bluuebunny/crossref_metadata_2025_split huggingface dataset:
P442 BASELINE ALBUMINURIA AND HEART FAILURE DURING HOSPITALIZATION WITH ACS AND LONG–TERM DEATH RISK. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE
Authors: Berton G , Palmieri R , Cavuto F , Cordiano R , Merotto D , Bagato F , Dal Bo A , Preti G , Mahmoud H 
Published: May 2023

Abstract

Background
Both albuminuria and heart failure are known predictors of poor outcomes in patients with acute coronary syndrome (ACS). Purpose: To assess the combined effect of albuminuria and heart failure on the long–term mortality risk prediction 24 years after ACS.

Methods
The present analysis includes 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization. Patients were followed for 24 years or until death.

Results
Virtually all patients completed the follow–up, representing 7066 person–years. Patients‘ mean age was 66 ± 12 years, 70% were males and 482(82%) had died during follow–up. Compared to those who survived, dead patients, were significantly different for many clinical features, they had baseline HF and microalbuminuria more frequently (39 % vs. 5% p&lt;0.0001) and (24 % vs. 7% p&lt;0.0001), respectively, and they showed significantly higher values of 3rd–day albumin–creatinine ratio (ACR) (p&lt;0.0001). The unadjusted Cox regression analysis showed that the presence of either albuminuria or HF at admission with ACS is independently associated with long–term mortality (HR:1.84; 95%CI 1.54–2.20; p&lt;0.0001) and (HR:2.48; 95%CI 2.05–2.98; p&lt;0.0001), respectively.

Results
were similar using the fully adjusted model. Moreover, patients who suffered from both pathologies were at higher risk of death than patients with either.

Conclusions
The Presence of heart failure and albuminuria during ACS is independently associated with long–term mortality with an additive effect.
P445 HEART RATE VARIABILITY AND HYPNOTIC COMMUNICATION
Authors: Cornara S , Somaschini A , Astuti M , Benigni M , Sartelli S , Donka P , Bacino L , Scaglione M , Bellone P 
Published: May 2023

Abstract

Background
Heart rate variability (HRV) can be influenced by the autonomic nervous system and several studies showed that hypnotic communication could modulate the autonomic nervous system. In particular, HRV is related to the activity of the vagus nerve and an increment of the vagal activation has been associated to an improvement in prognosis. It is, however, unclear whether hypnotic communication could influence HRV. Aim of the study The aim of the present study is to evaluate the impact of hypnotic communication on HRV.

Methods
Seven volunteer were included in the present study (5 M/2F) from June to August 2022. Each one of the volunteer underwent 1 hour of ECG registration in normal condition, 30 minutes during depth hypnotic communication and 1 hour after the hypnotic communication. The hypnotic communication was performed via 30 minutes of neutral depth hypnosis; the parameter considered for HRV evaluation were sNN50 (dec), SDNN(ms), SDNNi, RMS SD and the triangular index, analyzed throughout the dedicated software Pathfinder SL (V 1.9.3.13414, spacelabs healthcare Ltd 2021, WA, USA). The variation of each parameter was evaluated by Student T test.

Results
There was no statistically significant variation of sNN50 (dec), SDNN(ms), SDNNi, RMS SD among the normal condition, the hypnotic communication and the post hypnotic communication. There was a statistically significant variation of the triangular index (Fig.1) and of heart rate (Fig. 2).

Conclusion
Hypnotic communication could increase HRV, assessed as triangular index (the index suggested by European society of cardiology (ESC) and American college of cardiology (ACC) to measure HRV). The absence of a statistically significant variation between the normal condition and hypnotic communication could be explained by the deep modification in the respiratory pattern and heart rate induced by hypnotic communication; those parameter could mask the increment in the vagal activity due to hypnotic communication, that is unmasked in the post–hypnotic period in which the heart rate and the respiratory return to normal value. Further studies are needed to understand whether the increment in HRV due to hypnotic communication could show an improvement in prognosis in cardiopathic patients, as it has been demonstrated for the HRV increment due to muscular training.
P446 INDEPENDENT EFFECTS OF TYPE 2 DIABETES AND OBESITY ON CARDIOPULMONARY PERFORMANCE IN SUBJECTS AT HIGH CARDIOVASCULAR RISK
Authors: Nesti L , Pugliese N , Armenia S , De Biase N , Balletti A , Tricò D , Natali A 
Published: May 2023

Abstract

Background
Both obesity and type 2 diabetes (T2D) are associated with effort intolerance and heart failure. Since the two conditions often coexist and overlap, their distinct effect on cardiopulmonary performance remains to be elucidated.

