bluuebunny/crossref_metadata_2025_split huggingface dataset:
P310 CARDIOPULMONARY EXERCISE TEST IN THE EVALUATION OF A PATIENT WITH HFREF: THE IMPORTANCE IN THE ANALYSIS OF GAS KINETICS
Authors: Palermo P , Mapelli M , Campodonico J , Vignati C , Agostoni P 
Published: May 2023

Abstract

Introduction
exertional dyspnea is a symptom present in several diseases, identifying the origin is of fundamental diagnostic and therapeutic importance. Cardiorespiratory exercise testing (CPET) is a valuable tool not only to assess functional capacity but also for diagnostic and prognostic purposes.

Clinical case
55–year–old patient with a history of episode of acute pulmonary edema. Echocardiogram showed FE 35% with diffuse left ventricular (LV) hypokinesis and mild–to–moderate mitral insufficiency (MI). Diagnostic coronarography showed lesion–free coronary tree. An interrupted CPET at 140W showed peak O2 consumption of 23.6 mL/kg/min that excluded indication for cardiac transplantation. An echocardiogram from us confirmed dilated cardiomyopathy (CMPD) with FE=32%, diffuse VS hypokinesia and mild–to–moderate functional MI. CPET was repeated, maximal for respiratory quotient (1.42) interrupted due to muscle exhaustion, indicative of moderate reduction in functional capacity with peak VO2 at 64% of predicted, preserved anaerobic threshold at 51% of VO2 max and reduced VO2/W and Pulse Oxygen Ratio (VO2/HR) values from cardiogenic limitation. Also evident drop in VO2/HR during the final stages of the test and associated change in slope of the VO2/Work relationship a sign of decline in stroke volume and cardiogenic efficiency. Absent signs of ventilatory limitation, pulmonary vascular (Ve/VCO2=20.8 in normal range), or exercise desaturation. In the final phase of the test increase in VCO2 and Ve/VCO2 and Ve/VO2 equivalents. In order to find the explanation to the data collected by CPET, exercise echocardiogram was performed, which revealed the development of severe mitral valvular insufficiency and subsequent pulmonary hypertension justifying the behavior of the parameters collected by CPET.

Discussion
The oxygen pulse represents a metabolic surrogate for stroke volume. Normally during the active phases of exertion there is a progressive increase followed by a plateau. The evident flattening of the VO2/Work curve during the final phases of exercise and the concomitant decrease in oxygen pulse denote inadequate cardiac performance relative to the increased energy demands during exercise.

Conclusions
CPET proves to be a valuable clinical tool to guide the diagnostic–therapeutic pathway, particularly in the presence of complex heart disease (CMPD or IM).
P328 PROTOCOL OF REPEATED OUTPATIENT INFUSIONS OF LEVOSIMENDAN IN ELDERLY PATIENTS WITH ADVANCED HEART FAILURE: PRELIMINARY DATA FROM A REAL–WORLD EXPERIENCE
Authors: Camartini V , Orso F , Herbst A , Verga F , Salucci C , Virciglio S , Baldasseroni S , Ungar A , D‘errico G 
Published: May 2023

Abstract

Background
Intermittent infusions of Levosimendan (L) have been shown to reduce hospitalizations and improve quality of life in patients with advanced heart failure (HF). "Real–world" experience is currently insufficient, particularly in older patients. Purpose: Since November 2020 we treated elderly outpatients with advanced HF with repeated L infusions. Here, we present the preliminary analysis of the collected data.

Methods
The protocol involves three infusions of L given 14 days apart. The duration of each session was approximately 8 hours. The starting infusion rate is 0.05 μg/Kg/min, titrated every 30/60‘ to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and rhythm recorded on telemetry. We evaluated patients by clinical, labatorily and echocardiographic at baseline and two weeks after the end of treatment.

