bluuebunny/crossref_metadata_2025_split huggingface dataset:
840 ASSESSMENT OF ABSOLUTE CORONARY FLOW AND MICROVASCULAR RESISTANCE RESERVE IN PATIENTS WITH AORTIC STENOSIS
Authors: Gallinoro Emanuele , Paolisso Pasquale , Vanderheyden Marc , Esposito Giuseppe , Bertolone Dario Tino , Belmonte Marta , Bermpeis Konstantinos , Fabbricatore Davide , De Colle Cristina , Candreva Alessandro , Penicka Martin , Collet Carlos , Sonck Jeroen , De Bruyne Bernard , Barbato Emanuele 
Published: December 2022

Abstract

Introduction
The development of left ventricular hypertrophy in patients with severe aortic stenosis (AS) is accompanied by adaptive coronary flow regulation, both in epicardial and microvascular compartment, which ultimately lead to a chronic ischemic insult even in the absence of obstructive coronary artery disease. Intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow ®) is a novel tool that allows to measure absolute coronary flow and microvascular resistance at rest and during hyperemia and to calculate both coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR)

Purpose
We aimed to assess absolute coronary flow, microvascular resistance, CFR and MRR in patients with AS, assessed by continuous intracoronary thermodilution, comparing these hemodynamic findings with a propensity-score matched contemporary cohort of patients without AS.

Methods
Absolute coronary blood flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and compared to 15 controls matched for age, gender, diabetes mellitus and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac-CT.

Results
Patients with AS presented a significantly positive LV remodeling with lower global longitudinal strain and higher global work index compared to controls (p&lt;0.02). Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS. Compared to matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (86 [66–107] ml/min vs 68 [52–75] ml/min, p=0.036), resulting, in lower CFR (2.30 ± 0.69 vs 2.89 ± 0.77, p=0.005) and MRR (2.73 ± 0.74 vs 3.53 ± 0.95, p=0.005) in the AS cohort compared to controls (Figure 1). No differences were found in hyperemic flow and resting and hyperemic resistances. Interestingly, hyperemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD and expressed in mL/min/g), but not resting, was significantly lower in the AS group (1.9 [1.5–2.5] ml/min/g vs 2.3 [2–3.1] ml/min/g p=0.036).

Conclusions
In patients with severe aortic stenosis and non-obstructive coronary artery disease, with the progression of LVH, the compensatory mechanism of increased resting flow maintains an adequate perfusion at rest, but not during hyperemia (Figure 2). As consequence, both CFR and MRR are significantly impaired.
851 REPEATABILITY OF BOLUS AND CONTINUOUS THERMODILUTION FOR ASSESSING CORONARY MICROVASCULAR FUNCTION
Authors: Gallinoro Emanuele , Paolisso Pasquale , Bertolone Dario Tino , Bermpeis Konstantinos , Fernandez-peregrina Estefania , Esposito Giuseppe , Belmonte Marta , Vanderheyden Marc , Fabbricatore Davide , Sonck Jeroen , Barbato Emanuele , Collet Carlos , De Bruyne Bernard 
Published: December 2022

Abstract

Introduction
The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass.

Purpose
To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function.

Methods
Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment.

Results
A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p&lt;0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74 ± 10.41% vs 31.26±24.85%, respectively, p&lt;0.001; ICC= 0.78 (0.70-0.85) and 0.48 (0.32-0.62), respectively, p&lt;0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74-0.87) and 0.80 (0.71-0.86)) but the variability of the MRR was significantly lower (12.44 ± 10.06% vs 24.24±19.27, respectively, p&lt;0.001, figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Figure 2.

