bluuebunny/crossref_metadata_2025_split huggingface dataset:
139 INTRAVENOUS CONTINUOUS HOME INOTROPIC THERAPY IN ADVANCED HEART FAILURE - RESULTS AND PRACTICAL GUIDELINES
Authors: Gentile Piero , Palazzini Matteo , Tedeschi Andrea , Ammirati Enrico , Perna Enrico , Verde Alessandro , D´angelo Luciana , Masciocco Gabriella , Garascia Andrea 
Published: December 2022

Abstract

Background
no firm data exist regarding continuous intravenous inotropic infusion in outpatients with advanced heart failure (AHF).

Methods
We reviewed medical records of all inotrope dependent patients discharged from our institution on continuous home inotropes infusion for AHF after a hospitalization between 2014 and 2021. Indications for inotropic agents included bridge to transplant (BTT) or to candidacy (BTC) strategies or palliative care. We compared the number of hospitalizations the year before and the year after beginning the inotrope continuous infusion, assessing the main hospital diagnosis and the duration of hospital recovery in days, through hospital charts revision. Moreover, we used a linkert 7 item scale to assess quality of life (QoL) and, using peripheral blood sample, we esteemed the end organ damage trend evaluating NTproBNP, creatinine, blood urea nitrogen (BUN) and bilirubin.

Results
From 2014 to 2021, 27 patients (Median age 56 years (Q1-Q3 50-63 years), 74% male and 26% female) were dismissed with continuous inotrope infusion from our institution. The total number of days of hospital stay was 1591 the year before beginning inotropic support (average 58.93 ± 38.70 for patient), significantly different if compared with the post inotropes period (average 22,19 ± 36,84 days for patients, IC 95% 17,488-55,994 p &lt; 0,001). Moreover, the number of hospitalizations per patient fell from 1.93 ± 0.997 to 0,93 ± 0,958 (IC 95% 0,522- 1,478, p &lt; 0,001). After 6 months, 53% of the patients experienced an improvement in quality of life. Regarding end organ damage, while creatinine and BUN showed a significant reduction in the first month, with a trend to stability in the following period, bilirubin and NTproBNP significantly trended to reduction during the 6 month of monitoring.

Conclusions
In a real world population of contemporary AHF, continuous inotropes home infusion documented an improvement in hospitalization, QoL and end organ damage. We offer a practical guideline on initiation, selection and maintenance of chronic inotrope therapy in a population of challenging patients.
353 B-BLOCKERS EFFECTS ACCORDING TO SEX: DO SELECTIVITY AND DOSE EQUALLY MATTER?
Authors: Salvioni Elisabetta , Paolillo Stfania , Galotta Arianna , Mapelli Massimo , Mattavelli Irene , Basile Christian , Vignati Carlo , Moscucci Federica , Piepoli Massimo , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
β-blockers are one of the four recommended disease-modifying classes of drugs for the treatment of heart failure with reduced ejection fraction (HFrEF). Although their efficacy and prognostic role is unquestionable in the general population of HFrEF patients, the differences in their effect in relation to sex have not been yet investigated in detail. The present study analyzed a large, real-world, Italian population of HFrEF patients aiming to highlight any prognostic difference between males and females in relation to dose and β-selectivity of the ongoing β-blocker treatment.

Methods
Out of the 7900 HFrEF patients included in the MECKI score registry, we retrospectively analyzed those treated with β-blockers. We investigated the prognostic role of β-selectivity, dividing the population in assuming β1/β2-receptor blockers (carvedilol) vs. β1-selective blockers (bisoprolol, nebivolol or metoprolol), according to sex, and the prognostic role of daily carvedilol-equivalent β-blocker dose in relation to sex. The primary outcome of the study was the composite of all cause mortality, urgent heart transplant and LVAD implant analyzed at 5 years, both as raw data and after correction of potential confounders.

