bluuebunny/crossref_metadata_2025_split huggingface dataset:
586 BODY WEIGHT AND MICROVASCULAR DYSFUNCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AT LOW CARDIOVASCULAR RISK REFERRED TO POSITRON EMISSION TOMOGRAPHY
Authors: Fumagalli Carlo , Bonanni Francesca , Maurizi Niccolò , Zampieri Mattia , De Gregorio Maria Grazia , Palinkas Eszter D , Sciagrà Roberto , Olivotto Iacopo 
Published: December 2022

Abstract

Introduction
Whether obesity, a modifiable risk factor in patients with hypertrophic cardiomyopathy (HCM), can influence coronary microvascular dysfunction (CMD) is unknown.

Objective
To assess the relationship between body weight and CMD measured with myocardial blood flow (MBF) at positron emission tomography (PET) in patients with HCM.

Methods
All consecutive patients with HCM referred to PET scan from 2010 to 2020 were reviewed. Only patients with PET and cardiac magnetic resonance (CMR) analysis, &lt;60 years old at diagnosis, with no history of diabetes, dyslipidemia, and hypertension were included.
Patients were classified into three groups according to baseline BMI: BMI&lt;25 kg/m2, BMI 25-30 kg/m2, and BMI&gt;30 kg/m2.

Results
Of 1512 patients with HCM, 134 (8.9%) had been referred to a PET scan and 79 (5.2%) met the inclusion criteria (29% were women, median age was 44 [28-53] years). Overall, 52% had a BMI&lt;25 kg/m2, 37% had a BMI 25-30 kg/m2, and 11% had a BMI &gt;30 kg/m2.
At PET, average MBF was 2.08 [1.52-2.40] ml/min/g and was similar among BMI groups (p=0.288) irrespective of fibrosis at CMR. Prevalence of severe microvascular dysfunction was similar (MBF &lt;1.53 ml/min/g: (9 [22%] vs 8 [28%] vs 2 [22%], among study groups, p=0.833). Age at PET and atrial fibrillation were associated with MBF.

Conclusions
Obesity is not associated with worsening of CMD in HCM patients. These findings support the hypothesis that the worse symptomatic profile in obese HCM patients is due to increased prevalence of obstruction rather than accentuation of structural phenotype. Thus, the symptomatic handicap associated with obesity may be reversible following appropriate weight-reduction strategies
915 PHENOTYPIC EXPRESSION AND OUTCOMES OF CARDIOMYOPATHY CAUSED BY TITIN TRUNCATING VARIANTS: TRANSLATIONAL INSIGHTS
Authors: Perotto Maria , Radesich Cinzia , Paldino Alessia , Ferro Matteo Dal , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Titin truncating variants (TTNtv) represent the most prevalent genotype underlying dilated cardiomyopathy (DCM). Recent molecular studies provided initial evidence about different pathogenic mechanisms produced by different mutation sites of the truncating variant (A-Band vs non-A-band), possibly related to the presence or absence of truncated titin (TTN) peptides. However, to date, clinical studies on DCM patients carrying TTNtv failed to demonstrate any relevant clinical difference according to the titin band affected. We hypothesized this lack of variation could be partially explained by the selection bias of including only DCM phenotype patients. Thus, we studied the clinical phenotypes and outcomes of our entire population of subjects with pathogenic TTNtv regardless of phenotypic expression at the onset.

Methods
We retrospectively analyzed a population of pathogenic TTNtv carriers, enrolled in the Trieste Heart Muscle Disease Registry. TTNtv were classified according to their site (Z disk, I band, A band, A-M junction, M band) and further grouped for analysis in A-band and non-A band. Variables were expressed as mean±SD, median and interquartile range, or counts and percentage, as appropriate. Kaplan-Meier curves were estimated for the composite endpoints of (i) heart failure-related death, heart transplant, and destination left ventricular assist device implantation and (ii) first major ventricular arrhythmia (MVA, defined as SCD or life-threatening ventricular arrhythmia) and compared by the log-rank test.

Results
154 TTNtv carriers were included in the study, of whom 66% were probands. The most prevalent phenotype was DCM (92%). The mean age of subjects at diagnosis was 43±16 years and 70% were males. There was no difference between groups in the first composite outcome of heart failure-related death, heart transplant, and destination left ventricular assist device implantation. Instead, major ventricular arrhythmias were significantly more frequent in the non-A-band group, in which 47% (n=14) of TTNtv carriers experienced MVA as compared to 19% (n=20) of subjects in the A-band group (p=0.001). Interestingly, we observed a tendency in MVA occurrence at a higher mean left ventricular ejection fraction (LVEF) in the non-A-band group as compared to the A-band group (42±13% vs 35±9%, respectively).

Conclusions
Among TTNtv carriers referred to a tertiary center, those with a mutation in the non-A band seem characterized by higher arrhythmic risk. This novel finding highlights the importance of considering the site of TTN truncating variants to guide the most appropriate clinical management for each patient.
333 MASSIVE PERICARDIAL EFFUSION IN HYPOTHYROIDISM: A CASE REPORT
Authors: Pasero Guido , Pollina Alberto Vincenzo , Carugo Stefano , Tumminello Gabriele , Bertoletti Alessandra , Vicenzi Marco 
Published: December 2022

Abstract
Chronic massive pericardial effusion (PE) without cardiac tamponade is relatively rare. Of all possible etiologies of PE, hypothyroidism is an uncommon one.
We reported a case of a 75-year-old woman, admitted at E.R. with confusion and unresponsive status, with diffuse face and lower limb'swelling . First-level examinations were performed: blood gas analysis showed hypoxia, respiratory acidosis and severe anaemia; the EKG revealed slow atrial fibrillation with ventricular rate of approximately 40 bpm and low QRS voltages. Echocardiogram showed massive PE, without sings suggestive of cardiac tamponade. A CT-scan of the brain, chest and abdomen was performed to exclude major active bleeding or neoplastic formations, and confirmed the presence of massive PE. Eventually, the effusion was drained with a pigtail catheter through a sub-xiphoid approach. Meanwhile blood tests results revealed a TSH level of 115 mIU/L (normal range 0,28–4,3 mIU/L) and fT4 level of 0,4 ng/L (normal range 8,0–17,0 ng/L). Severe, previously unknown, hypothyroidism was then diagnosticated and specific treatment with L-thyroxine was started.
PE formation in hypothyroidism is due to several pathophysiologic mechanisms that include increased capillary permeability, extravasation of hygroscopic mucopolysaccharides, increased volume of albumin distribution, reduced lymphatic drainage, along with an increase in salt and water retention. The fluid accumulation in the pericardial space is a slow, chronic process, leading to huge effusions with no cardiac tamponade.
PE may represent a severe complication of hypothyroidism, which should be taken into account in the differential diagnosis of the underlying cause. Echocardiogram is the best diagnostic tool, able to provide useful information about location, volume and hemodynamic impact of the effusion. Pericardiocentesis is not normally required to establish an accurate etiological diagnosis, which in most cases can be obtained simply on the basis of the clinical history and simple blood tests. Treatment is aimed at targeting the specific cause, thus, in our case, replacing the missing hormone.
442 OVERWEIGHT AND TAKOTSUBO SYNDROME: SHORT- AND LONG-TERM OUTCOME. RESULTS FROM A MULTICENTER PROSPECTIVE REGISTRY.
Authors: Ragnatela Ilaria , Santoro Francesco , Vitale Enrica , Cetera Rosa , Mallardi Adriana , Leopizzi Alessandra , Matera Annalisa , Correale Michele , Iacoviello Massimo , Brunetti Natale Daniele 
Published: December 2022

Abstract

Background
Takotsubo Syndrome (TTS) is a clinical condition characterized by an acute transient heart failure with reversible ventricular motion abnormalities. Obesity is related with an increased oxidative stress, which is one of the postulated mechanism of TTS.

Aim of the study
To investigate the association between Body Mass Index (BMI) and in-hospital and long-term follow-up events among patients with TTS.

Methods
178 consecutive patients with TTS at admission were enrolled in a multicenter international registry. According to BMI, patients were divided into two groups: normal-weight (BMI 18.5-25 Kg/m2, N=70) and over-weight (BMI ≥ 25 Kg/m2, N=78). Medical history, clinical data, echocardiographic parameters and in-hospital and long-term follow-up events of all patients were evaluated.

Results
Mean body mass index was 26±5 Kg/m2. There were no significant differences between over- and normal- weight patients in terms of sex, age and cardiovascular risk factors (diabetes, dyslipidaemia, smoking habit) except for arterial hypertension (85% vs 67%, p=0.01). When evaluating non cardiovascular comorbidities, overweight patients had a higher prevalence of chronic pulmonary diseases (38% vs 20% p=0.018).
During hospitalization no differences in terms of admission LVEF and hospital length of stay were found; however, overweight patients had higher rates of in-hospital complications (51 vs 27%, p=0.004).
At follow-up, overweight patients had higher rate of MACE (44% vs 27%, p=0.03), one-year (32% vs 15%, p=0.02) and long-term mortality (37% vs 24%, log rank p=0.01), but no differences in terms of rehospitalizations and TTS recurrence.

Conclusion
Overweight in TTS is associated with higher rates of in-hospital events and long-term mortality and MACE.
793 RECURRENT PERICARDITIS AND COVID-19
Authors: Sciara Pietro 
Published: December 2022

Abstract

Background
Anakinra, an interleukin 1β recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL.)

Clinical case
A 86-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism.
Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred.
Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid.
During hospitalization patient tested positive for SARS-CoV-2. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies.
Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra.

Conclusions
treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of conventional pericarditis therapy.
1070 PROGNOSTIC PERFORMANCE OF CARDIAC MAGNETIC RESONANCE IMAGING MARKERS VERSUS COMPLICATED CLINICAL PRESENTATION AFTER AN ACUTE MYOCARDITIS
Authors: Varrenti Marisa , Ammirati Enrico , Sormani Paola , Moro Claudio , D´elia Saverio , Bernasconi Paolo , Raineri Claudia , Quattrocchi Giuseppina , Milazzo Angela , Maestroni Alberto , Valsecchi Maria Grazia , Garascia Andrea , Oliva Fabrizio , Giannattasio Cristina , Camici Paolo G , Pedrotti Patrizia 
Published: December 2022

Abstract

Background
Identifying markers associated with adverse events after acute myocarditis (AM) is clinically relevant to plan follow-up. We aimed to compare the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF)&lt;50% on baseline CMRI, versus complicated clinical presentation (CCP) of AM (defined as the presence of sustained ventricular arrhythmias or LVEF &lt;50% on the first echocardiogram or fulminant presentation).

Methods
We retrospectively assessed 248 AM patients from 6 hospitals with onset of cardiac symptoms &lt;30 days, increased troponin, and CMRI consistent with myocarditis.

Results
Patients had a median age of 34 years (male prevalence of 87.1%) and a median LVEF of 61% on baseline CMRI. Thirteen patients (5.2%) experienced at least one major cardiac event after a median follow-up of 1708 days. Among these 13 patients, 10 (76.9%) had septal LGE, 8 (61.5%) had LVEF&lt;50%, and 12 (92.3%) had a CCP. The best performance was observed for CCP in terms of sensitivity (0.99), and for LVEF&lt;50% in terms of specificity (0.90). The negative predictive value was at least 0.98 for all markers.

Conclusions
Major cardiac events after an AM are relatively low, and septal LGE, LVEF&lt;50% on CMRI, and CCP are significantly associated with events. The most relevant finding is the high NPV of these markers to identify patients without events after an AM. This observation can help clinicians to monitor the patients after an AM, in fact, patients without these markers had an uneventful follow-up.
Figure
A] Acute Myocarditis with complicated clinical presentation (CCP AM) vs non-complicated clinical presentation (NO CCP AM);
B] FE &gt; 50% vs FE &lt; 50% at basal cardiac MRI;
C] Presence of septal late gadolinium enhancemnet (LGE) vs no septal LGE on basal cardiac MRI.
369 PENTRAXIN 3 AS A DIAGNOSTIC AND PROGNOSTIC MARKER OF ACTIVE MYOCARDITIS
Authors: Villatore Andrea , Monno Antonella , Sciorati Clara , Sala Simone , Della Bella Paolo , Manfredi Angelo A , Peretto Giovanni 
Published: December 2022

Abstract

Background
Pentraxin 3 (PTX3) is an acute phase protein, which regulates the outcomes of inflammation. Currently, there are no myocarditis-typical biomarkers that allow a non-invasive diagnosis, and endomyocardial biopsy (EMB) is still the gold standard. Finally, risk stratification is often challenging in these patients.

Aim
To investigate whether PTX3 could be expressed in cardiomyocytes and released during myocarditis, serving as a novel and independent diagnostic indicator of myocardial inflammation, and contributing to prognosis prediction.

Methods
Fifty-five patients with a diagnosis of acute or chronic active myocarditis proven by cardiac magnetic resonance (CMR) and/or endomyocardial biopsy (EMB), were included. First, we evaluated tissue PTX3 expression by immunohistochemistry (IHC). Then, we assessed circulating blood PTX3 by ELISA technique.

Results
On cardiac tissue, PTX3 at IHC did not localize in the interstitium, and showed an inconstant expression in the vascular endothelium, but a marked staining by cardiomyocytes in all myocarditis patients. The only exception was represented by two patients with systemic COVID-19, with SARS-CoV-2 and PVB-19 intracardiac genomes, respectively, who showed a diffuse cardiac PTX3 expression. Remarkably, at semi-quantitative pixel analysis, viral aetiology showed higher levels of tissue expression, rather than the autoimmune one. Circulating PTX3 levels were significantly higher in myocarditis patients than controls, with pathologic values in 87% of myocarditis patients, and none among controls. Remarkably, plasma PTX3 proved to be more sensitive in myocarditis detection than CRP, ESR, troponin T, and NT-proBNP. As regards of prognosis, we observed that patients with heart failure (HF) presentation all had elevated PTX3 levels, as compared with chest pain or arrhythmia. Remarkably, patients with reduced LVEF (&lt;50%) at admission who recovered during follow-up had higher baseline PTX3 levels, rather than those whose systolic function did not improve.

Conclusions
Tissue PTX3 is mostly expressed by cardiomyocytes in patients with active myocarditis on EMB samples. In addition, plasma PTX3 is a sensitive diagnostic and prognostic marker in patients with inflammatory cardiomyopathy.
387 MITRAL VALVE MORPHO-FUNCTIONAL FEATURES DURING THE ACUTE AND RECOVERY PHASE IN PATIENTS WITH TAKOTSUBO SYNDROME
Authors: Vitale Enrica , Santoro Francesco , Cetera Rosa , Ragnatela Ilaria , Mallardi Adriana , Leopizzi Alessandra , Matera Annalisa , Manuppelli Vincenzo , Correale Michele , Iacoviello Massimo , Brunetti Natale Daniele 
Published: December 2022

Abstract

Background
Acute mitral valve regurgitation is known to be associated with a severe prognosis in patients affected by Takotsubo syndrome (TTS). The mechanisms involved are different and related to various pathogenesis such as cordal or mitral anterior leaflet (LAM) systolic anterior motion (SAM) and tethering of the mitral valve.

Aim of the study
to compare mitral valve morpho-functional features and concomitant left ventricle (LV) abnormalities by transthoracic echocardiography in patients during the acute and recovery phase of Takotsubo syndrome.

Methods
24 consecutive patients were enrolled from a multicenter prospective registry of TTS from July 2007 to February 2022. Through transthoracic echocardiography, LV ejection fraction, LV end-diastolic and end-systolic diameters and volumes, left atrium antero-posterior diameter and end-systolic volume, mitral anulus diameter, prevalence of mitral valve regurgitation, of LV outflow tract obstruction (LVOTO), coaptation depth and tenting area were collected during the acute and recovery phase of takotsubo syndrome.

Results
LVEF at admission was 39.6 ± 7.8% vs 60.5 ± 4% at functional recovery (p&lt;0.001). LVEDV, LVESV and LVESVi were found to be higher during the acute phase when compared to the recovery phase (103.8 ± 28.9 vs 89.7 ± 23.4 ml, p=0.012; 59.8 ± 17.2 vs 35.1 ± 10.1 ml, p&lt; 0.001; and 36.1 ± 9 vs 20.6 ± 5.4 ml/m2, p&lt;0.001 respectively).
No statistically significant differences were found between admission and recovery phase in term of mitral annular dimension (32.3 ± 4.6 vs 32.5 ± 4.1 mm, p=0.825), tenting area (2.3 ± 0.6 vs 2.2 ± 0.7 cm2, p=0.445), proximal thickness and length of both of the mitral leaflets, while coaptation depth was higher during the acute phase in comparison to functional recovery (1.1 ± 0.2 vs 1 ± 0.3 cm, p=0.018).
10 patients (41%) presented with moderate/ severe mitral insufficiency and 5 patients of them (20% of the general population) downgraded to mild at recovery.
Among the patients with values of LVEDV higher than 104 mL, LVESV higher than 43 mL, LVESVi higher than 25 mL/m2 and coaptation depth higher than 1.1 cm during the acute phase, 4 out of 5 patients experienced a downgrade of the severity of mitral valve regurgitation.

Conclusions
Left ventricle end-diastolic volume and coaptation depth are statistically different during the acute and recovery phase. Among the patients who experienced a downgrading of the severity of mitral valve regurgitation, higher values of LVEDV, LVESV, LVESVi and coaptation depth during the acute phase were found.
675 FACILITATORS AND BARRIERS THAT CAN INFLUENCE ADHERENCE TO INFECTION PREVENTION AND CONTROL GUIDELINES. A REVIEW.
Authors: Ruggiero Antonio , Chiaretti Ludovica , Chiala´ Oronzo 
Published: December 2022

Abstract

Introduction
Adherence to infection prevention and control (IPC) can be examined in two different ways: towards patients or among healthcare providers. In both cases, adherence to recommendations remains poor. Facilitators and barriers to adherence to evidence-based practice (EBP) can play a key role in establishing effective strategies, but are still poorly explored, especially in cardiac settings.

Methods
A review was conducted using the Medline database. Of 529 articles analyzed, only 14 met the inclusion criteria. Several factors were found in the articles included in the review that could facilitate or hinder adherence to the IPC guidelines.

Results
The main factors identified in the literature reviewed were: organizational factors (safety issues, guideline dissemination, availability of training programmes), environmental factors (social and community environment, work environment, availability of PPE), individual factors (knowledge, attitude, experience, belief, discomfort with PPE use) and factors related to patients and caregivers.

Discussion
The literature highlights the heterogeneity of factors that might influence adherence to IPC in cardiology settings. Although factors related to the organization, environment and healthcare provider knowledge, experience and beliefs were well explained, factors related to patients and caregivers remained rather unexplored. This underlines the need for further knowledge and insights.
1077 THE ROLE OF MILITARY NURSE IN THE CARDIAC AMBULATORY OF MILITARY HOSPITAL IN MILAN
Authors: Fabri Luca 
Published: December 2022

Abstract
Military nurses have a fundamental role in taking care of all military personnel, both in preventive medicine and direct health care, to be effective and competent during his duty, both in national settings and in operations abroad.
The military nursing, in a cardiac ambulatory setting, aim to guarantee, collaborating with the cardiologist medical officer, the fitness for military service, i.e. the possession of physical and psycho-attitudinal requirements needed to carry out military service that requires specific and dynamic efforts that could solicit determined organs or body systems.
Among the different visits that the military personnel have to attend, the cardiac ambulatory is specialized in: Personnel selection for volunteers recruitment;Evaluation for those soldiers that suffered from cardiovascular diseases that has to be visited by Military Legal Medical Facilities;Medical periodic visits for military personnel on duty to check the maintenance of psycho-physical requirements;Medical visits for military personnel ready to be deployed in missions abroad or that are just coming from them;Definition of diagnostic protocol and evaluation of those soldiers that suffered from cardiovascular disease.
In details, the main specific competences of the military nurse in a cardiology ambulatory are: assessment of cardiovascular health (cardiac anamnesis and physical evaluation), diagnostic exams procedures (ECG, supporting in sonography examination, positioning and management of Holter for blood pressure and ECG, cardiopulmonary test), evaluation of medication prescription per cardiovascular disease (antihypertensives, antiplatelet agents, antithrombotic, thrombolytics, antiarrhythmics, with focus on the initiation of therapy, mode of action and interactions).
The military nurse in cardiovascular ambulatory, in addition to the many activities, typical of being a warrant officer deployable in national activities or in operations abroad, must acquire competences and knowledge specific for cardiac setting, through basic training courses, continuous medical education, ensuring a constant synergy with all the équipe members, even at international level, also acting independently in all those complex situations that may arise to meet patients’ needs.