bluuebunny/crossref_metadata_2025_split huggingface dataset:
340 TELENURSING: MANAGEMENT OF LOOP RECORDER IMPLANTED IN PATIENTS WITH PREVIOUS CRYPTOGENETIC STROKE
Authors: Morelli Francesca 
Published: December 2022

Abstract

Introduction
According to the latest studies, atrial fibrillation is associated with an increase in death of 1,5 - 1,9%. The main cause of this increase in mortality is ischemic stroke, secondary to detachment of emboliÂ starting from thrombus in the left atrium or in the left auricle. To date, the data indicate that the cause of stroke in the course atrial fibrillation is 14,7% throughout Italy.
The loop recorder is a small device that is implanted in the patientâ€™s subcutis through a minimally invasive procedure and allows you to go to record any arrhythmias. After implantation, it is fundamental to monitor and manage the device to recognize an arrhythmia, make a diagnosis and intervene promptly.
One of the indications for the implantation of the loop recorder is precisely the presence of a previous cryptogenic stroke. Atrial fibrillation, being the cause of stroke, requires long - term monitoring to be diagnosed.
In recent years there has been an increase in systems and modernization of this device which allows not only monitoring and diagnosis, but also timely intervention for a possible subsequent stroke episode.

Purpose
The study that was conducted in the Hemodynamics Department of the Santa Maria Goretti Hospital in Latina analyzes the data related to the loop recorder system for cryptogenic stroke. The patients who have performed the implant are monitored, thanks to remote assistance, and after some time the atrial fibrillation is evaluated in how many of these patients. The final goal is therefore to evaluate the benefit of this preventive intervention.

Materials and methods
There have been several researches that have made it possible to carry out the study on more than twenty patients. First, datas have been collected among all the people who implanted loop recorders, looking for the "previous cryptogenic strokeâ€as the reason for the implant. Once this type of patient was taken into consideration, real monitoring was carried out in the following months. Data collection and analysis were carried out on the database of Medtronic, Abbot and Biotronick which are the manufacturers of all devices that allow telemonitoring.

Results
The study demonstrated the benefit of implanting this device, based on a precise diagnosis, which cannot be obtained in a short time. About 70% of the patients taken into consideration were diagnosed with atrial fibrillation and this made it possible to intervene in the most suitable way to prevent an eventual recurrence of stroke.
555 ADHERENCE AND PERSISTENCE OF PCSK9 INHIBITORS IN CLINICAL PRACTICE: THE REAL-WORLD ITALIAN EXPERIENCE (AT-TARGET-IT STUDY)
Authors: Marzano Federica , Basile Christian , Paolillo Stefania , Cesaro Arturo , Buonocore Davide , Asile Gaetano , Abbate Vincenza , Vicidomini Francesca , Maria Spaccarotella Carmen Anna , Spirito Giulio , Maloberti Alessandro , Iannuzzo Gabriella , Ciccone Marco Matteo , D´alleva Alberto , Corleto Antonella , Brunetti Natale Daniele , Indolfi Ciro , Gargiulo Paola , Perrone-filardi Pasquale 
Published: December 2022

Abstract

Introduction
Hypercholesterolemia is a major risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) are recommended in patients with documented ASCVD or Familial Hypercholesterolaemia (FH), not achieving LDL-C target while treated with maximally tolerated dose of lipid-lowering therapy (LLTs). In this conext, single country real-life data, reporting use of PCSK9i in clinical practice are needed.

Purpose
AT-TARGET-IT is an observational, retrospective, IV phase registry, involving 10 Italian sites, designed to study adherence and persistence of PCSK9i (either Evolocumab or Alirocumab) in patients with ASCVD or FH.

Methods
All clinical and demographic characteristics were recorded at the time of first prescription and at the latest observation preceding inclusion in the study. Adherence was calculated as Medical Possession Ratio (MPR), defined as the ratio between the drug units dispensed during the treatment period and the duration of the treatment period itself. Persistence was defined as therapeutic continuity from the start of treatment upon enrollment and was assessed at the time points of 6, 12 and 18 months from prescription.

Results
798 patients were enrolled. In the overall population, mean age was 62 years (±7.8) and the majority were male (66%). Patients were followed for a median time of 19.33 months. 760 patients (95.2%) showed high adherence to therapy, 13 (1.6%) partial adherence, and 25 (3.1%) no adherence. At 6 month 99.7% of patients enrolled in the study remained on therapy; there were 519 and 423 patients in the study with a follow up of at least 12 and 18 months respectively. Persistence in these groups was 98.1% and 97.5%, respectively. Overall, 28 patients (3.5%) discontinued therapy. No differences in adherence and persistence were found between patients on Alirocumab or Evolocumab.

