bluuebunny/crossref_metadata_2025_split huggingface dataset:
256 LEFT ATRIAL STRAIN ANALISIS IMPROVES NON-INVASIVE ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES IN TAKOTSUBO SYNDROME
Authors: Iannaccone Giulia , Graziani Francesca , Del Buono Marco Giuseppe , Camilli Massimiliano , Lillo Rosa , Vecchia Giulia La , Caffè Andrea , Pedicino Daniela , Sanna Tommaso , Trani Carlo , Lombardo Antonella , Lanza Gaetano Antonio , Montone Rocco A , Crea Filippo 
Published: December 2022

Abstract

Background
Takotsubo syndrome (TTS) is associated with a non-negligible risk of in-hospital complications. Elevated left ventricular filling pressures (LVFP) showed to predict adverse outcomes in this population. Recently, LA reservoir and LA pump strain, demonstrated a close correlation with increased LVFP in unselected patients. The aim of our study is to assess the ability of LA strain analysis to improve non-invasive estimation of LVFP and to predict IH complications in TTS patients.

Methods
We prospectively enrolled patients with confirmed TTS diagnosis. LVEDP was assessed invasively at the time of catheterization. Transthoracic echocardiography was performed within 48 hours from hospital admission. In-hospital complications were collected, including occurrence of acute heart failure, death from any cause and life-threatening arrhythmias.

Results
A total of 62 patients were analysed (72.2±10.1 years, female 80%). In-hospital complications occurred in 25 (40.3%). Patients who experienced IH complications had higher LVEDP and lower LVEF, LA reservoir strain and LA pump strain values compared to patients without IH complications (all p&lt;0.001). However, at multivariate analysis, only LVEF and LVEDP were independent predictors of worse IH outcomes (p&lt;0.001 and p=0.004, respectively). We observed that in our population the optimal LVEDP cut-off value to predict adverse in-hospital outcome was 24.5 mmHg (sensitivity 80%, specificity 63%). LA reservoir and pump strain resulted to be better predictors of LVEDP &gt;24.5 mmHg in comparison with E/e’, LAVi and tricuspid regurgitation (TR) peak velocity. Moreover, the incorporation of LA strain values in a multivariable model including E/e’ ratio, LAVi and TR peak velocity to predict a LVEDP&gt;24.5 mmHg led to a significant incremental predictive value (p=0.002).

Conclusion
In patients with TTS, lower LA reservoir and pump strain values correlate with increased LVEDP and improve non-invasive estimation of LVFP. LA strain analysis may be an easy tool to individuate subjects at higher risk of in-hospital complications.
897 PEAK RIGHT ATRIAL LONGITUDINAL STRAIN: A NEW PARAMETER IN PREDICTING VENOUS CONGESTION
Authors: Niro Lorenzo , Iseppi Manuela , Fanti Diego , Maffeis Caterina , Bergamini Corinna , Rossi Andrea , Tafciu Elvin , Benfari Giovanni , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Background
tricuspid regurgitation (TR) of either organic or functional etiology can lead to systemic venous congestion particularly in its more severe forms. Little is known about the role of the right atrium (RA) which acts as an intermediate player between TR and systemic veins.

Purpose
to assess the influence of right atrial size and function on venous congestion in TR patients.

Methods
101 stable patients with at least mild to moderate TR were enrolled at the time of echocardiography (age 74±13 years, 37% male). Systemic congestion was assessed by inferior vena cava (IVC) diameter and right atrial pressure (RAP) estimated according to inferior vena cava diameter and collapsibility. TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RA and right ventricular (RV) function were assessed respectively by peak atrial longitudinal strain (PALS) and free wall longitudinal strain (FWLS) while indexed RA volume (RAVi) by Simpson's disk summation method.

