed to developed resulting in isolated PLSV. The identification of PLSVC and the absence of RSVC during electrophysical study is crucial. For the purpose of a correct and safe transeptal puncture the use of intracardiac ultrasound is mandatory.
VALIDATION OF QUANTITATIVE FLOW RATIO DERIVED VIRTUAL ANGIOPLASTY WITH POST–ANGIOPLASTY FRACTIONAL FLOW RESERVE. THE QIMERA–I STUDY
Authors: Marengo G , Amat Santos I , Cortes Villar C , Doronzo M , De Benedictis M , Barbero U , Moncalvo C 
Published: May 2024

Abstract

Backgroud
Quantitative flow ratio (QFR) virtual angioplasty with pre–PCI residual QFR showed better results compared with angiographic approach to assess post–PCI functional results. However correlation with pre–PCI residual QFR and post–PCI fractional flow reserve (FFR) is lacking.

Methods
Multicenter prospective study including consecutive patientswith angiographically 50–90% coronary lesions and positive QFR result. All patients were evaluated with QFR, hyperemic and non–hyperemic pressure ratios (NHPR) before and after the index PCI. Pre–PCI residual QFR (virtual angioplasty) was calculated and compared with post–PCI fractional flow reserve (FFR), QFR and NHPR.

Results
A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5±10.9 years and 59% of single vessel lesion being the left anterior descending artery in 69%. The mean vessel diameter was 2.82±0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17±0.46. Baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 + 0.08 and 0.82 + 0.11, respectively. Mean post–PCI FFR increased to 0.87 ±0.05 whereas residual QFR had been estimated as 0.95 ± 0.05 showing poor correlation with post–PCI FFR (0.163; 95%CI:0.078–0.386) and a low diagnostic accuracy (30.9%, 95%CI:20–43%).

Conclusions
In this analysis, the results of QFR–based virtual angioplasty did not seem to accurately correlate with post–PCI FFR.
AORTIC PERIVASCULAR ATTENUATION ON CHEST COMPUTED TOMOGRAPHY ANGIOGRAPHY AND MARFAN SYNDROME
Authors: Tuttolomondo D , Gaibazzi N , Pini A , Secchi F 
Published: May 2024

Abstract

Introduction
Marfan syndrome (MFS, OMIM #154700) is an autosomal dominant inherited disorder with a prevalence in the general population of about 3/10,000. It mainly affects connective tissue due to mutations in the FBN1 gene (15q21.1) that codes for fibrillin–1. The prognosis of patients with MFS is dominated by the high risk of aortic dissection or rupture. Peri–vascular adipose tissue attenuation (PVAT) applied to thoracic angioTC (CTA) is a marker of localised vascular inflammation that is greater in ascending aortic aneurysm than in healthy controls and is associated with in–situ increase of fibrotic tissue. In patients with MFS there is excessive deposition of collagen and proteoglycans with increased wall stiffness that could be identified by PVAT analysis prior to aneurysm development.

Material
We enrolled 54 consecutive patients with a genetic diagnosis of MFS undergoing control CTA and 43 subjects at low cardiovascular risk undergoing CTA for chest pain.

Exclusion Criteria
Presence of aortic pathology; presence of at least one cardiovascular risk factor; previous vascular surgery/cardiac surgery; ischaemic cardiovascular pathology; presence of significant coronary atherosclerotic pathology; current or previous neoplasm; chronic inflammatory/infectious diseases.

Results
There were no statistically significant differences in age, gender and diameter of the ascending aorta between patients in the MFS group and controls. In contrast, PVAT in the ascending aorta appears greater in patients diagnosed with MFS (p&lt;0.001).

