bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHANGES IN LEFT ATRIAL VOLUME DURING ECHOSTRESS IN PATIENTS UNDERGOING MITRAL VALVE PLASTIC CARDIAC SURGERY
Authors: Tassone E , Morabito G , Carullo G , Nardella S , Maselli D 
Published: May 2024

Abstract
Mitral Regurgitation (MR) is characterized by a high morbidity and mortality that often finds a solution only in the reparative surgical treatment, in particular in presence of myxomatous degeneration that cause the prolapse of one or both leaflets. This results in an increase in diastolic pressure that leads to a progressive dilation of the left atrium. The increase in Left Atrium Volume Index (LAVI) during stress test represents a negative prognostic factor in the clinical evolution of many pathologies, such as ischemic heart disease, hypertrophic cardiomyopathy, heart failure. An increase in peak/rest LAVI &gt;6.8 ml/m2 correlates with a higher incidence of heart failure decompensation, reduced left ventricular contractile reserve (LVCR), pulmonary congestion.
We evaluate the effect of MR reparative surgery on the changes of LAVI during stress–echo. We enrolled 19 patients, 11 females and 8 males, affected by MR candidate to cardiac surgery. We performed a physical stress–echo test by using the ABCDE protocol suggested by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), before and after 12 weeks from surgery. During each test, the changes in LAVI (ΔLAVI) expressed as peak/rest difference in ml/m2 was measured. In addition, the prognostic score deriving from the sum of the ABCDE criteria was calculated, such as the LVCR (C parameter of the score) that represents a parameter of the force deriving from the hemodynamic changes during the test. In all patients we observed a significant reduction in ΔLAVI (8.4+0.5 mL/m2 vs 9.7+0.7 mL/m2; p&lt;0.0001). In addition, there was a significant reduction in the ABCDE prognostic score (from 4.19+0.43 to 3.48+0.37; p=0.002), secondary to the increase in the LVCR observed approximately 3 months after surgery (from 1.77 mmHg/ml to 2.44 mmHg/ml, p&lt;0.0001), as well as a significant reduction in pulmonary congestion during stress (B parameter). There were no significant changes in ejection fraction, wall motion score index–WMSI (A parameter), coronary reserve (D parameter) and heart rate reserve (E parameter).
These data demonstrate for the first time that mitral valve plastic surgery is able to reduce the ΔLAVI during stress echocardiography in patients with severe MR. The surgical procedure also resulted in both an improvement in the LVCR and a reduction in the degree of pulmonary congestion, that ultimately led to an improvement in the ABCDE prognostic score.
COMPLETE VS CULPRIT–LESION–ONLY MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH OUT–OF–HOSPITAL CARDIAC ARREST: INSIGHTS FROM THE MULTICENTRIC LOMBARDIA CARE REGISTRY
Authors: Raone L , Bongiorno A , Bendotti S , Currao A , Primi R , Adamo M , Ghiraldin D , Marino M , Dossena C , Poli A , Affinito S , Maffeo D , Kajana V , Baldi E , Ferlini M , Savastano S 
Published: May 2024

Abstract

Background
Out–of–hospital Cardiac Arrest (OHCA) is an uncommon yet potentially devastating complication of patients with Myocardial Infarction (MI). Multivessel Disease (MVD) is a frequent occurrence in this setting, being present in nearly half patients undergoing Coronary Angiography (CAG). We previously reported that, in case of MI complicated by OHCA and evidence of MVD, a complete myocardial revascularization, as compared to culprit–lesion–only revascularization, was associated with an improved 1–year survival and favorable neurological outcomes. We aimed to validate and confirm these results on a multicentric scale with a larger patient cohort.

Methods
This is a multicentric, prospective, observational study. We considered all consecutive patients with OHCA and MI enrolled in the Lombardia CARe Registry from January 1st 2015 to December 31st 2022 who underwent CAG in 6 centers in Northen Italy.

