bluuebunny/crossref_metadata_2025_split huggingface dataset:
118 SHORT-TERM EFFECTS OF DAPAGLIFLOZIN ON CARDIAC BIOMARKERS, FLUID RETENTION, RENAL AND PULMONARY FUNCTION IN HFREF PATIENTS: NOT AS GOOD AS EXPECTED
Authors: Mapelli Massimo , Capovilla Maria Teresa , Marongiu Alessandro , Maranzano Gaspare , Salvioni Elisabetta , Mattavelli Irene , Vignati Carlo , Gugliandolo Paola , Mantegazza Valentina , Garlasché Anna , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
Sodium-glucose co-transporter-2 inhibitors (SGLT2-i) are currently a standard therapy for patients with heart failure with reduced ejection fraction (HFrEF). Still, their potential benefits on biomarkers, respiratory function parameters and fluid retention have not been extensively studied. Bioimpedance vector analysis (BIVA) has emerged as a new tool capable of assessing congestion, providing an estimate of the total body water and hydration index (HI). BIVA is more accurate than NT-proBNP in detecting peripheral congestion in chronic heart failure and can be used to evaluate the effects of the treatment. This study aims to assess the short-term effects of Dapagliflozin on spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), cardiac biomarkers, and BIVA.

Methods
Stable HF patients (EF &lt;40%, NYHA class II or III) eligible for SGLT2-I therapy according to guidelines underwent standard spirometry, DLCO, BIVA and venous blood sampling at baseline (V0) and after 2-4 weeks of therapy (V1).

Results
Patients characteristics (N=32) at baseline are shown in Table 1. None of the patients interrupted the treatment and/or experienced adverse events. After 26±6 days, we observed worsening of renal function (eGFR from 73.1±28.5 mL/min/1.73m2 to 67.4±27.0 mL/min/1.73m2, p&lt;0.001) and potassium levels (4.36±0.36 mEq/l vs 4.58±0.57 mEq/l, p= 0.017). There were no significant changes in NT-proBNP levels (1378 [615-2542] ng/l vs 1034 [554-2552] ng/l, p= 0.538). HI, total body water, DLCO and spirometry values did not change. On the contrary, a mild reduction in hsTnI was observed (13.88 [9.24-26.8] ng/l vs 11.58 [7.7-24.2] ng/l).

Conclusions
Our study did not detect short-term effects of Dapagliflozin on spirometry values, DLCO, fluid retention and NT-proBNP. As revealed in DAPA-HF trial, a mild worsening of potassium and serum creatinine levels was observed. Taken together, these results suggest that the favourable effects of Dapagliflozin could unfold over a longer period of time. A more extended follow-up and a larger population are needed to confirm these preliminary data.
695 PRESCRIBING A COMPREHENSIVE THERAPY WITH THE FOUR FOUNDATIONAL TREATMENTS OF HEART FAILURE WITH REDUCED EJECTION FRACTION AMONG IN-PATIENTS AT DISCHARGE
Authors: Rodolico Daniele , Delvinioti Agni , Iacomini Chiara , Masciocchi Carlotta , Restivo Attilio , Lenkowicz Jacopo , Patarnello Stefano , Crea Filippo , D´amario Domenico 
Published: December 2022

Abstract

Background
Current guidelines recommend that patients with heart failure and a reduced ejection fraction (HFrEF) should receive four foundational treatments, i.e. renin-angiotensin system inhibitor (RASi) or angiotensin-receptor neprilysin inhibitor (ARNi), β-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i). There is emerging consensus that simultaneous initiation or rapid sequencing provide greater benefit, enhancing tolerability of these therapies and improving outcomes. However, implementation of a comprehensive approach is limited by common underuse and underdosing, and paucity of data exists on initiating the four pharmacological pillars of HFrEF during hospitalization or at discharge.

Aim
To investigate the feasibility of a comprehensive pharmacological approach in patients with HFrEF at discharge after an episode of heart failure (HF) hospitalization in a tertiary referral center.

Methods
In-patients with HFrEF and a first HF hospitalization (2019-2021) were categorized according to the number/type of treatments prescribed at discharge. Prevalence of contraindications and cautions for HFrEF treatments – as defined by current European Society of Cardiology (ESC) guidelines on HF – was as assessed. Logistic regression models were fitted to assess predictors of number of treatments prescribed and risk of re-hospitalization.

