bluuebunny/crossref_metadata_2025_split huggingface dataset:
1095 WHICH IS THE BEST MYOCARDIAL WORK INDEX FOR THE PREDICTION OF CORONARY ARTERY DISEASE? A DATA METANALYSIS
Authors: Ajello Manuela , Parlavecchio Antonio , Vetta Giampaolo , Caminiti Rodolfo , Magnocavallo Michele , Lofrumento Francesca , Foti Rosario , Della Rocca Domenico Giovanni , Micari Antonio , Carerj Scipione , Di Bella Gianluca , Zito Concetta 
Published: December 2022

Abstract

Background
Early diagnosis of Coronary Artery Disease (CAD) plays a key role to prevent adverse cardiac events such as myocardial infarction and Left Ventricular (LV) dysfunction. Myocardial Work (MW) indices derived from echocardiographic speckle tracking data in combination with non-invasive blood pressure recordings are able to predict CAD even in the absence of impairments of standard echocardiographic parameters. Our aim was to compare the diagnostic accuracy of MW indices to predict CAD and to assess intra-observer and inter-observer variability of MW through a metanalysis.

Methods
Electronic databases were searched for observational studies evaluating the MW indices diagnostic accuracy for predicting CAD and intra-observer and inter-observer variability of MW indices. Pooled sensitivity, specificity, and Summary Receiver Operating Characteristic (SROC) curves were assessed.

Results
5 studies enrolling 501 patients met inclusion criteria. Global Constructive Work (GCW) had the best pooled sensitivity (89%) followed by GLS (84%), Global Work Index (GWI) (82%), Global Work Efficiency (GWE) (80%) and Global Wasted Work (GWW) (75%). GWE had the best pooled specificity (78%) followed by GWI (75%), GCW (70%), GLS (68%) and GWW (61%). GCW had the best accuracy according to SROC curves, with an Area Under The Curve of 0.86 compared to 0.84 for GWI, 0.83 for GWE, 0.79 for GLS and 0.74 for GWW (Figure 1). All MW indices had an excellent intra-observer and inter-observer variability.

Conclusions
GCW is the best MW index proving best diagnostic accuracy in the prediction of CAD with an excellent reproducibility.
Figure 1: Pooled sensitivity, pooled specificity, SROC curves and AUC of Myocardial Work indices and GLS
1009 INTRAMYOCARDIAL HEMORRHAGE: A DIFFERENTIAL DIAGNOSIS OF HYPERTROPHY
Authors: Procopio Maria Crstina , Licordari Roberto , D´angelo Tommaso , Frumento Francesca Lo , Perfetti Silvia , De Sarro Rosalba , Irrera Natasha , Bitto Alessandra , Squadrito Francesco , Costa Francesco , Micari Antonio , Di Bella Gianluca 
Published: December 2022

Abstract
Hypertrophic cardiomyopathy (HCM) is a muscle disorder with impairment of microvascular circulation. Intramyocardial hemorrhage (IMH) represents a possible complication in patients with myocardial infarction (MI) involving left ventricular (LV) myocardial tissue and micro vascularization. We describe a case of a HCM patient with anterior STEMI with evidence of IMH.

Case Report
A 61-years-old male patient from Sri Lanka with no prior medical history presented to the emergency Department with persistent chest pain started from 3 hours. He was a smoker. The first ECG revealed ST-segment elevation in V2-5 leads and symmetric negative T-wave in I and aVL leads. Primary percutaneous coronary intervention (PCI) was performed, revealing sub-obstructive stenosis in the proximal left anterior descending artery (LAD) associated with extensive endoluminal thrombus. Invasive coronary angiogram also showed a critical stenosis in distal right coronary artery (RCA) and a chronic occlusion in the proximal left circumflex coronary artery (LCx). After tirofiban intravenous administration and rheolytic thromboaspiration, drug-eluting stent (DES) implantation of the LAD artery was performed successfully.
Transthoracic echocardiography, performed after primary PCI, documented akinesia of proximal LAD territories and LV ejection fraction (EF) of 45%. The curious feature was the evidence of concentric hypertrophy in absence of an apparent reason. Therefore, three days later, the patient underwent cardiac magnetic resonance (CMR), showing mildly reduced LV function (LVEF 42%). CMR images also showed subendocardial late enhancement in proximal LAD territory and transmural LGE with no-reflow phenomenon in mid-apical anteroseptum. (Figure) On T2-weighted images, there was an hypointense core enclosed in the transmural hyperintense area in basal-mid anteroseptum, likely in keeping with intramyocardial hemorrhage (Figure). After a staged PCI with the implant of another DES in RCA, patient was discharged in DAPT (aspirin + ticagrelor).

