bluuebunny/crossref_metadata_2025_split huggingface dataset:
C23 ELECTROCARDIOGRAPHIC PREDICTORS OF PRIMARY VENTRICULAR FIBRILLATION DURING A FIRST ACUTE MYOCARDIAL INFARCTION
Authors: Ruffinazzi M , Baldi E , Camporotondo R , Angelini F , Peano V , Picollo C , Cerea P , Kotta M , Cipriani A , Cacciavillani L , Dossi F , Noussan P , Caputo M , Auricchio A , Crotti L , Gnecchi M , Schwartz P , De Ferrari G , Dusi V 
Published: May 2023

Abstract

Introduction
Few small studies evaluated electrocardiographic (ECG) predictors of ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). None accounted for the time between symptom onset and ECG.

Objectives
To evaluate the ECG predictors of primary VF in the PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) population. Patients and methods: PREDESTINATION is an ongoing, prospective, multicenter, case–control study (1:2 match for sex and age) enrolling patients aged 18–80 with a first AMI, whether complicated (cases) or not (controls) by primary VF before reperfusion. For the present analysis, we matched 1:1 for age, sex, infarct site, and symptom–ECG time, the ECGs of cases before VF and those of controls revascularized at least 60 minutes after symptom onset. ECG traces were digitized in pdf and enlarged by 400%. Three blind analyzes were performed: on the entire population, on only anterior and only non–anterior AMI.

Results
PREDESTINATION currently includes 1478 patients (mean 59 years, 83% male), 533 of whom are cases. Among the cases, only 59 (58 ± 11 years, 10% females, 64% with anterior AMI, mean symptoms–ECG time 78±60 minutes, mean ECG–VF time 23±15 minutes) had a pre–VF ECG of adequate quality. Both in the general population (118 ECGs) and in anterior AMIs subgroup (76 ECGs), the presence of ventricular (VEB) or supraventricular ectopic beats (SVEB) was associated with an increased risk of developing VF (maximum OR 8.35 for VEBs in anterior AMIs). In the subgroup of anterior AMIs, the Tpeak–Tend interval in non–infarction leads, both corrected for the RR interval (Bazett) and for the QT interval (TpTe/QT) was significantly longer in cases compared to controls. A TpTe/QT ≥0.33 in non–infarction leads was associated with an OR of 4.6 (p=0.02) of developing VF.

Conclusions
the present analysis, aimed at identifying ECG predictors of primary VF, is the first to perform a rigorous case–control matching including symptom–ECG time. In addition to ectopic beats, a well–known marker and promoter of electrical instability, we identified, only for anterior AMIs, a single additional predictor (TpTe/QT), which correlates with an increased dispersion of repolarization and consequently of ventricular refractoriness.
C24 MICROALBUMINURIA DURING ACUTE CORONARY AS LONG–TERM PROGNOSTIC FACTOR. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC–9 STUDY ON HEART DISEASE
Authors: Berton G , Cordiano R , Palmieri R , Cavuto F , Mohammed Ahmed M , Bagato F , Merotto D , Menegon F , Palatini P , Mahmoud H 
Published: May 2023

Abstract

Background
Microalbuminuria is one of the earliest biomarkers of kidney injury that reflects an endothelial dysfunction with increased glomerular permeability and it is independently associated with adverse outcomes in several clinical situations.

Methods
To evaluate the very long–term prognostic yield of baseline microalbuminuria in patients with acute coronary syndrome (ACS), we prospectively studied 589 ACS patients admitted to three Italian hospitals. The baseline albumin/creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24–h urine samples. Patients were followed for 24 years or until death.

Results
Virtually all patients completed the follow–up, representing 7066 person–years. During follow–up, 482(82%) had died: 38% due to non–sudden cardiac death (non–SCD), 19% sudden cardiac death (SCD), and 43% due to non–cardiac (non–CD) death. Throughout the 1st admission week, ACR was consistently higher in the patients who died during follow–up than in those who survived. Similar higher values were found for deaths from non–SCD causes. The unadjusted Cox regression analysis revealed that ACR is a significant predictor of all–cause mortality (HR:1.24; 95%CI 1.20–1.28; p&lt;0.0001) and the 3 causes of death (HR:1.38; 95%CI 1.31–1.45; p&lt;0.0001), (HR:1.16; 95%CI 1.07–1.25; p=0.0001) and (HR:1.17; 95%CI 1.10–1.23; p&lt;0.0001) for non–SCD, SCD and non–CD respectively. Yet the fully adjusted model showed that ACR is a significant independent predictor of all–cause mortality (HR:1.10; 95%CI 1.08–1.14; p&lt;0.0001) and only non–SCD (HR:1.18; 95%CI 1.12–1.25; p&lt;0.0001). A positive interaction between ACR and the presence of heart failure during admission (HR:1.12; 95%CI 1.02–1.24; p=0.02) and a negative interaction with LVEF (HR:0.86; 95%CI 0.78–0.95; p=0.004) for all–cause death was also observed at the multivariable level.