Conclusion
Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.
487 LEFT MAIN TRIFURCATION RESTENOSIS: A COMBINED STRATEGY FOR A COMPLEX ANATOMICAL SCENARIO
Authors: Gioia Francesco Paolo , Ferrante Giuseppe , Liccardo Gaetano , Barberis Giancarlo 
Published: December 2022

Abstract
Unprotected left main trifurcations (ULMT) are highly challenging lesions for the interventionalist. There is still no evidence on the best revascularization strategy, and the risk of short-term procedural complications and long-term adverse outcomes remains high.
We report the case of a 62-years-old with multiple risk factors and a high bleeding risk attributable to severe pancytopenia. Due to an episode of unstable angina, he underwent coronary angiography showing a left main stem (LM) trifurcation with critical ostial left anterior descending (LAD) stenosis, and a proximal LAD sub-occlusive lesion extending to the ostium of the first diagonal (D1) Percutaneous coronary intervention (PCI) consisted of intravascular ultrasound (IVUS)-guided deployment of two drug-eluting stents (DES) from LM to mid-LAD.
One year later he was admitted for chest pain relapse. Coronary angiogram demonstrated critical in-stent restenosis at the proximal LAD and sub-occlusions of ostial ramus intermediate (RI) and ostial circumflex (Cx) (Figure 1).
Re-do PCI consisted of multiple pre-dilations and deployment of a DES on proximal-mid LAD within the previous stent, with two sequential triple kissing inflations on LAD-RI-Cx (Figure 2). Angioplasty on RI and Cx was accomplished with two drug-coated balloons (DCBs) kissing inflation, followed by final triple kissing, with an optimal angiographic result (Figure 3).
In our opinion, the combined use of DCBs and main branch stenting, further optimized by multiple triple kissing balloons, seems to be the most harmonious approach to treat such complex coronary lesions, where the use of multiple stenting strategies might be an overly cumbersome strategy, especially when an intrinsic bleeding risk makes long or powerful anti-thrombotic protocols not feasible.
303 IMPACT OF LEAD POSITION IN THE TRICUSPID ANULUS ON THE DEVELOPMENT OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES RELATED TRICUSPID REGURGITATION
Authors: Gitto Mauro , Fazzari Fabio , Del Monaco Guido , Monaco Maria Lo , Lisi Costanza , Regazzoli Damiano , Frontera Antonio , Reimers Bernhard , Monti Lorenzo , Francone Marco , Mangieri Antonio , Colombo Antonio , Sticchi Alessandro 
Published: December 2022

Abstract

Introduction
Originally considered as the “forgotten valve disease”, tricuspid regurgitation (TR) has recently been shown to correlate with consistent morbidity and mortality, suggesting the need for a deeper understanding of its natural course. Direct injury from Cardiac Implantable Electrical Device (CIED) leads is one of the most common causes of primary TR, with a prevalence up to 40%. The aim of the present proof-of-concept study was to evaluate the effect of CIED right ventricular (RV) lead position within the tricuspid anulus on TR development.

Methods
Consecutive patients undergoing CIED implantation at our institution (Humanitas Research Horpital IRCCS, Milan, Italy) were included, as long as they had been performed pre- and post- transthoracic echocardiogram (TTE) and a chest CT scan after the implantation. TTE and CT images were retrospectively reviewed. TR severity was graded using a pre-specified 4-class grading scheme: mild, moderate, severe and massive. CIED RV lead position was defined as postero-septal, antero-septal or antero-posterior, based on the commissure in which the lead was observed on a cross-sectional view of the tricuspid anulus at CT scan.

Results
64 patients undergoing CIED implantation from January 2015 to December 2021 were included. All CT scans were non-ECG gated. TR was detected in 42 patients (65.62%) at pre-implantation TTE. The RV lead was implanted across the postero-septal, antero-posterior and antero-septal commissures in 35 (54.7%), 16 (25%) and 13 (20.3%) patients respectively. After the implantation, 12 individuals (18.75%) had new-onset or worsening TR, with CIED lead contributing to TR in 46.88% of cases (30/64), and 26 (40.63%) had worse RV function. At logistic regression analysis, the absence of atrial fibrillation was the only independent predictor of new-onset or worsening TR (OR: 0.17, 95% CI: 0.03-0.86, p=0.032), while CIED RV lead in the postero-septal commissure was associated with a numerically lower risk as compared to other sites (OR: 0.34, 95% CI: 0.09-1.27, p=0.108). Consistently, the degree of increase in TR severity was numerically lower in patients with a lead in the postero-septal commissure (Δ = 0.38±0.10 vs. 0.63±0.13, p=0.07).