Methods
Patients at high cardiovascular risk, free from any clinical or instrumental evidence of heart disease, with a wide range of body mass index (BMI) values, and with or without T2D underwent combined echocardiography–cardiopulmonary exercise test (eCPET). Patients were divided in T2D and controls, as well as in lean (BMI &lt;25 kg/m2), overweight (BMI 25 – 30 kg/m2), and obese (BMI &gt;30 kg/m2).

Results
A total of 206 patients was analyzed, divided in 109 patients with T2D and 97 controls. Increased BMI is associated with multiple cardiovascular dysfunctions including chronotropic insufficiency, subclinical systolic dysfunction (reduced global longitudinal strain, GLS), and impaired systolic reserve, achieving significantly lower oxygen uptake and workload. Obesity is associated with reduced lung volumes and mild ventilatory alterations at peak exercise, irrespective of diabetes. T2D patients showed more frequent LV concentric remodeling, worse systolic and diastolic performance at rest with diminished ameliorations during exercise, and worse sympatho–vagal balance as expressed by the higher prevalence of chronotropic insufficiency and delayed heart rate recovery. Nonetheless, when divided in BMI subclasses, the differences between T2D and controls were only evident among lean subjects. In fact, while no difference between T2D and controls was evident among overweight and obese patients, lean individuals with T2D display worse cardiopulmonary performance than lean controls, achieving lower workload and lower VO2peak, revealing systolic dysfunction (lower GLS) and higher LV filling pressures (E/e’). Unlike glycated hemoglobin, strong linear relationships were proven between fat mass and oxygen uptake, workload, systolic, and diastolic indices.

Conclusions
T2D affects LV dimensions and geometry, systo–diastolic functions, autonomic balance, cardiopulmonary capacity, and exercise tolerance, independently of the presence of obesity. Nonetheless, increased BMI is an even more powerful independent negative determinant of systolic function, autonomic balance, and effort tolerance. These early alterations might partly explain the increased risk of developing heart failure associated with diabetes and obesity.
P447 TRANSCATHETER PACING SYSTEM IMPLANT: IS IT A MATTER OF GENDER?
Authors: Barletta V , Lepone A , Tamborrino P , Parlato A , Parollo M , Mazzocchett L , Sbragi S , Canu A , Di Cori A , De Lucia R , Segreti L , Bongiorni M , Zucchelli G 
Published: May 2023

Abstract

Background
The use of a leadless pacing system, like Micra Transcatheter Pacing System (M–TPS), is nowadays a convincing alternative to transvenous pacemaker. PURPOSE: The study aimed to investigate feasibility and long–term electrical outcomes of M–TPS implant in a real–world population and to estimate sex differences in leadless pacing.

Methods
All patients undergone M–TPS implantation in our Institution from May 2014 to October 2022. Device follow–up was scheduled at discharge, after 1 month from procedure and then every 6 months. Electrical performance was checked. Major complications were defined as life– threatening events, requiring surgical intervention or any event causing significant hemodynamic instability or resulting in death. Study population was divided between genders to analyze potential differences and those observed during the follow–up (FU).

Results
One hundred ninety–three consecutive patients [148 males, 76.7%, mean age 79 (IQR 73–84) years] were enrolled in the study. There were no statistically significant differences between groups for demographics characteristics (mean age at implant 79 vs 81, p=0.12), except gender. The mean FU was 12 (IQR 1–36) months, maximum 8 years. The implant procedure was effectuve in all patients and no complications were recorded. We observed no differences between groups in procedure duration [40 (IQR 30–60) min vs 40 (IQR 29–50), p=0.64], fluoroscopy time [9 (6–14) min vs 9 (7–11), p=0.81] and single device delivery (65.7% vs 65.9%, p=0.34). Electrical performance, except for pacing threshold at implantation [0.5 (IQR 0.38–0.75) V/0.24ms vs 0.38 (IQR 0.25–0.63) V/0.24ms, p=0.02), was similar between groups at discharge [pacing threshold 0.38 (IQR 0.38–0.63) V/0.24 ms vs 0.38 (IQR 0.25–0.55) V/0.24 ms, p=0.30; impedance 650 (IQR 560–760) Ohm vs 675 (IQR 580–780) Ohm, p=0.71; R wave amplitude 10.1 (IQR 7–16.2)mV vs 9.5 (IQR 7–14.45) mV, p=0.71] and during the FU [pacing threshold 0.5 (IQR 0.38–0.63) V/0.24 ms vs 0.5 (IQR 0.38–0.5) V/0.24 ms, p=0.11; impedance 570 (IQR 490–630) Ohm vs 580 (IQR 510–640) Ohm, p=0.46; R wave amplitude 11.5 (IQR 7.8–15.7)mV vs 12.7 (IQR 9–18) mV, p=0.26].

