bluuebunny/crossref_metadata_2025_split huggingface dataset:
1075 USE OF LIPID-LOWERING COMBINATION THERAPIES IN SANTORINI STUDY: EVIDENCE FROM ITALIAN COHORT
Authors: Cesaro Arturo , Calabrò Paolo , Arca Marcello , Solini Anna , Gambacurta Rosanna , Soronen Jarkko , Diamand Francoise , Catapano Alberico L 
Published: December 2022

Abstract
The SANTORINI registry is an observational study that aims to evaluate the management of patients with high and very high cardiovascular (CV) risk in clinical practice, collecting data at enrolment and after 12 months. Italy participated in this study with 1531 patients at very high risk and 446 at high risk. The scope of the present analysis was to investigate low-density lipoprotein cholesterol (LDL-C) goal attainment in patients who do not qualify for PCSK9 inhibitors (PCSK9i) (according to Italian reimbursement regulations) in Italian cohort, with focus on patients in secondary prevention. The current indications for PCKS9i charged to the National Health System in Italy in secondary prevention, are for patients aged ≤ 80 years with LDL-c levels ≥ 70 mg/dl in at least three detections despite therapy for at least 6 months with high intensity statin at the highest tolerated dose and ezetimibe or after a single LDL-C detection for recent myocardial infarction or multiple cardiovascular events or with demonstrated intolerance to statins and/or ezetimibe. At enrolment, a total of 509 (33.2%) of 1531 patients at very-high risk had an LDL-C level of less than 70 mg/dl. Of them, about half do not reach the LDL-C target. In particular, 34.4% takes statin monotherapy, and 50.3% of them do not reach the target. Even patients taking high-intensity statins as monotherapy reach the target in only 47.9% of cases, leaving more than half of patients with LDL-C levels between 55 and 70 mg/dl. Regarding combination therapy, statin and ezetimibe, patients taking this combination account for 26.9%, of these those taking the combination of moderate-intensity statin and ezetimibe reach the target in 56.7% of cases while those taking high-intensity statins and ezetimibe reach the target in 51.4% of cases. Our findings show that there is a proportion of patients with LDL-C below 70 mg/dl who do not qualify for PCSK9i who are not at target for LDL-C levels despite maximal therapy with statins and ezetimibe.
761 PRASUGREL OR CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES AT DIFFERENT THROMBOTIC RISK: RESULTS FROM THE PROMETHEUS STUDY
Authors: Chiarito Mauro , Cao Davide , Sartori Samantha , Zhang Zhongjie , Vogel Birgit , Nicholas Johny , Pivato Carlo Andrea , Spirito Alessandro , Tavenier Annerieke , Effron Mark , Stefanini Giulio G , Baber Usman , Kapadia Samir , Rao Sunil , Henry Timothy D , Pocock Stuart , Dangas George , Kini Annapoorna , Mehran Roxana 
Published: December 2022

Abstract

Background
Potent P2Y12 inhibitors are recommended in patients with acute coronary syndrome (ACS), although the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile. We evaluated if the benefits associated with prasugrel vs. clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI) are similar in patients with different thrombotic risk profiles.

Methods
PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. Patients were defined at high thrombotic risk if presenting with a clinical and a procedural risk feature. The primary endpoint was major adverse cardiac events (MACE), composite of death, myocardial infarction, stroke, or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis and with multivariable Cox regression.

Results
Among 16,065 patients, 4,293 were defined at high and 11,772 at low-to-moderate thrombotic risk. Patients receiving prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. High thrombotic risk patients had increased rates of ischemic and bleeding events at 90-day and 1-year follow-up. Patients treated with prasugrel had a lower adjusted 1-year risk of MACE (HR 0.86, 95% CI 0.77-0.96), irrespective of their thrombotic risk (pinteraction =0.32). Stratifying the study population by number of risk factors there was a significant interaction (pinteraction =0.026) for a greater reduction in MACE with prasugrel among patients with ≤1 thrombotic risk factor. The risk of clinically significant bleeding was similar in patients treated with prasugrel and clopidogrel.

