bluuebunny/crossref_metadata_2025_split huggingface dataset:
814 SLEEP DISORDERS AND DYSBIOSIS: CULPRITS IN CARDIOVASCULAR DISEASES
Authors: Pala Barbara , Pennazzi Laura , Tifi Priscilla , Volpe Massimo , Tocci Giuliano 
Published: December 2022

Abstract

Introduction
Primary prevention of cardiovascular disease, the leading cause of death worldwide, has become a mainstay in addressing this considerable global challenge. It has become clear that the gut microbiome plays a vital role in human metabolism, immunity, and reactions to diseases, including cardiovascular disease. Growing evidence suggests that sleep quality can be influenced by the Gut Microbiome (GM), since probiotic supplementation has been found to improve subjective sleep healthy. Disruption of sleep and sleep/wake functions has been associated with both short (increased stress responsivity or psychosocial issues) and long term health consequences, including cancer and cardiovascular diseases. Emerging evidence suggests that disturbance of circadian rhythm, which incorporates essential physiological and humoral functions in a 24-hour cycle, could be an understudied risk factor for cardiovascular disease. While impaired sleep quality is a significant contributor to circadian rhythm disturbance, the evidence regarding sleep interventions and their effect on cardiovascular events is lacking. We conduct a literature review to synthesize a body of evidence on the interaction between sleep and GM in order to achieve robust and broad conclusions and implications with the cardiovascular system.

Methods
We reviewed the literature on the relationship between sleep, gut microbiome and cardiovascular disease, from January 2017 up until August 2022.

Results
The human GM can influence health through a bidirectional communication channel linking the brain and gut, the Brain-Gut-Microbiome Axis (BGMA). Many authors have described several underlying factors that could be involved in sleep-disorder, such as the immune system, the vagus nerve (VN), the neuroendocrine system, and bacterial metabolites. Furthermore, several interventions targeting the GM have been proved to be beneficial for amelioration of sleep problems: gamma-amino butyric acid (GABA) produced by the intestinal microbiota may influence the central nervous system through the VN and have an influence on sleep, as some studies reported

Conclusions
Sleep health may constitute a novel cardiovascular risk factor and target for preventive intervention. More research and well-designed studies are needed to better evaluate the role of the microbiome in the multi-directional relationship between sleep, diet and CVD. From our analysis GM provides a wide range of potential therapeutic targets. Challenges ahead include the development of therapeutic interventions that target reversing gut dysbiosis, at an early stage, combined with good sleep behavior, which may open new horizons to prevent cardiovascular disease.
482 A CASE OF RIGHT SIDE INFECTIVE ENDOCARDITIS IN PATIENT WITH VENTRICULAR SEPTAL DEFECT
Authors: Bruno Noemi , Grieco Martina , Galea Nicola , Tanzilli Gaetano , Torromeo Concetta 
Published: December 2022

Abstract
A 25-years old white female was admitted to our emergency department presenting with dyspnea, fever, cough and nausea. Her medical background included a small ventricular septal defect (VSD) (congenital) with a left to right shunt, micropolicistic ovary syndrome, Sars Cov 2 infection on January 2022, history of cutaneous infection after sternal piercing in the last three years. Patient showed onset of fever, headache and nausea since 20 days and had a history of ampicillin and cephalosporin usage for 15 days for comunitary pneumonia.
Upon arrival in the emergency room, physical examination revealed temperature 38°C, crackles on down right lung fields, regular but tachycardic rhythm, 3/6 holosystolic murmur in the third left intercostal space, also skin redness around the piercing zone. Laboratory test showed increasing of WB (white blood cells), C-reactive protein (CPR) and procalcitonin. Because of worsening of respiratory conditions, CT chest was performed, showing tree in bud sign, with pulmonary pattern suggestive of staphylococcal “emboligenous-like” infectious state. According to patient's clinical history and CT results, she was referred to transthoracic echocardiogram (TTE) demonstrating the presence, on the right side of the small VSD, of a isoechoic large mass (20x 13 mm) with irregular margins attached to the right ventricular wall near the ostium of the VSD, compatible with vegetation; septal tricuspid valve leaflet involvement could not be ruled out. Methicillin-susceptible Staphylococcus aureus (MSSA) was detected six times from blood cultures; therapy with oxacillin 2 gr every 4 hours combined with daptomycin 750 mg daily was started. Cardiac MRI performed after few days, documented the infective involvement of the ventricular and atrial side of the septal leaflet with moderate tricuspid regurgitation (TR).
Congenital heart disease (especially Tetralogy of Fallot, bicuspid aortic valve, aortic coarctation, ventricular septal defect) is a lifelong risk factor for infective endocarditis (IE). Size of VSD is generally not correlated with IE that is directly correlated with turbulent flow; tricuspid valve involvement is mostly seen in VSD, often complicated by pulmonary embolism. In this predisposing situation, skin infection of the piercing zone could have caused transient bacteremia which led to the formation of vegetations in the highest turbulence flow zone.
574 DOUBLE VASCULAR COMPLICATION IN THE SITE OF PUNCTURE AFTER TAVI: A CASE REPORT
Authors: Calvelli Pierangelo , Polimeni Alberto , Sorrentino Sabato , Mongiardo Annalisa , Torella Daniele , De Rosa Salvatore , Riverso Vincenzo , Giamundo Angelo , Lombardo Vincenzo , Serratore Serena , Indolfi Ciro 
Published: December 2022

