bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE IMPACT OF DISOPYRAMIDE ON EXERCISE CAPACITY IN HYPERTROPHIC CARDIOMYOPATHY: IT IS NOT ALL ABOUT RELIEVING OBSTRUCTION
Authors: Dei L , Ciacci P , Giacalone G , Nardecchia G , Albi F , Sciarra L , Romano S , Gabrielli D , Halasz G , Re F 
Published: May 2024

Abstract

Introduction
Disopyramide has been extensively utilized since the late 1980s to decrease obstruction and improve symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM). Nevertheless, there is currently no evidence about the impact of this drug on functional capacity assessed with cardiopulmonary exercise test (CPET).

AIM
To investigate the impact of disopyramide on functional capacity and peak exercise gradient, assessed by CPET combined with stress echocardiography (Imaging–CPET).

Methods
21 disopyramide–treated oHCM patients were studied with Imaging CPET before and after 3 months of treatment starting at the cardiomyopathy unit of San Camillo Forlanini Hospital (Rome). After a baseline echocardiography, symptoms limited CPET was done on an upright bicycle ergometer utilizing a 10 Watt/min. ramp protocol. Cardiopulmonary variables were measured with breath–by–breath analysis. During CPET, Doppler Echocardiography was performed. LVOT velocities and trans–valvular gradient and diastolic function were taken at peak exercise and during recovery.

Results
21 patients (mean age 48.3 years; 57% male; average daily–dose 450 mg) were evaluated. Of those, 96% were taking concurrent b–blocker medication, whereas 4% were receiving a calcium antagonist. After 3 months of disopyramide, mean resting outflow gradient decreased from 40 to 29 mmHg (p =0.08) and from 63 to 41mmHg (p=0.014) at peak exercise. There was no notable reduction in EF (p=0.9) or improvement in diastolic function at rest (p=0.1) or at peak exercise (p=0.7). Mean heart rate significantly decreased both at rest (78 vs 68 bpm; p=0.02) and peak exercise (131 vs 113 bpm; p=0.001), along with a decrease in chronotropic response (predicted HR = 81% vs 70%; p=0.001). Furthermore, after treatment, mean functional capacity decreased significantly (20ml/kg/min vs 17ml/kg/min; p=0.02;) whereas neither VE/VCO2 (p=0.5) nor oxygen pulse(p=0.9) changed considerably. 19 patients (90%) reported improved quality of life despite no increase in NYHA class.

Conclusion
This study, for the first time, showed that although disopyramide decreases the exercise gradient, it does not improve functional capacity since it significantly alters the chronotropic response. These findings emphasize the value of heart rate response evaluation in patients with HCM and the importance of carefully adjusting the dose of negative chronotropic agents.
USING THE 6MWT FOR SETTING AEROBIC LOADS AFTER CARDIAC SURGERY AN INPATIENT SETTING
Authors: Romano N , Monina E , Longoni P , Forni G , Mazza A 
Published: May 2024

Abstract

Background
In the field of Preventive and Rehabilitative Cardiology (CPR), aerobic–type training turns out to be one of the cornerstones for intensive rehabilitation of patients undergoing cardiac surgery. One of the most critical issues appears to be the method by which the patient‘s initial workload is set. In this research project, an attempt is made to implement in clinical practice, an equation to identify the workload to be set at the first rehabilitation session. The formula in question is a modified version of Luxton‘s formula used to predict maximal workload using anthropometric/clinical data and results at the Six Minute Walk Test as indicators. The primary objective is to demonstrate that patients who trained from a load set through the use of the formula under consideration walk a greater distance at the end of hospitalization at the 6MWT than patients who did not use the equation for initial load setting.

Materials and Methods
Two small groups of patients (45 IG and CG 38 and 8 drop out) who underwent the same rehabilitation program at the O.U. of Rehabilitation Cardiology at ICS Maugeri in Pavia were compared, having as their only difference the mode of initial workload setting. Patients were recruited during the period April 2023– November 2023.

Results
At the final observation time, GI patients traveled more meters at the 6MWT than GC patients; they also finished the program with a higher workload.

