bluuebunny/crossref_metadata_2025_split huggingface dataset:
613 QTC PROLUNGATION IN TAKOTSUBO: DIFFERENT PATTERN, DIFFERENT OUTCOME?
Authors: Piccolo Solange , Dotto Alberto , Rizzetto Francesca , Lia Micaela , Widmann Maddalena , Pazzi Sara , Ferrigni Francesca , Tomasi Luca , Scarsini Roberto , Prati Daniele , Castaldi Gianluca , Ferrero Valeria , Tavella Domenico , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Introduction
QT prolongation has been widely described in Takotsubo Syndrome (TTS), but the pathophysiology and prognostic implications remain unclear, and it can still hold some surprise.
We have noticed two different populations based on electrocardiogram (ECG) findings that weren't described before. The aim of the study was to investigate the difference between the two of them, with a focus on prognosis.

Methods
We retrospectively analyzed in-hospital ECG from TTS (based on revised Mayo Clinic criteria) from 2014 to August 2022. QT interval was manually measured and corrected with Bazzett formula. Patients with bundle branch blocks or QT shorter than 460 (male), 470 msec (female) were excluded.
The population was divided into two groups, based on the lead with the longest QT: V5 (group A) or V2 (group B). Our primary endpoint was overall mortality. Secondary outcome ware either ventricular or supraventricular arrhythmias detected before discharge.

Results
Our final cohort was composed of 67 patients, 42 of which had the maximum QTc interval in V5 (group A) and the other 25 having the longest QTc in V2 (group B). These two populations did not differ much in terms of age, sex, comorbidities, and echocardiographic findings at presentation. Despite this, we observed a significant prognostic difference: patients in group B experienced more in-hospital arrhythmias than the other subgroup (p=0.035), but after a median follow up of 3.6 years their all-cause mortality was significantly lower (p=0.034).

Conclusion
Although quite similar in demographic characteristics and presentations, we observed that patients with longer QTc in V5 lead (Group A) seem to have a higher mortality rate, in comparison with patients with longer QTc in V2 (Group B). It could help to identify a high-risk subgroup of patients. This is a preliminary study, further investigation is needed to make more reliable inferences.
492 EMBOLIC STROKE OF UNDETERMINED SOURCE: ROLE OF IMPLANTABLE LOOP RECORDER IN ASYMPTOMATIC ATRIAL FIBRILLATION DETECTION AND SECONDARY PREVENTION OF NEW EMBOLIC EVENTS
Authors: Ravetti Emanuele , Gambino Andrea , Jorfida Marcella , Castagno Davide , Bergui Mauro , Cerrato Paolo , De Ferrari Gaetano Maria 
Published: December 2022

Abstract

Background and Aims
AF (Atrial Fibrillation) is the most important cause of Embolic Stroke of Undetermined Source (ESUS). Implantable Loop Recorder (ILR) demonstrated the highest sensitivity for detecting post-stroke asymptomatic AF.
This register was created to assess the prevalence of AF episodes in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA or stroke recurrence and death using ILR.

Methods
278 patients admitted to the Stroke Unit of “Città della Salute e della Scienza” hospital in Torino between 2011 and 2019, underwent ILR implantation if they had at least one risk factor for AF including obesity, hyperthyroidism, atrial enlargement at transthoracic echocardiography, severe mitral valve disease, CHADS-VASc score ≥ 4, age &gt; 70 years old and diabetes.
The control group was composed of 165 patients admitted in other departments of the same hospital diagnosed with ESUS, not implanted with ILR.
We used propensity score matching to select 132 patients from each group (matching age, sex, CHADS-VASc, and HAS-BLED baseline characteristics).
Risk and protective factors were estimated for clinical outcomes (deaths and TIA or stroke recurrence) and were evaluated with logistic regression univariate and multivariate analyses.

Results
The detection rate of AF episodes longer than 5 minutes was significantly higher in the ILR group (41.7% vs 15.9%, p&lt;0.001).
On univariate analysis, we found a trend towards a protective role of ILR for the composite outcome of TIA or stroke recurrence and mortality (OR 0.52, CI 0.26–1.04, p 0.06).
On multivariate analysis, we found a protective role of ILR in terms of deaths (OR 0.4, CI 0.17–0.94, p 0.03) and for the composite outcome of ischemic event recurrences and deaths (OR 0.41, CI 0.19–0.87, p 0.02). Age was consistently identified as a risk factor for all the clinical outcomes.