Abstract
Hemorrhages represent one of the most frequent complications during TAVI. Their rapid recognition and a prompt treatment are necessary to avoid hemorrhagic shock, which can lead the patient to death in a short time.
We report the case of a 79-year-old woman affected by severe and symptomatic aortic stenosis, who underwent TAVI in our Cath-lab. Through a right femoral echo-guided arterial access, implantation of a 26 mm self-expandable aortic bio-prosthesis and hemostasis in the site of puncture with 18F Manta vascular closure device were performed. At the end of the procedure, through radial artery, a femoral angiography was performed, showing an important leak of contrast medium upper the site of puncture, without any change in arterial pressure or heart rate. After echo-guided cannulation of left femoral artery with 8F sheath, implantation of endoprosthesis in the site of hemorrhage and hemostasis of left femoral artery with 8F AngioSeal VIP vascular closure device were performed. In cardiac intensive care unit (CICU) low dosage of vasoactive agents and blood were administered, guaranteeing a good arterial pressure. Computed tomography (CT) was performed after two days and confirmed the presence of a retroperitoneal hematoma, without active bleeding.
After six days, the patient left CICU and was admitted to the cardiological ward, starting a gradual mobilization. However, after 48 hours she reported abdominal pain and became rapidly hypotensive, tachycardic and asthenic, requiring readmission in CICU. Serum exams showed low hemoglobin concentration, an abdominal CT was perfomed, showing an active bleeding from left femoral artery and a homolateral retroperitoneal hematoma. The patient was rapidly lead in the cath lab. Angiography confirmed the hemorrage and an endoprosthesis was successfully implanted in the left femoral artery. Blood and vasoactive agents were administered with a progressive improvement in hemodynamic and clinical conditions of the patients. Post-operative course was complicated by fever and empiric antiobiotic therapy was administered until blood culture revealed no bacterial growth. A third CT showed the stability of the hematomas and the absence of active bleeding, allowing hospital discharge of the patient.
Vascular complications are frequent and sneaky during TAVI procedures. A prompt treatment is of paramount importance to prevent hemorrhagic shock. TAVI operators should have experience in the field of peripheral intervention for the management of vascular complications.
1083 RISK STRATIFICATION AND PREDICTORS OF OUTCOME IN ASYMPTOMATIC AORTIC STENOSIS: THE ROLE OF MULTIMODALITY IMAGING
Authors: Colarusso Luigi , De Sarro Rosalba , Licordari Roberto , Zito Concetta 
Published: December 2022

Abstract

Background
Management of asymptomatic severe aortic stenosis is controversial and the decision to intervene requires careful assessment of the benefits and risks in an individual patient. Multimodality imaging approach is becoming an important tool to evaluate the severity and outcome of aortic stenosis (AS).

Aim
To assess the outcome of asymptomatic AS and the usefulness of aortic calcium score (CS) by computed tomography (CT) for solving the dilemma of low-flow, low-gradients (LFLG) severe AS.

Methods
70 (81.4±8.4yrs) prospective asymptomatic patients with AS were followed for 2.77±2.01yrs with a trans-thoracic echo (TTE) every 6 months. End-points were all cause mortality, aortic valve replacement (AVR or TAVR), aortic velocity and gradients progression and symptoms occurrence. Prevalence of LFLG-AS was investigated and these patients underwent CT for CS calculation at the end of follow-up (FU), Figure 1.

