bluuebunny/crossref_metadata_2025_split huggingface dataset:
C10 HEART FAILURE DURING ACUTE CORONARY SYNDROME AND THE LONG–TERM RISK OF CANCER DEATH. THE ABC–9* STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Cordiano R , Palmieri R , Merotto D , Menegon F , Petucco S , Dal Bo A , Mahmoud M , Cavuto F 
Published: May 2023

Abstract

Introduction
Emerging evidence suggests that patients with coronary artery disease carry an increased risk of cancer death.

Methods
To assess the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long–term cancer death risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were followed prospectively for 24 years or until death.

Results
All except for three patients completed the follow–up, representing 6913 person–years. Patients‘ mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow–up, 107 patients (19%) died due to cancer; of them, 81 with no HF [79% of patients without HF] and 26 had baseline HF [14% of patients with HF]. The incidence rates for cancer death were 17 and 14 per 1000 person–years for patients with and without baseline HF, respectively (p = 0.48). The risks for cancer death associated with HF were (HR: 1.37; 95% CI: 0.88–2.15; p=0.16). Similar associations were observed among men and women and in patients younger and older than 75 years of age. The unadjusted HRs for incident cancer were (HR: 1.25; 95% CI: 0.61–2.53; p=0.53) and (HR: 1.26; 95% CI: 0.66–2.39; p=0.49) for patients with HFrEF and HFpEF respectively. We observed a positive interaction between age and LVEF for the risk of cancer death (HR: 1.002; 95% CI: 1.001 –1.004; p=0.01) in the unadjusted model.

Results
were the same in the fully adjusted model.

Conclusions
A lack of association between clinical HF at admission for ACS and the long–term cancer death risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.
C11 LARGE PLEURAL AND PERICARDIAL EFFUSION: WHICH DRAIN FIRST?
Authors: De Carlini C , Balestri G , Saltafossi D , Spinelli M , Centola M , Corticelli A , Achilli F 
Published: May 2023

Abstract

Introduction
Large pleural and pericardial effusion is a common finding in lung cancer patients. However, a chronic large pleural effusion and the “lung entrapment” fenomenon, due to the neoplastic lung infiltration, could precipitate the re–expansion pulmonary edema (REPO) after the thoracentesis procedure. REPO is a rare and potentially life–threatening complication after large volume thoracentesis. It is characterized by alveolar infiltration in the reexpanded lung.Indeed, in the presence of “lung entrapment”, REPO development could be due not only to and excessive fluid removal, but also to the development of an excessively negative intrapleural pressure (&lt; – 20 mmHg). As the REPO is often associated to an hemodynamic impairment, in patients with concomitant severe pericardial effusion, this condition could cause cardiac tamponade and the optimal therapeutic approach could be challenging.In this perspective, the decision on the effusion to be drained first, in this population, is not always straightforward.Case report In a 62 years –old woman with severe respiratory failure, a chest CT scan showed a massive left –sided pleural effusion with a complete collapse of the left lung, a severe pericardial effusion (35 mm) and the presence of malignant mediastinal nodes. (Figure 1).In the ICU a left thoracentesis was performed, with an early drainage of 1400 ml, the drain was then clamped. 30 minutes later, the patient developed a severe acute respiratory failure. An urgent chest x ray revealed an ipsilateral pulmonary oedema (Figure2). The patient was then treated with respiratory support with cPAP and intravenous diuretic therapy. Afterward, a rapid hemodynamic derangement occurred, with cardiac tamponade. An emergency echoguided pericardiocentesis was then performed followed by an immediate recovery. A repeated thorax CT scan revealed an advanced pulmonary tumor (Figure 3).

Discussion
In this case all the risk factors for REPO were coexistent: chronic pleural effusion and lung cancer. In addition, the large pericardial effusion represented a complicating factor in this situation as both the cPAP and the REPO’s hypovolemia may have brought to a clinical tamponade. In this context, where a neoplastic severe pleural and pericardial effusions are coexistent, it is essential to know which possible complications may occur after a large volume thoracentesis in order to prevent a high risk urgent pericardial drainage in patient with severe respiratory distress.
C13 AT THE ROOT OF HYPOXIA: NEVER UNDERESTIMATE THE CLINICAL
Authors: Pasero G , Guareschi A , Valli F , Vicenzi M , Mangini A , Carugo S 
Published: May 2023

