bluuebunny/crossref_metadata_2025_split huggingface dataset:
932 CASE REPORT OF MITROAORTIC INTERVALVULAR FIBROUS ANEURYSM IN IMMUNOSUPPRESSED PATIENT
Authors: Serratore Serena , Lombardo Vincenzo , Bellantoni Antonio , Petullà Maria , Zinzi Stefania , Mascaro Giuseppina , Indolfi Ciro , Aquila Iolanda 
Published: December 2022

Abstract

Introduction
infective endocarditis (IE) is a serious infection associated with high mortality and severe complications. Clinical signs of IE include manifestation of local cardiac damage, embolization of septic fragments, seeding of the infection during bacteremia, and tissue injury related to antibody response. Furthermore, immunocompromised patients are considered to be at high risk for developing infective endocarditis. This report describes a case of native valve infective endocarditis complicated by abscess formation in a oncohematological young patient.

Clinical Case
a 23-years-old male with a Hodgkin lymphoma in chemotherapy treatment, was admitted to our hospital for persistent fever, despite taking a long course of antibiotics, confusional mental state and dyspnea. Blood tests revealed anemia, neutrophilia, lymphopenia and elevated inflammatory markers (PCR, PCT, VES). The electrocardiogram showed sinus rhythm at 90 bpm with no evidence of atrio-ventricular block. S. Aureus has been isolated from the blood cultures.
The transthoracic echocardiography (TTE) showed left ventricular dilation, systolic dysfunction, a large pericardial effusion and a hyperechoic mass in the aortic root. An urgent pericardiocentesis was performed. The cytological examination of the drained fluid revealed an exudate fluid with a high proportion of neutrophils.
An urgent total body computed tomography (CT) scan was performed with no evidence of progression of malignancy, signs of pneumonia, signs of septic brain emboli. A rounded mass at aortic valve plane was detected. The mass was further evaluated with additional imaging modalities and then a transesophageal echocardiography (TEE) was performed. The exam showed: aortic posterior root abscess, involvement of left and non-coronary aortic cusps and severe aortic regurgitation.
The patient underwent urgent cardiac surgery: aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement. S. Aureus was also identified in surgically removed tissue.
Twenty days after surgery, chest CT showed no complications and the transthoracic echocardiography showed a well-seated prosthetic tissue valve with a medium gradient of 13 mmHg, and good global left ventricular systolic function and ejection fraction.

Conclusion
infective endocarditis carries a high risk of morbidity and mortality, particularly in the immunocompromised patient. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome.
97 MULTIMODAL EVALUATION OF MYOCARDIAL FIBROSIS IN PATIENTS WITH AORTIC STENOSIS
Authors: Tosto Giuseppe Giovanni , Deste Wanda , Gibiino Fortunata Alessandra , Passaniti Giulia , Tamburino Corrado 
Published: December 2022

Abstract

Introduction
Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac magnetic resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.

Aim
The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early marker of fibrosis. Clinical and laboratory data, particularly BNP, were also analyzed.

Material and Methods
In our study we recruited 33 patients with severe aortic stenosis, comparing echocardiographic values of GLS with those of Late Gadolinium Enhancement (LGE) and T1 mapping of CMR.

Results
70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032) and elevated Pro-BNP values (p = 0.021); for GLS, odds ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033 =) and hypertension (p = 0.025), but not with elevated Pro-BNP values.