Results
TR was quantified mild or moderate in 52 patients and more than moderate in 49 patients (mean EROA 37±31 mm2; mean RVol 34±23 ml). Mean indexed RA volume was 58±31 ml/m2; mean RA strain was 18±11% and mean RV strain (free wall) was -21 ± 7%. Mean IVC diameter was 20±6 mm; estimated RAP was ≤5 mmHg in 32 patients, 6-10 mmHg in 26, 11-15 mmHg in 26 and greater than 15 mmHg in 17 patients. In univariate analysis both IVC diameter and RAP correlated significantly with EROA, RVol, RAVi and RA strain (p&lt;0.0001 for all); only RAP correlated with RV strain. In linear multivariate analysis only RAVi and RA strain were independent predictors of IVC diameter (p=0.01 and &lt;0.0001, respectively), and only RVol and RA strain were independent predictors of RAP (p=0.001 and 0.002, respectively). We found a RA strain cut-off of -15% to have a sensitivity of 82% and specificity of 70% to identify a RAP greater than 15 mmHg (area under the curve-AUC 0.842).

Conclusions
RA size and function together with the TR-related volume overload were independent predictors of venous congestion. Among these variables, only RA strain predicted both parameters of venous congestion.
1082 LEFT VENTRICULAR FUNCTION ESTIMATION: WHEN VOLUMES MEASUREMENT IS NOT FEASIBLE
Authors: Pazzi Sara , Maffignoli Laura Bariselli , Bertani Gabriele , Bergamini Corinna , Pegoretti Monica , Siviero Valentina , Giorgio Daniela , Maffeis Caterina , Tafciu Elvin , Benfari Giovanni , Rossi Andrea , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Background
Contrast echocardiography is mainly performed for the assessment of global left ventricular (LV) function, left ventricular ejection fraction (LVEF) and stroke volume (SV) thanks to improved visualization of endocardial LV borders. Neverless in some patients estimation of ventricular volumes could be difficult also with contrast and assessment of LVEF can be really hard. The aim of the study was to find alternative methods for LV function evaluation independent from volume assessment.

Methods
Patients who underwent a contrast echocardiography between October 2015 and September 2022 were enrolled in the study. A complete transthoracic echocardiography was performed and Sonovue contrast was then injected. End-diastolic and end-systolic LV volume in apex 4 and 2 chamber views, were measured prior and after injecting contrast. Left ventricular outflow tract diameter (LVOTd) was measured and LVOT velocity time integral was traced in order to calculate LVOT VTI Stroke Volume (product of LVOT cross sectional area to the LVOT VTI). LVOT VTI SV obtained during traditional echocardiography was then compared to LV SV calculated as the difference between end-diastolic and end-systolic volume traced after contrast. After intravenous bolus injection of Sonovue pulmonary transit time (PTT) was recorded as contrast agent's transit time from right to left ventricle in apex 4 chamber view (seconds). PTT was then compared to measures of LV function: LVEF with and without Sonovue and LV SV with contrast.

Results
149 patients were enrolled in the study, 86 had history of CAD, 31 presented dilatative cardiomyopathy, 5 hypertrophic cardiomyopathy (HMC), 113 had arterial hypertension, and 37 diabetes. Medium BMI was 28. The main indications for contrast echocardiography were measurement of EF and exclusion of thrombi in LV apex. LVOT VTI SV was calculated in 126 patients. In the same patients LVEF Stroke Volume was calculated. A strong correlation (P value &lt; 0.0001) between LVOT VTI SV and LV SV was found (Figure 1). PPT was calculated in 74 patient and in the same patients LVEF with and without contrast (Figure 2) and LV SV were calculated. A strong correlation (P-value &lt;0.048, p-value&lt;0.006 and p-value &lt; 0.046 respectively) was found.

Conclusion
This study demonstrates that, besides extremely poor acoustic windows, bedside echocardiography, with and without contrast, can be used to estimate LV function using volume-independent methods like PTT and LVOT VTI SV.
186 RARE CASE OF A GIANT THYMIC CYST: A CHALLENGING DIFFERENTIAL DIAGNOSIS OF A PARACARDIAC CYSTIC LESION
Authors: Schiavo Maria Alessandra , Foroni Marco , Coccolo Fabio , Graziosi Maddalena , Attinà Domenico , Dolci Giampiero , Galiè Nazzareno 
Published: December 2022

Abstract

Background
Benign thymic cysts are a rare clinical entity, representing approximately 3% of all mediastinal masses. Thymic cysts can be congenital or acquired. We describe a case of a 58-year-old female with a giant benign thymic cyst which entered in differential diagnosis with a pericardial cyst and pericardial effusion.