Abstract
A 74–year–old woman arrived to the ER for syncope, reporting episodes of atypical chest pain for a few months. The initial ECG showed negative T waves in the lateral leads; an echocardiogram documented lower–limit systolic function due to akinesia of the antero–lateral segments and the presence of an ascending aorta aneurysm (AAA). The woman, with multiple cardiovascular risk factors, had previous transmural myocardial ischemia documented by MRI and never investigated with coronary angiography (ICA). Admitted to ICCU for suspected ischemic heart disease, she experienced a sudden clinical deterioration with onset of acute respiratory failure, initially stabilized with noninvasive ventilation. A chest angioCT excluded acute events (pulmonary embolism, aortic dissection) and confirmed the presence of AAA with bovine arch. Given the persistent need for oxygen therapy, closer clinical observation allowed objectification of platypnea–orthodeoxia syndrome (POS) that presented with desaturation, dyspnea, and mental confusion in the orthostatic position that improved with supine position. A bubble test in the two positions documented worsening intracardiac shunt in the sitting position, and a transesophageal echocardiogram showed the presence of a tunnel–like patent foramen ovale (PFO). The patient then underwent ICA that found a stenosis–free vascular tree, but a marked fusiform common trunk aneurysm (CTA) was appreciated. After exclusion of altered cardiopulmonary hemodynamic balance, percutaneous closure of the PFO was performed, which allowed progressive improvement of respiratory exchanges and subsequent complete weaning from oxygen. Typically, PFO occurs in the case of a pulmonary ventilo–perfusory mismatch or right–left shunt (rlS), associating mainly with atrial congenital defects and, to a lesser extent, pulmonary arteriovenous malformations. Sometimes, for POS to occur, the presence of a functional component facilitating rlS is necessary. In our case, it is conceivable that such a contribution was both ab–extrinsic compression of the right atrium by the AAA and compression of the pulmonary trunk at the level of the pulmonary valve by the CTA. This diagnostic hypothesis is compatible with the late presentation.
C14 CASE REPORT: MULTIMODALITY IMAGE–CHALLENGE IN PRIMARY CARDIAC DIFFUSE LARGE B–CELL LYMPHOMA
Authors: Colopi M , Civera S , Mabritto B , Annibali G , Quadri G , Bongioanni S , Aranzulla T , Musumeci G 
Published: May 2023

Abstract
A 76–year–old Caucasian woman presented to our hospital with progressive exertional fatigue and weight–loss over 2 months.Her past medical history revealed a recent local–hospital admission because of atrioventricular third–degree block, requiring permanent pacemaker implan­tation. At presentation her cardiovascular exam was normal.Laboratory studies revealed elevated LDH and PCR; electrolytes, cardiac biomarkers and complete blood count were normal. ECG demonstrated AF and ventricular stimulation.Transtoracich echocardiography showed LV hypertrophy in the basal segments, with normal ejection fraction and a reduced LV–GLS with a relative apical sparing pattern.There was a large, well–circumscribed mass arising from the right atrium, with a contextual moderate pericardial effusion (Fig1).Vasculitic, thrombophilic and infectious work–up were negative.The patient was immunocompetent. CMR was proposed but could not be performed due to patient claustrophobia. ECG gated cardiac CT was carried out for a better differential diagnosis of the mass, as well as to look for possible embolization or primary tumours, in the hypothesis of cardiac metastases. A CT total body showed a large ill–defined mass invading the interatrial and interventricular septum with projections into the left ventricle. Not enlarged lymph nodes were detected with neither hepatosplenomegaly nor abdominal lymphadenopathy. A total body 18FDG PET revealed significant tracer uptake in the heart and pericardium without extracardiac uptake, consistent with a malignant cardiac mass (Fig2).LV endomyocardial biopsy was attempted: pathology revealed large B–cell lymphoma expressing CD20, Bcl–2, Bcl–6, Mum–1, C–myc and with a high Ki67 proliferation rate. The patient underwent six cycles of chemotherapy(R–POCH).Echocardiography imaging after the second cycle showed significant reduction in myocardial wall thickness and concomitant improvement in LV–GLS. Repeated PET–CT scans 6 months post–chemotherapy showed complete remission with no evidence of FDG–avid lymphoma (Fig3). Primary cardiac lymphoma (PCL) is an extranodal non–Hodgkin’s B–cell lymphoma exclusively located in the heart or pericardium, accounting for 1–2% of primary cardiac tumours. PCL often presents with non–specific clinical symptoms making the diagnosis challenging. Multimodality approach and myocardial biopsy are essential in the diagnostic work–up. Early diagnosis and treatment are crucial since a good response to chemotherapy is expected.
C19 A STATISTICAL MODEL TO IMPROVE HEART SCORE IN STRATIFYING THE RISK OF MAJOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH CHEST PAIN
Authors: Bonora A , Turcato G , Bampa B , Lunardi A , Conte S , Tonelli M , Zaboli A , Pratticò F , Pfeiffer N , Maccagnani A 
Published: May 2023

Abstract

Background
Heart Score is a simple and reliable post–test score to predict chest pain patients at higher risk of major adverse cardiac events (MACE), but fails in 1.5 to 2.5% of cases. Aim of this study was to evaluate the effectiveness of the nomogram in improving Heart Score performance.

