bluuebunny/crossref_metadata_2025_split huggingface dataset:
1 ACE-INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS DO NOT IMPACT ON OUTCOME NOR IN LONG TERM CONSEQUENCES OF COVID-19
Authors: Salvotti Francesca , Boari Gianluca , Fusco Maria Elena , Borghi Erika , Volpe Pietro , Tosoni Federico , Turini Daniele , Malerba Paolo , Pasini Giancarlo , Guarinoni Vittoria , Ferrari-toninelli Giulia , Leidi Francesca , Bressa Stefano , Santagiuliana Marzia , Napoli Federico , Geroldi Veronica , Rosei Claudia Agabiti , De Ciuceis Carolina , Rizzoni Damiano 
Published: December 2022

Abstract

Introduction
COVID-19 pandemic still represents a major clinical problem worldwide. Many studies are actively being carried out to better understand prognostic factors of outcome as well as optimal treatment.

Aim
ACE-2 receptor is highly expressed on the surface of cardiac and pulmonary cells, and it is used by coronaviruses to enter host cells; this makes the role of ACE-inhibitors and Angiotensin Receptor Blockers (ARBs) drugs controversial. Moreover, it is still unclear whether these drugs may have any impact on sequelae.

Methods
In this retrospective study, we analysed a group of 244 hypertensive unvaccinated patients (134 on ACE-inhibitors, 110 on ARBs) admitted for moderate to severe COVID-19 pneumonia. As shown in the table, the two groups where homogeneous.
Of these patients, 46 (20 treated with ACE-I and 26 treated with ARBs) came to a follow-up visit after a mean of 260 days; they underwent a quality-of-life assessment, laboratory and radiologic tests and spirometry (with DLCO).

Results
A total of 20 of 110 (18%) patients under treatment with ARBs and 23 of 134 (17%) died during hospitalization (p=0.8, NS). At discharge, biochemical, radiological and respiratory data were not significantly different. We did not find any significant difference in terms of radiologic alterations, lung fibrosis, spirometry data, DLCO, persisting effort dyspnea. Biochemical data were substantially super-imposable in the two groups.

Conclusions
we could not detect any difference in outcome nor in complications type or number in the two groups undergoing treatment with ACE-inhibitor or ARBs. This result seems to support and to strengthen the idea that ACE-inhibitors and ARBs do not play a significant role in onset, evolution and outcome of moderate to severe COVID-19 pneumoniae. Although the number of follow-up patients is small, we did not find any difference in follow-up sequelae in both groups.
15 THE HEAVY BURDEN OF SARS-COV-2 RELATED PNEUMONIA REQUIRING HIGH-OXYGEN FLOW
Authors: Salvotti Francesca , Scipione Vittorio , Flamminio Gigliola , Pastori Antonella , Geroldi Veronica , Volpe Pietro , Borghi Erika , Tosoni Federico , Fusco Elena Maria , Malerba Paolo , Ferrari-toninelli Giulia , De Ciuceis Carolina , Rosei Claudia Agabiti , Rizzoni Damiano , Boari Gianluca E m 
Published: December 2022

Abstract

Aim
there is evidence of significant clinical sequelae of COVID-19 that may impair both life length and its quality. Aim of this study was to assess the long-term consequences of moderate to severe SARS-CoV-2-related pneumonia in patients requiring high-flow oxygen treatment.

Methods
This prospective follow-up study included 45 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from November 2020 to April 2021 Patients had COVID-19 related pneumonia with respiratory failure and needed at least treatment with an inspired fraction of oxygen of 40% (of them, 59% were treated with Venturi mask and 41% needed non-invasive ventilation). Patients underwent a clinical assessment with standard laboratory testing, chest CT scan, lung function tests with DLCO, and evaluation of vital parameters after a mean of 382 days after hospital discharge. A quality-of-life questionnaire was administered to each willing patient.

Results
See table for details. While standard laboratory testing showed a substantial normalization, we found persistence of radiological alterations (i.e. ground-glass opacities, irregular linear/reticular opacities) in 61% of patients; mean Tiffenau index (FEV1/FVC) was reduced, although not clearly pathologic (79%) and 38% of patients showed a mild to moderate reduction in CO lung diffusion (DLCO). Interestingly, 54% of subjects showed concomitant presence of radiologic alterations AND persistence of dyspnea OR reduction in CO lung diffusion, while 21% had all three concomitant conditions, compatible with the diagnosis of lung fibrosis. Overall, a total of 75% patients had some degree of functional or structural alteration of respiratory apparatus. We also evaluated quality of life thorough a structured questionnaire: after more than one year 62% of the patients still lamented fatigue, 62% effort dyspnea, 12% anorexia, 29% dysgeusia or anosmia, 31% insomnia and 43% anxiety.

