bluuebunny/crossref_metadata_2025_split huggingface dataset:
485 PROGNOSTIC IMPACT OF TREATMENTS EVOLUTION IN STEMI: INSIGHTS FROM A PRIMARY PCI REGISTRY
Authors: Boldrin Claudia , Fabris Enrico , Gregorio Caterina , Pezzato Andrea , Gagno Giulia , Vitrella Giancarlo , Rakar Serena , Perkan Andrea , Sinagra Gianfranco 
Published: December 2022

Abstract

Objective
We aimed to evaluate in a real world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis, comparing different decades of treatment.

Methods
Consecutive STEMI patients undergoing pPCI at University Hospital of Trieste, Italy, were enrolled in a pPCI registry. Outcomes were evaluated during two successive periods: the first cohort (old treatments cohort) included STEMI patients treated between January 2007 and December 2012, and the second cohort (new treatments cohort), included STEMI patients treated between January 2013 and December 2020. Cox regression models were performed to predict the risk of the study primary endpoint (PE) a composite of all cause death, reinfarction and re-PCI at 5 years. The secondary endpoint was all cause of mortality at 5 years. Moreover, we evaluated the incidence of stent thrombosis at 12 months.

Results
A total of 2425 STEMI patients, 947 in the old treatments cohort and 1478 in the new treatments cohort were analysed. The mean age of the population was 66 ± 12.5 years, most were males (74.3%), 20.2% were diabetics, and 12% presented in Killip class III-IV. At 5-years of follow-up the new treatments cohort compared to the old treatments cohort presented a lower rate of primary outcome (18.5% vs 23.1%, p=0.006) and mortality (15.5% vs 19.9%, p=0.006). At Cox regression model adjusted for baseline differences between the two cohorts, patients in the new treatments cohort had lower risk of PE (HR 0.717, 95% CI 0.567–0.907, p=0.006) and mortality (HR 0.662, 95% CI 0.509–0.860, p=0.002). When considering both clinical and procedural variables, complete revascularization (HR 0.459, 95% CI 0.265–0.796, p=0.006) and the administration of prasugrel or ticagrelor (HR 0.721, 95% CI 0.524–0.992, p=0.013) were independent predictors of PE as well as of 5 years mortality. The new treatments cohort compared to the old treatments cohort had more frequent use of radial approach (83.1% vs 24.4%, p&lt;0.001) and had lower ischaemia time (3.05 vs 3.45 hours, p&gt;0.001), however they were not associated with PE. Patients receiving prasugrel or ticagrelor or drug eluting stent (DES) were at lower risk of stent thrombosis at 12 months (HR 0.502, 95% CI 0.280–0.900, p=0.021).

Conclusions
In a real-word STEMI population the prognosis of patients is improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization. The application of new evidence-based therapies in clinical practise is fundamental to improve patient prognosis because the benefits demonstrated by clinical trials have translated into a benefit in the real-world population.
239 VASOSPASTIC ANGINA: A CASE OF COMPLETE FUNCTIONAL ASSESSMENT
Authors: Pricoco Francesco , Scala Antonella , Pompei Graziella , Campo Gianluca , Tebaldi Matteo , Biscaglia Simone 
Published: December 2022

Abstract

Introduction
Vasospastic angina is defined as a focal or diffuse spasm of the arterial wall of an epicardial coronary artery due to muscle cells hyperreactivity caused by an increased calcium sensitivity. Clinical presentation typically consists in chronic story of rest and/or effort typical chest pain, episodes of ST elevated or not ST elevated myocardial infarction, arrhythmias or cardiac arrest; an increased vagal tone, drugs, allergic reactions or the exposure to extreme cold also can trigger vasospasm.

