bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECT OF SGLT2 INHIBITORS ON THE ARRHYTHMIC BURDEN IN HEART FAILURE
Authors: Vecchi A , Saccinto G , Bisceglia F , De Ponti R , Campana C 
Published: May 2024

Abstract

Background
Sodium–glucose co–transporter 2 inhibitors (SGLT2–i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus, however, their potential beneficial effect on arrhythmic burden has been poorly investigated.

Objective
This observational study explores the potential arrhythmic burden reduction in a cohort of heart failure (HF) patients treated with SGLT2 inhibitors, regardless of ejection fraction.

Methods
29 consecutive HF patients, who underwent cardioverter defibrillator (ICD) implantation for at least 6 months before the enrollment, were followed up 6 months later SGLT2–i initiation. Every single event was analyzed by Cardiologists experienced in home monitoring systems and has been categorized as follow: atrial high–rate episodes (AHRE), SVT (Sustained Ventricular Tachycardia), non–sustained Ventricular Tachycardia (NSVT), Premature Ventricular Beat burden (PVC), anti tachycardia pacing (ATP), proper and inappropriate shocks. All data were collected in an arbitrary observational time of 6 months before and after SGLT2–i therapy has been initiated.

Results
In the 6 months before SGLT2–i introduction the following data were observed: 211 AHRE in 6 patients (21% of patients who experienced at least an event), 1 SVT (3%), 8 NSVT in 5 patients (17%), 2 ATP in 1 patient (3%), 1 inappropriate ICD shock. Considering the limited sample size which affected statistical power, after SGLT2–I initiation a trend of arrhythmic burden reduction was observed: 554 AHRE in 3 patients (10%), 1 SVT (3.4%), 7 NSVT in 3 patients (10%), 2 ATP in 1 patient, 1 appropriate shock. Despite an absolute increase in total AHRE episodes, patients who experienced at least an event halved (from 21% to 10%). Moreover, a remarkable NSVT reduction was observed both as patients who experienced the event (17% to 10%) along with absolute number of events.

Conclusions
SGLT2–is have been showing strong improvements on cardiovascular events, especially HF hospitalization and CV death. Besides, the burden of cardiac arrhythmias is still a matter of debate, especially in the field of ventricular burden. Our study delineates a positive effect of SGLT2i, showing a trend in reduction of the arrhythmic event, both in AHRE and NSVT. Expanding sample size of this study is mandatory to support the benefit of SGLT2i on arrhythmic burden, suggesting a charming pharmacodynamic model of these still unknown, extraordinary drugs.
HEART FAILURE AND PALLIATIVE CARE, ITALIAN VALIDATION OF THE "NEED ASSESSMENT TOOL: PROGRESSIVE DISEASE – HEART FAILURE" (NAT: PD–HF)
Authors: Mancuso G , Moggia F , Rizzello F 
Published: May 2024

Abstract
Palliative Care in Heart Failure cardiology setting is still a demanding topic and lacking of clear indications regarding which patients should be referred to palliative care is an actual issue, as confirmed by a systematic review of international literature. Assessment tools facilitate the identification of patient needs and guide the actions of healthcare professionals to address them. Some existing tools described in literature were used with non–cardiological patients, but they cannot be applied to Heart Failure as they are incomplete and investigate non–specific aspects of the disease. Two recent systematic reviews indicate that the most comprehensive and specific tool for Heart Failure patients is the "NAT: PD–HF." The "NAT: PD–HF" has already been translated and validated from English to Dutch and German, but an Italian validation is still missing in literature. It is a quick and easy–to–use tool consisting of four sections that assess the patient’s well–being and quality of life, the caregiver‘s ability to provide assistance and support, both patient’s and caregiver’s needs and requests and any critical element that, if present, would justify a specialist palliative evaluation. Therefore, with prior authorization from the original authors, we proceeded with the translation and transcultural validation of the tool. The study protocol was approved by the Bioethics Committee of Bologna in April 2023. We are currently at the final phase of the protocol, namely testing the tool on the target population by the professionals involved in the care process. The purpose of transcultural validation is to provide the Italian scientific community with the "NAT: PD–HF" tool: throw its incorporation into the medical records of Heart Failure Patients receiving care in the territorial setting, we aim to increase the use of palliative cares and, consequently, the quality of life of patients and caregivers, as demonstrated in the original study.
TAKING A WALK ON THE HEART FAILURE SIDE: COMPARISON OF METABOLIC VARIABLES DURING WALKING AND MAXIMAL EXERTION
Authors: Mapelli M , Salvioni E , Bonomi A , Paneroni M , Raimondo R , Gugliandolo P , Mattavelli I , Bidoglio J , Mirza K , La Rovere M , Gustafsson F , Campodonico J , Pezzuto B , Vignati C , Agostoni P 
Published: May 2024