Conclusion
In MFS patients with a normal aortic diameter the degree of vascular fibrosis estimated by PVAT is greater than in healthy controls; PVAT may therefore play a role in the MFS diagnostic process, allowing a potential economic benefit.
INDEPENDENT EFFECT OF SGLT2I ON DIASTOLIC FUNCTION IN HFREF POPULATION
Authors: Stracqualursi M , Nemola G , Moscardelli S , Santangelo G , Buratti S , Losito M , Bursi F , Guazzi M 
Published: May 2024

Abstract

Background
Scientific literature reinforces the role of diastolic dysfunction in patients with heart failure with reduced ejection fraction (HFrEF) as an independent prognostic indicator of all–cause mortality. In this context, E/e’ ratio plays a central role in diastolic dysfunction assessments and diagnosis. Despite the introduction of several novel medical therapies for HFrEF that led to improvement in mortality and HF hospitalization, the effect of the combined treatment with Sacubitril/Valsartan (SV) and Sodium Glucose Transporter 2 inhibitors (SGLT2i) on E/e’ ratio has not been addressed yet.

Aim
We aimed to evaluate the effect of SV alone vs SV+SGLT2i on E/e’ ratio in a real–life population of HFrEF outpatients.

Methods
This is an observational monocentric study including patients treated with either SV alone or with SV+SGLT2i from 2018 to 2023. E/e’ ratio was measured at baseline, at 6 and 12 months.

Results
178 HFrEF patients (mean age 69 years±11, left ventricular ejection fraction (LVEF) 31±6%) in optimal medical therapy were enrolled. 121 of them received SV and 58 received SV+SGLT2i. Baseline E/e’ ratio was similar in the two groups (median value 11,2 [IQR 8;16] in SV group and 10,9 [IQR 8;16] in SV+SGLT2i group, p=0.45). At follow up, only SV+SGLT2i group showed a significative decrease in E/e’ ratio after therapy initiation while SV group showed a E/e’ ratio similar to baseline (E/e’ ratio median value 8,5 [IQR 7;12] vs 11,8 [IQR 8;15] respectively, p=0.035). Moreover, after 12 months most patients receiving SV+SGLT2i didn‘t required diuretic administration compared to those treated with only SV (43% vs 16% respectively; p=0,0002).

Conclusions
Among patients with HFrEF, treatment with SGLT2i+SV was associated with a significative reduction of E/e’ ratio and of diuretic administration. This result might suggest a favorable independent effect of SGLT2i on diastolic function and myocytes relaxation and might provide new evidence on the positive results observed on hard endpoints.
IN–HOSPITAL CHANGES OF PLASMA TRIMETHYLAMINE N–OXIDE (TMAO) LEVELS PREDICTS MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Aleksova A , Fluca A , Stornaiuolo M , Pani B , Derin A , Pierri A , D‘Errico S , Novellino E , Sinagra G , Janjusevic M 
Published: May 2024

Abstract

Background
Trimethylamine N–oxide (TMAO), a gut microbiota–dependent metabolite, originates from choline, L–carnitine and phosphatidylcholine metabolism. It is abundant in animal–derived foods like red meat, and egg yolk. TMAO plays a crucial role in cardiovascular diseases (CVDs), altering lipid metabolism and endothelial function, inducing oxidative stress, platelet reactivity, inflammation, and arteriosclerosis.

Aim and Methods
Given the high mortality rate of CVDs patients, it is necessary to improve strategies to optimize stratification risk protocols. Previous studies about the impact of TMAO on outcomes relying on a singular measurement had yielded conflicting results. This study aims to assess the impact of in–hospital TMAO fluctuations in individuals with acute myocardial infarction (AMI). Blood samples from AMI survivors were obtained on admission and discharge. The endpoint was a three–point major adverse cardiovascular events (MACE) composed as all–cause mortality, reinfarction and development of heart failure.

