bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE COMPLEX WORLD OF NON CRITICAL CORONARY ARTERIES DISEASE
Authors: Aleksova A , Fluca A , Munaretto L , Chiaradia V , Barbati G , Derin A , D‘Errico S , Di Lenarda A , Hiche C , Sinagra G , Janjusevic M 
Published: May 2024

Abstract

Background and Aim
Acute coronary syndrome (ACS) with non–critical coronary arteries represents a major diagnostic, therapeutic and prognostic challenge for clinicians. The aim was to compare clinical–anamnestic characteristics and assess the prognosis of three cohorts with ACS with non–critical coronary arteries i.e. Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA), type 2 myocardial infarction (MI) and Takotsubo syndrome (TTS).

Methods
In this single center observational study, 18223 patients who underwent coronary angiography between 2005 and 2022 were retrospectively analyzed. The final cohort included 676 patients with initial presentation as NSTEMI (301 MINOCA, 237 type 2 MI and 138 TTS).

Results
The median age was 68±11, with the TTS population being the oldest (72±10, p&lt;0.01), presenting greater hypotension (p&lt;0.01), tachycardia (p&lt;0.01), and fewer cardiovascular risk factors, such as diabetes (p&lt;0.01) and hypertension (p&lt;0.01). The TTS cohort had worse LVEF on admission (p&lt;0.01) and on discharge (p&lt;0.01) (Fig. 1). At Kaplan–Meier analysis, patients with type 2 MI were more prone to the composite endpoint, while the TTS group was less likely (p&lt;0.01) (Fig. 2). In the overall cohort, ACEi/ARB therapy on admission was an independent predictor of the composite endpoint (HR: 1.58;p=0.01), while dual antiplatelet therapy (DAPT) (HR: 0.59;p=0.01) and statin (HR: 0.71;p=0.03) at discharge were protective. After stratification according to diagnosis, ACEi/ARB therapy remained a negative predictor only in the type 2 MI cohort (HR: 2.03;p=0.01) as well as beta–blocker therapy at admission in TTS (HR: 2.97;p=0.03), while statin therapy remained protective in the MINOCA (HR: 0.51;p=0.01) and DAPT therapy in the TTS group (HR: 0.21;p=0.04) at discharge. Although a substantial number of patients with all three diagnoses achieved the endpoint, the multivariable Cox regression analysis indicated that type 2 MI, in addition to older age, male gender, worse LVEF, and anemia, is an independent factor for worse outcomes (Fig. 3).

Conclusions
Among all cohorts, T2 MI were associated with worse outcome. The use of DAPT in TTS and Statins in the MINOCA group showed a protective role. Since the TTS population was more compromised, BB use in the ADHF phase of TTS could predict a poorer outcome as much as ACEI/ARB use at admission could be a marker of greater early LV impairment of the T2 MI cohort, which was an independent predictor for worst outcome.
SINGLE CENTER EXPERIENCE IN SURGICAL TREATMENT FOR ACTIVE ENDOCARDITIS BEFORE AND AFTER COVID–19 PANDEMIC
Authors: Mikus E , Fiorentino M , Fiaschini C , Zucchetta F , Sangiorgi D , Calvi S , Tripodi A , Savini C 
Published: May 2024

Abstract

Background
Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life–threatening condition. The impact of COVID–19 on diagnosis and outcome of surgical treatment of IE is uncertain.
The aim of this study was to analyze the incidence, characteristics and outcomes of surgically treated IE before and after the COVID–19 pandemic.

Methods
This study retrospectively analyzed data of 536 patients who underwent valve surgical procedures for IE between January 2010 and December 2022 in a single cardiac surgery center. Patients were divided in two groups depending on the date of operation: before (n=393) and after (n=142) COVID–19 onset. In order to balance the groups, inverse probability of treatment weighting (IPTW) calculated from the propensity score (PS) was applied.

Results
We noticed a significant increase (p=0.006) in the prevalence of infective endocarditis admitted for surgery throughout the years, comparing it to overall hospitalizations in our cardiac surgery department (Figure 1). Patients from the post COVID cohort (after march 2020) had more comorbidities such as diabetes (29.6% vs 16.3% p=0.001), hypertension (71.1% vs 59.5% p=0.015), and preoperative kidney injury requiring dialysis (9.2% vs 2.5% p=0.002), but median additive and logistic Euroscore were not statistically different. In the post COVID group, we observed a greater prevalence of S. Aureus related endocarditis (24.5% vs 15.4% p=0.026), and a consequent reduction in S. non Aureus related endocarditis (12.2% vs 20.1% p=0.048) (Figure 2), a decrease of aortic valve replacement (43.0% vs 53.9%), while the number of mitral valve replacement ad repair resulted to be higher (21.1% vs 15.0% and 6.3% vs 4.3% respectively) (Figure 3). No differences in the two groups concerning early death but also death or relapse at one year after surgery. Data obtained by the multivariable analysis identify the preoperative renal dysfunction requiring dialysis as the only common risk factor for early mortality stratifying by time periods in analysis.