Results
6784 HFrEF patients treated with β-blockers were analyzed (1215 females, 5569 males). Patients median follow-up was 4.05 years [1.72-7.47]: 4.37 [1.6-8.13] for females and 3.99 [1.75-7.3] for males (p=ns). According to β-selectivity no prognostic differences were found in the general population, as in female or males (Fig. 1 right panel). Stratification of patients according to β-blockers equivalent dose showed significant difference among groups: mortality decreases with increasing β-blockers dose in both males and females (Fig. 1, left panel), both at baseline and after adjustment for the main confounders (LVEF, age, peakVO2, systolic pressure, hemoglobin, rest heart rate; VE/VCO2 slope, etiology. ICD, MDRD).

Conclusions
In a large, real-life population of chronic HFrEF patients analyzed according to sex, no prognostic differences were found between stratifying for β-selectivity. A better outcome was observed in subjects receiving a high daily dose, independently from sex.
235 COMPARISON OF THE PROGNOSTIC RELEVANCE OF DIFFERENT ECHOCARDIOGRAPHIC PARAMETERS OF RIGHT VENTRICULAR SYSTOLIC FUNCTION IN CHRONIC HEART FAILURE
Authors: Sforna Stefano , Colucci Eliana , Viti Caterina , Mengoni Anna , Biagioli Paolo , Zuchi Cinzia , Lauciello Rosanna , Bardelli Giuliana , Carluccio Erberto , Ambrosio Giuseppe 
Published: December 2022

Abstract

Background
Right ventricular (RV) systolic function is an important predictor of prognosis in heart failure (HF). Several RV echocardiographic functional parameters have been described as sensitive prognostic markers.

Aim
To compare the predictive value of different RV systolic echocardiographic parameters in patients with HF.

Methods
One hundred and sixty patients with stable HF and left ventricular ejection fraction (LV EF) &lt;45% were assessed for the following: (1) tricuspid annular plane systolic excursion (TAPSE), (2) RV fractional area (RVFA), (3) tissue Doppler-derived RV peak systolic velocity (PSVtdi), (4) RV free wall longitudinal 2D-strain (RVFWS); and (5) 3D-RVEF. The primary endpoint was death and/or HF-hospitalization.

Results
During a mean follow-up of 16.9±10 months, 35 patients reached the primary endpoint. Each of the RV echocardiographic parameters was significantly associated with outcome at univariable analysis. After adjusting for age, eGFR, logNTproBNP, LVEF, restrictive filling pattern, pulmonary artery systolic pressure, and RV end-diastolic volume, by Lasso Cox multivariable analysis, RVFWS (HR 1.09, 95%CI: 1.02-1.18, P=0.0093) and 3D-RVEF (HR 0.95, 95%CI: 0.91-0.99, P=0.0076) remained the only parameters independently associated with outcome with a cut-off of -18.6% and 43.6% respectively, without any difference in C-statistic between the two models (0.826 versus 0.812, p=0.3255).

Conclusions
RVFWS and 3D-RVEF are strong independent predictors of outcome in HF and appear to be superior to other standard RV systolic echocardiographic parameters.
162 HFREF WITH IMPROVED EJECTION FRACTION AFTER CORONARY ARTERY BYPASS GRAFT (CABG) AND REVERSE REMODELING PREDICTOR FACTORS
Authors: Geatti Veronica , Varrà Giuseppe Guerino , Stolfo Davide , Enrico Fabris , Franzese Ilaria , Mazzaro Enzo , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
The purpose of this study is [1] to evaluate the incidence of heart failure with improved ejection fraction (HFimpEF) in patients with reduced ejection fraction (HFrEF, EF&lt;40%) undergoing surgical myocardial revascularization via coronary artery bypass graft (CABG), [2] to identify predictor factors for improved ejection fraction and [3] to study overall survival between the two populations, i.e. patients with improved EF (i.e. impEF) versus patients with non-improved EF (i.e. non-impEF).

Methods
N=699 patients, admitted between January 2000 and December 2020, were selected from the Cardiac Surgery database of our facility and analyzed retrospectively. The selection criteria for this study were [1] having EF&lt;40% at the time of surgery and [2] undergoing coronary artery bypass surgery. Patients were evaluated at preoperative baseline, immediate post-operative, 3-months follow up, 1-year follow-up and the last available follow-up. ImpEF was defined as EF&gt;40% and at least 10% EF points improvement at 1-3 months follow-up.
We assessed the incidence of improved Ejection Fraction (impEF) after surgical revascularization at 3-months follow-up, defined as the improvement of Ejection Fraction from a baseline LVEF of ≤40% to a new LVEF &gt;40%, within a measurable improvement of ≥10 points of percentage from baseline EF; predictors of impEF were investigated and the association between impEF and mortality risk was finally explored.