Results
The total cohort comprised 149 AMI patients, with 77% males and a mean age of 64(11) years. Main pro–atherosclerotic risk factors included dyslipidaemia (51%) and hypertension (54.4%). Median TMAO values were significantly higher on admission than discharge (7.81[3.47–19.98] vs. 3.45[2.3–4.78] μM, respectively, p&lt;0.01). TMAO measurements on discharge were used to determine the metabolite cut–off through continuous hazard ratio analysis, showing a linear association with values exceeding 3.45 μM and MACE incidence. The cohort was divided into two groups: low–low/high–low (LL/HL), with 75 patients (50.3%) with persistently low or initially higher and decreasing TMAO levels, and high–high/low–high (HH/LH), with 74 patients (49.7%) exhibiting consistently high or initially lower but increasing TMAO levels during hospitalization. Over the 30–months follow–up, 21.5% of patients experienced MACE. Survival analysis revealed that patients in the HH/LH group were more likely to experience the endpoint (p=0.05). Multivariate Cox analysis demonstrated that patients in the HH/LH group faced more than twice the risk of MACE compared to those in the LL/HL group, along with older age and impaired left ventricular systolic function.

Conclusions
AMI patients with consistently high or escalating TMAO levels face unfavourable outcomes. Understanding the dynamics of TMAO throughout hospitalization may be a predictive factor for patient outcomes.
CAROTID–FEMORAL PULSE WAVE VELOCITY PROGRESSION IN HYPERTENSIVE PATIENTS IS ASSOCIATED WITH SUBSEQUENT CV OUTCOMES
Authors: Maloberti A , Rebora P , Occhino G , Andreano A , Rita C , Tognola C , Toscani G , Peraro G , Morelli M , Pezzoli S , Cavalieri D‘Oro L , Russo A , Giannattasio C 
Published: May 2024

Abstract

Objective
Arterial stiffness (Pulse Wave Velocity – PWV) is associated with CV events and mortality. However, little is known on the relationship of its progression (ΔPWV) over time with CV outcomes. The aim of our study was to evaluate the relationship between PWV progression and all–cause mortality and CV events in hypertensive subjects.

Methods
We enrolled 402 consecutive hypertensive outpatients. At baseline anamnestic, clinical, BP, laboratory data and PWV were assessed. We performed a PWV follow–up examination at a median time of 3.7±0.5 years. Patients were subsequently followed for a median time of 10.1 (IQR 9.5 –10.5) years recording all–cause mortality and CV events.

Results
At baseline the mean age was 53.2±13.0 years, SBP and DBP were 141.8±17.5 and 86.8±10.5 mmHg and PWV was 8.5±1.9 m/s. Despite an improvement in BP control (–9.2±19.5 and –8.0±12.3 for SBP and DBP respectively), at follow–up the population showed a PWV increase (ΔPWV +0.6±1.9 m/s). Progressors (ΔPWV ≥ 0.5 m/s, 204 patients, 50.7%) had a significantly lower survival probability and higher cumulative incidence of composite events, while no differences were seen for CV events (unadjusted analysis). At cox multivariable analysis neither ΔPWV ≥ 0.5 m/s (progressors) nor ΔPWV (as a spline function) were associated with CV events and with all–cause mortality. However, the association with survival probability and cumulative incidence of CV events, as a composite outcome, was significant (HR = 2.32, 95% CI: 1.33 – 4.04, p=0.003).

Conclusions
In conclusion, our study shows that PWV progression of at least 0.5 m/s is frequent in hypertensive patients and that it is associated with a significantly higher risk of developing CV events or dying (composite outcome).
NSTEMI OR AL CARDIAC AMYLOIDOSIS: ALL IS NOT AS IT SEEMS
Authors: Starnazzi F , Dei L , Trambaiolo P , D‘Ambrosi A , Granatelli A , Romano S , Sciarra L 
Published: May 2024

Abstract

Background
Light–chain amyloidosis (AL) is caused by misfolded light chains produced by a small B–cell clone in bone marrow, that aggregate in plasma and deposit in various tissue, included the heart. The progressive nature of the disease and the high mortality rate within 6 months of diagnosis makes early diagnosis very important.

