bluuebunny/crossref_metadata_2025_split huggingface dataset:
417 CLINICAL IMPACT OF HEALED CORONARY PLAQUES: AN OPTICAL COHERENCE TOMOGRAPHY STUDY
Authors: Ricchiuto Alfredo , Zella Samuela , Lombardi Marco , Buonpane Angela , Bianchini Emiliano , Maino Alessandro , Busco Marco , D´amario Domenico , Leone Antonio Maria , Aurigemma Cristina , Romagnoli Enrico , Burzotta Francesco , Trani Carlo , Crea Filippo , Vergallo Rocco 
Published: December 2022

Abstract

Introduction
Pathological studies have shown that many atherosclerotic plaques destabilize without resulting in a clinical manifestation. Recent in vivo studies showed that healed plaques are more common in patients with chronic coronary syndrome (CCS) than in those with acute coronary syndrome (ACS), suggesting that they might be a marker of clinical stability. The aim of the present study was to evaluate the clinical impact of healed coronary plaques detected by optical coherence tomography (OCT) imaging.

Methods
A total of 208 patients with CCS or ACS who underwent OCT imaging of non-target/non-culprit vessels were enrolled. Only non-culprit segments were analyzed. Patients were divided into two groups according to the presence or absence of healed plaques detected by OCT. The incidence of major adverse cardiac events (MACE) at follow-up was assessed, defined as the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization (TVR).

Results
Healed coronary plaques were observed in 39.7% of patients, and the prevalence was higher in those presenting with chronic coronary syndrome. Median follow-up time was 4 years, and was not different between the two groups. Patients with healed plaques had a significantly lower incidence of MACE at follow-up (13.6% vs 22%, p=0.019), mainly driven by a lower rate of non-fatal myocardial infarctions (4.9% vs 10.2%, p=0.05). The incidence of cardiac death and TVR was not significantly different between the two groups (1.2% vs. 3.1%, p=0.288; and 13.6% vs. 15.0%, p= 0.187, respectively). At multivariate Cox regression analysis, the presence of plaque disruption was an independent predictor of MACE (odds ratio [OR] 3.33, 95% confidence interval [CI] 1.39-7.98, p=0.007), while the presence of healed plaque was an independent protective factor (OR 0.44, 95% CI 0.22-0.89, p=0.022).

Conclusions
Healed coronary plaques detected by OCT imaging are associated with a favorable clinical outcome at long-term follow-up.
395 ASSESSMENT OF VENTRICULAR ARRHYTHMIAS IN PATIENTS UNDERGOING TRANCATHETER AORTIC VALVE IMPLANTATION (TAVI): IMPACT ON CLINICAL OUTCOME
Authors: Tremamunno Saverio , Gnan Eleonora , Telesca Alessandro , Cambise Nello , Belmusto Antonietta , Gentile Giuseppe , De Vita Antonio , Crea Filippo , Lanza Gaetano Antonio 
Published: December 2022

Abstract

Background
Transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis has considerably grown in the latest years. There are limited data, however, about predictors of long-term prognosis in this population. Particularly, whether arrhythmic burden is associated with clinical outcome has poorly been investigated.

Methods
We performed 24-hour 3-channel ECG Holter recording (HM) in 284 consecutive patients who underwent TAVI for severe aortic stenosis at our Center within 30 days from a successful procedure (average 10.2 days, range 2-30). For each patient we obtained the number of premature ventricular complexes (PVCs) and the presence of non-sustained ventricular tachycardia (NSVT, ≥3 PVCs with a rate ≥100 bpm). Assessment of clinical events at follow-up was performed by clinical visits or telephone interview of patients or relatives (in case of fatal events). The primary end-point of the study was a composite of cardiovascular death and resuscitation from cardiac arrest (CVE); total mortality was assessed as secondary end-point.

