bluuebunny/crossref_metadata_2025_split huggingface dataset:
522 THE IMPACT OF SPECIALIST CARDIOLOGY INPUT ON OUTCOMES IN PATIENTS ADMITTED FOR HEART FAILURE WITH NORMAL EJECTION FRACTION. A MULTICENTRE STUDY
Authors: Cannata Antonio , Badawy Layla , Anyu Anawinla Ta , Samways Jack , Sweeney Mark , Zackeri Rosita , Scott Paul , Piper Susan , Plymen Carla , Mcdonagh Theresa , Bromage Daniel 
Published: December 2022

Abstract

Aims
Specialist cardiology care is associated with a prognostic benefit in patients with HF with reduced ejection fraction (HFrEF) admitted with decompensated heart failure (HF). However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown.

Methods
Data on patients hospitalised with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality.

Results
A total of 1,413 patients were included in the study. Of these, 23% (n=322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs 79%, p=0.03) and respiratory comorbidities (25% vs 31%, p=0.02) compared to those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (NYHA III/IV 83% vs 75% respectively, p=0.003; moderate-to-severe peripheral oedema 65% vs 54%, p&lt;0.001). Medical management was similar, except for a higher use of diuretics (90% vs 86%, p=0.04) and a longer length of stay for patients who received specialist input (9 vs 4 days, p&lt;0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (HR 0.19, CI 0.09-0.43, p&lt;0.001).

Conclusion
In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but it is independently associated with reduced in-hospital mortality.
504 ACUTE HEART DISFUNCTION IN PATIENT WITH PACEMAKER, ATRIAL FIBRILLATION AND OLD MYOCARDIAL INFARCTION: WHAT IS THE REASON?
Authors: Caruso Davide , Pestelli Stefano , Lonati Andrea , Novelli Cristiano , Lupi Gabriele 
Published: December 2022

Abstract
Patient (pt) 78 years old, ex smoker, with hypertension, dyslipidemia, iperuricemia and overweight. Myocardial inferior infarction with mechanical rivascularization and implant of drug eluting stent on right coronary artery in 2012. Residual ejection fraction of 47% with inferior hypocinesia. Pacemaker DDD implant for 2nd degree atrioventricular block in 2013. Atrial fibrillation from July 2021. Acute nocturnal heart failure with hypoxiemia (PO2 76%) and necessity of non invasive ventilation in November 2021 without worsening of coronary tree at coronarography and echocardiografic finding of EF 47% with inferior and posterior hypocinesia. Troponin I hs 53.6 pg/ml BNP 378 ng/ml. None relevant arrhytmias at pacemaker control. After hospital admission pt done polisonnography with finding of severe obstructive nocturnal apneas and need of CPAP (continous positive airways pressure).

Conclusions
in literature obstructive sleep apnea syndrome (OSAS) can cause heart failure, cardiac ischemic disease and hypertension. In this case a long obstructive apnea could have caused severe desaturation with hypoxiemia and then an acute episode of heart failure.
831 ECHO-API: CORRELATION WITH INVASIVE API AND PROGNOSTIC ROLE IN HEART FAILURE
Authors: De Lio Giulia , Frea Simone , Boretto Paolo , Gravinese Carol , Bellettini Matteo , De Ferrari Gaetano Maria 
Published: December 2022

Abstract

Background
The benefit of invasive hemodynamic assessment in the setting of heart failure (HF) is still controversial. Increased right and left filling pressure have been shown to be associated with adverse prognosis, while reduced cardiac index (CI) has not. For this reason, novel hemodynamic indexes have been developed aiming to better describe the cardiac function in different loading conditions. In this context, the aortic pulsatility index (API) is a hemodynamic variable integrating LV function and loading condition which has the potential to better predict clinical outcome. It is calculated as systolic blood pressure (SBP) minus diastolic blood pressure (DBP) divided by pulmonary capillary wedge pressure (PCWP); the difference between SBP and DBP, known as arterial pulse pressure, correlates with SV, while PCWP is a marker of the degree of pulmonary congestion. API has been shown to predict long-term outcomes in acute decompensated HF and advanced HF cohorts. To the best of our knowledge, hemodynamically-derived API has never been compared to echocardiography-estimated API.

Purpose
To evaluate the accuracy of API obtained with echocardiographic methods (echo-API) compared with the invasive hemodynamic measure obtained with right heart catheterization (RHC) and to explore its prognostic role in a HF cohort.

