bluuebunny/crossref_metadata_2025_split huggingface dataset:
678 WIDE COMPLEX TACHYCARDIA IN A PATIENT TREATED WITH PERMANENT HIS BUNDLE PACING: A CASE REPORT
Authors: Rizzello Davide , FrancescaNotarangelo Maria , Bearzot Luca , Crocamo Antonio , Gonzi Gianluca , Dinatale Alessandro , Grassi Francesca , Niccoli Giampaolo , Ardissino Diego 
Published: December 2022

Abstract

Introduction
Differential diagnosis of wide complex tachycardias based only on ECG analysis remains a challenging exercise. But, when intracardiac tracings are available (i.e., pacemaker EGM), electrophysiologists may consider several tricks to make a correct diagnosis.

Case Presentation
A 73-years-old sporty male was admitted to our hospital for palpitations and dizziness.
ECG monitoring revealed AF, typical atrial flutter and asystolic pauses following spontaneous cardioversion of atrial arrhythmias. We diagnosed sick sinus syndrome and implanted a dual-chamber pacemaker with an atrial lead in the right appendage and a stylet-directed active fixation lead in the His region, obtaining non-selective narrow paced QRS.
The day after PM implantation, during a new episode of AF, two runs of regular wide-complex tachycardia (LBBB morphology, cycle length of 270 ms) occurred (Fig 1A, B). LBBB morphology, patient's history, and AF favored aberrancy, but couldn't exclude VT or preexcitation (by atrio-fascicular AP).
Our diagnostic strategy consisted in adding atrial and His intracardiac electrograms registered by pacemaker to analysis of ECG traces.
The device interrogation showed AV dissociation at the time of the wide complex tachyarrhythmia and a negative HV interval (Fig. 2A). These findings ruled out aberrant ventricular conduction and bundle branch reentrant tachycardia, because both these arrhythmias are characterized by HV ≥ HV in sinus rhythm. We performed incremental atrial pacing maneuver, during SR, obtaining decremental AH conduction with constant HV interval (60 ms), excluding atrio-fascicular, nodo-fascicular and nodo-ventricular AP.
His bundle activity was identified just after the ventricular activation, producing a relatively short VH interval, suggesting the presence of a retrograde activation of the His bundle, therefore it was possible to hypothesize that the site of origin of the ventricular arrhythmia was within/or very close to RBB (Fig 2B, C). Just in few beats His bundle deflection was missing, probably because of recovery of functional LBBB (Fig 2D).

Discussion
Our final diagnosis was RBB VT. Patient was treated with Verapamil 80 mg t.i.d., with no further recurrence. This case highlights the diagnostic value of device interrogation in patients with permanent His bundle pacing, for the evaluation of wide complex tachycardias.
955 SUBCUTANEOUS VERSUS TRANSVENOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATORS IN CHILDREN AND YOUNG ADULTS: A METANALYSIS
Authors: Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Valente Debora , Caminiti Rodolfo , Polselli Marco , Vetta Francesco , Cirone Donatello , Cauti Fillippo Maria , Crea Pasquale , Rossi Pietro , Chierchia Gian Battista , Bianchi Stefano , De Asmundis Carlo , Natale Andrea , Della Rocca Domenico Giovanni 
Published: December 2022

Abstract

Introduction
The Implantable Cardioverter Defibrillator (ICD) has been demonstrated to successfully prevent sudden cardiac death in children and young adults. A wide range of device-related complications/malfunctions have been described, which depend on the intrinsic design of the defibrillation system [Transvenous (TV-ICD) vs Subcutaneous (S-ICD)].

Objective
To compare the device-related complications and inappropriate shocks with TV-ICD vs S-ICD.

Methods
Electronic databases were queried for studies focusing on the prevention of SCD in children and young adults with TV-ICD or S-ICD. The effect size was estimated using a random-effect model as Odds Ratio (OR) and relative 95% Confidence Interval (CI). The primary endpoint was a composite of any device-related complications and inappropriate shocks.

Results
We identified a total of 5 studied including 236 patients (Group S-ICD: 76 patients; Group TV-ICD: 160 patients) with a mean follow-up time of 54.2 ± 24.9 months.
S-ICD implantation contributed to a significant reduction in the risk of the primary endpoint of any device-related complications and inappropriate shock (OR:0.18; 95% CI: 0.05 - 0.73; p=0.02)(Figure 1).
S-ICD was also associated with a significantly lower incidence of inappropriate shocks (OR:0.28; 95% CI: 0.11 - 0.74; p=0.01) and lead-related complications (OR:0.18; 95% IC: 0.05 - 0.66; p=0.01). Otherwise, a trend towards a higher risk of pocket complications (OR:5.91; 95% CI: 0.98 - 35.63; p=0.05) was recorded in patients with S-ICD.

Conclusion
Children and young adults undergoing S-ICD implantation may have a lower risk of a composite of device-related complications and inappropriate shocks, compared to TV-ICD patients.
444 PULSE WAVE VELOCITY TO GLOBAL WORK EFFICIENCY RATIO IN HYPERTENSION: A NEW WAY TO EXPLORE VENTRICULAR-ARTERIAL COUPLING
Authors: Trimarchi Giancarlo , Lofrumento Francesca , Mandraffino Giuseppe , Cusmà-piccione Maurizio , Spanò Federico , Certo Giuseppe , Manganaro Roberta , Carerj Scipione , Di Bella Gianluca , Zito Concetta 
Published: December 2022

Abstract

Introduction
Ventricular–arterial coupling (VAC) is considered as the cornerstone of the functional interaction between ventricles and the arterial system. VAC is commonly assessed as arterial elastance (Ea) to ventricular end-systolic elastance (Ees) ratio and it has independent prognostic value in hypertension, so it may be used to refine risk stratification and monitor therapeutic interventions in hypertensive patients. Therefore, VAC may be better characterized by the measurement of each component of this ratio through novel and more sensitive markers of myocardial function (e.g. global longitudinal strain and myocardial work parameters) and arterial function (e.g. pulse wave velocity). In this context, we aim to investigate whether new coupling indices may be able to identify left ventricular (LV) performance changes induced by blood pressure (BP) overload earlier than conventional ones.

Methods
50 young individuals were prospectively enrolled, distinguishing between newly diagnosed untreated hypertensives (n= 25; 40±8 years) and controls (n=25; 39±9 years), matched for age and gender. All patients underwent at the same time carotid-femoral pulse wave velocity (PWV) measurement through an applanation tonometer (SphygmoCor® XCEL) and a transthoracic echocardiogram to calculate Ea/Ees ratio, assessed as end-systolic volume to stroke volume ratio (ESV/SV), global longitudinal strain (GLS) and myocardial work efficiency (GWE). Two new indices of VAC were derived: PWV/GLS, previously validated and PWV/GWE, still unknown.

Results
Ea/Ees ratio was lower in hypertensives (0,48±0,17) than in controls (0,57±0,14) but without any signiﬁcant difference (p=0.18), whereas PWV/GLS was signiﬁcantly higher in hypertensives than in controls (0,45±0,19 vs 0,35 ± 0,09 m/sec%; p= 0,02). PWV/GLS ratio correlated to Ea/Ees (r= 0,52; p &lt; 0,01), diastolic dysfunction degree (r=-0,59; p&lt;0,001), age (r=-0,64; p&lt;0,001), systolic BP (r=-0,41; p=0,002), diastolic BP (r=-0,39; p=0,005) and mean arterial pressure (MAP) (r=-0,40; p=0,004). PWV/GWE was higher in hypertensives than in controls (0,10± 0,02 vs 0,08±0,01 m/sec%; p=0,001) and it was associated with Ea/Ees (r=- 0,55; p = 0,006), age (r= 0,59; p&lt;0,001), diastolic dysfunction degree (r=0,55;p&lt; 0,001), systolic BP (r=0,8; p&lt; 0,001), diastolic BP (r=0,5;p&lt; 0,001) and MAP (r=0,52; p&lt;0,001).

Conclusions
Innovative indices of ventricular-arterial coupling could be more sensitive to investigate the impact of hypertension on LV performance.
747 HIGH PLATELET REACTIVITY AFTER DAPT IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ATRIAL FIBRILLATION
Authors: Sammartino Aniello , Toso Anna , Di Mario Carlo , Bellandi Francesco 
Published: December 2022

Abstract

Background
The incidence of atrial fibrillation (AF) in patients who undergo percutaneous coronary intervention (PCI) is not negligible, especially in the elderly. Both oral anticoagulation (OAC) and dual anti-platelet therapy (DAPT) are recommended by main guidelines, therefore is essential to balance the prevention of ischemic events with the risk of bleeding. Evidences from literature suggest that incidence of anti-platelet therapy resistance is higher in elderly patients. There is a paucity of data about the response to antiplatelet therapy in patients with AF. The purpose of this study is to analyze platelet reactivity during DAPT (aspirin + clopidogrel) in elderly patients hospitalized for acute coronary syndrome (ACS), stratifying them by the presence or absence of AF.

Methods
We analyzed data of patients admitted to our center for ACS. All patients were ≥ 75 years old and treated with DAPT (Aspirin 100 mg daily and Clopidogrel 75 mg daily). At discharge they were tested with a point-of-care antiplatelet-function test (VerifyNow assay) to assess the platelet response to aspirin in aspirin-reaction units (ARU) and to clopidogrel in P2Y12-reaction units (PRU). Low response to aspirin was defined as ARU ≥550; low response to clopidogrel was defined as PRU ≥208; high response was defined as PRU values ≤ 85.

Results
Among the 216 patients included in the registry we selected 154 of these [median age 81 (IQR 77-87) years; 45% female] who were submitted to the platelet function tested before discharge. Patients were divided into two groups: AF (43 pts); non-AF (111 pts). The table shows the platelet reactivity values by two groups.

Conclusions
In this series of elderly patients with ACS, AF was associated with higher residual platelet reactivity with both clopidogrel and aspirin. AF patients were significantly less responsive to clopidogrel than non-AF, while among non-AF patients there were significantly more high responders. No difference was found for aspirin low responders between AF and non-AF group. This evidence could assume clinical significance in the choice of antiplatelet drugs to be combined with chronic anticoagulant therapy for AF.
857 DEVELOPMENT AND VALIDATION OF A DIAGNOSTIC ECHOCARDIOGRAPHIC MASS (DEM) SCORE IN THE COMPLEX APPROACH TO CARDIAC MASSES
Authors: Bodega Francesca , Angeli Francesco , Paolisso Pasquale , Bergamaschi Luca , Armillotta Matteo , Sansonetti Angelo , Stefanizzi Andrea , Amicone Sara , Suma Nicole , Canton Lisa , Fedele Damiano , Impellizzeri Andrea , Tattilo Francesco Pio , Rinaldi Andrea , Foa´ Alberto , Galie´ Nazzareno , Pizzi Carmine 
Published: December 2022

Abstract

Background
Cardiac masses (CM) are an extremely heterogeneous clinical entity, including benign and malignant neoformations. 2D Echocardiography is, nowadays, the first-line approach to define nature and management of CM.

Purpose
The purpose of our study was to identify the echocardiographic predictors of malignancy and create a multiparametric score to further increase the diagnostic yield and accurately suggest the nature of CM.

Materials and methods
249 consecutive patients undergoing a complete echocardiographic assessment for suspected cardiac mass in our center were enrolled from January 2004 to December 2020. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic regression was performed to evaluate the ability of echocardiography to discriminate benign versus malignant masses.

Results
A scoring system was developed in a derivation cohort of 178 (70%) and validated in 71 (30%) patients. A weighted score [Diagnostic Echocardiographic Mass (DEM) Score] ranging from 0 to 9 was obtained from 6 variables: infiltration, polylobate mass, moderate-severe pericardial effusion, inhomogeneity, sessile and non-left localization. The AUC for the score was 0.965 (95% CI 0.938-0.993). In a logistic regression analysis using the DEM score as a predictor, the likelihood of malignancy increased more than 4 times for a 1-unit increase of the score (OR=4.468; 95% CI 2.733-7.304). The prognostic validity of the score was confirmed by its ability to predict survival during follow-up (median time of 31 months).

Conclusions
The application of a multiparametric echocardiographic score in the approach to CM accurately predicts mass malignancy, thereby reducing the need for second-level investigations, and minimizing the diagnostic delay in such a complex clinical scenario.
200 BERBERINE ASSOCIATED TO DAPAGLIFLOZIN SYNERGISTICALLY REDUCES CARDIAC CELL APOPTOSIS DURING EXPOSURE TO TRASTUZUMAB THROUGH INDUCTION OF PAMPK AND RECUTION OF NLRP3, IL6 AND LEUKOTRIENES LEVELS
Authors: Quagliariello Vincenzo , Paccone Andrea , Saviano Claudia , Maurea Fabrizio , Buccolo Simona , Bonelli Annamaria , Conforti Gabriele , Caronna Antonietta , Maurea Nicola 
Published: December 2022

Abstract

Background
Trastuzumab has improved the prognosis in patients with HER2-positive breast cancer, but it can induce left ventricular dysfunction with reduced ejection fraction or HF during treatment. Dapagliflozin is a SGLT2i with cardio-renal benefits. In the DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure) trial, the sodium-glucose cotransporter 2 inhibitor dapagliflozin decreased the risk of worsening HF events and cardiovascular death in patients with HF and reduced ejection fraction. Berberine is a nutraceutical compound characterized by multiple metabolic effects in patients with/without cardiovascular diseases. Recent preclinical systematic review indicated that Berberine significantly reduces myocardial infarct size and the incidence of ventricular arrhythmia, improves cardiac function, ameliorates myocardial apoptosis.

Purpose
To investigate on the potential cardioprotective properties of Berberine associated to SGLT2i Dapagliflozin against HER-2 blocking agent-induced cardiotoxicity

Methods
Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of trastuzumab (200 nM) alone or co-incubated with Berberine (200 mM) or Dapagliflozin (50 nM) or both in combination for 48 h. After the incubation period, we performed the following tests: cell viability, apoptosis, expression of NLRP3 inflammasome, methylglyoxal and leukotrienes-B4. Expression of pAMPK was analyzed through western blot. Moreover, quantification of IL-6 was performed through ELISA method.

Results
Berberine and Dapagliflozin increased significantly the cell viability of cardiomyocytes exposed to Trastuzumab. When combined, Berberine and Dapagliflozin increased synergistically cell viability of cardiac cells (p&lt;0.001 vs Trastuzumab). Cell apoptosis was reduced of 32.5, 41.8 and 72.7% for berberine, dapagliflozin and both combined (vs trastuzumab group). Methylglyoxal,a marker of AGEs, was strongly reduced compared to untreated cells. Western blot analysis clearly demonstrate that pAMPK was induced by berberine and Dapagliflozin, improving mitochondrial metabolism. No significant changes in Leukotriene B4 expression were seen. Intracellular levels of IL-6 were reduced of 46.3, 62.7 and 86.3% for berberine, dapagliflozin and both combined (vs trastuzumab group).

Conclusion
Berberine and Dapagliflozin exerts significant cardioprotective effects in cardiac cells exposed to the HER2-bloking agent Trastuzumab. Berberine and Dapagliflozin in combination induces an anti-inflammatory phenotype to myocardial cells through the reduction of biomarkers involved in heart failure and apoptosis.
766 NON-INVASIVE ASSESSMENT OF RIGHT VENTRICLE TO ARTERIAL COUPLING FOR PROGNOSIS STRATIFICATION OF FIBROTIC INTERSTITIAL LUNG DISEASE
Authors: Buongiorno Federica , Buonauro Agostino , Canora Angelo , Canonico Mario Enrico , Esposito Roberta , Sanduzzi Alessandro , Bocchino Marialuisa , Esposito Giovanni , Santoro Ciro 
Published: December 2022

Abstract

Background
The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance non-invasively estimable by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD).

Methods
Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF), (M=37; mean age 67±7 yrs) were studied with standard and speckle tracking echocardiography and compared to 30 age-matched healthy volunteers. Mean patients follow-up was of 70±4 months.

Results
Fibrotic-ILD patients had a larger right ventricle (RV) and a worst diastolic function as RV-global longitudinal strain (GLS) was significantly lower along with higher systolic pulmonary artery pressure (sPAP) estimates in comparison with controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV-GLS/sPAP were significantly reduced in f-ILDs patients (p&lt;0.0001). Patients with a RV-GLS/sPAP below the median value had a shorter survival (61 vs. 74 months, p=0.01), this parameter being an independent predictor of worse outcome.

Conclusion
Low estimates of RV-GLS/sPAP are predictive of worse outcome in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis repercussions.
1129 IMAGING STRESS TEST OR CORONARY COMPUTED TOMOGRAPHY PRIOR TO NON-CARDIAC SURGERY? A SEVEN YEARS SINGLE CENTRE EXPERIENCE
Authors: Fazzari Fabio , Cannata Francesco , Chiarito Mauro , Gitto Mauro , Terzi Riccardo , Didedda Emanuele , Lisi Costanza , Condorelli Gianluigi , Stefanini Giulio , Chiti Arturo , Bragato Renato , Francone Marco 
Published: December 2022

Abstract

Introduction
Recent published ESC guidelines on non-cardiac surgery suggest the use of imaging stress test in patients with poor functional capacity and high likelihood of coronary artery disease or high clinical risk (class I, level B), while the use of coronary computed tomography has lower evidence (class IIa, level B). Witch test has the best performance in the clinical contest of pre-operative risk assessment is a matter of debate.

Aim
The aim of our single centre, retrospective study was to compare the prognostic role of the three main cardiac imaging modalities (CCT: Cardiac computed tomography, sCMR: stress cardiac magnetic resonance, SPECT MPI:single photon emission computed tomography myocardial perfusion imaging) in relation to 30 days post-surgery cardiac events (composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema, life threatening cardiac arrythmias).

Method
Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Recorded data included demographic characteristics, clinical risk factors, results from laboratory tests, results from cardiac imaging tests, pharmacological therapy, type of intervention, cardiac complication within 30 days after surgery.

Results
Eight-hundred eighty-three patients were included (287 sCMR, 382 SPECT-MPI, 214 CCT). Rate of 30-days myocardial infarction was not significantly different between different modalities (CMR 1.1%, SPECT 1.3%; CT 0.5%; CMR vs SPECT p 0.998; sCMR vs CT p 0.639; SPECT vs CT 0.427); while planned invasive coronary angiography (ICA) was more common in CT group (CT 34%, CMR 16%, SPECT 10%, p&lt;0,001). Absence of ischemia on stress test and absence of relevant coronary artery disease on CT are associate to lower cardiac events at follow-up (0.67%).

Conclusions
The use of imaging stress test and coronary CT are both associated to low incidence of cardiac events and should be recommended in risk assessment before non-cardiac surgery, in the appropriate clinical context.
679 PROGNOSTIC IMPACT OF ECHOCARDIOGRAPHIC DERIVED PRECAPILLARY WEDGE PRESSURE AND PULMONARY VASCULAR RESISTANCES IN PATIENTS WITH HEART FAILURE
Authors: Giannoni Alberto , Gentile Francesco , Buoncristiani Francesco , Chubuchny Vlad , Sciarrone Paolo , Panichella Giorgia , Bazan Lorenzo , Gasparini Simone , Fabiani Iacopo , Taddei Claudia , Poggianti Elisa , Petersen Christina , Pasanisi Emilio , Passino Claudio , Emdin Michele 
Published: December 2022

Abstract

Background
A reliable echocardiographic algorithm for the estimation of precapillary wedge pressure (PCWP) and pulmonary vascular resistances (PVR) has been recently validated by our group in a large cohort of patients undergoing right heart catheterization (RHC). Those metrics may add relevant clinical and prognostic information in patients with heart failure (HF).

Objective
To assess the clinical/prognostic significance of echocardiographic derived PCWP and PVR in a large cohort of chronic HF patients on modern treatments.

Methods
Outpatients with chronic HF with either reduced (≤40%) or mildly reduced LVEF (41-49%) underwent a thorough clinical multiparametric assessment and were followed-up for a composite endpoint of cardiac death, appropriate ICD shock, or first HF hospitalization.

Results
Out of 1,483 patients prospectively enrolled (70±12 years, 73% males, 42% ischemic etiology, LVEF 35±8%, 74% HFrEF), PCWP (16.4±5.8 mmHg) was elevated (&gt;15 mmHg) in 53% of cases, while PVR (1.7±0.7) was elevated (&gt;2 WU) in 25% of cases. Of the latter group, most (83%) had also elevated PCWP. Patients with increased PCWP were older, had a higher heart rate and lower cardiac output, showed a higher degree of left and right chamber remodeling, had a higher neurohormonal activation, worse renal function, worse functional capacity and ventilatory efficiency on effort, particularly when also PVR were elevated (all p&lt;0.001). The optimal prognostic cut-point was identified for both PCWP (16.2 mmHg) and PVR (2 WU) by log-rank maximal likelihood ratio. Over a median follow-up of 27 (12-43) months, both measures significantly stratified patients for the risk of the primary endpoint at Kaplan-Meier analysis (Log Rank 99.5, p&lt;0.001 for PCWP; Log Rank 18.4, p&lt;0.001 for PVR). While both increased PCWP and PVR were associated with a higher risk of events in the HFrEF subgroup (both p&lt;0.001), only increased PCWP significantly stratified the outcome in HFmrEF patients (Figure). At multivariable Cox regression analysis (adjusted for age, sex, ischemic HF etiology, glomerular filtrate, LVEF, and NT-proBNP), increased PCWP (hazard ratio, HR 1.67 [95%CI 1.28-2.18], p&lt;0.001) but not PVR (HR 1.25 [95%CI 0.98-1.60], p=0.07) remained an independent predictor of the primary outcome.

Conclusion
The estimation of PCWP and PVR by echocardiography add relevant clinical and prognostic information and may help in the decision making in patients with HF.