Results
Frequent PVCs (≥30/hour) and episodes of NSVT were found in 49 (20.2%) and 52 (21.4%) patients, respectively. Clinical outcome was obtained for 243 patients (85.6%). At an average follow-up of 3.5 year (range 1.0-8.6), CVE occurred in 25 patients (8.8%) and 64 died (22.5%). Frequent PVCs at HM were detected in 11/25 (44.0%) and 38/218 (17.4%) patients with and without CVE, respectively (p=0.006). Episodes of NSVT were detected in 9/25 (36.0%) and 43/218 (19.7%) patients with and without CVE, respectively (p=0.07). Furthermore, frequent PVCs were present in 18/64 (28.1%) and 31/179 (17.3%) patients dead and alive, respectively (p=0.07), whereas NSVT episodes were detected in 17/64 (26.6%) and 35/179 (19.6%) patients dead and alive, respectively (p=0.29). Frequent PVCs maintained independent association with CVE after correction for confounding variables at multivariable analysis (HR 2.63; 95 CI 1.05-6.62; p=0.04).

Conclusions
Our data indicate that assessment of ventricular arrhythmic burden after TAVI is helpful to identify patients at increased risk of cardiovascular death/cardiac arrest during medium follow-up.
982 NON CULPRIT LESION IN ACS PATIENTS DISCREPANCY BETWEEN HYPERAEMIC AND RESTING INDEXES
Authors: Velato Letizia , Polimeni Alberto , Spaccarotella Carmen , Mongiardo Annalisa , Sorrentino Sabato , De Rosa Salvatore , Indolfi Ciro 
Published: December 2022

Abstract

Background
Multivessel disease occurs in approximately half of patients presenting with STEMI and the best management non-culprit lesions is still unclear. The case reported a patient with inferior STEMI, in which the non-culprit lesion has been evaluated with a “full-physiology” approach by a pressure wire.

Case Description
A 52-year-old woman with a history of hypertension and diabetes was admitted to our center diagnosed with inferior STEMI. Coronary angiography showed a thrombotic occlusion (TIMI 0) of the right coronary artery (culprit lesion) and intermediate stenosis of proximal left anterior descending (LAD). Primary PCI (p-PCI) of the right coronary artery has been performed. After 4 days a stepwise complete physiological approach on the LAD artery has been performed. The physiological study showed a negative discrepancy between FFR - and RFR + with increased index of microvascular resistance (IMR).

Discussion
The fractional flow reserve (FFR) represents the best-known invasive method for the
functional evaluation of intermediate coronary stenosis. Unlike the FFR, the resting flow ratio RFR is a non-hyperemic index that does not require the administration of a vasodilator such as adenosine as does the iwFR. There are many factors that can lead to a negative discrepancy between hyperemic and non-hyperemic indices. In the case presented, the functional values found were: FFR: 0.90 RFR: 0.86 and IMR = 76; CFR = 1.0. The FFR-/ RFR+ disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation. Therefore, we decided to treat the LAD lesion according the RFR value with a DES 3.0×33 mm implantation.

Conclusion
Myocardial infarction can result in altered microvascular and endothelial dysfunction also in the non-culprit territory. The FFR - / RFR + disagreement may reflect the attenuating influence of microvascular disease on adenosine-mediated vasodilation.
1106 CLINICAL AND MULTIMODAL IMAGING FOLLOW-UP OF PATIENTS WITH MYOPERICARDITIS FOLLOWING MRNA COVID-19 VACCINATION
Authors: Ballatore Federico 
Published: December 2022

Abstract

Background
Myopericarditis following coronavirus disease-2019 (COVID-19) vaccine is a described entity, but its evolution is still unclear.

Methods
Patients with a diagnosis of myopericarditis after mRNA COVID-19 vaccine represented our population. Clinical evaluation, laboratory tests and non-invasive cardiac tests were performed at baseline and at six months.

Results
Between January and August 2021, we identified 7 patients with myopericarditis following mRNA vaccination. The median age was 29 years (IQR: 25.5–53.5 years) and all patients were males. The median time from vaccine administration to symptoms onset was 5 days (IQR: 4–7 days); five patients received BNT162b2, two mRNA-1273 and only one patient developed symptoms after first dose of vaccine. The most common symptoms at presentation were chest pain (100%) and fatigue (71.4%). Left Ventricular Ejection Fraction (LVEF) was preserved in 6 of them while was mildly reduced in one (median LVEF: 61.3% [IQR: 60–62.9%]). Late Gadolinium Enhancement was detected at Cardiac Magnetic Resonance in the 42.9% of cases. Treatment was conservative for all patients except one; a pericardiocentesis was necessary due to massive pericardial effusion.
At six months follow-up all patients were asymptomatic with normal troponin level, electrocardiogram and echocardiogram confirming the complete healing of the inflammatory process. Two patients received a COVID-19 vaccine booster dose without evidence of myopericardial involvement.