Conclusion
This prospective study shows that baseline ACR during ACS seems to be a strong independent long–term risk predictor, chiefly associated with non–sudden cardiac death. Positive independent interaction with indicators of heart failure has been also observed.
C25 TEMPORAL TREND MORTALITY AND IN–HOSPITAL MORTALITY PREDICTORS IN AN ISCHEMIC CARDIOGENIC SHOCK POPULATION: A 10 YEARS SINGLE–CENTRE RETROSPECTIVE STUDY
Authors: Belfioretti L , Marini M , Francioni M , Battistoni I , Angelini L , Matassini M , Pongetti G , Shkoza M , Piva T , Compagnucci P , Munch C , Dello Russo A , Di Eusanio M , Perna G 
Published: May 2023

Abstract

Background
Cardiogenic shock (CS) after acute myocardial infarction (AMI) represents the most severe form of acute heart failure (AHF) syndromes with an high rate of in–hospital mortality. Purpose describe predictors of in–hospital mortality; evaluate ten years mortality temporal trend in our CICU; assess the feasibility of CARDSHOCK risk score; elaborate a simpler version of CARDSHOCK risk score.

Methods
All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study.

Results
We included 167 patients [males 67%; age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 mmol/L. All patients required inotropes: 71% required dopamine, 65% noradrenaline, 32% dobutamine; 32% adrenalina,17,4% received levosimendan alone. Mechanical cardiac support (MCS) was pursued in 91,1% [65% IABP, 23% Impella CP, 4% VA–ECMO]. From March 2012 to July 2021 we observed a significative temporal trend mortality reduction (p=0.0015) from 57% of first time–quartile to 29% of the fourth quartile (fig1). In addition we noted a significant increase in Impella catheter use (p=0,0005) with a consequent reduction of IABP (p=0,01), a reduction in dopamine administration (p=0,007) and a greater use of inotropic drugs with vasodilatory action (p=0,015 and p=0,001). In our population of AMI–CS patients CARDSHOCK risk score was a reliable in–hospital mortality predictor tool (p=0.00011). After the multivariate analysis only EF at baseline (p=0,009), lactate level at presentation (p=0,015) and presence of three–vessels CAD (p=0,0038) resulted to be in–hospital mortality predictors. A new prediction model composed by those three variables was created and it exhibited better predictive performance for in–hospital mortality than Cardshock risk score (AUC 0,94 vs 0,72 respectively, p=0,015) (fig2).

Conclusions
In our retrospective single–centre study a significant reduction of mortality through the years is observed, probably due to more extensive use of micro axial pumps and a greater use of inodilators drug therapies. Cardshock risk score represents a feasible tool to predict in–hospital mortality also in our sample composed only of ischemic CS patients. A new prediction model composed by three clinical variables demonstrates at least the same predictive performance but future validation in a larger population could be advisable to validate the simplified score.
C36 NON–CYCLIC INTERMITTENT PROSTHETIC MITRAL VALVE DYSFUNCTION: A CASE REPORT OF A DIFFICULT DIAGNOSIS CONFIRMED WITH MULTIMODALITY IMAGING
Authors: Piroli F , Mantovani F , Faragasso E , Andreoli A , Guiducci V , Fiorani V , Pergola V , Navazio A 
Published: May 2023

