bluuebunny/crossref_metadata_2025_split huggingface dataset:
797 ENDOTHELIAL FUNCTION AND RIGHT VENTRICLE DIMENSION AND FUNCTION IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: Croella Francesca , Tricarico Lucia , Alfieri Simona , Altomare Alberto , Mansueto Natalia , Correale Michele , Corrado Addolorata , Pugliese Rosanna , Romano Matteo , Noviello Giulia , Iacoviello Massimo , Cantatore Francesco Paolo , Brunetti Natale Daniele , Biase Matteo Di 
Published: December 2022

Abstract

Background
Systemic sclerosis (SSc) is a connective tissue disease characterized by the fibrosis of skin and internal organs, frequent immunity abnormalities and alterations in microvasculature. Among SSc complications, Pulmonary Hypertension (PH) is a frequent and severe one.
Many echocardiographic parameters are used to assess pulmonary pressure and Right Ventricle (RV) dimension and function in these patients, from classical echocardiographic indexes to the most recent Speckle-Tracking Echocardiography (STE), while flow-mediated vasodilation (FMD) is the most common method to assess vascular reactivity.

Aim of the study
To evaluate any possible relations between endothelial function and RV dimension and function in patients with SSc.

Method
48 sclerodermic patients underwent to echocardiographic examination and FMD, searching for relations between RV dimension and function and endothelial function indexes. For the RV we considered: 1) the eccentricity index (EI), 2) the fractional area change (FAC), 3) the ratio TAPSE/PAPs, 4) the RV basal diameter, 5) the RV free-wall strain and 6) the tricuspid regurgitation velocity; for the endothelium we evaluated the absolute difference between the radial artery diameters before and after 5 minutes of ischemia. We used a t-Student test (t-test) for unpaired samples with similar variances to verify the hypothesis that patients with altered RV parameters show a lower value in the absolute difference between radial diameters.

Results
Only EI and endothelial function showed a significant relation. In fact, with a level of confidence of the 95% we can say that patients with an EI&gt;=1,1 report a minor increase in radial artery diameter than patients with EI&lt;1,1.

Conclusions
In patients affected by SSc, the endothelial function is related to eccentricity index. Multicenter studies are needed in order to confirm the results of our study
354 THE ADDED VALUE OF MYOCARDIAL WORK IN EARLY DETECTION OF SYSTOLIC DYSFUNCTION IN CARDIAC AMYLOIDOSIS
Authors: Gaetano Fabrizio De , Losi Valentina , Consoli Alessio , Tamburino Corrado , Monte Ines Paola 
Published: December 2022

Abstract

Aim
The involvement of the heart represents the main determinant of mortality and morbidity for patients with systemic amyloidosis (SA). In cardiac amyloidosis (CA), numbered among the clearest examples of restrictive cardiomyopathies, EF (ejection fraction) often keeps itself preserved (≥ 50%) but this doesn't mean LV (left ventricle) systolic function couldn't be impaired, even in the early stages of disease. In this survey we searched for echocardiographic signs of early systolic impairment in CA: among them we adopted the analysis of myocardial work (MW), an emerging less load-dependent tool for the evaluation of cardiac performance.

Methods
We chose a cohort of patients (n=20; mean age 69±13 years) with AL or ATTR CA and we compared them with a control group (n=18; mean age 62±17 years) without evident cardiac damage. We examined their systolic and diastolic function and we calculated multilayer strain and all the contributors of MW from speckle tracking echocardiography.

Results
We found a statistically relevant difference in cardiac mass (138±35 versus 83±23 g/m2) and in signs of both systolic and diastolic function (LAVi, TR Vmax, E/e’) worsening between patients with CA and the control group. In CA average EF was 52±11% while the reduction in Global Longitudinal Strain (GLS) was significant, regardless of the considered wall layer and the stage of diastolic impairment. For our patients ejection fraction to strain ratio (EFSR, 4,41±1,38 vs 3,04±0,55), a simple way to quantify apical sparing, better underlined the dissociation between EF and strain than apex to base ratio. In CA we identified a dramatic decrease in Global Work Index (954±278 vs 2089±354 mmHg%) and Global Constructive Work (1103±323 vs 2376±390 mmHg%), with no significant difference between AL and ATTR amyloidosis.