Conclusions
CIED implantation is associated with increasing TR severity and worsening RV function. Positioning a lead across the postero-septal commissure of the tricuspid anulus might have a lower impact on TR development and worsening, thus representing a feasible option to prevent CIED-related TR.
215 PREDICTORS OF RECURRENT CEREBRAL ISCHEMIA AFTER PATENT FORAMEN OVALE CLOSURE: A SINGLE CENTER OBSERVATIONAL STUDY
Authors: De Gregorio Mattia , Gurgoglione Filippo Luca , Vignali Luigi , Cattabiani Maria Alberta , Solinas Emilia , Benatti Giorgio , Tadonio Iacopo , Barocelli Federico , Tuttolomondo Domenico , Indrigo Elia , Signoretta Gianluca , Ardissino Diego , Niccoli Giampaolo 
Published: December 2022

Abstract

Background
Transcatheter patent foramen ovale (PFO) closure is an effective therapy in patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) and evidence of PFO. However, the incidence of recurrent cerebral ischemia is not negligible and underlying pathogenic mechanisms remain largely unknown. We sought to evaluate the magnitude of the problem and to assess predictors of recurrent stroke/TIA after transcatheter PFO closure.

Methods
We enrolled non-randomized consecutive patients who underwent PFO closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2004 and 2021. Clinical, echocardiographic and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up.

Results
We enrolled a total of 154 patients. The primary indication for PFO closure was previous stroke (85 [55.2%] subjects) and a third of patients (51 [33.1%]) suffered from migraine, 22 [14.3%] with and 29 [18.8%] without aura. Moreover, mean Risk of Paradoxycal Embolism (ROPE) score at hospital admission was 6.4 ± 1.5. After a median follow-up of 112 months, the incidence of recurrent cerebral ischemia occurred in 13 [8.4%] patients, with an annualized rate of 0.92/100 patients. The presence of migraine, obesity and ROPE &lt; 7 were independent positive predictors of recurrent stroke/TIA.

Conclusion
The presence of obesity, a familiar history of CVD, ROPE &lt; 7 and migraine were independent positive predictors of recurrent ischemic neurological events after PFO closure.
372 PLATYPNEA-ORTHODEOXIA SYNDROME CAUSING POSITIONAL DYSPNEA AND ARTERIAL DESATURATION IN AN ELDERLY WOMAN: A CASE REPORT
Authors: Monte Marco Angelo , Di Salvo Maria Elena , Capodanno Davide , Tamburino Corrado 
Published: December 2022