Conclusion
The AT-TARGET-IT registry study demonstrated that, in a large single-country real-world population, PCSK9i therapy is extremely successful in routine clinical practice, very high adherence and persistence.
1125 AN UNDER-RECOGNIZED CAUSE OF VENTRICULAR ARRHYTHMIAS AND SUDDEN CARDIAC DEATH: A CASE REPORT
Authors: Coletti Federica , Ricottini Elisabetta , Appetecchia Alessandro , Salvati Giuseppe , Mega Simona , Ussia Gian Paolo , Grigioni Francesco 
Published: December 2022

Abstract
Mitral annular disjunction (MAD) is a structural abnormality which is commonly seen in patients with myxomatous mitral valve disease and mitral valve prolapse. MAD is a marker of severe disease including a higher need for mitral valve intervention and more arrhythmic events, which can be a cause of sudden cardiac death (SCD).
A 72-years-old man with several cardiovascular risk factors (hypertension, diabetes mellitus, obesity, previous smoking, family history of cardiovascular diseases, chronic kidney disease) experienced two pre-syncopal episodes. Therefore, he was referred to a 24-hour Holter EKG that showed a non-sustained ventricular tachycardia (VT). A transthoracic 2D echocardiogram evidenced a mitral valve prolapse with mild regurgitation, normal left and right heart dimensions and function. Elective coronary angiography was performed to rule out an ischemic aetiology of ventricular arrhythmias (multiple cardiovascular risk factors and strong familiarity for coronary artery disease). The coronary angiography revealed a stenosis of 30% of left anterior descending artery and an intermediate stenosis of right coronary artery. A myocardial perfusion scintigraphy was performed to evaluate the intermediate coronary stenosis. The scintigraphy showed numerous focal perfusion abnormalities non indicative for coronary disease but rather for a degenerative or inflammatory disease. Indeed, we decided to perform a cardiac magnetic resonance (CMR). The CMR revealed a MAD with detachment of the root of the mitral annulus from the postero-lateral ventricular myocardium during systole, without areas of myocardial fibrosis evidenced by late gadolinium enhancement (LGE). Factors for high risk of SCD, such as fibrosis affecting the infero-basal left ventricle free wall or the papillary muscles, family history of SCD, personal history of complex ventricular arrhythmias, were not represented in our case. Therefore, we opted for a medical therapy with beta-blockers and a careful follow-up.
MAD is an under-recognized cause of ventricular arrhythmias and SCD, generally associated to mitral valve prolapse. Echocardiography and CMR can identify and quantify MAD. A comprehensive evaluation, including multimodality imaging and clinical history, is mandatory for risk stratification of SCD and for optimal treatment.
456 NATURAL HISTORY AND CLINICAL BURDEN OF MODERATE AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Morelli Martina , Galasso Michele , Soriano Francesco Stefano , Nava Stefano , Da Pozzo Caterina , Esposito Giuseppe , Piccaluga Emanuela , Bossi Irene , Montalto Claudio , Oreglia Jacopo Andrea , Giannattasio Cristina 
Published: December 2022

Abstract

Objectives
The aim of this study was to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of left ventricular ejection fraction and of age with prognosis.

Background
The mortality risk of patients with moderate aortic stenosis is not well known but recent studies suggested that it might negatively affect prognosis.

Methods
A systematic research was conducted on PubMed. The inclusion criteria were: 1) inclusion of patients with moderate aortic stenosis; 2) report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.

Results
Fifteen studies and 11,596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than among controls: 10.7% (95% CI: 0.1010-0.1136) vs 4.5% (95% CI: 0.0438-0.0454) at 1-year, 17.7% (95% CI: 0.1692-0.1854) vs 7.6% (95% CI: 0.0754-0.0775) at 2-year, 23.0% (95% CI: 0.2204-0.2387) vs 9.9% (95% CI: 0.0973-0.0997) at 3-year, 27.9% (95% CI: 0.2685-0.2899) vs 11.9% (95% CI: 0.1177-0.1203) at 4-year, and 32.4% (95% CI: 0.3125-0.3360) vs 14.2% (95% CI: 0.1402-0.1430) at 5-year follow-up. Left ventricular ejection fraction did not significantly impact on the prognosis of patients with moderate aortic stenosis (estimate = -0.0020; 95% CI: -0.0078-0.0038; p = 0.4584), unlike of age (estimate = 0.0067; 95% CI: 0.0007-0.0127; p = 0.0323).

