bluuebunny/crossref_metadata_2025_split huggingface dataset:
1149 MACHINE-LEARNING BASED PREDICTION OF IN-HOSPITAL DEATH FOR PATIENTS WITH TAKOTSUBO SYNDROME: THE INTERTAK-ML MODEL
Authors: De Filippo Ovidio , Pancotti Corrado , Camman Victoria Lucia , Bianco Matteo , Gili Sebastiano , Di Mario Carlo , Luescher Thomas , Crea Filippo , Templin Christian , De Ferrari Gaetano Maria , D´ascenzo Fabrizio 
Published: December 2022

Abstract

Background
Takotsubo syndrome (TTS) is burdened by a not negligible rate of an impaired short-term prognosis. Current existing models, based on classical statistical methods, showed only moderate accuracy to predict the risk of in-hospital adverse events following admission for TTS. We sought to design a machine-learning (ML) based model to predict the risk of in-hospital death among patients admitted for TTS, and to provide clusters of TTS patients associated with different risks of adverse short-term prognosis.

Methods
A Penalized Logistic Regression-based ML model for predicting in-hospital death was trained and tested on a cohort of 3482 patients with TTS from the international, multicenter, InterTAK Registry. 33 clinically relevant variables were selected to be included in the prediction model. Model performance was assessed according to area under the receiver operating characteristic curve (AUC). A K-Means clustering algorithm was designed to stratify patients into phenotypic groups based on the most relevant features emerging from the main model.

Results
The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.88 (95%CI 0.87-0.90) and 0.87 (95%CI 0.83-0.91) with respect to in-hospital death prediction in the train and test cohorts, respectively. By exploiting the 5 variables showing the highest feature importance (use of catecholamines, type of triggering factor, left ventricular ejection fraction, white blood cell count, heart rate), TTS patients were clustered into five groups associated with different risks of in-hospital death (29.4% vs 3.9% vs 1.6% vs 1.3% vs 0.7%).

Conclusion
A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed accurate discriminative capability for the prediction of in-hospital death. To support clinical decision-making, TTS patients can be clustered into groups entailing different risks of death based on routinely collected variables.
962 CASE REPORT: ARRHYTHMIC MITRAL VALVE PROLAPSE - STATE OF THE ART AND WHAT'S NEW
Authors: Bandini Marta , Crociani Maria Federica , Sciara Pietro , Di Mario Carlo , Chechi Tania 
Published: December 2022

Abstract

Background
Mitral valve prolapse (MVP) is a well-known pro-arrhythmic condition that involves 2-3% of the general population with an incidence of nonfatal arrhythmic events up to 30% and sudden cardiac death of 2-4% per year. It is assumed that the pro-arrhythmic substrate consists in myocardial fibrosis, secondary to steer-stretch due to the anomalous mobility of the mitral valve apparatus. We still have gaps in the evidences about the arrhythmic risk stratification of MVP and the most appropriate therapy and follow-up.

Clinical case
We present the case of a 40-years-old man with a known MVP due to Barlow disease, who underwent an at-home resuscitated cardiopulmonary arrest. In hospital, an echocardiogram found left ventricular dilatation with diffuse hypokinesia and severe mitral insufficiency. A coronary angiogram showed an undamaged coronary tree. The 24h ECG monitoring showed very frequent ventricular ectopies and non-sustained ventricular tachycardia. The patient underwent valvular surgery and he is now waiting for cardiac defibrillator (ICD) implantation.

Conclusion
We discuss the state of the art in risk stratification of “malignant” MVP; the actual and potential future role of the cardiac magnetic resonance, ICD implantation, sympathetic modulation, and early surgical mitral valve repair, in the primary prevention of sudden cardiac death.
195 INFECTIVE ENDOCARDITIS POST-TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) WITH SYSTEMIC EMBOLIZATION TREATED WITH MEDICAL THERAPY
Authors: Barbera Chiara , Rizzo Sofia , Greco Ylenia , Lentini Giuseppe , Rugiano Gerardo , Gibiino Vincenzo , Uccello Salvatore , Bentivegna Agnese , Milici Anna Lisa , Scandura Salvatore , Tamburino Corrado 
Published: December 2022

Abstract

Introduction
Post-TAVI infective endocarditis is a rare event. The incidence is 3,25%, and it is associate with severe complications and high risk of mortality.

