bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFICACY AND SAFETY OF COLCHICINE FOR THE TREATMENT OF MYOPERICARDITIS
Authors: Collini V , Andreis A , De Biasio M , Massimo I 
Published: May 2024

Abstract

Background
Clinical trials have evaluated the efficacy and safety of colchicine only in simple pericarditis, excluding cases of concomitant myocarditis.

Objectives
To evaluate the efficacy and safety of colchicine for the treatment of the first attack of acute pericarditis with concomitant myocardial involvement.

Methods
Double–centre retrospective cohort study, analysing consecutive patients admitted for first attack of pericarditis with myocarditis. Patients who received colchicine in addition to conventional therapy constituted the study group, while patients who received only conventional therapy constituted the control group. The primary efficacy end point was the time to the first recurrence. Propensity score matching was used to generate 2 groups of patients with similar baseline characteristics. Colchicine–associated side effects were analysed as safety end–point.

Results
A total of 175 patients (mean age 46 (SD 40) years, 25% females, 88% with idiopathic/viral etiology, 79 (45%) treated with colchicine) were included. After a median follow up of 25.3 (IQR 8.3 – 45.6) months, 58 (33%) patients had recurrences. The propensity score generated 73 pairs of patients. In this population a lower incidence of recurrence (respectively 19% vs. 45%; p=0.001) and a longer event–free survival (p=0.05) was observed among patients receiving colchicine. In multivariable analysis women (HR 2.28, 95% CI 1.23 to 4.24; p=0.009) and corticosteroid use (HR 2.17, 95% CI 1.12 to 4.19; p=0.021) were independent risk factors for recurrences. Colchicine–associated side effects were mild and occurred in 3 (2%) patients.

Conclusions
In patients with first attack of pericarditis associated with myocardial involvement, colchicine was safe and efficacious for the reduction of recurrences.
REMOTE MONITORING IN CRYPTOGENIC STROKE
Authors: Pastore I , Ferrieri A , Benedetto L , Carretta D , D‘Agostino C 
Published: May 2024

Abstract

Introduction
In the neurological field, one of the pathologies that receives the most attention due to its etiopathogenetic complexity is cryptogenic stroke. In the literature, a significant percentage of cryptogenic stroke is associated with Paroxysmal Atrial Fibrillation (FAP). With this study we wanted to compare our data with those of the literature and evaluate the incidence of remote control in promoting patient adherence to anticoagulant therapy, also analyzing the incidence of possible stroke recurrences in the monitored patients.

Methodology
All patients admitted to the Stroke Unit with cryptogenic stroke were evaluated with the ESUS SCORE. Patients who tested positive following the administration of the score underwent Loop Recorder (ILR) implantation for prolonged cardiac monitoring. Patients who showed episodes of FAP during monitoring were subsequently referred to the Stroke Unit to start anticoagulant therapy. A close telephone follow-up was subsequently carried out (every 15 days) to evaluate adherence to therapy and any stroke recurrences.

Results
43 patients with cryptogenic stroke coming from the Stroke Unit and implanted by our center with Loop Recorder were evaluated. Among these 43 patients, 16 (37%) presented at least one episode of FAP, while 27 (63%) have not yet had any FAP event since the date of device implantation. In 60% of patients with FAP the duration of the event is greater than 5 hours. The time period between the stroke and the first FAP event in 6 out of 16 patients is approximately 1 month. Two patients presented the first episode within 7 days, while 8 patients within 10 months. In the telephone follow-up performed, 100% adherence to anticoagulant therapy was recorded, resulting in a recurrence of stroke in 0% of patients.

Conclusions
From the results obtained it was possible to conclude that the use of remote monitoring associated with close telephone follow-up allows the diagnosis of FAP and guarantees better patient adherence to anticoagulant therapy, significantly reducing stroke recurrences.
INTEGRATED CLINICAL PATHWAY FOR PATIENTS WITH HEART FAILURE DIAGNOSIS
Authors: Corazzola D , Surian C , Pontalti M , Moroder R , Unterhuber V , Di Gaetano R , Giacometti M , Oberhollenzer R 
Published: May 2024