Abstract

Background
Although cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e. 6–minute walk test, 6MWT) are also commonly used. Aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicenter, heterogeneous population.

Methods
We included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement.

Results
We enrolled 186 subjects (16 athletes, 40 healthy, 115 non–LVAD HF patients, and 15 LVAD carriers). CPET–peakV̇O2 was 41.0 [35.0–45.8], 26.2 [23.1–31.0], 12.8 [11.1–15.3], and 15.2 [13.6–15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (p&lt;0.001). During 6MWT they used 63.5 [56.3–76.8], 72.0 [57.8– 81.0], 95.5 [80.3–109], and 95.0 [92.0–99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT–V̇O2 higher than their CPET–peakV̇O2. Both 6MWT–V̇O2 and walked distance were significantly associated with CPET–peakV̇O2 in the whole population (R2=0.637 and R2=0.533, p=&lt;0.001) but not in the sub–groups. This was confirmed after adjustment for groups.

Conclusion
The 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine
IMPACT OF NEW MULTIPARAMETER ALGORITHM FOR THE MANAGEMENT OF HEART FAILURE PATIENTS WITH AN ICD IN TERMS OF REDUCED HOSPITALIZATION AND ROLE OF THE CARDIOLOGY TECHNICIAN IN TELECARDIOLOGY RELATED TO SPECIFIC HEART FAILURE SERVICE – OUR EXPERIENCE
Authors: Scapinelli M , Guerra A , Caputi A , Merighi S , Sacchetti G , Boccedi M , Bonfiglioli N , Bagni E 
Published: May 2024

Abstract

Introduction
Heart failure represents an important cause of hospitalization and is associated with an increased cardiovascular risk for the patient as well as an increase in healthcare spending. In recent years, algorithms for detecting pre–heart failure subclinical changes have been developed for implantable defibrillator (ICD) users so as to be able to act early and avoid hospitalization. In our reality we have created a teamwork dedicated to the evaluation of alerts which includes the electrophysiologist, the heart failure cardiologist and the cardiology technician.

Material and Methods
Thirteen patients implanted with Boston Scientific ICDs and CRT–Ds in the period between November 2019 and December 2022 were considered, 9 males and 4 females with an average age of 69.7 years. The object of the study were the Heart–Logic algorithm with a total of 41 alerts received which were followed by telephone contact in an average time of 2.6 days evaluating any ongoing symptoms, adherence to the prescribed therapy and whether there had been any changes to the same, blood pressure trend and any recent laboratory tests. On the basis of this, an outpatient visit was scheduled in 13 cases (31.7%) and the diuretic was increased in 19 cases (46.3%) and the beta–blocker in 6 cases (14.6%); in 4 cases (9.7%) has been modified the SGLT2 dose. In 12 cases (29.2%) no action was taken following telephone contact and among these only 2 hospitalizations occurred. The most represented component of alert activation was the variation in heart tones followed by thoracic impedance and nocturnal heart rate. The average time on alert was 3.4 weeks.

Conclusions
The multiparametric algorithm has shown, also in our experience, good sensitivity but the share of false positives is not negligible, for which we believe as very important the clinical–therapeutic evaluation following receipt of the alert, which must be analyzed in its activation components before therapy adjustments or other decisions. In our organization the Cardiology Technician plays a fundamental role as he receives the alert, quickly calls the patient collecting the information described above and interfaces with the doctor to decide the actions to take. As part of the specific heart failure service for patients with CIEDs, the Technician supports the cardiologist in the management of the patient, providing a fundamental contribution in the evaluation and interpretation of remote transmissions.
PULMONARY VENO–OCCLUSIVE DISEASE ASSOCIATED WITH METHAMPHETAMINE ABUSE: A FIRST CASE DESCRIPTION
Authors: Baratto C , Gagliardi M , Liberatore M , Dipierro P , Boniolo F , Perego G , Parati G , Caravita S 
Published: May 2024