Conclusion
Leadless pacing therapy is a feasible and safe alternative to conventional pacemakers with comparable electrical performance and outcomes even during a long–term FU. No differences were found between genders making it a good option especially in women who are often considered fragile in surgical procedures.
P453 RECURRENT SYNCOPAL EPISODES IN A YOUNG PATIENT: TO IMPLANT THE PM OR NOT TO IMPLANT THE PM, ALWAYS A DIFFICULT DECISION!
Authors: Scapinelli M , Guerra A , Boccedi M , Caputi A , Bagni E 
Published: May 2023

Abstract

Introduction
Syncope represents one of the main causes of access to the Emergency Department and outpatient visits, accounting for up to 13% of hospital admissions. Although usually benign, syncopal episodes are a source of considerable distress for the patient and family members, particularly when dealing with otherwise healthy young patients. We report the case of a young patient who presented with recurrent syncopal episodes with important psychological and professional implications.

Case Report
A 33–year–old man comes to our Syncope Unit with a long history of repeated syncopal episodes preceded by fleeting warning signs, sometimes with minor trauma, occurring during daily activities, in conjunction with minor injuries or post–voiding but never during exertion. The patient began to limit his activities for fear of syncope and was inhibited from driving work vehicles and performing tasks at height. The various cardiological examinations performed over the years were normal. The study of syncope evoked a syncope with a 13 sec pause on carotid sinus massage while the Head–up Tilt Test was negative. A Loop Recorder (ILR) was then implanted to correlate the syncopal episodes with any slowing or pathological pauses in the heart rhythm. At remote monitoring of the ILR, an asystole of about 16 seconds symptomatic for syncope was documented. In relation to the recurring syncopal episodes, the important professional limitations imposed on the patient, as well as at the explicit request of the patient himself, despite the lacking scientific evidences availables, we proceeded to implant a dual–chamber pacemaker with a frequency response algorithm. In the 4 years after the implant there were no syncopal recurrences and the patient resumed his normal daily and professional activities with a marked improvement also in his psychological setting. After 2.5 years, however, the ventricular lead broke and required its extraction and reimplantation.

Conclusions
The decision to implant the device was not easy, precisely in relation to the possible complications over the years, but this allowed the patient to resume a normal private and professional life. However, an accurate risk–benefit assessment is required, sharing the "weight" of the decision with the patient and his family.
P459 A SUDDEN STROKE AFTER CORTICOSTEROID THERAPY FOR HEART TRANSPLANT REJECTION
Authors: Zanella L , Toscano G , Fabozzo A , Tessari C , Pradegan N , Gerosa G 
Published: May 2023

Abstract
After heart transplant, the immune system of recipient could recognise the transplanted heart as foreign and reject it. To avoid it, immunosuppressive therapy is used, but sometimes it is not enough, in these cases high doses of immunosuppressors must be used. If the rejection is cellular mediated the main therapy is high corticosteroid therapy. A 63–years–old woman presented one year after heart transplant, due to acute cellular mediated graft rejection, detected at follow–up biopsies. High dose corticosteroid intravenous therapy was started. She had history of Chron’s disease treated by monoclonal therapy. Electrocardiography at admission showed a sinus rhythm. In the night of the second day of steroid therapy, she suddenly experienced facial asymmetry and left arm and leg hyposthenia. A cerebral angiographic scan was immediatly performed and it revealed a thrombotic occlusion of right internal carotid artery, from right carotid bifurcation to right internal carotid syphon (Figure 1). A few minutes later a percutaneous neuroradiological transcatheter thrombectomy was successfully performed and the patient had a full recovery without any neurological permanent disfunctions. The protocol for acute cellular mediated hear transplant rejection in our centre is corticosteroid intravenous therapy 1 gram per day for three days, followed by corticosteroids orally 1mg/kg on the fourth day, subsequently gradually reduced of 5mg per day till a dose of 5mg per day that we use to maintain as long–term prophylaxis. Three days after the stroke, the patient experienced high frequency atrial fibrillation, never detected before. She underwent a transoesophageal echocardiography to evaluate the feasibility of an electric cardioversion, but a thrombus in the left atrial appendage was firstly discovered. Therefore, the patient was treated with oral anticoagulants and beta blockers, at the follow–up echocardiography the thrombus was disappeared, and she didn’t experience any other cerebrovascular embolisms. The link between the high dose corticosteroid therapy and the stroke, in a patient with a chronic inflammatory bowel disease and maybe unknow paroxysmal atrial fibrillation, could showed that this therapy could be a trigger for rapid thrombus formation and cerebral embolisms in these patients. This highlights the importance of in hospital monitoring of this patients during high dose steroid therapy, combined to proper diagnosis and treatments of worst complications.
P463 LEFT ATRIAL APPENDAGE CLOSURE VERSUS TRIPLE ANTITHROMBOTIC THERAPY IN PATIENTS WITH LONG TIME INDICATION TO DUAL ANTIPLATELET THERAPY
Authors: Vella C , Festorazzi C , Ancona M , Bellini B , Ferri L , Russo F , Ghizzoni G , Gentile D , Montorfano M 
Published: May 2023