Abstract
A 59–year–old man,obese,with history of hypertension, 3 years ago underwent mitral valve (MV) replacement with a mechanical prothesis(Sorin Bicarbon 31) and preservation of the native subvalvular apparatus for severe mitral regurgitation due to anterior leaflet flail. Pre–discharge transthoracic echocardiography (TTE) showed normal prothesis function (mean pressure gradient (PG) 3,2mmHg), no valvular leaks and a normal ejection fraction (EF). Lately, the patient was admitted twice to emergency department for signs of heart failure, solved with increasing dose of oral diuretics. In both cases a TTE showed a normal EF, a trans–prosthetic mean PG of 6,5mmHg and no valvular impairment/leaks. Since the suboptimal TTE acoustic windows, a transesophageal echocardiography (TEE) was recommended. TEE showed a normal motion of both MV discs and no pannus/thrombus or leaks with the use of a 2–beat acquisition protocol. However, with longer observation a pattern of non–cyclic intermittent valve dysfunction was noted: whereas some cardiac cycles showed normal discs’ motion, other cycles demonstrated an emi–disc opening delay or blockage during diastole with significant prolongation of transmitral pressure half–time and higher transvalvular gradient, suggestive of flow impairment. A cine fluoroscopy and a CT assessment were also performed, showing the visible intermittent pattern of valve dysfunction without radiological signs of thrombosis or pannus. At this point, the interference of the MV apparatus with the emidisc was considered the most probable mechanism of dysfunction. A Heart Team decision toward reintervention was taken since the risk of a sudden worsening of the mechanical valve function, with potentially lethal consequences, was considered high. The surgeon at visual inspection confirmed the interference of the subvalvular apparatus with the posterior emidisc motion. The chronic shear stress generated on the mitral remnant likely developed a progressive fibrotic response that determined the thickening of the tissue and the periodical entrapment of the disc. MV prothesis was replaced with resection of the subvalvular apparatus. At dismissal,TTE evaluation showed normal valvular function confirmed at 6 months follow–up. Intermittent prosthetic MV dysfunction is a rare but potentially serious complication of MV replacement with subvalvular apparatus preservation. TEE, cine–fluoroscopy and CT may be useful as complementary tools to detect this rare complication.
C37 PROGNOSTIC IMPLICATION OF PREOPERATIVE ANEMIA IN REDO CARDIAC SURGERY: A SINGLE CENTER PROPENSITY MATCHED ANALYSIS
Authors: Rubino A , Montella A , Golini Petrarcone C , Palmieri L , Galbiati D , De Feo M , De Santo L 
Published: May 2023

Abstract
Preoperative anemia has been associated with increased morbidity and mortality after cardiac surgery, but little is known on its prognostic value in the setting of redo procedure. This study aimed to investigate whether preoperative anemia is an independent determinant of adverse events in this augmented risk patients’ subset. A retrospective, observational, cohort study of prospectively collected data was undertaken on 409 consecutive patients referred for redo cardiac procedures between January 2011 and December 2020 (mean age of 62 ± 12.7 years, octogenarians 5.6%, female 52.8%, diabetes 19.5%, chronic kidney disease 30%, urgent/emergent status 34.8%, third–time sternotomy 9.8%). The EuroSCORE II calculated an average mortality risk of 25.7 ± 15.4%. The prevalence of preoperative anemia (according to World Health Organization definition) and its relationships with postoperative morbidity were obtained. Selection bias was balanced with propensity–matching method. The prevalence of preoperative anemia was 41%. In unmatched analysis, significant differences between the anemic and non–anemic group emerged in the risk of postoperative stroke (0.6% vs 4.4%, p = 0.023), postoperative renal dysfunction (29,7% vs 15.6%, p = 0.001), need for prolonged ventilation (18.1% vs 7.2%, p = 0.002), high dosage inotropes (53.1% vs 32.9%, p &lt; 0.001) along with both length of ICU and hospital stay (8.2±15.9 vs 4.3±5.4 days, p=0.003 and 18.8±17.4 vs 14.9±11.1, p=0.012 ). After propensity matching (143 pairs), preoperative anemia was still significantly associated with postoperative renal dysfunction, stroke and need for high dosage inotropes. Preoperative anemia is significantly associated with acute kidney injury, stroke and need for high dosage inotropes in patients referred for redo procedures. Further studies are warranted to determine whether preoperative low hemoglobin concentration is a marker of severity of illness or a modifiable risk factor.
C39 TOTALLY ENDOSCOPIC VALVE SURGERY: FEASIBILITY AND ADVANTAGES IN OBESE PATIENTS
Authors: Zoni D , Cresce G , Hinna–danesi T , Salvador L 
Published: May 2023

Abstract

Objective
Obesity is a relative contraindication to Minimally Invasive Cardiac Surgery because of its technical challenges. Aim of the study is to evaluate if totally endoscopic approach is feasible in treating heart valve’s pathology in obese patients and if 30–days outcomes and complications are non–inferior to non–obese patients.