Conclusions
It was shown that the workload determined by the formula is well tolerated by the patient and has brought benefits on functional capacity and perception of health status by the patient with cardiac surgery outcomes.
INTRODUCTION OF LUNG ULTRASONOGRAPHY (LUS) AS A DIAGNOSTIC TOOL IN THE REHABILITATION OF POST–CARDIAC SURGERY PATIENTS WITH PLEURAL EFFUSION
Authors: Lovagnini M , Rossi D , Caporotondi A , Guazzotti G , Forni G , Pinna G 
Published: May 2024

Abstract

Background
Pleural effusion (PE) is a common complication after cardiac surgery and is associated with postoperative heart failure and adverse outcomes. Lung ultrasound (LU) has been shown to be more accurate than chest x–ray (CXR) in the diagnosis and evaluation of PE. Other advantages include bedside applicability, no radiation exposure, and low cost. However, the use of LU in the rehabilitation setting of post–cardiac surgery patients is still limited.

Objective
To determine the extent of the use of LU compared with CXR in the evaluation of PE in post–cardiac surgery follow–up (FUP) in an Italian rehabilitation hospital.

Methods
Fifty consecutive patients (pts) (mean age: 67+9 years, 28 males, 22 females) admitted to our rehabilitation center 9+2 days after cardiac surgery (25 valve surgery, 16 coronary artery bypass graft (CABG), 6 valve surgery + CABG, 3 pulmonary endarterectomy) were included in the study and underwent baseline LU + CXR (time T0). Based on the clinical condition of each patient, the treating cardiologist decided whether to perform follow–up assessment by LU alone (GROUP1, less severe patients) or by CXR + LU (GROUP2, more severe patients) (time T1). The severity of PE was graded by the radiologist/sonographer using a 4–point scale (0=none, 1=mild, 2=moderate, 3=severe PE). The presence of pulmonary atelectasis on LUS was reported to the physician. Patients performed a 6MWT at baseline and at discharge.

Results
Figure 1 shows the study flow chart and Table 1 shows the main patient characteristics in both Groups. Table 2 shows the comparison between the two methods of PE assessment. At T0, the severity of PE as assessed by LU was similar in both groups and was underestimated by CXR. Of the 18 patients who underwent CXR+LU at T1, 9 (50%) required CXR evaluation for the following pulmonary complications: 5 suspected pneumonia (2 confirmed), 2 congestive heart failure, 1 hypoxemia, 1 parenchymal nodule. Medical therapy and the percentage of patients with bilateral atelectasis were similar in the two groups.

Conclusions
Our data show that CXR underestimate the severity of PE. CXR is still unnecessarily ordered by the treating cardiologist in approximately one third of patients with moderate/severe PE and no other pulmonary complications.
LONG–TERM FUNCTIONAL LIMITATIONS ON CARDIOPULMONARY EXERCISE TESTING IN A COHORT OF PATIENTS WITH EMOTIONS–TRIGGERED TAKOTSUBO SYNDROME
Authors: Maggio E , Jabbour J , Arcari L , Cacciotti L , Magrì D , Recchioni T , Valeri L , Vizza C , Badagliacca R , Papa S 
Published: May 2024

Abstract

Background
In patients with prior Takotsubo syndrome (TTS), long lasting functional cardiac limitations were described as compared with normal subjects. Emotions–triggered Takotsubo syndrome (E–TTS) has more favorable outcomes than TTS preceded by a physical trigger or by no identifiable factors. The aim of the present study was to assess long–term cardiac functional limitations in a cohort of asymptomatic E–TTS patients.

Methods
We enrolled n=39 asymptomatic patients with a diagnosis of E–TTS. Cardiopulmonary exercise tests (CPET) were performed at 30 [12–40] months median follow–up from the acute event. A cohort of n=39 individuals matched for age, sex, body mass index and comorbidities served as control.

Results
Despite recovery of left ventricular ejection fraction, patients with prior E–TTS had lower peak VO2 and percentage of predicted peak VO2 (17.8 ± 3.6 vs 22.5 ± 6.5; P &lt; 0.001 and 75.2 ± 14.1 % vs 100.6 ± 17.1%, P &lt;0.001), VO2 at anaerobic threshold (AT) (11.1 [10.1–12.9] vs 14.4 [12.5–18.7]; P &lt;0.001), peak O2 pulse (9.7 ± 2.5 vs 13.1 ± 3.5; P &lt;0.001) and higher VE/VCO2 slope (30.4 ± 3.7 vs 27.2 ± 3.5; P &lt;0.001) compared with matched controls. We found no statistically significant differences in heart rate reserve (HRR), respiratory equivalent ratio (RER), mean blood pressure and peak PetCO2 between patients and controls.