Conclusion
In patients with ESUS and at least one risk factor for AF, episodes of AF longer than 5 minutes are identified in 41.7% of the cases thanks to ILR.
Our study demonstrated that a policy including ILR in patients with ESUS also gives a clinical benefit in terms of TIA or stroke recurrence and death, although limited size of the population and possible presence of selection bias may limit the generalisation of our results.
112 A CASE OF INCESSANT SLOW-FAST AVNRT TREATED WITH HIS BUNDLE PACING
Authors: Rizzello Davide , Francesca Notarangelo Maria , Crocamo Antonio , Gonzi Gianluca , Mattioli Maria , Paoli Giorgia 
Published: December 2022

Abstract

Introduction
Slow-fast AVNRT can rarely present as incessant SVT, particularly in patients with increased HV interval. We describe a case of incessant typical AVNRT, treated without transcatheter ablation.

Case Presentation
An 83-year-old man, with history of PAF, was admitted to our ICU complaining of dyspnea, dizziness and amaurosis. His ECG at presentation depicted sinus bradycardia, first degree AVB (PQ=400 ms) and RBBB (Fig 1A). After betablocker wash-out period, we decided to perform CSP using HBP to ensure AV synchrony and restore physiological pacing.
During wash-out period, an incessant regular wide complex tachycardia with RBBB morphology and ventricular rate of 110 bpm occurred: the tracing showed a P wave immediately after the QRS, with RP &lt; PR (Fig 1B). The tachycardia was incessant also in the EP lab. By means of 2 pacing leads (RV lead in the apical septum and RA lead in right appendage) and one diagnostic decapolar catheter (Inquiry, 2-2-2 Abbott) in His region, all connected to the polygraph, we performed an EPS. HV interval in sinus rhythm was 60 ms, AH 340 ms. The electrograms during tachycardia showed HVA sequence and 1:1 VA association, VA&lt; 70 ms, cycle length 520 ms. Pacing from RV lead, we performed the ventricular overdrive pacing maneuver obtaining a VAV response; PPI-TCL was 280 ms and SA-VA difference was 205 ms (Fig 2A). We also noted a VA linking response to atrial overdrive pacing, and AHA response at the end of maneuver excluding JT (Fig 2B). In addition, pacing by the His catheter during tachycardia, we interrupted the arrythmia: the V signal after the last paced beat was not followed by retro-conducted A signal (Fig 2C). Finally, by administrating adenosine 12 mg the tachycardia interrupted with A as last signal recorded (Fig 2D). All these findings were consistent with an incessant typical AVNRT. We chose to treat AVRNT with sequential atrial-His pacing, placing a third lead in His region and programming the device in DDD 70-120, with selective His bundle capture, not correcting the RBBB (Fig 1C, D).

Discussion
In patients with poor anterograde AV nodal conduction, also slow-fast AVNRT can present as incessant tachycardia. In fact, a shorter sinus cycle length or atrial extrasystole could initiate sufficient delay in anterograde conduction to allow for recovery in conduction in the retrograde direction led to a persistent tachycardia. This case highlights the value of performing EPS diagnostic maneuvers also during PM implantations in order to personalize therapy and programming.
975 SIMPLY-DETECTED INFLAMMATORY BLOOD MARKERS PREDICT INDEXED LEFT ATRIAL VOLUME AMONG PATIENTS UNDERGOING ATRIAL FIBRILLATION CATHETER ABLATION
Authors: Valeri Yari , Compagnucci Paolo , Volpato Giovanni , Falanga Umbero , Parisi Quintino , Cipolletta Laura , Ritq Enrico , Guerra Federico , Casella Michela , Dello Russo Antonio 
Published: December 2022

Abstract

Background
atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Predisposing factors for priming and maintenance of AF include increased left atrial (LA) size, which correlates with LA disease and is a major risk factor for recurrence after AF catheter ablation (CA). The role of inflammation in the pathogenesis of AF and the associated atrial cardiomyopathy has been ill-defined

Objective
we hypothesized that simply-detected inflammatory blood markers could correlate with left atrial volume, and thus with the severity of AF-associated atrial cardiomyopathy.

