bluuebunny/crossref_metadata_2025_split huggingface dataset:
P397 PROGNOSTIC VALUE OF CORONARY CALCIUM IN PATIENTS WITH COVID–19 AND SUSPECTED INTERSTITIAL PNEUMONIA: A CASE–CONTROL STUDY
Authors: Carletti R , Galvani M , Gardini E , De Vita M , Dallaserra C , Vizzuso A , Ottani F , Campacci F , Grosseto D , Di Gianuario G , Rinaldi G , Vecchio S , Mantero F , Mellini L , Albini A , Mughetti M , Gardelli G , Piciucchi S 
Published: May 2022

Abstract

Background
Short–term prognosis of SARS–CoV2 infection is mainly conditioned by the extent and severity of COVID–19 interstitial pneumonia. Coexistence of cardiac disease is however important and independently associated with an adverse outcome. Coronary calcium (CAC), detected at the time of chest computed tomography, can be a useful prognostic tool, as suggested by some cohort studies.

Material and Methods
We performed a retrospective, multi–centre, case–control (1:2) study in 195 COVID–19 patients admitted from 01–03–2020 to 30–04–2020. Cases were consecutive patients died within 30 days or admitted to the Intensive Care Units for invasive ventilation during the hospitalization (primary outcome measure). Controls were age– and sex–matched patients surviving until 30 days without need for invasive ventilation. For each case, we selected two controls, matched by age and sex dividing cases in age strata of 10 years, assuring within each age stratum twice the number of controls with an identical gender proportion. CAC estimation was performed with a with a semi–quantitative score (0 to 30) based on 10 segments and 4 degrees of severity of the calcification. Estimation of interstitial pneumonia, was similarly performed with a semi–quantitative score (from 0 to 20), based on 5 lobes and 5 degrees of severity of interstitial involvement. CT scans were acquired according to a standard protocol for non–cardio–synchronized chest CT, always on a multi–detector scanner with at least 16 layers.

Results
The mean CAC value in cases was significantly higher (p = 0.001) compared to controls: 5,52±1,38 vs 3,28±0,54 (mean value ± 95% CI). The percentage of cases with moderate–severe CAC was significantly higher (p = 0.013) compared to controls (41.5% vs 22.8%, OR 2.27 95% CI 1.20–4.29; primary end–point of the study). In multivariate analysis, independent predictors of outcome were (in descending order): interstitial pneumonia severity score (Wald 8.143, p = 0.004), CC score (Wald 5.569, p = 0.018), and the LDH value on admission (Wald 3.335, p = 0.034).

Conclusions
In our case–control study, the severity and extent of CAC is the main prognostic factor for the occurrence of adverse clinical outcome, beside the severity of interstitial pneumonia. These data suggest that a semi–quantitative estimation of CAC, feasible on any CT detector without the need of dedicated software, is clinically useful for the prognostic assessment of patients with COVID–19 interstitial pneumonia.
P408 CERTIFICATION FOR COMPETITIVE SPORTS ACTIVITY IN A TEENAGER WITH WPW BY VIA INTRAHYSSIAN ACCESSORY PATHWAY
Authors: Stuto A , Armaro B , Cosentino E , Canonico G , Ambu A , Cascone G , Lo Giudice A , Canonico S , Cassarisi S , Ierna S , Basile G , Gulletta S 
Published: May 2022

Abstract
The case of a 12–year–old male, height 160 cm, weight 46 kg, who practices water polo at a competitive level is reported. Negative family history of cardiovascular pathologies, general and cardiovascular physical examination within the limits of normality. On the electrocardiographic trace (ECG) presence of delta wave from ventricular pre–excitation from intrahyssian accessory pathway (Fig. 1). Echocardiography + color Doppler was normal. The subject underwent a cardiopulmonary stress test with an incremental ramp protocol and steps of 20 watts / min. Shutdown at 190 watts for muscle exhaustion with peak oxygen consumption (VO2) = 43.9 mL / Kg / min, Heart rate = 197 beats / minute, BP = 210/70 mmHg, VE / VCO2 slope = 27.6. Normal course of the cronotropic and pressure curve. The ventricular pre–excitation delta wave persisted for the entire duration of the test and in recovery (Fig. 2, Fig. 3). Secondary disturbances of ventricular repolarization characterized by ST segment sub–leveling and negative T wave appeared at high load and persisted in the first minutes of recovery, delta VO2 / delta WR = 12. Given the non–disappearance of the delta wave from ventricular pre–excitation during the maximal stress test, the subject was sent to an electrophysiological study and subsequent ablation of the accessory pathway. The electrophysiological study was negative for inducibility of atrial fibrillation (AF) and ventricular arrhythmias. Safe ablation was impossible given the intrahyssian position of the accessory pathway. Considering the negativity of the electrophysiological study due to non inducibility of supraventricular and ventricular arrhythmias, eligibility for competitive sports was granted.
P420 PLASMA LEVELS OF PARATHYROID HORMONE IN HEART FAILURE: CLINICAL CORRELATIONS AND PROGNOSTIC ROLE
Authors: Potenza A , Scicchitano P , Babbo R , Pinto M , Abruzzese S , Tangorra M , Cannito A , Gesualdo M , Paolillo C , Ciccone M , Caldarola P , Massari F 
Published: May 2022