Conclusions
Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events at 1 year. Prasugrel, mainly reserved to patients with less comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel.
290 A UNIQUE CASE OF AORTIC VALVE LEAFLET'S ANEURYSM DETECTED BY CARDIAC COMPUTED TOMOGRAPHIC ANGIOGRAPHY-CCTA
Authors: Pergola Valeria , Cabrelle Giulio , Mele Donato , Motta Raffaella , Amato Filippo , Cozza Elena 
Published: December 2022

Abstract
Heart valve leaflet's aneurysm is a rare finding and literature about this topic is sparse. Early recognition is important because their rupture can lead to catastrophic valve regurgitation.
An 84 years old male with chronic ischemic cardiomyopathy was admitted to coronary-intensive-care-unit for non-ST-elevation-myocardial-infarction. Baseline transthoracic-echocardiography showed normal biventricular function with inhomogeneous thickening of aortic leaflets with moderate aortic regurgitation. Because acoustic window was limited, a trans-esophageal echocardiography was performed detecting a small mass in the right aortic coronary cusp with moderate regurgitation (orifice regurgitation area: 0,54 cm2; med/max gradient: 16/32 mmHg). Endocarditis was ruled out. Because of the rapid worsening of patient's conditions, requiring mechanical ventilation and hemofiltration, and the potential hazard of an urgent coronary angiography, a cardiac computed tomographic angiography (CCTA) was performed. Detailed spatial reconstructions highlighted a bilobed cavitation in the commissure between right-left aortic coronary cusps. Diagnosis of aortic leaflets’ aneurysm was made. A “wait and see” strategy was chosen and patient's general conditions gradually improved and now he is stable and uneventful. To date no aortic leaflet's aneurysm were described in literature.
52 A DEEP-LEARNING APPROACH FOR SCAR DETECTION IN EARLY CONTRAST-ENHANCED CARDIAC COMPUTED TOMOGRAPHY IMAGES
Authors: Penso Marco , Babbaro Mario , Moccia Sara , Baggiano Andrea , Pepi Mauro , Andreini Daniele , Caiani Enrico Gianluca , Pontone Gianluca 
Published: December 2022

Abstract
Diagnosis of myocardial fibrosis has a relevant prognostic and therapeutic role. Scar-tissue analysis is commonly performed with late gadolinium contrast-enhanced (CE) cardiac magnetic resonance (CMR). However, CMR might be contraindicated or unavailable. Coronary computed tomography (CCT), which is the technique of choice for many routine assessments, is emerging as an alternative to CMR.
The objective of this study is to evaluate whether artificial intelligence (AI) could allow identification of myocardial fibrosis from routine early CE-CCT images.
Fifty consecutive patients with left ventricular dysfunction (LVD), who underwent both CE-CMR and (early and late) CE-CCT were retrospectively selected. According to the late enhancement CMR patterns, patients were classified as with ischemic (n=15, 30%) or non-ischemic (n=25, 70%) LVD. Scar regions were manually traced on late CE-CCT using CE-CMR as ground-truth. On early CE-CCT images, the myocardial sectors were extracted according to AHA 16-segment model and labeled as with scar or not based on the late CE-CCT manual tracing. A deep-learning model was developed to classify each sector (Picture).
Of the initial 44187 sectors computed out of the 8285 slices available from the early CE-CCT images, 4594 sectors (10%) presented scar. The CNN approach on the early CE-CCT images yielded a classification accuracy for all sectors of 71% (95% confidence interval (CI): 63%-79%) obtained through 5-fold cross validation. The mean sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for the testing fold resulted in 73% (95% CI: 66%-79%), 56% (95% CI: 48%-65%) and 85% (95% CI: 82%- 88%), respectively. The mean AUC across the five folds was 76% (95% CI: 72%-81%). In a per-segment analysis of the 16-segment AHA model the bull's eye segmental comparison of CE-CMR and respective early CE-CCT findings an 91% agreement was achieved.
Artificial intelligence can detect both ischemic and non-ischemic myocardial fibrosis from routine noninvasive coronary scans, without additional contrast-agent administration or radiational dose, thus assisting diagnosis and management of patients with LV dysfunction and coronary artery disease.
622 APPROPRIATENESS OF ECHOCARDIOGRAPHIC REQUESTS FOR DIAGNOSIS OF INFECTIVE ENDOCARDITIS. A RETROSPECTIVE SINGLE-CENTER STUDY.
Authors: Baroni Giulia , Borile Giovanni , Pergola Valeria , Aruta Patrizia , Baritussio Anna , Cecchetto Antonella , Mattesi Giulia , Previtero Marco , Romano Silvia , Iliceto Sabino , Mele Donato 
Published: December 2022

