bluuebunny/crossref_metadata_2025_split huggingface dataset:
C50 VERY LONG TERM FOLLOW UP OF PRIMARY TRANSCATHETER PATENT FORAMEN OVALE CLOSURE FOR MIGRAINE CURE
Authors: Rigatelli G , Filippo G , Russo M , Adami A , Aggio S , Roncon L , Zuin M 
Published: May 2023

Abstract

Background
Results of previous trials about PFO closure as a treatment for migraine are still doubtful and inconclusive. We sought to evaluate the long–term (&gt;10 years) effectiveness of migraine treatment by means of patent foramen ovale (PFO) closure.

Methods
From 2006 to 2010, 86 patients (68 female, mean age 40.0 ±3.7 years) with disabling, medication–refractory migraine and PFO were enrolled in a prospective study over a 48–month period. Criteria for transcatheter closure were all the following: presence of a permanent right–to–left shunt (RLS) having a shower/curtain pattern, presence of interatrial septal aneurysm and Eustachian valve, 3 to 4 class Migraine Disability Assessment Score (MIDAS), coagulation abnormalities, and medication–refractory migraine with or without aura.

Results
Forty patients (46.5%) (34 females, mean age 35.0±6.7 years, mean MIDAS 35.8 ± 4.7) underwent transcatheter closure. After a mean follow–up of 118.2 ±19.1 months (range 96 to 144), 37 patients continued the follow–up and experienced symptomatic improvement: aura was abolished in the totality of patients along with a durable improvement of migraine throughout the extended follow up also in patients without aura. The mean MIDAS significantly decreased in the closure group (p&lt;0.0001) (Figure 1). Patients with complete migraine resolution presented a shorter history of migraine, a more severe thrombophilic profile, more severe RLS and larger left atrial diameter and volume.

Conclusions
Primary transcatheter PFO closure in selected high–risk patients having disabling refractory migraine resulted in abolition of aura and in a sustained reduction in migraine in the very long–term period.
C53 EFFECTS OF CARDIAC CONTRACTILITY MODULATION THERAPY ON LEFT VENTRICLE GLOBAL LONGITUDINAL STRAIN AND MYOCARDIAL MECHANO–ENERGETIC EFFICIENCY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Martucci M , Kittleson M , De Vivo S , D’Onofrio A , Ammendola E , Nigro G , Contaldi C , Errigo V , Pacileo G , Masarone D 
Published: May 2023

Abstract

Background
Impairment of myocardial mechano–energetic efficiency (MEE) is present in virtually all patients with heart failure with reduced ejection fraction (HFrEF). Cardiac contractility modulation (CCM) improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling in patients with HFrEF. However, the effects of this innovative therapy on mechano–energetics efficiency and global longitudinal strain (GLS) are still unknown; therefore, the aim of this study is to evaluate whether CCM therapy can improve the MEE of patients with HFrEF.

Methods
We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic data were obtained from all patients 24 hours before and six months after CCM therapy.

Results
At six months, follow–up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8+7.1 vs. 36.1+6.9%; p = 0.032) as well a rise of GLS 10.3+2.7 vs.–12.9+4.2; p = 0.018), of MME (32.2 + 10.1 vs. 38.6 + 7.6 mL/s; p = 0.013) and of MEE index (18.4 + 6.3 vs 24.3 + 6.7 mL/s/g; p = 0.022).

Conclusions
CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi.
C54 ACUTE AND LONG TERM PERFORMANCE OF MAGMARIS BIORESORBABLE SCAFFOLD IMPLANTATION IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD): THE EXPERIENCE OF THE COORDINATOR CENTER OF THE INTERNATIONAL MULTICENTER REGISTRY DISCO
Authors: Giacobbe F , Cerrato E , Pavani M , Rolfo C , Biolé C , Bianco M , Franzé A , Zanda G , Piedimonte G , Lo Savio L , Celentani D , Lococo M , Tizzani E , Tomassini F , Chinaglia A , Varbella F 
Published: May 2023

Abstract

Background
Spontaneous Coronary Artery Dissection (SCAD) is a challenging clinical scenario and represents an increasingly studied cause of acute coronary syndrome (ACS). An interventional strategy in these cases remains controversial since it may require an extensive permanent metallic stenting of vessel to seal the dissection with a non negligible rate of complications. Moreover, SCAD patients are usually young women with non–calcified disease where Bioresorbable Scaffolds (BrS) may be an intriguing option.