Methods
we conducted a retrospective, observational study enrolling 472 consecutive patients (male gender, n= 357, 76%; mean age, 61±11 years) who underwent paroxysmal (n=318) or persistent (n=154) AF CA at our institution. In each patient, widely available laboratory markers of inflammation (C-reactive protein (PCR), uric acid, and red blood cells distribution width [RDW]) were measured prior to CA and correlated to LA volume, using univariable and stepwise multivariable linear regression.

Results
the mean left ventricular ejection fraction (EF) was 57,4±7,6%, whereas the mean indexed LA volume was 35,3±11,9 ml/m2. The mean RDW measured 13,5±1,3, the mean PCR value was 0,5±1 mg/L, and the mean uric acid value was 5,2±1,4 mg/dl. In univariable linear regression analysis, RDW (β 2.65; 95% CI [1.81-3.49]; p=0.0002), PCR (β 1.2; 95% CI [0.02-2.38]; p=0.047), CHA2DS2VASc (β 2,17; 95% CI [1.42-2.94]; p 0.001), uric acid (β 0.85; 95% CI [0.01-1.69]; p=0.05), EF (β -0.37; 95% CI [-0.51-0.23]; p=0.002) and age (β 0.35; 95% CI [0.25-0.45]; p=0.00004) were significantly related to LA volume. In multivariable linear regression model, EF (β -0.24; 95% CI [-0.39- -0.09]; p 0.002), age (β 02; 95% CI [0.08-0.32]; p 0.0017) and RDW (β 1.5; 95% CI [0.62-2.38]; p 0.00093) retained their independent association with LA volume.

Conclusion
RDW, a simple-detected blood marker, proved to be an independent predictor of LA size, suggesting a mechanistic link between inflammation and the severity of atrial cardiomyopathy. These observations may allow a very simple and low-cost identification of AF patients at higher risk of adverse outcomes and recurrences after CA, facilitating treatment plan decisions (e.g., rate vs. rhythm control).
1092 CATHETER ABLATION VERSUS MEDICAL THERAPY OF ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Magnocavallo Michele , Parlavecchio Antonio , Vetta Giampaolo , Gianni Carola , Polselli Marco , Vuono Francesco De , Pannone Luigi , Mohanty Sanghamitra , Cauti Fillippo Maria , Caminiti Rodolfo , Miraglia Vincenzo , Monaco Cinzia , Chierchia Gian Battista , Rossi Pietro , Biase Luigi Di , Bianchi Stefano , De Asmundis Carlo , Natale Andrea , Della Rocca Domenico Giovanni 
Published: December 2022

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) often coexist and syner-gistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF.

Methods
Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence in-tervals (CIs) were measured using the Mantel–Haenszel method.

Results
A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53–0.80); p &lt; 0.0001) (Figure 1), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51–0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54–0.82); p = 0.0001), AF re-currence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24–0.54); p &lt; 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39–0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35–7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83–30.14); p &lt; 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01–5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12–03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p &lt; 0.0001).

Conclusions
In HF patients, AF catheter ablation was superior to MT in re-ducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life.
Figure 1: Forest plot displaying a decrease in the composite endpoint in patients with AF and HF undergoing CA versus MT.
612 EVOLUTION OF ATRIAL FIBRILLATION PATTERNS AND IMPACT ON ALL-CAUSE MORTALITY IN A CONTEMPORARY COHORT OF EUROPEAN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Vitolo Marco , Bonini Niccolò , Francesco Imberti Jacopo , Mei Davide , Forzati Nicola , Laus Vera , Stuani Marco , Chiriaco Francesco , Menozzi Matteo , Francesco Romiti Giulio , Proietti Marco , Livio Malavasi Vincenzo , Lip Gregory Yh , Boriani Giuseppe 
Published: December 2022

Abstract

Background
Paroxysmal atrial fibrillation (AF) often shows a natural evolution towards more sustained forms of the arrhythmia. Real-world data on clinical factors associated with AF progression and its impact on long-term outcomes are limited.

Aim of the study
To investigate the factors associated with progression of AF and its impact on all-cause mortality in a contemporary cohort of European AF patients.

Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Patients with paroxysmal AF at baseline or first detected AF who underwent successful cardioversion were included. Patients with known rhythm status at 1-year were then stratified into two groups: (i) No AF progression and (ii) AF progression, (as defined by transition to persistent or permanent AF). All-cause mortality at 2-year of follow-up was the primary outcome of the analysis.