Abstract
A 72-years-old woman was admitted to the Emergency Department due to acute stroke in April 2022. Some days later the patient developed acute respiratory failure with oxygen arterial desaturation (SpO2 &lt;80%). Interestingly, she experienced deep hypoxia when she was in the orthostatic position, with partial resolution in the supine position, thus necessitating continuous oxygen therapy. Her pertinent medical history included hypertension for which she was taking valsartan 80 mg daily and bisoprolol 2.5 mg daily, obstructive sleep apnea syndrome under treatment with nocturne continuous positive airway pressure, thyroidectomy for multinodular goiter in replacement therapy with levothyroxine 100 mcg daily, and anxious-depressive syndrome for which she was taking trazodone 75 mg daily and escitalopram 10 mg daily. Given her presentation, our top differential diagnosis included acute pulmonary embolism, pneumonia, Sars-CoV-2 infection, and platypnea-orthodeoxia syndrome. The patient was then admitted to the Pneumology Department, where she underwent computed tomography angiography, which was negative for acute pulmonary embolism and pneumonia, and two SARS-CoV-2 nasal swabs, which were both negative. The transcranial Doppler showed a high-grade shunt (curtain effect). The transesophageal echocardiography with bubble test showed a lipomatous and aneurismatic interatrial septum with a massive right-to-left shunt through a patent foramen ovale (PFO) during the Valsalva maneuver. In the absence of other obvious cause of the positional desaturation and hypoxia, a diagnosis of platypnea-orthodeoxia syndrome was made. Platypnea-orthodeoxia syndrome is a rare clinical condition difficult to diagnose. However, it represents a potentially reversible cause of positional dyspnea and arterial desaturation. The patient then underwent percutaneous PFO closure with the Gore Septal Occluder 30/30 mm (W.L. Gore and Associates, Inc.) through intracardiac echocardiography guidance without any residual shunt. Although unfavorable anatomical features were present (atrial septal aneurism and lipomatous septum), the procedure was straightforward and without complication. The oxygen saturation on pulse oximeter, which was 91% in supine position with oxygen therapy with FiO2 60% during the procedure, rapidly became 97% soon after the placement of the prosthesis. The patient then experienced relief of the dyspnea and the oxygen therapy was stopped. The clinical follow-up performed three weeks later showed an asymptomatic patient with no limitation of daily physical activity.
210 TAVI WITH SAPIEN 3 ULTRA AND ACURATE NEO2: OUTCOMES FROM A HIGH VOLUME CENTER
Authors: Motta Silvia Crescenzia , Costa Giuliano , Strazzieri Orazio , Di Pietro Elena , Frittitta Valentina , Barbanti Marco , Tamburino Corrado 
Published: December 2022

Abstract

Background
Latest iterations of devices for transcatheter aortic valve implantation (TAVI) have brought refinements to further improve patients outcomes, but comparisons of balloon-expandable Sapien 3 ULTRA (ULTRA) and self-expanding Acurate Neo 2 (NEO2) valves are lacking.

Objectives
To compare hemodynamic and clinical outcomes of patients undergoing TAVI with ULTRA or NEO 2 devices.

Methods
Patients undergoing TAVI with ULTRA and NEO 2 and enrolled in the REPLACE Registry from June 2019 to July 2022 (n=174) were analyzed. The primary efficacy and safety outcomes were VARC-3 device success and early safety, respectively. Secondary outcomes included technical success, 30-day clinical outcomes and echocardiographic device performance.

Results
A total of 119 patients receiving ULTRA (68.4%) and 55 receiving NEO 2 (31.6%) were compared. The primary efficacy (90.8% vs. 87.3%, for ULTRA and NEO2 respectively, p=0.483) and safety (87.4% vs. 85.5%, for ULTRA and NEO2 respectively, p=0.725) outcomes did not differ between patients receiving ULTRA or NEO 2 transcatheter aortic valves. On post-TAVI echocardiography, no cases of severe PVR were detected. The rate of mild-to-moderate paravalvular regurgitation (PVR) was lower in the ULTRA group (0.9% vs. 6.1%, p=0.002), with similar mean transvalvular gradients between the study groups (median 10 vs. 8.5 mmHg, for ULTRA and NEO2 respectively, p=0.11).

Conclusions
In this comparison, device success rates were high with both new-generation devices, with overall low rates of adverse events at 30 days after TAVI. Very low PPI rates were reported with both devices. PVR rates were low, but higher in patients receiving NEO 2.
757 DIRECT ORAL ANTICOAGULANTS OR VITAMIN K ANTAGONISTS IN AFTER TAVR
Authors: Oliveri Federico , Montalto Claudio , Tua Lorenzo , Lanzillo Giuseppe , Compagnoni Sara , Fasolino Alessandro , Gentile Francesca Romana , Ferlini Marco , Pepe Antonella , Visconti Luigi Oltrona , Bongiorno Andrea , Leonardi Sergio 
Published: December 2022

Abstract

Background
Several patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral anticoagulants, DOACs, or vitamin K antagonists, VKA) is still unclear in this setting.

