bluuebunny/crossref_metadata_2025_split huggingface dataset:
330 INTRAVENOUS CANGRELOR INFUSION IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: PRELIMINARY RESULTS OF THE ICARUS REGISTRY
Authors: Benenati Stefano , Gragnano Felice , Scalamera Riccardo , Bertero Edoardo , Capolongo Antonio , Sio Vincenzo De , Musumeci Giuseppe , Annibali Gianmarco , Campagnuolo Salvatore , Galasso Gennaro , Silverio Angelo , Bellino Michele , Centore Mario , Menozzi Alberto , Caretta Giorgio , Rezzaghi Marco , Luca Leonardo De , Veneziano Francesco Antonio , Cirillo Plinio , Rosa Gennaro De , Calabrò Paolo , Porto Italo 
Published: December 2022

Abstract

Aims
To investigate the prevalence of high bleeding risk (HBR) criteria and compare clinical outcomes between HBR and non-HBR 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. HBR status was assessed according to the Academic Research Consortium (ARC-HBR) definition. 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.

Results
We enrolled 551 patients undergoing PCI with cangrelor between January 2019 and August 2022. HBR definition was met in 33% of cases. HBR patients were older (76±10 vs. 63±10 years, p&lt;0.001), more frequently affected by peripheral arterial disease (16% vs. 8%, p=0.010), atrial fibrillation (24% vs. 2%, p&lt;0.001), chronic kidney disease (35% vs. 3%, p&lt;0.001), active cancer (7% vs. 0%, p&lt;0.001) and heart failure (17% vs. 7%, p&lt;0.001). At 48 hours, HBR patients had a significantly higher rate of NACE (13% vs. 6%, p=0.004), and BARC 2, 3 or 5 bleeding (12% vs. 4%, p=0.001). In the HBR group, the frequency of the primary endpoint increased proportionally to the HBR score. There was no significant difference with respect to other 48-hour and in-hospital endpoints.

Conclusions
Among consecutive patients treated with cangrelor in the peri-PCI phase, about 30% fulfilled the ARC-HBR definition. In the HBR subpopulation, the incidence of 48-hour adverse events was higher than in the non-HBR subgroup, primarily driven by a higher rate of clinically relevant and major bleeding.
744 LEFT ATRIAL DISSECTION AFTER MITRACLIP IMPLANTATION: ECHOCARDIOGRAPHIC FEATURES
Authors: Carbone Andrea , Aquila Iolanda , Ielapi Jessica , Pasceri Eugenia , Chiarello Claudia , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro 
Published: December 2022

Abstract

Introduction
the MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR), presenting very low adverse event rates. Left atrial dissection (LAD) is defined as a gap from left atrial wall.

Aim
we report a case of LAD occurring after MC implantation, treated conservatively, focusing on suggestive echocardiographic features.

Materials and methods
transthoracic and transesophageal echocardiography with 3D reconstructions were performed.

Results
the patient was a 73-years-old woman with symptomatic severe MR due to flail leaflet, treated with MC. Seven days later, the echocardiography showed a large mass in the left atrium not visible previously, initially thought to be a thrombus. Further investigation using transoesophageal echocardiography showed a large formation, with uneven echogenicity, at the level of the left atrium without signs of obstructing mitral valve inflow. 3D-rendering was also performed, revealing an echolucent area between the endocardium and the left atrial free wall, presenting increase echogenicity portions, suggestive of being LAD with partial thrombosis inside. The patient was treated with unfractionated heparin and after six days the echocardiogram showed complete resolution of thrombotic elements, with residual double-track linear hyperechoic formation within the atrial posterior wall, identifying an anechoic space. Therefore, the echocardiographic features suggested the diagnosis of left atrial intramural hematoma, initially thrombosed, then dissolved.

Conclusions
LAD is a rare complication either of cardiosurgical and transcatheter procedures. Both operator awareness and imaging features are important for diagnosis. 3D rendering can be useful in the early differential diagnosis, facilitating an optimal management.
939 PROGNOSTIC IMPACT OF THE COAPT INCLUSION AND EXCLUSION CRITERIA IN REAL WORLD PATIENTS WITH SECONDARY MITRAL REGURGITATION UNDERGOING MITRACLIP IMPLANTATION
Authors: Serratore Serena , Polimeni Alberto , Mongiardo Annalisa , Spaccarotella Carmen , Messina Chiara , Vizzari Francesca , Velato Letizia , Di Costanzo Assunta , Ciliberto Federica , Indolfi Ciro 
Published: December 2022

Abstract

Background
The COAPT randomized trial has shown a huge benefit in the survival of patients with heart failure and functional mitral regurgitation treated with Mitraclip. However, patients in COAPT trial were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear.

