bluuebunny/crossref_metadata_2025_split huggingface dataset:
479 ECHOCARDIOGRAPHIC ESTIMQTION OF CQRDIQC POWER IN CARDIOGENIC SHOCK: CORRELATION WITH INVASIVE HEMODYNAMICS AND PROGNOSTIC IMPLICATIONS.
Authors: Boretto Paolo , Frea Simone , Gravinese Carol , De Lio Giulia , De Ferrari Gaetano Maria 
Published: December 2022

Abstract

Background
Cardiac power output (CPO) is currently used for cardiogenic shock patient's evaluation including shock phenotyping, mechanical circulatory support selection and weaning algorithms. Despite its remarkable prognostic role, CPO use is limited by the need for a Swan-Ganz catheter. Aim of this study was to evaluate the feasibility and accuracy of echocardiographic estimation of CPO compared to RHC-derived measurement. We also aimed to investigate the prognostic role of non-invasive CPO in the specific setting of cardiogenic shock.

Methods
We performed blinded echocardiography in all consecutive heart failure (HF) patients undergoing RHC as a part of their evaluation at Cardiology Department of Città della Salute e della Scienza University hospital in Turin. Echocardiographic CPO was calculated as: (cardiac output * mean arterial pressure)/451. eCPO was subsequently assessed in 80 patients admitted for cardiogenic shock in cardiac ICU of centers participating at the Altshock registry during the first 24 hours from shock onset. Primary endpoint was in-hospital MACE (death, heart transplantation or LVAD implantation during the index hospitalization).

Results
103 HF patients (57.6 ± 11.3 years, 63% males, median left ventricle ejection fraction 25% [IQR 20-51%]) were included in the derivation cohort. Mean invasive CPO was 0.72 ± 0.27 W, while eCPO was 0.74 ± 0.27 W. eCPO showed a good correlation with invasive CPO (Pearson r: 0.96, p&lt;0.001). In the Altshock registry cohort (80 patients, 81% males, mean age 62.5 ± 14.4 years, in-hospital mortality 31.4%) eCPO &lt;0.6 (HR 2,48 [95% CI 1,06 - 5,85], p=0,04), hemoglobin (p=0.005), systolic blood pressure (p=0.05) and SCAI class (p=0.02) were associated with increased risk of in-hospital MACE at univariate analysis. Echocardiographic CPO &lt;0.6 remained significantly associated with MACE also after adjustment at multivariate Cox analysis (HR 2,87 [95% CI 1,03 - 7,96] p=0,043).

Conclusion
Echocardiographic estimation of CPO (eCPO) is feasible and showed a good agreement with invasive CPO. Reduced eCPO during the first 24 hours was associated with increased in-hospital MACE in cardiogenic shock patients.
500 HEMODYNAMIC FORCES AS PREDICTORS OF CARDIAC REMODELING AND OUTCOME IN PATIENTS WTH HEART FAILURE WITH REDUCED EJECTION FRACTION TREATED WITH SACUBITRIL/VALSARTAN
Authors: Castiglione Vincenzo , Fabiani Iacopo , Pugliese Nicola Riccardo , Pedrizzetti Gianni , Tonti Giovanni , Chubuchny Vladislav , Taddei Claudia , Gimelli Alessia , Del Punta Lavinia , Balletti Alessio , Masi Stefano , Cameli Matteo , Emdin Michele , Giannoni Alberto 
Published: December 2022

Abstract

Aims
To evaluate the predictive value of echo-derived hemodynamic forces (HDF) compared to other echocardiographic, biohumoral and cardiopulmonary parameters on: a) angiotensin receptor-neprilysin inhibition (ARNI) response to 6-months treatment; b) cardiovascular events at follow-up.

Methods
Eighty-nine consecutive patients with heart failure with reduced ejection fraction (HFrEF) performed clinical, laboratory, ultrasound, and cardiopulmonary exercise testing. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and/or ≥10% increase in left ventricle ejection fraction over 6 months were considered responders to ARNI. We conducted a clinical follow-up for the composite endpoint of HF-related hospitalization, new-onset atrial fibrillation and cardiovascular death.

