bluuebunny/crossref_metadata_2025_split huggingface dataset:
63 CHEST PAIN AND THE DYNAMIC EVOLUTION OF SPONTANEOUS CORONARY ARTERY HEMATOMA
Authors: Franzino Marco , Costa Francesco , De Ferrari Tommaso , Vizzari Giampiero , Di Bella Gianluca , Micari Antonio , Carerj Scipione 
Published: December 2022

Abstract

Background
Spontaneous coronary intramural hematoma (SCIH) is a rare but underdiagnosed condition, with dynamic evolution.

Clinical presentation
A 45-year-old woman was admitted to the emergency department with chest pain and fever in the previous days. Markers of myocardial injury were elevated, white blood cell count and C-reactive protein were mildly elevated, whereas D-dimer, chest X-ray and ECG were normal. Transthoracic echocardiography showed inferior wall hypokinesia, so an urgent coronary angiogram was performed showing no evidence of obstructive coronary artery disease.

Investigations
Cardiac magnetic resonance (CMR) was performed two days later showing inferior wall ischemic pattern (Figure 1) and ECG showed changes in the inferior leads with T waves inversion. A second coronary angiogram with planned intravascular imaging was than performed and showed a critical stenosis of the mid-distal right coronary artery determining functional vessel occlusion (Figure 2). Coronary vasospasm was ruled-out after intracoronary nitrates infusion and intravascular ultrasound (IVUS) showed diffuse intramural hematoma of the ostial, proximal and mid-segment of the right coronary artery with subocclusive stenosis at the mid segment with no evidence of atherosclerosis (Figure 3).

Management
Considering the clinical and radiological evidence of evolving myocardial injury, conservative management was excluded, and direct stenting of the lesion was performed with IVUS guided implantation of four overlapping drug-eluting stents.

Conclusion
Our case highlights the dynamic and treacherous nature of spontaneous coronary intramural hematoma, causing initial symptoms of myocardial ischemia without evident coronary obstruction, and then rapidly evolving in a severe and life-threatening coronary occlusion upon hematoma expansion. Higher level diagnostic testing such as CMR and intravascular imaging were instrumental for correct diagnosis and treatment in this complex scenario.
Figure 1
Figure 2
Figure 3
1005 STROKE VOLUME INDEX AND TRANSVALVULAR FLOW RATE TRAJECTORIES IN SEVERE AORTIC STENOSIS TREATED WITH TAVR
Authors: Gallone Guglielmo , Gorla Riccardo , Melillo Francesco , Leone Pier Pasquale , Cimaglia Paolo , Pastore Maria Concetta , Franzone Anna , Landra Federico , Bruno Francesco , Scudeler Luca , Bragato Renato , Ilardi Federica , Toselli Marco , Conrotto Federico , Montorfano Matteo , Manzo Rachele , Cameli Matteo , Patti Giuseppe , Stefanini Giulio , Testa Luca , Giannini Francesco , Agricola Eustachio , D´ascenzo Fabrizio , De Ferrari Gaetano Maria 
Published: December 2022

Abstract

Aims
The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS.

Methods and results
Patients were categorized according to SVi (&lt;35 ml/m2) and FR (&lt;200 ml/sec). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor (SVi: HR 1.39, 95%CI 0.81-2.40, FR: HR 0.86, 95%CI 0.51-1.46). Among 731 patients undergoing early (5 days, IQR 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low-flow. Reduced FR following TAVR was an independent predictor of mortality (HR 2.08, 95%CI 1.07-4.04) while SVi was not (HR 0.68, 95%CI 0.34-1.36). Three-year estimated mortality in patients with recovered FR was lower as compared to patients with reduced FR (13.3% vs 37.7% vs, p=0.003) and similar to patients with normal baseline FR (p=0.317).

Conclusions
Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.
298 MPACT OF GUIDELINES-ORIENTED AGE CUT-OFF IN INTERMEDIATE TO LOWVRISK PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWEST GENERATION SELF-EXPANDING VALVES: A COMBINED ANALYSIS FROM NEOPRO AND NEOPRO-2 REGISTRIES
Authors: Sticchi Alessandro , Gitto Mauro , Pagnesi Matteo , Baggio Sara , Scotti Andrea , Barbanti Marco , Costa Giuliano , Adamo Marianna , Di Marco Federico , Casenghi Matteo , Lunardi Mattia , Regazzoli Damiano , Reimers Bernhard , Maffeo Diego , Buono Andrea , Saccocci Matteo , Giannini Francesco , Di Ienno Luca , Lanzillo Giuseppe , Ferlini Marco , Ielasi Alfonso , Latib Azeem , Mangieri Antonio , Colombo Antonio 
Published: December 2022

Abstract

Introduction
While randomized controlled trials have widely shown superiority or non-inferiority of transcatheter aortic valve replacement (TAVR) across the whole spectrum of surgical risks, 2021 ESC guidelines on valvular heart disease provide a class Ia indication for TAVR for patients at high surgical risk or, alternatively, aging &gt;=75 years, irrespective of their surgical risk. Conversely, for patients aging &lt;75 y and at low risk, surgical aortic valve replacement is recommended. Thus, in intermediate-low (IL) risk patients, the 75 y age cut-off is pivotal to guide the choice of intervention. The aim of the present study was to explore the impact on such cut-off on clinical outcomes in a real-world setting.

Methods
Consecutive IL surgical risk patients enrolled in the NEOPRO and NEOPRO-2 registries were included. A 1:1 propensity score matching (PSM) was used to match patients aged &gt;= vs. &lt;75 years old. The primary endpoint was the composite of all-cause death or cardiovascular hospitalizations.

Results
A total of 3642 patients undergoing TAVR with self-expanding transcatheter heart valves (THVs) from 2012 to 2021 were enrolled. After PSM, 484 patients (N=242 in both groups) were included in the final analysis. Mean age was 70.1±5.2 in patients aged &lt;75 y and 81.56±4.18 in those aged &gt;=75 y (p&lt;0.001), while mean Society of Thoracic Surgeon (STS) score was 3.6±2.5%. Implanted THVs were Acurate Neo, Evolut Pro, Acurate Neo 2 and Evolut Pro+ in 199 (41.1%), 188 (38.8%), 73 (15.1%) and 24 (5%) patients respectively, with no between-groups differences. Rates of in-hospital complications were comparable across the two age categories. At 1-year follow-up, the cumulative incidence of all-cause death was 11% in patients aged &gt;=75 y and 13% in those aged &lt;75y (Log-Rank p=0.627); similarly, the composite of all-cause death or cardiovascular hospitalizations occurred in 14% vs. 16% of patients (Log-Rank p=0.554).

Conclusions
TAVI has comparable benefit across age strata in IL risk patients. The age cut-off suggested by current guidelines is not predictive of adverse events during hospital stay, neither of all-cause mortality through a mid-term follow-up. This opens the question to future studies focusing on lifetime management and not age cut-off.
526 ALAGILLE SYNDROME, A CASE REPORT
Authors: Nobile Edoardo , De Filippis Aurelio , Circhetta Simone , Bernardini Federico , Viscusi Michele , Gallo Paolo , Ussia Gian Paolo 
Published: December 2022

Abstract
Alagille syndrome (AGS) is a dominantly inherited multisystem disorder caused by heterozygous mutations of genes that are components of the Notch signaling pathway. The main clinical manifestations of AGS are intrahepatic bile duct paucity, congenital heart defects involving primarily the pulmonary arteries, butterfly vertebrae, anterior chamber defects of the eye and facial dysmorphism.
A male patient of 39 years old came to our observation due to the worsening of dyspnea, cyanosis, dizziness, heartbeat and asthenia for about two years. His cardiological history includes percutaneous pulmonary artery angioplasty in both left and right main pulmonary artery in 1994. In 2012, finding of pulmonary hypertension and diagnosis of Alagille syndrome confirmed by genetic analysis (JAG1 gene), and vasoreactivity testing of the pulmonary circulation was positive. Intrastent restenosis of the right lobar pulmonary artery treated with POBA in 2016. Patient therapy includes, diltiazem 60 mg OD, macitentan 10 mg OD, sildenafil 40 mg TID. Echocardiogram showed: preserved global and segmental systolic function. Minimal mitral valve insufficiency. Dilated right ventricle (RV / LV&gt; 1), ipokinetic. Right atrium of increased size. Mild tricuspid valve insufficiency (VD-AD 20 mmHg). reduced systolic flow acceleration time (80 msec). Inferior vena cava of normal caliber with preserved inspiratory collapse. Indirect signs of pulmonary hypertension. The six minutes walking test showed severe desaturation after only one hundred meters.
Right catheterization showed severe pulmonary hypertension (PAPm 63 mmHg). blood gas analysis showed oxygen saturation of 83% in the pulmonary artery. Angiography of the pulmonary arteries showed intrastent restenosis on the left pulmonary artery and fracture of the stent on the right pulmonary artery. For which was performed angioplasty with stent intrastent implantation in the right pulmonary artery.
After the procedure there was immediate reduction in pulmonary mean arterial pressure (53 mmHg), a progressive improvement in 02 saturation (88% at discharge) while the echocardiogram after the procedure results unchanged except for the increasing of the systolic flow acceleration time (100 msec).
Right catheterization showed a gradient trans-stenosis of 96 mmHg. We performed angioplasty with stent intrastent implantation in the right pulmonary artery.
After that we saw a drop in the gradient trans-stenosis (63 mmHg) and a raise in the systolic pressure of the left pulmonary artery.
In Conclusion, in this particular population of patients with pulmonary hypertension even if on maximal therapy, the worsening of symptoms should in our opinion be an indication for right cardiac catheterization and angiography of the pulmonary arteries.
79 PERCUTANEOUS TREATMENT OF HIGH-MODERATE RISK PULMONARY EMBOLISM SUCCESSFULLY TREATED WITH LOCAL ULTRASOUND-ASSISTED THROMBOLYSIS
Authors: Perfetti Silvia , Costa Francesco , Micari Antonio , Di Bella Gianluca 
Published: December 2022

Abstract

Objective
A 74 y/o female presented at our emergency department with syncope and head trauma. At the physical examination she was dispnoic and tachycardic. Laboratory analysis showed elevated troponin and NT-proBNP. The TTE showed a dilated and dysfunctional right ventricle, 60/60 sign, elevated PAPs with flattening of interventricular septum. CT angiography showed massive pulmonary embolism (PE) affecting both branches of the pulmonary artery. The lower extremity venous ultrasound showed a long thrombus in the left distal tract of the common femoral vein, superficial femoral vein and popliteal vein.

Methods
The patient was admitted to the cardiac intensive care unit. Due to her worsening respiratory condition and her moderate-high early mortality risk PE with high risk of bleeding due to recent trauma, we decided to treat her with local ultrasound-assisted thrombolysis (Ekos). This combines ultrasound fragmentation of the thrombus with in situ reduced-dose thrombolysis. Two catheters were placed in the two pulmonary arteries through two right femoral venous accesses. The Ekos catheters were left on site for 6 hours and then removed without complications.

Results
The treatment was immediately effective and the clinical conditions improved within 24-48 hours. The follow up TTE showed improved right ventricle function with attenuated signs of PE. CT angiography at one week showed resolution of the vascular thrombosis. Our patient was discharged in good clinical conditions and with prescription of a NOAC. The monthly follow up was normal and any complication was referred.

Conclusions
A local thrombolysis technique is useful in intermediate-high risk patients at elevated bleeding risk. Future studies will shed light on the comparison between these catheter directed treatments and standard of care.
989 ANAESTHESIOLOGICAL MANAGEMENT IN PATIENTS UNDERGOING TEER: A NEW APPROACH IMPROVES CV OUTCOMES
Authors: Russo Massimo , Marchei Massimo , Idone Gaetano , Lecis Dalgisio , Di Landro Alessio , Macrini Massimiliano , Di Luozzo Marco , Sanseviero Angela , Romeo Francesco , Muscoli Saverio , Barilla´ Francesco , De Vico Pasquale 
Published: December 2022

Abstract

Background
Transcatheter edge-to-edge repair (TEER) with the MitraClip system is an alternative procedure for the treatment of severe mitral regurgitation (MR) in high-risk patients who are not suitable for conventional surgery and is usually performed under general anaesthesia (GA). GA may be associated with potential haemodynamic complications. A new alternative approach is deep sedation (DS) with spontaneous breathing using a target-controlled infusion (TCI). The aim of this study is to compare TCI during DS with manual administration of total intravenous anaesthesia (TIVA) during GA in patients undergoing TEER evaluating the impact of these approaches on anaesthesia time, remifentanil dose administered, haemodynamic profile, vasopressor requirements, adverse events and postoperative hospital stay.

Methods
The study population included 90 consecutive patients treated with MitraClip (mean age 73.5 ± 9.54 years). 65 patients (72%) suffered from functional MR. Mean LVEF was 35 ± 13% and logistic EuroSCORE was 23 ± 19%. 24 patients received GA and TIVA; 66 patients underwent DS and TCI, consisting of administration of midazolam and fentanyl citrate as induction of anaesthesia followed by continuous infusion of remifentanil hydrochloride.

Results
Acute procedural success was 100%, with no major complications during the procedure. No statistical differences were found between the GA-TIVA and the DS-TCI group in terms of demographics and surgical risk profile. Anaesthesia time was significantly shorter in the DS-TCI group (71 ± 30 vs. 118 ± 35 minutes; p &lt; 0.0001), as was procedure duration (54 ± 29 vs. 99 ± 74 minutes; p = 0.00007). In addition, there was a significant reduction in the remifentanil dose administered (249 µg vs. 2865 µg, p &lt; 0.01), the incidence of hypotension (p = 0.08) and the need for vasopressors (29.6% vs. 63%, p = 0.03) in the DS-TCI group. There were no differences in days of hospital stay after the procedure (5.4 days vs. 5.8 days, p = 0.4).

Conclusions
DS with spontaneous breathing using TCI could be a valid alternative during TEER which can ensure stable anaesthetic conditions, less drug administration, higher haemodynamic stability and fewer side effects, with particular advantages in patients at high risk for general anaesthesia.
441 EFFECTS OF TRANSCATHETER AORTIC VALVE IMPLANTATION ON RENAL FUNCTION IN CT-DEFINED SARCOPENIC PATIENTS
Authors: Ruzzarin Alessandro , Bonatti Matteo , Pernter Patrizia , Engl Patrick , Pescoller Felix , Pesarini Gabriele , Ribichini Flavio Luciano , Donazzan Luca 
Published: December 2022

Abstract

Introduction
Sarcopaenia, the age-associated decline in skeletal muscle and function, increases the risk of procedure-related complications and mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate whether CT-determined sarcopenia impacts on in-hospital renal function and on midterm outcomes following TAVI.

Methods
This was a retrospective cohort study including patients who underwent TAVI. Sarcopaenia was CT-defined as skeletal muscle mass index &lt;55.4 cm2/m2 in males and &lt;38.9 cm2/m2 in females at the level of L3 vertebra. Acute kidney injury (AKI) was defined as an increase in creatinine concentration of at least 0.3 mg/dL within 48 hours of TAVI according to Valve Academic Research Consortium-3 Criteria. Acute kidney recovery (AKR) was determined as an increase of 25% in eGFR within 48 hours following TAVI. The primary endpoint was freedom from major adverse cardiac and cerebrovascular events (MACCE; composite of any cause of death, any coronary revascularization, stroke and heart failure hospitalization) at the 1-year follow up in sarcopaenic and non-sarcopaenic patients.

Results
A total of 113 patients (mean age 82.2 ± 4.03 years, 52.2% female) were followed for a median of 1.1 year. Sarcopenia was found in the 59% of the TAVI population, more frequently among males (72.2% versus 33.8%, p&lt;0.01). The incidence of AKI was 8.0% and AKR was 6.9% without differences between sarcopaenic and non-sarcopaenic patients (9.4% versus 6.5%, p=0.59 and 11.6% versus 2.2%, p=0.08). The freedom from MACCE at 1 year follow up was 74.5% for sarcopaenic and 70.3% for non-sarcopaenic patients (p= 0.6). In sarcopaenic patients, the incidence of AKI and AKR had no significant impact on the freedom from MACCE at 1-year (p=0.58 and p=0.87).

Conclusions
Sarcopaenic patients had similar out of hospital incidence of adverse events to non-sarcopaenic patients following TAVI confirming the safety of this procedure in sarcopaenic patients.
789 USEFULNESS OF NEUTROPHIL-TO-LIMPHOCYTE RATIO AS A PROGNOSTIC BIOMARKER FOR IN-HOSPITAL COMPLICATIONS AND LONG-TERM MORTALITY IN OLDEST OLD STEMI PATIENTS
Authors: Donazzan Luca , Ruzzarin Alessandro , Zilio Filippo , Muraglia Simone , Zanon Sofia , Flaim Massimo , Baessato Francesca , Bonmassari Roberto , Oberhollenzer Rainer , Unterhuber Matthias 
Published: December 2022

Abstract

Background
the neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammation and a prognostic marker in patients undergoing percutaneous coronary intervention (PCI) that has been demonstrated to be related to in-hospital complications and long-term mortality in patients with ST segment elevation myocardial infarction (STEMI).

Aims
to assess the correlation between NLR and in-hospital complications and mortality, as well as long-term mortality in a population of oldest old (i.e. &gt;85 years old) STEMI patients.

Methods
we enrolled every oldest old patient admitted in two Hub hospitals with a diagnosis of STEMI who underwent an invasive strategy (coronary angiography ± percutaneous coronary intervention) between January 2010 and June 2021. Blood samples were performed at the first medical contact (in the emergency room or in the cath-lab according to presentation). Follow-up data were collected with phone calls or with revision of computer registries. In-hospital MACCE was defined as a composite of death, heart failure, in-stent thrombosis, relapsing angina, stroke, BARC 3 to 5 bleedings during hospital stay.

Results
four hundred fifty-eight patients accessed the Hub hospitals for STEMI during the selected period. Among them, 355 patients were eligible for this analysis. One hundred fifty-five patients (44%) experienced an in-hospital MACCE. Patients with in-hospital MACCE had a significantly higher NLR at baseline (10,2±7,4 vs 7,0±4,7 p&lt;0,001), this was also true when in-hospital mortality was considered per se (11,1±8,3 vs 8,0±5,8 p=0,002).

Conclusions
in our multicentre registry of oldest old STEMI patients, NLR has demonstrated to be an easy access, useful tool to predict in-hospital MACCE and in-hospital mortality.
535 CT SCAN AORTIC VALVE CALCIFICATION PATTERNS AND HEMODYNAMIC PERFORMANCE OF SELF-EXPANDING INTRA-ANNULAR TRANSCATHETER PROSTHESES
Authors: Viscusi Michele Mattia , Nusca Annunziata , Mangiacapra Fabio , Ricottini Elisabetta , Melfi Rosetta , Gallo Paolo , Cocco Nino , Rinaldi Raffalele , Cammalleri Valeria , Grigioni Francesco , Ussia Gian Paolo 
Published: December 2022

Abstract

Introduction
Aortic valve calcification (AVC) represents a negative prognostic factor in patients undergoing transcatheter aortic valve implantation (TAVI). Recent randomized clinical trials comparing commercially available self-expanding (SE) supra-annular and balloon-expandable (BE) devices with second-generation SE intra-annular devices demonstrated the clinical non-inferiority of the latter in terms of procedural success. However, no current data are available in vivo regarding the potential impact of AVC on SE intra-annular device performance and clinical outcomes.

Purpose
to evaluate the potential impact of different AVC patterns on SE intra-annular device performance in a consecutive cohort of patients undergoing TAVI.

Methods
this is an observational, non-randomized, prospective, single-center study preliminarily enrolling 53 consecutive patients who underwent TAVI with a SE intra-annular device (Portico - Abbott Structural Heart, St Paul, MN, USA) between 2019 and 2022 at our department. All patients underwent transthoracic echocardiography, contrast-enhanced multidetector row computed tomography (MDCT) with volumetric calcium score and coronary angiography before TAVI. Patients with bicuspid aortic valve and previous surgical aortic valve replacement eligible for valve-in-valve TAVI were excluded. AVC and left ventricle outflow tract (LVOT) calcification (up to 15 mm below the basal annular plane) were quantified in the contrast images by using a Hounsfield unit threshold of 850.

Results
Patients undergoing post-TAVI pacemaker implantation (19% of the overall study population) had higher AVC levels compared with those that did not show this complication (all three cusps AVA calcium score 270.6±409.6 vs 158.1±137.1, p=0.146; p=0.048, p=0.181 and p=0.346 for left cusp- LCC, right cusp – RCC- and non-coronary cusp-NCC, respectively). Severe LVOT calcification was also associated with a higher incidence of AV conduction abnormalities (37.9±44.5 vs 13.4±39.0 of patients without AV defects, p=0.045). Moreover, post-procedural moderate/severe aortic regurgitation occurred more frequently in patients with LCC calcification (183.7±87.0 vs 64.2±99.6, p=0.018) and RCC calcification (188.7±149.5 vs 58.7±120.8, p=0.019) rather than those with NCC or LVOT calcification.

Conclusion(s)
preliminary results of our observational registry highlight the potential impact of AVC patterns on the occurrence of aortic regurgitation and pacemaker implantation after a SE intra-annular device. A larger sample size is needed to better understand the impact of calcium patterns on each single outcome in order to identify patients at higher risk and to early manage these complications, improving long-term outcomes.