Methods and Results
The present study examined the clinical outcome in consecutive patients (n=146) with symptomatic moderate-to-severe or severe MR of dominant functional etiology undergoing Mitraclip therapy by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction &gt;20%, left ventricular end-systolic dimension &lt;70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure &lt;70 mmHg, mitral valve orifice area &gt;4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). The primary endpoint was the composite of all-cause mortality or heart failure hospitalization. Secondary endpoints were the single components of the primary endpoint (heart failure hospitalization, all-cause mortality) and cardiovascular mortality. Among 146 patients who underwent Mitraclip implantation 35.6% fulfilled the inclusion criteria of COAPT. The composite endpoint was significantly less frequent in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria [HR 0.3851 (0.2266 to 0.6642); p=0.0017] (Figure).

Conclusion
In this single center study the outcome of patients with functional mitral regurgitation undergoing Mitraclip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility.
841 ASSOCIATION BETWEEN CARDIORESPIRATORY SYMPTOMS AND LUNG FUNCTION IN PATIENTS WITH LONG-COVID SIGNS
Authors: Salvioni Elisabetta , Mapelli Massimo , Mattavelli Irene , Banfi Cristina , De Martino Fabiana , Vignati Carlo , Mancini Elisabetta , Harari Sergio , Rovai Sara , Tamborini Gloria , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
Many patients recovered from COVID-19 infection present a variety of symptoms which limits overall quality of life, as reduced exercise performance, dysfunctional breathing, cough, dyspnea, weakness and anxiety. This condition has been named long COVID. The origin of this symptomatology is still unclear. This study has the aim to analyse the relation between symptoms and respiratory function, focusing on the alveolar capillary membrane.

Methods
Consecutive patients with long COVID 19 symptoms after 6 months were included. Patients underwent full clinical evaluation, laboratory tests, echocardiography, thoracic CT scan, spirometry including alveolar capillary membrane diffusion by means of combined carbon dioxide and nitric oxide lung diffusion (DLCO/DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar capillary function. A questionnaire allowed to evaluate symptoms.

Results
We evaluated 204 post COVID-19 patients (age 56.5±14.5 y, 89 females (44%), BMI 25.7±4.0, 6% active smokers) referring to our hospital 171±85 days after the end of acute COVID-19 infection (Fig. 1). None of spirometry data was associated with long COVID 19 referred symptoms. SPB was not associated to differences in any of the referred symptoms. Subjects with lower capillary volume (VCap) have more frequently dyspnea, tiredness, fatigability and hair loss (Fig.2). CT scan lung damage correlated with SPB and membrane diffusion but not with VCap, exercise performance or VE/VCO2 slope.
The strongest correlation of SPB were with lung parenchyma damage and Vcap.

Conclusions
Our data suggest that a relevant reduction of alveolar capillary membrane function plays a central role in the long COVID cardiorespiratory symptoms.
465 LONG-TERM MAYOR ADVERSE CARDIOVASCULAR EVENTS AFTER COVID-19 INFECTION: A CLINICAL SCORE FROM A COHORT OF 2575 PATIENTS ENROLLED IN THE MULTICENTER INTERNATIONAL HOPE 2 REGISTRY
Authors: Santoro Francesco , Di Nunno Nicola , Centola Antonio , Cetera Rosa , Valeria Le Rose , Brunetti Natale Daniele 
Published: December 2022

Abstract

Background
Long-term consequences of COVID-19 infection are still partly known. According to some studies several patients may experience long term symptoms; however, predictors of long-term mayor adverse cardiovascular events among (MACE) patients with previous COVID-19 infection are unknown.

Aim of the study
To derive a simple clinical score for risk prediction of long-term MACE among patients with previous covid-19 infection.

Methods
2575 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from February 2020 to April 2021, and followed-up at long-term. A risk score was developed using a stepwise multivariable regression analysis.