Methods
Consecutive patients referred for RHC to Città della Salute e della Scienza hospital from May 2019 to August 2022 underwent complete two-dimensional echocardiographic evaluation and RHC. Patients ≥ 18 years with either acute or chronic HF, irrespective of etiology, were included. For the calculation of Echo-API PCWP was estimated using the average E/e’ ratio. The association between echo-API with MACE (composite of death, LVAD implantation or heart transplantation) at 1 year follow-up was evaluated.

Results
112 patients were included in the analysis. They were mostly male, mean age was 57 years and the underlying heart disease was predominantly idiopathic dilated cardiomyopathy (32%), followed by ischemic (30%); mean LVEF was 35,07%.
Mean Echo-API was 3,54. Echo-API showed a significant correlation with invasive API using the Pearson correlation coefficient (r = 0,6591, 95% CI 0,4639–0,7933, p &lt; 0,0001) and showed a linear correlation at Bland-Altman plot. At multivariate regression analysis Echo-API was significatively associated with primary outcome (OR 0.469, 95% CI 0.26–0.84, p 0,011).

Conclusions
Echocardiographically-derived aortic pulsatility index can be obtained in all patients with advanced HF and shows a good correlation with invasive API; it is associated with MACE, representing a useful tool for non-invasive hemodynamic evaluation and risk stratification.
338 PREVALENCE AND PERSISTENCE OF HYPOVITAMINOSIS D AMONG ITALIAN PATIENTS WITH MYOCARDIAL INFARCTION
Authors: Aleksova Aneta , Gagno Giulia , Pierri Alessandro , Fluca Alessandra Lucia , Janjusevic Milijana , Derin Agnese , Oriana Zhou Xin Ning , Restivo Luca , Hiche Cristina , Stenner Elisabetta , D’errico Stefano , Zandonà Lorenzo , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Hypovitaminosis D is common in the Italian population and has a comparable effect to diabetes mellitus on survival after an acute myocardial infarction (AMI). We aimed to evaluate if the prevalence of hypovitaminosis D changed over time, considering also frequent lockdowns in the last years due to COVID-19 pandemic.

Methods
According to the year of enrollment, we divided our cohort of 1042 patients hospitalized for AMI, into three groups (group 1 with 368 patients enrolled from 2014 till 2016, group 2 with 470 patients enrolled in the period from 2017 till 2019, and group 3 including 204 patients enrolled in the last three years, from 2020 till 2022) and evaluate whether the concentration of vitamin D changed in the last decade.

Results
The median concentration of vitamin D in our cohort of patients with AMI was 18.2 (11.48-25.73) ng/ml). Throughout the three groups (2014-2016, 2017-2019, 2020-2022), the median plasma vitamin D showed a trend toward an increase (17.3 (10.33–24.2) ng/ml, 18.95 (11.6–26.73) ng/ml, and 19.05 (12.5–27.3) ng/ml respectively), which was significant between the group 1 vs 2 and 3 (p = 0.033 and p = 0.004, respectively), while between the group 2 and 3 did not. Despite the trend of increase, the percentage of patients with hypovitaminosis D in each group remained high (61.4%, 53.8% and 52.0% respectively). As expected, samples taken between May and September have significantly higher vitamin D values compared to ones taken from October to April for each group (the group 1: 21.80 (15.55–31.23) ng/ml vs 15.8 (9.22–23.98) ng/ml, p &lt; 0.0001; the group 2: 22.05 (14.10–30.98) ng/ml vs 16.50 (11.03–23.90) ng/ml, p &lt; 0.0001); the group 3: 20.00 (11.90–26.90) ng/ml vs 16.30 (9.75–22.30) ng/ml, p = 0.001).