Methods
From January 2018 to June 2022, 1544 consecutive unselected patients underwent totally endoscopic heart valve treatment at our institution. Treated valves were aortic, mitral, tricuspid in various combination. Concomitant procedures and different etiology were included. Among them, 177 were obese people and 1367 were non–obese based on Body Mass Index (BMI). Main working port was obtained with limited skin incision: peri–areolar/sub–mammary for mitral and tricuspid treatment, right anterior mini–thoracotomy for aortic valve treatment. We used a 5 mm 30° endoscope and 2 additional 5 mm miniport for vent line and aortic clamp. Neo–chordae implantation plus annuloplasty ring was the preferred technique for mitral repair.

Results
Median BMI and 1°– 3° quartiles in non–obese group was 24 [22 – 26] and inferior to obese group 32 [30 – 33] (p &lt; 0.01). In both group CPB and Cross Clamp median time was not statistically significant: 147 minutes [121 – 181] vs 150 minutes [126 – 195] (p = 0.69), 95 [77 – 120] vs 97 [79 – 122] (p = 0.39). Conversion to full sternotomy occurred in 14 cases (0.9%) in non–obese patients vs 2 cases (1.12%) in obese patients (p = 0.89). Oro–Tracheal intubation median time was 5 hours [4 – 7] in non obese versus 6 hours [4 – 8] in obese (p &lt; 0.01). ICU median hours stay were 20 [16 – 40] vs 24 [18 – 48] respectively in non–obese and obese group (p &lt; 0.01). Post–operative hospitalization median stay was 5 days [4 – 7] vs 6 days [4 – 8] in obese group (p = 0.06). Stroke occurred in 15 non–obese patients (0.9%) vs 3 obese patients (1.6%) (p = 0.42). Wound complications occurred in 9 non–obese patients (0.65%) vs 5 obese patients (2.8%) (p = 0.52). All cause of mortality was 18 (1.1%) in non–obese vs 6 (3.3%) in obese (p = 0.11).

Conclusions
Surgery was feasible in both groups with comparable CPB and Cross–Clamp time, no difference in surgical revision rate and sternotomic conversion. Obese patients had slightly longer OTI time and ICU stay. However hospitalization days, mortality, stroke and wound complications rate were not different. Totally endoscopic approach was essential to achieve these results.
C42 OR 1896 EXERTS POSITIVE INOTROPIC EFFECTS IN ISOLATED HUMAN RIGHT ATRIAL MUSCLE
Authors: Neumann J , Gergs U , Berbhardt M , Hofmann B , Rayo–Abella L 
Published: May 2023

Abstract
Levosimendan is approved for use as an intravenous agent to treat temporarily patients with severe systolic heart failure. It is thought, but hitherto never tested in isolated human cardiac tissue, that the main metabolite of levosimendan, called OR 1896, might cause the positive inotropic effect of levosimendan in patients. For comparison, we studied mouse atrial preparations. OR alone (up to 10 µM) failed to increase force of contraction in mouse atrial preparations while in the presence of the phosphodiesterase (PDE) IV–inhibitor rolipram (0.1 µM) profound positive inotropic effects and positive chronotropic effects of OR 1895 were recorded in mouse atrial preparations. In contrast to mouse atrium, we noticed that OR 1896 alone (0.01 µM to 10 µM cumulatively applied) exerted time– and concentration–dependent positive inotropic effects 1 µM increase by 72 ± 14.7%, p&lt;0.05, n=7) and shortened the time of relaxation (by 7 .3 %, p&lt;0.05, n=7) in isolated electrically paced human right atrial muscle preparations (obtained during cardiac surgery), that started at 0.1 µM and plateaued at 1 µM OR 1896. The positive inotropic effect of OR 1896 was antagonized by 10 µM propranolol. The positive inotropic effect of OR 1896 in mouse atrial preparations and human right atrial preparations was less effective than that of 1 µM isoprenaline (human atrium by 154 %). The positive inotropic effect of OR 1896 was diminished by pre–incubation of the samples with the PDE III inhibitor cilostamide (10 µM). EMD 57033 (10 µM), a calcium sensitizer, increased force of contraction further in the additional presence of 1 µM OR 1896. Our data suggest that OR 1896 is indeed a positive inotropic agent in the human heart and that OR 1896 acts mainly as a PDE III – inhibitor because the effect of OR 1896 was attenuated by a β–adrenoceptor antagonist and thus OR 1896 is unlikely to act as a calcium sensitizer in the human heart.
C44 ATRIAL SEPTAL ABNORMALITIES: A CASE OF DOUBLE INTERATRIAL SEPTUM
Authors: Molisana M , Cicchitti V , Bagicalupi E , Ianni U , Procopio A , Toro A , Parato V , Gallina S , Ricci F , Zimarino M 
Published: May 2023