Results
Out of 89 patients, 45 (51%) were ARNI-responders. Among several variables evaluated at baseline, only the whole cardiac cycle left ventricle strength (wLVS) calculated from HDF was found to be higher in responders (4.4±1.3 vs 3.6±1.2; p=0.01) and the only independent predictor of ARNI-response at multivariate logistic regression analysis (odds ratio 1.36; 95% confidence interval 1.10–1.67; p=0.004), with good accuracy at receiver operating characteristic (ROC) analysis (optimal cut-off ≥3.7%; area under the curve [AUC]=0.736, 0.607–0.840; p&lt;0.0001). During a median follow-up of 33 months (interquartile range 23-41), 6-month wLVS increase (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off ≥0.5%; AUC=0.811, 0.69–0.90; p&lt;0.0001), stratified prognosis (log-rank p&lt;0.0001) and remained an independent prognostic predictor for the composite endpoint (hazard ratio 0.76, 0.61–0.95; p&lt;0.01), after adjusting for all clinical, functional and conventional echocardiographic parameters (Figure).

Conclusions
HDF analysis helps in predicting ARNI-response and optimizing follow-up and medical/device decision-making in patients with HFrEF.
1111 INTACT FIBROBLAST GROWTH FACTOR 23 TESTED BY A FULLY AUTOMATED ASSAY: CLINICAL CORRELATES AND PROGNOSTIC VALUE IN CHRONIC SYSTOLIC HEART FAILURE
Authors: Vergaro Giuseppe , Castiglione Vincenzo , Del Franco AnnaMaria , Gentile Francesco , Aimo Alberto , Saponaro Federica , Masotti Silvia , Prontera Concetta , Fusari Niccolò , Emdin Michele , Passino Claudio 
Published: December 2022

Abstract

Background and aims
Fibroblast growth factor-23 (FGF23) has been associated with left ventricular (LV) hypertrophy, fibrosis, and heart failure (HF). We aimed to investigate the clinical correlates and prognostic value of intact FGF23 (iFGF23) in HF patients.

Methods
Patients with systolic HF (left ventricular ejection fraction – LVEF &lt;50%) were prospectively enrolled. iFGF23 was tested with a fully automated immuno-chemiluminescent assay. Patients were divided into iFGF23 tertiles and followed-up for all-cause death, cardiac death, and the composite of all-cause death and HF hospitalizations.

Results
We enrolled 150 patients (82% males; median age 65 years). First, second, and third iFGF23 tertiles were &lt;35.2 pg/mL, 35.2-50.9 pg/mL, and &gt;50.9 pg/mL. Patients in the upper iFGF23 tertile had lower LVEF (p=0.014), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP, p=0.001), and lower peak VO2 (p&lt;0.001). Plasma phosphate, estimated glomerular filtration rate (eGFR), and LV mass index were independently associated with higher iFGF23 levels (all p&lt;0.05). Patients in the upper tertile were at higher risk of all-cause death (p=0.001), cardiac death (p=0.001), and of the composite of all-cause death and HF hospitalizations (p=0.003). iFGF-23 was an independent predictor of all the endpoints after adjustment for age, LVEF, eGFR, and NT-proBNP.

Conclusions
Circulating iFGF23 is associated with renal dysfunction, disease severity and outcome in systolic HF.
Figure. Prognostic impact of FGF23 levels in patients with systolic heart failure (HF). In a cohort of HF patients with systolic dysfunction, higher iFGF23 levels (marker of increased cardiac fibrosis and hypertrophy) were associated with a more severe disease, as expressed by lower left ventricular systolic function, higher circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), lower oxygen consumption at cardiopulmonary exercise test and worse renal function. Moreover, iFGF23 elevation identified patients at higher risk for all-cause and cardiac mortality, and HF hospitalization.
312 VIRTUAL VISITS FOR HEART FAILURE OUTPATIENTS MANAGEMENT: 12-MONTHS EXPERIENCE DURING COVID-19 PANDEMIC PERIOD
Authors: Severino Paolo , D´amato Andrea , Prosperi Silvia , Magnocavallo Michele , Maraone Annalisa , Notari Claudia , Papisca Ilaria , Cestiè Claudia , Francia1 Aurora Labbro , Tomarelli Elisa , Myftari Vincenzo , Costi Bettina , Germanò Rosanna , Mancone Massimo , Fedele Francesco 
Published: December 2022

Abstract

Background
Heart failure (HF) patients are predisposed to recurrences and disease destabilizations, especially during the COVID-19 outbreak period. In this scenario, telemedicine could be a proper way to ensure continuous care. The purpose of the study was to compare two modalities of HF outpatients' follow up, the traditional in-person visits and telephone consultations, during the COVID-19 pandemic period in Italy.