Conclusions
Moderate aortic stenosis is not a benign disease. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of the aortic valve replacement.
All-cause mortality of patients (red) vs controls (black) at 1-, 2-, 3-, 4- and 5-year follow-up.
889 ATRIOVENTRICULAR BLOCK, AN UNUSUAL CLINICAL PRESENTATION OF CALCIFIED BICUSPID AORTIC VALVE
Authors: Pisani Elena , Bartolini Simone , Sani Francesca , Signorini Umberto , Milli Massimo , Beltrami Matteo 
Published: December 2022

Abstract

Background
Bicuspid aortic valve (BAV) is the most frequent congenital valve disease in adults. It is often associated with other congenital cardiac defects. Sometimes it is associated with aortic dilatation. BAV is an heterogeneous disease with varying valve morphology (asymmetrical cusp size and rafe), annulus geometry and size, asymmetrical calcification of the aortic valve and left ventricular outflow tract.

Case Report
A 32 year-old male patient was diagnosed with bicuspid aortic valve after several cardiologic visits for eligibility to competitive sport. Since April 2021 he developed a progressive exertional dyspnea for strenuous efforts. In February 2022, he was referred to our department after a Holter ECG showed a bradyarrhythmia with complete atrioventricular block. The echocardiography evaluation demonstrated a preserved ejection fraction and a bicuspid aortic valve with a mild-moderate regurgitation. The coronary computed tomography showed a thick and calcified bicuspid aortic valve with a coarse calcification of the anterior cuspid that involve the pars membranacea of the interventricular septum. The ergometric exercise demonstrated chronotropy incompetence. The tomography confirmed the mildy aortic root dilatation. Therefore, an MRI was performed and reported a small laminar LGE on the infero-lateral wall of the left ventricle, of unclear significance. He underwent Dual-Chamber permanent pacemaker implantation. A conservative approach was preferred over valvular replacement, considering the mild aortic root dilatation on a background of mild-to- moderate aortic insufficiency.

Conclusion
Our case is unusual given the bicuspid aortic valve concomitant with atrioventricular block, which was connected with the location of the calcification. Thus, the aim of our case report is, to describe a complication to this condition which, although rare, represents a different clinical presentation of the pathology itself in a young adult.
317 IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN ARRHYTMIC MITRAL VALVE PROLAPSE: YOU'LL BE CONSIDER IT FOR PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH?
Authors: Pittorru Raimondo , Cecere Annagrazia , Marra Martina Perazzolo , Migliore Federico , Iliceto Sabino 
Published: December 2022

Abstract
A 50-year-old female with a history of bileaflet mitral valve prolapse (MVP) was admitted to our Department for persistent palpitation. Physical examination revealed a mid-systolic click, followed by a mid-to-late apical systolic murmur. The electrocardiogram showed sinus rhythm with negative T-waves in inferior leads and repetitive polymorphic premature ventricular contractions (PVCs) with a right bundle branch block pattern and superior axis morphology suggestive of a possible origin from the posterior papillary muscle. The echocardiography confirmed normal ventricular ejection fraction, bileaflet MVP with moderate regurgitation, systolic curling and mitral annulus disjunction. Exercise stress testing demonstrated an increase of polymorphic PVCs during maximum effort. The cardiac magnetic resonance showed an underlying late gadolinium enhancement at the level of the papillary muscles and in the inferobasal region. After a multidisciplinary evaluation, a transvenous implatable cardioverter defibrillator (ICD) was implanted for primary prevention without clear indications deriving from current guidelines. After eleven years, the patients experienced two appropriate shocks due to polymorfic ventricular tachycardia while she was sleeping. Furthermore, the patient underwent successful mechanical transvenous lead extraction and ICD re-implantation for lead failure. During this hospitalization a subsequent echocardiography detected severe ventricular dilatation with moderate systolic disfunction.