Aim
The aim of the study is to focus on the possibility of alternative therapy except surgery in treatment of a complicated endocarditis, choice taken also thanks to TEE, through it is possible analyze the integrity of the prosthesis, evidence/absence of rupture or ulceration and monitoring the evolution during therapy.

Material and Methods
A 76-year-old female patient who went to TAVI, reported fever, increased phlogosis indices and abdominal pain few days after the procedure. Diagnostic imaging resulted in infection of the aortic prosthesis and in thromboembolisms affecting splenic artery and celiac trunk. At TEE an isoechogenic vegetation (14×8 mm) was described in correspondence of aortic prothesis and high gradient was detected. Thromboembolic events have occurred and thrombo-endoarteriectomia of right femoral artery was performed. Staphylococcus Lugdunensis was found in blood cultures and intravenous antibiotic and anticoagulant therapy was undertaken.

Results
After one month of medical therapy, at TEE significant vegetation reduction was found. Patient was discharged at home, asymptomatic. After 1 month at TTE no sign of endocarditis was detected, blood sample was fine and patient was asymptomatic.

Conclusions
This case is an example of an early infective process involving biological valve post-TAVI, followed by systemic embolization, in which the only medical therapy was successful. Echocardiography has played a fundamental role to choose the strategy of therapy and to monitor its result.
254 DIFFERENT DEGREES OF DEGENERATION OF TRANSCATHETER VALVES IMPLANTED IN THE AORTIC POSITION OR EMBOLIZED DISTALLY: A CASE REPORT
Authors: Cacia Michele Antonio , Cozzi Ottavia , Gohar Aisha , Mangieri Antonio , Lancini Damiano Regazzoli , Stefanini Giulio , Reimers Bernhard , Colombo Antonio 
Published: December 2022

Abstract
While transcatheter aortic valve replacement (TAVR) gradually emerges as first line therapy for aortic disease in most surgical risk groups, structural prosthetic degeneration remains an issue that may must be considered when planning procedures in younger patients. We present the case of a 74 years old female who underwent a valve-in-valve TAVR following degeneration of a previously implanted TAVR which had initially been complicated by distal embolization of two prosthetic valves. The patient initially underwent TAVR in 2010 for severe aortic regurgitation and a porcelain aorta. The procedure was complicated by distal embolization of two prosthetic valves; firstly a 26 mm Sapien valve migrated to the pre-renal abdominal aorta. This was followed by the embolization of a 29 mm CoreValve to the descending thoracic aorta. Finally, on the third attempt, a 29 mm CoreValve was successfully implanted without complication. The patient remained clinically stable until February 2022 when she developed progressively worsening effort angina and dyspnea. Echocardiographic evaluation demonstrated prosthetic aortic valve degeneration with cusp fibrosis and calcification, with severe aortic regurgitation. Interestingly, neither of the embolized prosthetic valves showed signs of deterioration on CT imaging. The valve that had migrated to the abdominal aorta did not show any significant increase in gradient or regurgitation on Doppler evaluation. After careful evaluation and Heart Team discussion, a transfemoral valve-in-valve (ViV) procedure was performed uneventfully with a 23 mm Sapien Ultra implant, that resulted in complete abolition of regurgitation with mild prosthesis-patient mismatch (mean gradient 15 mmHg, EOA 0.8 cm2/m2). Post-procedural CT imaging confirmed a satisfactory result with no signs of dislocation of the previous valve prostheses (Figure 3). The patient was safely discharged on day 4 post-op on oral anticoagulation (due to a history of atrial fibrillation), and was asymptomatic at 30-day follow-up. This case report describes a challenging but successful ViV TAVR implantation.
888 THE USE OF QFR FOR THE FUNCTIONAL ASSESSMENT OF EXTRACRANIAL INTERNAL CAROTID ARTERY STENOSIS
Authors: De Rosa Maria Luisa , Carbone Carlo , Mitrano Lucia , Di Serafino Luigi , Giugliano Giuseppe , Piccolo Raffaele , Franzone Anna , Cirillo Plinio , Esposito Giovanni 
Published: December 2022

