bluuebunny/crossref_metadata_2025_split huggingface dataset:
DONORS WITH OUT OF HOSPITAL CARDIAC ARREST (OHCA): A SINGLE–CENTER EXPERIENCE
Authors: Fischetti G , Giovannico L , Parigino D , Santeramo V , Savino L , Silva A , Di Bari N , Bottio T 
Published: May 2024

Abstract

Aim
Out of Hospital Cardiac Arrest (OHCA) could be an alternative to existing efforts towards increasing the available pool of organs. The objective of this work is to demonstrate how hearts derived from marginal donors with Out of Hospital Cardiac Arrest (OHCA) have a quality that is not inferior in terms of survival compared to hearts originating from standard patients.

Methods
We performed a retrospective analysis in patients who received donor heart transplants with cardiac arrest of 20 minutes or more. The average time to cardiac arrest was 21 (±8.76) minutes. From January 2022 to September 2023, 70 cardiac transplants were performed at our cardiac surgery center, of which 74.24% were men (n=52) and 25.76 % women (n=18). The two populations compared showed similar characteristics in terms of risk factors, age, urgency/emergency status, ecmo before HTx.

Results
Patients who received hearts from donors with OHCA were 12,86% (n=9). Kaplan Meier survival curve show Kaplan Meier survival curve shows comparable 30–day survival in the two groups with a non–significant statistical difference (p = 0,5). In the group considered there is no significant difference in the use of post–operative VA ECMO (Group uDCD 22% post–HTx ECMO–VA, Group Control 23% post HTx ECMO–VA, p= 0,98).

Conclusion
According to these results it is possible to appreciate how OHCA hearts do not show inferior survival compared to hearts derived from patients who died from cerebral hemorrhage or other causes. Longer–term follow–up is necessary to evaluate the survival of such recipients.
TELEMONITORING IN PATIENTS WITH CHRONIC HEART FAILURE: EXPERIENCE FROM THE TELECUORE PROJECT IN PIACENZA
Authors: Novara P , Matrone B , Di Spigno F , Tedeschi A , Sticozzi C , Lisè G , Ballerio N , Pisati M , Ferraro S , Aschieri D 
Published: May 2024

Abstract

Background
Starting from February 2023, the Piacenza’s Hospital has approved the use of a cardiological telemonitoring system called ‘TeleCuore’ project. This system, through the monitoring of various vital parameters which are frequently sent by patients via a dedicated platform, allows for remote assessment of the clinical status of 250 individuals with chronic heart failure (CHF).

Objectives
The objective of this study is to analyze the number and nature of alerts in the data sent by patients and the consequences on patient’s management derived from the alerts received through the telemedicine system.

Materials and Methods
250 patients with CHF identified following recent episodes of clinical instability have been equipped with a home monitoring device (Adilife system). This involves collecting the following data: body weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead EKG. These data are daily filtered by perfusionist technicians (TFCPC) and dedicated nurses, reviewed by the Case Manager and cardiologists. In case of recognition of altered parameters, the platform generates alerts according to pre–set clinical parameters, enabling proactive and personalized interventions on patients. In the 9 months of the TeleCuore project, 494 alerts were received, with 119 (24%) judged not clinically relevant, while 375 (76%) required operator intervention. Of these, 99 were due to weight gain (26%), 40 to low blood pressure (11%), 42 to high blood pressure (11%), 33 to tachycardia episodes (9%), 30 to bradycardia (8%), 49 for technic issues with the weight scale (13%), 78 for EKG artifacts (21%), and 4 for previously unknown atrial fibrillation (1%). 25 patients (8%) were invited for ambulatory clinical evaluation, 28 (7%) were managed through teleconsultation, and the remaining majority (85%) was handled via telephone contact for therapy adjustments (60.5%). 39.4% underwent re–training on the correct device use in the first month.

Conclusions
The TeleCuore Project is a pilot cardiological telemedicine initiative. Initial data confirm the utility of this system in optimizing the follow–up of patients with CHF, allowing for instant therapeutic adjustments based on the patient’s clinical progress. Teamwork of different healthcare professionals have emerged as crucial for the proper management of alerts. Further data will be needed to assess whether TeleCuore also helps reduce hospitalizations related to CHF.
HEART FAILURE AND ITS PHENOTYPES IN THE REAL WORLD: DATA FROM THE CARDIOVASCULAR OBSERVATORY OF FRIULI–VENEZIA GIULIA
Authors: Russo G , Cittar M , Cappelletto C , Cherubini A , Bollini M , Faganello G , Grande E , Mattei L , Mazzone C , Fisicaro M , Sola G , Zeriali N , Zorzin Fantasia A , Ius A , Montesi M , Radini D , Di Lenarda A 
Published: May 2024

Abstract

Introduction
Heart Failure (HF) is a disease with high mortality and morbidity burden. Guidelines classify HF according the ejection fraction (EF) in three phenotypes. HF with preserved ejection fraction (HFpEF) is the most prevalent in the real world for increasing in life expectancy and the presence of many comorbidities.