Results
Out of 2575 patients enrolled in the HOPE-2 registry, 1481 (58%) were male, with mean age of 60±16 years. At long-term follow-up overall rate of MACE was 7.9% (202 of 2545 pts, 3.8% death, 1.3% coronary artery disease, 1.2% heart failure admission, 0.9% cardiac arrhythmias, 0.8% venous thrombosis, 0.7% cerebrovascular accident). After multivariable regression analysis, independent predictors of MACE were used to derive a simple prognostic score.
The HOPE-2 prognostic score may be calculated by giving: ½ point for every 10 years of age, 2 points for previous cardiovascular disease, 1 point for increased troponin serum levels during hospitalization, 2.5 points for heart failure and 3 points for sepsis during hospitalization, -1.5 points for vaccination at follow-up. Score accuracy at receiver operating characteristic curve analysis was 0.81.
Stratification into 3 risk groups (0-2, 3-5, and &gt;5 points) classified into low, intermediate and high risk. The observed MACE rates were 0.5% for low-risk patients, 4% for intermediate-risk patients, and 19.5% for high-risk patients (log-Rank p&lt;0.001).

Conclusions
The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 infection. High-risk patients may require a strict cardiological follow-up.
835 CARDIOMYOPATHIES: IS IT USEFUL TO ANALYZE MINOR GENES?
Authors: Mazzaccara Cristina , Barretta Ferdinando , Uomo Fabiana , Caiazza Martina , Monda Emanuele , Lombardi Raffaella , Losi Maria Angela , Limongelli Giuseppe , D´argenio Valeria , Frisso Giulia 
Published: December 2022

Abstract
The diffusion of Next Generation Sequencing (NGS)-based approaches has allowed the identification of cardiomyopathies and channelopathies pathogenic mutations in more than 200 different genes. Since also genes considered uncommon for a clinical phenotype are now included in molecular testing, the detection rate of disease-causing variants is increased. Here, we report the prevalence of genetic variants detected in a cohort of 133 patients, among which 73 showed complex or borderline phenotypes or a positive family history for SCD. The analysis was conducted by analyzing an enlarged panel of 129 genes, including 60 main genes associated to the different genetic cardiomyopathies (HCM, DCM, ACM, LQTS, BrS) and 69 genes without a strong or definitive evidence of disease association according to the NIH-funded Clinical Genome Resource (ClinGen), here named “uncommon genes”.
We identified 82 variants, of which 50 (61%) were identified in uncommon genes. Among these, thirty-five (70%) were reported as variants of unknown significance (VUSs), thirteen (26%) as pathogenic (P) or likely pathogenic (LP) mutations and 2 (4%) as novel (likely) benign (B/LB) variants, according to the American College of Medical Genetics (ACMG) classification. Interestingly, about 85% of P/LP variants identified in uncommon genes were in patients showing complex/unclear/borderline phenotypes or a positive family history for SCD.
These data support the need for an extended genetic testing, including genes that are not usually explored due to a currently poor association with the clinical phenotype, particularly when phenotype is borderline, in order to increase the diagnostic sensitivity of inherited cardiomyopathies and channelopathies genetic testing.
269 EFFECTS OF COLCHICINE TREATMENT AFTER MYOCARDIAL INFARCTION ON TOP OF STANDARD THERAPY: EVIDENCE FROM A PRECLINICAL STUDY
Authors: Aimo Alberto , Burchielli Silvia , Aquaro Giovanni Donato , Barison Andrea , Musetti Veronica , Masotti Silvia , Pucci Angela , Galvez-monton Carolina , Martinez-falguera Daina , Passino Claudio , Emdin Michele , Bayes-genis Antoni 
Published: December 2022

Abstract

Background
An intense inflammatory and fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Colchicine is an anti-inflammatory drug that has been reported to improve the outcome of patients with MI; its effects on LV remodeling have not been specifically investigated. We aimed to characterize the effects of the anti-inflammatory drug colchicine in an animal model of reperfused MI.

Methods
In 4-month-old pigs, MI was induced by occluding the LAD artery through an angioplasty balloon for 90 minutes. Pigs surviving MI induction were randomized in a 1:1 fashion to 2 arms:
The pigs underwent a first CMR scan 72 hours after MI induction, and another CMR at day 30. The pigs were then sacrificed the day after the second CMR. The primary efficacy endpoint was LGE mass (as a percentage of LV mass).

