bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort
Authors: Bruno Francesco , Adjibodou Boris , Obeid Slayman , Kraler Simon C , Wenzl Florian A , Akhtar M Majid , Denegri Andrea , Roffi Marco , Muller Olivier , von Eckardstein Arnold , Räber Lorenz , Templin Christian , Lüscher Thomas F 
Published: May 2023

Abstract

Background
Patients with ST-segment elevation typically feature total coronary occlusion (TCO) of the infarct-related artery (IRA) on angiography, which may result in worse outcomes. Yet, relying solely on electrocardiogram (ECG) findings may be misleading and those presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) may have TCO as well. Herein, we aimed to delineate clinical characteristics and outcomes of patients with ACS stratified by IRA location.

Methods
A total of 4787 ACS patients were prospectively recruited between 2009 and 2017 in SPUM-ACS (ClinicalTrials.gov Identifier: NCT01000701). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at 1 year. Multivariable-adjusted survival models were fitted using backward selection.

Results
A total of 4412 ACS patients were included in this analysis, 56.0% (n = 2469) ST-elevation myocardial infarction (STEMI) and 44.0% (n = 1943) NSTE-ACS. The IRA was the right coronary artery (RCA) in 33.9% (n = 1494), the left-anterior descending coronary artery (LAD) in 45.6% (n = 2013), and the left circumflex (LCx) in 20.5% (n = 905) patients. In STEMI patients, TCO (defined as TIMI 0 flow at angiography) was observed in 55% of cases with LAD, in 63% with RCA, and in 55% with LCx. In those presenting with NSTE-ACS, TCO was more frequent in those with LCx and RCA as compared to the LAD (27 and 24%, respectively, vs. 9%, P &lt; 0.001). Among patients with NSTE-ACS, occlusion of the LCx was associated with an increased risk of MACE during 1 year after the index ACS (fully adjusted hazard ratio 1.68, 95% confidence interval 1.10–2.59, P = 0.02; reference: RCA and LAD). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher levels of high-sensitivity C reactive protein (hs-CRP) and high-sensitivity cardiac troponin T, lower eGFR, and notably a negative history of MI.

Conclusion
In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.
ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome
Authors: De Luca Leonardo , Riccio Carmine , Navazio Alessandro , Valente Serafina , Cipriani Manlio , Corda Marco , De Nardo Alfredo , Francese Giuseppina Maura , Napoletano Cosimo , Tizzani Emanuele , Roncon Loris , Caldarola Pasquale , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio 
Published: May 2023

Abstract
Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.
C9 THE EFFECT OF ANTHRACYCLINE CHEMOTHERAPY ON PEAK LEFT ATRIAL LONGITUDINAL STRAIN: A METANALYSIS
Authors: Faggiano A , Giangiacomi F , Gherbesi E , Carugo S , Vicenzi M 
Published: May 2023

Abstract

Background
Currently there is a limited number of studies reporting atrial function, evaluated by peak left atrial longitudinal strain (PALS), among patients undergoing anthracycline chemotherapy.

Objective
We investigated this issue through a meta–analysis of echocardiography studies that reported data on: A) PALS before and after anthracycline chemotherapy and B) PALS in patients who have previously received anthracycline chemotherapy versus controls.

Methods
The PubMed, OVID–MEDLINE and Cochrane library databases were systematically analysed to search articles and abstracts published from inception to 29th December 2022. Studies were identified by using Me–SH terms and crossing the following terms: “left atrial strain”, AND “cardiotoxicity”, “anthracycline”, “anthracycline cardiotoxicity” and “echocardiography”.

Results
The meta–analysis included a total of 967 patients from 10 studies. A) The metanalysis of six studies evaluating PALS before and after anthracycline chemotherapy in a total of 343 patients showed a significant PALS worsening after anthracycline (30,05±2,5 vs 26,8±3,1) with standard mean difference (SMD) being –0,27±0,06, p &lt; 0.0001. Figure 1 panel A. B) Five studies evaluated PALS in 359 patients who have previously received anthracycline chemotherapy versus 356 controls. Compared with controls, PALS was significantly worse in the pooled anthracycline group (34,63±1,8 vs 37,64±2,7) with SMD being –0.35 ± 0,08, p &lt; 0.0001. Figure 1 panel B.

