bluuebunny/crossref_metadata_2025_split huggingface dataset:
1120 DIAGNOSTIC ACCURACY OF SMART GADGETS/WEREABLE DEVICES IN ATRIAL FIBRILLATION DETECTION: A METANALYSIS
Authors: Vetta Giampaolo , Magnocavallo Michele , Parlavecchio Antonio , Gianni Carola , Polselli Marco , Vuono Francesco De , Pannone Luigi , Mohanty Sanghamitra , Cauti Fillippo Maria , Caminiti Rodolfo , Miraglia Vincenzo , Monaco Cinzia , Chierchia Gian Battista , Rossi Pietro , Biase Luigi Di , Bianchi Stefano , De Asmundis Carlo , Natale Andrea , Della Rocca Domenico Giovanni 
Published: December 2022

Abstract

Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis.

Hypothesis
We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices.

Methods
We systematically searched Medline, Embase and Cochrane electronic databases up to April 15th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities.

Results
A total of 79 studies were included enrolling 36903 patients, 66.3% male with average age of 68.3±8 years. In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(95% CI: 94–96%), the specificity 96%(95% CI: 96–97%). Wrist-worn wearables had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 92–97%), the specificity 97%(95% CI: 96–98%)(Figure 1A). Smartphone applications had AUC of 0.98 (95% CI: 0.96-0.99), the sensitivity 96%(9% CI: 94–97%), the specificity 96%(95% CI: 93–98%)(Figure 1B). External devices had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 93–97%), the specificity 96%(95% CI: 95–97%)(Figure 1C). Single-lead ECG had AUC of 0.99 (95% CI: 0.98- 1.00), the sensitivity 95%(9% CI: 92–96%), the specificity 96%(95% CI: 95–97%). PPG had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 96%(9% CI: 95–97%), the specificity 97%(95% CI: 95–98%).

Conclusions
Smartphone application, wrist-worn devices and external devices with PPG and single-lead ECG have excellent diagnostic accuracy in atrial fibrillation diagnosis.
Figure 1. Summary Receiver Operating Characteristic curves and Areas Under The Curve of Wrist-worn wearables (A), Smartphone applications (B) and External devices (C).
164 HIGH HDL CHOLESTEROL INCREASES CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS
Authors: Manzi Maria Virginia , Trimarco Valentina , Izzo Raffaele , Morisco Carmine , Mone Pasquale , Falco Angela , Pacella Daniela , Gallo Paola , Lembo Maria , Santulli Gaetano , Trimarco Bruno 
Published: December 2022

Abstract

Background
Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension.

Methods
To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy.

Results
We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C&lt;40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C&gt;80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes (Figure 1). Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients.

Conclusions
Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.
567 BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT: THE MEASUREMENT OF OVERALL ECHOGENICITY (GSM) OF CAROTID INTIMA MEDIA COMPLEX SHOWS A POSITIVE CORRELATION WITH ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS
Authors: Natale Francesco , Loffredo Francesco , Molinari Riccardo , Covino Simona , Alfieri Roberta , Altobelli Ippolita , Cimmino Giovanni 
Published: December 2022

Abstract
Beyond the Intima Media Thickness assessment: the measurement of overall echogenicity (GSM) of Carotid Intima Media Complex shows a positive correlation with Arterial Stiffness of hypertensive patients.
According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk.
Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima-media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color-Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM &gt; 30 showed a significantly increased arterial stiffness and LVMI (P &lt; 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, &lt; 0.001), and duration of hypertension (r = 0.31, &lt; 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.
730 P2Y12 INHIBITORS MONOTHERAPY IN PATIENTS UNDERGOING COMPLEX VS NON-COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Oliva Angelo , Castiello Domenico Simone , Franzone Anna , Condorelli Gianluigi , Colombo Antonio , Esposito Giovanni , Stefanini Giulio , Piccolo Raffaele 
Published: December 2022

Abstract

Background
Monotherapy with P2Y12 inhibitors (P2Y12i) is emerging as alternative strategy to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). However, early withdrawal of aspirin as part of P2Y12i monotherapy regimens may pose concerns in high-risk patients, such as those undergoing complex PCI. Thus, we aimed to evaluate the efficacy and safety of P2Y12i monotherapy compared with standard DAPT according to PCI complexity.

Methods
We performed a meta-analysis of randomized trials using random effects models to combine hazard ratios (HRs) with 95% confidence intervals (CIs). No restrictions were applied to the type of P2Y12 receptor inhibitor or to the definition of complex PCI. Within-trial interactions were pooled to estimate heterogeneity between complex and noncomplex PCI strata. The study protocol was registered in the PROSPERO (CRD42021291027).

Results
After screening of 7,502 unique citations, we included in the analysis 5 randomized clinical trial enrolling 31,627 patients, of whom 8,328 (26.3%) underwent complex PCI (Table 1) Risk estimates for efficacy and safety outcomes associated with P2Y12i monotherapy and standard DAPT across studies included in the analysis, stratified by complex and noncomplex PCI, are reported in Figure 1. P2Y12i monotherapy compared with standard DAPT was associated with a similar risk of all-cause death, stent thrombosis, and stroke, with no evidence for interaction between complex and noncomplex PCI. We found heterogeneity in the treatment effect of P2Y12i monotherapy vs. standard DAPT with respect to myocardial infarction (P-interaction=0.027). Compared with standard DAPT, P2Y12i monotherapy decreased the risk of myocardial infarction in complex PCI (HR 0.77, 95%CI 0.60-0.99, P=0.042), but not in noncomplex PCI patients (HR 1.09, 95%CI 0.90-1.30, P=0.382). The risk of major bleeding was significantly reduced by P2Y12i monotherapy with a consistent treatment effect (P-interaction=0.699) in both complex and noncomplex PCI strata.

Conclusions
Patients undergoing complex PCI may derive more benefit and less harm from P2Y12i monotherapy after early aspirin withdrawal compared with standard DAPT, resulting in decreased risks of myocardial infarction and bleeding.
711 CROSS-SECTIONAL ANALYSIS OF CARDIOVASCULAR CAUSES OF COMMON PRESENTING SYMPTOMS IN PATIENTS WITH ACTIVE CANCER: THE EXPERIENCE FROM A TERTIARY ONCOLOGICAL CENTRE IN MODENA.
Authors: Maisano Anna , Valenti Annachiara , Alessandro Albini , Cherubini Benedetta , Mantovani Marta , Leo Giulio , Trapanese Paola , Rampini Francesca , Bertuglia Filippo Federico , Minnocci Melania , Boriani Giuseppe 
Published: December 2022

Abstract

Background and aim of the study
There is a rising interest in cardio-oncology as an holistic approach to oncological patients with established cardiovascular comorbidities or at increased cardiovascular risk. Symptoms of potential cardiovascular significance are a common cause of cardiologic consultation in patients with active cancer. Moving from this perspective, we analyzed the proportion of cardiovascular conditions underpinning potentially cardiologic presenting symptoms in a cohort of patients with active malignancy referred to the Emergency Department (ER) of a tertiary oncological centre.

Methods and Results
The study included 250 consecutive patients (median age 69 years [IQR 59.7-77.4], 50% female) presenting to the oncologic ER from September 1st 2021 to May 31st 2022. The most common presenting symptoms were fever (26.9%), gastrointestinal symptoms (24.9%), dyspnea (10.4%), hypotension and hypertension (1.6%), syncope (1.2%) and other (11.2%). We considered as symptoms of potential cardiologic significance the following: dyspnea, lipothymia and syncope, palpitations, fever, chest pain, hypotension and hypertension. We found that 101 of 250 patients (40%) presented with symptoms of potential cardiologic significance. Out of them, 14 patients (13.9%) had confirmed cardiologic diseases: pulmonary embolism (21.4%), heart failure (21.4%), pericardial effusion (21.4%), reflex syncope (14.2%), pericarditis (14.2%) and new onset atrial fibrillation (7.1%). As reported in the table, no significant difference was reported in terms of risk profile or history of cardiac diseases when comparing patients with and without cardiovascular cause of presenting symptoms (CV cause vs non-CV cause).

Conclusions
Cardiovascular conditions are not common causes of ER presentation among oncologic patients with active cancer. Nevertheless, when a cardiologic condition is diagnosed, it could be potentially life-threatening. The cardiovascular risk profile and the history of cardiac disease is not a good discriminator to identify a cardiac cause of presenting symptoms in this specific setting.
Table. Characteristics of patients with potentially cardiologic presenting symptoms.
13 CANCER-ASSOCIATED THROMBOSIS AND THROMBOCYTOSIS: THE EDOXABAN SOLUTION.
Authors: Fioretti Agnese Maria , Leopizzi Tiziana , Giotta Francesco , Luzzi Giovanni , Oliva Stefano 
Published: December 2022

Abstract

Introduction
TEV is the second highest cause of death in malignancy with 20% incidence. Platelets is a leading mediator of thrombosis as well as of tumor development. Indeed, thrombocytosis is a predictive biomarker of thrombosis risk and contributes to CAT burden. However, the management of thrombocytopenia in patients with CAT is well investigated, whereas evidence is poor on the management of patients with concomitant occurrence of thrombocytosis and CAT.

Case report
A 67 y-o woman, in primary thromboprophylaxis with 100 mg/die aspirin for myeloproliferative syndrome (PC: 771 x103/µl), was treated with left mastectomy for infiltrating ductal carcinoma (G3 pT1cN1a Mx Ki67:25%) and adjuvant chemotherapy with anthracyclines and anastrozole. Due to bone metastases, zoledronic acid, fulvestrant and palbociclib were administrated. For liver metastases, she was treated with exemestane, paclitaxel and bevacizumab and for disease progression, started capecitabine and cyclophosphamide, still ongoing. She experienced left jugular vein thrombosis (Fig 1-2) treated with edoxaban 60 mg/die with an almost total DVT regression after 2 months. The multidisciplinary team (oncologist, cardiologist, hematologist) decided to interrupt aspirin, proceeding antithrombotic therapy with edoxaban full dose. Concomitant cytoreductive therapy with hydroxyurea was started concomitantly with edoxaban. PC was reduced (522 x103/µl). After 1-month follow-up duplex ultrasound still documented mild persistence of the DVT (Fig 3-4), the patient was compliant and the anticancer regimens (addressed to both the solid cancer and the hematologic disease) were still administrated without any adverse effects.

Conclusions
CAT is a frequent and major complication of malignancy, worsening mortality, morbidity and decision-making. Platelets play a central role in promoting the hypercoagulable melieu of cancer as well as the metastases growth. Notably, thrombocytosis occurrence further increases the thrombogenic burden in malignancy; nevertheless, its concomitant development together with CAT is understudied. In the reported case, a solid tumor, together with hematologic cancer and DVT, concurred to a difficult management of a patient admitted to our multidisciplinary team. The use of a DOAC, edoxaban, at full dose, without concomitant therapy with aspirin, was an effective, safe and manageable antithrombotic treatment option, allowing the continuation of anticancer agents with no interruptions or delays. The knowledge of tumor-specific pathways may help to personalize strategies for CAT prevention.
Fig 1-2
Fig 3-4
201 CTLA-4 AND PD-1 BLOCKING AGENTS INCREASES SYSTEMIC SDF-1, CARDIAC DAMPS FIBRONECTIN EDA, S-100 CALGRANULIN, GALECTINE-3 AND NLRP-3/MYD-88 CHEMOKINE PATHWAYS
Authors: Quagliariello Vincenzo , Passariello Margherita , Mauro Annabella Di , Cipullo Ciro , Paccone Andrea , Barbieri Antonio , Palma Giuseppe , Luciano Antonio , Buccolo Simona , Bisceglia Irma , Canale Maria , Galluccu Giuseppina , Saviano Claudia , Maurea Carlo , Lorenzo Claudia De 
Published: December 2022

Abstract

Background
Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases.In this study, pro-inflammatory and pro-fibrotic effects of short-term ICIs therapy in preclinical models were analyzed.

Methods
Firstly, in a human in vitro model, human cardiomyocytes co-cultured with hPBMC were exposed to ICIs (with CTLA-4 or PD-1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through colorimetric and enzymatic assays. C57/Bl6 mice were treated with CTLA-4 or PD-1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF-kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs (S100- Calgranulin, Fibronectin and Galectine-3), MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF-1, IL-1β and IL-6 were analyzed before, during and after ICIs therapy.

Results
Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF-kB expression shows that short-term anti-CTLA-4 or anti-PD-1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin-3, pro-collagen 1-α and MMP-9 were increased after treatment with all ICIs. Both anti-CTLA-4 or anti-PD-1 treatments increased the expression of DAMPs, NLRP3 inflammasome and MyD88 and induced both in vitro and in vivo the secretion of IL-1β, TNF-α and IL-6. Systemic levels of SDF-1, IL-1β and IL-6 were increased during and after treatment with ICIs.

Conclusions
Short therapy with PD-1 and CTLA-4 blocking agents increases vascular expression of NF-kB, systemic SDF-1, IL-1β, IL-6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro-inflammatory cytokine storm was induced in myocardial tissues and in cultured cardiac cells after ICIs therapy. The overall picture of the study suggests new putative biomarkers of ICIs-mediated systemic and myocardial damages potentially useful in clinical cardioncology.
267 EFFECTS OF PIRFENIDONE ON SCAR SIZE AND VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION: A PRECLINICAL STUDY
Authors: Aimo Alberto , Burchielli Silvia , Aquaro Giovanni Donato , Barison Andrea , Musetti Veronica , Masotti Silvia , Pucci Angela , Modena Martina , Passino Claudio , Emdin Michele 
Published: December 2022

Abstract

Background
An intense fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Pirfenidone is a drug currently approved for the treatment of idiopathic pulmonary fibrosis, and reduces LV fibrosis in patients with heart failure and preserved ejection fraction. We aimed to characterize the different profiles or protein expression in the infarct zone in rats receiving or not receiving pirfenidone on top of standard therapy for MI.

Methods
Male Wistar rats were randomized to: sham procedure (group 1; n=13), reperfused MI induced by surgical ligation of the left anterior descending artery (LAD) for 45 minutes (group 2; n=17), reperfused MI plus standard therapy (aspirin, angiotensin-converting enzyme inhibitor, beta-blocker, and also mineralocorticoid receptor antagonist [MRA]) (group 3; n=17), reperfused MI plus pirfenidone alone (group 4; n=17), reperfused MI plus standard therapy and pirfenidone (group 5; n=17). Rats surviving LAD ligation and reperfusion underwent cardiac magnetic resonance (CMR) after 72 hours and 30 days from MI, and were sacrificed the day after the second CMR exam. The primary endpoint was the change in late gadolinium enhancement (LGE) mass as a percentage of LV mass.

Results
Forty-six rats survived until the second CMR. Percent changes in LV end-diastolic and end-systolic volume (p=0.370 and 0.423, respectively), ejection fraction (p=0.236) and mass (p=0.815) did not differ significantly between rats on pirfenidone plus standard therapy compared with those receiving standard therapy alone. The decrease in LGE mass was significantly greater in rats on pirfenidone plus standard therapy vs. those on standard therapy alone: -22.0% (interquartile range, -37.1 to -5.7, range -51.1 to +37.5) vs. +1.9% (-7.7 to +12.5, range -19.8 to +56.5), p=0.029.

Conclusions
Pirfenidone had additive effects to standard therapy for MI (including an MRA) in reducing LV fibrosis in a rat model of reperfused MI, while it did not further improve LV function, volumes or mass.
611 PLASMA EXOSOMES REFLECT MYOCARDIAL INJURY DETECTED BY CARDIAC MAGNETIC RESONANCE IN STEMI PATIENTS
Authors: Baggiano Andrea , Zarà Marta , Banfi Cristina , Campodonico Jeness , Tedesco Calogero , Amadio Patrizia , Gili Sebastiano , Dona Gianluca De , Sandrini Leonardo , Maragna Riccardo , Marenzi Giancarlo , Pontone Gianluca , Barbieri Silvia Stella 
Published: December 2022

Abstract

Background
CMR is the gold standard technique to detect microvascular obstruction (MVO) and myocardial salvage index (MSI) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Exosomes are lipid vesicles released by all cells that reflect the metabolic status of the releasing cells, thus representing potential biomarkers of disease.

Objectives
To evaluate the correlation between exosome profile and myocardial infarction characteristics as detected by CMR in patients after STEMI.

Methods
exosomes were isolated from plasma of 42 patients by different commercial kits, their concentration and size distribution determined by Nanoparticle Tracking Analysis, exosomal surface epitopes by the MACSPlex Exosome Kit and GPIIb-IIIa expression by ELISA kit. Data obtained were correlated with parameters of myocardial damage (STEMI location, culprit lesion, time to revascularization, MVO and MSI).

Results
Levels of circulating plasma exosomes were higher in patients with anterior STEMI (p = 0.0002) and when the culprit lesion was located in LAD (p = 0.045). In addition, a high number of exosomes was measured in the subset of patients who underwent a late revascularization (&gt; 3 h from onset of symptoms; p = 0.038). Patients with MVO and low MSI (&lt; 0.5) have smaller exosome (p = 0.0015 and p = 0.014, respectively). By analysing the expression of 37 surface protein markers, the strongest signals are platelet specific markers (CD41b and CD42a) followed by endothelial and immune cells markers. Interestingly, a lower expression of platelet marker GPIIb-IIIa was detected in both patients with MVO and anterior STEMI (p = 0.039 and p = 0.0038, respectively). Univariate analysis demonstrated that exosome size and GPIIb-IIIa were independent predictors of MVO/MSI and ROC analysis demonstrated that dimension and GPIIb-IIIa can identify patients with MVO/MSI (AUC 0.75 and 0.71, respectively).

Conclusions
The plasma exosome profile well reflects CMR-assessed myocardial injury after STEMI. In particular, the exosome dimension and the expression of platelet marker GPIIb-IIIa are independently associated with MVO. Future studies with larger populations are required to confirm the role of platelet-derived exosomes in risk stratification after STEMI.