Conclusions
The infiltration by amyloid and the consequent increase in cardiac mass lead to an early and often severe weakening of the intrinsic contractility of the heart in both AL and ATTR amyloidosis, even when ejection fraction is normal or slightly reduced. Therefore, we suggest the analysis of MW starting from the first echocardiographic evaluation in patients with known SA or multiple myeloma.
1044 CHARACTERISTIC AND OUTCOME IN PATIENTS WITH LOW FLOW, LOW GRADIENT AORTIC STENOSIS
Authors: Ferruzzi Germano Junior , Cristiano Mario , Peluso Angela Pamela , Migliarino Serena , Bellino Michele , Iuliano Giuseppe , Silverio Angelo , Attisano Tiziana , Baldi Cesare , Vigorito Francesco , Giordano Arturo , Vecchione Carmine , Ciccarelli Michele , Galasso Gennaro , Citro Rodolfo 
Published: December 2022

Abstract

Aim
The aim of this study was to assess the prevalence and outcome in patients with severe low flow, low gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve intervention (TAVI).

Methods
Patients with LFLG AS undergoing TAVI from 2013 to 2022 were prospectively collected.
Clinical, imaging data and procedural parameters were collected. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient &lt;40 mmHg and stroke volume index &lt;36 ml/m2. Overall population was classified in due subgroups: classical LFLG AS if left ventricular ejection fraction (LVEF) was &lt;50%, and paradoxical in patients with preserved LVEF. The major comorbidities and primary outcome defined as a composite of all-cause mortality and rehospitalization for worsening heart failure (HF) up to 1 year in the different subtypes of severe LFLG AS undergoing TAVI were evaluated.

Results
The study included 268 patients [81±6 years; 142 (53%) females]; of these, 155 patients (58%) had paradoxical LFLG AS and 113 patients (42%) had LFLG AS with low LVEF. Regarding echocardiography parameters, in the overall population the mean transaortic gradient was 31±6 mmHg, the mean iAVA 0.38±0.08 cm/m2, and the median LVEF 50% (IQR 38-55).
Compared with paradoxical LFLG AS, the patients with classical form were characterized by a lower percentage of women (43% vs. 60% p 0.07), worse renal function (46% vs. 30%, p 0.012), and a significantly higher number of cardiovascular disease as coronary artery disease (52% vs. 29%, p &lt;0.001) and atrial fibrillation (37% vs. 23%, p 0.018), resulting in higher Society of Thoracic Surgeons scores [7,34% (IQR: 4.96 to 13,25) versus 5,36% (IQR: 3,22 to 11); p value 0.037]. Higher percentage of patients of New York Heart Association functional class III or IV (61% vs. 27%; p 0.037) was observed in classical LFLG AS.
At one-year follow-up, the composite outcome was reported in 49 patients (18%), 21 patients (13%) had paradoxical LFLG AS and 28 patients (24%) had classical form.
Kaplan-Meier survival free from the composite outcome was significantly lower in patients with classical LFLG AS compared to those paradoxical LFLG AS (Log-Rank 0,022, Figure 1).

Conclusion
LFLG AS is a complex population with significant incidence of adverse event at one years. Patients with classical LFLG AS have higher number of risk factor and cardiovascular disease and lower survival compared paradoxical form.
Figure 1
468 EFFECT OF AGE ON GLOBAL KINETIC ENERGY DISSIPATION WITHIN THE LEFT VENTRICLE. AN ECHOCARDIOGRAPHIC STUDY.
Authors: Martini Marika , Fiorencis Andrea , Pergola Valeria , Grandi Silvia , D´andrea Emilio , Cozza Elena , Iliceto Sabino , Mele Donato 
Published: December 2022

Abstract

Background
The echocardiographic evaluation of the left ventricular function is traditionally based on parameters of cardiac mechanics and analysis of transvalvular blood flow, but recently the study of intracardiac fluid dynamics has been proposed as an integrative approach to the assessment of cardiac function. More precisely, dissipation of the kinetic energy of blood moving within the left ventricle (global kinetic energy dissipation, gKED) during the entire cardiac cycle (systole and diastole) can now be evaluated in a very practical way using the new non-contrast, color Doppler based HyperDoppler technique. Although feasibility of this technique and reproducibility of gKED have been demonstrated, the effect of age and its consequences have not been clarified.