Conclusion
IMH is considered a severe form of MVO, which occurs in the core of the infarcted area in patients with myocardial infarction. We describe an intriguing case with IHM in HCM patient. Moreover, it raises several questions on which is the best treatment option.
426 SPECKLE-TRACKING GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF CLINICAL OUTCOMES IN SYSTEMIC SCLEROSIS PATIENTS
Authors: Stronati Giulia , Alfieri Michele , Bastianoni Gianmarco , Paolini Federico , Brugiatelli Leonardo , Benfaremo Devis , Moroncini Gianluca , Dello Russo Antonio , Guerra Federico 
Published: December 2022

Abstract

Introduction
Cardiac involvement in patients affected by systemic sclerosis is frequent, although mostly asymptomatic, and associated with a negative prognosis. It may be secondary to pulmonary hypertension or defined as an actual systemic-sclerosis related cardiomyopathy, a standalone entity affecting the heart primarily and globally. Speckle-tracking derived global longitudinal strain (GLS) has been proven to be a cost-effective tool in the detection of LV and RV dysfunction in patients with SSc and no overt cardiac disease. The aim of our study was to assess whether GLS can predict clinical outcomes in patients with systemic sclerosis.

Methods
We conducted a prospective observational study enrolling all consecutive patients referred to our “cardiology clinic for autoimmune diseases and pulmonary hypertension” between June 2016 and January 2022. All patients had a confirmed diagnosis of SSc according to the EULAR guidelines and no overt cardiac disease, pulmonary hypertension, or atrial fibrillation at the time of enrollment. For each patient, echocardiogram and GLS calculations were performed at baseline and at each follow-up. We also collected all data regarding clinical history, hospitalizations or adverse events and ECGs.

Results
164 patients (148 female, 58±14 years)were enrolled. 19 (11.6%) patients died during a median follow-up of 3.2 years for mainly non-cardiovascular deaths (7.3%) while cardiovascular deaths were lower (3% non-sudden, 1.3% sudden). Left GLS at first visit was associated with all-cause death, with a 1% left GLS worsening associated with a 19% increased risk of death after adjusting for age, gender, and LVEF (adjusted HR 1.19; 95% CI 1.05-1.35; p=0.007).Similarly, right GLS at first visit was associated with all-cause death, with a 1% right GLS worsening associated with a 12% increased risk of death after adjusting for age, gender, and TAPSE (adjusted HR 1.12; 95% CI 1.03-1.21; p=0.005).Patients with a left GLS worse than -20% had a 3.5-fold increased risk of death when compared to patients with better left GLS (HR 3.55; 95% CI 1.28-9.88; p=0.015). Similarly, patients with a right GLS worse than -20% had a 4.5-fold increased risk of death when compared to patients with better left GLS (HR 4.47; 95% CI 1.4-13.74; p=0.009).Both left and right ventricular GLS were not associated with changes in risk of all-cause hospitalizations, cardiovascular hospitalizations or subsequent diagnosis of pulmonary hypertension.