Conclusions
Our metanalysis suggests a detrimental effect of anthracycline chemotherapy on atrial function evaluated by PALS.
C12 DAPAGLIFLOZIN INCREASES PAMPK AND REDUCES MYOCARDIAL AND RENAL NF–KB EXPRESSION IN PRECLINICAL MODELS OF SHORT–TERM DOXORUBICIN CARDIOTOXICITY THROUGH MYD–188 AND NLRP3 PATHWAYS
Authors: Quagliariello V , Paccone A , Iovine M , Palma G , Luciano A , Barbieri M , Bruzzese F , Maurea C , Zito F , Sabetta R , Montella M , Franco R , Maurea N 
Published: May 2023

Abstract

Background
Doxorubicin–mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have recently been shown to be of therapeutic value in patients with type 2 diabetes, chronic kidney disease, and heart failure with reduced ejection fraction (HFrEF), conditions that commonly coexist and are interrelated pathophysiologically. Purpose: We hypothesized that Dapagliflozin (an SGLT2i), administered during doxorubicin, could improve cardiac function in preclinical models

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO–DAPA, n=6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd88, DAMPs (galectine 3 and calgranulinS100), pAMPK, NF–kB, and 13 chemokines (IL–1α, IL–1β, IL–2, IL–4, IL–6, IL–10, IL–12, IL17–α, IL–18, IFN–γ, TNF–α, G–CSF, and GM–CSF) were quantified through ELISA and western blot methods.

Results
DAPA improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of NLRP3, MyD88, DAMPs and NF–kB in cardiac tissues was seen in DOXO–DAPA group compared to DOXO mice (p&lt;0.001). Cardiac expression of IL–1β, IL–6, TNF–α, G–CSF and GM–CSF were significantly reduced after treatment with DAPA indicating anti–inflammatory properties. Expression of pAMPK was strongly enhanced in DAPA–DOXO compared to DOXO group. Levels of Calgranulin S100 and galectine–3 were strongly enhanced in DOXO group; on the other hand their expression were reduced by 47.7 and 52.3% in DAPA–DOXO group vs DOXO (p&lt;0.005). Hystology evaluation indicate reduction NF–kB expression in myocardial and renal tissue in DOXO–DAPA vs DOXO. Radial strain (RS) is 38.8% in DAPA–DOXO vs 14.1% in DOXO groups (P &lt; 0.05); longitudinal strain (LS) is – 23.4 % in DAPA–DOXO vs – 10.5% in DOXO groups (P &lt; 0.001)

Conclusion
In this preclinical study, DAPA is able to improve cardiac function and reduce biomarkers involved in heart failure and fibrosis. The overall picture of the study pushes the use of DAPA in prevention of cardiomyopathies induced by anthracyclines in cancer patients.
C15 PERCUTANEOUS EDGE–TO–EDGE REPAIR USING EDWARDS PASCAL SYSTEM FOR SEVERE TRICUSPID REGURGITATION IN CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES
Authors: D'Agostino A , Berti S , Santoro G , Ravani M , Trianni G , Mariani M 
Published: May 2023

Abstract

Introduction
Congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac malformation characterized by ‘double’ discordance of atrioventricular and ventriculo–arterial connections, resulting in a systemic tricuspid atrioventricular valve and a systemic right ventricle.