Abstract

Patients diagnosed with HEART FAILURE undergo a diagnostic/therapeutic protocol that includes a DIAGNOSTIC FRAMEWORK with potential PATIENT AND/OR CAREGIVER MANAGEMENT, managed by the CARDIO–CLINICAL PSYCHOLOGY SERVICE operating within the Cardiology Division of the Bolzano Health District. The cardiopsychological pathway includes: First diagnostic phase: involves an assessment through a semi–structured interview with possible support from psychometric tests. Constructs related to mood and therapeutic adherence are investigated. Second therapeutic phase: involves supportive discussions using cognitive/behavioral methods, focusing on acceptance and adaptation to the disease. The purpose of this observational work is to establish a standardized multidisciplinary protocol to support cardiac facilities in managing heart failure. Improving patient management through integrated work aims to stabilize the disease progression, increase therapeutic adherence, enhance mood, and optimize the perception of quality of life.

Case Study
Patients YEARS 2021–2023 Heart Failure Center Category/Year 2021 2022 2023 Average Age 72 71 70 Gender F 72 M172 F 89 M221 F 101 M270.

Conclusions
The integrated approach in heart failure care becomes crucial to anticipate the recognition of factors hindering patient stabilization and defining a care path that meets the patient’s needs. Integrating the work of professionals such as physicians, nurses, and psychologists helps improve patient management, working towards a shared path for the delicate balance that the nature of the pathology entails. The goal of the multidisciplinary team is not only clinical improvement but, from a systemic perspective, accompanying the patient in the disease process with attention to what is crucial for the individual patient.

Bibliography
Heo S., Lennie T.A., et all. Quality of life in patients with heart failure: Ask the patients, Heart & Lung, Volume 38, Issue 2, 2009,Pages 100–108,ISSN 0147–9563 Hallas C.N., Wray J., et all. Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure, Heart & Lung, Volume 40, Issue 2, 2011, Pages 111–121, ISSN 0147–9563 Celano CM, Villegas AC, et all. Depression and Anxiety in Heart Failure: A Review. Harv Rev Psychiatry. 2018 Jul/Aug;26(4):175–184 Dal Lin C.,Migliorini R., et all. Approccio integrato nella cura della coronaropatia in "PNEI REVIEW" 2/2017, pp 71–80.
A VERY COMPLEX CLINICAL CASE OF ACUTE CORONARY SYNDROME COMPLICATED BY THROMBOSIS AND INTRACRANIAL HAEMORRHAGE
Authors: Sorvillo G , Olivieri F , Rainone A , Quercia E , Violante A , Mazza A , Russo M , Colangelo G , Corrado L , Luisi I , Calvanese C , Riccio G 
Published: May 2024

Abstract
Female patient, 62 years old, with a remote clinical history of colon adenocarcinoma, arrived at the emergency–urgency department for chest pain; clinical, ECG and laboratory evaluation revealed a ACS NSTEMI and was performed angioplasty with DES implantation on the LAD and Cx branch and DAPT was started with ASA 100 mg/day and ticagrelor 90 mg x 2/day. On echocardiographic re–evaluation, the appearance of left ventricular thrombosis was noted, in the absence of obvious ventricular dysfunction, and she underwent parenteral anticolagulant treatment with heparin sodium. In the following days, the patient manifested a right sensory–motor hemisyndromes and aphasia, for which she underwent encephalous CT and cranial AngioTC, which did not show any images referable to steno–occlusive alterations of the intra– and extracranial arterial vessels. After neurological consultation, the indication for thrombolytic and/or interventional neuroradiological treatment was excluded. At the 24–hour CT check–up a large area of cortical–subcortical hypodensity appeared in the left occipito–temporo–parietal area. At subsequent CT scans, hyperdense areolae appeared, which could be attributed to haemorrhagic infarction, for which anticoagulant therapy was postponed and DAPT was suspended due to the very high haemorrhagic risk. In the next days, due to ECGgraphic changes (ST elevated in the anterior leads), the patient underwent a new emergency coronarographic study and intrastent thrombosis of the LAD branch was found, subjected to mechanical thromboaspiration with a good final result. After the procedure we started treatment with ASA 75 mg/day and enoxaparin 4000 IU/day. At subsequent check–ups progressive reduction of haemorrhagic areas in the brain. She therefore underwent neurological re–evaluation with indication to start NAO therapy (dabigatran 110 mg x 2/day) and SAPT with ASA 100 mg/day. The hospital stay was complicated by left femoral–popliteal DVT at the site of previous femoral CVC placement. Haematochemical and genetic screening revealed a positive ANA 1:320 (AC–8/AC–19), a homozygous mutation in the gene for MTHFR C677T and a heterozygous mutation in the gene for Leiden Factor V H1299R. Antithrombotic treatment in the patient with ACS and intracranial haemorrhage represents a challenge for the cardiologist and neurologist. This clinical case is a food for thought on how many obstacles can be encountered on the way to correct antithrombotic therapy.
VASOSPASTIC INFARCTION STARTED WITH PULSELESS ELECTRICAL ACTIVITY CARDIAC ARREST
Authors: Scordato F , Giunta N , Peritore G , Zambelli G , Smecca I 
Published: May 2024

