bluuebunny/crossref_metadata_2025_split huggingface dataset:
633 THE EFFECTS OF AEROBIC EXERCISE TRAINING ON CARDIOPULMONARY EXERCISE TESTING AND HEART FAILURE BIOMARKERS IN ADULT PATIENTS WITH HYPOPLASTIC LEFT HEART SYNDROME AND FONTAN CIRCULATION
Authors: Perrone Marco Alfonso , Pomiato Elettra , Palmieri Rosalinda , Panebianco Mario , Già Giulia Di , Gagliardi Maria Giulia 
Published: December 2022

Abstract

Background
Several studies have shown that adult patients with Hypoplastic Left Heart Syndrome (HLHS) and Fontan circulation have a reduced exercise tolerance that affects daily life. Recent studies have investigated the effects of aerobic exercise training in these patients with univentricular heart; however, this research topic is still poorly studied. The aim of this study was to evaluate the effects of an aerobic exercise training program on cardiopulmonary exercise testing parameters and heart failure biomarkers in patients with HLHS.

Methods
We enrolled 12 patients with a mean age of 24 ± 2.5 years (range 22–27 years), 50% male, with HLHS at Bambino Gesù Children's Hospital IRCCS and University of Rome Tor Vergata. All patients underwent a cardiopulmonary test and blood sampling before (T0) and after (T1) a 4-week aerobic exercise program. Cardiac biomarkers hs-cTnT, NT-proBNP, ST2, GDF-15 were studied.

Results
Data analysis demonstrated an increase in cardiorespiratory performance after 4 weeks of aerobic exercise training activity. In particular, the data showed a significant improvement in test duration (p &lt; 0.05), heart rate at rest (p &lt; 0.05), heart rate recovery 1 min (p &lt; 0.05), VO2 max (p &lt; 0.01) and oxygen uptake efficiency slope (p &lt; 0.05). At the same time, the data showed a significant reduction in NT-proBNP and ST2 values (p &lt; 0.01 and p &lt; 0.05, respectively) and a significant increase in GDF-15 (p &lt; 0.01). No significant changes were found between the hs-cTnT values.

Conclusions
Our study demonstrated the 4-week efficacy of an aerobic training program in improving cardiorespiratory performance and heart failure biomarker values in adult patients with HLHS and Fontan circulation. To the best of our knowledge this is the first study that evaluated the effects of an exercise training program in patients with univentricular heart
1115 NON-INVASIVE MYOCARDIAL WORK INDICES IN PATIENTS WITH FONTAN CIRCULATION
Authors: Pozza Alice , Sabatino Jolanda , Cuppini Elena , Cerutti Alessia , Biffanti Roberta , Reffo Elena , Castaldi Biagio , Sirico Domenico , Fumanelli Jennifer , Di candia Angela , Basso Alessia , Di Salvo Giovanni 
Published: December 2022

Abstract

Background
Although the Fontan operation has contributed greatly to the improvement of survival in patients with a single ventricle, cardiac function and exercise capacity may deteriorate over time. However, there have been no quantitative analyses of the effects of Fontan circulation on myocardial work (MW).
Recently, a novel non-invasive method for calculating MW has been introduced on the basis of speckle tracking analysis with the estimation of left ventricular (LV) pressure from brachial artery cuff pressure.

Purpose
Aim of this study was to evaluate the diagnostic performance of the non-invasive myocardial work indices in predicting subclinical myocardial work impairment in Fontan patients.

Methods
A total of 69 patients were included and compared with healthy age- and sex- matched controls (CTRL).
Ventricular systolic function and global longitudinal strain (GLS) were assessed. Cardiopulmonary exercise test was performed. Global myocardial work index (MWI) was calculated as the area of the LV pressure strain loops. From MWI, global constructive work (MCW), wasted work (MWW) and work efficiency (MWE) were estimated.