Methods
In this multicenter retrospective study we considered all the patients consecutively observed for chest pain from January to June 2021 in the Emergency Departments of three Northern Italian hospitals. Main outcome was the onset of MACE within a 3 months–follow–up. All data were carefully recorded and included in univariate analysis. The variables associated with outcome (significance level p&lt;0.1) were subsequently evaluated in multivariate analysis by a Logistic Regression model and, when significant (accuracy level at least 0.5%), included in the final model, the nomogram. The statistical weight of each variable was numerically quantified and the total score corresponded to a risk probability. We further validate the model by internal bootstrap on 5000 patients re–sample. Validation and discrimination were assessed by the area under receiver operating characteristics curve (AUC).

Results
Overall 9837 patients (5863 males, 3974 females, mean age 63 ys) were eligible for the study. In the follow–up period 1671 patients (16.9%) developed a MACE (MACE+). Significant variables (p&lt;0.001) after univariate analysis were: risk factors (median MACE+ 3 vs MACE– 1); Chest Pain Score (median 7 vs 4); lenght of chest pain (median 1 vs 4 hours), electrocardiogram findings and troponin levels (median 70 vs 5). All those were confirmed in the multivariate analysis (p&lt;0.001): risk factors (OR 2.66); Chest Pain Score (OR 1.24); pain duration (OR 1.47); electrocardiogram findings (OR 1.51); troponin levels (OR 2.01). The Logistic Regression model reached a good likelihood level (R=0.685). The individual score of variables in the nomogram contributed to final score from 0 to 220, corresponding to a 3–months MACE risk rate (range 0.1–0.9). Discrimination level of nomogram (AUC 0.954) was higher than Heart Score (AUC 0.935) (p&lt;0.005). In our series 1.6% of MACE+ were “low–risk patients” according to Heart Score, but those reported as low risk (risk rate &lt; 0.2) in the nomogram were only the 0.2% (sensibility 99%, negative predictive value 99%).

Conclusions
In patients observed for chest pain nomogram achieved a more accurate stratification of low–risk ones than Heart Score.
C26 SIDE EFFECTS OF SGLT–2 INHIBITORS IN PATIENTS WITH HEART FAILURE: A META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Pozzi A , Cirelli C , Merlo A , Scangiuzzi C , Rea F , Tavano E , Iorio A , Giovanni C , Senni M 
Published: May 2023

Abstract

Background
sodium–glucose cotransoporter–2 inhibitors (SGLT–2Is) improve prognosis in heart failure patients both with reduced (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. Purpose: estimate the relative risk of side effects in HF patients treated with SGLT–2Is irrespectively from left ventricular EF and setting (acute and chronic HF).

Methods
4 randomized controlled trials (RCTs) enrolling patients with HFrEF 3 RCTs enrolling acute HF and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury diabetic ketoacidosis, hypotension, hypoglycemia, hyperkalemia, hypokalemia, bone fractures and amputations were considered in the analysis.

Results
overall 22687 patients were included in the analysis: 8830 (39%) patients with HFrEF, 12563 (55%) with HFpEF and 1295 (6%) with acute HF. There weren’t differences between SGLT–2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures and amputations. HFrEF patients treated with SGLT–2is had a significative reduction of acute kidney injury [RR 0.54; 95% CI 0.33–0.87) p= 0.011], whereas no differences have been reported in the HFpEF [RR 0.94 (95% CI 083–1.07) p=0.348] and acute setting [RR 0.97; 95% CI 0.58–1.64) p= 0.915] (Fig 1A). A higher risk to develop genital infection [overall 2.82; 95% CI 1.96–4.05) p &lt;0.001] was found irrespectively from EF [HFrEF 2.38 (95%CI 1.34–4.24) p= 0.003; HFpEF RR 3.04 (95%CI 1.88–4.90) p &lt;0.001] (Fig 1B). The risk to develop urinary infections and hypotension was increased in the overall HF population with a RR of 1.15 (95%CI 1.02–1.30) p= 0.028 and RR 1.15; 95%CI 1.02–1.29) p= 0.017, respectively (Fig 2 A–B). This risk was mainly driven by HFpEF patients [RR urinary infections 1.19 (95%CI 1.02–1.38) p= 0.029; RR hypotension 1.23 (95% CI 1.05–1.43) p= 0.011], whereas no differences have been reported in HFrEF [RR urinary infection 1.04 (95%CI 0.80–1.35) p= 0.774; RR hypotension 1.04 (95%CI 0.87–1.24) p= 0.687] and in the acute setting [RR urinary infections 1.19 (95%CI 0.81–1.74) p= 0.375; RR hypotension 1.23 (95%CI 0.78–1.96) p= 0.371].