Aim
Knowing and analysing the epidemiology and clinic features of HF to create the most appropriate diagnostic–therapeutic pathways. The Cardiovascular Observatory of Friuli–Venezia Giulia (CVOFVG), which allows this analysis, is a powerful tool for clinical governance.

Results
In Friuli Venezia Giulia, at 1st January 2023, 21.212 alive patients had a HF diagnosis (1.78% prevalence). Considering the different phenotypes, in the real world, from 2018 to 2023, the most prevalent patients had EF &gt; 40% (in 2022: HFpEF 55%, HFmrEF 9% and HFimpEF 20%). In our registry patients with HFpEF are older (mean age 80±10 yrs vs 79±11 yrs in HFmrEF vs 76±11 yrs in HFrEF), mostly women (52% vs 38% in HFmrEF, vs 27% in HFrEF), with many cardiovascular (CV) diseases, such as atrial fibrillation (57% vs 53% in HFmrEF vs 49% in HFrEF) and non CV as obesity and chronic obstructive pulmonary disease. As expected, ischemic heart disease is prevalent in HFrEF in 59% vs 38% in HFpEF. In the CVOFVG, in 2022 the hospitalization rate was 1260/100000 inhabitants (262 for HF hospitalization, 188 for CV causes, 808 for non CV disease). HFrEF has a higher incidence of HF hospitalization (54.3 on 166.2/100.000 totals). Furthermore, HFpEF because of its high prevalence, has a higher rate of CV and HF hospitalization than HFrEF (77.8 vs 54.3/100.000 inhabitants for year, 929 hospitalization vs 646). The mortality in one year is higher in HFrEF and HFmrEF vs HFpEF and above all HFimpEF. Drug prescription was different from clinical trial: in 2022, 72.2% of HFrEF patients received renin angiotensin system inhibitors (RASi), 89.2% beta blockers (BB), 62.6% mineralocorticoid receptor antagonist (MRA) and 44% SGLT2–inibitors (SGLT2–I). Same prescription for RASi, BB, MRA was in HFimpEF and HFmrEF, less for HFpEF.

Conclusions
The patients’ complexity, their increasing number, the new drugs for HFpEF lead to create multidisciplinary pathways, above all for HFpEF patients who are frequently visited by General Physicians, Internal Physicians and Geriatrics, to select the most complex case where a therapeutic intervention can be efficacy.
HIGH LEVELS OF SOLUBLE–SUPRESSION OF TUMORIGENICITY(S–ST2) PREDICT RIGHT VENTRICULAR/PULMONARY ARTERY UNCOUPLING WITH TAPSE/PAPS IN PATIENTS AFFECTED BY PULMONARY HYPERTENSION
Authors: Novielli M , De Tommasi E , Camassa N , De Michele L , Mannarini A , Cipollone E , Civino F , Fratini N , Giorgio A , Tota A , Palmieri V , Di Serio F , Colonna P , D‘Agostino C 
Published: May 2024

Abstract

Introduction
Pulmonary hypertension (PH) is a disease with an unfavorable prognosis, characterized by increasing in pulmonary resistence and right heart failure. One of the most important prognostic factors is the adaptation of the right ventricle to increased pressure overload, witch can be evaluated through tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/PAPs), a prognostic echocardiographic index of right ventricle–pulmonary artery coupling. In this setting, NT–proBNP, until now, is the only biomarker that, reflecting right ventricular function, gives prognostic information. However, NT–proBNP levels are influenced by age, body mass index, sex and comorbidities, such as anemia and renal failure. In previous studies soluble– Suppression of Tumorigenicity (s–ST2), a marker of myocardial stress, resulted a strong predictor of death in heart failure, acute coronary syndromes and pulmonary hypertension.

Aim
Our purpose is to study the possible correlation between sST2 and different echocardiographic parameters, in particular TAPSE/PAPs.