Conclusions
The incidence of surgical treated IE significant increase after COVID–19 pandemic with a higher incidence of mitral involvement instead of aortic valve. Despite the pandemic and the delay in surgical timing, results in terms of mortality and outcomes have improved and were largely unaffected by the COVID–19 pandemic.
THE “SANDWICH” TECHNIQUE IN MITRAL ANNULAR CALCIFICATION
Authors: Brega C , Di Carlo M , Fiaschini C , Pin M , Zucchetta F , Panzavolta M , Ceresa R , Costantino A , Fiorentino F , Mikus E , Longo M , Calvi S , Tripodi A , Savini C 
Published: May 2024

Abstract

Objective
To assess the feasibility and safety of the “Sandwich” technique in case of massive mitral annular calcification (MAC). MAC is a multifactorial chronic disease and a challenging clinical entity to the surgeon: both respecting and resecting techniques have been developed, in order to prevent eventual annular ruptures.

Methods
Twelve patients underwent mitral valve replacement (MVR) between January and September 2023, mainly because of steno–insufficiency of the mitral valve, in presence of MAC. Their mean age was 76 ± 4.5, their BMI was 27.2 ± 2.8 and their surgery was mostly elective, except for one urgent active endocarditis; their mean EUROscore II was 8.2 ± 2.9.

Results
We performed 12 MVR with biological valve, through full sternotomy approach. The cardiopulmonary bypass and aortic cross–clamp time were 195 ± 57 and 155 ± 42 minutes respectively. We perform a double line suture respectful of the annular calcium, in order to reinforce the mitral annulus, before fixing the prosthesis. Surgical stiches on the anterior annulus were ordinarily put; on the posterior annulus, which is usually the most calcified part, a teflon band underneath the calcium was fixed as first, through separate prolene 2–0 U–stitches. Then the usual 2–0 ticron stitches with pledget were put between the posterior annulus and the atrial wall. Both 2–0 prolene and ticron were passed through the prosthesis sewing ring: prolene was placed more externally than ticron. No leakages were found, both intraoperative and postoperative. There were no in–hospital deaths. No strokes, thromboembolic or coronary complications were observed.

Conclusions
The “Sandwich” technique is reproducible, feasible and safe and it does not imply a long surgical learning curve. It is not a disruptive approach, avoiding annulus failure and it is respectful of the cardiac structures.
EARLY SINGLE–CENTER EXPERIENCE IN AORTIC VALVE REPAIR WITH GEOMETRIC RING ANNULOPLASTY
Authors: Maraschioni G , Pocar M , Cura Stura E , Abbà P , Brenna D , Barbero C , Rinaldi M 
Published: May 2024

Abstract

Introduction
Degenerative valve disease is the most common cause of aortic regurgitation (AR) in Western country. These patients are good candidates to aortic valve repair (AVr), avoiding the long–term risks associated with prosthetic substitutes.

Methods
We analyzed retrospectively all AVr procedures with geometric ring annuloplasty at our Division between January 2022 and December 2023.