Clinical Case
A 64–year–old patient presented to the Emergency Room (ER) with shortness of breath for a month and externally positive exercise test for symptoms without ECG alterations. The ECG performed in the ER diffuse low voltages with no repolarization abnormalities. Laboratory tests showed an increase in Troponin I| from 0.658 to 0.669 ng/ml (normal range &lt;0.012) and elevated NTproBNP at 7080 pg/ml. The electrophoresis profile indicated MGUS, known since 2015.The patient was admitted to the Intensive Cardiac Unit (ICU) with a diagnosis of NSTEMI. The medical history revealed a family history of Chronic Coronary Syndrome (CCS) and hypertension. Home therapy included beta–blockers and Angiotensin Receptor Blockers (ARBs). Upon admission to ICU, the patient was asymptomatic. Coronary angiography revealed dual stenosis of the anterior descending coronary artery and was treated by dual drug eluting stent. The patient‘s symptoms remained unchanged. A single subsequent episode of paroxysmal dyspnea occurred. An echocardiogram conducted in the EchoLab raised suspicion of cardiac amyloidosis. Hematological exams to assess a possible AL type showed positive results. The patient underwent a bone marrow aspirate because the hematologists were unable to perform a biopsy due to the concomitant dual antiplatelet therapy. We are currently waiting for the histological results to start chemotherapy.

Conclusions
An early suspicion of amyloidosis could have aided in established the correct timing for angioplasty and double anti–aggregation. This clinical case requires a multidisciplinary approach between cardiologists and hematologists, especially given the very high mortality within a few months of diagnosis.
TRANSTYRETIN CARDIAC AMYLOIDOSIS IN ELDERLY PATIENTS: ALWAYS A WILD TYPE?
Authors: Costantino J , Ballatore F , Marchionni G , Alfarano M , Vizza C , Chimenti C 
Published: May 2024

Abstract

Background
Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome.

Methods and Results
In our centre, from September 2021 to June 2023, 52 patients older than 70 years received a diagnosis of cardiac ATTR (87% male, 13% female, mean age 81±5y). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.079 microg/L±0.074) and NT–proBNP (2000±1800 pg/ml), with the absence of a monoclonal component in the blood and urine, and miocardial bisphosphonate scintigraphy positive grade 2/3. All patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 10 elderly (70%male, 30% female, mean age 77±4 y) patients (19%) the genetic test resulted positive with 4 different mutations of pathogenetic significance (Val30Met; Ile68Leu; Val142Ile;, Phe84Leu). Three patients showed peripheral neuropathy with the presence of carpal tunnel syndrome, while isolated carpal tunnel syndrome was present in the remaining 7 cases. The three patients with neurologic involvement started Patisiran therapy, and 7 patients were treated with Tafamidis. First–degree relatives (16 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 9 (3 male and 6 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. These tests were normal in 8 probands, included in an annual follow–up protocol to identify an early manifestation of the disease, and was diagnostic for amyloidosis in 1 patient who started specific therapy.

Conclusions
Our experience shows that 19% of patients older than 70 years with a diagnosis of cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage occurs.
A VENTRICULAR TACHYCARDIA CASE NOT TREATABLE WITH TRANSCATHETER ABLATION DUE TO APICAL THROMBOSIS OF THE LEFT VENTRICLE RESOLVED WITH RADIOTHERAPY BASED ON THE NON–INVASIVE MAPPING SYSTE
Authors: Romanazzi I , Di Monaco A , Valenti N , Grimaldi M 
Published: May 2024