Methods
We performed an observational study on consecutive HF outpatients. The follow up period was 12 months, starting from the beginning of the COVID-19 Italy lockdown. According to the follow up modality, and after the propensity matching score, patients were divided into two groups: those in G1 (n = 92) were managed with traditional in-person visits and those in G2 (n = 92) were managed with telephone consultation. Major adverse cardiovascular events (MACE) were the primary endpoints. Secondary endpoints were overall mortality, cardiovascular death, cardiovascular hospitalization, and hospitalization due to HF.

Results
No significant differences between G1 and G2 have been observed regarding MACE (p = 0.65), cardiovascular death (p = 0.39), overall mortality (p = 0.85), hospitalization due to acute HF (p = 0.07), and cardiovascular hospitalization (p = 0.4). Survival analysis performed by the Kaplan-Meier method also did not show significant differences between G1 and G2.

Conclusions
Telephone consultations represented a valid option to manage HF outpatients during COVID-19 pandemic. They were comparable to traditional in-person visits.
Key words: heart failure; virtual visits; outpatients; COVID-19.
247 HEPATIC T1-TIME, CARDIAC STRUCTURE, FUNCTION AND CARDIOVASCULAR OTUCOMES IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION UNDERGOING CARDIAC MAGNETIC RESONANCE IMAGING
Authors: Bellicini Mariagiulia , Inciardi Riccardo Maria , Di Meo Nunzia , Rondi Paolo , Cersosimo Angelica , Lupi Laura , Pagnesi Matteo , Gavazzi Emanuele , Lombardi Carlo Mario , Targher Giovanni , Farina Davide , Metra Marco 
Published: December 2022

Abstract

Aim
Liver damage is frequently encountered in patients with cardiovascular (CV) disease, due to congestion or metabolic dysfunction-associated fatty liver disease (MAFLD). It has been shown that liver disease is associated with worse outcomes in patients with CV disease. Nevertheless, the association of liver disease with cardiac structure and function and CV events in patients with heart failure and reduced ejection fraction (HFrEF) is poorly known.

Methods
We retrospectively enrolled consecutive patients with HFrEF undergoing Cardiac Magnetic Resonance (CMR) Imaging. In addition to standard cardiac T1-mapping, 3 regions of interest were also defined at the liver parenchyma. Patients were stratified according to hepatic T1 mapping. Linear regression analysis adjusted for demographics and clinical characteristics was performed to cross-sectionally examine the association between hepatic T1-time on CMR and measures of cardiac structure and function. The Kaplan-Meier survival and Cox regression analyses were performed to prospectively investigate the association between hepatic T1-time and the composite adverse outcome of hospitalization for HF or all-cause death.

Results
Overall, 106 HFrEF patients were included in the study (mean age 56 ± 14 years, 75% male). Mean hepatic T1-time was 558 ± 70 ms. In logistic regression analysis, left-ventricle (LV) end-diastolic volume (EDV) (p = 0.027), left atrial volume (LAV) (p = 0.015), right-ventricle (RV) EDV (p &lt; 0.001) and RVEF (p = 0.035) were positively associated with hepatic T1-time. Over a mean follow-up of 5 ± 2 years, 32 patients (30%) experienced the composite outcome at a rate of 6.7 per 100 person-year. In Cox regression analysis, higher hepatic T1-time was independently associated with an increased risk of developing the composite outcome (adjusted-hazard ratio 1.07, 95% confidence interval: 1.01–1.12, p = 0.011). In particular, patients with a hepatic T1-time ≥558 ms had a higher risk of adverse outcomes compared to those with a hepatic T1-time &lt;558 ms (log-rank p = 0.02).

Conclusion
Among HFrEF patients undergoing CMR, higher hepatic T1-time was significantly associated with poorer measures of cardiac size and function. Hepatic T1-time was also significantly associated with higher rates of hospitalization for HF or all-cause-mortality. This parameter may be useful to stratify HFrEF patients at risk of adverse cardiovascular outcomes.
261 IMPACT OF BASELINE KIDNEY FUNCTION ON SGLT2 INHIBITOR EFFECTS ON RENAL AND HEART FAILURE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Cavallari Ilaria , La Porta Ylenia , Maddaloni Ernesto , Appetecchia Alessandro , D´onofrio Luca , Grigioni Francesco 
Published: December 2022

Abstract

Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce renal and heart failure (HF) events in people with and without diabetes. Although their glycemic efficacy is dependent on kidney function, it remains unclear to what extent baseline kidney function influences the magnitude of SGLT2i cardiorenal effects.