Clinical case
73 years old dyslipidemic woman; in past medical history thyroidectomy and radiotherapy for carcinoma and right quadrantectomy with radiotherapy and hormonal therapy for breast cancer. In 2017 admission to cath-lab for non-ST elevation myocardial infarction (NSTEMI) with the evidence of mild left coronary artery disease without critical obstructive stenosis (MINOCA). For the persisting of effort angina and dyspnea (NYHA and CCS II-III), started Diltiazem therapy (60 mg x3) with clinical benefit. In 2020, due to the onset of new episodes of angina, started Ranolazine therapy. In June 2022, for the worsening of clinical symptoms, was evaluated with a Coronary CT, that showed a 65% stenosis at right coronary-acute marginal bifurcation and mild disease on left coronary artery, and then was admitted for an elective coronary angiography, with no evidence of epicardial artery critical stenosis. At the functional evaluation FFR, CFR and IMR (&gt;0.80, 2.5 and 18) demonstrated normal coronary flow reserve and good microcirculation function. For the suspicion of vasospastic angina, acetylcholine test was performed with the evidence of mid-distal left anterior descending artery total occlusion, angina onset and ECG changes, promptly regressed with nitrates administration (Figure 1). Patient was discharged with the optimization of medical therapy with Diltiazem 120 mg x3, with clinical benefit.

Conclusions
To date vasospastic angina remains underdiagnosed. Functional evaluation of coronary arteries plays a fundamental role in the diagnostic algorithm of the disease and should always be investigated in case of patients with typical symptoms and the absence of critical epicardial stenosis. Further investigations are required to better explain pathogenesis and to identify affected patients in shorter times to ensure early optimized medical therapy.
1145 BAIL-OUT INTRAVASCULAR CORONARY LITHOTRIPSY FOR THE TREATMENT OF STENT IN-STENT UNDER EXPANSION
Authors: Riverso Vincenzo , Sorrentino Sabato , Mongiardo Annalisa , Polimeni Alberto , Spaccarotella Carmen , Calvelli Pierangelo , Esposito Giovanni , Indolfi Ciro 
Published: December 2022

Abstract

Background
in-stent restenosis remains a significant clinical problem for which optimal treatment is under debate. Intravascular lithotripsy (IVL) is mostly used for safe and effective treatment of de novo coronary calcifications, while the use of this technology to support bailout procedures, including stent under-expansion, is still off-label. One of the advantages of lithotripsy is the possible use after stent deployment.

Case presentation
a 66-year-old male patient was admitted to our Institution due to a medically refractory angina and a coronary computed tomography (CCT) detecting three vessel disease with multiple critical stenosis. The patient had multiple comorbidities including history of hypertension, dyslipidemia, type 2 diabetes and multiple myocardial rivascularization. In 2003 he underwent coronary artery by-pass (CABG) with left internal mammal artery (LIMA) to left anterior descending (LAD) artery and free saphenous vein graft (VG) to the ramus intermedius (RI). In 2009 the patient underwent percutaneous coronary intervention (PCI) of the right coronary artery (RCA) with the implantation of a stent at the central segment, and a second stent at the crux cordis. For recurrent in-stent restenosis of the stent previously implanted at the central segment the patient was treated in 2013 with percutaneous balloon angioplasty (POBA) and in 2017 with the implantation of another drug eluting stent (Resolute Onyx, Medtronic, Santa Rosa, California) overlapping the proximal part of the scaffold.
Coronary angiography revealed, a severe coronary artery disease with 80% stenosis of distal left main. The LAD was occluded at the middle segment and the ramus presented 99% stenosis at the proximal segment. The RCA had a diffuse severe in-stent restenosis involving the Resolute Onyx stent. Therefore, the operator decided to treat the restenosis with a direct stenting (Xience, Abbott Vascular Santa Clara, USA), but he was unaware of the fact that there was already an Onyx stent that was barely visible. After implantation, an inadequate expansion of the stents was observed (Figura 1A-B), which persisted despite post-dilation with non-compliant balloon (NCB) at high-pressure (Figure 1C). Given the persistence of stents under-expansion, it was decided to perform bail-out intravascular lithotripsy (IVL) therapy with a Shockwave balloon catheter (Figure 2A). The stent was then post-dilated with a NCB (Figure 2B). The final angiographic image and intravascular ultrasound (IVUS) showed an optimal stent expansion (Figure 3).