Results
The two groups were comparable for blood pressure, weight and height. Mean age of Fontan patients was 21.0±9.2 years. MWI (1162 ± 364 mmHg% vs 1777 ± 240 mmHg%, p &lt; 0.001), MCW (1554 ± 450 mmHg% vs 2102 ± 221 mmHg%, p = 0.001) and MWE (90 ± 6% vs 96 ± 2% p = 0.001) were significantly reduced in Fontan patients compared with healthy CTRL. Moreover, GLS (-13,9 ± 3,1% vs -21,2 ± 1.5%, p &lt; 0.001) and the ejection fraction (EF) (58,9 ± 4.5% vs 63.3 ± 3.9%, p &lt; 0.002) were significantly lower in Fontan patients. Fontan patients with normal EF showed, however, significantly reduced values of MWI compared with CTRL (p&lt;0.05).
Fontan patients with functional right ventricle showed significantly reduced MWE compared with patients with functional left ventricle (p=0.030).
In univariate analysis, peak VO2 was significantly associated with age, SatO2, MWI. In multivariate regression, lower peak VO2 was associated with older age (p = 0.003) and lower MWI (p = 0.026).

Conclusions
Fontan physiology is associated with disadvantageous ventricular work. In Fontan patients, estimation of MWI may be a more sensitive indicator of myocardial work impairment compared with EF and is able to predict exercise capacity.
22 RELATIONSHIP OF RIGHT VENTRICULAR FUNCTION AND EXERCISE TOLERANCE IN PULMONARY ARTERIAL HYPERTENSION
Authors: Sorvillo Graziano , Ferruzzi Germano , Vigorito Francesco , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Soriente Lucia 
Published: December 2022

Abstract

Introduction
Pulmonary arterial hypertension(PAH) is a rarely disease that is characterized by a progressive increase in pulmonary vascular resistance and arterial pressure. The main characteristic of pulmonary hypertension(PH) is exercise intolerance and determination of exercise capacity has an important role in the evaluation of patients.

Aim
The purpose of our study is to explore the relationship of right ventricular dysfunction(RVD) and poor exercise tolerance.

Materials and Methods
Patients with PAH were prospectively enrolled from 2018 to 2021 at baseline assessment in the PH center. RVD was defined as Tricuspid Annular Plane Systolic Excursion (TAPSE)&lt;17 mm in apical four chamber view. Patients were divided in two subgroups according to the presence or absence of RVD. Finally, all subjects underwent exercise tolerance evaluation with six minute walking test (6MWT). All evaluation were made according to current guidelines.

Results
A total of 33 PAH patients (66,33±12,74 years; 42% male) were included in the study. Most frequent comorbidities were dyslipidemia(n=15;44%), diabetes(n=7;20%), hypertension(n=23;67%). Concerning echocardiographyc evaluation, mean Left Ventricular Ejection Fraction (LVEF), PAPs and TAPSE was 56,64±5,37%, 57,88±25,85 mmHg, 20,93±5,20 respectively. Mean 6MWT was 318,91±11,61 meters. When compared patients with RVD with those without, a higher prevalence of atrial fibrillation/atrial flutter was observed (n=5, 62%; p 0,013) and statistically significant differences of right ventricular basal diameter (p 0,012), right atrial area (p 0,002), LVEF (p 0,015) and 6MWT (p 0,008) were detected. In the overall population a statistically significant linear regression was observed between RVD and 6MWT (p 0,029).

Conclusions
RVD is a predictor of poor functional capacity as assessed with 6MWT in patients with PAH at baseline.
496 LONG TERM PROGNOSIS FOLLOWING TRANSVENOUS LEAD EXTRACTION: INSIGHTS FROM A SINGLE CENTER REGISTRY
Authors: Arabia Gianmarco , Bontempi Luca , Cerini Manuel , Salghetti Francesca , Milidoni Antonino , Cersosimo Angelica , Curnis Antonio 
Published: December 2022

Abstract

Objective
The purpose of this analysis was to investigate the long-term prognosis following transvenous lead extraction (TLE).