Results
A total of 2688 patients were included (median age 67 years, interquartile range [IQR] 60-75, females 44.7%, CHA2DS2VASc score median 3 [1-4], HASBLED median 1 [1-2]). After 1-year of follow-up 2094 (77.9%) patients showed no AF progression while 594 (22.1%) developed AF progression. On multivariable logistic regression analysis, no physical activity (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.02-1.78), valvular heart disease (OR 1.63, 95%CI 1.23-2.15), left atrium diameter (OR 1.03, 95% CI 1.01-1.05) and left ventricular ejection fraction (OR 0.98, 95% CI 0.97-1.00) were independently associated with AF progression at 1-year. At the end of 2-year of follow-up, death occurred in 80/2621 (3.1%) patients. Kaplan-Meier analysis showed a lower cumulative survival from all-cause mortality in patients with AF progression compared to non-progression AF patients (Log Rank p=0.01, Figure). On multivariable Cox regression analysis, adjusted for age, sex, heart failure, coronary artery disease, hypertension, diabetes mellitus, previous thromboembolic events, peripheral artery disease, chronic kidney disease and use of oral anticoagulants, patients with AF progression had an independently higher risk for all-cause mortality (adjusted hazard ratio [aHR] 1.77, 95%CI 1.09-2.89).

Conclusions
In a contemporary cohort of European AF patients, a substantial number of patients evolved to persistent/permanent AF within 1 year. Clinical factors related to atrial structural remodeling were independently associated with arrhythmia evolution. AF progression was associated with an increased risk of all-cause mortality.
783 RELATIONSHIP BETWEEN PULSE WAVE VELOCITY AND MYOCARDIAL WORK IN UNTREATED HYPERTENSIVE PATIENTS WITH PRESERVED LVEF
Authors: Lofrumento Francesca , Mandraffino Giuseppe , Trimarchi Giancarlo , Mancinelli Anna , Restelli Davide , De Sarro Rosalba , Cusmà-piccione Maurizio , Manganaro Roberta , Di Bella Gianluca , Micari Antonio , Carerj Scipione , Zito Concetta 
Published: December 2022

Abstract

Introduction
Hemodynamic interaction between left ventricular (LV) and arterial system is a key determinant of cardiovascular performance. The non-invasive carotid-femoral Pulse Wave Velocity (PWV), obtained with applanation tonometry, is considered the most precise way of estimating arterial stiffness. The LV myocardial work (MW), based on non-invasive LV pressure-strain loop (PSL), is a new promising tool to assess LV function.

Aims
The aim of the study was to evaluate the correlation between PWV and MW parameters in a population of non-hypertensive and newly diagnosed untreated hypertensive people.

Materials and methods
80 people (M=48), divided in hypertensive (group 1 n=40, 45±10 years) and non-hypertensive (group 2 n=40, 40±12 years), were prospectively enrolled. All underwent conventional transthoracic echocardiogram and at the same day carotid femoral PWV was calculated with applanation tonometry (SphygmoCor® XCEL). MW parameters were obtained using 2D Speckle-tracking technique.

Results
Comparing the two groups, PWV and Global Work Wasted (GWW) were significantly higher in the hypertensives group (9,73±2,4 vs 7,79±1,1; p=0,001 and 146±50 vs 85±27, p=0,001), as shown in Figure 1, whereas Global Work Efficiency (GWE) and Global Work Constructive (GWC) were significantly lower (93,6±2,5 vs 95,6±1,2, p=0,001 and 2410±122 vs 2167±65, p=0,002). We found a linear and positive correlation of PWV with GWW (r=0,271, p=0,016), as seen in Figure 2, and a linear and negative correlation of PWV with GWE (r=-0,282, p=0,012).

Conclusion
This study highlights the role of PWV and MW evaluation in hypertensives. Higher PWV and GWW could be considered as red flags of myocardial damage suggesting the need of an early appropriate antihypertensive therapy.
275 MST1 MEDIATES DOXORUBICIN-INDUCED CARDIOMYOPATHY BY SIRT3 DOWNREGULATION
Authors: Schirone Leonardo , Vecchio Daniele , Forte Maurizio , Sciarretta Sebastiano 
Published: December 2022

Abstract

Introduction
Heart failure is a major side effect of doxorubicin (DOX) treatment in patients with cancer. However, the mechanisms underlying the development of DOX-induced cardiomyopathy (DCM) need to be addressed. Here, we demonstrate that the serine/threonine kinase MST1, a major Hippo pathway component, contributes to the development of DOX-induced myocardial injury.