Abstract

Background
Circulating concentrations of parathyroid hormone (PTH) increase in heart failure (HF) patients. Plasma concentrations in PTH are related to HF severity, thus considering PTH as biomarkers of HF worsening. The aim of our study was to evaluate clinical correlations and prognostic role of PTH in patients with HF.

Methods
We evaluated 229 HF patients (42% acute and 58% chronic HF). Patients underwent evaluation of NYHA functional class, measurements of bioactive PTH (1–84), B–type natriuretic peptide (BNP), creatinine cleareance, and hydration status (by means of bioimpedance analysis) and all–cause mortality during follow–up.

Results
PTH levels were higher in acute HF as compared to chronic HF (248±180 pg/ml vs 153±133 pg/ml, p &lt; 0.001), and significantly correlates with NYHA class, BNP levels (r = 0.4), creatinine clearance (r=–0.3), and hydration status (r = 0.4). Fifty patients died after a median follow–up of 408 days (IQR: 283–573). The cumulative mortality rate was 22%. At univariate Cox regression analysis, we found a strong and significant association of PTH plasma values at admission to mortality (HR 1.003). The optimal cut–off for death occurrence was: PTH &gt; 249 (AUC=0.65; sensibility 50% and specificity 82% ). At multivariate Cox regression analysis PTH level was no longer associated with death, while BNP, hydration status, and renal function maintained an independent predictive value for mortality (HR 1.0004, HR 1.06, and HR 0.98, respectively).

Conclusions
Our study demonstrated that circulating concentrations of bioactive PTH are related to other biomarkers of HF worsening, i.e. creatinine clearance and hydration status. Although PTH acted as a prognostic determinants of mortality in HF, it was not an independent prognostic biomarkers at multivariate regression analysis.
P429 PROGNOSTIC IMPACT OF ROUTINE SIX–MONTH EXERCISE STRESS TEST AFTER COMPLEX LEFT MAIN BIFURCATION PCI
Authors: Rigatelli G , Zuin M , Gianese F , Bilato C , Roncon L 
Published: May 2022

Abstract

Background/Aim
The prognostic value of the exercise stress after complex stenting of left main (LM) coronary artery bifurcations (LM) disease has been poorly investigated in the modern era.

Methods
We retrospectively analysed the procedural and medical data of patients referred to our center for complex LM bifurcation diseas, treated using either single versus dual stenting [Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT)] techniques between January 2008 to May 2018. The prognostic impact of an exercise test performed at 6 months during the follow–up period.

Results
Five hundred and two patients (316 males, mean age 70.3±12.8 years, mean Syntax score 31.6±6.3) were evaluated. At a mean follow–up of 37.1±10.8 months (range 22.1–47.3 moths), Target lesion failure (TLF) rate was 10.1%. Stent thrombosis and cardiovascular mortality were observed in 1.2% and 3.6% of cases, respectively. A positive exercise test at 6 months of follow–up was detected in 42 out of 502 patients (8.4%) and correlated with angiographic restenosis in 38 patients (7.6%): 7/171patients in Cross–over group (4.1%), 10/61 patients in T or TAP group (16.4%), 15/98 patients in Culotte group (15.3%) and 6/172 patients in NIT group (3.5%). Multivariate Cox regression analysis demonstrated that Age &gt; 75 years (HR 1.45, 95% CI: 1.33–1.58, p = 0.03), dyslipidaemia (HR: 1.68, 95% CI: 1.58–1.72, p &lt; 0.001), eGFR&lt;30 ml/min/1.73 m2 (HR: 1.44, 95% CI: 1.38–1.52, p = 0.04), presence of a triple vessel disease (HR: 1.89, 95% CI: 1.89, 95% CI: 1.84–1.93, p &lt; 0.001), additional ostial LM lesion (HR: 1.75, 95% CI: 1.76–1.81, p &lt; 0.001), additional LM body lesion (HR: 1.33, 95% CI: 1.28–1.36, o &lt; 0.001), a Syntax score &gt; 25 (HR:1.67, 95% CI: 1.61–1.76, p = 0.01), need of Rotablator (HR: 1.66, 95% CI: 1.61–1.75, p = 0.02) and the number of stents implanted (HR: 1.12, 95% CI: 1.08–1.16, p &lt; 0.001) were independent predictors of a positive stress test. Patients reporting a negative exercise test at 6 months of follow–us had a higher freedom from TLF and improved survival compared to those with positive exercise stress test (Figure 1 Panels A and B).