Methods
This is a prospective study conducted on 45 PH patients (75% affected by pulmonary arterial hypertension), which were followed for survival. They underwent echocardiography, right heart catheterization and venous sampling to measure s–ST2 levels.

Results
During an average 18–month follow–up, 17 patients died, 76% of whom had pulmonary arterial hypertension (PAH). sST2&gt;78 ng/ml represents a numerical value with the highest association with mortality in our study population: at 6–12 months the patients with sST2&gt;78 ng/ml showed statistically significant early higher mortality in comparison with sST2 &lt;78 ng/ml patients. Patients with sST2&gt;78ng/ml had statistically significantly higher right ventricular inflow diameter, reduced tricuspid annular planer systolic excursion, greater right atrial area, lower pulmonary artery acceleration time and lower TAPSE/PAPs, compared with patients with sST2&lt;78 ng/ml values. We showed a statistically significant inverse correlation between sST2 and TAPSE/PAPs.

Conclusions
s–ST2, predicting right ventricular/pulmonary artery coupling through TAPSE/PAPs, represents an usefull and promising marker in noninvasive hemodynamic assessment and risk stratification of PH patients.
EFFICACY OF COLCHICINE IN ADDITION TO ANAKINRA IN PATIENTS WITH RECURRENT PERICARDITIS
Authors: Collini V , Andreis A , De Biasio M , Isola M , De Martino M , Lepre V , Siega Vignut L , Cantarini L , Merlo M , Abbate A , Lazaros G , Brucato A , Klein A , Imazio M 
Published: May 2024

Abstract

Aim
Anakinra, an anti IL–1 agent targeting IL–1 alfa and beta, is available for the treatment of recurrent pericarditis in cases with corticosteroid dependence and colchicine resistance after failure of conventional therapies. However, it is unclear if the combination with colchicine, a non–specific inhibitor of the inflammasome targeting the same inflammatory pathway of IL–1, could provide additional benefit to prevent further recurrences. Aim of the present observational study is to assess whether the addition of colchicine on top of anakinra could prolong the time to first recurrence and prevent recurrences better than anakinra alone.

Methods
International, all–comers, multi–center, observational cohort study analysing consecutive patients treated with anakinra for corticosteroid dependent and colchicine resistant recurrent pericarditis. The efficacy end point was recurrence rate and the time to the first recurrence.

Results
A total of 256 patients (mean age 45.0 ± 15.4 years, 65.6% females, 80.9% with idiopathic/viral etiology) were included. 64 (25.0%) were treated with anakinra as monotherapy while 192 (75.0%) with both anakinra and colchicine. After a follow up of 12 months, 56 (21.9%) patients had recurrences. Patients treated with colchicine added to anakinra had a lower incidence of recurrences (respectively 18.8% vs. 31.3%; p=0.036) and a longer event–free survival (p=0.025). In multivariable analysis, colchicine use prevented recurrences (HR 0.52, 95% CI 0.29 to 0.91; p=0.021).

Conclusions
The addition of colchicine on top of anakinra treatment could be helpful to reduce recurrences and prolong the recurrence–free survival.
CASE PRESENTATION: A COMPLEX CLINICAL SCENARIO IN A 43–YEAR–OLD MALE WITH DEVICE–RELATED COMPLICATIONS
Authors: Zarra S 
Published: May 2024

Abstract
A 43 yo male presented with an exposed pocket of his ICD in the right prepectoral and axillary region, along with total exposure of the lead electrodes up to the fixation sleeves.The patient, a known carrier of double–outlet right ventricle, underwent surgical correction. At the age of one, he received a dual–chamber pacemaker in the left prepectoral region due to AVB. Due to recurrent sustained ventricular tachycardias an ICD was implanted in the right prepectoral region, with removal of the left–sided pacemaker and concurrent abandonment of the ventricular pacing lead. In October 2019, he was admitted for a recurrence of pocket erosion.Device extraction was proposed but declined by the patient. Subsequently, he was referred to our institution for device removal. After heart team discussion, the patient was offered a transvenous lead extraction, with potential cardiothoracic surgical intervention if transvenous extraction proved to be challenging.An attempt was made to extract the leads using a transvenous approach. The procedure proceeded without complications, and the leads were released from adhesions up to the superior vena cava. However, there was an adhesion point at this location that was not overcome by mechanical dilation.Due to this limitation, a few days later, a cardiothoracic surgical intervention was performed to complete the lead wires‘ extraction using an invasive approach. In this context, a cardiac resynchronization device CRT–P was reimplanted in the left prepectoral region with epicardial electrodes. The patient underwent submuscular subclavian implantation of a SCID.The patient presented with a new pocket erosion of the CRT–P.Considering the high infection risk, It was therefore decided to implant a leadless device following electroanatomic mapping of the right ventricle, as there were surgical patches in the septal region. This approach aimed to identify the optimal anchoring site for the device. Subsequently, he will go extraction of the generator of the CRT–P.The decision to forgo biventricular stimulation was made, because of the elevated infectious risk.Complications associated with implantable devices pose an increasingly significant challenge in managing young patients with cardiac arrhythmias. Only through an integrated approach and proactive sharing of knowledge and expertise can we significantly improve clinical outcomes and the quality of life for this increasingly relevant population.
NAVIGATING THE UNCHARTED WATERS: MANAGING CONCURRENT CYTOMEGALOVIRUS MYOCARDITIS AND ALLOGRAFT REJECTION IN A PATIENT WITH HEART TRANSPLANTATION
Authors: Abete R , Iacovoni A , Vittori C , Candiago E , Gianatti A , Terzi A , Sebastiani R , Senni M 
Published: May 2024