Methods
DISCO IT/SPA is a International observational registry which retrospectively enrolled patients admitted with a diagnosis of SCAD across 26 Italian and Spanish centers. Baseline, procedural characteristics, in–hospital management and outcomes of 369 SCAD patients were collected, of these 12 patients were treated with PCI with BrS MAGMARIS at the coordinator center of Rivoli and Orbassano. Major cardiovascular events (MACEs) were defined as the composite of cardiovascular death, non–fatal Myocardial infarction (MIs) and any PCI performed.

Results
In our cohort of SCAD patients treated with BrS there was a slight prevalence of women (n=7, 58,3%) with an average age of 50,9±7,4 years. NSTE–ACS was the most common clinical presentation (83,3%), followed by STEMI (16,7%). In 7 patients the first treatment choice for SCAD was PCI with BrS deployment, in 5 patients BrS were deployed during hospitalization for unplanned PCIs (four of them) and after one month for a MI due to SCAD recurrence in the last patient. Multivessel disease was present only in one case and LAD–DG was the main vessel affected (n=10, 83,3%). SCAD type 2A was the most frequent (41,7%). Intravascular imaging was performed in 10 cases (83,3%) and procedural success was achieved in all cases. Angiographic follow–up was obtained in 9 patients (75%), through coronary angiogram (n=8) or CT scan (n=1), at a mean length of 5,2±5,6 months. In–hospital MACE were 5 (23,8%) but none of them occurred after BrS deployment. The only MACE reported after BrS deployment was an unplanned PCI for SCAD progression.

Conclusions
In SCAD bioresorbable scaffolds represent an excellent option to preserve the natural physiology of the coronary vessels. Notably, in our cohort we reported a very high procedural success rate in PCI assisted in large part by intracoronary imaging. Further studies with larger numerosity are needed to demonstrate the advantages of this type of scaffold in these patients.
C60 MYOCARDIAL T1 MAPPING IN ANDERSON–FABRY DISEASE AND ITS CORRELATION WITH GENETIC ANOMALITIES
Authors: Casavecchia G , Mautone F , Pesolo M , Gravina M , Brunetti N 
Published: May 2023

Abstract

Objective
Cardiac involvement in Anderson–Fabry Disease is possible even in mild forms, and new analytical methods and the quantitative value evident with the T1 Native sequence for Mapping study demonstrated a linear correlation with disease severity compared with traditional MR sequences. GLA gene alterations on the X chromosome are very heterogeneous and correlated with decreased or absent alpha–galactosidase enzyme, resulting in different timing of manifestation and clinical evolution. In addition to the classic form of central nervous system, kidney and heart involvement there is a variant with only cardiac involvement, also found in our study. Materials and

Methods
We retrospectively analyzed 18 consecutive Cardiac MRI examinations performed in patients with established Anderson–Fabry disease at the University Radiology Department of Policlinico Riuniti di Foggia from August 2019 to January 2022. Native T1 sequences for T1 Mapping study are currently the gold standard for evaluation of cardiac involvement in Anderson–Fabry disease.