Materials and Methods
We retrospectively studied all consecutive CIED patients who underwent TLE between January 2014 and January 2016 followed in our institution. The primary outcome was the composite endpoint of time to death or repeated TLE stratified by the presence of infection; secondary outcomes included individual components.

Results
Of the 191 patients (85% male, median age 70 years) who underwent TLE, 96 (50%) had infection and 95 (50%) were extracted for a different reason. Complete procedural success was achieved in 189 patients (99%) with no major complications. During a follow-up of 6.5 (5.4–7.1) years, infectious indication was associated with a significantly lower event-free survival (67% vs 83%; adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02–3.81, P=0.04). The difference was significant also considering the death component (30% vs 10%, log-rank P&lt;0.01); while the rate of re-repeated TLE was similar (4% vs 7%, P=0.62). In the infectious group, the presence of vegetation (aHR 2.56; 95% CI 1.17–5.63, P=0.02) and positive blood coltures (aHR 2.64; 95% CI 1.04–6.70, P=0.04) were independently associated with the primary outcome.

Conclusion
Our long-term data showed a higher combined death or repeated TLE endpoint for patients who underwent TLE with infectious compared to those with a different indication. In the subgroup of infectious patients, the presence of vegetation and positive blood coltures were associated with poor prognosis despite an uncomplicated extraction and appropriate therapy.
870 COMBINING PERCUTANEOUS CORONARY INTERVENTION AND TRASCATHETER AORTIC VALVE REPLACEMENT PROCEDURES: THE IMPORTANCE OF INTRAVASCULAR LITHOTRIPSY
Authors: Bruno Federica , Sorrentino Sabato , Sportelli Martina , Panarello Alessandra , Spinali Martina , Aquila Iole , Polimeni Alberto , Mongiardo Annalisa , Indolfi Ciro 
Published: December 2022

Abstract

Background
Calcified coronary artery disease and severe valvular aortic stenosis (AS) often coexist. For instance, severely calcified lesions may strongly influence the revascularization strategy in patients undergoing transcutaneous aortic valve replacement (TAVR). Shock wave intravascular lithotripsy (S-IVL) (Shockwave Medical Inc. Santa Clara, CA) is the only technology available that cracks both medial and intimal calcium while minimizing trauma to the vessel wall, thus allowing a safe plaque debulking. We report a case of percutaneous coronary intervention (PCI) and TAVR in the same procedure, where S-IVL has been used to treat a heavily calcified lesion and optimize stent under-expansion.

Case Report
A 79 years-old male patient with a history of diabetes mellitus type 2, hypertension, and peripheral artery disease, was admitted to our institution with symptomatic severe AS and severe calcified left anterior descending (LAD) artery lesion at CT scan. Deemed eligible for TAVR, Heart Team planned a percutaneous coronary intervention (PCI) of LAD and TAVR in the same procedure. Through the left radial artery, coronary angiography confirmed 90% stenosis of the LAD at the central segment. Accordingly, pre-dilatation of the stenosis was performed with a 2.5×12 mm non-compliant balloon (NCB) and, because of the severe calcification, S-IVL with a 3.0×12 mm balloon inflated at 4-6 Atmospheres (ATM), delivering 40 pulses. Following, a 3.5×18-mm drug-eluting stent was implanted at 18 ATM. After implantation, an inadequate expansion of the stents was observed, which persisted despite post-dilation with 3.75×8 mm NCB at high-pressure. Bail-out S-IVL was then performed with the 3.0×12 mm balloon inflated at 4-6 ATM, delivering 40 pulses in-stent, followed by a further stent post-dilated with a 3.75×8 mm NCB up to 20 ATM. The final angiogram showed a satisfactory stent expansion. Since the low contrast volume was used, we decided to go ahead with transfemoral TAVR. Therefore, through the left femoral artery access, a 34-mm self-expandable Evolut R valve was implanted. Transthoracic echocardiography showed optimal valve implantation with a trivial periprosthetic leak. No complications were observed after the procedures and the patient was discharged after 6 days with 6 months of mandated dual antiplatelet therapy (Aspirin and Clopidogrel).