Conclusion
intravascular lithotripsy could be used to treat undilatable stent-in-stent restenosis. Of interest, the case presented demonstrated, for the first time, the possible use of IVL in 2-stent layers, with an optima final stent expansion.
823 MIGRAINE IN PFO PATIENTS: CHARACTERIZATION OF A PLATELET-ASSOCIATED PATHOPHYSIOLOGICAL MECHANISM BEFORE AND AFTER PFO CLOSURE: THE LEARNER STUDY
Authors: Trabattoni Daniela , Brambilla Marta , Teruzzi Giovanni , Canzano Paola , Muratori Manuela , Tedesco Calogero , Becchetti Alessia , Montorsi Piero , Camera Marina 
Published: December 2022

Abstract

Background
A strong relationship links migraine with aura (MHA) and patent foramen ovale (PFO). Increased platelet aggregation and oxidative stress were documented in migraineurs. To date, no mechanisms connecting MHA to PFO have been demonstrated.

Objectives
To perform a comprehensive analysis of platelet activation, inflammation, and oxidative stress status in 78 aspirin-treated MHA-patients before (T0) and 6-months after (T1) PFO closure (LEARNER Study-NCT03521193-clinicaltrials.gov). The primary endpoint was migraine regression rate in relation to these parameters.

Methods
P-selectinpos-, activated-glycoprotein IIbIIIa (aGPIIbIIIa)pos-, Tissue Factor (TF)pos-, reactive oxygen species (ROS)pos-platelets, platelet-leukocyte aggregates (PLA) and microvesicles (MVs) were evaluated by flow cytometry; thrombin generation (TG) by Calibrated Automated Thrombogram (CAT) assay; oxidative stress status by mass spectrometry; serotonin and cytokines by ELISA. 12 aspirin-treated-healthy subjects (HS) were enrolled for comparison.

Results
Migraine resolution occurred in 69.7%, a significant reduction in 27%, while no effect was observed in 2 patients (3.2%). Only ROSpos-platelets, and TFpos-platelets and -MVs were significantly higher at T0, sustaining a TG capacity that was associated with an altered blood GSSG/GSH (Oxidized/Reduced Glutathione). This phenotype reverted to HS levels at T1. MHA-PFO plasma, added to HS blood, mirrored the in vivo platelet activation and N-acetylcysteine blunted it. GSSG in vitro reproduced the in vivo condition. Aspirin had little effect on the platelet prothrombotic phenotype which was effectively inhibited by a P2Y12-antagonist.

Conclusion
This study suggests a pathophysiological mechanism linking PFO, or its right-to-left shunt, with MHA. MHA-PFO patients show a platelet-associated prothrombotic phenotype, sustained by altered oxidative stress status. This phenotype, not fully controlled by aspirin but by P2Y12-antagonism, could play a primary role in producing the prodromal symptoms of migraine, and it is reverted after PFO closure together with a complete migraine remission
1108 PERI-PROCEDURAL COMPLICATIONS AND LONG-TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTRE REGISTRY
Authors: Magnocavallo Michele , Della Rocca Domenico Giovanni , Van Niekerk Christoffel J , Gilhofer Thomas , Ha Grace , D´ambrosio Gabriele , Galvin Jennifer , Urbanek Lukas , Schmidt Boris , Christoph Geller J , Lakkireddy Dhanunaja , Di Biase Luigi , Price Matthew , Mansour Moussa , Saw Jacqueline , Horton Rodney P , Gibson Douglas , Natale Andrea 
Published: December 2022

Abstract

Background
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thromboembolic events. CKD concomitantly contributes to several pathophysiological changes predisposing towards a pro-haemorrhagic state.

Objective
To evaluate the impact of kidney function on peri-procedural complications and clinical outcomes in AF patients undergoing left atrial appendage occlusion (LAAO) with a Watchman device.

Methods
2124 consecutive AF patients undergoing Watchman implantation at 8 different centers were categorized into CKD stage 1+2 (n=1089), CKD stage 3 (n=796), CKD stage 4 (n=170), CKD stage 5 (n=69) based on the estimated glomerular filtration rate at baseline. The primary efficacy endpoint included a composite of cardiovascular (CV) mortality, stroke, transient ischemic attack, peripheral thromboembolism (TE), and major bleeding.

Results
A non-significant higher incidence of major peri-procedural adverse events (1.7% vs. 2.3% vs. 4.1% vs. 4.3%) was observed with worsening baseline kidney function (p=0.14). The mean follow-up period was 13 ± 7 months [2226 patient-years (PY)]. In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank p-value= 0.04), CKD stage 4 (log-rank p-value= 0.01), and CKD stage 5 (log-rank p-value= 0.001). A non-significant increase in event rates for stroke/TIA and clinically relevant bleeding was observed among the four groups. LAAO led to a TE risk reduction of 72%, 66%, 62%, and 41% in each group. The relative risk reduction in the incidence of major bleeding was 58%, 44%, 51%, and 52%, respectively.