Conclusions
There has been a trend of increasing vitamin D values over the years, but hypovitaminosis D remains frequent. During the pandemic, vitamin D levels did not decrease due to frequent lockdowns, possibly due to media awareness that emphasized the significance of vitamin D administration against viral infection.
349 INTRAVENOUS CANGRELOR INFUSION IN PATIENTS UNDERGOING COMPLEX VERSUS NON-COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Gragnano Felice , Benenati Stefano , Scalamera Riccardo , Bertero Edoardo , Capolongo Antonio , De Sio Vincenzo , Musumeci Giuseppe , Annibali Gianmarco , Campagnuolo Salvatore , Galasso Gennaro , Silverio Angelo , Bellino Michele , Centore Mario , Menozzi Alberto , Caretta Giorgio , Rezzaghi Marco , De Luca Leonardo , Veneziano Francesco Antonio , Cirillo Plinio , De Rosa Gennaro , Porto Italo , Calabrò Paolo 
Published: December 2022

Abstract

Aims
To compare the clinical characteristics and in-hospital outcomes of patients undergoing complex vs. non-complex percutaneous coronary intervention (PCI) with peri-procedural use of cangrelor.

Methods
Consecutive patients treated with cangrelor in 6 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Complex PCI was defined as any of the following: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length &gt;60 mm, or chronic total occlusion. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay.

Results
Among 551 patients enrolled in the ICARUS registry and undergoing PCI between January 2019 and August 2022, a total of 534 (97%) patients had complete information on PCI complexity, of whom 173 (32%) underwent complex PCI and 361 (68%) underwent non-complex PCI. In general, patients with complex PCI had similar clinical features compared with non-complex PCI patients, including comparable prevalence of high bleeding risk (HBR) status according to the ARC-HBR definition (35% vs. 30%, p=0.253), but complex PCI patients presented more often with cardiogenic shock (9% vs. 2%, p&lt;0.001). PCI with ≥3 stents implanted was the most frequent criterion of procedural complexity (62%). The incidence of the primary endpoint of 48-hour NACE (10% vs. 7%, p=0.264) and other clinical endpoints occurring at 48 hours or during hospitalization did not differ between complex and non-complex PCI patients.

Conclusions
Among patients receiving peri-procedural cangrelor, about 30% of cases underwent complex interventions. Notwithstanding higher procedural complexity, short-term clinical outcomes were similar between complex and non-complex PCI patients.
509 RECURRENCE OF ACUTE MYOCARDIAL INFARCTION AFTER MINOCA: INSIGHTS FROM A MULTICENTRE NATIONAL REGISTRY
Authors: Ciliberti Giuseppe , Guerra Federico , Pizzi Carmine , Merlo Marco , Zilio Filippo , Bianco Francesco , Mancone Massimo , Zaffalon Denise , Gioscia Rocco , Bergamaschi Luca , Stronati Giulia , Armillotta Matteo , Sansonetti Angelo , Casella Michela , Foà Alberto , Paolisso Pasquale , Russo Antonio Dello , Gallina Sabina , Fedele Francesco , Bonmassari Roberto , De Luca Giuseppe , Sinagra Gianfranco , Kaski Juan Carlos , Verdoia Monica 
Published: December 2022

Abstract

Background
Myocardial infarction with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Prognosis of this patients could be of concern, in particular for those who experienced recurrent acute myocardial infarction (re-AMI). Moreover, there are limited data on characteristics of re-AMI among MINOCA patients.

Methods
In this retrospective multicentre cohort study involving seven Hub Hospitals across Italy we enrolled consecutive patients 18 years and older discharged with diagnosis of MINOCA according to the IV universal definition of myocardial infarction who experienced hospitalization for re-AMI during follow-up.

Results
A total of 54 patients were included (mean age 66±13). Compared to MINOCA patients without re-AMI (n=695), on first angiography MINOCA patients with re-AMI showed less frequently angiographically normal coronaries (37 versus 53%, p=0,032) and had higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p=0,049).
Twenty four patients (44%) with re-AMI underwent a new coronary angiography and 25% had normal coronary arteries, 12% had mild luminal irregularities (&lt;30%), 21% had moderate coronary atherosclerosis (30-49%), and 42% showed obstructive coronary atherosclerosis (≥50%).
Among patients undergoing new angiography, only 4% had LDL cholesterol under 55 mg/dL, atherosclerosis progression was observed in 11 (46%), 38% received revascularization and 33% experienced a new cardiovascular event (death, AMI, heart failure, stroke) at subsequent follow-up.