Conclusions
SGLT–2is increase the risk of genital infections in HF patients. In HFpEF patients SGLT–2Is increase the risk of urinary infections and hypotension compared to placebo, whereas reduce the risk of acute kidney disease in patients with HfrEF.
C30 24–HOUR PULMONARY ARTERY ELASTANCE IS THE STRONGEST HEMODYNAMIC PREDICTOR OF IN–HOSPITAL MORTALITY IN ACUTE DECOMPENSATED HEART FAILURE–RELATED CARDIOGENIC SHOCK
Authors: Baldetti L , Den Uil C , Fiore G , Gallone G , Romagnolo D , De Ferrari T , Peveri B , Cianfanelli L , Calvo F , Gramegna M , Pazzanese V , Sacchi S , Frias A , Ajello S , Scandroglio A 
Published: May 2023

Abstract

Aim
The initial bundle of cares strongly affects hemodynamics in acute decompensated heart failure cardiogenic shock (ADHF–CS). We sought to characterize whether 24–hour hemodynamic profiling provides superior prognostic information as compared to admission assessment, and which hemodynamic parameters best predict in–hospital death.

Methods and results
We included 99 patients (62±14 years, 24.2% females) with ADHF–CS and available admission and 24–hour invasive hemodynamic assessment from two academic institutions. Overall, in–hospital mortality was 28.3%. In the admission multivariable model, age (OR=1.08; 95%CI 1.03–1.13; padj=0.002) and CPIRAP (OR=0.62; 95%CI 0.39–0.90; padj=0.022) were significantly associated with in–hospital death. Among several 24–hour hemodynamic univariate predictors of in–hospital death, pulmonary artery elastance (PaE) was the strongest (AUC 0.73; 95%CI 0.66–0.86). At 24–hours, PaE (OR=5.86; 95%CI 1.87–18.50; padj=0.003), PAPi (OR=0.75; 95%CI 0.55–0.92; padj=0.023) and age (OR=1.08; 95%CI 0.1.03–0.1.14; padj=0.005) were independently associated with in–hospital death. This 24–hour model outperformed admission model (AUC 0.85 [0.76–0.93] vs AUC 0.77 [0.67–0.88]; Figure 1). Patients were then grouped according to the optimal cutpoints of PaE 1.11 mmHg/mL and PAPi 2.12. Patients with high 24–hour PaE exhibited the highest in–hospital mortality at either low and high PAPi. The “high PAPi–low PaE” group had best parameter of (bi)ventricular function and lowest right and left filling pressures; the “low PAPi–low PaE” group exhibited parameters of poor RV function and high RAP (prevalent RV dysfunction); the “high PAPi–high PaE” group had signs of LV dysfunction coupled with parameters of relatively preserved RV function (compensated RV afterload mismatch); finally, the “low PAPi–high PaE” group exhibited worse parameters of LV and RV functions, coupled with high degree of pulmonary circulation overload and high biventricular filling pressures (decompensated RV afterload mismatch). We observed a different mortality in the cohorts identified by this classification (13.5 vs 25.0 vs 50.0 vs 43.8%; p=0.016, Figure 2).

Conclusion
PaE was the most powerful 24–hour hemodynamic predictor of in–hospital death in ADHF–CS. This index, coupled with PAPi, may identify patients with RV afterload mismatch and was independently associated with hospital mortality event after adjustment for multiple clinically relevant variables.
C38 EARLY AND MID-TERM RESULTS FROM THE RESILIA AORTIC TISSUE VALVE ITALIAN REGISTRY (RES-ITA)
Authors: D'Ascoli R , Prestipino F , Luzi G 
Published: May 2023

Abstract

Objective
The objective of our study is to evaluate safety, hemodynamic performance and durability of the new generation aortic bioprosthesis with Resilia Tissue.