Abstract

Background
Transthoracic echocardiography (TTE) is the first cardiac imaging modality generally requested for diagnosis of suspected infective endocarditis (IE), while transesophageal echocardiography (TEE) can be performed as initial or supplemental test. Although IE is a relatively rare disease characterized by high mortality, the number of daily in-hospital TTE and TEE requests to diagnose this disease is high, probably because of inappropriate prescriptions.

Objective
The principal aim of this study was to assess the clinical appropriateness of TTE and TEE requests for suspected IE.

Methods
Electronical data relative to TTE and TEE examinations performed for suspected IE between September 2013 and July 2022 at our center were extracted and retrospectively analyzed. All TTE and TEE requests were defined as appropriate according to the criteria indicated by the 2017 international guidelines on appropriateness for cardiac imaging in valvular heart disease.

Results
After exclusion of repeated ultrasound examinations, a total of 2249 first requests of echocardiographic examinations for suspected IE were analyzed (patients’ age 64±18 years, 61% males). TEE examinations were 447 (20%). Diagnosis of IE was made in 293/2249 (13%) cases. During the 10-year observation period, 33.1% of the TTE requests was appropriate and 12.2% of the appropriate examinations was positive for IE. Percentages of prescriptive appropriateness and diagnostic TTEs did not change significantly before and after publication of the 2017 international guidelines: in fact, appropriate TTE requests were 31.6% before and 35.3% after (P=0.579), and positive TTEs were 12.1% before and 12.4% after (P=0.948). Regarding TEEs, during the 10-year observation period 51.2% of the 447 examinations was appropriate and 35.8% of these evaluations was positive for IE. As for TTE, percentages did not vary significantly before and after publication of the 2017 international guidelines: appropriate TEE requests were 52.2% before and 50% after (P=0.756), and positive TEEs were 35.9% before and 35.6% after (P=0.965).

Conclusions
The majority of echocardiography requests for diagnosis of IE at our center during a 10-year observation period was inappropriate, especially TTE requests. No significant impact of the 2017 international guidelines on appropriateness for cardiac imaging in valvular heart disease was observed. A corrective strategy could be based on several actions: periodic monitoring of prescriptive appropriateness, dissemination of knowledge about published guidelines and development of in-hospital operative protocols shared among all physicians involved in TTE and TEE prescription.
146 AORTIC ACCELERATION TIME/EJECTION TIME RATIO AND BI-VENTRICULAR PERFORMANCE IN SEVERE AORTIC STENOSIS
Authors: Dotto Alberto , Ciceri Luca , Springhetti Paolo , Urbani Giulia , Del Sole Paolo Alberto , Nistri Stefano , D´ascenzo Fabrizio , Gallone Guglielmo , Tafciu Elvin , Bergamini Corinna , Rossi Andrea , Luciano Ribichini Flavio , Benfari Giovanni 
Published: December 2022

Abstract

Introduction
Echocardiographic evaluation of severe aortic stenosis (SAS) is is important to guide the therapeutic approach but often challenging. Recent studies have demonstrated that the ratio of acceleration time/ejection time (AT/ET) is a simple and reproducible echocardiographic parameter that integrates aortic stenosis severity evaluation and adds information on patient's prognosis.

Aim
The aim of the study is to investigate the role of the ratio of acceleration time (AT) and ejection time (ET) and its major determinants in severe aortic stenosis .