Hypothesis
The inhibition of MST1 protects from DCM by preserving SIRT3 expression

Methods
C57BL/6J WT mice and mice with cardiomyocyte-specific dominant-negative MST1 (kinase-dead) overexpression received 3 weekly injections of DOX, reaching a final cumulative dose of 18 mg/kg. Echocardiographic, histological and biochemical analyses were performed 6 weeks after the first administration of DOX.

Results
MST1 signaling was significantly activated in cardiomyocytes in response to DOX treatment in vitro and in vivo. Wild-type (WT) mice treated with DOX had reduced fractional shortening (46,1±1,77 vs. 31,1±1,07, n=7-11) and mitochondrial abnormalities (3,7±0,93 vs. 10,2±1,5, n=12 microscopic fields from 3 independent samples). However, systolic dysfunction was abolished in mice with cardiomyocyte-specific overexpression of dominant-negative MST1 (DN-MST1) (31,1±1,07 vs. 46,3±1,13, n=11) or treated with the MST1 inhibitor ‘XMU-MP-1’ (37,5±1,8 vs. 46,6±1,87, n=8), indicating that MST1 inhibition attenuates DOX-induced cardiac dysfunction. Also, DOX treatment led to a significant downregulation of cardiac levels of SIRT3 (1±0,12 vs. 0,6±0,11, n=4), a deacetylase involved in mitochondrial protection, in WT mice, which was rescued by MST1 inhibition (0,6±0,11 vs. 1,3±0,04, n=4). Pharmacological inhibition of SIRT3 blunted the protective effects of MST1 inhibition (44,5±1,55 vs. 32,5±2,33, n=4), indicating that SIRT3 downregulation mediates the cytotoxic effects of MST1 activation in response to DOX treatment. Finally, we found a significant upregulation of MST1 levels in human myocardial tissue of cancer patients treated with DOX (1,5±0,23 vs. 2,4±0,12, N=81-123 cells from 3 different patients).

Conclusion
MST1 contributes to DOX-induced cardiomyopathy by promoting mitochondrial damage through SIRT3 downregulation in cardiomyocytes.
751 CANCER TREATMENT RELATED COMPLICATIONS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
Authors: Zampieri Mattia , Schoonvelde Stephan , Vinci Michele , Visani Luca , Coppini Raffaele , Michels Michelle , Morelli Ilaria , Meattini Icro , Livi Lorenzo , Romei Andrea , Olivotto Iacopo 
Published: December 2022

Abstract

Introduction
Cardiotoxicity involves direct effects of cancer related treatment on heart function, commonly presenting as left ventricular contractile dysfunction. However, limited data are available regarding cardiotoxicity on hypertrophic cardiomyopathy (HCM), because most studies and registries have not specifically analyzed the effects of oncological treatment in HCM populations. This gap in knowledge may lead to unjustified restriction of HCM patients to radical cancer treatments.

Aim
We aimed at describing the potential clinical cardiotoxicity of oncological treatments in a cohort of consecutive HCM patients, systematically followed up at two national referral centres for HCM.

Methods
We retrospectively analysed all clinical and instrumental data of all consecutive HCM patients who underwent oncological treatment between January 2000 and December 2020, collected in a centralized database.

Results
Of 3256 HCM patients, 121 (3.7%) had a reported diagnosis of cancer; 109 (90.1%) patients underwent oncological surgery, 45 (37.2%) chemotherapic treatment, 22 (18.2%) chest radiotherapy. After a median follow up of 5 (2-13) years from oncological diagnosis, 32 of the 121 patients (26.4%) died. The cause of death was mainly attributed to the oncological condition, while 4 (12.5%) patients died of sudden cardiac death without previous chemotherapy or chest radiotherapy.
No patient interrupted or reduced the dose of oncological treatment due to cardiac dysfunction. No sustained ventricular tachyarrhythmia was induced by chemotherapy or radiotherapy.

Conclusions
Cancer treatment is well tolerated in HCM patients. In our oncology series, none died of cardiovascular complications induced by chemotherapy or chest radiotherapy and none required interruption or substantial tapering of treatment due to cardiovascular side effects. Although expert multidisciplinary evaluation is mandatory and regimens must be tailored individually, the diagnosis of HCM per se should not be considered a contraindication to radical cancer treatment.