Results
The infarcted area at 72 hours (expressed as absolute mass or as a percentage of the LV mass) and the changes over 1 month did not differ significantly between pigs on colchicine plus standard therapy vs. those on standard therapy alone. When assessing the extent of fibrosis on the explanted hearts (as a percentage of the tissue sample areas) there was a trend toward a lower extent of myocardial fibrosis in pigs on colchicine plus standard therapy (p=0.091). The percent differences in LV volumes, ejection fraction and mass across the two CMR scans did not reach statistical difference.

Conclusions
The results from a pig model of reperfused MI suggest that colchicine has no additional effects to standard MI therapy on MI size and LV remodeling.
1134 IN-HOSPITAL ARRHYTHMIC BURDEN REDUCTION IN DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH SGLT2-INHIBITORS: INSIGHTS FROM THE SGLT2-I AMI PROTECT STUDY
Authors: Cesaro Arturo , Gragnano Felice , Paolisso Pasquale , Bergamaschi Luca , Gallinoro Emanuele , Sardu Celestino , Mileva Niya , Foà Alberto , Armilotta Matteo , Sansonetti Angelo , Amicone Sara , Impellizzeri Andrea , Esposito Giuseppe , Morici Nuccia , Oreglia Andrea Jacopo , Casella Gianni , Mauro Ciro , Vassilev Dobrin , Galiè Nazzareno , Santulli Gaetano , Pizzi Carmine , Barbato Emanuele , Calabrò Paolo , Marfella Raffaele 
Published: December 2022

Abstract

Background
Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) have shown significant cardiovascular benefits in patients with and without type 2 diabetes mellitus (T2DM). They have also gained interest for their potential anti-arrhythmic role and their ability to reduce the occurrence of atrial fibrillation (AF) and ventricular arrhythmias (VAs) in T2DM and heart failure patients.

Objectives
To investigate in-hospital new-onset cardiac arrhythmias in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-i vs. other oral anti-diabetic agents (non-SGLT2-i users).

Methods
Patients from the SGLT2-I AMI PROTECT registry (NCT05261867) were stratified according to the use of SGLT2-i before admission for AMI, divided into SGLT2-i users vs. non SGLT2-i users. In-hospital outcomes included the occurrence of in-hospital new-onset cardiac arrhythmias (NOCAs), defined as a composite of new-onset AF and sustained new-onset ventricular tachycardia (VT) and/or ventricular fibrillation (VF) during hospitalization.

Results
The study population comprised 646 AMI patients categorized into SGLT2-i users (111 patients) and non-SGLT2-i users (535 patients). SGLT2-I users had a lower rate of NOCAs compared with non-SGLT2-i users (6.3 vs.15.7%, p=0.010). Moreover, SGLT2-i was associated with a lower rate of AF and VT/VF considered individually (p = 0.032). In the multivariate logistic regression model, after adjusting for all confounding factors, the use of SGLT2-i was identified as an independent predictor of the lower occurrence of NOCAs (OR=0.35; 95%CI 0.14–0.86; p = 0.022). At multinomial logistic regression, after adjusting for potential confounders, SGLT2-I therapy remained an independent predictor of VT/VF occurrence (OR=0.20; 95%CI 0.04–0.97; p = 0.046) but not of AF occurrence.

Conclusions
In T2DM patients, the use of SGLT2-i was associated with a lower risk of new-onset arrhythmic events during hospitalization for AMI. In particular, the primary effect was expressed in the reduction of VAs. These findings emphasize the cardioprotective effects of SGLT2-i in the setting of AMI beyond glycemic control.
Trial registration: Data are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov Identifier: NCT05261867.
673 A CRACK AND A CLOT
Authors: Rochira Carla 
Published: December 2022