Conclusions
these data seem to demonstrate that SARS-CoV-2-related pneumonia requiring high flow oxygen has a heavy long-term burden, both in terms of persistence of functional and structural pulmonary damage (which may be progressive and evolve to a more severe degree) and of burden on overall quality daily life.
872 ENDOTHELIAL AND CARDIAC AUTONOMIC FUNCTION IN PATIENTS WITH A RECENT SARS-COV-2 INFECTION
Authors: Tremamunno Saverio , Telesca Alessandro , Felici Tamara , De Vita Antonio , Villano Angelo , Lamendola Priscilla , Tosato Matteo , Landi Francesco , Lanza Gaetano Antonio 
Published: December 2022

Abstract

Background
A significant proportion of patients recovering from SARS-CoV-2 infection (Covid-19) complain a wide variety of bothersome symptoms, including symptoms potentially related to cardiac involvement, that may significantly impair their quality of life (post-Covid or long-Covid syndrome). However, full diagnostic investigation usually does not reveal significant structural or functional cardiac abnormalities. Whether cardiac autonomic dysfunction and/or endothelial dysfunction may play a role in post-COVID-19 symptoms, however, has poorly been investigated.

Methods
We prospectively enrolled 63 young adult patients (age 18-55 years) without any previous cardiovascular disease, referred to our “Post-COVID-19” Day Hospital ward for a clinical follow-up after 3 months from SARS-CoV-2 infection.
In all patients endothelium-dependent vasodilator function was assessed non-invasively by measuring the change of brachial artery diameter in response to hyperaemia after 5 minutes of forearm ischemia (flow-mediated dilatation, FMD); furthermore, endothelium-independent vasodilator function was assessed by measuring the change of brachial artery diameter in response to sublingual nitro-glycerine (25 µg) (nitrate-mediated dilatation, NMD). A 24-hour ECG Holter monitoring (HM) was performed to assess cardiac autonomic function by obtaining time-domain and frequency-domain parameters of heart rate variability (HRV).

Results
Symptoms of potential cardiac origin (dyspnoea on exertion, chest pain, arrhythmic symptoms) were referred by 47 patients (74.6%, Group 1), whereas 16 (25.4%, Group 2) were free from any possible cardiac symptom. The two groups did not differ in age, sex and cardiovascular risk factors. FMD was 7.29±3.4% and 7.01±2.3% in Group 1 and 2, respectively (p=0.77), whereas NMD was 11.1±3.8% and 14.2±4.9 in the two groups, respectively (p=0.013). No significant differences were observed for HRV parameters between the two groups (see Table).

Conclusions
Our data do not support a role for both endothelial dysfunction and cardiac autonomic dysfunction in the persistence of symptoms of potential cardiac origin in patients with a recent SARS-CoV-2 infection. The lower endothelium-independent arterial vasodilator found in these patients, however, deserves further investigation.
467 EFFICACY OF TRANSCATHETER INTERATRIAL SHUNT DEVICES IN HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Basile Christian , Marzano Federica , Dellegrottaglie Sarto , Gargiulo Paola , Abbate Vincenza , Ambrosio Antonio , Carbone Francesca , Dell´aversana Simona , Esposito Immacolata , Fierro Maria Francesca , Perrone-filardi Pasquale , Paolillo Stefania 
Published: December 2022

Abstract

Background
In patients affected by heart failure with reduced ejection fraction (HFrEF), pharmacological treatments have been proven to alleviate symptoms and improve prognosis, while no treatment other than sodium-glucose co-transporter-2 inhibitors have demonstrated significant effects in HF with preserved ejection fraction (HFpEF). Left-to-right interatrial shunt devices are now being investigated for left atrial decompression in patients with HF.

Objectives
To assess the efficacy of left-to-right interatrial shunt devices (IASD) on soft endpoints in HF patients.

Methods
PubMed and Web of Science were searched without restrictions from inception to 28 May 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified main outcomes were the change from baseline in 6-minute walking distance (6MWD), NYHA class and health-related quality of life (HRQoL). Secondary outcomes were reduction in HF hospitalizations, and echocardiographic and hemodynamic parameters.