Conclusion
Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative risk reduction in the incidence of TE and major bleeding was consistent across CKD groups, irrespective of the very different risk profiles at baseline.
988 UNCLEAR SUDDEN DEATH IN THE YOUNG: DIFFERENT DISTRIBUTION AMONG THE ITALIAN REGIONS
Authors: Mastroianno Sandra , Lucia Bevere Ester Maria , Greco Antonio , Potenza Domenico , Massaro Raimondo , Salvatori Mauro , Di Stolfo Giuseppe 
Published: December 2022

Abstract

Introduction
Sudden death (SD) in the young due to cardiovascular diseases remains a focus of the public health system. It occurs unexpectedly in apparently healthy people. In addition, several of the diseases that cause sudden death in the young can be diagnosed and treated prior to the first lethal event; on the other hands, a post mortem approach, by the means of clinical autopsy and molecular autopsy, may clarify the underling disease to better develop futher prevention by a familial approach. The attention on this issue has greatly sensitized doctors and public opinion.

Aim
The aim of the manuscript was to evaluate the frequency of sudden deaths in Italy in the decade 2008-2017.

Methods and Data sources
The searches were carried out by consulting the database of the National Institute of Statistics (ISTAT). We counted in the ISTAT database all the deceased under the age of 40 due to unclear causes in the decade 2008-2017.

Results
We counted 7159 young patients with DS, unevenly distributed throughout the Italian territory. In detail, 10% (1373) were in the North-West, 14% (988) in the North-East, 13% (934) in the Center, 44% (3178) in the South and 10% (686) in the islands.
The analysis showed how the unclear SD in Italy have decreased over time. Southern Italy had the highest number (357) of SD at the start of the observation which slightly dropped to 272 in 2017. Despite this significant reduction, the South remains the place where the largest number of unclear SD are counted. Most likely, the initial studies conducted in the Veneto region sensitized doctors to SD in young people and athletes, leading a wider screening through cardiological examination and electrocardiogram for prevention; furthermore a widespread recurrence to clinical autopsy, to reach a clear diagnosis, allows the awareness that other cases could occur in the same family. Grief coping approach and cultural competency may explain the regional difference. The new methods available to genetics, such as next generation sequency (NGS), have allowed an increase in diagnoses even in the deceased and have identified possible pathogenic genes in family members.

Conclusions
Sudden death in young people represents an important challenge, considering the number of events that occur in our country and the different distribution in the Italian regions.
Medical community need to better address this issue, by implementing both prevention and post-mortem analysis, to reduce the sudden death burden, especially in southern region.
Thiene G. Sudden cardiac death in the young: a genetic destiny? Clin Med (Lond). 2018 Apr 1;18(Suppl 2):s17-s23. Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med. 2021 Mar;135(2):483-495.Webster G, Carberry T, Berger S. Screening for prevention of sudden death in the young: what is new? Curr Opin Cardiol. 2020 Jan;35(1):80-86.
337 RECLASSIFICATION OF GENETIC VARIANTS WITH PREVIOUSLY UNRECOGNIZED PATHOGENIC ROLE IN PATIENTS WITH INHERITED CARDIAC CONDITIONS
Authors: Manzoni Martina , Sommariva Elena , Colombo Gualtiero , Biondi Maria Luisa , Mushtaq Saima , Farina Stefania , Roberto Maurizio , Pizzamiglio Francesca , Casella Michela , Pompilio Giulio , Novelli Valeria 
Published: December 2022

Abstract

Introduction
In the last years, genetic testing for inherited cardiac conditions (ICCs) is expanded and evolved at an incredible rate. This tool may inform treatment options and lifestyle choices to avoid arrhythmia triggers. Furthermore, identifying the genetic underpinning of the disorder improves risk assessment for asymptomatic or pre-symptomatic family members.
However, despite the large numbers of disease-causative genes identified in the last years, only 60% of the patients with a clinical diagnosis of ICCs carry a pathogenic or likely pathogenic variant. The remaining 40% of the cases have an inconclusive or ambiguous test caused by negative results or mainly by the identification of one or more variants of unknown significance (VUS). In this case, the test results are uninformative and clinically irrelevant, increasing uncertainty about medical management.