Results
At 3-months follow-up, 221 patients were evaluated and the 42.5% (n=94) of these showed impEF. BMI, LVESVi and LVEF were predictors of impEF at multivariable analysis. ImpEF was significantly associated with better long-term survival in our cohort.

Conclusions
In patients with reduced EF undergoing surgical myocardial revascularization, impEF occurs in 42.5% of cases within 3 months and is associated with better overall survival. The predictors of impEF identified in this study might be helpful in the definition of patients at higher probability of impEF before surgery.
8 DIFFERENCES BETWEEN PATIENTS HOSPITALIZED FOR PAROXYSMAL ATRIAL FIBRILLATION AND HEART FAILURE WITH PRESERVED, MIDLY-REDUCED, AND SEVERELY-REDUCED EJECTION FRACTION
Authors: Tufano Nicola 
Published: December 2022

Abstract

Introduction
Paroxysmal atrial fibrillation (PAF), is a very common cardiac arrhythmya in patients with heart failure (HF). In the last five years we observed many patients with AF. Aim of this observation was to evaluate differences on clinical outcomes of a paroxysmal AF episode on patients with preserved (HFpEF), mildly reduced (HFmrEF), or severely-reduced (HFrEF) ejection fraction.

Methods
439 patients consecutively hospitalized in our Cardiology Unit from January 2017 to January 2022 for paroxysmal AF were retrospectively evaluated. Of them, 201 presented without heart failure, 59 with a previously known HFpEF, 49 patients with HFmrEF, and 130 patients with HFrEF. For each patient, demographic and clinical characteristics, comorbidities, instrumental data and clinical outcomes (percentage of cardioverted arrhythmia, length of hospitalization) were collected. To examinate the correlations between characteristics of patients and clinical outcomes, chi-square or Pearson test were performed.

Results
patients with AF and HF were significantly older rather than AF patients without HF. No significantly differences we found between the three HF groups. The three groups of AF patients with HF presented more comorbidities rather than AF patients without HF. The duration of hospitalization were significantly longer for AF patients with HF rather than AF no-HF patient, without differences between the three goups . Percentage of cardioverted AF were significantly higher in no-HF patients rather than in HFrEF, but not in HFpEF and HFmrEF patients . In no-HF and in HF groups, age and length of hospitalizations were significantly correlated, but no differences we found between the groups. In the three HF groups, number of comorbidity were inversely correlated with percentage of cardioversion, but not in no-HF group. Age was significantly correlated with failure in attemps of cardioversion, without differences between HF and no-HF patients.

Conclusions
our hospitalized patients for a newly onset AF and HF presented worse clinical outcomes rather AF patients without HF. This worsening clinical outcome, seem at least in part due to differences on age and comorbidities between the three groups, whereas cardiac systolic function seems not been significantly related with worse clinical outcomes.
192 GLP1-RA AND HEART FAILURE-RELATED OUTCOMES IN PATIENTS WITH AND WITHOUT HISTORY OF HEART FAILURE: A SYSTEMATIC REVIEW AND METANALYSIS
Authors: Villaschi Alessandro , Pini Daniela , Corrada Elena , Reimers Bernhard , Condorelli Gianluigi , Stefanini Giulio G , Chiarito Mauro 
Published: December 2022

Abstract

Background
GLP1-receptor agonists (GLP1-ra) are recently developed anti-diabetic drugs which have shown promising results in phase-3 cardiovascular (CV) outcomes trials in diabetic patients, demonstrating a reduction in major adverse cardiovascular events (MACE) and, possibly, in heart failure (HF) hospitalizations. However, whether these medications improve such outcomes in patients with a history of HF remains unknown.