Conclusions
GLS is a reproducible, cost effective echocardiographic based method to assess both primary heart disease and its progression. It has proven to be associated with clinical outcomes in patients with systemic sclerosis, therefore allowing a prompt intervention when needed in order to try and prolong the life expectancy of this cohort of patients.
227 THE PROGNOSTIC VALUE OF RIGHT ATRIAL STRAIN IN PATIENTS WITH SECONDARY TRICUSPID REGURGITATION
Authors: Tomaselli Michele , Paolo Badano Luigi , Paolo Perelli Francesco , Radu Noela , Oliverio Giorgio , Francesca Heilbron , Stucchi Davide , Pece Cinzia , Camponetti Virginia , Cascella Andrea , Caravita Sergio , Baratto Claudia , Ciambellotti Francesca , Parati Gianfranco , Gavazzoni Mara , Muraru Denisa 
Published: December 2022

Abstract

Background
in secondary tricuspid regurgitation (STR), the remodeling of the right ventricle (RV) and the right atrium (RA) is associated with different outcomes. However, the potential prognostic role of right RA function in this setting, assessed by 2D-speckle tracking echocardiography (2D-STE), remains to be tested. Accordingly, the aim of our study is to assess the prognostic value of RA 2D-STE in patients with significant (i.e. moderate or severe) STR.

Methods
we retrospectively studied 227 (mean age 74±14, 40% men, 59% sinus rhythm) consecutive patients with significant STR, acquired between May 2012 and June 2021. RA 2D-STE was obtained from a dedicated, non-foreshortened RV-focused apical 4-ch view, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). Among the three longitudinal strain components provided by the software package (reservoir, conduit and, contraction), we focused on RA longitudinal strain during reservoir (RASR). Patients were divided into two groups according to the median value of RARS (12%). A combined endpoint of heart failure hospitalization and all-cause mortality was defined.

Results
after a median follow-up period of 14 months (IQR, 1-27), 93 patients (41%) reached the combined endpoint. The predictive power of RARS&lt;12% (AUC 0.64 [IC 95% 0.56-0.71]), was significantly higher than RA maximum volume (AUC 0.38 [IC 95% 0.31-0.47]). Patients with RARS ≤ 12% were more symptomatic (according to NYHA class), had larger RA volumes (119 vs 89 mL, p&lt;0.001) and, a reduced right ventricular systolic function (TAPSE: 14.7 vs 18.9 mm; FAC 37.7 vs 42.4%; RV free-wall strain: 17.5 vs 20.8%; all p&lt;0.001). In addition, patients with RARS&lt;12% had more severe TR (corrected EROA: 0.85 vs 0.41 cm2; p&lt;0.05). Prevalence of atrial fibrillation (58 vs 61%), left ventricular ejection fraction, and right ventricular size were similar between the groups. Patients with RARS ≤12% had a significant risk for death (log rank, p&lt;0.001), even after correcting for confounding variables. Moreover, RA strain was independently associated with the combined endopoint in multivariate analysis (p &lt; 0.001)

Conclusions
in patients with significant STR, RARS is an independent predictor of the combined endpoint of heart failure hospitalization and all-cause mortality and provides incremental prognostic value over RA volume.
642 VALUE OF CORONARY CTA TO RULE OUT OBSTRUCTIVE CORONARY ARTERY DISEASE IN HIGH-RISK PATIENTS CANDIDATES FOR TAVI
Authors: Virgili Giacomo , Busi Gherardo , Fumagalli Carlo , Acquafresca Manlio , Moroni Mario , Migliorini Angela , Meucci Francesco , Valenti Renato , Di Mario Carlo , Marchionni Niccolò , Carrabba Nazario 
Published: December 2022

Abstract

Background
Coronary computer tomography angiography (CTA) is currently considered a reliable method to rule out obstructive coronary artery disease (O-CAD) before valvular heart surgery in patients with low-intermediate pretest probability. However, its role in excluding O-CAD before transcatheter aortic valve implantation (TAVI) is less well established.

Purpose
To assess the value of coronary CTA in safely ruling out O-CAD in high-risk patients undergoing TAVI in a tertiary center.