Results
During the study period, 44 patients underwent AVr at our Division. Mean age was 50.4 years and 37 were male. Mean Logistic EuroSCORE was 4.74%. Mean ejection fraction (EF) was 57% and mean left ventricle (LV) end–diastolic diameter (EDD) and volume (EDV) were 55.1 mm and 159.3 ml, respectively. All but one patient had moderate or severe AR (97.8%). The aortic valve was tricuspid in 24 patients (54.6%) and bicuspid in 20 (45.4%), respectively. The bicuspid cohort were younger (mean age 35.15 vs. 63.2 yo) with more dilated LV (mean EDV 173 vs. 144.5 ml) and annulus (28.3 vs. 25.3 mm). 3 patients had previous cardiac surgery procedures. All patients were operated electively. Cardiopulmonary bypass time was 147.4 min (± 35.7) and aortic cross–clamp time was 124.5 min (± 28.5). In all the patients, AVr was performed with the geometric ring annuloplasty, 24 tricuspid and 20 bicuspid rings. 40 (90.9%) patients needed cusps repair. 22 (50%) patients had concomitant cardiac procedures: 13 patients had ascending aortic replacement (29.5%), 8 mitral valve surgery (1 replacement and 7 repair), 1 tricuspid valve repair, 2 coronary bypass graft and 1 AFib ablation. In 2 patient aortic valve replacement was necessary at the time of AVr because of residual significant AR. Mean length–of–stay in ICU and in hospital were 1 and 6.5 (± 1.7) days. Only 1 patient, already listed for kidney transplantation before surgery, needed dialysis. No other complications were reported, nor intra–operative and in–hospital mortality. At 6–month echocardiographic follow up, the mean post–operative EF was 54.6%, with LV mean EDD and EDV of 49.3 mm and 133.1 ml, respectively. The mean aortic gradient was 12.6 mmHg (±3.5). Only 1 patient was found with severe AR and was successfully reoperated for valve replacement. Only 1 death occurred after discharge within 30 days of surgery, due to extracardiac pathology.

Conclusion
In selected centers, AVr for AR is safe and reproducible procedure alternative to replacement with good early results.
MITRAL VALVE REPLACEMENT OR REPAIR IN INFECTIVE ENDOCARDITIS: ROLE OF THE ISOLATED PATHOGENS ON MORTALITY AND EARLY OR LATE RELAPSE RATE
Authors: Fiorentino M , Mikus E , Costantino A , Pin M , Sangiorgi D , Tenti E , Tripodi A , Savini C 
Published: May 2024

Abstract

Background
Mitral valve repair (MVr) is unquestionably superior to mitral valve replacement (MVR) in non–infective settings. European Society of Cardiology (ESC) and American Association for Thoracic Surgery guidelines recommend repair oxver replacement where possible even for endocarditis. Despite these recommendations, mitral valve repair rates are still low in this population.
The aims of this study were to compare outcome of patients with infective endocarditis undergoing mitral valve repair compared to those undergoing mitral valve replacement and to investigate the impact of microbial etiology on patient outcomes.

Methods
The study retrospectively analyzed 215 patients undergoing valve replacement or repair for endocarditis from January 2010 to December 2022 in a large cardiosurgical center. The primary outcome was a composite outcome of early (30–days) all–cause mortality and/or endocarditis relapse, while the secondary outcome was medium/long term (1 year) all–cause mortality.

Results
A total of 215 patients with either active or healed mitral valve endocarditis were included in our study: 154 (71.6%) underwent mitral valve replacement and 61 (28.4%) underwent mitral valve repair. Patients with multi–valve disease were also included (97, 45.1%). 188 patients (87.4%) were operated in the active phase (80.9% as an urgent/ emergency). In–hospital mortality was observed in 5 patients (8.2%) in the repair group and 19 (12.3%) in the replacement group. Endocarditis relapse occurred in 6 patients (9.8%) in the repair group after a median time of 3.8 months and in 5 (3.3%) in the replacement group after 11.8 months. (p=0.356). Median follow up was 12.6 months. Early and medium survival rates in the propensity–adjusted cohort showed no difference between mitral valve repair and replacement, but resulted to be influenced by the microbial etiology with the worst prognosis for both Staphylococcus aureus and Coagulase–negative Staphylococci.

Conclusions
The choice of surgical treatment strategy in infective endocarditis had no effect on major postoperative complications, mortality, relapse or medium/long–term survival. Mitral valve repair seems to have a major incidence of relapse even though non statistically significant, probably due to the low number of events. Both Staphylococcus aureus and Coagulase–negative Staphylococci are a risk factor for early mortality and relapse rate. Mitral valve repair for endocarditis should be pursued, if feasible.
SPORT INDUCED QT PROLONGATION: DETECTION AND MANAGEMENT OF THIS NEW COMPLEX ENTITY
Authors: Roagna E , Visalli A , Tribuzio A , Saglietto A , Vairo A , Angelini F , Brach G , Deaglio S , Giustetto C , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Introduction
Intense exercise training has been recently associated with QTc prolongation and morphologic repolarization abnormalities, whereas detraining, in asymptomatic genotype negative patients, was associated with ECG normalization. Data about this condition and its best management are scant.