Results
Among 305 patients with HFrEF, 49.2% received at least two current recommended drugs. A β-blocker was prescribed in 93.4% of patients, and a RASi/ARNi in 68.2%. Based on current recommendations, 46.2% of patients could receive four foundational drugs. An MRA was prescribed in 32.5% of patients and 100% of patients did not show contraindications to MRA use. Renal dysfunction was present in 13.1% of patients, while hypotension in 11.8%. Bradycardia and renal dysfunction were associated with lower number of drugs prescribed [adjusted OR (95% CI) 0.18 (0.06-0.50), and 0.50 (0.39-0.64), respectively]. A higher number of drugs used was associated with no rehospitalization during the 30 days after discharge [OR (95% CI) 0.22 (0.10-0.49) per number of pillars increase].

Conclusions
Based on the presence/absence of contraindications, a quadruple therapy could be implementable in a contemporary cohort of HFrEF in-patients at discharge. Renal dysfunction and bradycardia were the main prevalent conditions limiting the achievement of a more comprehensive therapeutic approach. Use of a higher number of drugs was associated with lower risk of re-hospitalization within 30 days after discharge.
348 PROGNOSTIC EVALUATION OF HEART FAILURE IN WOMEN: INSIGHT FROM THE MECKI SCORE DATABASE
Authors: Salvioni Elisabetta , Moscucci Federica , Bonomi Alice , Mapelli Massimo , Paolillo Stefania , Corrà Ugo , Vignati Carlo , Magrì Damiano , Sciomer Susanna , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
Heart failure (HF) in women often assumes extremely peculiar characteristics. The risk stratification and prognostic evaluation of HF in women is a challenge for clinicians. The actual prognostic scores are, in fact, lacking a specific sex-oriented assessment. In HF women show better survival despite a comparatively low peak oxygen consumption (VO2) at cardiopulmonary exercise testing: this raises doubt about the accuracy of risk assessment in women. Previous studies on MECKI score database have demonstrated that female prognostic advantage is lost when sex-specific differences are correctly considered. The present analysis has the aim to identify parameters which could be differently associated to prognosis in men and women and to re-calibrate the MECKI score according to these differences.

Methods
The new weights of the MECKI score variables according to gender, were calculated using the means of the 200 repetitions obtained to cross-validation procedure. The primary outcome of the study was the composite of all-cause mortality, urgent heart transplant and LVAD implant. The difference in predictive ability between the native and gender re-calibrated MECKI was calculated with the ROC curve at 2 years follow-up and calibration plot.

Results
We retrospectively analyzed 7900 HF patients with reduced ejection fraction included in the MECKI score registry (61±13 years, 6456 M/ 1444 F, LVEF 33±10%, VO2 /kg 14.9±4.9 mL/min Kg). Patients follow up was: 4.05 years [1.72-7.47]. Table 1 presents the weights of the individual MECKI variables for males and females. The main differences have been detected for the intercept value, hemoglobin and Na+. We used these variables to recalibrate the algorithm of MECKI score. We obtained higher AUC for MECKI re-calibrated by gender than for Native MECKI (0.7893 vs. 0.7799, p=0.0194, Fig. 1 left panel). Moreover, the gender MECKI was better calibrated (Fig. 1, right panels).

Conclusions
The calibration of MECKI Score according to gender specific differences improves the prognostic power and accuracy of mortality prediction at two years follow up.
135 ASSOCIATION OF TRICUSPID REGURGITATION WITH OUTCOME IN ACUTE HEART FAILURE
Authors: Cocianni Daniele , Stolfo Davide , Perotto Maria , Contessi Stefano , Barbisan Davide , Savonitto Giulio , Rizzi Jacopo Giulio , Barbati Giulia , Merlo Marco , Altinier Alessandro , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Tricuspid regurgitation (TR) is common in chronic heart failure (HF) and is associated with negative prognosis. However, evidence on prognostic implications of TR in acute HF (AHF) is lacking.

Objectives
We sought to investigate the association between TR and mortality and the interaction with pulmonary hypertension (PH) in patients admitted for AHF.

Methods
We enrolled 1176 consecutive patients with a primary diagnosis of AHF and with available non-invasive estimation of TR and pulmonary arterial systolic pressure (PASP).