Results
Ten studies, with a total of 539 patients were included. IASD significantly improved 6MWD of 44.19 m (95% CI: 29.82–58.56 m), decreased NYHA class by 0.89 (95% CI: 1.10–0.67), and improved HRQoL questionnaire by 20.19 points (95% CI: 12.94–27.44) with better results for all outcomes in younger patients and in patients with lower EFs (Figure).

Conclusion
The present meta-analysis suggests that IASD are favorable in improving 6MWD, NYHA class, and HRQoL in HF across a wide spectrum of ejection fraction, with better outcomes in younger patients and in patients with lower EFs.
143 ESTIMATION OF RIGHT ATRIAL PRESSURE BY ULTRASOUND-ASSESSED JUGULAR VEIN DISTENSIBILITY IN PATIENTS WITH CHRONIC ADVANCED HEART FAILURE
Authors: Colombo Giada , Marchetti Davide , Gentile Piero , D´angelo Luciana , Masciocco Gabriella , Macera Francesca , Occhi Lucia , Musca Francesco , Perna Enrico , Moreo Antonella , Oliva Fabrizio , Garascia Andrea , Metra Marco , Ammirati Enrico 
Published: December 2022

Abstract

Aims
In patients with chronic advanced heart failure (HF) signs of congestion are not always evident on clinical examination. We aim to validate the ultrasound (US)-assessed jugular vein distensibility (JVD), as a non-invasive tool to identify patients with normal right atrial pressure (RAP≤7 mmHg).

Methods and Results
In a single-center prospective study, we assessed chronic HF patients with a left ventricular ejection fraction (LVEF)&lt;50% who underwent a pulmonary artery catheterization in the setting of advanced HF therapies workup. We first identify the JVD threshold (Valsalva/rest ratio of the vein diameter) of 1.6 that allowed the most accurate discrimination between patients with RAP≤7 vs. &gt;7 mmHg (area under the curve [AUC] of 0.74; p&lt;0.0001) in a calibration cohort of 100 patients (mean age 53 years, median LVEF 25%). Based on this JVD threshold, we defined patients with low JVD (≤1.6; n=58; median RAP 8 mmHg) and high JVD (&gt;1.6, n=42; median RAP 4 mmHg). Then, we tested the threshold in 101 patients (validation cohort), where we found comparable results (AUC of 0.82; p&lt;0.0001). The JVD threshold had 0.86 and 0.94 predictive positive values to identify patients with RAP≤7 mmHg in the calibration and validation cohorts. Finally, the low JVD vs. high JVD group had a 42.7% vs. 16.1% incidence of major cardiac events at 2 years (log-rank p=0.006), showing its prognostic value.

Conclusion
US-assessed JVD is an accurate diagnostic tool to identify advanced HF patients with normal RAP. This tool could be tested in the ambulatory setting to modulate diuretic/vasodilator therapies.
733 NT-PROBNP CONCENTRATIONS ACROSS PULMONARY HYPERTENSION GROUPS
Authors: Costa Paolo , Solimano Martina , Crimi Gabriele , Vercellino Matteo , Macchione Andrea , Toma Matteo , Porto Italo , Ameri Pietro 
Published: December 2022

Abstract

Background
Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are found in both pre-capillary pulmonary hypertension (PH), including pulmonary arterial hypertension, PH associated with hypoxia/lung disease and chronic thromboembolic pulmonary hypertension, and post-capillary PH associated with left heart disease. We asked the question of whether NT-proBNP concentrations differ among these PH subtypes.

Methods
Based on right heart catheterization (RHC) data collected at our institution between Jan. 2019 and Dec. 2021, 146 patients were classified as no PH, pre-capillary PH, isolated post-capillary PH (iPC-PH) or combined pre- and post-capillary PH (cPC-PH) according to the 2022 ESC/ERS guidelines (GL). NT-proBNP values were compared across PH groups by Kruskal-Wallis test with Bonferroni correction. The characteristics of subjects with pre-capillary PH and NT-proBNP ≤ or &gt;1.100 pg/mL, a cut-off for severity proposed by the 2022 GL, were compared by chi-square test, T-test, or Mann-Whitney test, as appropriate. We also applied the hemodynamic definitions of the 2018 6th World Symposium on PH (6WSPH) and of the 2015 GL, examined the differences in the distribution of PH groups with the McNemar test, and reassessed NT-proBNP concentrations.