Conclusions
Despite their overall favorable outcome, asymptomatic patients with E–TTS were found to have long–term subclinical functional cardiac impairments. CPET proved to be a useful tool in the long–term evaluation of E–TTS patients after recovery of LVEF. Further studies are needed to fully clarify the origin of the detected CPET abnormalities as well as their prognostic relevance in patience with recovered E–TTS.
A TAVI VALV IN VALV AT ALMOST 90 YEARS
Authors: Salucci C , Orso F , Verga F , Corti G , Graziani M , Alfano F , Poletti E , Cagnoni C , Ungar A , Baldasseroni S 
Published: May 2024

Abstract
Degeneration of the biologic aortic valve prosthesis represents an increasingly important issue. This process often affects frail elderly patients who are not candidates for cardiac re–intervention. TAVI valve–in–valve implantation therefore probably remains the only viable option in such patients.We report the clinical case of Mrs. Luciana F., currently 94 years old, who underwent biological aortic valve replacement in 2016. In charge of the Elderly Patient‘s Heart Failure Outpatient Clinic (SOD Geriatrics–UTIG) since January 2023.At first evaluation,89 years old, widowed, living alone; MMSE 29/30. SPPB 7/12. Totally autonomous in BADL, and partially in IADL.She complained of decreased exercise tolerance (NYHA Class III). No alterations in left ventricular kinetics. Calcified and degenerated aortic valve prosthesis with markedly reduced box opening and severe stenosis (Vel 4.7 m/s; Grad max/med (86/55 mmHg) mild insufficiency. May 2023 access to DEA for syncopal episode, complicated by fall down stairs and head injury; on echocardiogram relief of further degeneration of aortic bioprosthesis (moderate–grade intra–prosthetic insufficiency at 2 jets with PTH 300 msec and severe stenosis, Gmax/Gmed 88/55 mmHg, DVI 0.20 June 2023 worsening of dyspnea that appeared even at rest NYHA IV. At echocolordoppler confirmed severe aortic stenosis severe bioprosthesis degeneration. She was evaluated in Heart Team: low overall risk (MPI 0.31) therefore percutaneous implantation of Medtronic Evolut R aortic bioprosthesis has been performed. At discharge asymptomatic, eupnoic, walking independently without aids for short stretches. At subsequent follow–up.–1 month: substantial clinical well–being in the absence of dyspnea on ordinary exertion (NYHA II), no orthopnea or paroxysmal nocturnal dyspnea; denies angor, heart palp or syncopal episodes. She has resumed household chores and leaves the house almost every day –6 months: clinical stability. She walks long distances every day in the absence of symptomatology. –1 years (turned 90 years old): clinical stability with dyspnea for moderate exertion continues active life. Trans prosthetic gradient max/medium 22/12 mmHg, VD–AD 30 mmHg. In conclusion TAVI procedure on degenerated biological prosthesis should be an option to be considered in the elderly patient selected and evaluated by a multidisciplinary Heart Team to achieve improvement of cardiovascular symptoms and concomitantly recovery of functional autonomy.
LOCK PROTOCOL: A NEW ROBUST WORKFLOW FOR A VERY HIGH FIRST PASS PULMONARY VEIN ISOLATION DURING ATRIAL FIBRILLATION ABLATION
Authors: Zarra S 
Published: May 2024

Abstract

Introduction
Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. First pass PVI is often demanding when a raw geometry reconstruction is used in combination with an inaccurate automarks annotation, accounting for discontinuous or non–transmural lesions and related AF recurrences. We hypothesized that a magnetic–post processing of left atrial geometry in combination with an LSI–guided high power short duration (HPSD) automarks annotation could improve procedural efficiency.

Purpose
Aim of the study was to determine the impact on procedural outcomes of the new “Lock PVI protocol” during AF ablation with the new voxel mode EnSite X mapping system.

Methods
We included in the study consecutive patients with AF scheduled for pulmonary vein isolation (PVI) at our Departement between January 2021 and December 2022. Patients were divided in two Groups, the Lock–PVI Group and the control No Lock–PVI Group. The “Lock PVI” Group was ablated with the new Ensite X System using the new protocol, which consisted in (1) performing a road map with contact–force annotation at potential PVI sites after High Density reconstruction, (2) shaving the magnetic geometry reconstruction to unearth true 3D location of contact points, (3) Use of 3D–Automarks color–coded with a Lesion Index (LSI) target of 5.5 (anterior) and 4.5 (posterior) (4) Inter–lesion distance £6 mm (5) High Power Short Duration Approach (50 W). The No–Lock PVI was represented by patients ablated with and HPSD ablation with the previous version of the EnSite Precision mapping suit as per local standard practice. Groups were compared in term of procedural duration, radiological exposure and “first pass” isolation.