Case
An asymptomatic, 16 years old, competitive basketball player (training load 11 hours/week, significantly increased in the previous 6 months), with negative family history was referred to our Center for the appearance of notched T waves in V2–V3 and of late T wave peak in the other leads, with mild QTc prolongation in DII (455 msec), severe in V2–V3. Holter ECG (12 leads) confirmed the presence of a 2nd dynamic component of ventricular repolarization leading to a markedly prolonged QT (QTc max&gt; 550 ms), that was more evident after sudden heart rate (HR) increases. A genetic test was performed using in silico long QT panel by next–generation sequencing (NGS) and then multiplex–ligation dependent probe amplification (MLPA) to exclude deletions/duplications, and turned out negative. A complete 6–month detraining was recommended. At the reassessment, QTc and morphological abnormalities had both normalized at resting ECG (QTc in DII 401 msec) and for most of Holter ECG (QTc mostly between 375 and 400 msec). A 2nd dynamic component of ventricular repolarization with U wave characteristics could be detected only after sudden HR increases. Exercise stress test confirmed preserved QTc adaptation during exercise and recovery (with a 4th minute recovery QTc of 401 msec). Cardiac ultrasound in detraining showed preserved LVEF (62%) and global longitudinal strain (–23%), with a global electromechanical dispersion of 34 ms and an electromechanical window of –11 ms at 73 bpm. Return to play was granted with a reduced training load (6 hours/week) and mandatory complete cardiological assessment after 6 months (pending). Resting ECG after 3 months was within normal limits.

Conclusion
Our case confirms that intense exercise training can induce dynamic non physiological abnormalities in ventricular repolarization with QTc prolongation, in genotype negative patients. Detraining is therefore mandatory before definitive long QT diagnosis every time this condition is suspected and, if the level of suspicion of an expert Center is high, beta–blocker therapy initiation may be temporarily deferred. Return to play and best subsequent monitoring are still a matter of debate.
CARDIOINSIGHT: A NEW MAPPING SYSTEM
Authors: Bianco Dolino E , Manconi S , Gallone G 
Published: May 2024

Abstract
Cardioinsight is a non–invasive mapping system that collects chest ECG signals and combines them with CT scan data to produce and display simultaneous biatrial and biventricular three–dimensional cardiac maps. Cardioinsight is intended for the collection, analysis, visualization and storage of cardiac electrophysiology data and maps for subsequent medical analysis. It is therefore a device capable of identifying the point from which cardiac arrhythmias originate. Cardioinsight is an innovative system as until 2018 electrophysiological studies were used to study the electrical properties of the heart. The substantial difference between Cardioinsight and electrophysiological studies is that Cardioinsight is non–invasive and allows the point from which the arrhythmia arises to be identified without the need to resort to catheterization and therefore leading to zero risk of intra–procedural and post–procedural complications. The Cardioinsight consists of: the mapping vest and the Workstation. The mapping vest is a non–sterile, disposable device that includes: 3 panels: front right, front left and rear 252 electrodes Connectors that connect the mapping vest to the system The Cardioinsight Workstation consists of the monitor and the amplifier and is always used with the Cardioinsight mapping vest. Cardioinsight has 3 advantages: it is not invasive 3D simultaneous multi–camera mapping: Capable of capturing rhythms that span multiple cameras) a single heartbeat is enough to generate maps.
The use of Cardioinsight requires 3 phases: Prepare the patient and apply the vest Obtain a CT scan and record the signals Combine CT and signal data to create maps The doctor analyzes the maps and plans the next step of care for the patient Treatment can be catheter ablation or stereotactic ablation. The latter provides an alternative therapeutic strategy to traditional ablation as it is non–invasive and painless and consists in the administration of precise and targeted doses of radiation which produce tissue damage resulting in cell death. In our reality we have had the opportunity to use Cardioinsight twice and it has been established that it is a valid alternative to traditional mapping with advantages for the patient and for an optimal path in the search for the most appropriate therapeutic approach.
PERIPROCEDURAL ANTITHROMBOTIC THERAPY AND IN–HOSPITAL OUTCOMES IN OUT–OF–HOSPITAL CARDIAC ARREST PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION
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
Myocardial Infarction (MI) is the leading cause of Out–of–Hospital Cardiac Arrest (OHCA). The management of periprocedural antithrombotic therapy in this setting is still challenging due to limited data available and given the heightened thrombotic and hemorrhagic risks in this subset of patients. We aimed to investigate the application of antithrombotic therapy, in–hospital bleeding rate and mortality in OHCA patients undergoing percutaneous coronary intervention (PCI).