Abstract

Background
In asymptomatic patients with haemodynamically significant internal carotid artery stenosis, if endarterectomy cannot be considered, a selective invasive angiography is indicated before deciding for percutaneous revascularization. Sometimes, the angiographic assessment of the stenosis might be discordant with the non-invasive assessment, usually performed with Doppler. Therefore, the use of an angiography-based method that allows a functional assessment of the stenosis could be useful to help the diagnostic-therapeutic process. The aim of this study was to evaluate the diagnostic accuracy of Quantitative Flow Ratio (QFR) in the assessment of extracranial internal carotid artery stenosis.

Materials and methods
This registry prospectively enrolled asymptomatic patients with an indication to perform a selective angiography of the supra-aortic trunks. The systolic peak velocity obtained by colour Doppler ultrasound was used to determine the hemodynamic significance of the carotid stenosis (PSV&gt; 120 cm / sec), whereas it was defined angiographically significant a stenosis with a %DS &gt; 60%, according to NASCET criteria (%DSNASCET). After three-dimensional reconstruction of the angiographic data, QFR, Area Stenosis (AS%) and the minimum luminal area (MLA, mm2) were obtained.

Results
30 consecutive patients were enrolled, and 60 carotid arteries analysed, 8 of which were excluded because of previous percutaneous (n = 3) or surgical (n = 5) revascularization. On linear regression analysis, an inverse linear correlation was observed between QFR and PSV values ​​(r2 = 0.71, p &lt;0.001) and% DSNASCET (r2 = 0.79, p &lt;0.001) (Figure 1). Similarly, the MLA values ​​showed a significant correlation with both PSV and% DSNASCET (respectively, r2 = 0.67 and r2 = 0.75, p &lt;0.001), as well as AS values, which also showed a significant correlation with both PSV and% DSNASCET (respectively, r2 = 0.68 and r2 = 0.88, p &lt;0.001). The QFR and the% DSNASCET showed a comparable and high diagnostic accuracy (AUC = 0.99, p &lt;0.001) using PSV as a reference, with a cut-off value of 0.95 for the QFR (Figure 2). However, considering the% DSNASCET cut-off values, the QFR showed higher diagnostic accuracy, sensitivity and negative predictive value as compared with % DSNASCET.

Conclusions
This study showed the feasibility of QFR for the assessment of extracranial internal carotid artery stenosis. It was effective indeed for predicting the functional significance of the stenosis considering the Doppler as standard of reference. However, whether revascularization of the carotid stenosis should be guided by QFR rather than the angiography alone has still to be evaluated.
410 “SHARK-FIN“ ECG: NOT ALWAYS A STEMI!
Authors: Marrone Andrea , Piscitelli Laura , Zagnoni Silvia , Colletta Mauro , Casella Gianni 
Published: December 2022

Abstract

Background
Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. The International Registry of Acute Aortic Dissection (AAD) shows that only 5% of AAD patients present with ECG evidence of acute myocardial infarction, and prognosis is ominous due to the additional myocardial damage and missed or delayed diagnosis. The shark fin waveform is an uncommon but high-risk ECG pattern formed by fusion of QRS, ST-segment, and T waves. It is associated especially with the sub-occlusion of the left main coronary artery or proximal left anterior descending artery with a high risk of death due to cardiac arrest and cardiogenic shock.