Abstract
The Case A 41–year–old asymptomatic male was referred to our cardiology outpatient clinic for diagnostic evaluation of a suspected bicuspid aortic valve at transthoracic echocardiography. Trans–oesophageal imaging ruled–out the bicuspid aortic valve, but detected an accessory membrane lining the interatrial septum with a double–layered appearance encompassing most of the fossa ovalis. Agitated saline infusion demonstrated an inter–atrial communication with right–to–left shunt under Valsalva manoeuvre. Cardiovascular magnetic resonance cine imaging confirmed the presence of a double interatrial septum featuring a midline recess enclosed by the two septa. Under end–expiratory breath–holding conditions, a transient right–to–left shunt was observed confirming the echocardiographic evaluation (Panel 1). No history of cerebrovascular disease and no clinical or imaging findings of right heart overload were registered.

Discussion
Double interatrial septum is a rare congenital condition, by morphological side, allegedly associated with an increased risk of left–sided embolic events due to blood stasis within the accessory interatrial chamber, that is often found in continuity with both atria through patent foramen ovale or additional septal fenestrations. In this case, multimodality imaging effectively was able to detect the presence of this rare atrial septal abnormality and to distinguish that from others alterations of the interatrial septum shown in the table below (Table 1). Nevertheless, the clinical significance of double interatrial septum remains uncertain, no clear relationship with embolic stroke is known and no recommendation can be made regarding the decision–making for long–term anti–thrombotic management. High quality evidences are needed to evaluate whether double atrial septum or other atrial septal abnormalities might be considered as actionable risk factors of ischemic stroke or not.
C45 MULTI–INSTITUTIONAL ITALIAN EXPERIENCE OF ATRIAL FLOW REGULATOR DEVICE IN CONGENITAL AND ACQUIRED HEART DISEASE
Authors: Cuppini E , Castaldi B , Sirico D , Piccinelli E , Butera G , Di Salvo G 
Published: May 2023

Abstract
The Atrial Flow Regulator is a self–expandable nitinol device implanted into the interatrial septum to establish a communication with a predetermined diameter.The creation of such shunt is advisable in several cardiovascular diseases.In pediatric population,the experience is limited to a few case reports describing patients with failing Fontan,pulmonary hypertension,or severe heart failure.We aim to report the preliminary data of Italian registry of AFR implantation in children with heart failure in congenital and acquired heart disease.The goal is to create a local and national register,to monitoring the safety and efficacy of the AFR in pediatric population.The register is prospective and multi–institutional, with 2 centers involved: Pediatric Cardiology department of Padova Hospital and of Bambino Gesù Hospital in Rome,started on the 27/11/2021 and ongoing.AFR implantation was proposed for all patients with symptomatic heart failure,not responding to maximal medical therapy and a history of complex congenital or acquired cardiac diseases.We enrolled 8 patients (median age 124 months)indications were LV systolic dysfunction in 4 patients,restrictive cardiomyopathy with pulmonary hypertension in one, post–operative RV dysfunction after surgical repair of a native TOF and 2 patients with failing Fontan.AFR implantation was successfully reached in all 8 patients.In one case,it was performed a hybrid procedure during pulmonary artery surgical banding, with peratrial approach through the right atrial free wall.Atrial septostomy was needed in 5 cases, in the other 3 cases pre–existing PFO and ASD were used.Balloon pre–dilation was performed in 4 cases.Mean time of procedure was 50 minutes and median radiation exposure dose was 3 Gy/cm2.No complications were reported during the procedure.No acute or sub–acute shunt occlusion or stroke was observed.One patient died of sepsis not related to the procedure;one patient presented a cardiac arrest due to a cerebral ischemia 24 hours after the procedure.Heparin or aspirin were administered to all patients for at least 6 months.Clinical improvement was observed in all patients with an increase in ejection fraction (p=0.02), reduction in LA dilation(p&lt; 0.05)and in HF symptoms(62% of patients improved their NYHA class).AFR implantation is safe and feasible in children with specific congenital and acquired heart diseases,allowing right/left cavities unloading and improvement of hemodynamics and symptoms.