Conclusions
A negative exercise performed after 6 months from complex left main stenting predicted excellent outcomes at 3 years follow–up.
Update on supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease according to the LIRA method
Authors: Iannopollo Gianmarco , Romano Vittorio , Esposito Antonio , Guazzoni Giulia , Ancona Marco , Ferri Luca , Russo Filippo , Bellini Barbara , Buzzatti Nicola , Curio Jonathan , Prendergast Bernard , Montorfano Matteo 
Published: May 2022

Abstract
Recent evidence has shown that transcatheter heart valve (THV) anchoring in bicuspid aortic valve (BAV) patients occurs at the level of the raphe, known as the LIRA (Level of Implantation at the RAphe) plane. Our previous work in a cohort of 20 patients has shown that the delineation of the perimeter and device sizing at this level is associated with optimal procedural outcome. The goals of this study were to confirm the feasibility of this method, evaluate 30-day outcomes of LIRA sizing in a larger cohort of patients, assess interobserver variation and reproducibility of this sizing methodology, and analyse the interaction of LIRA-sized prostheses with the surrounding anatomy. The LIRA sizing method was applied to consecutive patients presenting to our centre with raphe-type BAV disease between November 2018 and October 2021. Supra-annular self-expanding THVs were sized based on baseline CT scan perimeters at the LIRA plane and the virtual basal ring. In cases where there was discrepancy between the two measurements, the plane with the smallest perimeter was considered the reference for prosthesis sizing. Post-procedural device success, defined according to Valve Academic Research Consortium-2 (VARC-2) criteria, was evaluated in the overall cohort. A total of 50 patients (mean age 80 ± 6 years, 70% male) with raphe-type BAV disease underwent transcatheter aortic valve replacement (TAVR) using different THV prostheses. The LIRA plane method appeared to be highly successful (100% VARC-2 device success) with no procedural mortality, no valve migration, no moderate-severe paravalvular leak, and low transprosthetic gradients (residual mean gradient 8.2 ± 3.4 mmHg). There were no strokes, no in-hospital or 30-day mortality, and an incidence of in-hospital pacemaker implantation of 10%. Furthermore, measurement of the LIRA plane perimeter was highly reproducible between observers (r = 0.980; P &lt; 0.001) and predictive of the post-procedural prosthetic valve perimeter on CT scanning (r = 0.981; P &lt; 0.001). We confirm the feasibility of supra-annular sizing using the LIRA method in a large cohort of patients with high procedural success and good clinical outcomes at 30 days. Application of the LIRA method optimizes THV prosthesis sizing in patients with raphe-type BAV disease.
ANMCO position paper ‘Appropriateness of prescribing direct oral anticoagulants in stroke and systemic thromboembolism prevention in adult patients with non-valvular atrial fibrillation’
Authors: Mocini David , Di Fusco Stefania Angela , De Luca Leonardo , Caldarola Pasquale , Cipriani Manlio , Corda Marco , Di Lenarda Andrea , De Nardo Alfredo , Francese Giuseppina Maura , Napoletano Cosimo , Navazio Alessandro , Riccio Carmine , Roncon Loris , Tizzani Emanuele , Nardi Federico , Urbinati Stefano , Valente Serafina , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio 
Published: May 2022