Case presentation
A 61-year-old man was admitted to our cardiac cath-lab for typical chest pain and suspected acute ST segment elevation myocardial infarction (STEMI). A triangular pattern known as the ‘shark-fin’ sign in the precordial and inferior leads, and mirroring ST-segment depression in dI and aVL was detected. Unexpectedly coronary angiography revealed normal epicardial vessels, but a very-regular-shaped staining of the aortic sinus was observed. This finding was suspicious for acute aortic dissection. Bedside 2D-echocardiography within the cath-lab demonstrated an intimal flap in the aortic root and arch, with mild aortic regurgitation. Contrast-enhanced computerized tomography (CT) confirmed our diagnosis of Type A aortic dissection (AAD) highlighting the same dissection flap revealed by angiography arising from the left coronary cusp of the aortic root. The left main trunk was not directly involved, but the dissection extended from the ascending to the distal aorta involving both left and right external and internal iliac arteries with a thrombotic occlusion of the right femoral-iliac axis There was also a right inferior-pole renal infarction. Thus, the patient was immediately submitted to heart surgery.

Conclusions
Type A aortic dissection is a life-threatening disease in which early diagnosis and treatment are critical for survival. Occasionally it could mimic STEMI due to coronary involvement or dynamic obstruction of a coronary ostium. In our experience a bedside echocardiography performed before primary percutaneous coronary intervention (PCI) may confirm the clinical suspicious and avoid dangerous diagnostic delays.
Reconstructing a single-head formula to facilitate logical forgetting
Authors: Liberatore Paolo 
Published: December 2022

AbstractLogical forgetting is removing some variables from a formula while maintaining its consequences on the remaining variables. This removal may require exponential time on arbitrary propositional Horn formulae, but it only takes polynomial time on single-head propositional definite Horn formulae. Single-head means that no variable is the head of multiple clauses. An algorithm to make a formula single-head if possible is shown. It enlarges the set of formulae admitting polynomial-time forgetting by making them single-head if possible and then running the usual algorithm for forgetting.
77. Demonstration of stable clusters of symptoms in long COVID
Authors: Kenny Grace , McCann Kathleen , O'Brien Conor , Savinelli Stefano , O'Broin Cathal , Tinago Willard , Yousif Obada , Lambert John S , Feeney Eoin , de Barra Eoghan , Sadlier Corinna , Landay Alan , Doran Peter , Mallon Patrick W G 
Published: December 2022

Abstract

Background
Long COVID is a heterogenous condition. We previously demonstrated distinct phenotypes of long COVID, but the impact of later waves caused by SARS-CoV-2 variants on long COVID presentations has not been described.

Methods
We selected individuals with ongoing symptoms &gt; 4 weeks from PCR-confirmed COVID-19 in a multicentre, prospective cohort study. We used multiple correspondence analysis and hierarchical clustering on self-reported symptoms to identify symptom clusters, in individuals recruited during two periods; cohort 1 from March 2020 to April 2021, and cohort 2 from April 2021 to March 2022. We explored differences in symptoms by mapping acute infection to one of four COVID-19 waves in Ireland (table 1) as well as vaccination status, and used Chi2 test to compare symptoms frequencies.

Results
Demographics are shown in Table 2. Cluster analysis of each cohort demonstrated 3 distinct clusters in both cohorts, which shared similar clinical characteristics; a musculoskeletal/pain symptom cluster, a cardiorespiratory cluster and a third less symptomatic cluster (Figure 1).
While symptoms within clusters were similar across both periods, in the cardiorespiratory cluster, the frequency of palpitations decreased (56% vs 16%) and cough increased (14% vs 45%) between reporting periods (both P&lt; 0.01). Furthermore, a greater proportion of palpitations were reported in those with COVID-19 from waves 1 and 2 (35% and 28%) compared to 3 and 4 (both 12%, P&lt; 0.001), and a greater proportion of chest pain in waves 1, 2 and 4 compared to wave 3. There were no differences in other symptoms (Table 3). Additionally there were significantly less palpitations reported in those vaccinated at the time of review (17% vs 31% P=0.002), but not chest pain (30% vs 39% P=0.13). In multivariate analysis, infection in wave 3 and 4 but not vaccination status remained significantly associated with lower reported palpitations (OR (95% CI) 0.28 (0.13–0.97) and 0.5 (0.06–0.87) for waves 3 and 4, both P&lt; 0.05), and wave 3 infection remained independently associated with lower reported chest pain (OR 0.3 (0.25–0.7)).