Objectives
The purpose of this study was to evaluate: 1) the effect of age on gKED measures; and 2) whether this impacts on the ability of gKED to differentiate physiological and pathological hemodynamic models, expected to have different loss of kinetic energy within the left ventricle.

Methods
Two groups of individuals were considered for this study: 50 normal subjects (physiological model) and 50 patients with chronic heart failure in stable clinical and hemodynamic condition, with no signs of clinical and echocardiographic increase of left ventricular filling pressure (pathological model). Normal subjects were divided into 3 age groups: 17-32 years (group I), 33-48 years (group II) and 49-64 years (group III). All participants underwent both standard and HyperDoppler echocardiography using a Esaote MyLab X8 echo scanner.

Results
In normal subjects, gKED decreased with age (group I 0.8, group II 0.59, and group III 0.27; P=0.001). In particular, this reduction was statistically significant between group III (age &gt;=49) and the other 2 age groups. At the multivariate analysis, gKED was associated with both age and peak of transmitral E-wave, while there was no association with left ventricular ejection fraction. Patients with heart failure showed lower gKED values (0.715 vs. 0.18, P&lt;0.001). HF patients with age &lt;49 years had a markdly different gKED compared with normals of the same age, while the difference in gKED between normals and HF patients with age &gt;= 49 years was much less pronounced, although significant (P&lt;0.003). HF patients were characterized by reduced left ventricular ejection fraction in addition to reduced peak E-wave and this may explain the low gKED values observed in these patients.

Conclusions
Our preliminary observations show that gKED depends on age but maintains the ability to differentiate two physiological and pathological hemodynamic and functional models. These results should be taken into account when applying the HyperDoppler technique in clinical practice for evaluation of gKED.
398 CARDIAC MAGNETIC RESONANCE PHENOTYPE AND GENOTYPE IN LEFT-SIDED CARDIOMYOPATHIES: CHARACTERIZATION AND CLINICAL OUTCOMES
Authors: Castrichini Matteo , De Luca Antonio , Paldino Alessia , Cittar Marco , Dal Ferro Matteo , Angelis Giulia De , Barbati Giulia , Medo Kristen , Groves Daniel , Quaife Robert , Eldemire Ramone , Gigli Marta , Stolfo Davide , Graw Sharon , Addison Jeffrey , Taylor Matthew Rg , Mestroni Luisa , Merlo Marco , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
The combined prognostic role of cardiac magnetic resonance (CMR) and genotype in cardiomyopathies has not been fully investigated. The aim of this study was to identify specific genotype-CMR phenotype correlations in a well-characterized cohort of patients with a spectrum of left-sided cardiomyopathies spanning from arrhythmogenic (ACM) to dilated cardiomyopathy (DCM), and analyze patients’ outcome.

Methods and Results
One-hundred and seventy-four patients with DCM (127) and left sided ACM (47), who underwent a comprehensive evaluation including genetic testing and CMR imaging, were enrolled in this study. The phenotype was classified as DCM or ACM according to current consensus criteria. The primary outcome was a composite of sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA). DCM patients showed more frequently pathogenic or likely pathogenic (P/LP) variants of non-arrhythmic genes (34% vs. 7%, p &lt; 0.001), whereas ACM patients reported more frequently P/LP variants of arrhythmic genes (47% vs. 8%, p &lt; 0.001) and non-ischemic free-wall LGE (30% vs. 10%, p = 0.002). After a median follow-up of 92 months (interquartile range 46 - 168), 39 patients (22%) reached the combined endpoint. Carrying a P/LP variant of arrhythmic genes (hazard ratio (HR) 2.2, 95% confidence interval (CI) 1.1 - 4.4, p = 0.024) along with presence of LGE (HR 4.5, 95% CI 1.99 - 11.5, p &lt; 0.001) were independently associated with the study endpoint.