Conclusions
In patients with severe aortic stenosis, association between GLS and LGE can help identify earlier those with structural changes caused by the disease, who could benefit from early intervention. It remains to be established, through a longer follow-up, how the presence of these alterations can influence the outcome of patients suffering from aortic stenosis.
874 A NOT-SO-RARE COMPLICATION OF CONNECTIVE TISSUE DISEASE
Authors: Bonadies Davide , Palumbo Rossana , Manna Martina La , Santopietro Mario , Sorvillo Graziano , Visco Valeria , Vigorito Francesco , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Soriente Lucia 
Published: December 2022

Abstract
Pulmonary hypertension is a not-so-rare complication of connective tissue diseases and is usually related with an inauspicious prognosis. We present the case of a 67-years-old woman hospitalized for progressive dyspnea.
Two-dimensional echocardiography showed numerous features related to pulmonary hypertension (PH) with moderate Mitral Regurgitation.
The right cardiac catheterization confirmed mixed PH (pre and post capillary) without chest angio-TC evidence of pulmonary thromboembolism.
Thanks to optimized medical therapy (B-Blocker, ACE-i and diuretics), there was a significant clinical improvement documented at discharge.
After 1 year, due to recurrence of dyspnea, she was admitted to our medical unit.
Her clinical examination showed some of the characteristics of a connective tissue disease.
Compared to previous echocardiography, a moderate to mild reduction of MR was documented.
Chest CT scan revealed interstitial lung disease likely related to patient's underlying pathology. Immunological screening tests detected the presence of antinuclear (ANA) and anti-topoisomerase (ATA) antibodies. Right heart catheterization documented a worsening of PH with only pre-capillary component. On the basis of the above findings, a diagnosis of CREST syndrome complicated with PH was made, and the patient was started on oral combination of macitentan and riociguat. The frequency of this complication in connective tissue disease, the need for screening tests and different treatment approaches of pre and post capillary pulmonary hypertension is discussed.
152 PERFORMANCE OF RISK STRATIFICATION SCORES AND ROLE OF COMORBIDITIES IN OLDER VS YOUNGER PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION
Authors: Stolfo Davide , Barbisan Davide , Ameri Pietro , Lombardi Carlo Mario , Monti Simonetta , Driussi Mauro , Zovatto Isabella Carlotta , Gentile Piero , Howard Luke , Toma Matteo , Pagnesi Matteo , Collini Valentino , Bauleo Carolina , Guglielmi Giulia , Adamo Marianna , D´angelo Luciana , Nalli Chiara , Sciarrone Paolo , Moschella Martina , Zorzi Barbara , Vecchiato Veronica , Milani Martina , Poi Emma Di , Airò Edoardo , Metra Marco , Garascia Andrea , Sinagra Gianfranco , Giudice Francesco Lo 
Published: December 2022

Abstract

Background
Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown.

Methods
Patients with PAH enrolled from 2001 to 2021 were divided in ≥ 65 years old vs &lt;65 years old patients. Study outcome was 5-year all-cause mortality. FPHN, FPHN non-invasive, COMPERA and REVEAL 2.0 risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated.

Results
Among 383 patients, 152 (40%) were ≥ 65 years old. Older patients had more comorbidities, with the exception of obesity and diabetes (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in &lt;65 years patients). At 5-year follow-up, 36% of ≥ 65 years patients vs 10% of &lt;65 years patients died. Except for the COMPERA, risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74) and in younger (C-index 0.72) and older (C-index 0.69) patients. Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients, with the highest accuracy achieved in addition to REVEAL 2.0 (C-index 0.79).

Conclusions
Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients. Comorbidities increased the accuracy of risk scores only in younger patients.
345 INTRAVENOUS CANGRELOR INFUSION IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Benenati Stefano , Gragnano Felice , Capolongo Antonio , De Sio Vincenzo , Scalamera Riccardo , Bertero Edoardo , Musumeci Giuseppe , Annibali Gianmarco , Campagnuolo Salvatore , Galasso Gennaro , Silverio Angelo , Bellino Michele , Centore Mario , Menozzi Alberto , Caretta Giorgio , Rezzaghi Marco , De Luca Leonardo , Antonio Veneziano Francesco , Cirillo Plinio , De Rosa Gennaro , Calabrò Paolo , Porto Italo 
Published: December 2022

Abstract

Aims
To assess the clinical characteristics and compare in-hospital outcomes of elderly and non-elderly patients receiving cangrelor in the peri-percutaneous coronary intervention (PCI) phase.