Abstract

Background
Recreational methamphetamine is widely used worldwide (about 35 million people), mainly as 3,4–Methylenedioxymethamphetamine (MDMA). A definite association has been established between methamphetamine and pulmonary arterial hypertension (PAH). This drug–associated form of PAH shares histological, clinical and hemodynamic characteristics, prognosis and treatment strategies with idiopathic PAH. However, the association between MDMA and a rarer and devasting form of PAH with concomitant venous involvement (pulmonary veno–occlusive disease, PVOD), has never been reported. Notably, initiation of PAH–specific treatment in PVOD may lead to catastrophic consequences.

Case Description
A 32–year–old man was fast–track referred to our PH Centre in December 2023, due to high echocardiographic probability of pulmonary hypertension (PH). After interrogation, he admitted the regular use of MDMA. No other risk factor for PAH was found. Right heart catheterization showed a pre–capillary PH (mean pulmonary artery pressure 35 mmHg; wedge pressure 12 mmHg; pulmonary vascular resistance 5.9 WU) with low cardiac output (2.2 L/min/m2) and no acute response to vasoreactivity testing. Exercise capacity was severely reduced (oxygen consumption 19.6 mL/Kg/min, 50% of predicted) due to absent stroke volume reserve, accompanied by augmented exercise hyperventilation (VE/VCO2 slope 60) and exercise–induced desaturation (SaO2 94 à 77%), this latter not explained by a right–to–left shunt. Diffusion capacity of the lung was severely reduced (DLCO 28%). Chest CT and perfusion scan excluded both thromboembolic etiology and parenchymal lung disease. A diagnosis of PVOD was made, based on the presence of pre–capillary PH, oxygen desaturation, extreme exercise hyperventilation and very low DLCO, even in the absence of pathognomonic CT features. Counselling for stopping MDMA abuse was offered. Cautious monotherapy with macitentan was started and was well tolerated. A genetic testing for EIF2AK4 is ongoing. Contact with transplant center has been performed. A follow–up RHC has been planned before careful therapy up–titration.

Conclusions
This is the first case reported of the potential association between methamphetamines and PVOD. Due to the large worldwide use of MDMA, this link should be considered because of its prognostic and therapeutic implications. The diagnosis of PVOD is a clinical one, needing a high index of suspicion especially in the absence of chest CT findings.
AN UNUSUAL CASE OF PULMONARY ARTERIAL HYPERTENSION FOLLOWING SURGICAL TREATMENT OF A LUNG ABSCESS IN A PATIENT WITH LATENT SYSTEMIC SCLEROSIS
Authors: Damele A , Pittaluga M , Somaschini A , Buscemi M , Cordone S , Toma M , Bellone P , Ameri P 
Published: May 2024

Abstract

Background
Pulmonary arterial hypertension(PAH) is frequently associated with systemic sclerosis(SS). Nevertheless, little is known about the triggers that may exacerbate PAH in these patients.

Case Report
A 71–year–old woman, previously diagnosed with Raynaud‘s Syndrome and without any other significant medical history, was admitted to our Emergency Room due to dyspnea and fever. She was diagnosed with pulmonary infection complicated by empyema(Figure1) and underwent surgical toilet and decortication of the lower lobe with full recovery. Echocardiography during the hospital stay was normal. Few months after discharge she developed dyspnea WHO–FC III and fatigue and eventually she was hospitalized with a diagnosis of acute heart failure. The ECG showed right bundle branch block and signs of right ventricle strain(Figure2). The echocardiogram(Figure3) was characterized by normal left ventricular systolic function, enlarged right ventricle with D shape and moderate impairment of systolic radial function; pulmonary hypertension(PH) with an estimated pulmonary artery pressure of 60mmHg was also detected. Pulmonary CT angiography excluded pulmonary embolism. Aiming to better characterize PH, a right heart catheterization was performed with the following findings: mean pulmonary artery pressures 34mmHg(55 mmHg systolic–22mmHg diastolic), wedge pressure 5mmHg, right atrium pressure 2mmHg, pulmonary vascular resistance 8WU; the cardiac output and cardiac index were only mildly reduced. Elevated levels of NT–proBNP and troponin I were also found(1926pg/m [n.v.&lt;125] and 65.9ng/L [n.v.&lt;19] respectively), whereas blood count, liver and renal function, rheumatoid factor, and C–reactive protein levels were normal. Based on the above findings, a diagnosis of pulmonary arterial hypertension(PAH) in intermediate–high risk class was made. Therefore, dual specific therapy for PAH with sildenafil and macitentan was initiated. The rheumatologic screening findings(CENP A/B positive, typical pathological findings at capillaroscopy) associated with the patient’s history PAH, Raynaud Syndrome) were consistent with a diagnosis of SS. After three months the patient showed a good response to dual therapy and progressed to a low–risk class(WHO–FC II, 6MWD=420m, normal NT–proBNP values).