Abstract
The clinical case focuses on a 52–year–old man smoker, heavy alcohol consumer. In 2017 he began with sustained ventricular tachycardia (VT) effectively treated with DC–shock. The following ECG showed signs of anterior necrosis. Severe left ventricular (LV) dilatation, apical thrombosis and severe impairment of LV function were found on echocardiogram. Angiography was performed and LAD occlusion was found. Since of 68% necrosis of the LV at myocardial scintigraphy, no revascularization was performed. He underwent to a dual chamber ICD implantation and started oral anticoagulation therapy. In the following years recurrence of arrhythmic episodes, despite the optimization of antiarrhythmic therapy, led the patient to numerous hospitalizations. Unfortunately the persistence of the apical thrombosis, made transcatheter ablation NOT possible. The only chance for the patient remained stereotactic arrhythmia radioablation. But which area of the LV to highlight as responsible for the arrhythmia and how to program the radiotherapy treatment plan was a challenging problem. We proposed in March 2023 non–invasive mapping of arrhythmia using Cardioinsight. The patient performed heart high–resolution computed tomography (CT) for the anatomical reconstruction with precise spatial resolution of all LV aereas and surrounding structures. A 252–electrode vest is applied to the patient’s torso and connected to the system Cardioinsight. A programmed ventricular stimulation was performed using ICD inducing two VT morphologies. Through electroanatomical mapping we identified the mid LV antero–septal and infero–septal sites as target areas. Thanks to multidisciplinary team a personalized treatment plan was created to deliver an effective lesion in the target area and minimize exposure to nearby organs at risk. The treatment was generated, optimized and delivered by TrueBeam, lasted 3 minutes and no complications arose. The patient was quickly discharged in good clinical condition. After 3 months of clinical well–being he was hospitalized for a single episode of VT. Up to now no hospitalizations occurred. This treatment may represent a "bail–out" choice in patients with advanced heart failure with arrhythmic storm who have exhausted all other therapeutic options.
REAL–WORLD SINGLE CENTER EXPERIENCE WITH THE WEARABLE CARDIOVERTER DEFIBRILLATOR: SEX DIFFERENCES IN RISK STRATIFICATION FOR SUDDEN CARDIAC DEATH
Authors: Bolognesi M , Rossi L , Biagi A , Sticozzi C , Comastri G , Puccio F , Pisati M , Aschieri D 
Published: May 2024

Abstract

Background
Wearable cardioverter defibrillator (WCD) demonstrated an important role for prevention of sudden cardiac death in patients with advanced heart failure and reduced left ventricular ejection fraction. Although in randomized trial there are no gender difference in WCD use and defibrillator (ICD) implantation rate, real world data in female patients is lacking. Purposes: We aimed to describe the sex differences in WCD use, the rate of cardiac events detected with WCD and the rate of ICD implantation after WCD use in women in a real–world single center experience with reduced left ventricular ejection fraction or prior ventricular tachyarrhythmia.

Methods and Results
According with the current guidelines indications, between August 2017 and June 2023 ninety–six consecutive patients (mean age 66.0±11.1 years) received a WCD at Piacenza Hospitals and were retrospectively included in this analysis. There were no differences in clinical characteristics between female (18 patients, 18,8%) and male: in particular baseline left ventricular ejection fraction (LV EF) were similar between the two groups (29.5±5.2 vs 27.9±7.9, p=0.23) and no differences were found in the rate of ischaemic cardiopathy (66,6% vs 69,2% p=0.51). After 3–months follow up with WCD use, a similar rate of ventricular arrhythmias were found in the two groups (5.5% vs 3.8%, p=0.48) and no ventricular fibrillation was detected. The WCD usage period and median daily wear time were not different between female and male (55.2±50.6 vs 56.2±34.8 days p=0.53, 21.0±6.4 vs 23.1±1.5 hours p=0.48, respectively). However women presented a better LV EF improvement (12.2±9.7 vs 7.2±6.8, p=0.01), with a significant lower ICD implantation rate at the end of WCD use (55.5% vs 43.8%; p&lt; 0.01).

Conclusions
In this real word analysis women presented a nice compliance using WCD. In spite of a similar burden of ventricular arrhythmic events, women presented a better LV EF improvement with a significant lower ICD implantation rate.