Results
44 (30%) of patients did not have PH, 38 (26%) had pre-capillary PH, 18 (12%) had iPC-PH, and 46 (32%) had cPC-PH. NT-proBNP levels were progressively higher from pre-capillary PH to iPC-PH to cPC-PH (Figure). Interestingly, the 25th percentile of the cPC-PH group was 1.138 pg/mL, close to the 1.100 pg/mL cut-off. Compared with patients with pre-capillary PH and NT-proBNP ≤1.100 pg/mL, those with &gt;1.100 pg/mL NT-proBNP had larger right ventricle basal diameter [50 (43-53) vs 43 (36-45) mm; p=0.02], lower TAPSE/sPAP ratio [0.21 (0.15-0.25) vs 0.35 (0.25-0.43), p=0.01], more often massive tricuspid regurgitation (83% vs 20%, p&lt;0.001), higher pulmonary vascular resistance [9.5 (7.6-15.1) vs 5.7 (2.7-7.8) WU; p=0.004], and lower stroke volume index [28 (17-32) vs 36 (32-50) mL/m2; p=0.002]. The proportion of no PH decreased and the one of cPC-PH increased when the 6WSPH or the 2015 GL criteria were used (p for trend &lt;0.001). Nonetheless, the trend of NT-proBNP remained similar to that observed with the 2022 GL definitions (Figure).

Conclusions
A gradient of NT-proBNP exists across PH groups, with the highest values being in cPC-PH. The concentrations of NT-proBNP in severe pre-capillary PH overlap with those in cPC-PH, indirectly confirming the validity of this biomarker to discriminate the severity of pre-capillary PH.
306 HEART FAILURE AS THE CANCER FOR THE HEART: THE PROGNOSTIC ROLE OF THE HLM SCORE
Authors: Severino Paolo , Mancone Massimo , D´amato Andrea , Mariani Marco Valerio , Prosperi Silvia , Fegatelli Danilo Alunni , Birtolo Lucia Ilaria , Angotti Danilo , Costi Bettina , Cestiè Claudia , Francia Aurora Labbro , Tomarelli Elisa , Myftari Vincenzo , Germanò Rosanna , Milanese Alberto , Cerrato Enrico , Maestrini Viviana , Pizzi Carmine , Foà Alberto , Vestri Annarita , Palazzuoli Alberto , Vizza Carmine Dario , Casale Paul , Mather Paul , Fedele Francesco 
Published: December 2022

Abstract

Background
The multiorgan involvement of heart failure is similar to the spread observed in cancer. We proposed a new score, named HLM, analogous to TNM classification used in oncology. HLM refers to (i) H: heart damage, instead of “T” for tumor; (ii) L: lung involvement, instead of “N” for lymph nodes; (iii) M: systemic multiorgan involvement, instead of “M” for metastasis.

Objectives
to compare HLM score to NYHA class, ACC/AHA stages and left ventricular ejection fraction (LVEF) classification, to assess the most accurate prognostic tool for HF patients.

Methods
We performed a multicentric, observational, prospective study of consecutive patients admitted for HF, or at risk for HF. Parameters for heart, lungs and organs’ function were collected. Each patient was classified according to HLM, NYHA, ACC/AHA stages and LVEF classification. Patients were followed up for 12 months. The primary composite endpoint was all-cause death and rehospitalization due to HF.

Results
We enrolled 1720 patients who completed the 12-month follow-up. As shown by Kaplan Meier curves, HLM was the most accurate score to predict primary endpoint at 12- month. The area under the ROC curve (AUC) was greater for HLM score than NYHA, ACC/AHA stages and LVEF classification, regarding the composite endpoint (HLM=0.645; NYHA=0.580; ACC/AHA=0.589; LVEF=0.572) (Figure 1). HLM score related AUC showed statistically significant differences compared to LVEF (p=0.002), ACC/AHA (p=0.029) and NYHA (p=0.009).

Conclusions
HLM score has a greater prognostic power compared to other nosologies, in terms of the composite endpoint of all-cause death and rehospitalization due to HF, at 12-month follow-up.
Key words: heart failure; HLM score; prognosis; mortality; rehospitalization.
Figure 1.
61 LEFT ATRIAL RESERVOIR AND STIFFNESS IN PATIENTS WITH WILD-TYPE TRANSTHYRETIN AMYLOID VS HYPERTROPHIC CARDIOMYOPATHY
Authors: Campisi Mariapaola , Trimarchi Giancarlo , De Sarro Rosalba , Poleggi Cristina , Luongo Alfredo , Teresi Lucio , Lofrumento Francesca , Restelli Davide , Recupero Antonino , Zito Concetta , Di Bella Gianluca , De Gregorio Cesare 
Published: December 2022

Abstract

Objectives
Left atrial (LA) function can be investigated by advanced ultrasound speckle tracking modality, much better than in the past. Modern ultrasound technology allows attaining myocardial deformation profiles from both ventricular and atrial chambers. Each of the 3 components of LA function [reservoir, also known as peak longitudinal strain (PALS); conduit and pump] can be impaired in various chronic diseases. We previously demonstrated that PALS (reservoir) and pump function weaken in patients with cardiac transthyretin amyloidosis (ATTR) and hypertrophic cardiomyopathy (HCM). In the present study we sought to recognize LA stiffness (LAst), a relatively novel marker of atrial dysfunction, in the same clinical settings.