Results
A total of 623 patients were included; of these, 403 underwent CAG. Median age was 64 years, and about 80% had no history of ischemic heart disease. Median ejection fraction (EF) was 40%. MVD was present in 186 patients and was subsequently treated with either complete (32%) or incomplete (67.7%) coronary revascularization. Left anterior descendent (LAD) artery was the culprit lesion in almost 1/3 of patients. The 1–year survival rate was 78.3% in the complete revascularization group and 42.9% in the culprit–lesion–only revascularization group (p–value &lt; 0.001). After correction for EF, hypercholesterolemia, mechanical or pharmacological support, cardiac arrest time and first shockable rhythm, complete revascularization strategy was independently associated with a reduced risk of death [HR: 0.27 (95% CI: 0.01 to 0.739; p = 0.01] and death or unfavorable neurological outcome [HR: 0.23 (95% CI: 0.08 to 0.67); p = 0.007].

Conclusions
in patients resuscitated from OHCA, complete revascularization strategy was confirmed to be associated with an improvement of 1–year survival and with a good neurological outcome. These results highlight the independent impact on survival of a complete percutaneous coronary intervention strategy in patients with OHCA plus MVD.
LONG–TERM ISCHEMIC STROKE AFTER ACUTE CORONARY SYNDROME IN SELECTED URBAN AND RURAL AREAS. THE ABC STUDY ON HEART DISEASE
Authors: Mahmoud H , Cordiano R , Palmieri R , Cavuto F , Bagato F , Dariod M , Merotto D , Menegon F , Petucco S , Berton G 
Published: May 2024

Abstract

Background
Little is known about the long–term risk of stroke among acute coronary syndrome (ACS) survivors.

Methods
In this prospective study, we enrolled 535 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy, discharged and followed for 24 years or death. The patient‘s residency was classified into three urban and rural areas.

Results
All patients completed the follow–up (6142 Perso–years). 85 (16%) patients suffered an acute stroke. Patients median age was 67 years, 70% were male, and 318 patients were residing in rural areas. Patients who had a stroke and those who had not shared most of the demographic and clinical characteristics. The incidence rate of overall stroke was 14/1000 person–year. Cox analyses showed older age (HR 3.13;95%CI 2.31–4.26), male gender (HR 1.88;95%CI 1.20–2.95), baseline diabetes (HR 2.25 95%CI 1.37–3.69), heart failure (HR 2.69;95%CI 1.71–4.24), and higher albumin/creatinine ratio (HR 1.75;95%CI 1.33–2.30) were all associated with an increased risk of stroke. while higher baseline eGFR, reperfusion, statin and beta–blockers treatment during follow–up were associated with a decreased risk; HR (0.55 (95%CI 0.42–0.72), 0.45(95%CI 0.29–0.71), 0.21(95%CI 0.13–0.34), and 0.37(95%CI 0.23–0.57), respectively). In the multivariate analysis, only older age (HR1.55;95%CI 1.08–2.21; p=0.02) was an independent predictor of stroke while statin treatment was independently associated with a lower risk (HR 0.35;95% CI 0.21–0.58; p&lt;0.0001). However, all these variables did not predict the risk of stroke in competing risk regression analysis where death was treated as the competing event. A sub–analysis of the 43 patients who had a fatal stroke (FS) revealed 7/1000 person–year FS IR. The Cox regression and competing risk analyses of predictors of FS showed similar results. Interestingly, we observed an association between geographic areas of residence and the long–term FS risk as the risk increased going from rural to urban (HR 2.08;95%CI 1.14–3.80; p=0.02) areas and from north to middle and south provinces (HR 1.47;95%CI 1.00–2.15; p=0.04) in the univariate Cox regression analysis.

Results
kept true using multivariate Cox and Competing risk regression models.

Conclusion
This analysis reveals the significant urban–rural difference in the long–term risk of fatal stroke among unselected ACS patients which highlights the importance of implementing a preventive policy based on area–specific knowledge.
ROLE OF THE MOLECULAR TESTS FOR PATIENTS WITH INFECTIVE ENDOCARDITIS UNDERGOING CARDIAC SURGERY: AN EXPANDING HORIZON
Authors: Cammertoni F , Pavone N , Calabrese M , Scoppettuolo G , Bruno P , Massetti M 
Published: May 2024

Abstract

Background
Molecular tests have been proven to be a highly sensible tool to identify the pathogen of infective endocarditis (IE). However, their usefulness in the management of both blood culture positive and valve culture negative IE remains unclear.

Methods
We prospectively enrolled 100 consecutive patients with IE who underwent cardiac surgery between April 2020 and June 2023. Molecular testing (broad–range PCR 16S rRNA) was systematically performed and results were collected together with those of preoperative blood culture, valve culture and histopathological analysis of the specimen.