Methods
Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Elderly patients were defined if age was ≥75 years at the time of PCI. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay. Independent predictors of the primary endpoint were also assessed.

Results
Out of 551 patients undergoing PCI with cangrelor between January 2019 and August 2022, 174 (32%) were elderly. Mean age was 81±5 vs. 61±8 years in elderly vs. non-elderly patients (p&lt;0.001). Female sex (32% vs. 21%, p=0.006), atrial fibrillation (20% vs. 5%, p&lt;0.001), chronic kidney disease (30% vs. 6%, p&lt;0.001) and heart failure (14% vs. 8%, p=0.041) were more frequent in the elderly group, whereas presentation with acute coronary syndrome (ACS) was less frequent (69% vs. 83%, p=0.001). Elderly patients received shorter cangrelor infusion (122±25 vs. 134±43 minutes, p=0.001) and were more frequently administered with clopidogrel after PCI (50% vs. 19%, p&lt;0.001). At 48 hours, elderly patients had higher rates of NACE (13% vs. 6%, p=0.006) and BARC 2, 3 or 5 bleeding (11% vs. 5%, p=0.013), whereas the rates of other 48-hour and in-hospital clinical endpoints did not differ. At multivariable analysis, age ≥75 years (odds ratio [OR] 1.07, 95% CI 1.02-1.12, p=0.004), major anemia (OR 1.10, 95% CI 1.005-1.22, p=0.038), ACS at presentation (OR 1.08, 95% CI 1.03-1.14), femoral access (OR 1.13, 95% CI 1.06-1.22) and cardiogenic shock (OR 1.35, 95% CI 1.21-1.50) independently predicted the occurrence of 48-hour NACE.

Conclusions
Advanced age is a distinctive risk feature among patients receiving intravenous cangrelor in the peri-PCI phase. Elderly patients had higher rates of adverse events at 48 hours, with advanced age (≥75 years) being an independent predictor of NACE.
158 AIR POLLUTION AND CORONARY VASOMOTOR DISORDERS IN PATIENTS WITH MYOCARDIAL ISCHEMIA AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE
Authors: Camilli Massimiliano , Russo Michele , Rinaldi Riccardo , Iannaccone Giulia , Lavecchia Giulia , Vergallo Rocco , Trani Carlo , Niccoli Giampaolo , Crea Filippo , Antonio Montone Rocco 
Published: December 2022

Abstract

Background
Coronary vasomotor abnormalities are important causes of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). However, the role of air pollution in determining coronary vasomotor disorders has never been investigated.

Objectives
We aimed to evaluate the association between long-term exposure to particulate matter 2.5 (PM2.5) and 10 (PM10), and coronary vasomotor disorders in NOCAD patients.

Methods
Patients with myocardial ischemia and NOCAD undergoing coronary angiography and intracoronary provocation test with acetylcholine (ACh) were prospectively studied. Both patients with chronic myocardial ischemia (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) were enrolled. Based on each case's home address, exposure to PM2.5 and PM10 was assessed.

Results
We included 287 patients (median age 62.0 years [52.0-70.0], 149 [51.9%] males): 161 (56.1%) INOCA and 126 (43.9%) MINOCA. One hundred seventy-six patients (61.3%) had positive provocation test. Exposure to PM2.5 and PM10 was higher in patients with a positive provocation test (p&lt;0.001). At multivariate logistic regression analysis, PM2.5 and PM10 were independent predictors of a positive provocation test (p=0.001 and p=0.029, respectively). Interestingly, among these patients, PM2.5 and PM10 were both independent predictors of MINOCA (p&lt;0.001 and p=0.001, respectively) as clinical presentation, while PM2.5 was independently associated with the occurrence of epicardial spasm as opposed to microvascular spasm (p=0.001).