Results
Baseline TTE results from the 70 pts were: peak velocity 3.1±0.8m/sec; peak gradient 44±21mmHg; mean gradient 26±14 mmHg; AVA 1±0.3 cm2; DVI 0.31 ±0.1; Svi 33.8±18 ml/m2; EF: 55±9% with an AS being mild in 32.9%, moderate in 28.4%, severe in 27.1%; 36.8% of severe AS were LFLG. During FU, 23 (32.8%) pts died (5.7% LFLG) and 13(18.5%) underwent AVR/TAVR. Predictors of mortality were aortic gradients (p=0.03), AVA (p=0.008), DVI (p&lt;0.001), pulse pressure (p=0.005) and dilated ascending aorta (p&lt;0001). Predictors of AVR/TAVR were: gradients (p=0.003), peak aortic velocity (p=0.02) and dilated ascendent aorta (p=0.01). The best cut-off to predict survival was AVA =1cm2 (100% sensitivity and 80% specificity). In 34 pts ending FU we found an overall progression of AS severity (peak velocity 3.6±0.9m/sec; peak gradient 50±24mmHg; mean gradient 33±15 mmHg; AVA 0.7±0.3 cm2; DVI 0.25±0.08; Svi 36±10 ml/m2; EF 54±10%; p&lt;0.05 for all vs baseline) with 24 (70.5%) pts with severe AS and 10 (29.5%) with not severe AS. 18 (75%) of progressive severe AS were LFLG, 12 asymptomatic and 6 symptomatic and all underwent CS revealing that AS was not severe in 6 (1233±1123 AU; 622±55AU/m2) and true severe in 12 (3388±1188 AU;1858 ±795 AU/m2; p=0.005 and p=0.002, respectively). Symptomatic severe LFLG AS were all true severe according to CS (Figure 1). Table 1 shows the main CS correlations.

Conclusions
Asymptomatic AS in elderly people is associated with high mortality risk and rapid progression. AVA remains the best predictor of outcome. In severe LFLG AS, calcium score correlates with symptoms occurrence, progression of valve disease, LV hypertrophy and function and also with RV function.
961 RIGHT VENTRICLE-PULMONARY ARTERY COUPLING RATIO AS PROGNOSTIC FACTOR FOR PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TAVI
Authors: Del Sole Paolo Alberto , Fezzi Simone , Mammone Concetta , Flaim Massimo , Lunadi Mattia , Scarsini Roberto , Tavella Domenico , Pesarini Gabriele , Pighi Michele , Ribichini Flavio Luciano 
Published: December 2022

Abstract

Background
Right Ventricle/Pulmonary Artery (RV/PA) coupling has recently emerged as a relevant prognostic factor in patients undergoing transcatheter valvular interventions. The aim of this study is to assess the interaction between RV/PA coupling ratio and the incidence of Acute Kidney Injury (AKI) following TAVI in patients with severe aortic stenosis. Furthermore we investigated the interaction between this novel ratio and adverse events at 24 months follow-up.

Methods
A population of 283 patients was selected from the Verona Valvular Registry (CESC n =1918). RV/PA coupling was estimated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPs) obtained through transthoracic echocardiograms. AKI was defined as an increase in serum creatinine (sCr) of at least 0.3 mg/dL up to 48 hours following TAVI. Major adverse cardiovascular events (MACEs) were defined as the composite occurrence of cardiac death, re-hospitalization for congestive heart failure and stroke.

Results
Mean age was 83.4 ± 5.36 years and 41.3% of patients were female. The median value of TAPSE/PAPs ratio was 0.5667 mm/mmHg and was used as a cut-off. A TAPSE/PASP ratio &lt;0.5667 was found to be associated with a higher incidence of MACE at Kaplan Meyer analysis at 24 months (10.4% vs 3.5%, log p = 0.004) and higher occurrence of AKI (17.0% vs. 7.7%; p=0.027). Notably TAPSE/PAPs interquartile comparison showed higher incidence for AKI in patients in the lowest quartile compared to higher ones (24.2% vs. 8.5%; p = 0.001). Following Cox multivariate analysis, TAPSE/PAPs ratio and diabetes mellitus were found to be independent predictors of AKI.
Furthermore, risk for 24 months MACEs was higher in the population with lower TAPSE/PAPs ratio (HR 2.672; CI 95% [1.195–5.974]; p = 0.017).