Methods
RES-ITA Registry is the Italian multicenter registry created in 2017, enrolling patients who underwent isolated or combined AVR with Resilia tissue valve. The Registry was recently recognized by SICCH as the official national registry of Resilia tissue valve implantations, with Potenza’s Cardiac Surgery Unit as its coordinating center. Isolated AVR (50%) was performed predominantly through an upper J mini-sternotomy or a right anterior mini-thoracotomy, while combined procedures (50%) were performed in full sternotomy and included associated CABG, ascending aorta surgery, mitral valve repair or replacement, aortic annulus enlargement. For all patients, clinical and echocardiographic assessment were evaluated at discharge, 30 days, 6 months and every year after surgery.

Results
Between June 2017 and March 2022, about 1000 patients were included, coming from 13 Italian cardiac surgery centers. During last year, 6 more Italian centers have asked to join the Registry. Mean age was 57±11 years. Mean Euroscore II was 2.24±3.01%. Redo surgery was performed in 11%. Most frequently implanted valve sizes were 23 mm (30%), 25 mm (27.7%) and 27 mm (19%). Two-year freedom from all-cause mortality for isolated AVR and for all patients was 97.4±1.3% and 95.7±1.1%, respectively. Two-year freedom from major paravalvular leaks (≥2+/4) was 98.4±0.8; freedom from prosthesis thrombosis was 96.7±2 and freedom from prosthesis dysfunction (according to VARC-2 criteria) was 96.7±1.7. Mean gradient was 13.3±8.3 mmHg and maximum gradient was 23.2±16.2 mmHg at 2-year follow-up.

Conclusions
The new generation aortic prosthesis with RESILIA tissue demonstrates versatility of use, safety, good early and mid-term outcomes and hemodynamic performance. Further investigations and longer follow-up are needed to evaluate long-term durability.
C40 SYSTEMATIC TOTAL ARCH REPLACEMENT WITH THORAFLEX HYBRID GRAFT IN ACUTE TYPE A AORTIC DISSECTION: A SINGLE CENTRE EXPERIENCE
Authors: Chivasso P , Mastrogiovanni G , Miele M , Colombino M , Triggiani D , Cafarelli F , Leone R , Masiello P , Iesu S 
Published: May 2023

Abstract

Introduction
The traditional surgical management for acute Type A aortic dissection focuses on handling emergencies in the aortic root and ascending aorta. The remaining untreated distal portion of the aorta has a potential risk of rupture or causing malperfusion syndrome. Therefore, an aggressive repair approach using total aortic arch replacement combined with the frozen elephant trunk (FET) implantation has been advocated. We describe the early and midterm clinical outcomes of the Thoraflex Hybrid graft for the treatment of emergency type A aortic dissection.

Methods
Between December 2017 and January 2022, 69 consecutive patients were admitted with acute type A aortic dissection; of those, 66 patients (62.9 ± 10.2 years of age, 81.8% men) underwent emergency hybrid aortic arch and frozen elephant trunk repair with the multibranched Thoraflex hybrid graft and were enrolled in the study. Primary end point were 30 days– and in–hospital mortality. To better clarify the impact of age on surgical outcomes, we have divided the study population into two groups: group A for patients &lt; 70 years of age (47 patients), group B for patients ≥ 70 years (19 patients).

Results
All 66 device implants were technically successful. Mean follow–up was 19.7 ±17.4 months. 30–days– and in–hospital mortality were 10.6 and 13.6%, respectively. Stroke occurred in 3 (4.5%) patients. Two (3.0%) patients experienced spinal cord ischemia. Renal failure requiring CVVH and respiratory failure requiring tracheostomy were 30.3% and 28.8%, respectively. Overall survival for the entire cohort at 3 months, 6 months, 12 months and 24 months was 85%, 80.3%, 76.5%, 74.4% respectively. We did not find any statistically significant difference among the two groups in terms of main post–operative outcomes. The multivariable Cox proportional hazard model showed left ventricular ejection fraction (HR: 0.83, 95% CI: 0.79–0.92, p &lt;0.01), peripheral vascular disease (HR: 15.8, 95% CI: 3.9–62.9, p &lt; 0.01), coronary malperfusion (HR: 0.10, 95% CI: 0.01–0.77, p =0.03), lower limbs malperfusion (HR: 5.1, 95% CI: 1.10–23.4, p = 0.04) and cardiopulmonary bypass time (HR: 1.02, 95% CI: 1 – 1.04, p = 0.01) as independent predictors of long term mortality.

Conclusions
Hybrid aortic arch and frozen elephant trunk repair with the Thoraflex Hybrid graft to treat emergency type A aortic dissection appears to be associated with good early and mid–term clinical outcomes even in the elderly.