Discussion
In this case, the bail-out use of S-IVL was essential for an optima stent implantation, allowing TAVR procedure and avoiding prolonged theoretical antithrombotic therapy underlying suboptimal stent implantation. Despite encouraging initial results, future large studies with long-term observation are required to evaluate the safety and efficacy of S-IVL in this scenario.
1150 SEX-BASED DIFFERENCES IN CORONARY PLAQUE PHENOTYPE AND HEALING AT OPTICAL COHERENCE TOMOGRAPHY (OCT) ANALYSIS
Authors: Buonpane Angela , Ricchiuto Alfredo , Lombardi Marco , Maino Alessandro , Bianchini Emiliano , 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
Atherosclerotic plaque healing is a dynamic process that promotes plaque repair after destabilization. Previous studies showed that healed plaques are more common in patients with chronic coronary syndrome than in those with acute coronary syndrome, suggesting that they might be a marker of clinical stability. The mechanisms underlying plaque healing are not completely understood. The aim of the present study was to evaluate sex-based differences in plaque phenotype and healing of non-culprit coronary lesions by optical coherence tomography.

Methods
In this observational, single-center cohort study, we enrolled patients from the OCT Registry of the Fondazione Policlinico A Gemelli IRCCS. A total of 205 patients with both acute coronary syndromes or chronic coronary syndromes undergoing coronary angiography and intravascular OCT imaging of non-culprit vessels were included in the analysis and divided into two groups according to gender.

Results
Of 205 patients, 153 were male (75%) and 52 (25%) female. Compared with male patients, female patients had lower prevalence of lipid-rich plaque (40.4% vs. 57.7%; p=0.030), plaque rupture (7.7% vs. 21.2%; p=0.028) and cholesterol crystal (13.5% vs. 29.5%; p=0.022). Mean lipid arc and calcium depht were significantly lower in female patients than in male ones (118.0° ± 79.9° vs. 135.5° ± 77.9°; p=0.011; and 52.7 µm ± 79.2 µm vs. 72.3 µm ± 93.5 µm; p=0.007) while fibrous cap tended to be thicker (108.2 µm ± 70.4 µm vs. 96.2 µm ± 72.9 µm; p=0.055). Healed plaques were significantly more frequent in female patients than in male patients (51.9% vs 34.6%; p = 0.027). The prevalence of fibrous plaque, thrombi, neovascularization, diffuse calcifications and spotty calcification was not different between the two groups.

Conclusion
Females have a distinct atherosclerotic phenotype and healing capacity compared with male patients, including lower prevalence of lipid-rich plaque, cholesterol crystals and plaque ruptures and higher prevalence of healed plaques in non-culprit coronary lesions.
279 LAYERED PLAQUES: NOT ALL ARE HEALED
Authors: Ciardetti Niccolò , Mattesini Alessio , Di Muro Francesca Maria , Nardi Giulia , Kucukseymen Selcuk , Francesca Ristalli , Stolcova Miroslava , Meucci Francesco , Di Mario Carlo 
Published: December 2022