Conclusions
Myopericarditis associated with mRNA COVID19 vaccination is more frequent in young males and is usually characterized by a benign evolution.
85 ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY
Authors: Maloberti Alessandro , Giannattasio Cristina , Rebora Paola , Occhino Giuseppe , Ughi Nicola , Rizzo Jacopo , Fabbri Saverio , Leidi Filippo , Cartella Iside , Rossetti Claudio , Epis Oscar Massimiliano , Molon Giulio , Bonfanti Paolo , Valsecchi Maria Grazia , Genovesi Simonetta 
Published: December 2022

Abstract

Background
Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.

Methods
We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.

Results
145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)

Conclusion
AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.
144 LONG-TERM PROGNOSTIC IMPACT OF SUBCLINICAL MYOCARDIAL DYSFUNCTION IN PATIENTS RECOVERED FROM COVID-19
Authors: Cannata Francesco , Pinto Giuseppe , Chiarito Mauro , Maurina Matteo , Condello Francesco , Bombace Sara , Villaschi Alessandro , Novelli Laura , Stankowski Kamil , Liccardo Gaetano , Gasparini Gaia , Donia Dario , Celata Anastasia , My Ilaria , Kallikourdis Marinos , Figliozzi Stefano , Mantovani Riccardo , Fazzari Fabio , Bragato Renato Maria , Condorelli Gianluigi , Stefanini Giulio Giuseppe 
Published: December 2022

Abstract

Aims
Cardiovascular sequelae may occur in patients recovered from COVID-19. Recent studies have detected a considerable incidence of subclinical myocardial dysfunction – assessed with speckle-tracking echocardiography – and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia.

Methods and Results
We prospectively followed-up 110 patients hospitalized at our Institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 6-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization and all-cause mortality. A subclinical myocardial dysfunction – defined as an impairment of left ventricular global longitudinal strain (≥ -18%) - was identified at 6-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (AUC: 0.73) and resulted a strong independent predictor of extended MACE in a multivariate regression analysis (OR 9.29, 95%CI 2.20–39.3, p=0.002). Long-COVID condition was not associated with a worse long-term prognosis, instead.

Conclusion
In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one third of the whole population at 6-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimise the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has not prognostic relevance.
614 PREDICTIVE ROLE OF ECHOCARDIOGRAPHIC PULMONARY TO LEFT ATRIAL RATIO FOR IN-HOSPITAL DEATH IN PATIENTS WITH COVID-19
Authors: Pizzoferrato Giovanni , Esposto Daniele , Alberani Angela , Falasca Katia , Vecchiet Jacopo , Mennuni Marco , Patti Giuseppe , Gallina Sabina , Renda Giulia 
Published: December 2022

Abstract

Background and aims
Echocardiographic Pulmonary to Left Atrial ratio (ePLAR, tricuspid regurgitation Vmax/mitral E/e') represents an accurate and sensitive non-invasive tool to estimate trans-pulmonary pressure gradient, showing a sensitivity for pre-capillary pulmonary obstruction higher than traditional echocardiographic measures. The prognostic value of ePLAR in patients with coronavirus disease-2019 (COVID-19) remains unknown.
We aimed to investigate the predictive role of ePLAR on mortality in COVID-19 patients.

Methods
One hundred consecutive patients admitted in two Italian institutions for COVID-19 undergoing early echocardiographic examination were included. ePLAR was determined from the maximum tricuspid regurgitation velocity at continuous wave Doppler (m/s) divided by the transmitral E-wave: septal mitral annular Doppler Tissue Imaging e′-wave ratio (TRVmax/E:e′). Main outcome measure was in-hospital death.

Results
Patients who died during hospitalization had a higher prevalence of tricuspid regurgitation, higher ePLAR and right-side pressures, lower Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Artery Systolic Pressure (PASP) ratio and reduced inferior vena cava collapse than survivors. Patients with ePLAR &gt;0.28 m/s showed increased in-hospital mortality compared to those having ePLAR ≤0.28 m/s (27% vs 10.8%, p=0.05, Figure). A Cox model of multivariate analysis demonstrated that an ePLAR &gt;0.28 m/s was independently associated with increased risk of death (HR 5.07, 95% CI 1.04-24.50, p=0.043), particularly among patients with increased pulmonary arterial pressure.