AbstractThe appropriateness of prescribing direct oral anticoagulants [dabigatran, rivaroxaban, apixaban, and edoxaban (DOACs)] is regulated on the criteria established in Phase III trials. These criteria are reported in the summary of the product characteristics of the four DOACs. In clinical practice, prescriptions are not always in compliance with established indications. In particular, the use of lower doses than those recommended in drug data sheets is not uncommon. Literature data show that the inappropriate prescription of reduced doses causes drug underexposure and up to a three-fold increase in the risk of stroke/ischaemic transient attack, systemic thromboembolism, and hospitalization. Possible causes of the deviation between the dose that should be prescribed and that prescribed in the real world include erroneous prescription, an overstated haemorrhagic risk perception, and the presence of frail and complex patients in clinical practice who were not included in pivotal trials, which makes it difficult to apply study results to the real world. For these reasons, we summarize DOAC indications and contraindications. We also suggest the appropriate use of DOACs in common clinical scenarios, in accordance with what international guidelines and national and international health regulatory bodies recommend.
ANMCO statement on the use of sodium-glucose cotransporter 2 inhibitors in patients with heart failure: a practical guide for a streamlined implementation
Authors: Di Fusco Stefania Angela , Gronda Edoardo , Mocini Edoardo , Lucà Fabiana , Bisceglia Irma , De Luca Leonardo , Caldarola Pasquale , Cipriani Manlio , Corda Marco , De Nardo Alfredo , Francese Giuseppina Maura , Napoletano Cosimo , Navazio Alessandro , Riccio Carmine , Roncon Loris , Tizzani Emanuele , Nardi Federico , Urbinati Stefano , Valente Serafina , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Imperoli Giuseppe , Colivicchi Furio 
Published: May 2022

Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin, and empagliflozin, first developed as glucose-lowering agents for the treatment of Type 2 diabetes, have been demonstrated to improve prognosis in patients with heart failure and reduced ejection fraction (HFrEF) regardless of the presence of diabetes. Since these drugs have only recently been included among the four pillars of HFrEF treatment, cardiologists are still unfamiliar with their use in this setting. This article provides an up-to-date practical guide for the initiation and monitoring of patients treated with SGLT2 inhibitors.
Association of ZFHX3 genetic polymorphisms and extra-pulmonary vein triggers in patients with atrial fibrillation who underwent catheter ablation
Authors: Hwang I , Kwon O-S , Hong M , Yang S-Y , Park J-W , Yu H T , Kim T-H , Uhm J-S , Joung B , Lee M-H , Pak H-N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare, National Research Foundation of Korea (NRF)
Abstract

Background
The ZFHX3 gene (16q22) is the second most highly associated gene with atrial fibrillation (AF) and is related to inflammation and fibrosis.

Purpose
We hypothesized that ZFHX3 is associated with extra-pulmonary vein (PV) triggers, left atrial (LA) structural remodeling, and poor rhythm outcomes of AF catheter ablation (AFCA).

Methods
We included 1782 patients who underwent a de novo AFCA (73.5% male, 59.4±10.8 years old, 65.9% paroxysmal AF) and genome-wide association study and divided them into discovery (n=891) and replication cohorts (n=891). All included patients underwent isoproterenol provocation tests and LA voltage mapping. We analyzed the ZFHX3, extra-PV trigger-related factors, and rhythm outcomes.

Results
Among 14 single-nucleotide polymorphisms (SNPs) of ZFHX3, rs13336412, rs61208973, rs2106259, rs12927436, and rs1858801 were associated with extra-PV triggers. In the overall patient group, extra-PV triggers were independently associated with the ZFHX3 polygenic risk score (PRS) (OR 1.65 [1.22-2.22], p=0.001, model 1) and a low LA voltage (OR 0.74 [0.56-0.97], p=0.029, model 2). During 49.9±40.3 months of follow-up, clinical recurrence of AF was significantly higher in patients with extra-PV triggers (Log-rank p&lt;0.001, HR 1.89 [1.49-2.39], p&lt;0.001, model 1), large LA dimensions (Log-rank p&lt;0.001, HR 1.03 [1.01-1.05], p=0.002, model 2), and low LA voltages (Log-rank p&lt;0.001, HR 0.73 [0.61-0.86], p&lt;0.001, model 2) but not the ZFHX3 PRS (Log-rank p=0.819).

Conclusions
The extra-PV triggers had significant associations with both ZFHX3 genetic polymorphisms and acquired LA remodeling. Although extra-PV triggers were an independent predictor of AF recurrence after AFCA, the studied AF risk SNPs intronic in ZFHX3 were not associated with AF recurrence.
Accuracy of noninvasive electrocardiographic imaging using isopotential versus isochronal map for identifying the site of origin of ventricular arrhythmias
Authors: Parreira A , Carmo P , Marinheiro R , Chambel D , Marinescu C , Ferreira A , Marques L , Nunes S , Chmelevsky M , Amador P , Coelho R , Cavaco D , Goncalves P , Marques H , Adragao P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim
Previous studies reporting the results of noninvasive electrocardiographic imaging (ECGI) used both isopotential map and isochronal map to assess the site of origin (SOO) of premature ventricular contractions (PVCs). The aim of this study was to evaluate the accuracy of both methods globally, and according to the location of the arrhythmia: from the right ventricular outflow tract (RVOT) or other locations (non-RVOT).