Conclusion
RV/PA coupling, as characterized by TAPSE/PAPs ratio, is a promising independent predictor of AKI, also associated with higher risk of major adverse cardiac events at follow-up in subjects undergoing TAVI. These data suggest a possible role for this novel index in risk stratification, assessment of the prognosis, and decision-making in these patients.
738 A RARE CASE OF UNICUSPID AORTIC VALVE WITH SEVERE STENOSIS AND REGURGITATION: CLINICAL PRESENTATION AND MANAGEMENT
Authors: Saro Riccardo , De Luca Antonio , Radesich Cinzia , Pezzato Andrea , Restivo Luca , Korcova Renata , Mazzaro Enzo , Bardari Stefano , Rauber Elisabetta , Merlo Marco , Sinagra Gianfranco 
Published: December 2022

Abstract
A 19-year-old Pakistani migrant, who arrived in our country on foot, presented at emergency department with angina and worsening dyspnoea on exertion. The patient reported an unclear history of aortic valve disease.
Clinical examination revealed a 6/6L systolic murmur with thrill. The electrocardiogram showed sinus rhythm and signs of left ventricular hypertrophy. Chest X-ray reported cardiomegaly and signs of congestion. Troponin I HS was mildly elevated (39 ng/L, n.v. &lt; 18 ng/L).
The patient was admitted to our Cardiology department. Transthoracic echocardiography revealed a mildly dilated left ventricle (LV), with severe hypertrophy, normal kinetics and systolic function (EF 63%), dilated ascending aorta (diam. 41 mm) and severe aortic steno-insufficiency. Transesophageal echocardiography was then performed, revealing a highly calcified, unicuspid unicommissural aortic valve with severe stenosis and regurgitation. A separate origin of left coronary ostia was also documented.
The patient was referred to urgent cardiac surgery. A modified Bentall procedure (mechanical valve and prosthetic conduit) was performed with reimplantation of the coronary ostia. Due to a post-surgical complete atrioventricular block, a dual-chamber pacemaker (DDD) was implanted.
Follow-up echocardiography showed reduction of LV volumes and wall thickness and normal prosthetic function.
Unicuspid aortic valve is a very rare congenital disease, with a prevalence of about 0.02% in the adult population and is frequently associated with ascending aorta dilatation. The treatment is aortic valve replacement. Complete atrioventricular block can occur after surgery, requiring cardiac pacing.
450 USE OF A DOUBLE MITRACLIP FOR SEVERE MITRAL REGURGITATION IN A HEART TRANSPLANT PATIENT
Authors: Santacroce Flavia , Carella Maria Cristina , Acquaviva Tommaso , Lapetina Ornella , Milano Aldo Domenico 
Published: December 2022

Abstract
Despite the progresses made over the recent years on heart transplantation, there are few data in literature about mitral regurgitation in transplated hearts.
We report a case of a 62-year-old Italian man who presented dyspnea for mild exercise two years after orthotopic heart transplantation. He was found to have sever mitral regurgitation and underwent a successful implantation of a double MitraClip with the reduction of the mitral regurgitation and improvement of the symptoms.
Two months later, he was still doing well and a repeted echocardiogram showed good results with only residual mild aortic insufficiency. We found few previously reported cases using the MitraClip to treat mitral regurgitation in adult cardiac transplant patients.
914 ATRIAL AND VENTRICULAR FUNCTIONAL MITRAL REGURGITATION: CLINICAL CHARACTERISTICS AND OUTCOMES IN MITRACLIP TREATED PATIENTS
Authors: Scalzi Giuseppe , Aquila Iolanda , Polimeni Alberto , Lucchino Alessandro , Ielapi Jessica , Volpe Lorenzo , Velato Letizia , Vizzari Francesca , Mascaro Giuseppina , Spaccarotella Carmen , Indolfi Ciro , Mongiardo Annalisa 
Published: December 2022

Abstract

Background
mitral regurgitation (MR) is the second most common valvular heart disease in Europe. In the contest of functional (or secondary) MR recently has emerged a new entity, the atrial functional MR. This form is due to left atrial dilatation, it has no significant degenerative change in mitral valve complex or significant LV systolic disfunction. Conversely the ventricular functional mitral regurgitation (V-FMR) is due to systolic disfunction and left ventricular dilatation.

Aim
the aim of this study was to evaluate the differences in clinical characteristics and outcomes of patients with AFMR and VFMR treated with Mitraclip.

Methods
a retrospective analysis collected consecutive patients with functional MR who underwent transcatheter mitral valve repair using Mitraclip system in our division. A total of 161 patients were divided into the following two categories: VFMR (127 patients), defined as EF&lt;40% or EF ≥40% with history of myocardial infarction, and AFMR (34 patients) identified as EF≥50% and LAVi &gt;48 mL/m2. Baseline and clinical characteristics, echocardiographic parameters and 12 months clinical outcomes (overall mortality at 12 months, MACE at 12 months, re-hospitalization for heart failure (HF), re-hospitalization from other causes at 12 months and number of re-hospitalization at 12 months) were analyzed.

Results
compared to AFMR, patients with VFMR were younger (73 vs 78 years) had a higher man prevalence (72,4% vs 50%), higher rate of: hypercholesterolemia (79,5% vs 67,6%), smokers (14,2% vs 5,9%), diabetes (39,4% vs 20,6%), chronic kidney disease (55,9% vs 47,1%), NT-proBNP mean value (4403,437 pg/ml vs 2063,409 pg/ml), NYHA class ≥III (84.3 vs 52.9%) and lower rate of hypertension (85% vs 97.1%). In AFMR population there was higher prevalence of atrial fibrillation (70.6% vs 45.7%) and tricuspid valve regurgitation ≥2+ (82.3% vs 68,5%). Moreover, in this group, was lower the all-cause mortality rate at 12 months (9.4 vs 22%), MACE at 12 months (4.5 vs 24.5%), re-hospitalization for HF (15.6% vs 33.1%), re-hospitalization from other causes at 12 months (18.8% vs 31.6%) and number of re-hospitalization at 12 months ≥1 (31,3% vs 59.9%).

Conclusion
our analysis demonstrated that clinical outcomes at 12 months were lower for the AFMR group. These data are consistent with the literature, where AFMR is considered to have a better prognosis than VFMR, and underline the importance of differentiating these two types of population.
900 PREDICTORS OF OUTCAMES IN PATIENTS WITH MITRAL REGURGITATION UNDERGOING PERCUTANEOUS VALVE REPAIR
Authors: Serafino Sergio , Polimeni Alberto , Mongiardo Annalisa , Spaccarotella Carmen , Sorrentino Sabato , Mascaro Giuseppina , Aquila Iolanda , Lucchino Alessandro , Vizzari Francesca , Serratore Serena , Messina Chiara , Di Costanzo Assunta , Velato Letizia , Ciliberto Federica , Indolfi Ciro 
Published: December 2022

Abstract

Aims
Mitral regurgitation is the second-most frequent VHD in Europe. According to the latest ESC Guidelines, transcatheter edge-to-edge repair (TEER) was included as a treatment option in patients with severe symptomatic MR at high risk for surgery (Class IIb recommendation) for primary MR and a Class IIa recommendation for secondary MR.
We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair.

Methods and Results
The MITRA-UMG study, a single-center registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy between March 2012 to October 2021 at Magna Graecia University. Clinical, echocardiographic and procedural data were collected and compared with post procedural outcomes. Procedural success was defined as successful implantation of one or more clip(s) with a post-procedure reduction of MR of 2 + or less at discharge. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure.
The median follow-up was 456 days (IQR 372–1130 days) with a complete 1-year follow- up in 188 of 200 (97%) patients. A functional aetiology was classified in 75% of patients. Procedural success was obtained in 98% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 77 patients (36%) with cumulative incidences of 7% at 30 days and 25% at 1 year. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi &gt; 92 ml/m2 was associated with an increased incidence of the primary endpoint (HR 3.55, 95%CI [2.03, 6.18], P&lt;0.0001) (Figure).

Conclusions
In this study, patients presenting with dilatated ventricles (LVEDVi &gt; 92 ml/m2) and advanced heart failure symptoms (NYHA IV) carried the worst prognosis after TEER.
1056 AN OUT OF ORDINARY CASE OF ACUTE SEVERE AORTIC REGURGITATION IN SPONTANEOUS AORTIC VALVE LACERATION
Authors: Cava Francesco , Cosentino Nicola , Lauri Gianfranco , De Metrio Monica , Marenzi Giancarlo 
Published: December 2022

Abstract
A 77-year-old male presenting with acute chest pain and syncope was sent to our emergency room by ambulance. An echocardiogram revealed severe pericardial effusion, thoracic aortic ectasia, and mild aortic regurgitation (AR). Computed tomography (CT) scan did not demonstrate aortic dissection. He underwent emergency pericardiocentesis for acute cardiac tamponade. After three hours of clinical monitoring, the transthoracic echocardiogram revealed de-novo severe AR, and CT scan showed a probable laceration of left ventricular wall at the level of left sinus of Valsalva. The lesion was confirmed during urgent cardiac surgery and it was successfully repaired using stitches intertwined with double pledglet and aortic bioprosthesis implant.