Abstract
We report the case of a 48–year–old female with a special history of ischemic heart disease. It started in 2021 with an acute anterior ST myocardial infarction: the coronary angiography showed subocclusive stenosis at the first tract of the left anterior descending (LAD), without other coronary stenoses. The patient was treated with primary PCI + DES; the echocardiogram showed EF 30% and akinesia of apex, intermediate segments of anterior wall and interventricular septum. During the same hospitalization the patient experienced recurrence of angina with transient ST elevation in the anterior and inferior leads; a control coronary angiography was unchanged. She was started on therapy with nitrates and diltiazem up to the tolerated dose, statin as well as antiplatelet and anticoagulant therapy due to apical thrombus. She underwent ICD implantation in primary prevention in January 2022. During 2022, there were several accesses to the ED for vasospastic angina despite medical therapy at the maximum tolerated dose. In October 2023 the patient experienced an acute chest pain followed by cardiac arrest, pulseless electrical activity and acute cardiogenic shock. After resuscitation procedures, she underwent an emergency coronary angiography which showed excellent result of the previous PCI, as well as stenosis of the distal edge of the stent resolving after injection of i.c. nitrates. No arrhythmic events at ICD recording and continuous electrocardiographic monitoring in ICU were observed. Cardiac MRI showed areas of subendocardial LGE involving the apex, anterior, anterolateral and septal segments due to ischemic scar; we also observed areas of edema and LGE with an ischemic pattern at the infero–septal and inferior wall in toto, suggesting recent ischemia; EF was 31%. During hospitalization the patient experienced episodes of typical angina with poor response to medical therapy at the maximum tolerated dose. The current clinical case most likely points to acute myocardial infarction due to vasospasm of the right coronary artery with acute pump failure resulting in cardiac arrest and no specific recommendations exist in recent cardiologic guidelines on the strategy to adopt for this acute clinical setting. In the hypothesis of a vasospastic pathogenesis of the problem, counseling for modulation of the stellate ganglion was requested.
IMPROVING THE KNOWLEDGE, RISK STRATIFICATION AND OUTCOMES IN ADVANCED HEART FAILURE. THE ISMETT HEART FAILURE REGISTRY
Authors: Nuzzi V , Manca P , Mulè M , Cipriani M 
Published: May 2024

Abstract

Background
Advanced heart failure (AdHF) accounts for approximately 10% of patients in HF clinics worldwide. Clinical management of patients with AdHF remains challenging and most of the available studies focus on chronic but not advanced HF. Registry studies may provide important insights into this specific population.

Methods
All consecutive patients referred to our centre for AdHF therapies candidacy (left ventricular assist device (LVAD), heart transplant (HTx)) are prospectively studied and enrolled in the registry. On the same day, all patients undergo a comprehensive clinical and instrumental examination, including electrocardiogram, echocardiography, extended laboratory tests and right heart catheterisation. Most patients also undergo a cardiopulmonary exercise test and, in the case of a non–ischaemic aetiology, cardiac magnetic resonance imaging and genetic testing, if not already performed. Echocardiography is also performed to assess advanced echocardiographic measures (biventricular and atrial strain, myocardial work, 3–D chambers assessment).