Methods
We conducted a systematic review and meta-analysis of randomized, placebo-controlled trials testing the effects of SGLT2i on renal and CV outcomes (PROSPERO registration number CRD42022325976). Efficacy outcomes, stratified by five estimated glomerular filtration rate (eGFR) categories, included progression of renal disease (as defined in each trial), a composite HF outcome (defined as CV death or hospitalization/urgent visit for HF), and all-cause mortality.

Results
Eleven trials testing five SGLT2i (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin and sotagliflozin) in 77,541 participants were included. The majority of participants (39.8%) had eGFR values between 60 and 90 ml/min/1.73m2, with only 1.3% having advanced kidney disease (eGFR between 20 and 30 ml/min/1.73m2). Overall, SGLT2i reduced the risk of renal disease progression by 41% (HR 0.59, 95%CI 0.54–0.65, p&lt;0.001) and the risk of HF outcomes by 22% (HR 0.78, 95%CI 0.73–0.83, p&lt;0.001). Meta-regression analyses showed a significant direct relationship between baseline eGFR and the magnitude of SGLT2i renal protection (p=0.040). The greatest relative risk reduction was in participants with eGFR values ≥90 ml/min/1.73m2 (HR 0.43, 95%CI 0.32–0.58) and the smallest was in those with an eGFR between 30 and 45 ml/min/1.73m2 (HR 0.64, 95%CI 0.55–0.76). Conversely, the HF outcome showed a non-significant trend to greater benefit in participants with lower eGFR categories (p=0.086). The greatest relative risk reduction was in those with an eGFR between 20 and 30 ml/min/1.73m2 (HR 0.68, 95%CI 0.48–0.96, p=0.026) and the smallest was in those with an eGFR ≥90ml/min/1.73m2 (HR 0.87, 95%CI 0.56–1.35, p=0.52).

Conclusions
SGLT2i reduce risk of renal disease progression and HF outcomes for all eGFR subgroups. However, the opposite trends for the influence of baseline kidney function between renal and HF outcomes suggest different SGLT2i mechanisms for renal and cardiac protection.
652 SUCCESSFUL SURGICAL REPAIR OF LEFT VENTRICULAR PSEUDOANEURYSM IN A PATIENT WITH SUBACUTE ST-ELEVATION MYOCARDIAL INFARCTION
Authors: Chianese Salvatore , Capone Valentina , Salzano Andrea , Bossone Eduardo , Cocchia Rosangela 
Published: December 2022

Abstract
A 65-year-old man was admitted to the emergency department for abdominal pain begun 4 days before. Past medical history consisted of ischemic stroke and diabetes mellitus. Of note, he was not taking any medication. Vital signs: blood pressure 90/50 mmHg, heart rate 50/minute, respiratory rate 18/minute, body temperature 36.5°C; saturation oxygen level 93%. High-sensitivity cardiac troponin was mildly elevated (121 pg/mL). Electrocardiogram showed sinus bradycardia, Q waves with ST elevation in antero-lateral leads consistent with subacute STEMI. Transthoracic echocardiogram (TTE) revealed aneurysmatic expansion of apical left ventricular (LV) walls (ejection fraction 30%) with a large apical thrombus (35×15 mm). Coronary angiography showed complete occlusion of proximal left anterior descending artery and a critical stenosis of right coronary artery; percutaneous coronary intervention with stent implantation on right coronary artery was performed. He received triple antithrombotic therapy with aspirin, clopidogrel, intravenous heparin first and then oral anticoagulation with warfarin. During coronary care unit stay, the patient was asymptomatic and hemodynamically stable. However, a control TTE (day 6) in cardiology ward revealed the presence of pseudoaneurysm with an oval out-pouching (23 × 13 mm) from the apical aspect of LV septum, communicating with the LV chamber through a passage measuring 1.6 cm. Partially organized pericardial effusion was evident around right ventricular free wall (Figure 1). Thus, the patient was immediately transferred to the cardiac surgery department for urgent surgical repair. The LV anterior wall rupture with pseudoaneurysm was then treated with endoaneurysmectomy of the LV with dacron patch and freewall reconstruction with prolene sutures and teflon felt stripes. The patient was finally discharged 3 weeks after surgery with betablockers, ace- inhibitors, diuretics, statins and dual antiplatelet therapy with aspirin and clopidogrel. At one month follow-up visit, the patient was hemodynamically stable with acceptable functional capacity. Figure 1Modified five chamber view (a, b) and three chamber view (c, d) showing apical LV pseudoaneurysm (arrows) with moderate pericardial effusion (arrowhead); color Doppler through the passage (arrow) in 3 chamber view (d). LV, left ventricular.
691 RELATION BETWEEN HIGH-SENSITIVITY TROPONIN I SERUM LEVELS AND MYOCARDIAL ISCHEMIA IN PATIENTS WITH SUSPECTED CHRONIC CORONARY SYNDROME: THE RESET-MI STUDY
Authors: De Vita Antonio , Bruno Isabella , Baroni Silvia , Moretti Giacomo , Tempestini Federica , Telesca Alessandro , Tremamunno Saverio , Felici Tamara , Verrillo Alfonso , Tempesta Valeria , Feudo Vanessa , Lamendola Priscilla , Liuzzo Giovanna , Crea Filippo , Lanza Gaetano Antonio 
Published: December 2022