Conclusions
Higher exposure to PM2.5 and PM10 in patients with myocardial ischemia and NOCAD is associated with coronary vasomotor abnormalities. In particular, PM2.5 is an independent risk factor for the occurrence of epicardial spasm and MINOCA as clinical presentation.
778 IN-STENT USE OF INTRAVASCULAR LITHOTRIPSY IN THE TREATMENT OF STENT UNDEREXPANSION: A SYSTEMATIC REVIEW AND METAREGRESSION
Authors: Caminiti Rodolfo , Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Della Rocca Domenico Giovanni , Cerrato Enrico , Saporito Francesco , Andò Giuseppe , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Vizzari Giampiero 
Published: December 2022

Abstract

Introduction
Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologist. Stent Underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis. To date, SU with heavily CCP can be addressed by means of scoring/cutting balloons, very-high/high pressure non-compliant balloons, off-label rotational/orbital atherectomy and intravascular lithotripsy (IVL).

Objective
In this meta-analysis we investigate the success rate of IVL for the treatment of SU due to CCP.

Methods
Studies and case-based experiences reporting on the use of IVL strategy for treatment of SU were included. The primary outcome was IVL strategy success, defined as adequate expansion of the underexpanded stent. Metanalysis was performed for the main focuses to calculate proportions of procedural success rates with corresponding 95% confidence intervals (CI). Random effects models weighted by inverse variance were used because of clinical heterogeneity.

Results
Our study included 13 studies with 354 patients. Mean age was 71.3 years (95% CI: 64.9-73.1) and 77% (95% CI: 71.2-82.4%) were male. The mean follow-up time was 2.6 months (95% CI: 1–15.3). Strategy success was seen in 88.7% (95% CI: 82.3–95.1) of patients. The mean Minimal Stent Area (MSA) was reported in 6 studies, pre-IVL value was 3.4 mm2 (95% CI: 3–3.8) and post-IVL value was 6.9 mm2 (95% CI: 6.5–7.4). The mean diameter stenosis (%) was reported in 7 studies, pre-IVL value was 69.4% (95% CI: 60.7–78.2) and post-IVL value was 14.6% (95% CI: 11.1–18). The rate of intraprocedural complications was 1.6% (95% CI: 0.3-2.9).

Conclusions
The “stent-through” IVL plaque modification technique is a safe tool to treat SU due to CCP, with high success rate and very low incidence of complications.
265 PROGNOSTIC ROLE OF VITAMIN D DEFICIENCY IN STEMI PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Verdoia Monica , Gioscia Rocco , Rolla Roberta , Rognoni Andrea , De Luca Giuseppe 
Published: December 2022

Abstract

Background and Aims
The pandemic proportion of vitamin D deficiency has raised particular concerns on its association with mortality and cardiovascular disease (CVD). However, the independent and causative role of hypovitaminosis D in CVD is still debated. Few data have been reported, so far, among STEMI patients undergoing primary percutaneous coronary intervention (pPCI), that was therefore the aim of the present study.

Methods
A consecutive cohort of patients admitted for STEMI treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Hypovitaminosis D was defined for 25(OH)D &lt; 10 ng/ml. The primary study endpoint was net adverse cardiovascular events (a composite of death, recurrent MI and target vessel revascularization) at the longest available follow-up. Secondary endpoints were overall mortality, major bleedings or the individual components of the primary endpoint.

Results
We included 136 patients divided according to tertiles values of 25(OH)D (&lt; 12.98 ng/ml, n=44; 12.98-22.1 ng/ml, n=41; ≥ 22.1 ng/ml, n=51). The prevalence of renal failure (p=0.047) and coronary calcifications inversely related with vitamin D. Lower vitamin D levels were associated with “no reflow” (10.3% vs 6.7% vs 0%, p=0.04), with increased use of adenosine. At a mean follow-up of 305± 217 days (mean + SD), the primary endpoint (NACE) was slightly increased in patients with lower vitamin D values (adjusted HR [95% CI] = 3.07 [0.85-11.1], p = 0.09). Similar results were observed for ischemic events (MACE: adjusted HR [95% CI] = 2.78 [0.68-11.48], p = 0.16). However, when considering separately patients with severe hypovitaminosis D (&lt;10 ng/ml), we found a significant increase in the risk of NACE and MACE (adjusted HR [95% CI] = 5.17 [1.42-18.8], p = 0.01 and HR = 4.75 [1.14-19.7], p = 0.03, respectively).