Methods and Results
We conducted a single-center retrospective study where patients with severe symptomatic aortic stenosis underwent coronary CTA and then invasive coronary angiography (ICA) if indicated, as part of the TAVI planning. All patients were examined with a retrospectively ECG gated CT scan of the heart, followed by a high-pitch-scan of the vasculature access route utilizing a single intravenous bolus of 70 mL iodinated contrast agent, with an average interval of 31.65 (± 42.50) days to ICA. In both coronary CTA and ICA, O-CAD was defined as a ≥ 50% stenosis in an epicardial vessel ≥ 2 mm diameter. Based on coronary CTA, in case of minimal/non O-CAD, invasive ICA was omitted, whereas it was performed in case of obstructive CAD or inconclusive test.
Our registry included 163 patients, out-off 28 did not receive coronary CTA for clinical reasons. Thus, 135 patients (87 female – 64%) presenting a mean age of 87.27 (± 1.23) years underwent coronary CTA. Twenty-one (15%) CTA test were judged positive for O-CAD and 25 (18.5%) were inconclusive (and considered as positive). All of these patients underwent ICA and 17/21 (80.95%) and 16/25 (64%) resulted positive for O-CAD, respectively. About the positive O-CAD and inconclusive CTA group, 11/21 (52.38%) and 11/25 (44%) patients were treated with PCI of ostial or proximal/middle segment lesions, respectively. On a per-patient analysis, coronary CTA showed: a specificity of 78.76% (95% CI 70.07% - 85.89%); a positive predictive value of 82.48% (95% CI 76.75% - 87.04%); and the accuracy was 89.38% (95% CI 82.92% - 94.02%). In patients with minimal/non O-CAD, coronary CTA led us to safely avoid invasive ICA in 65.92% (n=89) patients, with no need for additional contrast agent and without occurrence of related adverse events during the procedure and during the follow-up (up to 12 months).

Conclusion
Pre-procedural coronary CTA may help us to safely rule out O-CAD in an eligible significant proportion of high risk patients undergoing TAVI. Quite the opposite, the added value in the management of O-CAD by CTA is scarce and it remains to be clarified.
1060 HOW TO EVALUATE RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH SIGNIFICANT TRICUSPID REGURGITATION: PRELIMINARY DATA BEFORE AND AFTER TRICLIP IMPLANTATION
Authors: Volpe Lorenzo , Aquila Iolanda , Lucchino Alessandro , Mancuso Cinzia , Ventura Ettore , Levato Letizia , Vizzari Francesca , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro 
Published: December 2022

Abstract

Objective
transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients with symptomatic significant tricuspid regurgitation (TR) not eligible for tricuspid valve surgery. In the absence of a single reliable measure of the RV systolic function, a number of surrogate echocardiographic parameters have been proposed for clinical use (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), peak S wave velocity of the lateral tricuspid annulus by tissue Doppler imaging (S’ RV-TDI) and RV 2D-FWS. At present, TTVR is not recommended in patients with severe PH and poor RV function, but exact cut-offs when TTVR should be rejected are lacking. Aim of this study was to assess RV function before and after Triclip implantation.

Materials and methods
from June 2021 to June 2022 clinical and echocardiographic data of 8 patients with TR who underwent TTVR intervention in our division were evaluated for RV function. TAPSE, FAC, S’RV-TDI, RV GS and RV FWS at baseline and 1 month of follow up were assessed. Continuous variables are presented as mean ± standard deviation (SD). Categorical variables were presented as frequencies and percentages.

Results
the mean values of RV function assessed before and after Triclip implantation were respectively (18,75 mm± 4,04 vs 18,38 mm ± 3,34) for TAPSE, (10,50 cm/sec± 2,33 vs 10,38 cm/sec ± 1,19) for S’ RV-TDI, (38% ± 0,05 vs 37% ± 0,04) for FAC, and (-17% ± 0,03 vs -19% ± 0,02) for RV FWS. The number of patients that show at baseline RV dysfunction, according to the cut-offs indicated from guidelines, were 4 for TAPSE; 3 S’ RV-TDI; 1 for FAC and 7 for RV 2D-FWS. At 1 month of follow-up, patients with ventricular dysfunction were respectively 3,2,2,4.