Abstract

Background
Although the detection of a rise and/or fall pattern of cardiac troponin (cTn) serum levels in presence of a clinical context of acute myocardial ischemia, represents the main criterion for the diagnosis of acute myocardial infarction (AMI), troponins may increase in various conditions of myocardial injury different from ischemic myocardial necrosis or simply following myocardial ischemia, in the absence of cell necrosis. Some studies found that troponins also increase after physical exertion and other types of stressful stimuli in the absence of obstructive CAD and myocardial ischemia. No previous study, however, investigated the relation between cTn serum levels and the extent of myocardial ischemia in patients with a suspect of CCS.

Methods
We prospectively enrolled consecutive patients undergoing an elective stress myocardial perfusion scintigraphy (MPS) because of a clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups based on the evidence and degree of stress-induced MI at MPS: 1) group 1, no MI (≤4%); 2) group 2, mild MI (5-10%); 3) group 3, moderate-to-severe MI (≥10%). High sensitivity (hs)-cTnI was measured immediately before (T0) and 1 hour (T1) and 4 hours (T2) after the stress test. A successive evaluation of patients was performed at 24 months.

Results
One-hundred consecutive patients (64 males; age 65.5±9.5 years) were enrolled in the study. Serum hs-cTnI concentrations significantly increased after MPS, compared to baseline, in the whole population, from (median, interquartile range) 3.9 (2.5-6.1) ng/L at T0, to 4.2 (2.8-7.3) ng/L at T1 (p&lt;0.001) and 6.7 (3.8-14.1) ng/L at T2 (p&lt;0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p=0.35). Heart rate achieved during the test was the strongest determinant of cTnI increase (p &lt; 0.001). No major adverse cardiac event occurred during follow-up. Only 12 patients (12%) underwent coronary revascularization, whereas angina episodes were reported by 23 patients (23%). There were no significant differences in hs-cTnI increase after the stress test between patients with clinical events at follow-up compared with those who did not report myocardial revascularization or angina recurrence (p=0.21).

Conclusions
In patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and the extent of myocardial ischemia and is mainly related to myocardial work, as indicated by HR achieved during the test.
145 PREDICTION OF NEW ONSET ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION USING THE C2HEST AND MC2HEST SCORES A REPORT FROM THE MULTICENTER REALE-ACS REGISTRY
Authors: Gelfusa Martina , Biccirè Flavio Giuseppe , Tanzilli Gaetano , Prati Francesco , Sammartini Emanuele , Celeski Mihail , Budassi Simone , Barillà Francesco , Lip Gregory Y H , Pastori Daniele 
Published: December 2022

Abstract

Aims
New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of patients at risk of NOAF remains challenging, and various clinical scores of varying complexities have been proposed to predict incident AF. We tested the value of the simple C2HEST score for predicting NOAF in patients with ACS.

Methods
We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The C2HEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mC2HEST score.

Results
We enrolled 555 patients (mean age 65.6±13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p&lt;0.001) and had more prevalent hypertension (p=0.012), COPD (p&lt;0.001) and hyperthyroidism (p=0.018). Patients with NOAF were more frequently admitted with STEMI (p&lt;0.001), cardiogenic shock (p=0.008), Killip class ≥2 (p&lt;0.001) and had higher mean GRACE score (p&lt;0.001). Patients with NOAF had a higher C2HEST score compared with those without (4.2±1.7 vs 3.0±1.5, p&lt;0.001). A C2HEST score &gt;3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19-8.59, p&lt;0.001). ROC curve analysis showed good accuracy of the C2HEST score (AUC 0.71, 95%CI 0.67-0.74) and mC2HEST score in predicting NOAF (AUC 0.69, 95%CI 065-0.73).

Conclusion
The simple C2HEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.