Results
T1 Mapping values were lower with characteristic normality of ECV after mdc. In PSIR sequences acquired after mdc for the study of "Late Gadolinium Enhancement" usually a mesocardial signal hyperintensity of the infero–lateral wall of the left ventricle characterized by fibrotic deposits is evident but this sign usually occurs when the heart is already hypertrophied. Instead, reduced Native T1 values serve as an early marker of myocardial involvement, even before the development of hypertrophy as also found in our study population. In fact in 10 out of 18 patients the only value indicating myocardial involvement was reduced T1 Mapping Native values below 1000 in at least 3 out of 17 segments. In 6 cases there was concentric left ventricular wall hypertrophy and in 2 cases mesocardial hyperintensity was evident in the PSIR sequences for the "Late Gadolinium Enhancement" study of the basal segments of the infero–lateral left ventricular wall.

Conclusions
Magnetic resonance imaging plays a key role in the study of cardiac involvement in Anderson–Fabry disease with potential to predict the extent of detectable accumulation at the cardiac level based on the genetic abnormality.
C63 PREVALENCE AND CLINICAL SIGNIFICANCE OF RIGHT VENTRICULAR PULMONARY ARTERIAL UNCOUPLING IN CARDIAC AMYLOIDOSIS
Authors: Palmiero G , Monda E , Verrillo F , Dongiglio F , Caiazza M , Rubino M , Lioncino M , Diana G , Vetrano E , Fusco A , Cirillo A , Mauriello A , Ciccarelli G , De Rimini M , D’Alto M , Cerciello G , D‘Andrea A , Golino P , Calabrò P , Bossone E , Limongelli G 
Published: May 2023

Abstract

Background
This study aims to evaluate the prevalence and clinical significance of the right ventricular pulmonary arterial (RV–PA) uncoupling in patients with cardiac amyloidosis (CA).

Methods
The study population consisted in 92 consecutive patients with CA (age 71.1±12.2 years, 71% males; 47% with immunoglobulin light chain (AL), 53% with transthyretin [ATTR]). All patients underwent a comprehensive evaluation. A pre–specified tricuspid annulus plane systolic excursion on pulmonary arterial systolic pressure (TAPSE/PASP) value &lt;0.31 mm/mmHg was used to define RV–PA uncoupling and to dichotomize the study population.

Results
Thirty–two patients (35%) showed RV–PA uncoupling at baseline evaluation (15/44 [34%] AL and 17/48 [35%] ATTR). Patients with RV–PA uncoupling in both AL and ATTR showed worse NYHA functional class, lower systemic blood pressure, and more pronounced left and right ventricular systolic dysfunction than those with RV–PA coupling. During a median follow–up of 8 months (IQR 4–13), 26 patients (28%) experienced cardiovascular death. Patients with RV–PA uncoupling showed lower survival at 12 months follow–up than those with RV–PA coupling (42.7% [95%CI 21.7–63.7%] vs. 87.3% [95%CI 78.3–96.3%], p–value&lt;0.001). Multivariate analysis identified high–sensitivity troponin I values (HR 1.01 [95%CI 1.00–1.02] per 1 pg/mL increase; p–value 0.013) and TAPSE/PASP (HR 1.07 [95%CI 1.03–1.11] per 0.01 mm/mmHg decrease; p–value 0.002) as independent predictors of cardiovascular death.

Conclusions
RV–PA uncoupling is common among patients with CA, and it is a marker of advanced disease and worse outcomes. This study suggest that TAPSE/PASP ratio has the potential to improve risk stratification and guide management strategies in patients with CA.
C64 REDUCTION IN EJECTION AND PRE–EJECTION PERIODS ARE PREDICTIVE OF MORTALITY IN AL AND ATTR HEART AMYLOIDOSIS
Authors: Cicco S , Melaccio A , De Fazio G , Marozzi M , Solimando A , Ria R , Vacca A 
Published: May 2023

Abstract

Background
Amyloidosis is a systemic disease caused by fibrillary misfolded protein deposition in several organs including the heart. Cardiac deposition is the leading cause of death in these patients. Echocardiography is the imaging technique mostly used to study cardiac amyloidosis. Many studies tried to identify earlier markers to stratify the mortality risk. Heart stiffness is the main issue leading the heart dysfunction. However, few data are available on the possible role of connection between heart and possible vessels alterations. Purpose: Aim of this study was to evaluate heart stiffness using Ventricular–arterial coupling (VAC) for relationship between heart and vessel tree.