Results
The treated population had a mean age of 79 years, a long history of disease (mean 12 years) and high comorbidities (mean Charlson Comorbidity Index of 6.8). As shown in Table 1, we compared our population with that of leading international trials on this type of treatment, and we found that our population was significantly older and more complex. Of the 19 patients enrolled, 15 completed the expected treatment of infusions while 4 were lost due to hospitalizations for cardiovascular causes and/or social issues. In the 50 infusions performed, we observed good tolerance to the therapy with a failure rate of 2 % and good safety profile in the absence of major adverse effects, particularly in terms of arrhythmias (Figure 1). At the end of the infusion cycles, there was significant improvement of clinical and hemodynamic parameters (Figure 2). Moreover, we found a decrease in systemic congestion in terms of VD–AD gradient reduction (p=0.031) associated with a downward trend in average daily furosemide dose, clinical congestion scores and mean NTproBNP value.

Conclusions
Our preliminary analysis seems to confirm the safety and tolerability of the developed treatment scheme. Further data are needed to confirm its efficacy in clinical, hemodynamic, and therapy effects.
P351 FATAL RECURRING SYSTEMIC THROMBOEMBOLYSM IN A PATIENT WITH CARDIAC AL AMYLOIDOSIS WITHOUT EVIDENCE OF ATRIAL FIBRILLATION
Authors: Ajmone F , Costantino J , Manguso G , Ciaramella P , Ballatore F , Maggio E , Vernile A , Alfarano M , Lavalle C , Vizza C , Chimenti C 
Published: May 2023

Abstract
Backgound: Cardiac amyloidosis is associated with an increased thromboembolic risk. While the need to anticoagulate patients in atrial fibrillation regardless of the CHA2DS2–VASc score is evident, it is not clear whether and which patients in sinus rhythm should be treated with anticoagulant drugs

Case Presentation
A 51–year–old man presented with repeated episodes of chest pain and exertional dyspnea. The ECG showed synus rhythm, left–axis deviation, 1st degree AV–block, left anterior hemiblock and no significant anomalies of ventricular repolarisation. Transthoracic echocardiography revealed markedly thickened left ventricular (IN) walls (maximum interventricular septum dimension 18 mm) with a granular–sparkling appearance of the myocardium, bi–atrial enlargement, preserved LV ejection fraction (EF 52%), restrictive mitral flow pattern with a very small A–wave, thickened interatrial septum and atrio– ventricular valves; circumferential pericardial effusion ( maximum 11mm). Laboratory tests showed an increase in troponin and NTproBNP levels and serum and urine immunoelectrophoresis showed a monoclonal component in zone kappa. A periumbilical fat biopsy was negative for amyloidosis so the patient underwent an endomyocardial biopsy which showed positive Congo red, and immunohistochemistry positive for kappa light chains and negative for transthyretin. A diagnosis of cardiac amyloidosis AL was then made and the patient was referred to the hematologist to perform specific therapy. One week after discharge he was hospitalized for acute pain in the lower limbs due to acute thrombosis of the left common femoral artery treated with Fogarty embolectomy. Discharged in therapy with low molecular weight heparin after a few days he was again symptomatic for pain in the lower limbs and went to the emergency room where he died of electromechanical dissociation.

Conclusions
Our case demonstrates that cardiac AL amyloidosis is associated with an increased thromboembolic risk, irrespective of the presence of atrial fibrillation, for the hematological disease itself and for the infiltration of the atrium by the amyloid substance. This suggests that in selected cases, with reduced A–wave amplitude and evidence of impaired atrial mechanics, empirical anticoagulation should be considered even in sinus rhythm.
P358 FATAL CONSPIRACY: MIDVENTRICULAR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY COMPLICATED BY GIANT APICAL ANEURYSM AND SEVERE MITRAL REGURGITATION
Authors: Capodaglio I , Lombardi G , Vagnarelli F , Lofiego C , Tofoni P , Pietrucci F , Schicchi N , Esposto Pirani P , Perna G 
Published: May 2023