Conclusions
in the presence of significant TR, the accurate assessment of RV function becomes even more challenging as a result of the load and angle dependency of TAPSE, RVFAC. Significant TR results in a reduction in RV afterload, which may preserve the aforementioned markers of RV function even when contractility is impaired. Probably RV 2D-STE is less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.
255 IMPACT OF SEVERE VALVULAR HEART DISEASE IN ADULT CONGENITAL HEART DISEASE PATIENTS
Authors: Graziani Francesca , Iannaccone Giulia , Chiara Meucci Maria , Lillo Rosa , Delogu Angelica Bibiana , Grandinetti Maria , Perri Gianluigi , Galletti Lorenzo , Amodeo Antonio , Butera Gianfranco , Secinaro Aurelio , Lombardo Antonella , Antonio Lanza Gaetano , Crea Filippo , Burzotta Francesco , Massetti Massimo 
Published: December 2022

Abstract

Background
The clinical impact of valvular heart disease (VHD) in adult congenital heart disease (ACHD) patients is unascertained. Aim of our study was to assess the prevalence and clinical impact of severe VHD (S-VHD) in a real-world contemporary cohort of ACHD patients.

Methods
Patients followed-up at our ACHD Outpatient Clinic were enrolled. Clinical characteristics and echocardiographic data were prospectively entered into a digitalized medical records database. VHD at the first access was evaluated and graded according to VHD guidelines. Clinical data at follow-up were collected.

Results
A total of 390 patients were included and S-VHD was present in 101 (25.9%) patients. Over a median follow-up time of 26 months (IQR: 12-48), the primary composite endpoint occurred in 76 patients (19.5%). The cumulative primary endpoint-free survival was significantly lower in patients with S-VHD vs patients with non-severe VHD (Log rank p &lt;0.001). At multivariable analysis, age and atrial fibrillation at first visit (p=0.029 and p=0.006 respectively), lower %Sat O2, higher NYHA class (p=0.005 for both), lower LVEF (p=0.008) and S-VHD (p=0.015) were independently associated to the primary endpoint. The likelihood ratio test demonstrated that S-VHD added significant prognostic value (p=0.017) to a multivariate model including age, severe CHD, atrial fibrillation, Sat O2, NYHA, LVEF and right ventricle systolic pressure&gt;45 mmHg.

Conclusion
In ACHD patients, the presence of S-VHD is independently associated with the occurrence of cardiovascular mortality and hospitalization. The prognostic value of S-VHD is incremental above other established prognostic markers.
687 RIGHT VENTRICULAR DISFUNCTION IN A PATIENT WITH CCTGA TREATED WITH ARNI
Authors: Benvenuto Ciro Pollio , Grandinetti Maria , Massetti Massimo , Aspromonte Nadia 
Published: December 2022

Abstract
Congenitally Corrected Transposition of Great Arteries is a unique condition in which atrio-ventricular discrepancy e ventricular-arteriosus discrepancy are mutually balanced, so that there is the normal oxygenation and distribution of the blood to the tissues, but the morphologically right ventricle and the tricuspid valve have to deal with systemic pressures, developing severe ventricular disfunction and valve regurgitation along the years.
We presented the case of a young male patient from India with Congenitally Corrected Transposition of Great Arteries, Ventricular Septum Defect and Pulmonary Artery Stenosis, for which he was treated surgically by positioning a valved conduit between the morphologically left ventricle and the pulmonary artery; he developed worsening dyspnoea years after the operation and further investigations in our centre demonstrated the patency of the conduit and right (systemic) ventricular disfunction that we decided, in a pioneering manner, to treat with Sacubitril/Valsartan.
607 TRICUSPID VALVE IN VALVE AND RENAL ARTERY ANGIOPLASTY: A RARE CASE OF HEART FAILURE TREATED BY TWO MINIMALLY INVASIVE INTERVENTIONAL PROCEDURES
Authors: Bandini Marta , Cesarini Daniel , Mattesini Alessio , Meucci Francesco , Di Mario Carlo 
Published: December 2022