Methods
A multicentric, prospective, observational study was conducted, enrolling all consecutive OHCA patients from January 1st, 2015, to December 31st, 2022, undergoing PCI at 6 Northern Italy centers. Bleeding events were categorized using the BARC (Bleeding Academic Research Consortium) scale, defining major bleeding as BARC ≥ 3.

Results
A total of 623 patients were included; of these, 403 underwent coronary angiography and 249 underwent PCI. Patients’ median age was 64.0 years (54–73); femoral artery was the site of access for PCI in 131 (52.6%) patients. Ticagrelor was the most used oral P2Y12 inhibitor, with 164 patients (65.9%) receiving it, while cangrelor and a glycoprotein (GP) IIb/IIIa receptor inhibitor were used in 27 (10.8%) and 66 (25.3%) patients, respectively. Overall survival rate at hospital discharge was 69.5%. Minor and major bleeding events occurred during hospital stay in 12 (4.8%) and 19 (7.6%) patients, respectively. While the rate of major bleeding was similar among patient groups treated with different oral P2Y12 inhibitors, patients treated with cangrelor or GPIIb/IIIa inhibitors exhibited a higher prevalence of major bleeding events (cangrelor: 7/27 vs 12/219, χ² = 5.4248, p = 0.006; GPIIb/IIIa inhibitors: 9/63 vs 10/183, χ² = 14.0994, p = 0.002). Regardless of baseline bleeding risk, cangrelor was significantly associated with the risk of a bleeding event [OR 6.8 (CI 2.3 to 20.4); p–value &lt; 0.001] and with an increase probability of survival at discharge [OR 3.7 (CI 1.2 to 12.8); p–value 0.037].

Conclusions
In patients with OHCA undergoing PCI, administration of cangrelor was associated with an increased risk of in–hospital bleeding events and, at the same time, with a better survival at discharge. Our results suggest a potential net clinical benefit that may outweigh the increased bleeding risk, possibly due to its protective effect against periprocedural thrombotic events. Specific and larger studies are needed to confirm this hypothesis.
ATRIAL FIBRILLATION IN A CIED POPULATION: RESULTS FROM A TELEMONITORING FOLLOW–UP
Authors: Toniolo S , Veneziano F , Cavedon S , Zimelli E , Mecenero A , Volpiana A , Fortuna G , Dalla Valle C , Dolci G , Battisti V , Loddo I , Verlato R , Bilato C 
Published: May 2024

Abstract

Background
Telemedicine has emerged as a crucial tool in managing patients with Cardiac Implantable Electronic Devices (CIED), addressing the common challenge of the Atrial Fibrillation (AF) in cardiology. The incidence of AF in CIED recipients varies widely (30–70%), influenced by implant indication, device type, and population characteristics. This study aims to evaluate AF in an unselected, real–world CIED population, considering patients’ characteristics and the remote follow–up.

Methods and Results
808 consecutive CIED recipients were evaluated between 2021 and 2023 in two Italian Division of Cardiology by collecting patients’ baseline characteristics and the scheduled remote follow–up data. Mean age was 75.6±12.6 years, 42% were females. 16.7% of the population was working actively and 73% of individuals were assisted by at least one caregiver, reflecting a diminished quality of life (EQ–5D score 8.9±4.3). Over a median follow–up of 20.6 months, 8.9% of patients died. 68.8% of the patients received a pacemaker, 19.3% an ICD and 11.9% a loop recorder. History of AF was present in 40.1% of the population, with a prevalence of permanent AF (46.6%). Ongoing anticoagulant therapy was documented in 303 patients (37.5%), 71% of whom were taking direct oral anticoagulants. Baseline CHA2DS2–VASC score was ≥3 in 79.7%, and the median HAS–BLED score was 1. During the observation period, scheduled remote transmissions revealed 719 AF episodes (15.7 episodes/patient/year), causing 21% of the overall remote alarms. Among patients without AF history, 69 (14.3%) experienced AF episodes (4.8 episodes/patient/year). Notably, 21.8% of the AF episodes lasted less than 10 minutes.

Conclusions
The wide spreading of heart rhythm monitoring technologies reveals the challenge of the subclinical AF in healthcare systems. This study, encompassing an unselected CIED population of elderly and frail patients with high AF prevalence, highlights AF as a primary cause of remote alerts and a substantial burden in telemonitoring controls. Telemedicine facilitated new AF diagnoses in 14.3% of individuals without a prior AF history and resulted a valuable tool considering the significant cardioembolic risk in these patients. However, the initiation of anticoagulation therapy remains debatable, especially for episodes of brief duration which in our experience exceeded 20% of the cases.