Abstract
A 49–year–old female with hypertrophic cardiomyopathy underwent orthotopic heart transplantation. She was cytomegalovirus(CMV)–positive and received a heart from a CMV–negative donor, so prophylaptic therapy was not administered. Initial immunosuppression included cyclosporine and induction with Basiliximab in a steroid–free regimen. The first routine biopsy (EMB) showed mild focal cellular rejection (grade 1A) and C4d positivity with granular aspect. Mycophenolate mofetil (MMF) was added. The second EMB, 7 days later, showed mild diffuse cellular rejection (grade 1B) and diffuse C4d positivity. Anti–HLA donor–specific antibodies (DSA) had increased anti–B13 levels (MFI=21298) compared to pre–transplantation tests. Echocardiography showed a normal ejection fraction (LVEF) and mild concentric hypertrophy (LVH). Treatment included pulse methylprednisolone therapy (1 g/day for three days) followed by oral prednisone with a slow tapering regimen, and increased MMF. CMV count weekly monitored was negative. The next two EMBs performed one week apart from each other described a grade 1A mild focal pattern while the 5th EMB (1 month and 2 weeks post–transplant) showed a grade 1A rejection together with focal mild fibrosis and eosinophils, so we replaced cyclosporine with tacrolimus, increased MMF and prednisone. At this time, the patient had no overt clinical signs of CMV infection but a CMV–PCR of 100847 IU/mL so ganciclovir 5 mg/Kg bid was started and CMV–PCR decreased to 42308 IU/mL after 1 week. Subsequently, she developed sinus tachycardia, mildly reduced LVEF, moderate LVH and diastolic dysfunction. Troponin was elevated. A new EMB revealed interstitial edema, diffuse ischemic injury, and eosinophilic inclusions suggesting CMV myocarditis. Treatment involved down–titrating MMF and Prednisone, administering standard intravenous immunoglobulin (IVIG), and high–dose Ganciclovir (7.5 mg/Kg bid). Leukopenia subsequently led to Ganciclovir down–titration. In the next days, the patient improved, CMV cleared, and leukocyte count normalized. She was discharged on Tacrolimus, MMF, Prednisone and Valganciclovir. Subsequent tests showed no cellular or antibody–mediated rejection (AMR), no CMV inclusions, recovered cardiac function, and markedly reduced anti–B13 DSA (MFI 3000). This case raises some concerns: in this context, the use of IVIG in the treatment of CMV infection and AMR appears reasonable, in support of antiviral and immunosuppressive therapy.
SHEATHLESS RADIAL APPROACH IN CONTEMPORARY CORONARY ROTATIONAL ATHERECTOMY: DATA FROM TWO HIGH VOLUME CENTERS
Authors: Dall‘Ara G , Alagna G , Spartà D , Compagnone M , Grotti S , Guerrieri G , Campanella F , Taverna G , Galvani M , Tarantino F , Andò G 
Published: May 2024

Abstract

Aim
To analyze the feasibility and procedural outcome of percutaneous coronary intervention (PCI) using rotational atherectomy (RA), performed via transradial sheathless guiding catheter as compared to a standard radial and femoral vascular approach.

Methods
All consecutive patients undergoing RA at two high–volume PCI centers from May 2011 to May 2023 were included. Comparisons were made between the two transradial approaches and between the three types of vascular access.