Conclusion
In cohort of well-characterized left sided cardiomyopathies patients spanning from ACM to DCM, a P/LP variant of arrhythmic genes along with presence of LGE were independent predictors of SCD/MVA.
64 PULMONARY ARTERY INTIMAL SARCOMA: A CASE REPORT
Authors: Passaniti Giulia , Deste Wanda , Cannizzaro Maria Teresa , Tosto Giuseppe , Tamburino Corrado 
Published: December 2022

Abstract
We present the case of a 56-years old man, with a history of smoking and chronic hypertension. From September 2021, he began experiencing shortness of breath, with marked limitation of ordinary physical activity. He underwent a cardiologic evaluation: an echocardiogram was performed, finding no alterations in the wall motions, but founding an increased atrioventricular gradient in the right heart and an augmented systolic pulmonary arterial pressure. Also, the acceleration time in the pulmonary artery was increased. Patient's physician prescribed him laboratory exams that resulted within normal ranges, with no increased levels of D-dimer and Chest X-ray in which it resulted to be a nodule, in the lower lobe of the left lung, that was biopsied in our center.
We evaluated the patient with CT scan, CT angiography, PET-scan and cardiac MRI and discovered that the increased pressure in the pulmonary artery was due to a non-better specified tumor, which was then completely resected.
After one month, the final diagnosis came back: poorly differentiated pleomorphic sarcoma, with high mitotic index and large areas of necrosis, characterized mainly by spindle cells and cells with epithelioid morphology; furthermore, there was a formation of vascular spaces surrounded by pleomorphic cells and areas of lower density cells with myxoid stroma and hemangiopericytoma-like aspects. Considering several factors such as anamnesis, localization of the tumor, growth from the tunica intima of the pulmonary artery and immunophenotypic expression, the tumor was diagnosed as a pulmonary arterial intimal sarcoma.
948 MULTIMODALITY IMAGING IN CARDIAC MASSES
Authors: Angeli Francesco , Bergamaschi Luca , Stefanizzi Andrea , Armillotta Matteo , Sansonetti Angelo , Amicone Sara , Bodega Francesca , Fedele Damiano , Canton Lisa , Suma Nicole , Tattilo Francesco Pio , Impellizzeri Andrea , Galiè Nazzareno , Rinaldi Andrea , Paolisso Pasquale , Foà Alberto , Pizzi Carmine 
Published: December 2022

Abstract

Background
Cardiac masses (CM) are an extremely heterogeneous clinical scenario, including benign and malignant neoformations. After a first echocardiographic assessment, Cardiac Computed Tomography (CCT) together with Cardiac Magnetic Resonance (CMR) and 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG-PET) represent second-line and third-line imaging techniques to determine the nature of the mass. However, data regarding their diagnostic performance and a standardized imaging algorithm are lacking.

Purpose
To evaluate the different roles of CCT, CMR, and PET in defining the nature of CMs and to propose an evidence-based, stepwise, diagnostic approach.

Materials and methods
Out of 312 patients with suspected mass from January 2000 and August 2022, we enrolled 87 patients who underwent CCT, CMR and 18-FDG-PET within a month from the initial evaluation. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. For each imaging technique, we identified a model with the strongest predictors of malignancy at multivariate analysis and evaluated their ability to discriminate between benign and malignant neoformations. A multiple model with forwarding selection was performed to identify the strongest predictors of malignancy at CCT, CMR and 18-FDG-PET.

Results
CCT model included 4 variables (irregular margins, mass dimension, invasiveness and not-hypodense lesion) with an Area Under the Curve (AUC) of 0.972, 95% Confidence Interval (CI) 0.94-1.0; CMR model included 3 parameters (invasiveness, pericardial effusion and irregular margins, AUC 0.976 with 95% CI 0.95-1.0); PET model included only cardiac maximum Standardized Uptake Value (SUVmax), with an AUC 0.87 (95% IC 0.74-0.971). When implemented with SUVmax, CCT and CMR models showed only a slight improvement in their discrimination ability (AUC 0.975 and 0.986, respectively). No statistical difference was observed between CCT and CMR models regarding their discrimination ability (AUC 0.972 vs 0.976, p=0.26). However, on a multiple model with forwarding selection evaluating CCT, CMR and PET variables, only the 3 MR parameters remained significant predictors of malignancy.