Results
Forty–four patients (22 “Lock PVI” and 22 controls mean age 63,3±8 years, 65,9% male, 47,7% persistent AF), for a total of 88 PVI circles were enrolled. Procedural duration was similar between approaches (121,1±43,6 vs 125,3±30,1 min; P=0,72) but RF time was shorter in the “Lock PVI” group (19,6±4 vs 29,55±9,1 min; P&lt;0,001), even if with a longer fluoroscopy (19,5±10,1 vs 13,4±4,9 min; P=0,01). Of note, first pass isolation was significantly higher in the “Lock PVI” group: 40/44 (90,9%) vs 28/44 (63,6%) circles (P=0,002).

Conclusion
The new “Lock PVI” approach allowed a consistently better first pass isolation (&gt;90%) with less RF time when compared to standard of care PVI.
CONTINUOUS LEFT STELLATE GANGLION BLOCK DURING VT ABLATION TO SLOW VT AND IMPROVE ABLATION OUTCOME
Authors: Morena A , Matta M , Ferraris F , Frea S , Anselmino M , Berruquier P , Gravinese C , Giannino G , Angelini F , Saglietto A , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Introduction
Perioperative management of advanced patients with indication to ventricular tachycardia (VT) ablation is complex. A PAINESD score ≥ 15 was proposed to identify those who might benefit from pre–emptive mechanical cardiopulmonary support (MCS). We present a case successfully managed with continuous percutaneous left stellate ganglion block (C–PLSGB).

Case
A 71–year–old diabetic man with severe post–ischemic cardiomyopathy (LVEF 24%, NYHA Class III) and chronic pulmonary disease was admitted for electrical storm with multiple ICD shocks due to poorly tolerated monomorphic VT (MMVT) at 176 bpm resistant to anti–tachycardia pacing (ATP), despite ongoing chronic oral therapy with amiodarone and carvedilol. Poorly tolerated and ATP–resistant MMVTs at 170–180 bpm recurred despite intravenous (iv) amiodarone and lidocaine (20 mcg/kg/min) and oral propranolol. Ultrasound guided C–PLSGB was therefore started; lidocaine was chosen for the continuous infusion due to the short half–life, at the initial dose of 10 mg/h; 6 hours later, his poorly tolerated MMVT recurred at 167 bpm. Therefore, at first we increased iv lidocaine to 30 mcg/kg/min, without benefit, then we increased C–PLSGB at 37.5 mg/h and decreased iv lidocaine to 20 mcg/kg/min due to neurological symptoms. With this regimen, the patient stayed VT free for 2 hours, then the clinical VT recurred at 130 bpm, with good hemodynamic tolerability and ATP–response. C–PLSGB infusion was than increased to 75 mg/h, with no more VT. Endocardial VT ablation was planned. Despite a very high PAINESD score (31) we decided to avoid pre–emptive MCS. We stopped lidocaine (both iv and as C–PLSGB) 2 hours before ablation. As soon as the patient came in the EP room (before instrumentation), the clinical MMVT recurred at 133 bpm. C–PLSGB was then resumed (initially at 100 mg/h for 30 minutes, then at 37.5 mg/h). The MMVT then spontaneously recurred at 133 bpm: it was mapped and ablated in the medio–apical anterior wall, with acute VT interruption. A second VT morphology then appeared, that was mapped and ablated at a more basal site, despite a partial epicardial component of the circuit was identified. C–PLSGB was then stopped and no more VT occurred nor were induced 1 hour later. At 8 months the patient is still alive with no more VT.