Results
Blood culture, valve culture and molecular testing were positive in 83%, 47% and 76% of patients, respectively. Both the sensitivity of valve culture and 16S rRNA PCR decreased significantly with increasing duration of preoperative antibiotic therapy. In 7% of cases, molecular test was the only positive test, allowing an etiological diagnosis. In 33% of cases, valve culture was negative but molecular test was positive. In the majority of these patients, histopathological analysis documented acute inflammation. Finally, molecular test clarified discrepancies between the results of blood cultures and those of valve cultures in 12.5% of patients.

Conclusions
The molecular tests showed high sensitivity. Although it decreased as the duration of preoperative antibiotic therapy increased, it was still higher than that of valve culture 28 days after the start of treatment. In addition to patients without an etiological diagnosis, the molecular test proved useful in other circumstances: 1) when the valve culture was negative because, together to the results of the histopathological analysis, it allowed to identify those patients who could benefit from a prolongation of antibiotic treatment; 2) in cases of discordance between the results of blood cultures and those of valve cultures, because it allowed the type of antibiotic treatment to be directed. Figure 1: Usefulness of molecular tests (PCR) according to the results of blood and valve cultures. Figure 2: Valve cultures are of paramount importance in the management of antibiotic therapy (ABT). However, their sensibility is low and the risk of under–treatment exists. Molecular tests may help targeting the duration of ABT but they could be persistently positive leading to an over–treatment. Figure 3: Flow–chart showing the possible role of molecular test in the management of patients with infective endocarditis.
HOW TO MANAGE MITRAL VALVE POSTERIOR LEAFLET HYPOPLASIA
Authors: Fiorentino M , Mikus E , Antonino C , Savini C 
Published: May 2024

Abstract

Background
Mitral valve posterior leaflet hypoplasia is a relatively rare and often congenital anatomical malformation. In this condition, achieving a good and durable mitral valve repair still represents a challenge for surgeons.

Methods
We present the case of a 43 years old man presenting with exertional dyspnoea due to severe mitral regurgitation. Transthoracic and transesophageal echocardiograms revealed a severe hypoplasia of the posterior mitral leaflet with an significant prolapse of the anterior leaflet (particularly A2–A3), which determined massive regurgitation. The anteroposterior annular diameter was 38 mm with a 4 mm mitro–anular disjunction, left ventricular telediastolic diameter was 59 mm and ejection fraction 68%. No other cardiac malformations were evident; in particular tricuspid valve was normal.

Results
Surgery was performed through a right mini–thoracotomy with femoral cannulation, using three–dimensional video–assisted technology. The mitral valve was approached from the left atrium, behind the interatrial groove. Surgical inspection revealed a severely hypoplasic posterior leaflet and a wide anterior leaflet prolapsing near the postero–medial commissure (A2–A3) (Figure 1). Based on our previous experience, we decided to repair the valve performing a posterior para–commissural edge–to–edge (A3–P3) followed by an atypical annuloplasty using a bovine pericardium band, shaped on a 40 mm ring sizer, only in the postero–medial portion of the mitral annulus (Figure 2). On the hydrostatic test, the valve showed a satisfactory continence, that was confirmed on the intraoperative TEE. Postoperative course was uneventful and the patient was discharged home on postoperative day 7. Transthoracic echocardiography at discharge showed a good result of the mitral valve repair with no residual regurgitation a medium gradient across the mitral valve of 3 mmHg.

Conclusions
In our experience, reductive annuloplasty isn’t the optimal treatment for hypoplasic mitral valve posterior leaflet because it lowers the already small posterior leaflet, thus reducing the coaptation surface. To avoid this, we introduced this technique that improved our surgical outcomes.
INAPPROPRIATE S–ICD SHOCK RELATED TO ATRIO–VENTRICULAR BLOCK: WHEN THE TRUE CULPRIT IS NOT OVERT
Authors: Cesarano E , Casula M , Tola G , Perra F , Schintu B , Setzu A , Corda M 
Published: May 2024

