bluuebunny/crossref_metadata_2025_split huggingface dataset:
C6 IN VIVO CHIARI NETWORK REMOVAL. COMPLICATION OR INNOCENT SURPRISE
Authors: Lupo A , Bacchiega E , Zerbo F , Sacca‘ S 
Published: May 2022

Abstract
A 78 years old man was admitted to our hospital because of a syncope and evidence of complete AV– block, low ventricular rate and suitable for definitive PM implantation. He had no other pathologies or previous surgical interventions. A transthoracic echocardiography was performed and any particular structural anomaly was detected and the left ventricular ejection fraction was normal. In the electrophysiology laboratory, a vascular access through the left axillary vein was used to insert a passive fixation catheter for the right ventricular using a 9 F sheath. When the ventricular lead reached the right atrium it was impossible to advance it farther into the right ventricle; the lead was blocked near tricuspid anulus without any possibility to move it towards any direction despite many and vigorous manual traction maneuvers were attempted. Immediately, a transesophageal echocardiography was performed and it showed the lead entrapment into a mobile structure, likely a Chiari network.The patient needed a PM implantation as soon as possible and also a temporary PM could further complicate the procedure. Since the hospital did not have a cardiac surgery department and our crew was not familiar with lead extractions, an expert hemodynamist, who suggested to remove the lead by using a snare, was consulted. The tip of the lead was stuck in the atrial wall so it was impossible to capture it as expected. So, from right femoral vein access, a 6F pig–tail catheter was inserted through a a 45 cm– 8 F Terumo Destination sheath in order to give more stability to the pig–tail catheter until it hooked the lead. A 0.035 mm normal hydrophilic Terumo wire was later passed into the pig–tail catheter, snared and externalized with an AndraSnare 25 catheter inserted through another 6F introducer. A vigorous traction was performed simultaneously pulling both the ends of the wire from the bottom and the lead from the top. After a few seconds, the lead was unstuck and removed from the axillary vein [Fig. 1a,b]. At the external examination, the tines of the lead were found attached to a net–like structure that was actually the Chiari network that had been completely removed from the atrium [Fig 2–3]. A transthoracic echocardiogram ruled out any pericardial effusion. The anatomical finding was sent to tissue analysis and was confirmed to be the tendon material. After that the patient was immediately implanted with a VDD PM without any complications, and dismissed after 2 days.
C12 MANAGING CARDIAC ARREST SECONDARY TO SPONTANEOUS CORONARY ARTERY DISSECTION: SHOULD WE ROUTINELY CONSIDER ICD IMPLANTATION? INSIGHTS FROM PARMA SCAD REGISTRY
Authors: Giacalone R , Toselli M , Pelà G , Cattabiani M , Vezzani A , Benatti G , Tadonio I , Ferretti M , Gurgoglione F , Noni M , Niccoli G , Ardissino D , Vignali L , Solinas E 
Published: May 2022

Abstract

Background
Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention.

Methods
We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation (Table1).

Results
Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter–defibrillator (S–ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD (Figure 2 A). Evaluating risk of SCAD recurrence and sudden cardiac death. The management of SCAD patients complicated by malignant ventricular arrhythmias and cardiac arrest is challenging. Looking at published registries, it appears that SCAD patients are more likely to suffer from ventricular arrythmia or sudden cardiac death than non–SCAD MI patients. The risk–benefit ratio of ICD implantation in these patients remain uncertain . Evaluation of scar burden with CMR can help stratify the global arrhythmic risk, especially as extensive myocardial scar with a residual impaired LVEF increases the risk of future arrhythmic events (Figure 2 B). In our series, only one patient underwent S–ICD implantation, and the decision was mainly driven by the finding of underlying arteriopathy affecting other vascular territories, suggesting a potentially higher rate of SCAD recurrence. For this particular subset of patients, we propose an algorithm that combines predisposing factors and myocardial injury quantification data (Figure 2 B) that could be useful for the estimate of the risk of malignant arrythmias, as well as the risk of recurrence of SCAD, but needs to be validated in larger case studies.

Conclusions
The acute management of cardiac arrest related to SCAD deserves specific consideration. The residual myocardial damage, predisposing and precipitants factors should be evaluated in order to estimate the SCAD recurrence and sudden cardiac death risks.
C16 PROPENSITY SCORE COMPARISON OF ELASTIN–BASED AND COLLAGEN–BASED MECHANICAL PROPERTIES OF AORTIC WALL IN BICUSPID VS TRICUSPID AORTIC VALVE PATIENTS UNDERGOING AORTIC SURGERY
Authors: Totaro P , Scocozza F , Morganti S , Auricchio F , Pelenghi S 
Published: May 2022

Abstract

Objective
Several studies addressed characteristics of aortic wall in patients with bicuspid aortic valve (BAV) compared to those with tricuspid aortic valve (TAV). Different patients population and lack of randomization were the main limitations in many of such studies, focused furthermore, only on ultimate properties (at rupture). In this study we compared mechanical properties in BAV and TAV patients undergoing aortic surgery using propensity score analysis to obtain two homogeneous groups of patients. We also focused on both elastin–based and collagen–based mechanical properties.

Methods
Among 87 overall patients undergoing surgery of ascending aorta, 26 were selected, following propensity score analysis, and divided in 2 groups according the type of native aortic valve (13 BAV and 13 TAV). Mechanical tests were completed following circumferential and longitudinal force application. 137 cumulative tests were accepted (93 from anterior aortic wall). Aortic wall strain (marker of elasticity) and aortic wall stress (marker of strength) were measured either in the Elastin–based (initial) distension and in the Collagen–based ultimate distension (until rupture).

Results
Cumulative comparison of specimens thickness confirmed that anterior aortic wall is thinner in BAV patients. Aortic wall thickness, however was not correlated to any of mechanical tests in Elastin–based or Collagen–based distensions. Aortic wall elasticity and strength (applying either longitudinal and circumferential force) were not different in BAV compared to TAV patients. Initial and ultimate elasticity were significantly correlated either applying circumferential and longitudinal force. Direct correlation between initial and ultimate strength, on other hands, was showed only in BAV patients when a longitudinal force was applied.

Conclusions
We clearly showed that, in dilated aorta, anterior wall is thinner in case of BAV compared to TAV. Our study, furthermore, confirms that mechanical properties of aortic wall in BAV patients are no impaired, compared to an homogeneous group of TAV patients, neither in initial or ultimate tests. Elastin–based and collagen–based aortic wall mechanical properties (under circumferential force) are directly correlated regardless BAV presence. Lack of correlation between initial and ultimate strenght in TAV patients, under a longitudinal force, needs further evaluation as it could be related to an increased frailty of aortic wall in such conditions.
C20 IMPACT OF TELEMEDICINE SERVICES DURING THE COVID–19 PANDEMIC
Authors: Nodari S , Fioretti F , Glisenti F , Bollani G , Gabbrielli F 
Published: May 2022

Abstract
During the Italian national lockdown (11/3 to 4/5/2020), the COVID–19 epidemic caused a shift of hospital resources towards the management of the COVID+ patient; hospitals saw a progressive drop of admissions for acute myocardial infarction and arrhythmias. In order to verify the role of Telemedicine in this context, we compared 6104 ECGs recorded by 5000 pharmacies, with the 17280 ECGs of the same period of 2019, evaluated and stored in the telemedicine platform of Health Telematic Network (HTN), in collaboration with the Department of Cardiology of the University of Brescia, Federfarma and Istituto Superiore di Sanità. Chest pain was the reason for examination in 298 patients (4.88%) vs 402 (2.33%) in 2019 (+109.86%). Of these, 118 were in Lombardy, (39.50% of the total), 36 in the province of Brescia (30.50%) and 28 in the province of Bergamo (23.73%). 8 ECGs showed a STEMI picture, (2.68%), compared with 7 STEMIs (1.74%) detected in 2019 (+ 54.17%). All of these patients were referred urgently to the emergency department. We detected Atrial Fibrillation in 344 patients (5.64%), vs 393 (2.27%) in 2019, (+ 40.25%); 32 cases of Atrial Flutter (0.52%), vs 25 (0.14%) detected in 2019 (+ 26.92%). Finally, we found paroxysmal supraventricular tachycardia in 8 cases (0.13%), vs 6 cases (0.03%) detected in 2019(+ 23.07%). During the lockdown period, 384 patients (6.29%) were referred to the emergency department for symptomatic tachyarrhythmia, vs 424 patients (3.47%) in 2019(+ 55.16%). In Lombardy, 194 cases of tachyarrhythmia were reported in territorial pharmacies (about 50.52% of the total in Italy), 93 in the Brescia area (47.94%), 50 in the Bergamo area (25.77%). Conclusions: a high number of patients with cardiovascular symptoms preferred to refer to territorial pharmacies during the COVID–19 blast. Telemedicine allowed patients with STEMI to access hospitals quickly, avoiding a serious diagnostic delay; a significant proportion of accesses to local pharmacies for chest pain occurred in the region most affected by the COVID–19 outbreak; the service also allowed to refer to the hospital only patients with clinically relevant tachyarrhythmias, avoiding delay of care and inappropriate accesses. This underlines how the telemedicine network provided by pharmacies can become an important resoruce for the citizen, supporting the services of the Italian National Health System.
C25 PREDICTION OF ALL–CAUSE MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION IN BIFURCATION LESIONS USING MACHINE LEARNING ALGORITHMS – THE RAIN–ML PREDICTION MODEL
Authors: Gallone G , Burrello J , Burrello A , Iannaccone M , De Luca L , Patti G , Cerrato E , Venuti G , De Filippo O , Mattesini A , Muscoli S , Trabattoni D , Giammaria M , Truffa A , Cortese B , Conrotto F , Mulatero P , Monticone S , Escaned J , Usmiani T , D‘ascenzo F , De Ferrari G , Breviario S 
Published: May 2022

Abstract

Aims
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet need. Machine learning (ML) may identify patterns from multidimensional, non–linear relationships to make outcome predictions. We sought to develop a ML–based risk stratification model built on clinical, anatomical and procedural features to predict all–cause mortality following contemporary bifurcation PCI.

Methods and Results
Multiple ML models to predict all–cause mortality were tested on a cohort of 2,393 patients (training, n = 1,795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real–world RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry. Among 38 commonly available features, 25 (13 patient–related, 12 lesion–related) were selected to train ML models. The best performing model (the RAIN–ML prediction model) was validated in an external validation cohort of 1,701 patients undergoing bifurcation PCI from the DUTCH PEERS (DUrable polymer–based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial and the BIO–RESORT trial cohorts. The area under the receiver operating characteristic curves for the prediction of 2–year mortality was 0.786 (0.74–0.83) in the overall population, 0.736 (0.72–0.847) at internal validation and 0.706 (0.6919–0.794) at external validation. Performance at risk ranking analysis, k–center cross validation, and with continual learning confirmed the generalizability of the models, available also as an online interface.

Conclusions
The RAIN–ML prediction model represents the first tool combining clinical, anatomical and procedural features to predict all–cause mortality among patients undergoing contemporary bifurcation PCI with a good discriminative performance.
C26 COMPLETE REVASCULARISATION IMPROVES SURVIVAL OF PATIENTS RESUSCITATED AFTER AN OUT–OF–HOSPITAL CARDIAC ARREST
Authors: Kajana V , Primi R , Gentile F , Compagnoni S , Baldi E , Mandurino Mirizzi A , Repetto A , Ferrario M , Ferlini M , Marinoni B , Bendotti S , Currao A , Oltrona Visconti L , Savastano S 
Published: May 2022

Abstract

Background
Sudden cardiac death is a major issue in industrialised countries and survival of patients after out–of–hospital cardiac arrest (OHCA) remains low. Acute myocardial infarction (AMI) is the principal cause of OHCA and myocardial revascularisation plays a positive role on survival. In this setting little is known about the role of complete (CR) versus culprit–only revascularisation (IR) on survival.

Purpose
The aim of this study was to assess whether CR could lead to a better one–year survival as compared to IR. Methods. Among patients prospectively enrolled in the Lombardia CARe OHCA registry from January 1 2015 to May 1 2021, who underwent a coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo were enrolled in this study. CAGs were retrospectively reviewed by two interventional cardiologists. Prehospital and survival data were retrieved from the registry.

Results
We enrolled 239 patients [mean age 63.7±12.4 years; male 79.9%; shockable presenting rhythm 84.1%; AMI at post ROSC ECG 67.9%; ejection fraction 37% (30–45), circulatory support with ECMO 10.9%]. Among the 119 (50%) patients with multi–vessel disease, 82 (69%) received IR whereas 37 (31%) received CR [8 during the first procedure, 29 in a second procedure with a median time after OHCA of 5 (2.5–10) days]. This latter group showed significantly higher one–year survival (54.9% vs 16.2%, p &lt; 0.001). At univariable logistic regression only a shockable presenting rhythm and the presence of chronic total occlusion (CTO) were significantly associated with the probability of receiving a CR [OR 5.1 (95%CI 1.1–22), p = 0.03; OR 0.37 (95%CI 0.16–0.85), p = 0.02 respectively]. However, at multivariable regression analysis only CTO was significantly associated with the probability of receiving a CR [OR 0.36 (95%CI 0.15–0.9), p = 0.007]. At Cox multivariable regression model cardiac arrest duration (longer that the median value of 24 min) and CR were independently associated with the probability of death [HR 3.6 (95%CI 1.9–6.9), p &lt; 0.001; HR 0.2 (95%CI 0.1–0.9), p = 0.02]. Similarly, cardiac arrest duration, CR and a shockable presenting rhythm were associated with the probability of death or poor neurologic outcome [HR 3.3 (95%CI 1.8–6), p &lt; 0.001; HR 0.5 (95%CI 0.3–0.9), p = 0.03 and HR 0.2 (95%CI 0.1–0.5), p &lt; 0.001].

Conclusions
Complete revascularisation is independently associated with a better one–year survival in patients resuscitated from an out–of–hospital cardiac arrest.
C28 THE FINANCIAL BURDEN OF NEWER GENERATION TAVI DEVICES: RESULTS FROM THE ITALIAN OBSERVANT STUDIES
Authors: D‘Errigo P , Marcellusi A , Barbanti M , Biancari F , Tarantini G , Baglio G , Tamburino C , Rosato S , Seccareccia F 
Published: May 2022

Abstract

Objectives
To estimate the financial burden of using newer generation transcatheter aortic valve implantation (TAVI) devices compared with older generation devices.

Background
TAVI is becoming the standard treatment for severe aortic stenosis in symptomatic elderly patients and is increasingly offered also to younger and lower risk patients. Resource utilization in performing TAVI has become an important focus due to the high likelihood of hospital readmissions, but it is unclear whether readmissions after TAVI contribute to a significant proportion of overall costs of TAVI to the healthcare system at mid–term follow up.

Methods
A probabilistic Markov model was developed in order to estimate the cost consequence of introducing newer generation TAVI devices were calculated as the absolute deterministic difference between a cohort of 6,000 patients treated with the newer TAVI devices (TAVI–new scenario) and the same cohort treated with old TAVI devices (TAVI–old scenario). Transition probability and hospitalization costs were retrieved among patients enrolled in the OBSERVANT I and OBSERVANT II studies; 1898 patients treated with older generation TAVI devices and 1417 patients treated with new generation TAVI devices were compared. Outcomes were adjusted using propensity score matching.

Results
Propensity score matching resulted in 853 pairs, whose baseline risk factors were well balanced. The mean EuroSCORE II (6.6 vs. 6.8; p = 0.76) and the mean age (82.0 vs 82.1; p = 0.62) of older generation TAVI patients and newer generation TAVI patients were similar. The use of newer generation TAVI devices determined a significant reduction of re–hospitalizations (–30.5% re–intervention, –25.2% major re–hospitalization and –30.8% minor re–hospitalization) and mortality (–20%). These reductions were associated with significant cost savings over a 1–year period (−€4.1 million in terms of direct costs and −€19.7 million considering the additional cost of the devices). The main cost–reduction was estimated for re–hospitalization that cover 79% of the overall cost reduction in the economic analysis without the costs of the devices.

Conclusions
After adjusting for baseline characteristics, patients undergoing TAVI with newer generation devices had lower risk of all–cause death and re–hospitalization. These reductions are leading to significant cost savings at 1 year, mainly due to the reduction in re–hospitalization costs.
C29 SEEING BEYOND APPEARANCES: INTRACORONARY IMAGING TECHNIQUES IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD)
Authors: Desario P , Rutigliano D , Basso P , Palumbo V , Ricci G , Sublimi Saponetti L , Locuratolo N , Caldarola P 
Published: May 2022

Abstract
Over recent years, mainly due to a broad use of coronary angiography and intracoronary imaging techniques (IIT), SCAD has emerged as a no longer rare cause of acute coronary syndrome (ACS). Early diagnosis is extremely important to avoid potentially lethal complications; nevertheless, considerable uncertainty remains about optimal acute and post–discharge management. Current endorsed therapeutic strategy lean towards an initial conservative approach, relegating percutaneous or surgical coronary intervention to high–risk coronary anatomy or in case of hemodynamic instability. We report our experience in the field by presenting a clinical case of a 36–year–old woman admitted to emergency department with acute, anginal pain started 24 hours earlier, referring no medical history, except for a syncopal episode occurred four days earlier, in correspondence of a mournful event. She was hemodynamically stable, with work–up significant only for elevated troponin level of 3649.5 ng/ml (n.v. &lt;11). Coronary angiogram showed atherosclerotic–like changes limited to right coronary artery (RCA), with focal subcritical stenosis at its proximal segment (Fig 1). In the absence of major precipitating factors for atherosclerotic coronary disease, SCAD was suspected. IVUS and OCT were performed, with evidence of dissection and intra–mural haematoma (Fig. 2), extending from proximal RCA to posterior descending branch take–off, compressing the true lumen. Considering both anatomical (coronary ostium not involved) and clinical (patient asymptomatic and hemodynamically stable) factors, conservative treatment with low dose aspirin and beta blocker was prescribed. After three days of hospitalization occurred a single episode, lasted 5 minutes, of anginal pain associated with ST elevation in inferior leads, managed with nitrates administration; subsequent cardiac computed tomography angiography excluded disease progression (Fig.2). On the 23rd day, due to angiographic evidence of SCAD partial healing (Fig.3), the patient was discharged. This case highlights the importance of keeping in mind the possibility of SCAD, especially when healthy young women with prior emotional stress present with ACS. IIT allow to shed light on the true mechanism of ACS without significant obstructive coronary disease. Finally, in case of conservative approach, close in–hospital monitoring is mandatory, given the highest probability of complications in the first days after clinical onset.
C30 IMPACT OF CORONARY ANATOMY AND RESIDUAL SYNTAX SCORE ON ARRHYTHMIC EVENTS IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY
Authors: Meynet I , Quadri G , Tricomi L , Tomassini F , Rolfo C , Franzè A , Zanda G , Piedimonte G , Minniti D , Varbella F 
Published: May 2022

Abstract

Background
ICD implantation is a cornerstone for primary prevention in patients with ischemic cardiomyopathy and impaired left ventricular function; reduced ejection fraction alone, however, doesn’t seem enough to discriminate which patients will really experience arrhythmic events in the follow up. We hypothesized that coronary anatomy and the extent of residual coronary lesions, measured with syntax score, could be a better predictor of the outcome in this setting.

Materials and Methods
Data of all patients implanted with single or dual chamber ICD in primary prevention for ischemic cardiomyopathy from 2011 to 2020 were retrospectively collected, together with follow up data obtained from clinical visits and ICD remote monitoring. Residual syntax score (RSS) was calculated for each patient, taking into consideration the last coronary angiography performed before ICD implantation.

Results
110 patients were included in our registry. 90.1% were male, mean age was 66±7 years. 23.6% ICD were dual chamber devices. 96 (87.2%), 8 (7.3%) and 6 (5.5%) presented respectively with low (0–22), intermediate (23–32) or high (≥33) RSS. After a mean follow up of 4.4±2.9 years, 31 patients (28.2%) died; 20 patients (18.2%) and 27 patients (24.5%) received any appropriate ICD therapy, either shock or ATP. 12 patients (10.9%) experienced inappropriate shock. The composite outcome of death or any appropriate therapy (MACE) was observed in 47 patients (42.7%); left main or left descending artery stenosis were predictors of MACE (p = 0.026 and p = 0.040 respectively). Intermediate or high RSS was the only predictor of appropriate shock (p = 0.046).

Conclusions
Coronary anatomy and residual coronary stenosis quantified with syntax score are promising predictors of arrhythmic events during the follow up in patients with ischaemic cardiomyopathy and ICD implanted in primary prevention.