Methods
We studied with ECGI 35 consecutive patients with frequent (&gt;10.000/24 h) PVCs. Patients were excluded if the ablation was not performed (7 patients) or was unsuccessful (7 patients). The study group consisted of 21 patients, 11 male, median age of 56 (44-71) years. The ECGI was performed with the epi-endocardial system Amycard. Two noninvasive maps were obtained: isopotential map based on the analysis of the shape and amplitude of the unipolar electrogram (FND method) and an isochronal map obtained using the activation direction method (ADM) (Figure). The invasive activation map was obtained with the Carto or the Ensite system and radiofrequency was applied at the earliest activation site with QS morphology on the unipolar electrogram and a pace match of at least 11/12. The SOO of the PVCs was considered the site where the PVCs were abolished. We assessed the accuracy of the ECGI to identify the SOO of the PVCs using both methods. A perfect match was defined as a predicted location by the ECGI within the same anatomic segment of the actual SOO of the PVCs, whereas a near match as a predicted location within the same segment or a contiguous one. Values are presented as median (Q1-Q3)

Results
PVCs originated in the RVOT in 11 (52%) patients. The percentage of near matches was not significantly different between FND and ADM methods (95% vs 86%, p=0.50), however the percentage of perfect matches was significantly higher with the FND than with the ADM technique (95% vs 67 %, p=0.031). We found no significant differences in accuracy according to the location of the PVCs, in the RVOT or outside (Table).

Conclusions
We found a good agreement between ECGI and invasive maps, however the FND technique showed a better accuracy regardless the site of the PVCs.
Changes of the non-invasive myocardial work in patient undergoing transcatheter aortic valve replacement: the influence of left bundle branch block
Authors: Lakatos BK , Ruppert M , Ladanyi Z , Fabian A , Ujvari A , Tokodi M , Molnar L , Zima E , Apor A , Nagy A , Kovacs A , Merkely B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Patients with left bundle branch block (LBBB) are known to have substantially increased afterload sensitivity. It gains particular importance in subjects with aortic stenosis: patients with pre-existing LBBB may benefit more from interventions such as transcatheter aortic valve replacement (TAVR) by an effective and rapid reduction of the left ventricular (LV) pressures.
Accordingly, our aim was to investigate the changes of LV myocardial work indices in patients undergoing TAVR by the presence of preoperative LBBB. Non-invasive myocardial work indices are novel echocardiographic parameters which adjust LV deformation to the instantaneous LV pressure, overcoming the the load-sensitivity of the traditional LV functional measures.
Thirty patients undergoing TAVR were enrolled (37% female; age: 78±6 years; aortic valve area [AVA]: 0.7±0.3 cm2). Fourteen patients (47%; LBBB group) showed LBBB pattern on ECG, by demonstrating native LBBB (n=6; 20%) or having ventricular pacing dependency (n=8; 27%), while 16 patients had narrow QRS (53%; non-LBBB group). Prior to the procedure, subjects underwent a detailed echocardiographic investigation. Speckle-tracking analysis was performed and global longitudinal strain (GLS) was measured. LV pressure curve was estimated by adding the mean aortic valve gradient to the aortic systolic pressure. Using these measures, LV global constructive work index (CMWI) and global work efficiency (GWE). were quantified by commercially available software. A 6 months follow-up examination was also performed and at that time point we determined the aforementioned parameters.
As expected, AVA significantly improved after the procedure in the pooled study group (1.8±0.4 cm2; p&lt;0.001). GLS also significantly increased (-13.2±4.2 vs. -15.2±3.9 %; p&lt;0.01), while CMWI only showed a tendential decrease (2422±788 vs. 2166±640 mmHg%; p=NS) at the follow-up. GLS (-10.6±3.7 vs. -15.5±3.4%; p&lt;0.001), CMWI (1877±679 vs. 2898±529 mmHg%; p&lt;0.001), and also GWE (82±9 vs. 91±4%; p&lt;0.01) was significantly lower in the LBBB-group compared to the non-LBBB patients. At the follow-up, GLS was still significantly lower in the LBBB patients (-13.2±4.6 vs. -16.9±2.1%; p&lt;0.01), however, CMWI was comparable between the two groups (1956±776 vs. 2350±439 mmHg%, p=NS).
Pressure overload of the LV may affect patients with LBBB substantially more than subjects without it. TAVR causes an immediate and significant decrease in the LV afterload, which results in a more pronounced improvement in the LBBB group compared to those with no LBBB.