Purpose
We investigated whether a periodic re-evaluation of the detected VUS, using the American College of Medical Genetics and Genomics (ACMG) criteria, may impact the clinical setting of patients with suspected ICC and their family members.

Methods
We reevaluated 306 consecutive probands with suspected ICC undergoing genetic testing by next-generation sequencing using the Illumina TruSight Cardio Sequencing panel, from 2017 to 2021.

Results
Thirty-five percent of patients carried at least one variant in a gene associated with the phenotype. Of these, 94 had been previously classified as VUS and were not considered clinically actionable. After an average time of 36 months, they were reevaluated and 26.6% of the VUS were reclassified. In particular, 1 was downgraded to Benign and 24 were upgraded to Likely Pathogenic (16) or Pathogenic (8). According to the different phenotypes, the reclassification rate was 45.8% in Hypertrophic cardiomyopathy, 33.3% in Dilated cardiomyopathy, 27.3% in Arrhythmogenic cardiomyopathy, 12.5% in Brugada syndrome, and 50% in Long QT syndrome patients. This reclassification process allowed to recategorize 24 probands as clinically and molecularly diagnosed and to extend the genetic screening to their at-risk family members.

Conclusions
Given the extent of the clinical impact that genetic testing can have, these findings suggest that a periodic reevaluation of genetic test results, particularly VUS, should be a mandatory step in the ICC diagnostic workflow.
588 EXPLORING THE IMPACT OF SEVERE SECONDARY TRICUSPID REGURGITATION ON REST AND EXERCISE HEMODYNAMICS OF PATIENTS WITH HEART FAILURE AND A PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Baratto Claudia , Caravita Sergio , Corbetta Giorgia , Soranna Davide , Zambon Antonella , Parati Gianfranco , Badano Luigi P , Muraru Denisa 
Published: December 2022

Abstract

Background
Both secondary tricuspid regurgitation (STR) and heart failure with preserved ejection fraction (HFpEF) are relevant public health problem in the elderly population, presenting with potential overlaps and sharing similar risk factors. However, the impact of severe STR on hemodynamics and cardiorespiratory adaptation to exercise in HFpEF remains to be clarified.

Aim
To explore the impact of severe STR on exercise hemodynamics and cardiorespiratory adaptation in HFpEF.

Methods
We analyzed invasive hemodynamics and gas-exchange data obtained at rest and during exercise from HFpEF patients with severe STR (HFpEF-STR), compared with 1:1 age, sex and body mass index matched HFpEF patients with mild or no STR (HFpEF-controls).

Results
13 HFpEF-STR (mean age 72 years, 85% females, BMI 28 Kg/m2) and 13 age-, sex-, and BMI-matched HFpEF-controls patients were included. HFpEF-STR had higher (p&lt;0.01) right atrial pressure than HFpEF-controls both at rest (10±1 vs 5±1 mmHg) and during exercise (23±2 vs 14±2). During exercise, pulmonary artery wedge pressure as well as left ventricular transmural pressure increased less in HFpEF-STR than in HFpEF-controls (interaction p-value&lt;0.05). Similarly, cardiac output (CO) increased less in HFpEF-STR than in HFpEF-controls (interaction p-value&lt;0.05) during exercise, due to the lower stroke volume (SV) values both at rest (49±8 vs 78±8, p&lt;0.05) and at peak exercise (55±9 vs 92±9 mL, p&lt;0.05). Despite these differences, the two groups of patients laid on the same oxygen consumption isophlets because of the increased peripheral oxygen extraction in HFpEF-STR (p&lt;0.01). An inverse relationship was found between pulmonary vascular resistance and SV, both at rest and at peak exercise (R2=0.12 and 0.19, respectively).

Conclusions
Severe STR complicating HFpEF impairs SV and CO reserve, leading to pulmonary vascular de-recruitment and relative left heart underfilling, mining the typical HFpEF pathophysiology.
Exercise pathophysiology of secondary tricuspid regurgitation (STR) in heart failure with preserved ejection fraction (HFpEF).