Clinical case
We describe a case report of 54 years–old male patient with ccTGA, diagnosed when he was 3 years–old. Patient performed regular follow–up. Since December 2019, the patient reported onset of effort dyspnoea (NYHA III), fatigue and exercise intolerance. Despite medication optimization, his symptoms persisted. He was referred at our Centre for specialist evaluation. Transthoracic echocardiography showed mild dilatation and dysfunction of right ventricle, massive systemic tricuspid valve regurgitation (EROA 42 mm2), due to multiple jets and systolic pulmonary artery pressure of 45 mmHg. As reported by most recent guidelines, indication was given for surgical replacement of the systemic tricuspid valve. However, the patient refused the cardiac surgery option. Transesophageal echocardiography (TEE) screening showed feasibility of percutaneous approach to tricuspid regurgitation. Being the jet central, the strategy was to place one device implant between the septal and the anterior leaflet (9–3 oriented), as central as possible. Following simultaneous leaflet capture and further optimization of leaflet, the result was excellent. Post–implant deployment TEE revealed only mild–to–moderate residual tricuspid regurgitation, with no tricuspid stenosis (mean gradient 2 mm Hg). The result was a percutaneous bicuspidization of a tricuspid systemic valve. The patient recovered quickly and was discharged to home 2 days after the procedure. Patient experienced significant improvement in functional status (NYHA I), exercise capacity and quality of life at 6 months follow–up.

Conclusions
In ccTGA patients, treatment of severe tricuspid regurgitation and improvement of the systemic ventricle’s systolic function is critical since progression of dysfunction of the RV and tricuspid regurgitation are considered key determinants for morbidity and mortality in these patients. Based on the results obtained in our case, percutaneous edge–to edge repair seems to be a reasonable alternative to the surgical approach and three–dimensional transesophageal echocardiography is imperative for the proper visualization of the leaflets outcome of the procedure and his durability.
C16 NONCOMPACTION OF VENTRICULAR MYOCARDIUM AND X–LINKED RECESSIVE ICHTYOSIS
Authors: Bevere E , Mastroianno S , Greco A , De Luca G , Potenza D , Brunetti N , Salvatori M , Di Stolfo G 
Published: May 2023

Abstract
Noncompact left ventricle is a rare congenital cardiomyopathy characterized by numerous ventricular trabeculae separated by deep intertrabecular recesses. It can occur in isolation or in association with neuromuscular disorders and congenital heart defects. The cause is not known but it is thought to be due to the arrest of the normal maturation process of the myocardium. Among the responsible mutations are taffazzine, ZASP and distrobrevin. It can manifest as left ventricular dilatation and dysfunction, arrhythmias, thromboembolic events, and sepsis. The echocardiogram is the investigation of first choice. Magnetic resonance allows you to more precisely distinguish compact and non–compact layers, thrombi and myocardial fibrosis.

Clinical case
A 19–year–old patient came for syncope. She presented with midfacial hypoplasia, cupped ears, synophrium, high palate, ichthyosis, small hands, and scarring from Achilles tendon lengthening. She denied a family history of cardiovascular disease and sudden cardiac death. Karyotype analysis showed karyotype 46Y, –X, + der t (X; Y) (p22.2; q11.1), with a chromosome derived from the X;Y translocation (a feature already known in the mother and in several maternal relatives ). Coronary angiography, electroencephalogram and brain MRI were within limits. Echocardiogram and MRI showed non–compact myocardium at the left ventricular apex and mild ventricular dysfunction with areas of anterior and posterior dyssynergia (Fig. 1). The ECG showed high QRS voltages. The Holter ECG showed numerous supraventricular extrasystoles even in pairs and runs, rare PVCs, and nocturnal pauses of up to 3 seconds. The patient underwent genetic screening by NGS for sarcomeric mutations which resulted negative. Subsequent genetic analysis showed deletion in two chromosomal regions that could be interpreted as pathogenic (chromosomal region Xp22.33 containing the SHOX gene and involving the deleted locus in Leri–Weill dyschondrosteosis and in the Xp22.33p22.31 region containing the STS gene involving the locus deleted in X–linked recessive ichthyosis) and a duplication in the chromosomal region Yq11.221q11.23 of uncertain significance.

Conclusions
After review of the scientific literature, the association of the illustrated complex deletion and translocation with non–compact myocardium represents a new finding, worthy of being explored in genetically affected patients.
C17 AN UNUSUAL CASE OF RIGHT HEART FAILURE AND PULMONARY HYPERTENSION: WET BERIBERI. THE IMPORTANCE OF DIFFERENTIAL DIAGNOSIS
Authors: Sambenedetto M , Mapelli M , Biondi M , Vignati C , Palermo P , Nepitella A , Muratori M , Agostoni P 
Published: May 2023

Abstract

Introduction
High–output heart failure is a rare form of heart failure. Possible causes include vitamin B1 (thiamine) deficiency. This vitamin plays an important role in the aminoacids energy metabolism and in the transmission of nerve impulses. Thiamine deficiency can affect the cardiovascular (wet beriberi), nervous, and immune systems. Case report: This case report concerns a 73–year–old man with a history of alcohol abuse affected by arterial hypertension, persistent atrial fibrillation, COPD and alcoholic liver disease. Home therapy included low–dose diuretic, mineralocorticoid antagonists, anticoagulant, hypotensive drugs and oral antidiabetic drugs. Due to the occurrence of dyspnoea and progressive swelling of the lower limbs he was hospitalized. Transthoracic echocardiogram (TTE) showed mild biventricular dilatation with normal function. The Doppler study revealed moderate–severe tricuspid regurgitation (anulus dilatation) and indirect signs of an increase in pulmonary pressures. Blood tests showed a picture of cytopenia, altered hepatic synthesis indexes and high values of natriuretic peptides. He performed invasive hemodynamic evaluation with right heart catheterization which showed mild pulmonary hypertension (mPAP 28 mmHg) with normal pulmonary vascular resistance and an increase in cardiac index (CI 4.2 L/min/m2). The cardiopulmonary testing (CPET) indicated a slight reduction in functional capacity (pVo2 77% of predicted value) and initial pulmonary vascular involvement. In the following months the patient manifested haemodynamic instability with the need for intravenous diuretic therapy. At a subsequent check–up, the dosage of thiamin was performed, which was found to be deficient, so he started supplementation. In the next period the patient reported well–being and maintained euvolemia. At a hospital re–evaluation, he performed a new TTE evaluation which showed a reduction in ventricular volumes and tricuspidal regurgitation as well as a new evaluation of invasive cardiac output which showed a reduction in right sections pressure (mPAP 22 mmHg) with normalization of the CI value (2,20 L/min/m2). CPET showed almost the same results of the previous one.

Conclusion
Beriberi is a possible treatable cause of high–output heart failure. Although it is a rare pathology in Western countries, it should always be suspected in some categories of patients such as alcoholics, subjects with eating disorders and those undergoing bariatric surgery.
C27 RBM20 VARIANTS RELATED CARDIOMYOPATHY: AN ITALIAN CASE SERIES
Authors: Manai R , Dusi V , Pidello S , Angelini F , Bocchino P , Gallone G , De Lio G , Gobello G , Saglietto A , Castagno D , Anselmino M , Giustetto C , Brach Del Prever G , Valeria B , Deaglio S , De Ferrari G , Raineri C 
Published: May 2023

Abstract

Background
RNA–binding motif protein 20 (RBM20) regulates post–transcriptional splicing, particularly in sarcomeric, but also in other cardiac genes crucial for homeostasis. RBM20 variants are a rare cause of cardiomyopathy (CMP), but genotype–phenotype correlation is still elusive, starting from the type of CMP (dilated, non–compacted, hypertrophic, and even restrictive phenotypes have been described), and ranging to sex–dependent and arrhythmic expression. Purpose: To describe cardiac involvement in 8 patients with RBM20 variants.

Methods
189 patients (pts) underwent genetic analysis in our center (2019–2022) for suspected genetic CMP (TruSight Cardio panel, Illumina); 72% had a positive genetic report, including pathogenic/likely pathogenic (P/LP) or variants of undetermined significance (VUS). Among them, 9 (5%, 6 males and 3 females, from 6 families) carried a heterozygous RBM20 variant: 5 a sole P variant, 3 an RBM20–VUS associated to a second VUS in another CMP related gene, one an RBM20–VUS associated to a LP variant in BAG3; the last patient was excluded (figure with 8 pts).

Results
Most pts (75%) had a positive family history (FH) for sudden death. Mean age at diagnosis was significantly lower for P variant carriers compared to VUS carriers (25±15 vs 46±2 years, p=0.04); no other significant differences were found between the 2 groups. At diagnosis, 4/8 pts (50%) had NYHA class&gt;2, mean LVEF was 34±18% and mean LV end diastolic volume 83±14 ml/m2; most pts (6/8, 75%) presented with a dilated phenotype, one with a non–compacted and one with a hypertrophic phenotype. Cardiac magnetic resonance, available in 6 pts, showed non–ischemic fibrosis in 3 (50%). At presentation, two pts had non–sustained VT (NSVT), one atrial flutter, one first degree AV block. The median follow–up was 2 years (IQR 2–10). Four pts (50%) underwent ICD implantation at 40 ± 13 years old. One female patient underwent heart transplant at the age of 13 and no one died from end stage HF; 3 pts had NSVT, one patient had atrial fibrillation (successfully treated with ablation), and none developed advanced AV blocks.

Conclusions
This is the first Italian case series of RMB20 variants related CMP. In our case series, RBM20 variants are associated with an early onset cardiac expression both in male and female pts, with LV dilated CMP and heart failure being the most common presentation. None of the pts presented with or developed advanced AV blocks, most suffered from NSVT.
C28 LEFT VENTRICULAR OUTFLOW TRACT VELOCITY–TIME INTEGRAL (LVOT–VTI) IMPROVES RISK STRATIFICATION IN HEART FAILURE PATIENTS WITH SECONDARY MITRAL REGURGITATION
Authors: Gentile F , Buoncristiani F , Sciarrone P , Bazan L , Panichella G , Gasparini S , Chubuchny V , Fabiani I , Taddei C , Poggianti E , Passino C , Emdin M , Giannoni A 
Published: May 2023

Abstract

Background
Reduced left ventricular ejection fraction (LVEF) has been used as a key criterion for the management of mitral regurgitation (MR) in patients with heart failure (HF), including the decision about mitral valve repair. However, LVEF, not taking into account mitral regurgitant volume, may be an imprecise predictor of outcome in HF patients with MR. Conversely, the estimation of the forward volume through the LV outflow tract (LVOT) may be a better metric in this setting. In this regard, LVOT velocity time integral (LVOT–VTI), not relying on geometrical assumptions, has been shown to be more reproducible than the calculated stroke volume (i.e., LVOT–VTI * LVOT cross sectional area).

Objective
To assess the prognostic significance of LVOT–VTI in a contemporary cohort of patients with chronic HF and significant MR.

Methods
Consecutive patients with chronic HF with reduced (≤40%) or mildly reduced (41–49%) LVEF and moderate–to–severe or severe MR, according to the latest European Society of Cardiology criteria, were selected and followed–up for the endpoint of cardiac death.

Results
287 patients were enrolled in the study (74±11 years, 70% men, 46% ischemic etiology, HFrEF 89%, LVEF 30±9%, mean LVOT–VTI 20±5 cm). Most patients showed a NYHA class II (40%) or III (31%) and received beta–blockers (93%), ACE–inhibitors/ARBs or ARNI (77%), and mineralocorticoid receptor antagonists (76%). One hundred and ten patients (39%) had permanent atrial fibrillation and 82 (29%) a cardiac resynchronization therapy device. Over a median follow–up of 33 (16–47) months, 114 patients died, 71 of whom for cardiac cause, and 28 underwent mitral valve repair/replacement. The risk of cardiac death increased proportionally to the decrease of LVOT–VTI (Figure 1, panel A), with an optimal prognostic cut–off of 17 cm (Figure 1, panel B). Reduced LVOT–VTI was associated with higher NYHA class, NT–proBNP concentration, and worse right ventricle systolic function (all p&lt;0.005). At multivariable competing risks regression analysis, a unit decrease of LVOT–VTI (HR 0.87 [95%CI 0.80–0.93], p&lt;0.001), but not of LVEF (p=0.254), was independently associated with a higher risk of cardiac death (Figure 1, panel C).

Conclusion
Left ventricular forward volume, noninvasively estimated through LVOT–VTI, but not LVEF, predicts the risk of cardiac death in patients with chronic HF and significant MR.