Methods
All randomized, placebo-controlled trials of GLP1-ra (and predefined/post-hoc analysis) reporting CV outcomes stratified by HF history were searched in Pubmed from inception to August 31st, 2022. The primary outcome was HF hospitalizations. Secondary outcomes included MACE, CV death and a composite of HF hospitalization and CV death. The analysis was performed after stratifying for HF history. Odds-ratio (OR) and 95% confidence interval (CIs) were used as effect estimated and calculated via a random-effects model. P for interaction between subgroups were calculated via meta-regression analysis and a level of p&lt;0.10 was considered as significant.

Results
Data from 6 trials and a total of 40300 patients (n=20127 GLP1-ra group, n=20173 placebo group) were included. GLP1-ra reduced HF hospitalizations in patients without HF history (OR 0.71, 95% CI 0.51-0.99) but had neutral effect on those with previous HF (OR 1.04, 95% CI 0.88–1.22, p-interaction=0.089). CV death was also reduced by intervention only in the group without history of HF (OR 0.81, 95% CI 0.71–0.92), as well as the composite of HF hospitalizations and CV death (OR 0.80, 95% CI 0.72–0.90). Indeed, no difference between treatment arms was found in the HF group for CV death (OR 0.99, 95% CI 0.82–1.18, p-interaction=0.18) and the composite of HF hospitalization or CV death (OR 1.02 95%CI 0.89–1.18, p-interaction=0.073). MACE reduction was similar in patients with (OR 0.87 95% CI 0.72–1.06) and without HF history (OR 0.84 95% CI 0.76–0.93, p-interaction = 0.75).

Conclusion
GLP1-ra do not reduce HF hospitalization and CV death in patients with history of HF, as the benefit on cardiovascular outcomes provided by this anti-diabetic class of drugs seems to be mainly limited to patients without HF history. Future studies focused on HF patients are needed to confirm such findings and clarify the limited efficacy of GLP1-ra in this relevant group of patients.
1112 DOUBLE RUPTURE OF INTERVENTRICULAR SEPTUM AFTER MYOCARDIAL INFARCTION
Authors: Bonadies Davide , Carpentiero Giovanna , Palumbo Rossana , Grossi Alma , Cristiano Mario , Vassallo Mariagiovanna , Torre Mario , Coscioni Enrico , Galasso Gennaro 
Published: December 2022

Abstract
Ventricular septal rupture (VSR) is a mechanical complication of acute myocardial infarction (MI). VSR and early surgical repair is associated with a high mortality rate and suboptimal results with frequent postoperative residual shunt. Rapid diagnosis and proper management are critical.
We present the case of a 73-year-old patient who came to our Emercency Room (ER) reporting oppressive chest pain and profuse sweating .
The physical examination showed a 4/6 L rude holosystolic murmur in right parasternal location. Electrocardiogram (ECG) showed inferior MI. Hematochemicals tests detected an increase of myocardial necrosis markers. Two-dimensional and three-dimensional transthoracic echocardiography (TTE) showed normal-sized left ventricle with akinesia of inferior and posterolateral walls and akinesia of posterior basal septum with ventricular septal rupture at this level. Coronary angiography showed total occlusion in mid right coronary artery (RCA). An intra-aortic balloon pump (IABP) was inserted to promote hemodynamic stability of the patient and as a bridge. Afterload was reduced using vasodilatators. A preoperative transesophageal echocardiography (TOE) showed the presence of an additional septal rupture into middle posterior interventricular septum. The role of echocardiographic assessment in VSR, therapeutic management, IABP use and timing of surgery are discussed.
43 CARDIAC TROPONINS AND COVID-19: WHAT DO WE KNOW ABOUT HETEROPHILIC ANTIBODIES?
Authors: Campana Pasquale , Forzano Imma , Pepe Marco , Basile Christian , Perillo Errico Federico , Ranieri Alessandro , Conte Maddalena , Parisi Valentina , Sibilio Gerolamo 
Published: December 2022

Abstract

Background
During the Coronavirus disease-19 (COVID-19) pandemic, a significant increase in cardiovascular events and death for acute Myocardial Infarction (AMI) has been widely described. In turn, cardiac troponins represent the main serum diagnostic biomarkers of AMI. However, several mechanisms of troponins elevation other than AMI could be identified such as the analytic interference due to the Heterophilic Antibodies (HA), which represents a less explored and underestimated cause.