Case presentation
A 58-year-old female was brought to our hospital due to new onset dyspnoea and fatigue. She had a history of a liquid mediastinal mass accidentally discovered 9 years before which was interpreted at that time as a loculated pericardial effusion (Fig. 1). An echocardiogram was performed which showed increased size of the known lesion without any signs of hemodynamic compromise (Fig. 2). A magnetic resonance showed a voluminous liquid lesion that originated from the anterior mediastinum, extending caudally to the diaphragm with maximum dimensions on the right hemithorax of 16×12×9 cm (antero-posteriorly, transversely and cranio-caudally respectively) and of 10×5×13 cm on the left hemithorax (Fig. 3). It was initially interpreted as a pericardial cyst. All the findings were then collegially reviewed and for the first time it was suspected of being a giant thymic cyst, especially due to its spatial distibution and growth over time; in particular the cranio-caudal growth in both the hemithoraxes suggested that it might have originated from the thymus gland and then, by force of gravity, extended downword bilaterally. The cyst was surgically removed using a unilateral thoracoscopic approach. Histological examination confirmed the thymic origin of the cyst and excluded malignancy. At the three month follow up, the patient presented no symptoms, and the echocardiogram was normal.

Discussion
The echocardiographic features of mediastinal cysts are not lesion-specific, so the origin and location of the cyst can be used for differential diagnosis. Computed tomography has the best spatial resolution, while the magnetic resonance has better capacity to differentiate the content of the cyst, especially when it is not a homogeneous liquid lesion. In our case, spatial distribution and, in particular, growth over nine years were crucial hints to suspect the thymic origin of the lesion. Indeed, the sole evaluation of the last imaging exam would have made the diagnosis more problematic because of its huge dimensions, which made the exact site of origin very challenging to identify.

Conclusion
Our case is a rare example of a giant thymic cyst which was extremely difficult to differentiate from other paracardiac cystic lesions and required integrated imaging and discussion by a team of experts of different specialties to make the correct diagnosis.
876 VENTRICULAR SEPTAL DEFECT AND RIGHT-SIDED INFECTIVE ENDOCARDITIS
Authors: Sforna Stefano , Del Papa Marco , Grikstaite Egle , Sardone Mariagrazia , Savino Ketty 
Published: December 2022

Abstract

Introduction
Right-sided infective endocarditis (IE) accounts for 5-10% of IE cases; it is most frequently associated with intravenous drug abuse but can also be observed in patients with cardiac implantable electronic devices, central venous catheters or congenital heart diseases.

Case report
A 34-year-old female, with unrepaired perimembranous ventricular septal defect (VSD) and right ventricle and tricuspid valve (TV) IE with lung septic embolism treated conservatively with antibiotic therapy 16 years ago, was admitted to our hospital for persistent fever and cough unsuccessfully treated with empiric antibiotic therapy. She denied intravenous drug abuse and recent surgical or dental procedures. Blood cultures resulted positive for multi sensitive Staphylococcus lugdunensis, so antibiotic therapy with Oxacillin and Gentamicin was started. Suspecting IE, transesophageal echo (TEE) was performed and showed, inside VSD, a small fluctuating vegetation and, along the right side of the interventricular septum, next to the VSD, a voluminous hypomobile vegetation; septal and anterolateral TV leaflets appeared thickened and infiltrated by vegetations floating into the right atrium; at color-Doppler moderate TV regurgitation. A whole-body computed tomography showed right lung abscess and right kidney septic infarct. Endocarditis Team, considering hemodynamic stability and inflammatory biomarkers and surveillance blood cultures negativization, decided for medical therapy with echocardiographic follow-up. TEE performed at the end of antibiotic therapy demonstrated complete disappearance of the above described vegetations and surgical VSD closure was scheduled.