Method
We performed systematic literature research and meta-analysis in PubMed, Medline, and EMBASE databases for studies reporting either all-cause mortality, major/life-threatening bleeding or stroke events.

Results
Ten observational studies and one randomized controlled trial (RCT), including 29,333 patients, were eligible for inclusion. Compared to VKA, DOACs use after TAVR was associated with a modest but significantly lower rates of all-cause mortality (RR 0.88; 95% CI: 0.78-0.99, p-value 0.04). Total stroke events (RR 0.97; 95% CI: 0.76-1.23, p-value 0.79) and major/life-threatening bleeding (RR 0.94; 95% CI: 0.70-1.27, p-value 0.69) were comparable among the two treatments. In the following sensitivity analysis including observational studies only, results in terms stroke events were consistent (RR 1.00;95% CI: 0.75-1.34, p-value 0.99) . However, the overall mortality was comparable between the two treatments (RR 0.88; 95% CI: 0.77-1.00, p-value 0.99), while major/life-threatening bleeding occurred less in the DOACs group (RR 0.80; 95% CI: 0.68-0.94, p-value 0.006).

Conclusion
Considering the totality of published evidence in TAVR patients with a concomitant indication for OAC, DOACs use was associated with reduced all-cause mortality and comparable major/life-threatening bleeding and stroke events compared to VKA.
521 IMPACT OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY DERIVED “FULL MOON“ CALCIFICATIONS IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTIONS (CTO-PCI)
Authors: Panuccio Giuseppe , Tonini Greta , Erbay Aslihan , Skurk Carsten , Landmesser Ulf , Werner Gerald S , Leistner David M , Abdelwahed Youssef S 
Published: December 2022

Abstract

Background
There is an increasing incidence of chronic total coronary occlusions (CTO). CTO are complex coronary lesions and known to represent a technical challenge for percutaneous recanalization procedures. However, the success rates of CTO- percutaneous coronary interventions (CTO-PCI) have increased tremendously with the continuous innovations in equipment and procedural techniques.
Circular heavily calcified “Full Moon”- like plaques have been observed in CTO patients, however their frequency and relevance for CTO-PCI outcomes remain unclear, despite they can be straightforward identified by Coronary Computed Tomographic Angiography (CCTA) during CT-scans to select the CTO-PCI recanalization strategy.

Purpose
The aim of this study was to investigate the clinical value of CCTA – derived “Full Moon”-like plaques and to analyze its impact on percutaneous CTO recanalization.

Methods and Results
Out of the Charité CTO-PCI registry a total of 29 consecutive patients undergoing CTO-PCI and upstream CCTA-imaging for CTO planning were enrolled into the entire analysis. One patient was excluded due to stent artefacts with insufficient CCTA quality. Within the study cohort 17.9% (n=5) presented a “Full Moon”-like stenosis as CTO-causing target lesion. During CTO-PCI all these lesions (100%) required extensive debulking techniques as rotablation or ultrasound lithoplasty due to difficulties in device crossing compared to 13% (n=3) lesions in the non “Full Moon” group (p&lt;0.001).
In detail, 40% of lesions in the “Full Moon” group had to be prepared by rotablation-therapy (compared to 0% in the non- “Full Moon” group; p&lt;0.05) and 20% of lesions underwent shockwave therapy as compared to 13% non- “Full Moon” lesions (n=3; p=.0.69). However, 40% of the “Full Moon” interventions resulted in a complete failure of crossing the device compared to 13.0% in the non- “Full Moon” group (p=0.15).

Conclusions
: “Full Moon”- like calcification derived by CCTA represents a frequently observed phenomenon in CTO and represents an important predictor for complexity during CTO-PCI. Coronary Computed Tomography can be used to identify such a marker of calcium complexity and therefore to plan the procedure in advance.