Conclusions
A high ePLAR value at baseline predicts in-hospital death in patients with COVID-19, especially in those with elevated pulmonary arterial pressure. These results support an early ePLAR assessment in patients admitted for COVID-19 to identify those at higher risk and potentially to guide strategies of diagnosis and treatment.
829 IMPACT OF SODIUM-GLUCOSE COTRANSPORTER-2 INHIBITORS ON CARDIAC REMODELLING IN LOW RISK PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Del Giudice Carmen , Fabiani Dario , D´aquino Malvezzi Marco Caracciolo , Scognamiglio Gabriella , Pezzullo Enrica , Caso Valentina , Castagnola Patrizia , Volpe Alessandra , Liccardo Biagio , Nigro Gerardo , Golino Paolo , Russo Vincenzo 
Published: December 2022

Abstract

Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated to a reduced risk of major adverse cardiovascular events in type 2 diabetes mellitus (T2DM) patients. Subclinical left ventricular (LV) systolic disfunction has been observed in DM patients, even if ejection fraction is preserved. The impact of SGLT2i on cardiac structure and function is still unclear. Our aim was to evaluate the effects of SGLT2i on LV remodelling and global longitudinal strain (GLS) in patients with well compensated TIIDM.

Methods
Between November 2021 to April 2022, we prospectively evaluated 35 consecutives subjects with TIIDM in need of SGLT2i according to their referring physician. Main inclusion criteria were preserved ejection fraction (EF&gt;50%), no history of heart failure and coronary artery disease, and the lack of moderate to severe valvular heart disease and chronic kidney disease (EGFR &lt;50%). Conventional and speckle tracking echocardiography were performed at baseline and after 6 months of treatment.

Results
17 patients have been evaluated for statistical analysis (6% F, mean age 65± 9 years). GLS (p=0,007) and EF (p=0.01) reached statistically significance after 6 months therapy. Moreover on ECG analysis, we found significant reduction in P-wave dispersion (p =0.019). However no statistically significant changes in diastolic function parameters and Myocardial Work indices have been found.

Conclusions
Our study showed that SGLT2i treatment in people with T2DM may display a positive effect on LV remodelling and improve GLS, even in patients with low-risk DM.
Keywords: Diabetes mellitus; SGLT2 inhibitors; Speckle tracking echocardiography; Left ventricular systolic function; Cardiac remodelling.
769 EFFECT OF GLUCOSE LOWERING AGENTS ON CARDIAC AUTONOMIC FUNCTION AND STRUCTURE IN TYPE 2 DIABETES MELLITUS
Authors: Veneziano Francesco Antonio , Cavallari Ilaria , Grigioni Francesco , Tuccinardi Dario , Maddaloni Ernesto , Indennidate Carla , Pieralice Silvia , Napoli Nicola , Buzzetti Raffaella 
Published: December 2022

Effects of novel glucose-lowering agents on cardiac autonomic function and structure in type 2 diabetes
Ilaria Cavallari, Ernesto Maddaloni, Francesco Veneziano, Carla Indennidate, Maria Valeria Giaccari, Dario Tuccinardi, Silvia Pieralice, Nicola Napoli, Raffaella Buzzetti, Francesco Grigioni

Background
Novel glucose-lowering agents, such as sodium glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, have the potential to reduce major adverse cardiovascular events among people with type 2 diabetes. However, mechanisms behind their cardiovascular protection and the implications of positive chronotropic effects of GLP-1 receptor agonists are not fully understood.

Purpose
To elucidate and compare the effects of novel glucose-lowering agents on cardiac autonomic function and structure.

Methods
This prospective observational study included subjects with type 2 diabetes and either a history of established cardiovascular disease or multiple risk factors and early initiation (within 2 weeks) of a SGLT-2 inhibitor or a GLP-1 receptor agonist on top of standard of care. Patients were followed for a median of 2 months. As per study protocol, background medical therapy should have remained stable for the entire duration of the study. Cardiac autonomic reflex tests (heart rate response to a deep breathing and to standing) and echocardiography were performed in all patients at baseline and at the end of follow-up. Endpoints were changes from baseline of E/I ratio, 30:15 ratio and indices of cardiac structure and function.