Methods
Consecutive echocardiograms of patients with severe AS referred to our center were analyzed offline using Tomtec Arena (Tomtec, Untershlei heim, Germany). AT was measured from the start of the CW Doppler aortic wave, to the peak of the aortic jet. ET was calculated from the same starting point, to the end of the CW Doppler aortic wave.

Results
A total of 135 patients with severe aortic stenosis formed the study cohort: patients with AT/ET below the median value of 0.35 (vs. higher) presented lower LVEDV (60 vs. 71 ml/mq; p 0.014), left ventricle mass index (116 vs 130 g/m2; p 0.035) and higher LVEF (58 vs 50%; p 0.001), GLS (- 14 vs - 12%; p 0.025), FAC (46 vs 41%; p 0.01), SBP (141 vs 131 mmHg; p 0.003).
At multivariable analysis the major AT/ET determinants were systolic arterial pressure and bi-ventricular performance parameters. The following nested regression were created: the first inclusive of systolic arterial pressure (PAS), fractional area change (FAC), left ventricular mass indexed (LVMI), global longitudinal strain (GLS) (R2=0.48 p&lt;0.001), the second inclusive of PAS, FAC, LVMI, GLS, AVA (R2=0.57, p&lt;0.001), the third inclusive of PAS, FAC, LVMI, LVEF, AVA (R2=0.64, p&lt;0.001).

Conclusion
Our study demonstrated that AT/ET ratio relates quite well with LV performance in the context of SAS. An high ACT/ET ratio tends to be associated with a poor bi-ventricular performance and LV negative remodeling. It is possible that this simple parameter in the next future could help in staging the disease among SAS patients.
501 CASEOUS CALCIFICATION OF THE MITRAL ANNULUS AND THE IMPORTANCE OF ITS IDENTIFICATION IN THE CLINICAL PRACTICE: A REPRESENTATIVE CASE
Authors: Ciceri Luca , Springhetti Paolo , Dotto Alberto , Maffeis Caterina , Tafciu Elvin , Bergamini Corinna , Rossi Andrea , Benfari Giovanni , Luciano Ribichini Flavio 
Published: December 2022

Abstract

1. Introduction
Caseous Calcification of the Mitral Annulus (CCMA) is a rare condition characterized by a liquefaction degeneration that usually involves posterior mitral ring and it is considered a variant of mitral annulus calcification. Its prevalence is very low, but it is possible that it is often underdiagnosed or misdiagnosed. This condition is related with increased age, female sex, chronic kidney disease and calcium metabolism disorders. The lesion can be detected using imaging techniques and its management is conservative in most cases.

2. Case Study
A 72-year-old man hospitalized for bilateral pneumonia complicated with ARDS has come to our attention. The patient had a history of stage IV renal failure, type 2 diabetes mellitus and calcific degenerative aortic valve disease. During its stay in the Intensive Care Unit a routine Transthoracic Echocardiogram showed a vegetation suspected for infective endocarditis that involved the posterior mitral leaflet. However, the clinical presentation did not support endocarditis diagnosis as no microorganisms were isolated at multiple blood cultures and other Duke Criteria were negative. Given the limited acoustic viewing of transthoracic echocardiogram it was necessary to perform a Transesophageal Echocardiogram (TEE) for a better characterization of the valve lesion. TEE showed the presence of a round lesion, about 2×2 cm in size, with smooth borders, located over the mitral annulus with extension up to the posterior mitral leaflet and with a partially mobile portion. The lesion had a corpuscular appearance inside with less echogenicity and without evidence of flow. No significant functional alterations of the mitral valve were detected (anterograde transmitral flow Mean Gradient 4-5 mmHg; Mild regurgitation). We therefore concluded for Caseous Calcification of the Mitral Annulus as the most likely diagnosis and decided for a conservative management. A new TEE was performed as a control after one week showing no significant changes on the valve lesion.