Conclusion
Three symptom clusters define long COVID across the two cohorts, but characteristics of the cardiorespiratory phenotype have evolved over time with evolution of SARS-CoV-2 variants.

Disclosures
All Authors: No reported disclosures.
78. Longitudinal Analysis of T cells in COVID-19 Survivors with Post-Acute Sequelae of COVID-19 Reveals Associations between Individual Symptoms and Inflammatory Indexes
Authors: LaVergne Stephanie , LaVergne Stephanie , Dutt Taru , McFann Kim , Baxter Bridget , Webb Tracy , Berry Kailey , Stomberg Sophia , Dunn Julie , Henao-Tamayo Marcela , Ryan Elizabeth 
Published: December 2022

Abstract

Background
Many individuals infected with SARS-CoV-2 are left with persistent symptoms of COVID-19. Post-acute sequelae of COVID-19 (PASC) can affect quality of life and functionality. The mechanism underlying PASC is unknown but elevated inflammatory markers several months post infection have been found in those with PASC.

Methods
Individuals diagnosed with COVID-19 were evaluated longitudinally for PASC and persistent symptoms. CD4+ and CD8+ cellular markers and intracellular cytokines were assessed at each follow-up time point and analyzed by individual PASC symptoms reported.

Results
Participants who reported persistent dyspnea, forgetfulness, confusion, and chest pain had significantly higher levels of CD8+Ki67+ cells. Those with dyspnea also had significantly higher levels of CD8+CD38+, CD8+Granzyme B+, and CD8+IL10+ cells. Those who suffered from forgetfulness, chest pain, and joint pain had significantly higher levels of CD4+CD25+ cells.

Conclusion
These findings suggest continued CD8+ T cell and CD4+CD25+ T cell activation and response following SARS-CoV-2 infection in patients with PASC. An increase in T regulatory cells suggests an ongoing attempt to control host inflammation in a subset of these patients. These results shed further light on continued immune system activation and chronic inflammation as a link to symptoms in COVID-19 survivors suffering from PASC.

Disclosures
All Authors: No reported disclosures.
89. On-going impact of the SARS-CoV-2 pandemic on the evolution of carbapenemase-producing Enterobacterales in Ontario, Canada
Authors: Mozafarihashjin Mohammad , Jamal Alainna J , Kandel Christopher , Kohler Philipp , Mataseje Laura , Mulvey Michael , Allen Vanessa , Barker Kevin R , Baqi Mahin , Borgia Sergio , Coleman Brenda , Faheem Amna , Farooqi Lubna , Johnstone Jennie , Katz Kevin , Melano Roberto , Muller Matthew , Mubareka Samira , Patel Samir , Poutanen Susan , Richardson David , Li Angel , Zhong Zoe , McGeer Allison 
Published: December 2022

Abstract

Background
The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada.
Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017–2021.
The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period.

Methods
TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada.

Results
From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Their median age was 68.7yrs (IQR 54–78yrs); 761 (56%) were male. 772 (56%) were colonized when first identified; 115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%); the most common genes were NDM±OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM (44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61% and remained stable until 3/2022 (Figure, upper panel). The decline was greater for E. coli (56% decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020; however, KPC containing organisms increased again in 2021 (Figure, lower panel).

Conclusion
The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic.

Disclosures
All Authors: No reported disclosures.