Conclusion
Our report demonstrated that MVP represents potentially cause of life-threatening ventricular arrhythmias and tachycardia induced cardiomyopathy. Beta-blockers are often inadequate in order to reduce PVCs burden. We need more arrhytmic predictors to assestment of sudden cardiac death risk and evaluate ICD for primary prevention. Obtain left ventricular function recovery is difficult and it requires a multidisciplinary approach. It will be important in the future to better define the role will play cathether ablation and mitral valve repair or replacement to prevent malignant arrhytmias.
322 TRICUSPID VALVE REGURGITATION AFTER TRANSVENOUS LEAD EXTRACTION: WE NEED TO KNOW MORE
Authors: Pittorru Raimondo , Dall´aglio Pietro Bernardo , Migliore Federico , Micciolo Matteo , D´onofrio Augusto , Iliceto Sabino , Gerosa Gino 
Published: December 2022

Abstract
Since 2003 a 73-year-old man was submitted to a pacemaker implantation because of atrio-ventricular block. After fourteen years, upgrading to CRT-D was made due to recovery for acute heart failure in a dilated cardiomyopathy with severe left ventricular systolic dysfunction. In 2019 and 2020 he presented pocket erosion therefore underwent to a submuscular reimplantation. After one year, he came to Arrhythmology outpatient appointment with inflammatory signs of the CRT-D pocket. The patient was started on Meropenem and Vancomicin. Transthoracic (TTE) and transesophageal echocardiogram didn't reveal any vegetation on valvular apparatus or on leads. The patient was submitted to transvenous lead extraction (TLE) with bidirectional rotational mechanical sheats and a epicardial lead on postero-lateral left ventricular wall was implanted. The post-procedural TTE showed a moderate to severe organic tricuspid valve regurgitation with annular dilatation despite the patient was asymptomatic. There weren't flail leaflets or tricuspid valve damage. The reimplantation of right atrial and ventricular leads was hindered by complex venous anatomy documented by intraprocedural phlebography. After Heart Team discussion, we agreed to tricuspid valve repair with annuloplasty ring and other two epicardial leads - right atrial and ventricular - was implanted. We achieve a successful result without complications. The patients was discharged without symptoms; the device interrogation showed good assessment of lead impedances, sensing thresholds, and capture thresholds.

Conclusion
The mechanisms of tricuspid valve regurgitation following TLE are complex. There isn't a standardized best practice to approach this phenomenon. It's important after TLE to assess tricuspid valve structure and function with TTE in order to understand the incidence of underlying potential mechanism and how to prevent it. Complex venous anatomy could direct the choice toward epicardial leads implantation.
221 NONBACTERIAL THROMBOTIC ENDOCARDITIS WITH ATYPICAL PRESENTATION AS OVERT CONGESTIVE HEART FAILURE
Authors: Restelli Davide , Trio Olimpia , Poleggi Cristina , Cusma´ Piccione Maurizio , Manganaro Roberta , Certo Giuseppe , Zito Concetta , Ando´ Giuseppe 
Published: December 2022

Abstract

Introduction
Non-Bacterial Thrombotic Endocarditis (NBTE) is a form of endocarditis associated with malignancy or autoimmune disorders. Diagnosis remains a challenge as patients are often asymptomatic up to embolic events or, rarely, valve dysfunction. We report a case of NBTE with uncommon clinical presentation and identified with multimodal echocardiography.

Case presentation
An 82-year-old man presented to our outpatient clinic reporting dyspnea. Past medical history included hypertension, diabetes, kidney disease, and unprovoked deep vein thrombosis. On physical examination, he was apyretic, mildly hypotensive and hypoxemic, had a systolic murmur and lower limbs edema. Transthoracic echocardiography revealed severe mitral regurgitation due to verrucous thickening of the free margin of both leaflets, increased pulmonary pressure, and dilated inferior vena cava. Multiple blood cultures were negative. Transesophageal echocardiography confirmed “thrombotic” thickening of mitral leaflets. Nuclear investigations were highly suggestive of multi-metastatic pulmonary cancer. We did not further proceed in the diagnostic workup and prescribed palliative care.

Discussion
Lesions seen on echocardiography were suggestive of NBTE: they involved both sides of mitral leaflets, close to the edges, had irregular shape and echo-density, a broad base, and no independent motion. Criteria for infective endocarditis were not met and the final diagnosis was paraneoplastic NBTE due to underlying lung cancer. We remark the lack of definitive recommendations about treatment of NBTE and the only role of anticoagulation to prevent systemic embolism.