Methods
We studied 58 patients (22 F and 36 M, aged 67.14± 12.49) with AL or ATTR amyloidosis and heart involvement. They were 42 AL and 16 ATTR patients. All patients were evaluated before treatment with a complete history, physical exam, serum markers of disease, and echocardiogram. The abdominal fat biopsy to confirm amyloid deposition was performed before treatment. Among all patients, 18 died with a mean OS of 12 months [IQR 1–24 months].

Results
At baseline, VAC was increased in died patients (alive 1.53 ± 0.43 vs died 2.06 ± 1.73, p=0.09) but was ineffective to predict the risk of mortality (ROC analysis AUC 0.54, p=0.57). By analysing ejection and pre–ejection periods we found that they were both increased in alive patients (p=0.0016 and p=0.0072, respectively). Moreover, these periods were effective in prediction of the death risk (ejection time AUC 0.81, cut–off 239 msec, sensitivity 61.54% and specificity 88.24%; pre–ejection time AUC 0.75, cut–off 82 msec, sensitivity 84.62% and specificity 58.82%). No difference in VAC, ejection time or pre–ejection time were found comparing AL to ATTR, nor both parameters had a predictive role.

Conclusion
Amyloidosis induces an increase in heart stiffness and reduces heart contractility. This causes a reduction of peripheral blood flow and a worsening in heart failure. We demonstrated that this mechanism affects the capacity to pump blood in vessels due the reduction in time for loading during the systole. These results may predict the mortality with a significant sensitivity and specificity, regardless of the type of amyloidosis.
C68 PREVALENCE OF CARDIOINHIBITORY SYNCOPE IN A SERIES OF PATIENTS WITH THE CORRECT TILT TABLE TEST INDICATION. PRE–TEST PREDISPOSING FACTORS IDENTIFIED
Authors: Cavarra M , Salerno E , Chiarandà M , Chiarandà G , Tamburino C 
Published: May 2023

Abstract
Purpose of study : Data from the last ESC LLGGs on syncope show that the prevalence of cardioinhibitory syncope ( IIB according to VASIS classification ) at the Tilt table test (TTT) is 8% in the general population and 13% in patients with positive TTT ( TTT + ).The purpose of our work was to evaluate a) the prevalence of TTT+ with cardioinhibitory response (IIB VASIS) in a population correctly subjected to TTT for suspected neuromediated reflex syncope; b) if there are predisposing pre–test indicators; c) how many patients (pts) with TTT + with IIB response suitable for permanent pacemaker implant (PPM ) Material and methods : In our laboratory, in the last 6 years, there have been considered 989 patients for suspected neurally reflex syncope (NMRS) and subjected with correct indication to TTT using the Italian protocol. From this population was extrapolated a case study of pt with TTT+ for vasovagal syncope. In this case the prevailing TTT+ with IIB VASIS response was evaluated. Were sought multivariate analysis indicators pre test predisposing. In addiction, it was evaluated how many pts there was a correct indication for a PPM.

Results
TTT+ occurred in 641 pts ( 64.8%). In this case the TTT+ was found in 79 % of the pts with suspected typical NMRS and 55 % of the pts with suspected atypical NMRS. In 641 pts with TTT+ the prevalence of IIB response was observed in 41.1 %. In particular in 59 % of pts with typical NMRS and 29 % of pts with atypical NMRS ( p 0.0001 ). Multivariate analysis was identified as indicators independently associated with the IIB response male ( HR 0.5981 p .0134 ), syncope with trauma ( HR 3.1123 p .0015 ), hypertensive heart disease ( HR 2.9834 p.0058 ). The TTT+ IIB pts that had a correct indication to the PPM implant according to ESC LLGGs were 21 % ( 134 pcs )