Abstract
Subcutaneous implantable cardiac defibrillator (S–ICD) is a well–established alternative to transvenous defibrillator in patients with an indication for an ICD without the concomitant need of pacing. Despite the overall excellent performance of S–ICD, oversensing of cardiac and non–cardiac signals is still the main cause of inappropriate shocks (IS). We present a case of IS due to F–wave oversensing and QRS morphological variability related to compete atrio–ventricular (AV) block.
A 77–year–old man was admitted to the Emergency Room reporting two episodes of defibrillator shock, identified by remote monitoring as IS due to F–wave oversensing during paroxysmal atrial flutter (Figure 1). His past medical history included paroxysmal atrial fibrillation and post–ischemic left ventricular (LV) dysfunction with left bundle branch block, treated in 2012 with cardiac resynchronization therapy and implantable defibrillator (CRT–D) with subsequent normalization of LV ejection fraction (EF). The LV stimulation was later deactivated due to phrenic capture unavoidable with device reprogramming; afterwards, the occurrence of aortic valve and lead endocarditis resulted in CRT–D system extraction. At that time, considering the persistence of normal LVEF even without LV stimulation, an S–ICD was then implanted in primary prevention. The ECG at the time of admission presented with a complete AV block (Figure 2A), not clearly evident at the remote monitoring report. Few hours later a new episode of atrial flutter occurred, reveling a variable QRS morphologies of ventricular rhythm (Figure 2B). A more careful analysis of device memory reveals a previous episode of AV block with variable QRS morphologies leading to SMART Pass filter disabling (Figure 3). A transvenous ICD with left bundle branch area stimulation was then successfully implanted and the patient was discharged at home after two days.
To the best of our knowledge, this is the first described case of inappropriate S–ICD shock related to AV block. The unpredictable QRS morphology of an escape rhythm and the inability of S–ICD to store diagnostic data regarding bradyarrhythmia may limit our knowledge on the behavior of S–ICD in case of AV block. The occurrence of an IS should always prompt careful analysis of all available S–ECGs. Previous events of QRS morphology change and/or disabling of the SMART Pass filter should be regarded with suspicion, even if an AV bock is not overt evident.
UNPREDICTABLE IDENTIFICATION OF A TITIN MUTATION IN A YOUNG PATIENT PRESENTING WITH INFLAMMATORY CARDIOMYOPATHY
Authors: Marchionni G , Alfarano M , Bottillo I , Grammatico P , Vizza C , Chimenti C 
Published: May 2024

Abstract

Case Presentation
A 23 years old patient, affected by type 1 diabetes, presented with fever, dyspnea and bilateral peripheral edemas. In the last week he received antibiotic treatment for a persistent dry cough and sore throat, and became symptomatic for exertional dyspnea from three days. His mother died at the age of 40 for sudden cardiac death. Blood pressure and oxygen saturation were normal: the ECG showed sinus tachycardia with symmetric negative T waves in all precordial leads. High sensitivity troponin T was 0.01 mcg/L (normal value &lt; 0.014 mcg/L). All remaining blood tests were normal, except for CRP that was slightly elevated. His echocardiogram revealed left ventricular (LV) remodelling and dilation, severely reduced LV ejection fraction (LVEF 20%) with global hypokinesia, more pronounced at the level of the anterior wall, interventricular septum and apex and a dilated right ventricle (RV) with reduced systolic function. Cardiac magnetic resonance (CMR) confirmed severe biventricular disfunction (LVEF 19%; RVEF 23%) and showed a small area of subepicardial inferior junctional late gadolinium enhancement (LGE). The patient underwent an endomyocardial biopsy that showed a lymphocytic virus–negative myocarditis. Given his known type 1 diabetes, steroid treatment was not considered and anakinra was started. The patient was discharged after two weeks with a slight amelioration of the LV function (LVEF 27%), on optimal heart failure therapy and anakinra. At six months he was in NYHA class II and CMR showed slight reduction in LV dimensions and improvement of the LV and RV function (LVEF 39%; RVEF 45%), with no changes in the LGE pattern. A genetic test was performed and revealed two titin gene mutations, both categorized as likely pathogenic (TTN c.[11831T&gt;A]; c.[72510_72517delGACAAATG]), responsible for a genetic form of dilated cardiomyopathy.