Abstract
This case refers to a 69–year–old woman with a history of hypertrophic cardiomyopathy (HCM) with severe mid–ventricular obstruction complicated by apical aneurysm and restrictive phenotype. This patient had no left ventricular outflow tract obstruction and previous examinations showed moderate mitral regurgitation (MR) with suboptimal echocardiographic follow–up. ICD was previously implanted for primary prevention. Disease progression was complicated by episodes of acute heart failure (HF) caused by atrial fibrillation/tachycardia (AF or AT) with rapid ventricular response despite pharmacological therapy and a transcatheter ablation attempt. The patient was admitted to our Cardiac Intensive Care Unit with acute pulmonary oedema and extreme general frailty. EKG showed normal sinus rhythm alternating with AT with high ventricular rate. Transthoracic (TTE) and transesophageal (TEE) echocardiograms gave evidence of severe hypertrophy of left ventricular (LV) mid–cavity segments (mid IVS = 26 mm) with mid–ventricular systolic obliteration (with no more evidence of significant gradient) and a large apical aneurysm (37x35 mm) resulting in an “hourglass” shaped LV cavity (Figure 1). In addition the examinations highlighted systolic dysfunction with severe stroke volume reduction and severe MR caused by annulus dilatation with anterior jet direction due to leaflets abnormal coaptation (Figure 2). HF was multifactorial, caused not only by MR and atrial tachyarrhythmias but also due to the abnormal large apical aneurysm and the small left ventricular chamber with low compliance. The anatomical features obtained from TEE and cardiac CT (Figure 3) were analyzed by the Heart Team. Surgery with aneurysmectomy and mitral valve repair or replacement was excluded due to patient‘s frailty. Despite the suboptimal valve and LV chamber anatomy, percutaneous mitral valve repair with MitraClip was considered but also deferred owing to the unstable hemodynamic conditions. Further hemodynamic deterioration led to the patient’s exitus.

Discussion
HCM with mid–ventricular obstruction may be complicated by apical aneurysm. Large apical aneurysms can reduce LV contractile efficiency and the combination with severe MR can cause further loss of anterograde cardiac output leading to a progressive and fatal deterioration. A better outcome can only be achieved through careful follow–up and early detection and management of disease complications.
P425 TEAMWORK IS SUCCESSFUL (3): IMMUNOTHERAPY WITH IMMUNE CHECKPOINT INHIBITORS (ICIS) FAVOURABLE RESPONSE AND CARDIOVASCULAR COMPLICATION. A CASE REPORT
Authors: Piroli F , Stefanelli U , Di Girolamo S , Masini C , Cerasa F , Azzarone M , Leuzzi C , Pinto C , Navazio A , Tarantini L 
Published: May 2023

Abstract
Immunotherapy in recent years has revolutionized the oncology practice. ICIs targeting T lymphocyte antigen–4 (CTLA–4) and programmed death–1/ligand–1 (PD–1/PD–L1) transformed treatment landscape of many different cancers. The answers occur in a substantial fraction of patients and are often durable. ICI‘s combined block (CB) (CTLA–4 + PD–1/PD–L1) seems to improve even further clinical outcomes compared to monotherapies. However, this treatment exposes patients to the risk of immune adverse events (iAE) including cardiovascular (CV) iAE, which can be potentially fatal and, in any case, compromise the continuation of oncological treatment. Here we present the case of a young woman with advanced renal cancer (Stage IV, T3b, N0, M1) in ICI combined block therapy (Nivolumab + Ipilumab) complicated early by a pericardial effusion (PE) Clinical case Oct 2021: a 48 yrs old woman with sarcomatoid and rhabdoid renal cell cancer with liver metastases underwent left radical nephrectomy and splenectomy + cavotomy for neoplastic thrombus removal. Dec 21, she started ICIs CB (Nivolumab + Ipilumab) X 4 and sequential Nivolumab. March 2022: on CT assessment for disease restaging at the end of induction therapy with nivolumab + Ipilumab a favorable response of metastases was detected but incidental finding of G2–G3 PE was identified (figure 1). Therapy with prednisone (1 mg/kg/day) and Colchicine 0.5 mg/day was promptly started with progressive reduction of the effusion in the serial cardiological checks without recurrence although maintenance immunotherapy with Nivolumab was rechallenged. ICIs was permanently discontinued in June 2022 due to gastrointestinal G4 toxicity. At MRI evaluation after 6 months ICIs discontinuation (December 2022), liver metastases were further reduced compared to previous assessments.