In conclusion
lung abscess and its surgical treatment may have played a role in our patient. Close follow–up of SS patients should be ensured when they face interventions and/or acute stresses.
INDIPENDENT PROGNOSTIC VALUE OF SOLUBLE–SUPRESSION OF TUMORIGENICITY (S–ST2) IN PATIENTS AFFECTED BY PULMONARY HYPERTENSION
Authors: Novielli M , De Tommasi E , Camassa N , De Michele L , Mannarini A , Cascella S , Andreani S , Mazzilli D , Lucente F , Discipio O , Di Serio F , D‘Agostino C 
Published: May 2024

Abstract

Introduction
According to ESC 2022 guidelines, pulmonary hypertension (PH) is a hemodynamic condition characterized by mean pulmonary arterial pressure&gt;20 mmHg. Pulmonary arterial hypertension (PAH) represents 5% of the PH, with an unfavorable prognosis primarily because of late diagnosis and treatment. In PAH, it is important to evaluate the individual patient mortality risk through a multiparametric approach: a three–layer model at diagnosis and a four–layer model based on WHO–FC, 6MWD and NT–proBNP at follow up, which allows better discrimination within the intermediate risk group helping therapeutic decision making. The only biomarker included in risk stratification is NT–proBNP; however, in previous studies soluble–Supression of Tumorigenicity 2(s–ST2), a marker of myocardial stress, resulted a strong predictor of death in heart failure and acute coronary syndromes.

Aim
The aim of this study is to analyze the prognostic value of s–ST2 in patients with pulmonary hypertension.

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

Results
During an average 18–month follow–up, 17 patients died, 76% of whom had pulmonary arterial hypertension (PAH). They showed significantly higher values of s–ST2. 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 (Fig. 1). At multivariate analysis s–ST2&gt;78 ng/ml is confirmed to be a statistically significant predictor of mortality, regardless of WHO functional class III–IV, PAPs and NT–proBNP. Furthermore, s–ST2 appears a better early mortality predictor than NT–proBNP, at the limit of statistical significance (Fig. 2).

Conclusions
In a population of patients with pulmonary hypertension (predominantly PAH) we define a numerical value of sST2&gt;78 ng/ml, which is a prognostic discriminator, independent and incremental to NT–proBNP at short–term follow–up. It allows the clinician the appropriate planning of therapeutic strategies in a condition in which the earliness of therapy affects prognosis.
PULMONARY HYPERTENSION AND CONGENITAL HEART DISEASE: THE CLINIC BEYOND THE EVIDENCE
Authors: Ferrara A , Di Fonzo R , Vigorito F , Galasso G , Vecchione C , Soriente L 
Published: May 2024