Discussion
Patients with unoperated small VSDs and without volume overload signs usually remain asymptomatic and do not require surgery; nevertheless, a small percentage of them develops problems later in life and IE represents one of the main concerns. Even if unrepaired VSD is associated with increased risk of IE compared with the general population, antibiotic prophylaxis is still recommended only for high-risk patients undergoing at-risk dental procedures, while non-specific oral and cutaneous hygiene measures should always be applied. Latest ESC Guidelines for the management of adult congenital heart disease state that in patients with no significant left to right shunt, but a history of repeated episodes of IE, VSD closure should be considered (IIa, C); it's still matter of debate whether closure should be performed after the first episode of IE.

Conclusion
IE should always be suspected in patients with VSD and persistent fever. Optimal oral and skin hygiene are effective prevention measures, while prophylactic antibiotic therapy is indicated only in selected cases. Surgery should be considered after repeated episodes of IE.
114 SURVIVAL OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AND CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION LISTED FOR LUNG TRANSPLANTATION
Authors: Magnani Ilenia , Manes Alessandra , Dolci Giampiero , Salvaterra Elena , Daddi Niccolò , Paganelli Gian Maria , Antonacci Filippo , Guarino Daniele , Dardi Fabio , Palazzini Massimiliano , Galiè Nazzareno , Manes Alessandra 
Published: December 2022

Abstract

Background
despite the approval of pulmonary arterial hypertension (PAH) specific therapies, bilateral lung transplantation (LT) remains the therapeutic option of choice for patients that fail to reach an adequate clinical and hemodynamic response on maximal medical therapy.

Methods
we describe the survival of transplant recipients (TR) patients in comparison to not-transplanted (NT) patients in a single tertiary PAH centre. We included patients with Group 1 PAH and non-operable CTEPH who were listed for lung transplantation at our Centre from January 1999 to February 2022. The survival of NT, TR and of all listed patients was evaluated starting from the date of listing (patients were censored as alive at the time of LT in the intention to treat analysis). The survival of TR was also evaluated starting from the date of the LT. Kaplan Meier curves and log rank test were used for survival analysis. Data are expressed as median (interquartile range).

Results
141 patients were included (80% had Group 1 PAH). Fifty-eight (41%) patients were transplanted, after a mean waiting time of 17 (5-36) months. Of the 83 NT patients 53 (38%) died while on the list and 30 (21%) were alive on the list up to February 2022. The survival of all patients since listing (intention to treat analysis) at 1, 3 and 5 years was 83%, 54%, 45% respectively. The survival of TR at 1, 3, 5 and 10 years since transplantation was 67%, 65%, 62% and 57% respectively. When comparing, NT and TR patients’ survival since listing, TR patients had a better survival than NT patients [survival at 1, 3 and 5 years of 88%, 72% and 66% vs 73%, 42% e 34% for TR and NT patients, respectively (p= 0.0002)].

Conclusions
our experience demonstrated that TR's survival at our center is in line with principal European national registries and confirmed that the risk of death in the first-year post-transplant is higher for patients with pulmonary hypertension than it is for other diseases which might require LT. Finally, our study showed that the prognosis of patients listed is extremely poor and that, despite biases in the comparison of non-randomized groups, survival of TR is better than the one of NT patients.
346 IMPACT OF EXERCISE-INDUCED PULMONARY HYPERTENSION ON THE RIGHT VENTRICLE AND WORSENING OF CARDIOVASCULAR RISK IN HIV PATIENTS
Authors: Ridolfi Lorenzo , Biondi Filippo , Morganti Riccardo , Fabiani Silvia , Forniti Arianna , Iapoce Riccardo , De Caterina Raffaele , Madonna Rosalinda 
Published: December 2022

Abstract

Background and Aim
Exercise-induced pulmonary hypertension (ExPH), due to impaired pulmonary vascular and right ventricular contractile reserve on effort,predicts clinical outcomes, such as all-cause mortality or cardiovascular (CV) hospitalizations in patients with dyspnea on effort. We investigated its prognostic significance in HIV patients at risk for Pulmonary Arterial Hypertension (PAH).