Abstract
Tricuspid valve pathology has unfavorable anatomy for repair and valve replacement is often required. Biological tricuspid valves have a shorter lifespan compared to aortic and mitral prostheses and their replacement is considered a high-risk procedure. In addition, patients with tricuspid valve disease have multiple comorbidities and a reduced functional class, which contribute to an increased risk of mortality. The recent spread of percutaneous valve treatments has demonstrated a good safety profile and a high short-term success rate.
Regarding nephrovascular hypertension, it is still a matter of debate whether there is a long-term benefit of renal artery angioplasty plus medical therapy over medical therapy alone. According to recent evidence, revascularization would provide benefit only in specific circumstances such as, failure of optimal medical therapy, relapsing episodes of acute pulmonary edema and refractory heart failure.
We present the case of a 62-years-old woman with right heart failure associated with prosthetic tricuspid valve dysfunction and nephrovascular hypertensive crisis, treated by two minimally invasive interventional procedures, with excellent short-term clinical outcome
Tricuspid valve in valve procedure
Renal artery angioplasty
909 TIMING AND DETERMINANTS OF PERMANENT PACEMAKER IMPLANTATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: IS THE NEW GENERATION BETTER?
Authors: Bellantoni Antonio , Sorrentino Sabato , Boccuto Fabiola , Carabetta Nicole , Panarello Alessandra , Bruno Federica , Spinali Martina , Sportelli Martina , Polimeni Alberto , Rosa Salvatore De , Mongiardo Annalisa , Spaccarotella Carmen , Indolfi Ciro 
Published: December 2022

Abstract

Background
conduction disturbances requiring permanent pacemaker (PPM) implantation are among the most common adverse events in patients undergoing transcatheter aortic valve replacement (TAVR). The introduction in clinical practice of a new generation of TAVR devices has contributed to a significant reduction in procedural complications. However, limited data is available regarding the usual timing of PPM implantation after TAVR with the latest available valves. Therefore, in this analysis, we aimed to investigate the incidence, risk factors, and timing of new permanent pacemakers after TAVR, with respect to the type of valve implanted.

Methods
Patients who underwent TAVR at our Institution from September 2008 to June 2022 were included in this analysis. Patients with previous PPM/ICD implantation or receiving only balloon angioplasty were excluded, as well as cases with procedural unsuccess. The independent association between baseline clinical and procedural variables and the occurrence of PPM implantation was investigated with cross-sectional logistic regression analysis.

Results
A total of 497 patients were included in the study, with a mean age of 80.4±5.6 years old; 59% were females, 37.2% of patients had diabetes, 60.2% had dyslipidemia, and 25.8% had chronic kidney disease. The mean left ventricular ejection fraction (LVEF) was 52.1%, and the mean Euroscore II was 7.7±5.1. The new generation of self-expandable valves was used in 280 (56.3%) patients, while the new generation of balloon-expandable devices was implanted in 118 (23.7%). After TAVR, 109 (21.3%) patients underwent PPM/ICD implantation after a mean time of 4.1±3.1 days. After adjustment, self-expandable devices, larger valve sizes (29 or 34 mm), and diabetes were significantly associated with PPM/ICD implantation. Of note, the new generation of valve devices was associated with a lower risk of PPM/ICD implantation.

Conclusion
The necessity for a permanent pacemaker is a well-known possible adverse effect after TAVR. In this analysis, we confirm the previous evidence of an increasing risk of PPM implantation with self-expandable compared to balloon-expandable devices. Interestingly, the new valve generation was associated with a lower risk of conduction disturbances requiring PPM implantation. Further analyses and investigations will be needed to assess the impact of developing interventional techniques and advanced technologies on the occurrence of conduction disturbances.