Abstract
Layered plaques are the effect of a previous plaque event. They are associated with coronary spasm and found in more than 50% of patients with stable angina and a quarter of those with an acute coronary syndrome. Nevertheless, it is not clear whether their presence is indicative of a healing process or rather is predictive of an increased risk of future events. A 71-year-old male, heavy smoker and hypertensive, presented with episodes of angina at rest that resolved spontaneously in less than 5 minutes, with evidence of ST-segment elevation (STE) in the lower leads during one of these episodes. Coronary angiography showed an intermediate stenosis at the end of the mid segment of the dominant right coronary artery (RCA) (Figure A). Optical coherence tomography (OCT) revealed a layered plaque, consisting of high backscattering layers alternated with low reflection layers (Figures A1-3). Given the minimum luminal area of 3.65 mm2 and the absence of other criteria for plaque instability (erosion, thin-cap, etc.), we treated the patient conservatively with medical therapy alone, consisting of a single antiplatelet agent and a high-dose statin with ezetimibe. A non-dihydropyridine calcium antagonist and a long-acting nitrate were started given the suspicion of coronary spasm. Four months later the patient returned to the emergency department for persistent oppressive chest pain unresponsive to sublingual nitrates with evidence of STE in the lower leads. Emergency coronary angiography showed an acute occlusion of RCA with TIMI 0 flow in correspondence to the layered plaque highlighted 4 months earlier on OCT (Figure B). Antegrade flow was restored with manual thrombus aspiration (Figure C) and OCT showed lesion progression with many new layers, together with a cavity suggestive of plaque rupture (Figures C1-3). A 3.5×38 mm everolimus eluting stent was deployed – based on OCT sizing – and post-dilated with a 4.0×8 mm non-compliant balloon, obtaining an excellent angiographic result with TIMI 3 flow (Figure D). Low-reflecting layers within layered plaques are generally considered to be lipid deposits, but they could also represent intraplaque haemorrhages, generated by coronary spasm. The haematoma can be reorganised within the plaque to create a new layer, leading to lesion progression without necessarily requiring a loss of endothelial integrity. The progressive increase of the haematoma may lead to plaque rupture when the pressure exceeds the resistance of superficial layers. This case reveals a new possible mechanism of plaque progression in patients with coronary spasm and explains how layered plaques can be ambivalently considered to be either stable or vulnerable. Their treatment should be meticulously tailored not only based on classical criteria of plaque instability but also according to the underlying trigger mechanism.
547 AN UNUSUAL CONSERVATIVE STRATEGY FOR ACUTE AORTIC RUPTURE AFTER TAVI POST-DILATATION
Authors: Ciardetti Niccolò , Kucukseymen Selcuk , Meucci Francesco , Stolcova Miroslava , Di Muro Francesca Maria , Nardi Giulia , Ristalli Francesca , Mattesini Alessio , Di Mario Carlo 
Published: December 2022

Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for symptomatic severe aortic stenosis in patients deemed to be at high operative risk for the surgery. Despite its high success, TAVI is associated with rare life-threatening complications. The frequency of aortic annular rupture (AAR) has been reduced by advances in pre-procedural screening and patient selection but, when occurs, often requires emergency surgery with a very high mortality. We described an unusual case managed conservatively.
A 86-year-old female patient with NYHA Class III and STS score for mortality of 4.8% underwent TAVI via a transfemoral approach. At preprocedural MDCT the aortic annular area was 293 mm2 with severe calcification of the valve leaflets extending in the outflow tract and in the sinotubular junction with effacement of the coronary sinuses (Fig. 1A-B). Following deployment of a 23-mm self-expanding valve (Medtronic Evolut Pro+) without predilatation, moderate-to-severe residual aortic regurgitation (AR) was observed (Vid. 1). After balloon post-dilatation using a 20×40mm noncompliant (NC) OSYPKA - VACS III balloon, mild-to-moderate AR still persisted (Fig. 1C, Vid. 2). Accordingly, we decided to perform a second post-dilatation using a 22×40mm NC balloon which reduced AR to mild but caused a contained AAR was observed (Fig. D&E, Vid. 3). The patient remained hemodynamically stable with no chest pain and had no pericardial effusion on echo. The risk of a Bentall operation in such a frail elderly patient was judged prohibitive and a conservative strategy was recommended. Postprocedural MDCT confirmed the presence of a pseudoaneurysm with the maximum dimensions of 24×15 mm (Fig. 1F). Patient was followed-up for 23 days first in hospital keeping a low blood pressure with iv nitrates and then in a rehabilitation centre. An MDCT control on day 10 showed no growth of the pseudoaneurysm with a reduction of the brisk filling initially observed. She was discharged without additional problems, and scheduled for a three month control MDCT.
Established risk factors for AAR include valve and balloon oversizing, bicuspid valve, small annulus, shallow Valsalva sinuses, and massive annular or sub/supra-annular calcification. When these recognized risk factors are present, a conservative strategy for valve postdilatation is strongly recommended. Early recognition and prompt surgical management of AAR are essential but occasionally also a conserative strategy can prove successful.
806 BRIDGING COLLATERALS OF CHRONICALLY OCCLUDED LEFT INTERNAL MAMMARY ARTERY BYPASS GRAFT TO LEFT ANTERIOR DESCENDING ARTERY
Authors: De Ornelas Benjamin , Ferraiuoli Giovanni , Di Caccamo Leandro , Di Fazio Luca , Alaimo Chiara , Buccheri Giancarlo , Sacco Tania , Lentini Emanuele , Testa Gabriella , Vadalà Giuseppe , Galassi Alfredo 
Published: December 2022