Conclusions
the prevalence of cardioinhibitory syncope in our case studies is reused higher (41 %) than the literature data in previous cohorts ( 13–16 %). The percentage of pts with correct indication at PPM was almost 1 in 4 ( 21%). Trauma and hypertensive heart disease appear to be independent factors of cardioinhibitory TTT response useful to guide therapeutic diagnostic conduct.
C69 SHORT–TERM OUTCOMES OF ABLATION INDEX–GUIDED CAVOTRICUSPID ISTHMUS ABLATION VERSUS UNIPOLAR RECORDED POTENTIAL INVERSION: A RANDOMIZED, SINGLE–CENTRE STUDY
Authors: Matteucci A , Galeazzi M , Russo M , Schiaffini G , Cappuccio C , Di Fusco S , Lombardi E , Pandozi C , Colivicchi F 
Published: May 2023

Abstract

Background
Ablation of the cavotricuspid isthmus (CTI) using contiguous lesions guided by electroanatomical mapping on fluoroscopy assisted by the ablation index (AI) in typical atrial flutter (AFL) is a widely used procedure. Unipolar signal inversion during radiofrequency catheter ablation (RFCA) was found to be a predictive index of transmural lesion, as well as AI–guided strategy showed to be effective in CTI ablation while maintaining an inter–lesion–distance (ILD) ≤ 6mm. Both are related to the block of the CTI, however, it remains unclear how AI is related to the inversion of the negative component of the unipolar signal. The aim of our study is to evaluate the effectiveness of ablation based on unipolar recorded potential inversion and the corresponding AI values.

Methods
Thirty consecutive patients with AFL diagnosis were enrolled in our Centre to undergo CTI ablation. Patients were randomized 2:1 into the control arm and the experimental arm respectively. Contiguous lesions were performed using current AI standards until values of 500 were reached in the control group. In the experimental group, contiguous lesions were dispensed until inversion of the negative component of the unipolar signal was achieved, while simultaneously recording AI values. After CTI ablation, a 30–minute monitoring was performed to evaluate the efficacy and possible inducibility of AFL.

Results
A successful ablation procedure was performed in 30 patients. High–density mapping acquired on average 2766±1767 points vs. 2930±2177 (p=0.82), with a mean mapping time of 10.3±4.9 min vs 13.4±5.8 min (p=o.13). The procedural time between the two groups was comparable ( 77.9±27.6 vs 78.3 78.3±22.4 p 0.96). In both arms, the treatment effectively reduced the mean local potential in CTI (2.42±1.09 mV vs 2.71±1.26 mV p=0.51). Compared to the control group, unipolar signal inversion showed significantly lower ablation index values (500 vs 405±41.1 p &lt; 0.0001).

Conclusions
The inversion of the negative component of the unipolar signal confirms to be an effective strategy in cavotricuspid isthmus ablation. Procedural success can be achieved at significantly lower corresponding ablation index values.
C70 WEARABLE CARDIOVERTER DEFIBRILLATOR IN LONG QT SYNDROME DURING PREGNANCY: TIME TO USE THE SHIELD
Authors: Forleo C , Carella M , Basile P , Memeo R , Dadamo M , Resta N , Vimercati A , Guaricci A , Ciccone M 
Published: May 2023