Methods
The research of the following keywords “Heterophilic” or “Heterophile Antibodies” associated with “Troponin”, “Troponin I”, “Troponin T” or “High-sensitive Troponin” have identified 73 works in the most popular bibliographic databases such as PubMed, Scopus, and Web of Science, in which the first was published in 1998. In our systematic review, the inclusion criteria have considered all the works in which clinical information about the patients are described. The results have included 55 papers for an overall population of 128 cases that have presented HA's interference in troponins’ assay. In the great part of the works, HA's capture test has been performed to diagnose this interference. The association between HA and COVID-19 has also been explored with the identification of three works in scientific literature. In addition, we reported a clinical case of a young patient with persistent high serum ultra-sensitive Troponin levels due to HA, during the COVID-19 pandemic.

Results
The results have indicated the most at-risk population in patients with a history of multiple hospitalizations and with poor cardiovascular risk factors, who usually complained of atypical chest pain combined with persistent elevation of cardiac troponins without high CK-MB values.
Instead, only a few data could be isolated in the literature about HA's interference on troponins essay in COVID-19 patients. However, has been widely ascertained how increased serum levels of cardiac troponins have been identified in most of the SARS-COV-2 swabs positive populations, and several cardiac and extracardiac mechanisms may explain this condition.

Conclusions
The description of the most common clinical features of patients with HA's interference could help clinicians to early recognize this phenomenon, reducing the number of instrumental examinations and the hospitalization period of these patients. Therefore, the analytical mistake due to HA could be always considered in AMI differential diagnosis, and the use of HA's capture test in the at-risk population may determine an early diagnosis. Finally, the HA's phenomenon could increase during the COVID-19 period, considering how infections and vaccinations may stimulate heterophile's activity.
308 THE BROKEN HEART: A LEFT VENTRICLE FREE WALL RUPTURE IN MINOCA
Authors: Costantino Roberto , Leopizzi Alessandra , Milo Maria , Martino Roberto , Ignone Gianfranco 
Published: December 2022

Abstract
86 years-old man was admitted to our ICCU for chest pain with an ECG diagnosis of atrial fibrillation and inferior STEMI. He had a history of hypertension and ascending aorta aneurysm (48 mm) with no other known cardiovascular risk factor. He reported few episodes of short-duration chest pain in the last days.
A fast echocardiogram excluded ascending aorta dissection and pericardial effusion but showed hypokinesia of inferolateral left ventricle wall.
Urgent angiography only revealed a moderate stenosis on mid left anterior descending artery associated with slow run-off. No lesions were found on the expected culprit artery.
Due to persisting chest pain and patient's history of ascending aorta aneurysm, an urgent Angio CT was performed, but unexpectedly, during the exam, the patient lost consciousness with asistolia. RCP was practised with ROSC.
CT scan showed mild pericardial effusion with blushing. A free wall heart rupture was suspected by radiologist. Urgent echocardiogram revealed moderate pericardial effusion with a suggestive colour doppler systolic flow originating from an apparent hole in apical inferolateral left ventricle wall.
Rapid hemodynamic failure occurred so pericardiocentesis with amine support and blood transfusions were performed.
Heart team excluded urgent surgery due to extremely high operative risk related to patient's age, hemodynamic impairment and poor expected repair durability consequent to acute phase of rupture.
ICCU observation was made, with liable hemodynamic stability obtained with norepinephrine infusion. In accordance with patient's family other invasive measurements were not taken.
Unfortunately, the patient died the day after.
Only few cases of myocardial rupture in myocardial infarction-non obstructive coronary
artery disease (MINOCA) are reported in literature.
Recurrent chest pain makes plaque complication/embolus resolution a reliable hypothesis. New onset atrial fibrillation might have caused an embolization in coronary artery determining transmural ischaemia, as well as coronary artery plaque rupture/ulceration might have done.
Unfortunately, no further exams to exploit the underneath pathological process could be performed: Coronary intravascular ultrasound, optical coherence tomography, Cardiac Magnetic resonance would be a valid help in prognosis and future treatment.