Abstract

Methods and results
The internal mammary artery (IMA) is the conduit of choice to bypass the left anterior descending (LAD) coronary artery in patients eligible for coronary artery bypass grafting (CABG).
In case of graft occlusion, it is still not clear whether it is better to revascularize the graft or the recipient native vessel, on top of optimal medical therapy.
A 55-year-old man, with prior CABG, underwent urgent coronary angiography for an acute coronary syndrome.
LAD CTO, severe proximal circumflex artery stenosis, and mild atherosclerosis of the right coronary artery were found. Moreover, a proximal occlusion of the venous graft to the obtuse marginal branch and LIMA CTO within the body of the graft were shown as well. Surprisingly, many well-developed bridging collaterals, arising close to the proximal cap of the LIMA occlusion, supplied the bloodstream circulation distal to the occlusion within the LIMA.
At that time, a left main–proximal circumflex artery stenting was performed (3.5×24-mm Xience Sierra, Abbott) because that was judged the culprit lesion.
One month later the patient still complained of effort angina and dyspnoea despite optimized antianginal medical therapy. The patient was scheduled for elective antegrade LIMA CTO PCI, considered the most appropriate treatment strategy. Indeed, the presence of a prior stent implanted in the left main– circumflex artery would have made difficult a proximal cap negotiation and its penetration by guidewires in case of antegrade LAD CTO PCI. Thus, the LIMA CTO negotiation was initially attempted with a Fielder FC guidewire (Asahi Intecc) and a supporting Corsair Pro (Asahi Intecc) microcatheter. The polymeric soft wire prolapsed preferentially into the bridging collaterals without the chance to engage the CTO proximal cap. Finally, a moderate-weight hydrophilic GAIA second (Asahi Intecc) succeeded in cap penetration and final CTO crossing. After lesion predilatation with a 2.0×15-mm balloon (Emerge, Boston Scientific), 2 overlapped stents, respectively 2.75×44 mm and 3.0×18 mm (VIVO ISAR, Translumina) were deployed and postdilated by a 3.0×15-mm non-compliant balloon (Accuforce, Terumo). The final result was deemed very satisfactory with a TIMI 3 flow.

Conclusions
Many studies showed that IMA has active biological functions, providing a sort of protection against atherosclerosis and self-reparative properties. These biological properties might justify the IMA high long-term patency rates as CABG conduits. The development of bridging collaterals in this patient, represents a clear proof of the LIMA self-reparative properties. Whereas bridging collaterals are a common feature of coronary CTO, their development in a LIMA bypass graft represents a unique finding which requires further investigation.