Conclusion
This case confirms that the association between iAE side effects and efficacy of ICIs is a real possibility. Vigilant surveillance and close collaboration between oncologists and cardiologists facilitate timely capture of CV iAE and appropriate management to allow effective management.
P440 PREVALENCE OF HYPOVITAMINOSIS D OVER THE YEARS AND ITS RELATIONSHIP WITH DIABETES MELLITUS AND ANEMIA IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Aleksova A , Fluca A , D‘errico S , Munaretto L , Zhou X , Sinagra G , Janjusevic M 
Published: May 2023

Abstract

Background
Hypovitaminosis D is a common condition among patients with cardiovascular diseases and it is closely associated with inflammation, oxidative stress, endothelial dysfunction, diabetes mellitus (DM), insulin resistance and anemia. Aims and methods: We aim to assess the prevalence and persistence of hypovitaminosis D (&lt;20 ng/ml) over years among 1510 patients with acute myocardial infarction (AMI), admitted at the University Hospital in Trieste. To access changes in vitamin D values over the years, we separated the patients into 4 groups according to the year of enrolment: group 1 (2009–2010), group 2 (2014–2016), group 3 (2017–2019) and group 4 (2020–2022).

Results
The median vitamin D concentration in our cohort was 17.15 (10.2 – 24.7) ng/ml, meaning that the majority of enrolled patients were vitamin D deficient (59.7%). Comparing the defined groups, it is observed that the plasma vitamin D values significantly increased during the years respectively: 14.45 (7.73 – 22.58) ng/ml vs 17.3 (10.28 – 24.2) ng/ml vs 18.95 (11.63 – 26.78) ng/ml vs 19.05 (12.5 – 27.3) ng/ml, p&lt;0.0001 (Figure 1). Vitamin D was negatively correlated with Galactin–3, glucose levels, HbA1C and pro–inflammatory markers such as CRP, TNF–α and Il–1β. Patients with DM have significantly lower levels of vitamin D compared to patients without (respectively: 18.95 (13.25 – 27.18) ng/ml vs 22.8 (14.1 – 31.5) ng/ml p&lt;0.001). Furthermore, anemic patients have lower vitamin D levels compared to patients without (respectively, 13.7 (8.0 – 22.65) ng/ml vs 18.4 (11.5 – 25.5) ng/ml, p&lt;0.0001). In a multivariate analysis, hypovitaminosis D was predicted by fall–winter sampling (p&lt;0.0001), higher body mass index (p=0.001), DM (p=0.001), smoking (p=0.001), older age (p=0.008), increased triglyceride levels (p=0.01) and female gender (p=0.038).

Conclusions
Hypovitaminosis D remains common among patients with AMI, although there is a trend of increasing vitamin D values over the years probably due to media awareness. Supplementation of vitamin D should be mandatory in patients with cardiovascular diseases given its close relationship with DM and anemia and their association with mortality.
P482 CALCIFIED AORTIC VALVES EXPLANTED FROM CHIP CARRIERS REVEAL IMMUNE INFILTRATION AND INCREASED RISK OF 1–YEAR MORTALITY AFTER SURGERY
Authors: Mikus E , Savini C , Tripodi A , Rizzo P , Fortini F , Fiorentino F , Vieceli Dalla Sega F 
Published: May 2023

Abstract

Background and aims
Blood cell clones carrying cancer–related mutations are frequently present in the elder, often without determining symptomatic hematological disease. This condition is defined clonal hematopoiesis of inderminate potential (CHIP). In recent years, epidemiological investigations have clearly shown that CHIP increases not only the risk of blood cancer but also the risk of atherosclerosis and cardiovascular mortality. The present study aims to evaluate the possible association between CHIP and aortic valve stenosis and to explore the pathological mechanism of calcified aortic valve disease (CAVD) in CHIP carriers.