Conclusion
C–PLSGB with individually tailored infusion rates could be used during VT ablation as a mean to reduce VT cycle length and allow for mapping without MCS.
MISDIAGNOSED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN AS A CAUSE OF RIGHT VENTRICULAR DILATION IN TRICUSPID VALVE DYSPLASIA
Authors: Pierfelice F , Rende G , Gallina S , Balducci A 
Published: May 2024

Abstract
A 38–year–old woman comes to our attention for regular follow–up of a known tricuspid valve dysplasia, diagnosed since she was 19 years old. The patient has been persistently asymptomatic and hemodynamically compensated. In previous cardiac assessments, there was moderate and stable tricuspid regurgitation (TR) that never reached the diagnostic criteria for Ebstein‘s anomaly (7 mm). The right atrium was dilated, and the right ventricle was at the upper limits of normal dimensions. However, our evaluation revealed a worsening of TR to a severe degree, associated with valvular annulus dilation and severe dilation of the right ventricle, which remained normokinetic, and evident diastolic overload of the interventricular septum. Therefore, a cardiac surgery intervention was indicated to correct the valvulopathy. During hospitalization, a transthoracic echocardiogram was repeated to investigate a possible cause of right ventricular overload, not fully explained by the relatively short duration of severe TR. During the exam, suspecting Partial Anomalous Pulmonary Venous Return (PAPVR) as one of the possible determinants, a vessel compatible with left superior pulmonary venous return was visualized, which converged into the anonymous vein and then into the right superior vena cava. Further diagnostic investigation with magnetic resonance angiography and computed tomography angiography confirmed the severe dilation of the right cardiac chambers and the presence of left upper pulmonary venous return and part of the left lower lobe into the left anonymous vein, with a Qp/Qs of 1.7 in relation to the pre–tricuspidal shunt. Therefore, a cardiac surgery intervention was indicated for PAPVR correction. However, previously unnoticed thrombocytosis was revealed in the hematological exams, leading to the initiation of a pertinent hematological workup and the cardiac surgery intervention was postponed to reduce the risk of perioperative complications. In conclusion, PAPVR is a rare congenital condition that can remain asymptomatic until adulthood due to a chronic adaptation of the right heart to volume overload and should, therefore, be considered in the differential diagnosis of right cardiac chambers dilation, especially when other causes do not justify its pathophysiology.
A 20–YEAR FOLLOW–UP OF SUCCESSFUL SURGICAL MANAGEMENT OF DOUBLE–OUTLET RIGHT VENTRICLE WITH PULMONARY STENOSIS: A CASE REPORT
Authors: Giordano M , Molinari L , Mansour D , Ricci F , Renda G , Gallina S , Paloscia L , Di Marco M 
Published: May 2024

Abstract
A 25–year–old man, suffering from worsening exertional dyspnea for 4 months, was referred to our Cardiology Unit. The patient was previously diagnosed with a late diagnosis of double outlet right ventricle (DORV), as well as pulmonary stenosis, VSD, and right–sided aortic arch for which he underwent a first surgical procedure around the age of 2 involving an intersternal anastomosis through a left lateral thoracotomy approach. A second intervention took place 2 years later for a radical correction of the anomaly through a median sternotomy. The patient had sporadic follow–up since then. A baseline ECG was performed, showing evidence of sinus rhythm, normal AV with a bifid P wave in lead II, slight RAD, incomplete RBBB, and asymmetric negative T waves from V1 to V3 and in aVL, and biphasic T waves in V4–V5. We performed an echocardiogram which showed: a dilated RA, a normal–sized LA, an apparently intact interatrial septum without evident shunts; a normal sized LV; EF 60%; a moderately dilated, hypertrophic and hypertrabeculated RV; FAC 33%; normal aortic flow; a minimal MR; a massive residual pulmonary insufficiency; a moderate TR; a dilatated pulmonary trunk; a normal–sized and collapsible IVC upon inspiration; PAPs of 70 mmHg; no pericardial effusion. A maximal exercise stress test appeared to be normal throughout. However, due to the severe pulmonary hypertension he was referred to our PH centre. While these patients are commonly affected by residual early or late left ventricular outflow tract obstruction, fortunately our patient was not. DORV is a relatively common congenital heart defect characterized by an abnormal connection between the ventricles and arteries, in which both the aorta and the pulmonary trunk are connected completely or predominantly to the right ventricle. The anatomical spectrum of this anomaly is quite large, and it can be associated with the presence of a VSD that often extends towards one or both of the arterial valves, allowing the flow of blood from the left ventricle to the aorta. An accurate diagnosis through echocardiography or CMR is essential in order to guide the surgical repair and the appropriate therapeutic approach for individuals affected by this anomaly. A successful surgical correction of DORV is essential, but it is important to be aware of the potential complications of post–operative PH (especially in patients with preoperative PH), which necessitates close surveillance and appropriate therapeutic management.