Results
Forty–five patients were enrolled from March 1, 2023 to December 22, 2023 (enrolment rate 4.5 patients/month). Mean age was 54 years and 2/3 were male. Median disease duration was 69 (28–165) months. Non–ischemic HF was the most common aetiology with a NYHA IV prevalence of 4% (all others were in NYHA III). 31% of patients had chronic kidney disease and overall liver function was preserved. 67% of patients were treated with sacubitril/valsartan, &gt; 90% were taking beta–blockers (median dose 4.8 mg bisoprolol–equivalent dose) and 84% SGLT2 inhibitors. Both standard and advanced echocardiography showed features of advanced disease. Over a median follow–up of 4 (2 – 6) months 2 (4%) patients died, 5 (11%) underwent urgent HTx and 8 (18%) underwent LVAD implantation. For most variables, there was a trend showing that patients with events were sicker but, currently, the sample size limited the statistical power.

Conclusions
A systematic comprehensive evaluation of patients with AdHF evaluated for advanced HF therapies could help to reduce the knowledge gap for this high–risk HF population.
UNLOADING STRATEGIES IN ADVANCED HEART FAILURE: THE ROLE OF POINT–OF–CARE ULTRASOUND
Authors: Del Giudice C , Caputo A , D‘Arienzo D , Delle Femmine F , Liccardo B , Amarelli C , Marra C , Loffredo F , Varricchio A , Golino P 
Published: May 2024

Abstract
Patients with advanced heart failure (HF) exhibit repeated episodes of fluid retention (pulmonary and/or systemic congestion) and/or of reduced cardiac output at rest (peripheral hypoperfusion) requiring hospitalization along with diuretics/inotropic infusion. Pulmonary artery catheter (PAC) provides haemodynamic information to guide the therapy, however PAC is invasive and time consuming. Point of care ultrasonography (POCUS) represents a promising diagnostic tool at the bedside, performed by the physician to assess non invasively volume status, cardiac output and monitor decongestive therapy. Recently, abnormal Doppler flow patterns due to increased right atrial pressure have been described in the hepatic, portal, and intrarenal veins. Thus, the recent venous excess ultrasound score (VExUS) has been used to describe fluid status along with the diameter and collapsibility of the inferior vena cava. Furthermore HF patients show high filling pressures, therefore they often require mechanical or medical unloading. In this regard, point of care ultrasound represents a valid tool to monitor non invasively the filling pressures and the responsiveness to those treatments. Here, we illustrate with several clinical cases where VExUS/POCUS were pivotal in clinical management.
A RARE CASE OF ACUTE BIVENTRICULAR DYSFUNCTION IN SYSTEMIC SCLEROSIS
Authors: Iezzi L , Palermi A , Cieri C , Testa S , Gallina S 
Published: May 2024

Abstract
Systemic sclerosis (SSc) is a rare immune–mediated rheumatic disease characterized by diffuse vasculopathy leading to multiorgan fibrosis. We report the case of a 61–year–old man who was diagnosed with SSc one year before. At the time of diagnosis, the patient exhibited exertional dyspnea (NYHA II–III) due to mild signs of interstitial impairment at chest HRCT and stage 3b of chronic kidney disease. Echo was performed, showing severe impairment of the right ventricular systolic function in the absence of LV dysfunction. Right heart catheterization (RHC) was unremarkable (mPAP 19 mmHg, PCWP 16 mmHg). Several months later, despite immunosuppressive treatment, the patient experienced clinical worsening, in the absence of remarkable worsening of Echo and RHC parameters. Therefore, he was started with mycophenolate mofetil and tocilizumab. After 60 days of second line therapy, the patient presented to the ER with severe resting dyspnea (NYHA IV), in a clinical–laboratory data of acute heart failure due to new onset left ventricular dysfunction (EF 36%), and severe impairment of renal function (AKI on CKD). ECG (figure 1) showed chaotic ectopic atrial rhythm with prolonged atrio–ventricular conduction and frequent polymorphic premature ventricular contractions. This report presents a rare case of primary myocardial involvement in SSc, where right ventricular failure was the initial cardiac manifestation, rapidly progressing to severe biventricular dysfunction. As a potential cause of biventricular systolic dysfunction, we ruled out both drug–induced cardiotoxicity and autoimmune or infectious myocarditis, based on consistently negative results for inflammation and viral markers. We assumed fibrosis to play a significant role in this case of heart failure, as supported by electrocardiographic features of several conduction disturbances. Unfortunately, second level imaging with cardiac magnetic resonance was rejected by patient because of claustrophobia, and coronary angiography was excluded because of severe renal impairment. Patient was successfully empirically treated with diuretics, antiarrhythmic therapy, peritoneal dialysis and levosimendan. After 40 days of hospitalization, we reported complete regression of left ventricular systolic disfunction (last Echo showing EF 50%), and the patient was discharged in decent hemodynamic stability.
TWO YEARS OF EXPERIENCE OF THE REGIONAL CENTER FOR SPORT IN YOUNG PEOPLE WITH HEART DISEASE: ANALYSIS OF CRITICAL ISSUES AND BARRIERS
Authors: Vessella T , Merlo L , Pegoraro C , Giorgiano F , Barra B , Meneguzzo G , Sarto P 
Published: May 2024