Abstract
A 74-year-old man with a history of ischaemic heart disease (multiple percutaneous coronary interventions (PCI)), broke his ankle. Therefore, he discontinued dual antiplatelet therapy (DAPT) -acetylsalicylic acid plus clopidogrel- and started enoxaparin sodium 4000 UI/day on medical advice. A few days later, he was admitted to the emergency department for refractory chest pain, vomit and syncope. Twelve-lead electrocardiogram (ECG) showed a sinus rhythm interrupted by frequent premature ventricular contractions in a pattern of trigeminy. The transthoracic echocardiogram revealed a mildly dilated LV with normal wall thickness and marked hypokinesis/ akinesis in apical, infero-lateral and antero-lateral walls, with a 33% ejection fraction. High sensitivity cardiac troponin was increased, and a second ECG showed a diffuse ST segment depression. The patient was loaded with aspirin and emergently taken to the cardiac catheterization lab. Coronary angiography showed a very late stent thrombosis of the left circumflex artery (LCx), with occlusion of the extreme distality of the second obtuse marginal artery and a 50-60% intrastent restenosis of the ostium-proximal tract of the left anterior descending artery (LAD). Given the non-obstructive nature of the thrombus, risk of peripheral embolization, TIMI flow grade 3 and improvement of symptoms, the decision was made to adopt a conservative strategy with loading dose of ticagrelor, heparin and tirofiban infusion. Besides, an optical coherence tomography (OCT) control was scheduled for the next day.
OCT of the LCx revealed a well apposed and well expanded stent with a non-obstructive residual thrombus, nevertheless not visible on angiography. Thus, the tirofiban infusion was prolonged up to 48 hours. OCT of the LAD detected a fibro-calcific disease determining a significant restenosis of the distal left main (LM)-LAD ostium. OCT-guided provisional stenting with two drug eluting stents on LM-LAD-LCx was performed successfully. The patient was discharged home on acetylsalicylic acid (lifelong), ticagrelor (for 12 months) and enoxaparin sodium 4000 UI/day (according to specialist indication).
DAPT is superior to anticoagulant therapy in preventing stent thrombosis in patients undergoing PCI, and a more informed inter-specialist communication is needed. Intracoronary imaging can help in the management of stent failure and in the guidance of complex PCI, allowing a patient-tailored treatment.
415 DOES MYOCARDIAL BRIDGING TRIGGER MYOCARDIAL ISCHEMIA?
Authors: Tremamunno Saverio , Pastena Paola , Cambise Nello , Telesca Alessandro , Tinti Lorenzo , Di Renzo Antonio , De Vita Antonio , Lamendola Priscilla , Lombardo Antonella , Crea Filippo , Lanza Gaetano Antonio 
Published: December 2022

Abstract

Background
Myocardial bridging (MB) is a congenital epicardial coronary abnormality, in which a segment of the artery runs through the myocardium, determining dynamic stenosis during systole. Whether MB can be responsible by itself for myocardial ischemia remains unclear. Thus, we aimed to evaluate whether the dynamic stenosis related to MB can cause signs and symptoms of myocardial ischemia.

Methods
We enrolled 41 consecutive patients who underwent coronary angiography because of chest pain suspected for ischemic heart disease and were found to have MB in the absence of any significant flow-limiting coronary stenosis and any other cardiac disease. A group of 14 patients who also underwent coronary angiography because of chest pain suspected for ischemic heart disease, but found to be free of any coronary or cardiac abnormality (including MB) and also showed negative results at exercise stress test (EST) served as controls.
All enrolled patients underwent a maximal treadmill EST according to standard Bruce protocol. A complete echocardiographic examination was performed at rest and at peak exercise.

Results
Baseline EST parameters were comparable between groups, whereas peak diastolic blood pressure (pDBP) was slightly higher in the MB group (p=0.044).
No clinically significant differences were found in baseline echocardiographic parameters, although the E wave deceleration time (DcT) was longer (p=0.038) and global longitudinal strain (GLS) was higher (p=0.05) in the MB group. During exercise, left ventricular ejection fraction (LVEF) improved significantly in both groups (p&lt;0.001), without any difference between the 2 groups. GLS did not show any significant changes with exercise in both groups.
Moreover, among MB patients, no differences were found in stress echocardiographic results between those with positive vs. those with negative EST.

Conclusions
We failed to demonstrate any significant ischemic impairment of LV systolic and diastolic function at maximal EST in patients with MB. Moreover, we also failed to demonstrate any LV dysfunction in MB patients that developed ECG signs of myocardial ischemia during EST, as compared to those without evidence of myocardial ischemia. Thus, our data question about the ability of MB itself to trigger significant myocardial ischemia in clinical practice.