Abstract

Introduction
Recent guidelines suggest a limited duration of triple antithrombotic therapy (TAT) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) at elevated bleeding risk. Indeed, in patients who are also at elevated thrombotic risk and with indication to prolonged dual antiplatelet therapy, percutaneous left atrial appendage closure (LAAC) could be a possible safe and effective option to prevent both bleeding and thrombotic events.

Methods
retrospective single–center study enrolling all consecutive patients between September 2012 and February 2020, comparing patients deemed at increased thrombotic and bleeding risk who received LAA percutaneous closure to avoid TAT before or after PCI with patients who received TAT after PCI. The aim of the study was to establish the safety and efficacy of LAAC in comparison to TAT.

Results
A total of 168 patients were included in the study: 56 underwent percutaneous LAAC while 112 were discharged in TAT. Median age was 75 (69–79). TAT patients had a CHA2DS2–VASc score of 4 (3–5) and a mean HAS–BLED score of 3 (2–3), whereas in LAAC patients the mean CHA2DS2–VASc was 4.9 (±1.5) and the mean HAS–BLED was 3.9 (±0.9); the difference in Score Points was statistically significant (p=0.001). The population who underwent LAAC was characterized by a remarkable procedural PCI complexity with a mean DAPT score of 1.4 (±1.3), with respect to the population discharged in TAT which was 0 (0–2). At follow–up (mean follow–up period in days: 727 [489–1000]), four bleeding episodes were recorded in LAAC population in comparison to 16 bleeding episodes observed in TAT population (12.6% vs. 15.4%; p–value=0.142): two bleeding episodes were major in LAAC group and five in TAT group (3.6% vs. 4.8%; p–value=1). One case of stroke (1.8%) occurred in LAAC population and two cases (1.8%) in TAT population (p=1.000).

Conclusions
In a single–centre retrospective study no significant difference was observed in terms of bleeding between TAT and LAAC, in patients at high ischemic and thrombotic risk with indication to prolonged dual antiplatelet therapy after PCI and anticoagulation for AF. Nevertheless, the non statistical trend to reduction of bleeding events in LAAC group might be explored in a larger study population.
P468 CLINICAL CHARACTERISTICS OF PATIENTS AFFECTED BY HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION AND UNDERGOING SGLT2I THERAPY
Authors: Alcidi G , Pugliese R , Ioannoni S , Romano M , Granatiero M , Diomede D , Benvenuto M , Correale M , Brunetti N , Gronda E , Iacoviello M 
Published: May 2023

Abstract

Background
The type–2 sodium–glucose cotransporters inhibitors (SGLT2i) are a new relevant therapeutic option for patients affected by chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate the clinical characteristics and therapy of HFrEF patients undergoing SGLT2i therapy.

Methods
We evaluated the consecutive patients affected by HFrEF in whom the SGLT2i therapy was prescribed since December 2021. At baseline clinical visit, ECG, echocardiography, assessment of sodium, potassium, fasting glucose, hemoglobin, hematocrit, glomerular filtration rate (GFR) by creatinine were assessed.

Results
Ninety patients were enrolled. In the Table clinical characteristics and therapy are reported. Interestingly, most of patients were already trated with the classes of drugs currently recommended fo HFrEF treatment.

Conclusions
In this “real world” study, SGLT2i were prescribed in HFrEF patients most of all already in therapy with the other classes of drugs currently recommended for their treatment. These data further support the use of this therapeutic approach in routine clinical practice.
P470 BERBERINE ASSOCIATED TO DAPAGLIFLOZIN EXERTS SYNERGISTIC CARDIOPROTECTIVE EFFECTS IN CARDIAC CELLS EXPOSED TO THE HER2–BLOKING AGENT TRASTUZUMAB THROUGH PAMPK ACTIVATION AND REDUCTION IN INTERLEUKIN–6 LEVELS
Authors: Quagliariello V , Scherillo M , Maurea F , Iovine M , Paccone A , Maurea N 
Published: May 2023