Results
Two hundred twenty–three patients were enrolled. Baseline characteristics were similar, with the exception of gender. We observed, in percentages, fewer cases of failure for sheathless than standard transradial attempts (7.5% vs. 11.5%, respectively), whereas all trans–femoral attempts were successful. Transfemoral procedures were longer and more frequently performed under mechanical circulatory support. There was no difference in procedural success between the three vascular approaches. A trend towards a higher rate of vascular and bleeding complications was found in the femoral group.

Conclusion
Sheathless transradial vascular access is a viable option when performing RA during complex PCI procedures, tending to result in fewer failures than the standard transradial approach and in reduced bleeding and vascular complications compared to the femoral method.
DISCOVERING PALPITATIONS
Authors: Vecchio C , Zuffada F , Bianchi M , Nassiacos D 
Published: May 2024

Abstract
NA is a 51 years old dyslipidemic man without previous cardiovascular history. It’s been for 2 years that occasionally transient palpitations appear but nothing has been made. He came to ED for palpitations after vomiting: the ECG showed sinus rhythm with transient NSVT then sinus rhythm again and SVT with ST alteration. Metoprolol 2.5mg ev and MRA ev were administered because of mild hypokalemia with benefit. Echocardiogram and chest X–ray were normal without drugs intake. During hospitalization we started bisoprolol 2.5mg po and anti–dyslipidemic therapy but we observed very frequently PVC and PSVC and symptomatic wide QRS complex sustained tachycardia paroxysms at 180 bpm without loss of consciousness, hypotension or electrolytic abnormalities and SVT 170 bpm unresponsive to BB and amiodarone. The stress test without BB evidenced early wide QRS complex sustained tachycardia at 220 bpm well hemodynamically tolerated: metoprolol 10mg ev administration showed a brief sinus rhythm and then a narrow QRS complex sustained tachycardia at 160 bpm with significantly ST underleveled so flecainide 150mg ev was given with cardioversion to sinus rhythm and slowly ST abnormality regression. Subsequent coronary angiography and cardiac magnetic resonance resulted normal. The electrophysiological study demonstrated AVRT with a left lateral pathway retroconduction with and without LBBB and subsequent short AF paroxysms: the left lateral pathway was ablated without complications but the high atrial electrical vulnerability with reproducible SVT and triggered AF paroxysms lead to ILR implantation. The patient was discharged without antiarrhythmic and anticoagulant therapy: during the follow up there’s no arrhythmic relapses evidence and the patient is asymptomatic. Never give up to looking for solutions about palpitations: accessory pathway happens when you least expect it.
PERMANENT JUNCTIONAL RECIPROCATING TACHYCARDIA: IT IS IMPORTANT TO KNOW HOW TO RECOGNIZE IT
Authors: Testa S , Gallina S , Renda G , Ricci F 
Published: May 2024

Abstract
Permanent junctional reciprocating tachycardia, also known as Coumel‘s tachycardia, is a rare form of supraventricular tachycardia that is usually incessant, characterised by retrograde conduction via an accessory pathway usually located in the posteroseptal region with slow and decremental conduction. Tachycardia is virtually incessant, at a rate ranging from 120 to 250 beats/minute. The electrocardiogram inscribes inverted P waves in leads II, III, AVF, as well as left lateral leads, along with a P–R interval shorter than the R–P interval during the tachycardia. The characteristic, but not diagnostic, electrocardiographic feature is a long R–P interval consistent with slow retrograde conduction. Spontaneous resolution of tachycardia is not un common. Electrocardiographically, it manifests as a narrow QRS tachycardia with long RP‘, with negative retrograde “p” waves in lower leads (D2, D3 and avF). The initiation and termination of the arrhythmia is not determined by a premature beat, but by critical changes in the RR cycle, that is, for values of the heart rate at which the activating front finds the retrograde decremental pathway outside refractoriness. Due to its incessant characteristic in some cases, patients may present tachycardiomyopathy, with myocardial dilation and ventricular dysfunction. We report the case of a 5–year–old girl who came in for onset of heart palpitation for several hours. On electrocardiogram finding of supraventricular tachycardia, narrow QRS, HR 170/min, negative p waves in DII–DIII–AVF. The electrocardiographic finding was compatible with a picture of permanent junctional reciprocating tachycardia. Following the administration of 50mg of phleicanide, there is a progressive reduction in heart rate until the clinical picture stabilizes. antiarrhythmic therapy was subsequently set with subsequent re–evaluation and discharge to the patient‘s home.