Abstract
Eisenmenger syndrome (ES), first described by Victor Eisenmenger, was defined by Paul Wood in pathophysiologic terms as “pulmonary hypertension (PH) at systemic level, caused by a high pulmonary vascular resistance (PVR), with reversed or bidirectional shunt at aorto–pulmonary, ventricular, or atrial level.” It represents the most severe hemodynamic phenotype of pulmonary arterial hypertension (PAH) in association with congenital heart disease (CHD) and develops in the presence of large, unrepaired atrial or ventricular septal defects, arterial shunts, or complex forms of CHD. Although therapeutic management has rapidly advanced in recent years, these patients were not included in randomized controlled trials for specific pulmonary arterial hypertension drugs, except for bosentan. However, in clinical practice we apply treatment strategies combining drugs targeting multiple pathobiological pathways. The clinical case we describe is that of a 44–year–old patient, suffering from Down syndrome, with ES due to subaortic VSD and a a patency of Botallo duct, followed in our PH clinic of the "Ruggi D‘Aragona" University Hospital for about 9 years. The patient, on dual therapy with Macitentan 10 mg and Sildenafil 60 mg, was in the intermediate–high risk class, stationary. During the last two checks, there was a progressive worsening of the hemodynamic parameters, walking distance of only 100 meters, with SpO2 at baseline 90% and desaturation during the 6mwt. On cardiac color Doppler ultrasound evidence of TAPSE 18 mm, PAPS 100 mmHg, RAA 20 cm²; TAPSE/PAPS 0.18. The patient presented in WHO class 3. The only RCTs currently available concern the use of bosentan, but in clinical practice, initial monotherapy with an endothelin receptor antagonist or a phosphodiesterase type 5 inhibitor for symptomatic patients is proposed. Reassess and consider escalation to a double combination therapy in case of clinical worsening or inadequate clinical response. Consider uptitration with the addition of prostanoids when inadequate response and timely assess the eligibility for transplantation. For our patient therefore, in consideration of the impossibility of surgery, although there is little evidence on prospective observational studies based on cohorts of a few patients, we added selexipag 200 ug x 2/day to titrate therapy.This case opens the door to still unclear scenarios in which unfortunately the only weapon available remains the clinician‘s judgment and experience.
OUT–OF–HOSPITAL MANAGEMENT INDICATORS IN THE APPLICATION OF THE UNIFIED PDTA "STEMI NETWORK" FOR THE AST OF ASCOLI PICENO AND FERMO: FROM DIAGNOSIS TO PCI WIRE–CROSSING. LONGITUDINAL OBSERVATIONAL CLINICAL STUDY
Authors: Paolone L , Parato V , Traini T 
Published: May 2024

Abstract

Introduction
The incidence of STEMI in European countries varies between 40 and 140/100 000/year, which equates to more than 500 000 patients with STEMI hospitalized each year. STEMI is defined by chest pain or equivalent symptoms and ST segment elevation or left bundle branch block on diagnostic ECG and subsequent confirmation of diagnosis by cardiac troponin elevation. The cornerstone of STEMI treatment is acute reperfusion therapy preferably with primary percutaneous coronary intervention (PPCI).Objective The general objective of the study proposes to detect the process and outcome indicators contained in the unified PDTA "STEMI Network" of the AST of Ascoli Piceno and the AST of Fermo. The specific objective of the study is to aggregate in percentage form, the Items included in the data collection of patients diagnosed with ACS STEMI taken from the territory by emergency vehicles or arrived in the Emergency Room of the plants mentioned above with their own vehicle, in the 8 extra–hospital indicators provided for by the PDTA through.

Materials and Methods
All medical records diagnosed with SCA STEMI made available by U.T.I.C. have been selected of the HUB Hospital of Ascoli Piceno. All services provided for diagnosis of ACS N–STEMI have been excluded. The analysis period includes the last two months of 2022 and the first six months of 2023. A limitation emerged in identifying whether the rescue vehicle needed remote telephone consultation if the diagnosis had been doubtful in cases where the nursing staff did not use the intervention card provided by PDTA.

Results and Conclusions
Indicators: patients transferred to the HUB center and PCI 120‘ N 45 (85%) Ntot 53; Patients in Spoke and PCI 90‘ N6 (30%) Ntot 20; DIDO &lt;30‘ N9 (45%) Ntot 20; ECG in Triage within 10‘ N29 (41%) Ntot 41; Pre–PCI drug treatment N89 (100%); Arrival PCI Hub 60‘ N13 (62%) Ntot 21; remote consultation N12 (23%) Ntot 53; favorable transmission ECG N31 (58%) Ntot 53. Other timing: FMC/WC ratio N89, average 110’. To reduce the timing target, increase the performance of the indicators according to the standards recommended, the only solution is the training of health personnel who works within the network and information to citizens for an early recognition of symptoms with a consequent first medical contact and the decision to subject the patient to a PCI–W.C. in the shortest possible time for a better long–term outcome term.