bluuebunny/crossref_metadata_2025_split huggingface dataset:
220 MANAGING CARDIAC ARREST SECONDARY TO SPONTANEOUS CORONARY ARTERY DISSECTION: SHOULD WE ROUTINELY CONSIDER ICD IMPLANTATION?
Authors: Rizzello Davide , Gurgoglione Filippo Luca , Giacalone Rossella , Ferretti Marco , Noni Manjola , Pelà Giovanna , Cattabiani Maria Alberta , Benatti Giorgio , Tadonio Iacopo , Ardissino Diego , Niccoli Giampaolo , Vignali Luigi , Solinas Emilia 
Published: December 2022

Abstract

Introduction
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.

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. 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. 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 myocardia injury quantification data 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.
222 INFARCT-LIKE MYOCARDITIS IN A PATIENT WITH CORONARY ARTERY DISEASE PRESENTING WITH CHEST PAIN: LOOKING BEYOND THE SIMPLEST DIAGNOSIS
Authors: Amelotti Nicola , Brusamolino Matteo , Mapelli Massimo , Baggiano Andrea , Vignati Carlo , Campodonico Jeness , Mattavelli Irene , Salvioni Elisabetta , De Martini Stefano , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
A significant proportion of patients with acute myocarditis (AM) presents with chest pain as their first symptom, with ST-segment elevation, regional myocardial dysfunction and cardiac enzyme release (“infarct-like” pattern).

Case description
A 68-year-old patient, already known for coronary artery disease (CAD) who underwent a percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation of distal left anterior descending artery (LAD) six months before, presented with chest pain at rest. An ECG showed ST elevation in the infero-postero-lateral leads with specular ST-depression in aVL; hsTnI was 5900 ng/L (UNL &lt; 51 ng/L). A coronary angiography excluded acute thrombosis, and showed a normal right coronary artery (RCA), significant (70%) stenosis of proximal LAD and left circumflex artery, both treated with PCI + DES. A transthoracic echocardiogram (TTE) showed hypokinesia of the middle portions of the inferior, posterolateral and inferior interventricular septum (SIV) walls. According to a research protocol ongoing in our hospital in post-myocardial infarction patients, a cardiac magnetic resonance (CMR) was performed 48 hours later, showing signs of acute non-ischemic myocardial damage (myocardial edema involving the whole infero-septal wall, late gadolinium enhancement with subepicardial – non-coronary - distribution at apical and antero-apical septum). A final diagnosis of infarct-like AM was established. No complications occurred during the hospital stay and hsTnI progressively decreased (at discharge 37 ng/L). A 6-month follow-up CMR showed normal biventricular function and kinesis, and absence of alterations in tissue characterization sequences.

Conclusion
This case highlights how even patients with a known CAD can present with AM mimicking myocardial infarction. Multimodality evaluation, including CMR, can help make the right diagnosis to avoid unnecessary therapies or procedures (i.e. PCI), especially in case of discrepancy between different clinical findings, (i.e. ST-elevation in the inferior leads with a dominant unscathed RCA, non-occlusive stenosis at angiography, echocardiography wall motion abnormalities in RCA territory).
480 ICD AFTER STEMI: WHEN AND HOW FREQUENTLY IS IMPLANTED AND WHICH IS THE RATE OF APPROPRIATE INTERVENTIONS
Authors: Pezzato Andrea , Fabris Enrico , Gregorio Caterina , Cittar Marco , Contessi Stefano , Carriere Cosimo , Lardieri Gerardina , Zecchin Massimo , Perkan Andrea , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
there are limited data of implantable-cardioverter-defibrillator (ICD) implantation after STEMI treated with primary percutaneous coronary intervention (pPCI). This study sought to evaluate when and how frequently is ICD implanted after STEMI, the rate of appropriate ICD-interventions, and the independent predictors of ICD implantation.

Methods
We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients data with those present in the Trieste ICD registry.

Results
1805 consecutive patients treated with pPCI were analyzed. During a median follow-up of 6.7 (IQR 4.3-9.2) years, the probability of ICD implantation at 12 months was 2.3% (95%CI: 1.7-3.1) and it remained stable overtime (at 24 months: 2.5%, 95%CI 2.0-3.5 and at 36 months: 2.6%, 95%CI 2.3-3.8). Mean time before ICD implantation was 35.5 months (95%CI: 34.8-36) . 83.1% of implanted ICD were for primary prevention, and more than half (55%) were implanted in patients with ejection fraction (EF)&gt;35% at the moment of STEMI discharge. During a median follow-up of 5.7 (IQR 3.3-8.3) years after ICD implantation, the probability of appropriate ICD intervention was 9% and 11% after 12 and 24 months respectively. In patients with EF&gt;35% at STEMI discharge (median EF 43%; IQR 40-48), predictors of ICD implantation were male sex, anterior STEMI and troponin peak &gt;100.000 ng/dl.

Conclusions
The rate of ICD implantation after pPCI is low, however the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantation at follow-up despite a non-severe EF at discharge after STEMI. Among these patients those with high troponin release deserve strict follow-up and full optimal medical treatment.
473 LUNG ULTRASOUND IN CORONARY CARE UNIT, AN IMPORTANT DIAGNOSTIC TOOL FOR CONCOMITANT PNEUMONIA
Authors: Chirico Alfonsina , Basile Christian , Mancusi Costantino , Fucile Ilaria , Mosca Mariangela , Migliaccio Biagio , Gargiulo Giuseppe , Santoro Ciro , Paolillo Stefania , Perrone-filardi Pasquale , Gargiulo Paola 
Published: December 2022

Abstract

Background
In the setting of coronary care unit (CCU), early detection of pneumonia is of para-mount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in detection of pneumonia and compared with chest x-ray (CXR).

Method
We enrolled 110 consecutive patients admitted to CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs no-pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n=34).

Results
Mean age was 70 ± 11 years old, 68% males. Pneumonia was clinically diagnosis in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92% specificity 81%). Chest radiography was positive in 9 patients (sensitivity 43% specificity 95%). Using CT scan as referee LUS exhibit 92% of sensibility and a specificity of 96%. In ROC curve analysis diagnostic accuracy of CXR and LUS for diagnosis of pneumonia was 0.86 (95% CI 0.77-0.94), higher than CXR 0.68 (95% CI 0.55-0.84), p&lt;0.05 (Figure).

Conclusion
Based on the findings of the present study, accuracy of LUS in detection of pneumonia was significantly higher than chest x-ray, with comparable sensibility to CT scan.
916 THE SMARTWATCH DETECTS ECG ABNORMALITIES TYPICAL OF BRUGADA SYNDROME
Authors: Ferraro Daniel , Curcio Antonio , Spaccarotella Carmen , Santarpia Giuseppe , Romano Letizia Rosa , Cardia Giada , Mancuso Cinzia , Purri Ilaria , Indolfi Ciro 
Published: December 2022

Abstract

Introduction
Brugada syndrome (BrS) is a genetic disorder with a characteristic pattern on the electrocardiogram (ECG) that predisposes to lethal arrhythmias and sudden cardiac death (SCD). Precise diagnosis is therefore mandatory.

Aims
We evaluated the feasibility and accuracy of a smartwatch in recording multiple ECG leads and detecting ST-segment changes diagnostic for BrS both in basal condition and after ajmaline infusion.

Materials and Methods
Twelve-leads and smartwatch ECGs were obtained in 32 unselected patients admitted at our institution with type II/III ST-segment elevation suspected for BrS from September 2021 to March 2022. After written informed consent for continuous ECG monitoring during ajmaline test (1 mg/kg, i.v. for 10 min), consecutive ECG strips acquired with both techniques were analyzed before and after drug administration. For each patient smartwatch was tested at three different sites: wrist, abdomen and chest, and intercostal spaces from second to fourth were further studied. The concordance among the results of the smartwatch and standard ECG recordings was assessed using the Cohen κ coefficient and Bland-Altman analysis.

Results
Subjects were 42±15 y.o. on average; 67% were men (n=25), and diagnosis of BrS was reached in 12 cases (37.5%). Concordance was found between the smartwatch and standard ECG for the identification of the following findings: i) a normal/negative ECG (Cohen κ coefficient, 0.89); ii) ST-segment elevation shift (Cohen κ coefficient, 0.934). In addition, the Bland-Altman analysis demonstrated concordance between the smartwatch and the standard ECG in the assessment of the amplitude of ST-segment elevation shift (bias, −0.003; SD, 0.68; lower limit, −0.52; and upper limit, -0.031). The smartwatch power in diagnosing normal ECG showed a sensitivity of 92% (95% CI, 66%-99%) and a specificity of 100% (95% CI, 64%-100%); for detection of ST-segment elevation and BrS diagnosis, sensitivity was 92% (95% CI, 64%-99%) and specificity was 95% (95% CI, 76%-99%).

Conclusions
The findings of this study suggest agreement between the multichannel smartwatch acquisition and standard ECG for the identification of Brugada syndrome-associated ST-segment changes.
640 QRS INDEX TO PREDICT CARDIAC RESYNCHRONIZATION THERAPY RESPONSE: A TRICENTRIC STUDY
Authors: Madaudo Cristina , Prezioso Amedeo , Bonni´ Enrico , Mascioli Giosuè , Pecora Domenico , Ciaramitaro Gianfranco , La Greca Carmelo , Zanchi Simone , Cuccia Claudio , Novo Giuseppina , Corrado Egle , Coppola Giuseppe , Galassi Alfredo Ruggero 
Published: December 2022

Abstract

Background
Several studies have evaluated the role of QRS duration (QRSd) or QRS narrowing as predictor of response to cardiac resynchronization therapy (CRT) in order to reduce non-responders. However, their results have been conflicting. In our study we analyzed retrospectively a cohort of patients from three centers to better correlate the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who underwent CRT implantation.

Methods
We included 398 patients in whom a CRT device was implanted in accordance with current guidelines in our three centres. Baseline clinical variables, echocardiographic parameters and pharmacological therapies were included. QRS duration before and after CRT implantation and QI [(pre implant QRS duration - QRS duration during CRT)/pre implant QRS duration × 100] were measured.

Results
Respect to echocardiographic follow up at 6 months, a significant improvement in all parameters (EF, LVEDV, LVESV) was observed. In 68% of patients, LVESV decreased by 10% or more. QI was significantly related to reverse remodelling (r = + 0.22; 95% CI: 0.11 to 0.32, p = 0.001). The cut-off value of QI that predicted best LV reverse remodelling after 6 months of CRT was 12.25% (sensitivity 65,49%, specificity 75%, area under the curve 0.7, p = 0.001).
Regarding clinical outcomes at 12 mounths, a statistically significant difference was found between patients with a QI ≤ 12.25%, and those with a QI &gt; 12.25%, in terms of NYHA class worsening (p 0,04). Another statistically significant difference was found analyzing the relation between QI and the causes of deaths, the mean of the QI of patients who died from cardiovascular causes was lower than patients who died of other causes. (p 0,0179).

Conclusions
Therefore decrease in QRSd after CRT initiation was related to greater echocardiographic reverse remodelling and better outcome from death or cardiovascular hospitalization.
Even if larger studies are needed, QI seems to be an easy-to- measure variable that could be used or evaluated to predict CRT response.
960 EARLY ONSET OF SUBTLE LIVER DAMAGE IN TTR AMYLOIDOSIS PATIENTS TREATED WITH TAFAMIDIS
Authors: Agbariah Andrea , Nannelli Chiara , Comunello Andrea , Cemin Roberto 
Published: December 2022

Abstract

Background
misfolded transthyretin amyloid fibrils can deposit in the myocardium causing transthyretin amyloid cardiomyopathy (ATTR-CM). Tafamidis has become recently available for the treatment of ATTR-CM, but to date very few data about its possible side effects have been published.

Aims
to investigate the potential liver toxicity of Tafamidis 61 mg/day in a group of patients affected by wild type ATTR-CM treated in our department.

Materials and Methods
14 consecutive patients with wild-type ATTR-CM were treated with Tafamidis accordingly to the classical recommendations. The patients’ liver function was checked through transaminases and gammaGT determination at baseline and for the first six months and their changes analysed with the non-parametric Wilcoxon test for paired samples.

Results
mean age of the patients included (13 males and a female) was 78 years. Baseline transaminases were all within the normal range (median GOT level 25.0 U/L - IQR 19.0-29.0; median GPT levels 24.0 U/L - IQR 15.0-27.0) and remained stable for the first two months (median GOT at 2 months 25.5 U/L - IQR 19.0-28.0; median GPT at 2 months 22.5 U/L – IQR 16.0-27.0). Median GGT baseline level was 138.0 U/L (IQR 58.0-204.0) and raised to 142.0 U/L (IQR 56.0-270.0) after a two-month therapy (p&lt;0.01). The further follow-up confirmed a similar trend in the first six month of treatment, with a linear and constant increase of gammaGT levels.

Conclusions
even not clinically relevant, the wild-type ATTR-CM patients included in our analysis showed all a subtle increase of gammaGT values after only two months of Tafamidis treatment, which was confirmed at six months. This observation underlines the potential hepatotoxicity of the drug, thus confirming the recommendations of strict and regular liver function analysis provided by the manufacturer.
396 ARE BLOOD LEVELS OF RETINOL BINDING PROTEIN USEFUL IN DIAGNOSING ATTR-CA? A NEGATIVE STUDY, SO FAR
Authors: Barbarossa Alessandro , Coraducci Francesca , Torselletti Lorenzo , Belleggia Sara , Coretti Francesca , Brugiatelli Leonardo , Bastianoni Gianmarco , Alfieri Michele , Paolini Federico , Principi Samuele , Ciliberti Giuseppe , Stronati Giulia , Russo Antonio Dello , Guerra Federico 
Published: December 2022

Abstract

Introduction
Retinol binding protein (RBP) is a protein synthesized in the liver which forms, along with transthyretin (TTR) the retinol-transport-complex. This complex ligates retinol and thyroxine and transports them in the human plasma. TTR is a protein longer and heavier than RBP. It ligates RBP preventing its renal filtration. Our hypothesis is that the relationship between RBP and TTR is dual: TTR avoids renal filtration of RBP, but also RBP itself, functioning as an endogenous ligand, has an action on TTR by stabilizing and avoiding TTR misfolding.
Misfolded TTR proteins form amyloid fibrils rich in beta-cross-sheets that can infiltrate healthy tissues altering their physiology. The infiltration of these fibrils in the cardiac tissue leads to the well-known condition of TTR cardiac amyloidosis (ATTR CA).
Our hypothesis is that the lack of TTR stabilization that can happen with low blood levels of RBP is a risk factor for developing ATTR CA. The main goal of our study is to understand if high or normal values of RBP can help exclude any pathological condition linked to the accumulation of misfolded TTR proteins.

Methods
All patients referred to our Cardiomyopathy Clinic with a clinical and echographic suspicion of CA were consecutively enrolled. All patients underwent a complete diagnostic workup in order to confirm or exclude CA, comprehending lab tests (including RBP4), SPECT, cardiac MR, genetic testing and cardiac biopsy as recommended by current recommendations. At the end of the diagnostic process, patients with ATTR-wt CA were enrolled as cases, and patients with no CA were considered as controls. Patients with ATTR-mutated CA or AL CA were excluded from the present analysis.

Results
Fifty-nine consecutive patients (42 males, age 77+/-13 years) were enrolled. Of those, 27 had a definitive diagnosis of ATTR-wt CA, while 32 had another diagnosis. Mean levels of RBP4 were not different between patients with and without CA (5.4+/-1.9 vs. 5.0+/-1.8 mg/dl; p=ns) as were Troponin I, BNP and NT-proBNP levels (all p=ns). Among patients with a definitive diagnosis of ATTR-wt CA and a positive SPECT, RBP4 levels were similar between Perugini 2 and 3 scores (5.4+/-2.1 vs. 5.6+/-2.0 mg/dl; p=ns).

Discussion
From our findings, it seems that there is no significant correlation between low levels of RBP and the presence of ATTR CA as we found no difference in the distribution of RBP levels between cases and controls. It also did not seem to be a useful marker to stratify the levels of myocardial infiltration as long as there is no difference in RBP between Perugini score 2 and 3.
170 WHEN THE HEART GETS DRUNK
Authors: Contini Francesca Valeria , Pietro Spissu Paolo Marco , Fazzini Luca , Caggiari Ludovica , Angius Simone , Pittau Roberta , Dessalvi Christian Cadeddu , Montisci Roberta 
Published: December 2022

Abstract
A 53-old male with arterial hypertension, obesity (BMI 32) and gout presented to our Emergency department symptomatic for dyspnea, complaining about reduced functional capacity (NYHA III), gain of weight e increased abdominal circumference. In the days after we discovered a history of potus (2 liter of wine/day).
At a first physical examination we confirmed clinical features of heart failure with pulmonary congestion and ascites. The EKG showed atrial fibrillation, 80 bpm.
An echocardiogram showed severely reduced ejection fraction (EF 23%) with diffuse hypokinesia, increased left ventricular mass, deeply increased volumes, with only slightly increased thickness, a mild moderate diastolic dysfunction. Also, the right ventricular was hypokinetic and dilatated.
During the hospitalization the patient underwent coronary angiography, which showed no coronary lesion, e cardiac RMN with no pathological features in both T1 and T2 weighted sequences. No increased uptake of contrast in LGE sequences was evidenced.
We started diuretic therapy and optimized heart failure therapy with clinical improvement.
The management of anticoagulant therapy was difficult because of hepatic dysmetabolic cirrhosis (Child-Pugh Score 8, class B) with contraindication for DOACs treatment.
Moreover the patient performed a gastroscopy, which evidenced an ulcerative gastro-duodenitis and erosive gastritis confirming the temporary DOACs contraindication.
The patient was discharged in hemodynamic stability, with wearable defibrillator and was taken in charge by a multidisciplinary team.
After the normalization of hepatic function the anticoagulation was no longer forbidden so after three weeks we proceeded to successful electrical cardioversion.
An echocardiogram was performed after 6 months with almost completely recovery of systolic function (EF 62%) and a slightly reduction of chamber dilatations.
The patient denied alcohol consumption throughout the period.
This case demonstrates that alcoholic cardiopathy if it's diagnosed at the beginning can be partially reversible. This case presents a challenging clinical setting due to the frequent comorbidities requiring a multidisciplinary approach. Achieving a significant patient compliance is also crucial for long term lifestyle changes.
580 INCIDENCE AND FACTORS ASSOCIATED WITH DE NOVO ATRIAL FIBRILLATION IN PATIENTS WITH WILD-TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS - A MULTICENTER STUDY
Authors: Fumagalli Carlo , Zampieri Mattia , Argirò Alessia , Musumeci Beatrice , Tini Giacomo , Di Bella Gianluca , Cipriani Alberto , Porcari Aldostefano , Canepa Marco , Merlo Marco , Sinagra Gianfranco , Rapezzi Claudio , Olivotto Iacopo , Perfetto Federico , Cappelli Francesco 
Published: December 2022

Abstract

Purpose
We described the incidence and ECG factors associated with de novo atrial fibrillation (AF) in patients diagnosed with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) to drive tailored arrhythmia screening.

Background
Data on the incidence rate and factors associated with de novo AF in patients with ATTRwt CA is limited.

Methods
Multicenter, retrospective, observational cohort study performed in six referral centers for CA. All consecutive patients diagnosed with ATTRwt-CA between 2004 and 2020 with &gt;1-year follow up (FU) were enrolled in the study and were divided into three groups according to presence of AF: (1)patients with ‘known AF’; (2)patients in ‘sinus rhythm’ and (3)patients developing ‘de novo AF’ during FU. Incidence and factors associated with AF in patients with ATTRwt were the primary outcomes.

Results
Overall, 266 patients were followed for a median of 469 days: 148 (56%) with known AF, 84 (31.6%) with sinus rhythm, and 34 (12.8%) with de novo AF. Age and gender were similarly distributed. At multivariable analysis, PR (Hazard Ratio[HR]: 1.008 95% C.I. 1.001-1.016), QRS (HR: 1.022 95% C.I. 1.002-1.043) and left atrial dilatation&gt;50mm (HR: 3.429 95% C.I. 1.565-7.329) were associated with de novo AF at FU. Patients presenting with at least two risk factors (PR&gt;200ms, QRS&gt;120ms or LAD&gt;50mm) had a higher risk of developing de novo AF compared to patients with no risk factors (HR 14.918 95% C.I. 3.242-31.646).

Conclusions
Incidence of de novo AF in patients with ATTRwt is 20.7%/year. Longer PR and QRS duration and left atrial dilation are associated with arrhythmia onset.