Conclusion
After a first echocardiographic assessment, the application of the CMR model may be the most accurate second-level investigation to discriminate between benign and malignant lesions. When CMR is not available, or the patient has contraindications to CMR, the CCT model performs similarly, and 18-FDG-PET provides a negligible advantage.
572 INTRAMYOCARDIAL CALCIFICATION IN APICAL HYPERTROPHIC CARDIOMYOPATHY ASSESSED USING MULTIMODALITY IMAGING: OUR CASE SERIES
Authors: Radano Ilaria , Mabritto Barbara , Luceri Stefania , Bongioanni Sergio , Maiellaro Francesco , Zappia Luca , Lario Chiara , Macera Annalisa , Cirillo Stefano , Pizzuti Alfredo , Musumeci Giuseppe 
Published: December 2022

Abstract

Introduction
Apical Hypertrophic Cardiomyopathy (ApHCM) characterized by persistent diastolic apical contraction results in dynamic apical small-vessel obstruction with microvascular ischemia. Of note, endomyocardial fibrosis (EMF) and calcification are described only in few patients.

Case presentation
We report 5 cases of ApHCM with apical intramyocardial calcification. They presented characteristic ECG pattern and fibrosis at echocardiogram. All patients presented a preserved ejection fraction (EF), except for one patient with mild reduced EF. Global longitudinal strain was reduced in 3 patients. Diastolic dysfunction was evidenced in 3 patients. Right ventricle involvement was detected in one patient only.On cardiac magnetic resonance, a superficial hypo-intense component, compatible with calcium and a deep layer featured by late gadolinium enhancement (LGE) related to fibrotic tissue, were revealed. LGE was present in all of patients in the apex. One patient presented an apical aneurysm, with high ESC-SCD risk score and ICD implantation.

Conclusion
EMF pathologic hallmarks were the endocardium and myocardium scarring, evolving to dystrophic calcification. In clinical practice, only a minority of ApHCM patients develops EMF and calcifications. Our clinical series is the largest one in literature. Analyzing patients’ history, a microvascular inflammatory trigger was evident in all of them, particularly severe chronic kidney disease, diabetes, high degree obesity, malaria infection, peripheral microangiopathy and form of thalassemia. This series could demonstrate the pathophysiological relation between apical fibrosis, calcification and microvascular ischemia due to hypertrophy and inflammatory conditions coexistence. A broader case series could evaluate any correlation with their long-term outcome and management strategies.
817 IDENTIFICATION OF ECHOCARDIOGRAPHIC FACTORS PREDICTING MACE AT 30 DAYS FROM NON CARDIAC SURGERY IN A PRE-HOSPITALIZATION COURSE
Authors: Rizzi Fabio , Martucciello Arianna , Goffredo Costanza , Grigioni Francesco 
Published: December 2022

Abstract

Background
200 million adults all over the world undergo noncardiac surgery each year, of which more over than 10 million develop MACE within 30 days of surgery. Cardiovascular complications represent the majority of the causes of mortality and morbidity (incidence from 0.5% to 30%), especially myocardial infarct and atrial fibrillation. Ecocardiographic patterns of increasing atrial size and reduction ejection fraction (EF) related to ischemic injury after surgery are related to the construction of a proarrhythmic substrate.

Methods
The study carried out at the Campus Bio-medico Polyclinic recruits a population of 100 candidates for non-cardiac surgery at intermediate or elevated-risk and with cardiac disease or cardiovascular risk factors. These patients after clinical and 12-lead ECG examination have done echocardiographic study, with evaluation of Global ventricular longitudinal strain, left atrial volume, left ventricular ejection fraction, left ventricular filling volumes and aortic vessel diameters.

Results
Patients underwent a follow-up 30 days after surgery and it was shown that there is a important significance in relation to Global Longitudinal Strain (p = 0.01) in MACE patients and a modest significance in relation to the ejection fraction (p = 0.07) among MACE patients. Patients with atrial fibrillation (p = 0.10) and type 2 diabetes mellitus (p = 0.15) have a mild predisposition to MACE. Maiority of events were 30 day after surgery in patients with elevated risk.

Conclusion
This study underlines the importance of careful preoperative selection and appropriate cardiological postoperative patient evaluation and the value of echocardiographic predictive factors of main perioperative cardiovascular events.