Results
Moderate-severe TR was present in 352 patients (29.9%) and was associated with older age and more comorbidities. The prevalence of PH (i.e., PASP&gt;40mmHg), right ventricular dysfunction (RVD) and mitral regurgitation (MR) was higher in moderate-severe TR. At 1 year, 184 (15.6%) patients died. Moderate-severe TR was associated with higher 1-year mortality risk after adjustment for other echocardiographic parameters (PASP, left ventricle ejection fraction – LVEF, RVD and MR; HR=1.623, p=0.004) and the association with outcome was maintained when clinical variables were added to the multivariable model (HR=1.515, p=0.035). The association between moderate-severe TR and outcome was consistent in patients with vs without PH, with vs without RVD, and with vs without LVEF&lt;50%. Patients with coexistent moderate-severe TR and PH had 3-fold higher 1-year mortality risk compared to patients with no TR or PH (HR=2.920, p&lt;0.001).

Conclusions
In patients hospitalized for AHF, the severity of TR is associated with 1-year survival, regardless of the presence of PH. However, the combination of moderate-severe TR and PH conferred a further incremental mortality risk.
589 THE EFFECT OF DAPAGLIFLOZIN ON SYMPTOMS, QUALITY OF LIFE AND ECHOCARDIOGRAPHIC PARAMETERS IN A REAL-WORLD POPULATION OF HFREF PATIENTS
Authors: Visco Valeria , Rispoli Antonella , Di Fonzo Rosanna , Di Pietro Paola , Izzo Carmine , Melfi Americo , Carrizzo Albino , Galasso Gennaro , Vecchione Carmine , Ciccarelli Michele 
Published: December 2022

Abstract

Background
Large cardiovascular (CV) trials enrolling patients with type 2 diabetes showed that sodium glucose co-transporter-2 inhibitors (SGLT2i) significantly decreased heart failure (HF) hospitalization, both in patients with or without a history of HF.
Accordingly, DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure)
demonstrated the efficacy of dapagliflozin, for the reduction of CV death/HF hospitalization in patients with HF with reduced ejection fraction (HFrEF) regardless of type 2 diabetes status. However, there are still few real-word data and it is still not well known how early the clinical benefits are after the introduction of the drug into therapy; consequently, we aimed to evaluate the effect of dapagliflozin three months after its introduction in therapy in our real-world population.

Methods
From February 2022 to September 2022 we introduced Dapagliflozin in 23 HFrEF patients’ therapy and we collected data of 11 patients (66.78±3.96 years; 89% men) at 3-months-FU. Specifically, on the first visit we collected the clinical, laboratory and echocardiographic parameters and dapagliflozin was added to optimal medical therapy of patients; then, the patients were evaluated after 3 months (follow-up).

Results
At follow-up, all patients were free from side effects and we did not record statistically significant differences in laboratory parameters and/or blood pressure values.
As regards the echocardiographic parameters, there was an improvement in FE (28.11±2.95 vs 37.00±5.71%, p0.17), PAPS (46.89±3.94 vs 37.63±5.27mmHg, p0.17), and LVEDVind (75.34±10.58 vs 57.20±13.55 ml/m2, p0.30), although not statistically significant. Moreover, we observed a statistically significant reduction in the diameter of the inferior vena cava (18.89±1.78 vs 11.5±1.15 mm, p&lt;0.01), in NYHA class (2.78±0.15 vs 2±0, p&lt;0.001), in basal SO2 (95.67±0.78 vs 97.67±0.47%, p0.04) and an improvement of quality of life (EQ5Dtot 73.33±4.71 vs 86.67±4.41, p0.05; pain/discomfort 3.67±0.29 vs 4.78±0.22, p&lt;0.01; anxiety/depression 3.67±0.29 vs 4.67±0.24, p0.0163). Finally, we recorded a not statistically significant reduction in the amount of mineralocorticoid receptor antagonists (MRAs) at follow-up (62.5±12.5 vs 37.5±5.59 mg of eplerenone, p0.09).

