bluuebunny/crossref_metadata_2025_split huggingface dataset:
334 AMYLOID-BETA 1-40 AND DAPT IN ACUTE MYOCARDIAL INFARCTION
Authors: Aleksova Aneta , Janjusevic Milijana , Gagno Giulia , Fluca Alessandra Lucia , Derin Agnese , Santon Daniela , Oriana Zhou Xin Ning , Chiaradia Vincenzo , Pierri Alessandro , Restivo Luca , Hiche Cristina , D’errico Stefano , Fabris Enrico , Perkan Andrea , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Atherosclerotic plaque destabilization and platelet activation is a prompt and progressive process that is the basis of acute coronary syndromes (ACS). Amyloid-β 1-40 (Aβ (1-40)), is highly expressed in atherosclerotic plaques and is released in plasma by activated platelets. Some animal studies suggested that an increase in amyloid precursor protein (sAPP770) levels upon atherosclerotic plaque activation, anticipates myocardial injury. Platelets inhibition is the keystone in the management of patients with ACS, but the data regarding the benefits of Dual Antiplatelet Therapy (DAPT) before coronary angiography is still disputed.

Methods
In a large prospective cohort of 1038 patients hospitalized for AMI (both STEMI 702 /NSTEMI 333 patients), we evaluated the impact of DAPT on Aβ (1-40) levels, the correlation with inflammatory biomarkers, and Aβ (1-40) prognostic value on long-term mortality.

Results
The median concentration of Aβ (1-40) in plasma at admission was 90.47 (54.49-130.47) pg/ml. At hospital admission patients on DAPT had significantly lower levels of Aβ (1-40) compared to patients receiving only aspirin (67.56 (42.7-120.23) pg/ml vs. 92.25 (56.16-131.17) pg/ml, p=0.004), independently of patients’ gender or diagnosis STEMI/NSTEMI. