bluuebunny/crossref_metadata_2025_split huggingface dataset:
C4 DOUBLE RHYTHM MAPPING FOR COHERENT ELECTROPHYSIOLOGICAL SUBSTRATE CHARACTERIZATION IN ATRIAL FIBRILLATION PATIENTS
Authors: Grossi B , Pagani S , Taormina A , Ceriotti C , Poggio L , Battaglia V , Galimberti P , Del Monaco G , Gregusova N , Latini A , Valcher S , Stankowski K , Mincione L , Condorelli G , Frontera A 
Published: May 2023

Abstract

Background
Atrial fibrillation (AF) progresses with a cascade of combined structural, functional, and systemic dysfunctions. Electro–anatomical maps are employed to investigate pro–arrhythmic areas. However, single rhythm maps provide only a partial reconstruction: rhythm and wavefront directionality might mask some of these areas. Purpose. To demonstrate that the combined quantitative analysis of different rhythm maps (i.e., parallel sinus rhythm and paced maps) could allow consistent identification of structural and functional defects sustaining AF.

Methods
Thirty AF clinical procedures have been performed with mapping system support. In particular, a sinus rhythm activation map and a paced map have been created with a multipolar catheter by setting an extra beat every three sinus beats. Areas of abnormal conduction have been identified and a comparison of electrophysiological biomarkers (EGMs voltage and fractionation) among the two rhythms has been performed.

Results
This comparative analysis allowed us to identify both structural and functional electrophysiological phenomena. Specifically, we distinguished: (i) abnormal conduction zones confirmed in both maps, both characterized by signal fractionation and a lower voltage (0,56 ± 0,18 mV) with respect to healthy atrial tissue (2,40 ± 0,41 mV), and (ii) abnormal conduction zones visible in only one of the two maps. In the latter, we distinguished whether the absence of the phenomena was due to wavefront orthogonality to the diseased area (revealed thanks to a change in wavefront direction) or due to the presence of a functional phenomenon induced by the pacing. In the first group signal fractionation has been detected in both rhythms and a lower voltage has been found (1,79 ± 1,1 mV) with respect to normal conduction zones (3,26 ± 0,98 mV), while in functional cases EGMs fractionation has been identified only in paced maps and no significant difference has been observed in terms of voltage.

Conclusion
Double rhythm mapping provides a more robust characterization of atrial abnormal conduction phenomena which better represent AF electrical substrate. It allows the distinction of true structural dysfunctions from dynamic ones thanks to the different wavefront directionality and paced rhythm. Moreover, the structural defects have been confirmed by EGMs analysis, which revealed both low voltage amplitude and high fractionation, characteristics that have not been reported in functional cases.
C7 COMBINATION OF SPIRULINA, GANODERMA LUCIDUM AND MORINGA OLEIFERA IMPROVES CARDIAC FUNCTIONS AND REDUCES PRO–INFLAMMATORY BIOMARKERS IN PRECLINICAL MODELS OF SHORT–TERM DOXORUBICIN–MEDIATED CARDIOTOXICITY
Authors: Quagliariello V , Ostacolo C , De Anseris R , Di Mauro A , Scognamiglio G , Palma G , Iovine M , Luciano A , Barbieri M , Bruzzese F , Maurea F , Paccone A , Berretta M , Maurea N 
Published: May 2023

Abstract

Background
Anthracyclines are essential adjuvant therapies for a variety of cancers, particularly breast, and gastric and esophageal cancers. Whilst prolonging cancer–related survival, these agents can in–duce drug–related cardiotoxicity. Spirulina, Reishi (Ganoderma Lucidum) and Moringa are three nutaceuticals with anti–inflammatory effects that are currently used in cancer patients to improve quality of life and fatigue.

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with short–term doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), Singo at 12 mg/kg (Singo, n=6) or doxorubicin combined to Singo (DOXO–Singo, n=6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100, Fujifilm). Myocardial expression of NLRP3, DAMPs (galectine 3 and calgranulin S100) and 13 cytokines (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 selective mouse ELISA methods. Myocadial fibrosis, necrosis and hypertrophy were analyzed through Immunohistochemistry (IHC). Human cardiomyocytes (HFC cell line) were exposed to subclinical concentration of doxorubicin (200 nM) alone or in combination to Singo ( at 10, 25 and 50 µg/ml) for 24 and 48h. Cell viability studies were performed through MTS assay. Expression of NLRP3 and p65/NF–kB) were made through selective ELISA methods.

Results
In preclinical models of short–term DOXO cardiotoxicity, Singo improved significantly EF and FS and prevented the reduction of radial and longitudinal strain after 10 days of treatment with DOXO. A reduced expression of myocardial NLRP3 and NF–kB levels in cardiac tissues were seen in DOXO–Singo group compared to DOXO mice (p&lt;0.05). Myocardial expression of pro–inflammatory cytokines were significantly reduced after treatment with Singo indicating anti–inflammatory properties. Myocardial levels of Cal–granulin S100 and galectine–3 were strongly enhanced in DOXO group; on the other hand their expression were reduced in Singo–DOXO group vs DOXO (p&lt;0.05). Immunohistochemistry analysis indicates that Singo reduces fibrosis and hypertrophy in myocardial tissue of mice during exposure to DOXO.

Conclusion
Singo is able to improve cardiac function and reduce biomarkers involved in heart failure and fibrosis. Cardioprotective properties of Singo are mediated by the reduction of lipid peroxidation products and expression of NLRP3–NF–kB –cytokine pathways.
C48 TEN–YEARS, SINGLE–CENTER EXPERIENCE WITH MELODY TPV IMPLANTATION: EARLY OUTCOMES AND MID–TERM FOLLOW–UP
Authors: Giordano M , Marzullo R , Gaio G , Cappelli Bigazzi M , Fabiani D , Palladino M , Della Cioppa N , Sarubbi B , Russo M 
Published: May 2023

Abstract

Objectives
Melody TPV is the first percutaneous valvular bio–prosthesis approved for trans–catheter pulmonary valve implantation (TPVI). We describe our ten–years experience about Melody TPV implantation in patients with congenital heart disease (CHD).

Methods
This is an observational retrospective single–center study. All patients undergone Melody TPV implantation were included. The early outcomes analyzed were: procedural failure, death of patient, life–threating adverse events. The long–term outcomes analyzed during follow–up were: infective endocarditis, trans–catheter redo–procedure, and surgical redo–procedure.

Results
From 2012 to 2022, 39 patients were evaluated in our catheterization laboratory for TPVI with Melody TPV. Mean age and weight were 21,31±11,58 (range 8–66) years and 57,5±16,24 (range 23–96) kilograms. The patients were affected by the following CHD: tetralogy of Fallot (22 pts, 56,4%), pulmonary atresia with ventricular septal defect (VSD) (4 pts, 10,3%), aortic stenosis s/p Ross surgery (4 pts, 10,3%), transposition of the great arteries with VSD and PS (3 pts, 7,7%), pulmonary stenosis (PS) (2 pts, 5,1%), truncus arteriosus (2 pts, 5,1%), double outlet right ventricle (1 pt, 2,5%), Ebstein’s anomaly (1 pt, 2,5%) In 4 cases (10,3%), the procedure failed because of coronary compression during balloon RVOT interrogation. One patient (2,5%) died due to post–procedural septic shock. In the other 34 patients (87,2%), the Melody TPV was implanted effectively. No life–threating adverse events were recorded. In 3 cases, the Melody TPV was implanted off–label: in tricuspid position (one case) and in “small conduits” (&lt;16 mm) (two cases). The mean follow–up was 4,41±2,82 years. During follow–up, 5 patients (14,7%) developed an infective endocarditis, 7 patients (20,6%) required a trans–catheter procedure (6 Melody balloon dilation and 1 Melody valve–in–valve), and 2 patients (5,9%) underwent surgical Melody TPV replacement.

Conclusion
Trans–catheter Melody TPV implantation is effective to deal RVOT dysfunction. At a mid–term follow–up, the most of the implanted Melody TPV worked properly and only a few patients required surgical valve replacement.
C55 A GIANT PSEUDOANEURYSM OF MITRAL–AORTIC INTERVALVULAR FIBROSA PRESENTING AS RECENT–ONSET ANGINA AND CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION
Authors: Tofoni P , Patani F , Vagnarelli F , Lofiego C , Capodaglio I , Dottori M , Angelini L , Francioni M , Bonanni C , Grossi P , Galeazzi M , D‘Alfonso A , Marini M , Di Eusanio M , Perna G 
Published: May 2023

Abstract
A 66–year–old man was suddenly referred to the emergency department (ED) for an extra–hospital cardiac arrest due to ventricular fibrillation, promptly treated by a single DC shock. Four months prior, he had undergone aortic valve replacement with a biological valve prosthesis (BVP, Perimount Magna n. 23) for severe aortic stenosis. One month after cardiac surgery the patient was hospitalized for acute cholecystitis requiring antibiotics and percutaneous cholecystostomy. On arrival to the ED the patient was awake and completely asymptomatic; no fever during days before the episode. He had been complaining of constricting retrosternal chest pain during physical exertion for ten days. However, no signs of ischemia were seen on the EKG. TT echo showed a very large pulsatile anaechogenic area posteriorly to BVP. Transesophageal echocardiography (TEE 2D, Traditional 3D and TrueVue) highlighted a very large pseudoaneurysm of mitral–aortic interventricular fibrosa (P–MAIVF; Figures 1 and 2, long axis and short–axis views). TEE features included: 1) a very large cavity with thickened walls, extended for more than two–thirds of the prosthetic circumference and with multiple septa; 2) a large communication between the left ventricular outflow tract (LVOT) and P–MAIVF (see yellow dotted line in Fig.1A) with a to–and–fro flow into the cavity and a prominent systolic pulsation; 3) no paraprosthetic leak and absence of any attached mass or intraprosthetic aortic regurgitation. These findings suggested a prosthetic aortic valve endocarditis with an extensive periannular involvement. Moreover, the P–MAIVF may have led to “ab extrinseco” compression of the left coronary artery, with a potential role in the genesis of chest pain and ventricular arrhythmia (in absence of significant CAD at preoperative coronary angiography). An empiric antibiotic therapy with daptomycin and piperacillin–tazobactam was started. The patients subsequently underwent Bentall surgery with a subannular implantation technique (Perimount valvular prosthesis n.23 and Gelweave vascular prosthesis n.28). Figure 3 shows an intraoperative image and postoperative TEE. In conclusion, P–MAIVF is an ominous complication of prosthetic valve endocarditis. Presentation with exertional angina and cardiac arrest is unusual. TEE is sensitive for diagnosis and 3D echo provides better insights into the anatomy helping formulate an appropriate surgical strategy.
C72 POSTERIOR WALL CHARACTERIZATION IN PATIENTS AFFECTED BY ATRIAL FIBRILLATION
Authors: Valcher S , Benedetta G , Kamil S , Latini A , Pagani S , Vincenzo B , Del Monaco G , Taormina A , Galimberti P , Poggio L , Ceriotti C , Frontera A 
Published: May 2023

Abstract

Background
Several clinical data in humans demonstrate that atrial fibrillation (AF) dominant frequencies and rotors are mostly localized on the posterior wall (PW), but the correlation among these phenomena and abnormal conduction properties during sinus (SR) and paced rhythm (PR) has never been analyzed. Aims. To provide a characterization of the left atrial PW in patients affected by persistent AF. In particular, the purpose is to describe the electrophysiological properties in terms of rotational and focal activities during AF, propagation uniformity during SR and functional sites definition during PR.

Methods
Six patients from two EP centers have been selected for this analysis. The clinical procedures have been performed with CARTO3 mapping system. All EGMs have been collected with Pentaray and Octaray catheters. For each patient, the module CARTOFINDER has been used during AF to identify areas with shorter and longer cycle length (site of conduction jump), rotational and focal activities; at least 15 areas have been collected in the PW. SR and PR map were performed after electrical cardioversion to exploit the functional phenomena. The paced map has been created by setting an extra beat from the coronary sinus every three sinus beats (pacing interval=local effective refractory period +40ms). Rotational and focal activities during AF have been identified and associated with signals collected during SR and PR. EGMs have been characterized in terms of voltage amplitude (mV), signal duration (ms) and fractionation.

Results
Abnormal areas of conduction recorded during AF were 33; at least one site of conduction jump was found in every patient, in most of the cases (77%, 10 out of 13) it was localized on the PW. 10 areas of focal activities have been found of which 7 (70%) were localized on the PW. Rotational activity has been found in 2 patients (in one on the PW). During SR and paced rhythm, at sites of interest, we found lower voltages (SR 1.9 ± 1,3mV, PR 1,7 ± 1,15mV), signal fragmentation and longer signal duration (SR 52,7 ± 8,85ms, PR 51,3 ± 11,04ms) compared to healthy tissue.

Conclusion
There is a strong correlation between sites of interest during AF and signal abnormalities recorded during SR and PR. This research work may pave the way to the study of abnormal conduction sites during SR which represent a relevant element for AF maintenance, providing a further step towards substrate characterization in patients affected by AF.
C79 NEGATIVE T WAVES ON ECG: NOT JUST HYPERTROPHIC CARDIOMYOPATHY
Authors: Micillo M , Assabbi P , Cossu A , Lapolla D , Boccadoro A , Amantea V , Guardigli G , Tonet E 
Published: May 2023

Abstract

Background
Arrhythmogenic cardiomyopathy is still considered a rare and difficult–to–diagnose condition, yet a well–founded clinical–instrumental suspicion and proper diagnostic procedure can unveil this condition early from common instrumental findings.

Clinical Case
In September, a 34–year–old man presented to our center for the presence on the electrocardiogram of ventricular repolarization changes (negative T waves in D1, inferior site and in all precordial leads with mild ST elevation in V1– V2). He denied family history of cardiological events. In 2018, following a suspected preoperative EKG, he performed an echocardiogram and cardiac magnetic resonance imaging (CMR); these examinations showed mild left ventricular hypertrophy with preserved systolic function. Clinically, the patient reported rare episodes of palpitation presented on ambulatory EKG with the same repolarization changes as mentioned above. In consideration of the clinic–instrumental findings, a diagnostic workup with echocardiogram and CMR was started for suspicion of hypertrophic cardiomyopathy in the first hypothesis. On echocardiogram, an non dilated left ventricle was found with left ventricular ejection fraction, parietal thicknesses, and segmental kinetics within normal limits, in the absence of significant valvulopathy; however, frequent ventricular extrasystoles were reported during the examination. Given the EKG–graphic alterations, although there weren‘t any echocardiographic changes, a CMR was performed, showing extensive irregularity of the epicardial profile of the lateral and infero–lateral mid–apical wall, site of adipose infiltration, in which evidence of intramyocardial late gadolinium enhancement (LGE) was also present; the right ventricle showed extensive microbulging of the mid–basal free wall in the absence of adipose replacement or LGE. In view of the clinical–instrumental pattern, the diagnosis of "left dominant" arrhythmogenic cardiomyopathy with initial involvement of the right ventricle was made.

Conclusions
EKG–graphic interpretation may in some cases be the only instrumental data underlying clinical suspicion of arrhythmogenic cardiomyopathy, allowing early diagnosis of a condition at high risk of sudden cardiac death.
C81 ROLE OF RESTRICTIVE DIASTOLIC DYSFUNCTION FOR RISK STRATIFICATION OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A BAYESIAN MODEL AVERAGING
Authors: Buongiorno A , Albani S , Grilli G , Merlo M , Berchialla P , Ricotti A , Pierri A , De Luca A , Barbisan D , Mabritto B , Bongioanni S , Luceri S , Porto I , Musumeci G , Sinagra G 
Published: May 2023

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular (LV) stiffness, leading to raised ventricular filling pressures and restrictive diastolic dysfunction (RDD), in itself independently associated with an increased risk of a clinical deterioration. We assessed whether echocardiography evaluation of diastolic function in HCM could yield prognostic value and be useful in HCM risk stratification.

Methods
We retrospectively reviewed clinical and imaging (echocardiography and cardiovascular magnetic resonance, CMR) data from 361 consecutive patients from two HCM Italian referral centers (Mauriziano Hospital, Turin; University Hospital of Trieste, Trieste). Among them, 28 patients were classified after Doppler echocardiography examination as restrictive (E/A &gt; 1.5, DecT E &lt; 140 ms, E/e’ &gt; 10). The primary endpoint was a large cardiovascular composite consisting of sudden cardiac death (SCD), major ventricular arrythmias (MVAs), heart transplant (HT) and hospitalization for heart failure (HF). Other secondary endpoints were investigated as follows: 1) a secondary arrhythmic endpoint consisting of SCD and MVAs, 2) a key secondary composite of HF, HT, non–SCD. A Bayesian Model Averaging (BMA) was then performed to overcome the bias determined by the limited number of observations.

Results
Over a mean follow up of 7 ± 3 years, 61 (17%) patients experienced at least one primary composite endpoint event. Of them, 10 were identified with a restrictive diastolic pattern. When BMA was performed, late gadolinium enhancement (LGE) presence at CMR and RDD were significantly associated with the primary composite outcome (respectively, PI = 100, HR = 3.55, pd = 1.00; PI = 74.5, HR = 3.33, pd = 0.99). Left atrium (LA) diameter was not strongly associated with the arrhythmic endpoint, whereas it was significantly associated with the key secondary composite outcome, as well as with increased filling pressures (E/e’) (respectively, PI = 94.5, HR = 1.10, pd = 1.00; PI = 86.8, HR = 1.08, pd = 0.99).

Conclusions
Restrictive diastolic dysfunction is an independent predictor of poor prognosis in early stages of HCM in absence of systolic dysfunction. In particular, RDD predicted outcomes related to heart failure better then LA diameter and E/e’.
C86 ASSOCIATION OF PLASMA TMAO VALUES WITH ANOTHER ISCHEMIC EVENT DURING LONG–TERM FOLLOW–UP IN PATIENTS WITH MYOCARDIAL INFARCTION
Authors: Aleksova A , Janjusevic M , Stornaiolo M , Fluca A , Zhou X , Hiche C , D’Errico S , Novellino E , Sinagra G 
Published: May 2023

Abstract

Background
Elevated plasma trimethylamine N–oxide (TMAO) levels, a metabolite derived from the intestinal microbiota, are closely related to atherosclerosis due to its involvement in increased inflammation, oxidative stress and cholesterol reverse transport.

Objectives
Blood samples were collected at admission from 81 patients who survived acute myocardial infarction (AMI) and from 10 healthy individuals. TMAO concentrations were measured by means of liquid chromatography–tandem mass spectrometry with an aim to evaluate the predictive value of this biomarker in terms of another major event during long–term follow–up.

Results
Patients with AMI have significantly higher median plasma TMAO concentration compared to healthy individuals (respectively, 1.62 (1.37 – 2.25) µM vs 0.55 (0.35 – 0.74) µM, p &lt; 0.0001). Considering only patients with AMI, TMAO values positively correlated with pro–inflammatory markers CRP and TNF–α. In addition, TMAO positively correlated with creatinine and negatively correlated with GFR. Moreover, we noted the trend of higher TMAO values among patients with diabetes mellitus compared to patients without (1.68 (1.44 – 5.43) µM vs 1.59 (1.33 – 2.099) µM, p=0.065). During a median follow–up of 61.74 (59.34 – 64.24) months, 10 patients suffered another infarction. Those individuals had significantly higher TMAO values compared to subjects without another ischemic event (respectively, 2.29 (1.60 – 6.49) µM vs 1.60 (1.34 – 2.09) µM, p = 0.026). Kaplan–Meier analysis confirmed that elevated values of TMAO were associated with the risk of another infarction (p=0.029), whereas multivariate Cox regression analysis did not demonstrate the prognostic value of TMAO towards re–infarction probably due to the small cohort.

Conclusions
Higher plasma TMAO values at admission in patients with AMI are associated with re–infarction at long–term follow–up.
P4 TRANSTHYRETIN–INDUCED CARDIAC AMYLOIDOSIS: A RARE MUTATION IN AN ITALIAN FAMILIAL CASE
Authors: Moscardelli S , Santangelo G , Bursi F , Rusconi D , Guazzi M 
Published: May 2023

Abstract
A 65–year–old man came to our hospital for a subacute stroke of the left parietotemporal area. An aorto–coronary bypass for stable coronary artery disease and aortobisiliac bypass for infrarenal aortic aneurysm (with post–operative courses complicated by multiple atrial fibrillation paroxisms which were pharmacologically cardioverted) was reported. No undergoing anticoagulant therapy for CHADSVASc=1 was reported. Hypothesizing a cardioembolic origin of the stroke, echocardiographic analysis was performed which showed increased ventricular thickness and mass, inhomogeneous texture, reduced systolic function and strain with apical sparing, II degree diastolic dysfunction and severe left atrial dilatation. The strong suspicion of amyloidosis, raised by the echocardiographic findings, was confirmed by bone scintigraphy. The absence of free immunoglobulin chains in blood and urine and a normal protein electrophoretic pattern, would have instead excluded the diagnosis of AL amyloidosis. Thus we performed genetic testing to characterize the type of ATTR (transthyretin). An homozygous Val142Ile mutation in exon 4 of the TTR gene was found. This mutation, typically found in patients of African ancestry, is extremely rare in the Caucasian population. In fact, only 5 cases of patients with this mutation and with phenotypic manifestations very similar to the African ancestral ones have been so far reported, thus indicating that this mutation is not restricted to African ancestry but may be an underestimated Caucasian variant. The large GnomAD database estimates that this homozygous mutation is present in only 0.72% of the general population, while the remaining part of the carriers are heterozygous. Val142Ile leads to increased formation of amyloid fibrils and to the formation of a particularly unstable TTR tetramer. This variant is associated with a worse quality of life, a higher incidence of AF and a lower survival than the wild type TTR. In light of the worse clinical outcomes associated to this variant it is therefore essential to maintain a high level of clinical suspicion in order to perform an early diagnosis from a clinical and molecular point of view in order to be able to direct the patient as soon as possible to the current available therapies that can modify the course of the pathology and avoid premature fatal events.