Conclusions
Dapagliflozin improved symptoms, and quality of life in patients with HFrEF of our real world population already after 12 weeks, accordingly with previous data of DEFINE-HF trial. Moreover, already after 3 months was possible to record improvements in the echocardiographic parameters, even if they are not statistically significant. Certainly, it will be necessary to continue with the study to evaluate these results on a larger sample.
681 RIGHT ARM PAIN WITH RIGHT BUNDLE BRANCH BLOCK: SHOULD WE PERFORM TROPONIN ASSAY?
Authors: Acone Lorenzo , Foti Marco , Tarantini Roberto , Sorropago Antonio , Toscano Evelina , Mortara Andrea 
Published: December 2022

Abstract
We present the case report of a 67 year old man with no previous cardiovascular history, who was admitted to our emergency department (ED) for two days onset of right arm pain which was not responsive to painkillers. On admission, he was asymptomatic for typical angina. His BP was 190/100 mmHg, HR 80 bpm, SpO2 99% and apyretic. The clinical examination was unremarkable. The ECG showed sinus rhythm, complete right-bundle-branch-block (RBBB) and left-axis deviation, negative T-waves in V1-V2 and positive T-waves in V3 &gt; V6 (figure 1A) (no previous ECGs were available). The blood samples showed normal renal function and blood count. Surprisingly, there was a progressive rise in troponin I levels 0.023 &gt; 0.061 &gt; 0.38 ng/ml (ULN 0.010 ng/ml). Echocardiography revealed preserved LVEF without major regional wall motion abnormalities (RWMA), nor any valvulopathy.
Despite the atypical presentation and ECG, the troponin rise was strongly suggestive for an acute coronary syndrome (ACS), so the patient was sent to the Cath lab to undergo coronary angiography (CAG). At the time of the CAG he was asymptomatic. The exam revealed thrombotic occlusion of mid-segment left anterior descending artery (LAD). Primary PCI with DES implantation was performed obtaining TIMI 3 flow (figure2). The remaining hospital stay was uneventful, the patient was discharged asymptomatic after 4 days. Pre-discharge echocardiography reported normal LVEF with no RWMA. Discharge ECG showed persistency of the RBBB with negative T-waves from V1 to V4 (figure 1B). On 3 months follow up visit the patient is asymptomatic with preserved LVEF. On ECG there is persistency of RBBB and normalization of the T-waves in the precordial leads (figure 1C).

Discussion
This case report is an atypical presentation of acute thrombotic occlusion of an epicardial coronary artery, without the typical ST segment elevation (STEMI equivalent) and without the typical angina. RBBB may represent an uncommon ECG presentation of acute myocardial ischemia, with an incidence from 2 to 6% overall, with TIMI 0 flow in the infarct-related artery only in half of the cases. RBBB (especially new or presumably new onset RBBB) is also associated with increased mortality and morbidity, possibly due to delay in diagnosis and primary reperfusion strategies. Troponin dosage was fundamental to understand that we were facing an acute coronary syndrome, however we were not expecting complete occlusion of the LAD.
In conclusion, the presence of RBBB on admission may delay primary reperfusion strategies, especially when symptoms are atypical. However, in case of unresponsive pain and presumably new-onset conduction disturbances on ECG it is mandatory to perform troponin assay and therefore drive the correct timing of coronary revascularization.
706 ETIOLOGICAL ROLE OF STRESS IN ACUTE CORONARY SYNDROME: THE STRESS-ACS-ACTION STUDY
Authors: Magnani Giuia , Denegri Andrea , Bottioni Federico , Gurgoglione Filippo Luca , Tuttolomondo Domenico , Noni Manjola , Barocelli Federico , Vrenozaj Rosi , Catellani Davide , Indrigo Elia , Donelli Davide , Maccari Chiara , Andreoli Roberta , Corradi Massimo , Ossola Paolo , Marchesi Carlo , Ardissino Diego , Niccoli Giampaolo 
Published: December 2022

Abstract

Background
Acute coronary syndrome (ACS) is the main cause of mortality worldwide and despite the adherence to guidelines it is still burdened by an unacceptable risk for cardiovascular (CV) events recurrence, highlighting the need to identify other than traditional cardiovascular risk factors (CVrF) implicated in atherosclerotic plaque instability. In this regard, psychosocial stress appears to be a crucial player in the development of CV disease. Nevertheless, stress is not easy to standardize and the mechanisms by which it promotes coronary artery disease (CAD) are poorly understood.

Materials and Methods
We therefore prospectively enrolled patients with ACS, stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and subjects presenting traditional CVrF but without established CV disease. Multimodality cortisol assessment, expression of acute and chronic stress, through blood, urine and hair samples collection was ascertained at baseline. A regression analysis was performed to assess the relationships between significant variables at univariate analysis.