Conclusion
The present case suggests that in young patients presenting with clinical or histological diagnosis of myocarditis, genetic testing for cardiomyopathies should be considered especially in presence of a positive family history for sudden death or an incomplete recovery of the LV function at follow–up. Identification of a gene mutation in these patients allows a more tailored risk stratification of the index case and a proper management of the entire family.
OUTCOMES OF OUT HOSPITAL CARDIAC ARREST: SEX DISPARITIES IN OUR REGION
Authors: Bolognesi M , Carinci V , Bricoli S , Cardelli L , Pelizzoni V , Gamberini L , Rossi L , Barbato G , Biagi A , Casella G , Aschieri D 
Published: May 2024

Abstract

Background
The incidence of out of hospital cardiac arrest (OHCA) differs consistently between women and men.Besides sex related factors, OHCA risk may relate to gender related factors.Although previous studies regarding sex difference outcomes after OHCA yielded conflicting results, from some researches it seems that women have less shockable initial rhythm than men and they have worse survival.

Methods
We considered 5524 consecutively OHCA survivors resuscitated from emergency medical System (EMS) or bystander In two city of Emilia Romagna: Piacenza (3452 ) and Bologna (2072) from January 2009 to December 2019 and we evaluated the outcomes, considering sex and gender disparities.

Results
Out of 5524 patients, who experienced OHCA, 3340 (60%) were males with average age 70,6 ±14 years and 2184 (40%) females with average age of 78,9 ±13 years (p&lt;0,001).Overall survival rate was 8% .In our population we observed as initial rhythm of cardiac arrest : 3057 (57%) asystole, 1070 (22%) ventricular fibrillation (VF) and 998 (21%) pulseless electrical activity (PEA) with sex disparities.In fact we have found : 1695 asystole (51%), 840 FV (25%), 583 pea (17%) in men and 1362 asistolia (62%), 230 fv (11%), 415 pea (19%)in women. Asystole was more frequently in females (62 f vs 51m %, p&lt;0.001), whilst VF in males (25 vs 11%, p&lt;0.001).Furthermore considering sex disparities, survival was better in males 299 (9%) than in females 115 (5%), p&lt;0.001.

Conclusions
In our population OHCA was more frequent in males in line with previous published data. However, females affected by OHCA are older, tend to present more frequently with non–shockable rhythms and show worse outcome. It’s unknown if these data are related to sex biological differences or gender disparities . Further data will be necessary to explain this challenge.
THE ROLE OF THE NURSING FIGURE IN THE MANAGEMENT OF INJECTABLE LOOP RECORDERS: THE IMPACT OF ARTIFICIAL INTELLIGENCE IN THE CLINICAL PRACTICE OF OUR CENTER
Authors: Affuso N , Bruno R , De Fazio D , Mazzei E , Chiarello O , Tomaselli C , Talarico A , Quirino G 
Published: May 2024

Abstract

Background
Injectable loop recorders (ILRs) are integral devices in managing cardiac disorders, with recent advancements in miniaturization enhancing installation and management processes. The Reveal LINQTM, introduced in 2014 by Medtronic, marked a breakthrough with significantly smaller dimensions than standard ILRs. The introduction of a tablet–based SmartSync Device manager programmer, coupled with the Linq Mobile Manager (LMM) application, further streamlined installation, ensuring direct data integration into the Medtronic CareLink Network. Nursing responsibilities involve triaging remotely transmitted data for clinical actions.

Materials and Methods
Over three years, 97 Linq II loop recorder implants were performed, mainly for syncope or cryptogenic stroke, utilizing the SmartSync programmer and LMM application. Eighty–two patients were enrolled in the Medtronic CareLink Network. Episodes recorded by Linq II™, classified by device algorithms, were sent to the Carelink platform via a monitor or patient‘s mobile app. Nurses review data to distinguish real episodes from false positives. The AccuRhythm™ AI platform, introduced in June 2022, applies AI to filter recorded episodes before reaching Carelink, reducing data and nursing staff time significantly.

Results
Results indicate a drastic reduction in false positives with AccuRhythm™, boasting high sensitivity (about 99.3%) and positive predictive value. In clinical practice, this led to a 100% reduction in pause alerts and a 21% reduction in atrial fibrillation alerts, saving 145 hours.

Conclusion
underscores the AccuRhythm™ AI Platform‘s cloud–based application of AI algorithms to LINQ II™ data, achieving time savings without compromising diagnostic yield. LINQ II‘s sensitivity on Atrial Fibrillation and High Pause is maintained, allowing efficient diagnosis and reallocating saved time to other essential patient–focused activities.