Methods
We enrolled 105 CAVD patients undergoing surgical aortic valve replacement in which we assessed the presence of CHIP by next generation sequencing (NGS) of DNA extracted from blood cells. Moreover, we investigated the effect of CHIP on 1–year all–cause mortality. Finally, to reveal possible mechanisms linking CHIP to CAVD, we extracted the RNA from a subset of explanted aortic valves and compared the whole transcriptome of patients with or without CHIP.

Results
We found that CHIP is present in patients with CAVD, with a frequency of around 30%. Analysis of the transcriptome of aortic valves revealed that high immune infiltration and immunoglobulins presence frequently occur in CHIP patients. Importantly, we observed that the presence of CHIP is associated with increased mortality within 12 months after surgery.

Conclusions
Our findings indicate that the broad cellular and humoral immune response in the aortic valves of the CHIP patients reflects alterations in the immune cells that may be linked to the poor prognosis after valve replacement.
P493 ASSOCIATION BETWEEN IMPROVEMENT IN PHYSICAL FITNESS AND ANTHROPOMETRIC PARAMETERS WITH MAINTENANCE OF PHYSICAL EXERCISE HABITS IN A POPULATION OF PATIENTS WITH ISCHEMIC HEART DISEASE UNDERGOING A REHABILITATION CYCLE WITH 6 MONTHS FOLLOW–UP
Authors: Schenal N , Bugana R , Fent M , Menegon F , Piergentili C , Bonso A 
Published: May 2023

Abstract

Background
Increased physical activity is associated with a reduction in all–cause mortality and may increase life expectancy, an effect strongly linked to a reduction in the risk of cardiovascular (CV) disease. Regular aerobic exercise (EX) results in modest reductions in waist circumference (CIRC) (associated with CV mortality) and visceral adipose tissue. Vigorous intensity EX may offer greater benefits than moderate intensity. Aim of the study: To evaluate whether the continuation of EX after Cardiac Rehabilitation (CR) leads to an improvement in physical capacity and parameters related to CV pathology of patients (PZ) with ischemic heart disease (IC).

Methods
retrospective observational study on patients referred to the Outpatient CR of the O.C. S.M. del Prato (Feltre) from January 2018 to May 2021. Of the initial population of 270 PZ, 47 did not show up at the f.–up, 22 did not perform 6MWT at the f.–up and 33 had CR indications other than IC. The Outpatient CR consisted of 10 monthly sessions with 3 modalities: • educational (ED) + supervised EX • ED only • online (Covid period). Supervised EX: soft bodyweight gymnastics (30 min) + 30 minutes monitored moderate to vigorous supervised EX on stationary bikes and treadmills ED: frontal lessons (1–2 h) multidisciplinary (doctor, nurse, dietician, psychologist) aimed at improving the patient‘s management of CV disease and risk factors. On–line: soft bodyweight gymnastics (30 min) + ED by videoconference The f.–up was on average 6 months after the CR. Statistical processing with Jamovi 2.3.13 Materials and methods: At admission to CR and at f.–up, weight, height, CIRC, calculated BMI were measured, performed 6–minute walk test (6MWT) with Borg scale detection. At the f.–up a questionnaire was self–administered and adherence to EX, bodyweight exercise, how often, attendance at a gym, use of heart rate monitor (CF), etc. were declared.