Results
Fifty patients were enrolled in the present study. Cortisol levels in blood and urine were numerically higher in patients with ACS compared to CAD patients and subjects with traditional CVrF only. Hair cortisol levels did not differ between the three groups. The regression analysis showed an inverse correlation (R= -,532, p&lt;0.001 and R=-,615, p&lt;0.001 respectively) between urinary cortisol (UC) and UC/creatinine ratio and left ventricular ejection fraction (LVEF).

Conclusion
The preliminary results of our study showed that patients with ACS did not have significantly higher levels of hair cortisol compared to stable patients. The finding of an inverse relationship between higher UC, UC/C ratio levels and lower LVEF values support a link between a hyperactivity of the hypothalamic-pituitary-adrenal axis and a worse ACS presentation. These preliminary data will be implemented with serial multimodality assessment of cortisol that allow potential implications in diagnosis and outcome.
947 THE IMPACT OF UEFA EURO 2020 FOOTBALL CHAMPIONSHIP ON TAKOTSUBO SYNDROME: RESULTS OF A MULTICENTER NATIONAL REGISTRY
Authors: Ielapi Jessica , Polimeni Alberto , Spaccarotella Carmen , Ccu Investigators Group , Indolfi Ciro 
Published: December 2022

Abstract

Objectives
The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of cardiovascular events.

Methods and Results
Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. Acute cardiovascular events were assessed in 1235 patients. Cardiovascular events during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6 - 495.1, P&lt;0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P=0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P=0.80)] or TTS [IRR 1.66(0.80-3.4), P=0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period.

Conclusions
The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions as the victory of the European Football Championship finals.
512 ACADEMIC RESEARCH CONSORTIUM HIGH BLEEDING RISK CRITERIA ASSOCIATED WITH ONE-YEAR NACES IN A MULTICENTER COHORT OF OLDEST OLD STEMI PATIENTS
Authors: Ruzzarin Alessandro , Zilio Filippo , Muraglia Simone , Unterhuber Matthias , Baessato Francesca , Bonmassari Roberto , Flaim Massimo , Zanon Sofia , Oberhollenzer Rainer , Donazzan Luca 
Published: December 2022

Abstract

Introduction
The balance between thrombotic and bleeding events after myocardial revascularization is of paramount importance. Patients with higher bleeding risk are at high risk for complications. Age and frailty are also major risk factors for complications. We sought to evaluate the incidence of major bleeding events (BE) and their impact on prognosis in a real life oldest old (i.e. &gt;85 years) ST elevation myocardial infarction (STEMI) patients population.

Methods
We evaluated all consecutive oldest old STEMI patients hospitalized in two hub-centers between January 2010 and June 2021. Patients were stratified according to Academic Research Consortium for High Bleeding Risk (ARC-HBR) in high bleeding risk (HR) and non-HR (nHR) patients. BE were defined according to the Bleeding Academic Research Consortium (BARC) criteria, BARC 3 or 5. Patients were also divided in groups according to anti-thrombotic therapy (AT) regimens at discharge: single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT) or triple therapy (DAPT plus oral anticoagulation) (TT). Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. Follow-up data were determined from local clinical records during a twelve-months period.

Results
340 oldest old (mean age 88.6 ± 2.9 years, 52.6% female) STEMI patients were eligible for the analysis. 161 patients (47.4%) were categorized as nHR and 179 patients (52.6%) as HR.
AT regimens at discharge were: 28 patients with SAPT (8.2%), 276 with DAPT (81.2%) and 36 with TT (10.6%). The overall incidence of BE was 4.6% within 12 months, without difference between nHR and HR patients (3.0% vs 5.9%, p=0.16). No BE were found in the SAPT group while the incidence of BE in the HR group was not statistically different between the DAPT and TT regimens (11.2% vs 9.5%; p=0.8).
The incidence of NACE was statistically higher in HR than nHR patients (40.9% vs 25.5%, p&lt;0.01) at 1-year. In addition, time-to-NACE was statistically inferior in HR group than nHR group (256.2 days vs 294.2 days, p&lt;0.01) (Figure).

Conclusions
Our oldest old STEMI population was characterized by a large proportion of HR patients according to ARC-HBR criteria. This population experienced a higher rate of NACE in a shorter time when compared to nHR patients in the same age group.