Methods
In 52 consecutive HIV patients with either low (n=47) or intermediate probability (n=5) of PH at rest, we evaluated at time 0 and after 2 years the prognostic determinants of CV risk: onset or progression of heart failure/syncope; worsening of functional class; functional performance at the 6-Minute Walking Test and at cardiopulmonary exercise test (CPET); right atrial area; and pericardial effusion. We assigned a severity score 1-3 to each prognostic determinant, derived an overall CV risk score, and its 0-2 years change. Patients were classified as either at low, intermediate or high probability of ExPH at Stress Echocardiography (ESE), while ExPH at CPET was defined as absence of PH at rest, reduced peak VO2, VE/VCO2 &gt;30 at anaerobic threshold, reduced O2 pulse, and ΔVO2/ΔW &lt;9 mL/min/W. We then correlated ExPH at time 0 with clinical worsening (risk score increase &gt;20% after 2 years).

Results
Right ventricle (RV) systolic function was significantly reduced in patients with ExPH compared to those without ExPH at CPET, as well as in patients with intermediate/high compared to those with low probability of ExPH at ESE, who exhibited worse values of TAPSE and FAC (p&lt;0.001 and p=0.01, respectively). A significant higher proportion of patients with ExPH (CPET) or with intermediate/high probability of ExPH (ESE) had higher sPAP (p&lt;0.001), mPAP (p=0.004), higher TRV (p=0.006) as well as higher right atrial area (p&lt;0.001) and indexed right atrial volume (p=0.004). Total pulmonary vascular resistance (expressed by the ratio between TRV and velocity-time integral at the level of right ventricular outflow tract) was higher in patients with ExPH as well as in patients with intermediate/high probability of ExPH (p&lt;0.001). Patients with intermediate/high probability of ExPH at ESE showed a trend towards clinical worsening compared to those with low probability of ExPH, albeit not statistically significant (p=0.137). In patients with low probability of ExPH, none had &gt;20% increased CV risk score after 2 years. We found an association between higher NT-proBNP and the presence or intermediate/high probability of ExPH after 2 years (p=0.048 at CPET, p=0.033 at ESE).

Conclusions
At short follow-up, ExPH is associated with a worsening trend in the CV risk score which, if confirmed after longer follow-up, could contribute to better risk stratification in HIV patients.
729 BIOMARKERS FOR EARLY DIAGNOSIS OF CARDIAC INVOLVEMENT IN SYSTEMIC SCLEROSIS
Authors: Tifi Priscilla , Pala Barbara , Tempestini Federica , Cristiano Ernesto , Bocci Alessandro , Rosato Edoardo , Salerno Gerardo , Romaniello Antonella 
Published: December 2022

Abstract

Introduction
Systemic Sclerosis (SSc) is an autoimmune disease characterized by microvascular damage, immune system dysregulation and fibrosis of skin and internal organs. It is reported that asymptomatic involvement of the heart was found in 70% of SSc patients. The role of biomarkers in the early detection of fibrosis and vascular damage in SSc is not yet completely defined. Serum levels of sST2, Galectin 3, ANP, IL6 are a potential marker of cardiac involvement. In patients with chronic heart failure elevated levels of galectin-3 (&gt;17.8 ng/ml) are a marker of worse prognosis. Moreover, a previous study reported a possible role of galectin-3 as an independent predictor of all-cause and cardiovascular mortality in SSc.

Material and Methods
We enrolled 62 SSc patients (53 females, median age 52 years) who fulfilled inclusion criteria.
35 patients had limited cutaneous SSc and 27 diffuse cutaneous SSc.
30 Healthy Controls (HC) were also enrolled [20 females; median age 50 years].
All SSc patients had normal echocardiographic and cardiac MRI findings.

Results
In SSc patients, the median Galectin value was 16.7 ng/ml, significantly higher than HC median (10,7 ng/Ml).
sST2 and IL-6 median value was 30 ng/mL and 12,3 pg/mL respectively, which resulted significantly higher than the median value of HC patient (21,55 ng/mL and 4,5 pg/mL respectively).
Therefore, there was a significant difference in biomarkers levels in the SSc group compared with controls.

Conclusion
These data suggest that these biomarkers can help identify a subgroup of SSc patients, with normal echocardiographic and RMN findings, who are at risk of developing heart involvement. In fact, all patients are scheduled for yearly echocardiographic re-evaluation as ESC guidelines recommend for earlier detection of pulmonary arterial hypertension (PAH), a leading cause of death in systemic sclerosis (SSc).