Abstract

Background
Trastuzumab has improved the prognosis in patients with HER2–positive breast cancer, but it can induce left ventricular dysfunction with reduced ejection fraction or HF during treatment. Dapagliflozin is a SGLT2i with cardio–renal benefits. In the DAPA–HF (Dapagliflozin And Prevention of Adverse–outcomes in Heart Failure) trial, the sodium–glucose cotransporter 2 inhibitor dapagliflozin decreased the risk of worsening HF events and cardiovascular death in patients with HF and reduced ejection fraction. Berberine is a nutraceutical compound characterized by multiple metabolic effects in patients with/without cardiovascular diseases. Purpose: To investigate on the potential cardioprotective properties of Berberine associated to SGLT2i Dapagliflozin against HER–2 blocking agent–induced cardiotoxicity

Methods
Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of trastuzumab (200 nM) alone or co–incubated with Berberine (200 mM) or Dapagliflozin (50 nM) or both in combination for 48 h. After the incubation period, we performed the following tests: cell viability, apoptosis, expression of NLRP3 inflammasome, methylglyoxal and leukotrienes–B4. Expression of pAMPK was analyzed through western blot. Moreover, quantification of IL–6 was performed through ELISA method.

Results
Berberine and Dapagliflozin increased significantly the cell viability of cardiomyocytes exposed to Trastuzumab. When combined, Berberine and Dapagliflozin increased synergistically cell viability of cardiac cells (p&lt;0.001 vs Trastuzumab). Cell apoptosis was reduced of 32.5, 41.8 and 72.7% for berberine, dapagliflozin and both combined (vs trastuzumab group). Methylglyoxal,a marker of AGEs, was strongly reduced compared to untreated cells. Western blot analysis clearly demonstrate that pAMPK was induced by berberine and Dapagliflozin, improving mitochondrial metabolism. No significant changes in Leukotriene B4 expression were seen. Intracellular levels of IL–6 were reduced of 46.3, 62.7 and 86.3% for berberine, dapagliflozin and both combined (vs trastuzumab group).

Conclusion
Berberine and Dapagliflozin exerts significant cardioprotective effects in cardiac cells exposed to the HER2–bloking agent Trastuzumab. Berberine and Dapagliflozin in combination induces an anti–inflammatory phenotype to myocardial cells through the reduction of biomarkers involved in heart failure and apoptosis.
P472 SACUBITRIL/VALSARTAN IMPROVES EXERCISE PERFORMANCE IN PATIENTS WITH HEART FAILURE: A DOSE–DEPENDENT EFFECT
Authors: Mapelli M , Mattavelli I , Salvioni E , Paolillo S , Basile C , De Martino F , Vignati C , Magrì D , Mantegazza V , Tamborini G , Agostoni P 
Published: May 2023

Abstract

Background
Sacubitril/Valsartan therapy has become a cornerstone of heart failure with reduced ejection fraction (HFrEF) pharmacological therapy due to its positive prognostic impact. However, conflicting results have emerged on the effects of sacubitril/valsartan on exercise performance assessed by cardiopulmonary exercise test (CPET). Aim of the study: The aim of this study was to prospectively evaluate the effects of sacubitril/valsartan on prognostically significant CPET parameters in a larger population of HFrEF patients at different drug doses.

Methods
We prospectively enrolled HFrEF outpatients eligible to start sacubitril/valsartan according to 2016 ESC Guidelines in 3 Heart Failure Units. Patients underwent CPET at baseline (before sacubitril/valsartan treatment), after 1, 2, 3 months (respectively after a month taking the 24/26 – 49/51 – 97/103mg doses), and 6 months after the maximum tolerated dose was reached (end–study). The subjective impression of disease–related limitation was assessed using the 12–item Kansas City Cardiomyopathy Questionnaire (KCCQ).

Results
113 patients were enrolled (age 64.5±9.7, 81% males). Peak oxygen intake (peakVO2) improved at each step from 15.0±4.5 mL/min/kg at baseline to 16.5±4.9 mL/min/kg at end study visit, corresponding to 61.5±16.0 and 67.9±17.4 % of predicted, respectively (p&lt;0.05). Minute ventilation/carbon dioxide production relationship (VE/VCO2 slope) reduced from 39.6±5.5 to 35.9±7.1 (p = 0.005) in the 39 patients (42%) with pathological VE/VCO2≥34 at baseline. KCCQ improved significantly since the first visit with an overall summary score increase from 47.9±11.1 to 52.6±9.8 (p&lt;0.001).

Conclusions
These findings suggest that sacubitril/valsartan benefits on exercise capacity are immediately evident at the lowest dose and progressively improve as the dose increases.