Abstract

Introduction
Long QT Syndrome (LQTS) is a rare cardiac channelopathy characterized by a high risk of lethal arrhythmias. Pregnancy and post–partum period may induce an increased vulnerability, so an appropriate prevention is needed. Case presentation A 31–year–old primigravid woman at 36 weeks of pregnancy was referred to our Cardiomyopathy Unit located in a tertiary centre for LQTS screening. The patient had a family history of LQTS (mother and brother) and Brugada syndrome (cousin). The 12–lead ECG (Figure 1) showed a long QT interval (QT corrected: 508 msec), while the transthoracic echocardiogram was unremarkable. The genetic test performed is still ongoing. The patient reported sporadic episodes of palpitations at rest and the following 24–hour ambulatory ECG revealed a very high burden of polymorphic ventricular arrhythmias, with about sixteen thousand premature ventricular complexes and a non–sustained ventricular tachycardia. Therefore, due to the patient’s high–risk for life–threatening arrhythmic events, metoprolol 25 mg o.d. was initiated and a wearable cardioverter defibrillator (WCD) with remote monitoring was provided during pregnancy and labour. After 3 weeks a caesarean delivery in epidural analgesia was performed and managed by a pregnancy heart team including a cardiologist, gynaecologist, obstetrician, and anaesthetist in close cardiac monitoring. No maternal or infant complications occurred, without arrhythmic episodes detected by the device. The WCD will be maintained also in the post–partum period with a narrow follow–up of the patient.

Discussion
In pregnant high–risk LQTS patients, beta–blockers are the first line therapeutic option, but they do not able to interrupt lethal arrythmias in out–of–hospital setting. The implantable cardiac defibrillator is not the best choice, due to the concerns about radiation exposure and anaesthesia during pregnancy. Moreover, lead–associated thrombosis and infections during pregnancy were reported in literature. The WCD is the ideal option in these cases. It is an external device suited for transient higher arrhythmic risk periods. Moreover, it allows a remote monitoring of arrhythmic burden (figure 2) which may help clinicians in guiding the follow–up and the therapeutic management of the patient. One drawback is the need of continuous patient’s compliance. Finally, a pregnancy heart team is mandatory in presence of these rare cardiac syndromes.
C76 FINDING OF MYOCARDIAL CRYPTS IN SUDDEN CARDIAC ARREST PATIENTS: TWO CASE REPORT
Authors: Caraffini A , Bricoli S , Canu E , De Santis N , Pelizzoni V , Binno S , Vermi A , Di Spigno F , Perrino F , Ferraro S , Aschieri D 
Published: May 2023

Abstract
Left ventricular myocardial crypts are definined as deep blood–filled invaginations trasversing &gt; 50% of the myocardial wall and are located predominantly at the mid–basal segment of inferoseptal wall or at the apical segment. To date the incidence of crypts is 9.1% of patients undergoing cardiac CT and are not associated with intermediate–term major adverse cardiovascular events. However several studies have suggested that the presence of crypts is a marker of myocardial disease that should warrant clinical follow–up prior to the potential development of left ventricular hypertrophy and occurrence of serious cardiovascular events, such as heart failure or death. A lot of publications demonstrate that ventricular crypts could be a pre–phenotypic marker of hypertrophic cardiomyopathy (HCM). HCM is a genetic ereditary cardiomyopathy which is associated with fatal ventricular arrhytmias. We present the case of two patients who had a sudden cardiac arrest resuscitated with cardiac defibrillation. These are two males, 59 and 53 years old respectively, without cardiovascular risk factor and with familiarity for HCM. The first patient had a sudden cardiac arrest during exercise and was resuscitated with early cardiac defibrillation. The second patient had ventricular fibrillation after otolaryngology surgery treated with single defibrillator shock. Coronary arteries were free from atherosclerotic lesions at the angiografy study and no other reversible causes of cardiac arrest were identified. CMR showed normal biventricular funtion and ruled out signs of myocardial oedema or fibrosis. The only morphological finding was the detection of single left ventricular myocardial crypt at the CMR study in both patients: in one patient the crypt was located at the inferior wall while in the other at the level of the septum in the mid–apical segment. Ultimately both patients underwent genetic testing for cardiomyopathy. These findings may be a pre–phenotypic markers of HCM in patients who don’t present a clear expression of the pathology but may be a correlation with sudden cardiac arrest. The rarity of their finding in patient who have had sudden cardiac arrest can be explained by the small survival rate in patients with sudden cardiac arrest. Future studies and the increasingly simple access to advanced imaging methods like CMR and CT will allow us to clarify the role of these myocardial anomalies in the risk of developing fatal arrhythmic events.