3. Conclusions
It is important for echocardiographers to be familiar with CCMA and to know how to distinguish it from other valve lesions such as infective vegetation, abscesses or tumors. An integration with other cardiac imaging techniques, patient past medical history and clinical-laboratory data can help the physician in the correct characterization of valve lesions and subsequent most appropriate therapeutic approach for the patient.
1098 CHARACTERIZATION OF DIFFERENT TYPES OF LV REMODELING USING QUANTITATIVE INTRACARDIAC FLUID-DYNAMICS
Authors: Calvelli Pierangelo , Sabatino Jolanda , Bella Sabrina La , Rosa Romano Letizia , Strangio Antonio , Leo Isabella , Montemurro Vincenzo , Critelli Claudia , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Salvo Giovanni Di , Indolfi Ciro , Rosa Salvatore De 
Published: December 2022

Abstract

Background
Hyperdoppler is a novel advanced echocardiographic technique for the quantitative assessment of intracardiac fluid-dynamics. Recently, its use has been proven useful to complement traditional echocardiographic evaluation of cardiac function in Heart Failure. However, no specific data are available on its application to differentiate between different types of LV remodeling. Thus, our aim was to investigate whether quantitative changes in fluid dynamics might be able to characterize patients with different ventricular geometry.

Methods
We enrolled 100 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling, normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler, Esaote, Genova, Italy). The following parameters were obtained: vortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability.

Results
Mean Vortex Depth was significantly higher in CR (p=0.011), CH (p=0.001) and EH (p=0.025) compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). In addition, CH had significantly higher Vortex Length (p= 0.008) and larger VA (p=0.012) compared to CTRL. No significative differences in vortices parameters have been observed between CH and EH.

Conclusion(s)
Quantitative fluid-dynamic assessment was feasible and reliable in the whole population and is a promising tool to complement standard echocardiography for the early characterization of different types of LV remodeling.
381 PROGNOSTIC VALUE OF TWO DIMENSIONAL STRAIN IN EARLY ISCHEMIC HEART DISEASE: A 5-YEAR FOLLOW-UP STUDY
Authors: Campanella Francesca , Licordari Roberto , Pistelli Lorenzo , Parisi Francesca , Cocuzza Federica , Allegra Marta , Lo Savio Armando , La Cognata Olga , Poleggi Cristina , De Sarro Rosalba , Morabito Claudia , Crea Pasquale , Imbalzano Egidio , Micari Antonio , Di Bella Gianluca , Dattilo Giuseppe 
Published: December 2022

Abstract

Introduction
Dipyridamole stress echocardiography (Dipy-stress) compared to exercise ECG, has an higher specificity in non-invasive detection of coronary artery disease (CAD). Two-dimensional strain echocardiography (2D-SE) is able to detect even minimal abnormalities of systolic function. The aim of the study was to observe changes in 2D-SE parameters during dipy-stress and to assess prognosis in a group of patients who had previously a non-diagnostic dipy-stress test result.

Methods
In the first phase 71 patients were enrolled and a dipy-stress test was performed. Each patient was then studied by off-line measurement of 2D-SE and coronary computed tomography angiography (CCTA), to check the presence of CAD. In the follow-up phase, an echocardiographic re-evaluation and outcome analysis during a mean follow-up of 78 months was carried out.

Results
In the first phase, Global Longitudinal Strain (GLS) was reduced (p &lt; .0001) in the CCTA positive group compared to the CCTA negative group (23±3 vs 26±2 at rest; 20±3 vs 26±2 after stress). CCTA negative group and the CCTA positive group did not differ in terms of clinical features, cardiovascular risk factors, or treatments. Despite a trend in reduction for positive CCTA group (23±3 vs 20±3 at rest; 20±3 vs 19±3 after stress), no statistically significant changes were seen in the analysis of GLS rest and stress values, between baseline and follow-up in the two groups. None of the enrolled patients experimented cardiac events during follow-up.

Conclusions
Left ventricular GLS analysis improves the accuracy of dipy-stress echocardiography in the detection of mild CAD compared with the assessment of Wall Motion changes, particularly in those with preserved left ventricular ejection fraction. Patients may have a better mid-term prognosis thanks to close follow-up and early treatment of all cardiovascular risk factors.