Methods
17 patients, 9 with ATTR wild-type (wt) and 8 with non-obstructive HCM, mean aged 67±12 years, were investigated by using transthoracic color-Doppler and strain ultrasound equipment. LV mass index (LVMI), LA area index (LAAI), LV ejection fraction (LVEF), E/E’ ratio, LV global longitudinal strain (GLS), PALS and LAst were assessed in both groups. LAst was calculated by PALS/E/E’ ratio, as suggested by studies.

Results
LVMI and LAAI were similar in the 2 groups: 171±40 vs 161±51 g/m2.7 and 14±3 vs 16±4 cm/m2.7 in ATTRwt vs HCM, respectively (p=NS). However, patients in the former group showed poorer LV diastolic and systolic function (LVEF was 47±9 vs 58±5%, respectively, p&lt;0.01), as well as GLS (9.5±2.2 vs 12.6±2.8, respectively, p=0.02). PALS and LAst were more impaired in ATTRwt compared to HCM patients (Figure), despite similar LA chamber size. Considering that LAst value &gt;0.65 has been reported as a predictor of adverse LA morphofunctional remodeling, both groups were considered at risk for atrial dysfunction, but mainly the former one.

Conclusions
Although present findings were achieved by a small patient population, LA reservoir and stiffness were impaired in patients with ATTRwt more than in those with HCM. Left atrial dysfunction may not be strictly related with LVMI or LA size, but with LV-GLS, confirming an atrio-ventricular functional interplay in cardiac amyloidosis. Further larger study is needed to corroborate present results.
542 USE OF ANGIOTENSIN RECEPTOR/NEPRYLISIN INHIBITORS (ARNI) IN WILD TYPE TTR CARDIAC AMYLOIDOSIS (WTATTR) AND HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) : IS IT WORTH A TRY?
Authors: Fowler Bianca , Vincenzi Antonella , Massa Paolo , Massabo Didi , Vullo Eleonora , Lettino Maddalena 
Published: December 2022

Abstract

Background
wtATTR is a therapeutic challenge. Although the majority of patients with wtATTR presents with HFpEF, some evolve to systolic disfunction. According to international guidelines, Tafamidis is the only recommended disease modifiyng agent in wtTTRCA. Therapies for neurohormonal antagonism have no established role and concerns have been raised about their safety. Observational studies have focused on beta blockers (bb), angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers. The role of ARNI has not been directly explored. We report results of the use of ARNI in three male patients with HFrEF in wtATTR who were not eligible to Tafamidis, due to advanced HF (NYHA III-IV).

Cases
wtATTR was diasgnosed in all three patients in 2019 when no drugs were yet available. Baseline median LVEF was 57%. At two years follow up (FU), at average age of 83 years old, patients developed systolic disfunction (median LVEF 21%). They were all symptomatic for dyspnoea (NYHA III-IV), median systolic blood pressure (SBP) was 103mmHg (95-120), median N-terminal fraction of pro-B-type natriuretic peptide (NTproBNP) levels were 11.500 pg/ml (10.263-13.000) and estimated glomerular filtration marked CKD between stages III-IV. Two out of three patients were in anticoagulant treatment for atrial fibrillation and all three were on low dose of bb. S/V 24/26 mg was introduced (T1) in all patients according to eGFR. At 8 months (T2) downgrade of NYHA class was observed in all three patients, none of them developed symptomatic hypotension. Average NTproBNP levels were reduced (average 6853 ng/l), despite of mild worsening of renal function, and reverse remodelling of LV with improvement of contractile function (EF 21% &gt; 45%) was showen at ecocardiography (Tab 1).

Conclusions
A very remarkable clinical, laboratoristic and echographic improvement was observed after 8-months therapy with S/V. The result may be purely due to natriuretic effect of ARNI in patients so strictly reliant on volemic state because of severe dyastolic disfunction, or more complicated effects may be mediated by neprilisin on amiloyd protein. Further research and clinical studies are certanly warranted to guarantee patients with wtATTR HFrEF best possible care.