Conclusions
In the present study near one out of two patients with re-AMI after MINOCA showed angiographic atherosclerosis progression requiring revascularization in the majority of cases. These patients rarely presented with recommended LDL cholesterol levels and are at risk for further cardiovascular events, indicating a possible underestimation of cardiovascular risk in this population.
893 FUNCTIONAL ASSESSMENT OF INTERMEDIATE CORONARY ARTERY STENOSIS
Authors: Carbone Carlo , De Rosa Maria Luisa , Mitrano Lucia , Di Serafino Luigi , Piccolo Raffaele , Franzone Anna , Cirillo Plinio , Esposito Giovanni 
Published: December 2022

Abstract

Background
FFR represents the gold standard to functionally assess the ischemic potential of intermediate coronary artery stenoses particularly in patients presenting with multivessel disease. However, it is still underused in the current practice. Less invasive techniques have been identified for the evaluation of intermediate stenosis. The Quantitative flow ratio (QFR), based on the angiography with 3D-reconstruction of the coronary artery and computational fluid dynamics, has been showed to well correlate with the FFR. The Angiography-DeriveD hEmoDynamic index (ADDED Index) has also been validated to assess the ischemic potential of intermediate coronary stenosis and was also found to well correlate with FFR. It considers the jeopardized subtended myocardium and the minimal lumen diameter calculated at the angiography. This study aimed to compare the ADDED Index with QFR in terms of diagnostic accuracy.

Methods
A retrospective observational study was conducted. We included all patients presenting with an intermediate stenosis assessed with QFR. Both QFR and ADDED Index were calculated. Correlation was studied using Pearson's r test and linear regression. Receiver operator characteristics curve analysis was also performed.

Results
A total of 54 patients presenting with either stable angina or acute coronary syndromes were enrolled and finally 62 intermediate stenoses were included. A significant correlation between the ADDED Index and QFR was found (r2=0,32, p &lt;0.001) (Figure 1). At ROC analysis, and with the QFR as reference, the ADDED Index showed a significant and very high area under the curve (0.99 (0.99-1.00), p&lt;0.001), Figure 2) suggesting the high accuracy for the assessment of the ischemic potential of intermediate coronary artery stenoses.

Conclusion
ADDED Index was found similar to the QFR in terms of accuracy for the functional assessment of intermediate coronary artery stenoses.
845 THE PREDICTIVE ROLE OF HIGH-SENSITIVITY CARDIAC TROPONIN T IN THE EMERGENCY ROOM: COMBINING BIOMARKERS WITH CLINICAL DATA LEADS TO THE DIAGNOSIS OF CARDIOVASCULAR DISEASE
Authors: Golino Michele , Marazzato Jacopo , Blasi Federico , Morello Matteo , Chierchia Valentina , Cadonati Cristina , Ghirimorldi Elena , Pellitteri Alessia , Matteo Federica , Licciardello Claudio , Zappa Martina , Ageno Walter , Passi Alberto , Angeli Fabio , De Ponti Roberto 
Published: December 2022

Abstract

Background
Small amounts of high-sensitivity cardiac troponin (hs-cTn) I and T can be detected in healthy individuals or can occur in the absence of any clinical features of myocardial ischemia (myocardial injury). However, it is not possible to clinically distinguish whether and which increase in hs-cTn are due to which mechanisms. Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scanty. Consequently, with this monocentric retrospective study, we aimed at expanding the knowledge of this biomarker in this setting.

Methods
Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing variations were correlated with the clinical presentation and diagnosis. Subsequently, multivariable models were built to assess which clinical and laboratory variables most influenced hospital admissions.

Results
At a first screening, 4660 patients were considered, and 4149 patients were enrolled (Figure 1). Of these, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized according to the following diagnoses: acute coronary syndrome (ACS, 182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values as well as significant hs-cTnT variations were found in the ACS group (p &lt; 0.01). Furthermore, in the latter, the mean percentage of variation of hs-cTnT was higher, while it was intermediate in the non-ACS group, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02–0.39, p &lt;0.01 and OR: 0.9988, 95% CI: 0.9979–0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908–0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000–1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97–132.32, p &lt; 0.01) and eGFR (OR: 1.04, 95% CI: 1.004–1.083, p = 0.03) were significantly associated with the ACS diagnosis.