Conclusions
We report a case of NBTE presenting with atypical symptoms and likely related to the prothrombotic state induced by underlying lung cancer. Provided the unconclusive microbiological tests, multimodal imaging played a crucial role for the final diagnosis.
951 PROGNOSTIC IMPACT OF DISPROPORTIONATE FUNCTIONAL MITRAL INSUFFICIENCY IN PATIENTS UNDERGOING PERCUTANEOUS “EDGE-TO-EDGE“ VALVE REPAIR
Authors: Velardi Silvia , Polimeni Alberto , Mongiardo Annalisa , Spaccarotella Carmen , Messina Chiara , Vizzari Francesca , Velato Letizia , Di Costanzo Assunta , Scebba Jacopo , Estévez-loureiro Rodrigo , D´ascenzo Fabrizio , Indolfi Ciro 
Published: December 2022

Abstract

Aims
The ideal phenotype of patients with functional mitral regurgitation (FMR) who benefit most of transcatheter edge-to-edge repair (TEER) is still unclear. Some studies have suggested that patients with disproportionate FMR may have a better outcome. The purpose of this study is to evaluate the prognostic value of proportionate versus disproportionate FMR, in patients undergoing TEER with MitraClip system.

Methods and Results
The multicenter observational MITRA-CTV registry includes 200 patients with moderate-severe (3+) to severe (4+) FMR undergoing MitraClip, between March 2013 and June 2021, at three European institutions such as Magna Graecia University of Catanzaro, University of Turin (Italy) and University of Vigo (Spain). Patients were defined as having proportionate or disproportionate FMR if their EROA/LVEDV (left ventricular end diastolic volume) ratio was ≤ or &gt; from the median value (0.15), respectively. The primary endpoint was the composite of death from all causes and rehospitalizations for HF, at 1-year follow-up. The secondary endpoint was composed of the individual components of the primary endpoint and cardiovascular death. Patients with disproportionate FMR had higher EROA (0.47±0.2 cm2 vs 0.27±0.1 cm2) and smaller ventricles (LVEDV: 207 ± ml vs 239 ± 83 ml) than those with proportionate FMR. Procedural success was achieved in 95% of patients. Notably, 30-day residual MR was comparable in patients with disproportionate versus proportionate FMR. There were 4 (2%) deaths during hospitalization, and the median hospital stay after the procedure was 9 days (IQR 7- 9 days). At Kaplan-Meier analysis, an EROA/LVEDV ratio both higher and lower than the median value (0.15) was not associated with an increased incidence of the primary endpoint of death and rehospitalization for HF (HR 1.17 CI 95%[0.72;1.90],p=0.50). The only independent predictors of clinical outcomes at 1 year were: the presence of CKD (HR 4.11 95% CI[1.73;9.75], p=0.0014) and a post TMVR hospital stay &gt;10 days (HR 2.53 95% CI[1.24;5.18],p=0.0111).

Conclusion
In our study, there were no significant differences in outcome in patients with proportionate versus proportionate FMR undergoing TEER with Mitraclip system.
1130 ZEBRA HOOFBEATS: A RARE CASE OF STEMI IN GRANULOMATOUS NECROTIZING AORTITIS
Authors: Facci Gabriele , Alberti Giorgia , Dotto Alberto , Briani Francesco , Benfari Giovanni , Pighi Michele , Ribichini Flavio 
Published: December 2022

Abstract
We present the unusual case of an AMI STEMI, complicated by ventricular fibrillation, in a 26 years old caucasic male patient, affected by necrotizing and granulomatous aortitis, in the context of a primary immunodeficiency.
Initially the patient was referred to the Cardiology Unit for worsening dyspnea and fatigue. In his medical history he has primary immunodeficiency complicated by multiple opportunistic infections.
We performed an echocardiography that revealed an aneurismatic ascending aorta (58 mm) with associated significant aortic valvular regurgitation. He was later referred to heart surgery OR where Bentall-De Bono operation was performed. Two years later he developed a lateral STEMI, complicated by ventricular fibrillation. The coronary angiography, performed in foreign country, showed total occlusion of the circumflex coronary artery with diffuse aneurismatic coronary disease, granulomatosis and ulcerative lesions. A percutaneous revascularization approach was tried, but ineffective.
Actually the patient, during follow up, presents dilatative post-ischemic cardiopathy with moderate ejection fraction reduction, initial aortic bioprosthesis failure. We noted at follow up echocardiograms early dilatation of the native aortic arch (35 mm), suggesting a progressive disease.
In conclusion, AMI's etiology includes many non atherosclerotic mechanisms that should be considered alongside common causes.
This case shows a rare cause of STEMI in a very young male patient, and teaches us that aortitis is a progressive and complex pathology, often involving multiple arteriosus districts, that needs close follow-up and integrated management.