Results
A total of 37 patients completed follow-up, of whom 20 were on SGLT-2 inhibitors and 17 on GLP-1 receptor agonists. Mean age was 69 years, mean disease duration was 14 years and mean HbA1c value was 7.5%. Cardiac autonomic dysfunction, defined as at least an abnormal test, was found in 19% of patients (n=7). At a median follow-up of 2 months, there were no differences from baseline in heart rate response to a deep breathing test (p=0.92) and to standing (p=0.86). No differences were found when patients were stratified according to drug class. Among echocardiographic parameters, significant reductions of left ventricular mass (300.5±73.3 vs 280.4±68.3 g/m2, p=0.048) and left atrial volume (61.3±29.4 vs 54.7±18.0 ml, p=0.034) were found with no interaction by drug class. Left ventricular end-diastolic and systolic volumes, ejection fraction, filling pressures and pulmonary artery pressure did not substantially change.

Conclusions
In a population of patients with type 2 diabetes, short-term treatment with novel glucose-lowering agents significantly reduced left ventricular mass and left atrial volume but did not affect cardiac autonomic function.
820 VARIABLE EXPRESSIVITY OF SCN5A MUTATION IN A FAMILY WITH CARDIAC DYSFUNCTION AND SUSPECTED BRUGADA SYNDROME
Authors: Malizia Biagio , Curcio Antonio , Rodolfo Iuliano , Colao Emma , Pingitore Elisabetta , Cardia Giada , Romano Letizia Rosa , Pasceri Eugenia , Aquila Iolanda , Indolfi Ciro 
Published: December 2022

Abstract

Background
Inherited arrhythmogenic diseases (IADs) represent a group of life-threatening genetic cardiomyopathies that predispose young individuals to sudden cardiac death (SCD), often in the absence of structural cardiac alterations. Some IADs share mutations in genes encoding for surface membrane ion channels, and the gene for the alpha subunit of the voltage-dependent channel Nav1.5 (SCN5A) is among the ones mostly involved. Brugada syndrome represents one of the possible spectrum deriving from SCN5A gene mutations, and it is characterized by “loss-of-function” genetic alterations. Interestingly, both loss-of and gain-of-function mutations have been associated with familial dilated cardiomyopathy (DCM).

Materials and Methods
In the context of an Italian Ministry of Health-funded research project devoted to identify genetic isolates of IADs in the Calabria region, we found a family affected by different cardiovascular manifestations including cardiac dysfunction, ventricular tachyarrhythmias, atrioventricular block and suspected Brugada syndrome pattern in first-degree relatives in association with a newly identified SCN5A mutation.

Results
The proband came to our attention with a diagnosis of DCM, echocardiographic assessment of reduced left ventricular ejection fraction (EF) to 38%, high occurrence of premature ventricular complexes (PVCs) and first-degree atrioventricular block (PR = 240ms) at electrocardiogram. In spite of negative electrophysiologic study, he underwent implantable cardioverter defibrillator implantation (ICD), hypothesizing lamin A/C mutation; genetic analysis turned out negative for lamin A/C and CACNA1C, while a SCN5A gene mutation (c.4554 G&lt;T p.Gln1518His) was detected. Proband's sons and his brother underwent clinical evaluations as well as genetic testing: the second son's ECG showed first-degree AV block (PR = 220ms), QTc interval 426ms, and coved type ST-segment elevation of 1.5mm, in the context of normal cardiac function; the remaining male (see Figure 1) was asymptomatic, while the daughter had a hypokinetic non-dilated cardiomyopathy. The proband's brother had first-degree AV block and very frequent monomorphic ventricular couplets.

Conclusions
These phenotypic differences in first degree-relatives, can be explained by the concept of variable expressivity of genes, according to which individuals carrying the same mutation can have different clinical features. Therefore, the search for genetic mutations assumes a preponderant role for stratifying the risk of SCN5A-related diseases and to adopt appropriate diagnostic and therapeutic strategies.