Abstract

The aim of our study was to identify the critical issues of our clinical–psychological–sports management program of young ex–athletes patients judged unfit for competitive sport following the diagnosis of heart diseases potentially at risk of sudden death. In these two years, 114 patients have been referred to our Center, with an average age of 28 years +– 17. Of these, 13 have decided not to join the program. 7 dropped out of the prescription program at follow–up. The most common critical issues are the following:

Psychological and motivational
Difficulty in achieving a complete awareness of the pathology by the athlete and parents (if minor) Psychological problems related to diagnosis and unfitness (anxiety, anger, sense of isolation, depressive symptoms) Difficulty in accepting therapy when needed Patient adherence to prescription Failure to enjoy prescribed physical activity.

Clinical
Difficulty in communicating the diagnosis and prognosis Difficulty in correctly determining training intensities (hrr, thresholds, lactate?) Influence of therapy schedule on training frequencies Difficulty in Monitoring the Prescribed Activity.

Organizational
Difficulty in testing and monitoring all types of prescribable activities Resistance on the part of sports clubs to accept the return of these former athletes without the competitive certificate The identification of these "limits" has allowed us to adapt and modify the phases of the project in progress, reducing the number of non–adhesions and dropouts in the last year.

Conclusions
Prescribing exercise in athletes with conditions at risk of sudden death is a challenge for the future. In addition to a detailed knowledge of heart disease and a correct risk stratification, it is however essential to work on patient awareness and consider a series of psychological, motivational, logistical aspects aimed at optimizing the adherence of these ex–athletes, to prevent the prescription letter from translating into something unworkable, not understood, and therefore not followed.
QUALITY OF LIFE AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: SINGLE CENTRAL STUDY
Authors: Picciani A 
Published: May 2024

Abstract

Aims
The objective of this study is to provide an overview of the quality of life (QoL) before and after TAVI, of the patients undergoing this procedure, at the U.O.S.D. Hemodynamics of the Chieti. Since QoL is a multidimensional concept, it is studied through items that include physical limitation, the frequency of symptoms, social limits, general well–being and the relative functional status.

Methods and Results
The study provided for the administration of a questionnaire: the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ12), in two steps: 1) Administration of the questionnaire by telephone, two weeks before the TAVI; 2)Administration of the questionnaire by telephone two weeks after the TAVI implantation. The time span of the duration of the study is defined by the period between October 2022 and October 2023. For the study, 76 patients were selected who met the inclusion criteria. The statistical processing of the KCCQ–12 questionnaire data was performed by comparing the averages of the samples observed before and after the TAVI implantation. The statistical analysis was performed with the use of Student‘s T for paired data, a fundamental tool in comparing the scores of the averages obtained from each domain present in KCCQ12. We can say with a 95% confidence interval that patients before implantation have an average score lower than the post–implantation score. Based on the analysis carried out, we can say that the quality of life has improved in patients who have performed TAVI in a statistically significant way.

Conclusions
The study focuses on changes in quality of life after the TAVI procedure, a topic that is gaining increasing importance in addition to standard clinical goals, such as survival and the NYHA functional class. The objective improvement of the quality of life is perceived already two weeks after the treatment, at the same time determining an indirect benefit in terms of economic and social costs.In conclusion, we can say that patients with severe symptomatic aortic stenosis who underwent TAVI, analyzed with this study, found an improvement in their quality of life in a short time, infact the minimal invasiveness of the procedure, is able to minimize the time postoperative recovery, the time of hospitalization and rehabilitation, necessary instead in the case of more invasive interventions.