Conclusion
In our study, differently from the investigated hs-cTnT, only clinical variables predicted hospitalizations in different patients’ subgroups.
536 CHANGES IN MYOCARDIAL BIOMARKERS TO DIFFERENTIATE TYPE 2 MYOCARDIAL INFARCTION FROM TYPE 1 MYOCARDIAL INFARCTION AND ACUTE MYOCARDIAL INJURY: A PROSPECTIVE COMPARISON STUDY.
Authors: Mautone Francesco , Mele Marco , Ragnatela Ilaria , D´alessandro Damiano , Rossi Luciano Umberto , Diomede Nicolangelo , Diomede Davide , Giannetti Laura , Palmieri Gianpaolo , Corbo Maria Delia , Vitale Enrica , Brunetti Natale Daniele 
Published: December 2022

Abstract

Background
According to 4th Universal Definition of Myocardial Infarction (MI), it is possible to differentiate clinically type 2 MI (T2MI) from type 1 MI (T1MI) and acute myocardial injury (AMI). However, in many cases this differentiation may be difficult. To date there are poor data that allow to distinguish AMI, T2MI and T1MI from the changes and the absolute or relative values of biomarkers of myocardial necrosis. We sought to compare T2MI vs T1MI and vs AMI in terms of cardiac biomarkers changes.

Methods
we consecutively enrolled 90 patients (30 with T1MI, 30 with T2MI and 30 with AMI). excluding patients with ST-segment elevation myocardial infarction. The ratio of the peak to the upper limit of normal (RULN) were calculated for both CK-MB and cardiac troponin T (cTnT). Moreover, the ratio of peak cTnT to peak CK-MB was also calculated.

Results
the ratio peak/RULN for cTnI and CK-MB were significantly higher for T1MI in comparison with T2MI (cTnI 100.8 vs 67.1, p &lt; 0.001; CK-MB 2.1 vs 0.66, p 0.003) while there were not significant differences between T2MI and AMI (T2MI 67.1 vs AMI 47.3., p 0.159; T2MI 0.66 vs AMI 0.39, p 0.052). Interstingly, there was a higher rise of cTnT than CK-MB in type 2 compared with type 1 myocardial infarction, so that the ratio of peak cTnT to peak CK-MB was significantly higher for T1MI in comparison with T2MI (T1MI 196.2 vs AMI 20.5, p 0.008).

Conclusions
Both cTnT and CK-MB peaks were higher in T1MI than in T2MI. Furthermore, cTnT rises out of proportion to CK-MB in T2MI. These changes may contribute to a better differentiation between T2MI and T1MI.
323 LONG TERM CARDIOVASCULAR OUTCOMES BY SEX AND SPECIFIC METABOLIC PHENOTYPES POST ACS PATIENTS
Authors: Orlando Luana , Russo Vincenzo , Dattilo Giuseppe , Imbalzano Egidio 
Published: December 2022

Abstract

Background and Aims
Obesity, a major risk factor for acute coronary syndrome (ACS), is a multifaced disease with different metabolic phenotypes and sex-specific features. We evaluated the long-term cardiovascular risk by different obesity/metabolic phenotypes and by sex in ACS patients.

Methods
The occurrence of the composite outcome of death, non-fatal re-infarction with or without PCI and/or stroke was evaluated in 674 patients (504 men; 170 women), consecutively hospitalized for ACS and followed-up for 7 years, who were stratified in metabolically healthy (MHNW) and unhealthy normal weight (MUNW), and in metabolically healthy (MHO) and unhealthy obese (MUO) groups, as shown in Figure 1.

Results
At baseline, 54,6% of patients were included in the MHNW group, 26,4% in the MUNW, 5,9% in the MHO and 13,1% in the MUO, with no sex-differences in the phenotypes distribution. The overall rate of major outcome (100 person-years) in the reference group (MHNW) was higher in men that in women (RR: 1.19 vs 0.6). The Kaplan-Meier curves (see Figure 2) for cumulative survival free from cardiovascular events according to obesity/metabolic status diverged significantly according to sex (long rank test, P= 0.006), being this effect more prominent in men (P=0.011), than in women (P=0.047). Compared to MHNW, the risk increased in obese men (RR: 2.2; 95% CI 1.11-1.54 in MUO group), whereas in women the risk was confined to the metabolically unhealthy subjects (RR: 3.2; 95% CI 1.23-9.98, MUNW group).

Conclusions
Our data show a sex-specific impact of obesity phenotypes on long-term cardiovascular risk in patients hospitalized for ACS.
Thus, while MHO women seemed to be protected over time, in men, obesity had a stronger impact irrespective of metabolic status.
These data emphasize the importance of assessing metabolic status and implementing systematic metabolic surveillance in patients undergoing coronary revascularization procedures, even if their weight is normal.