Conclusion
The present study shows that among patients with STEMI undergoing pPCI, extremely low levels of vitamin D are independently associated with impaired outcomes. Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.
478 VENTRICULAR AND ATRIAL REMODELING AFTER EDGE-TO-EDGE TRANS-CATHETER MITRAL VALVE REPAIR: A PILOT STUDY
Authors: Albini Alessandro , Passiatore Matteo , Leo Giulio , Imberti Jacopo Francesco , Valenti Anna Chiara , Coppi Francesca , Sgura Fabio Alfredo , Boriani Giuseppe 
Published: December 2022

Abstract

Background
Percutaneous mitral valve repair (PMVR) is an established therapy for mitral regurgitation (MR) in patients at high risk for surgical treatment. The aim of this study was to determine the impact of PMVR on left and right ventricular (LV, RV) and left and right atrial (LA, RA) remodelling according to the mechanism of MR and history of atrial fibrillation (AF).

Methods and results
Twenty-four patients (mean age 78.54 years ± 7.64 SD; 62.5% males) undergoing PMVR at our centre were prospectively enrolled. All the patients underwent echocardiography 1.6 ± 0.9 months before the procedure and after 5.7 ± 3.5 months; functional MR accounted for 54% of cases. Compared to baseline, a statistically significant improvement in LV end-diastolic diameter (LVEDD), LV indexed mass (ILVM), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), indexed LA volume (iLAV) and morpho-functional RV parameters was recorded. LVEDD and LVEDV improved in primary MR cohort whereas in secondary MR a significant reduction in LVEDV and LVESV with a nonsignificant improvement in ejection fraction were found. (Table 1) LA positive remodelling was found in organic MR with a trend toward ameliorated function; in functional MR, with more dilated and dysfunctional LA, no significant improvement was found. (Table 1) Furthermore, a significant reduction of LA volumetry was detected only in patients without history of AF (AF baseline 51.4 mL/m2 IQR 45.6-62.5 mL/m2 f-u 48.9 mL/m2 IQR 42.9-59.2 mL/m2; p=0.101; no AF baseline 43.5 mL/m2 IQR 34.2-60.5 mL/m2 f-u 42.0 mL/m2 IQR 32.0-46.2 mL/m2; p=0.012). As regards right sections, the most relevant positive remodeling was obtained in patients with functional MR with a baseline poorer RV function and more severe RA and RV dilation. (Table 1)

Conclusion
At mid-term follow-up after PMVR, a positive cardiac remodeling is detected in atrial and ventricular chambers also involving the right sections. To deliver a tailored intervention, MR mechanism and history of AF should be considered in view of the impact on remodeling process.
532 SEX-RELATED DIFFERENCES IN THROMBUS BURDEN IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Manzi Maria Virginia , Buccheri Sergio , Jolly Sanjit S , Zijlstra Felix , Frobert Ole , Lagerqvist Bo , Mahmoud Karim D , Dzavik Vladimir , Barbato Emanuele , Sarno Giovanna , James Stefan 
Published: December 2022

Abstract

Background
Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated.

Objectives
The aim of this study was to assess the sex-related differences in TB and its clinical implication in patients with STEMI.

Methods
We analyzed individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year.

Results
Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death; 1.52; 95% CI: 1.10-2.12; P=0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, this risk for 1-year CV death was higher only in women with HTB (HR 1.23, 95% CI: 1.18-1.28; P&lt;0.001) who also had an increased risk for all-cause death and ST than men.

Conclusion
In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for stent thrombosis, CV and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.