Conclusions
The 6MWT improves in a statistically significant way in all PZs at f.–up except in those who declare not to perform EF. Significant improvements in CIRC, BMI and Borg were observed in PCS performing EX more frequently weekly (2–4 times), using CF and in PCS undergoing complete RC (ED + EX). No predictors of improvement at 6 months of the examined variables were identified.
Seismicity parameters dependence on main shock-induced co-seismic stress
Authors: Sharma Shubham , Hainzl Sebastian , Zöller Gert 
Published: May 2023

SUMMARY
The Gutenberg–Richter (GR) and the Omori–Utsu (OU) law describe the earthquakes’ energy release and temporal clustering and are thus of great importance for seismic hazard assessment. Motivated by experimental results, which indicate stress-dependent parameters, we consider a combined global data set of 127 main shock–aftershock sequences and perform a systematic study of the relationship between main shock-induced stress changes and associated seismicity patterns. For this purpose, we calculate space-dependent Coulomb Stress (ΔCFS) and alternative receiver-independent stress metrics in the surrounding of the main shocks. Our results indicate a clear positive correlation between the GR b-value and the induced stress, contrasting expectations from laboratory experiments and suggesting a crucial role of structural heterogeneity and strength variations. Furthermore, we demonstrate that the aftershock productivity increases nonlinearly with stress, while the OU parameters c and p systematically decrease for increasing stress changes. Our partly unexpected findings can have an important impact on future estimations of the aftershock hazard.
Automatic velocity analysis using interpretable multimode neural networks
Authors: Zhang Haifeng , Yuan Sanyi , Zeng Huahui , Yuan Huan , Gao Yang , Wang Shangxu 
Published: May 2023

SUMMARY
Seismic velocity analysis is the basis for seismic imaging and understanding complex subsurface geological structures. Although the performance of automatic velocity analysis methods based on Common Middle Point (CMP) data or Velocity Spectra (VS) is encouraging, particularly deep learning methods. However, most methods ignore the complementarity between CMP data and VS data, and only one of them is selected for velocity modelling. We propose a multimodal neural network (MMN) that combines the advantages of CMP data details representation and simplification of VS. MMN includes multilayer convolution structures and auto-encoder structures, which are used to extract time–space amplitude information from CMP gathers and energy groups features from VS data, respectively. This paper compared MMN with the CMP single-modal network (CSN) and the velocity spectra single-modal network (VSSN). Based on synthetic data, we investigated their differences in terms of continuity, accuracy, noise resistance and generalization. The MMN prediction results makes a trade-off between the overall continuity and local details. Visualization analysis of the intermediate feature maps explains the MMN velocity prediction mechanism, that is, the multi-angle representation and complementary fusion of velocity information. Finally, the performance of the proposed method is demonstrated using the braided river deposited field data example.
Potential for efficient microbial remediation of Cr(VI) in wastewater using Deinococcus wulumuqiensis R12
Authors: Sun Shengmiao , Shen Bowen , Jiang Ling , Zhu Liying 
Published: May 2023

Abstract

Aims
This study aimed to investigate the potential of Deinococcus wulumuqiensis R12 (D. wulumuqiensis R12) as a bioadsorbent for Cr(VI) removal from aqueous solutions.

Methods and results
Effects of various factors, including initial concentration of Cr(Ⅵ), pH, adsorbent dosage, and time were explored. The maximal Cr removal efficiency was achieved by adding D. wulumuqiensis R12 to the solution at pH 7.0 for 24 h, with an initial Cr concentration of 7 mg l−1. Characterization of bacterial cells showed that Cr was adsorbed to the surface of D. wulumuqiensis R12 by combining with functional groups, such as carboxyl and amino groups on the surface. Furthermore, D. wulumuqiensis R12 was able to keep its bioactivity in the presence of Cr and tolerate Cr concentrations as high as 60 mg l−1.

Conclusions
Deinococcus wulumuqiensis R12 demonstrates a comparatively high adsorption capacity for Cr(VI). Under the optimized conditions, the removal ratio reached 96.4% with 7 mg l−1 Cr(VI), and the maximal biosorption capacity was 2.65 mg g−1. More importantly, it was found that D. wulumuqiensis R12 still had strong metabolic activity and maintained its viability after adsorbing Cr(VI), which is beneficial for biosorbent stability and reuse.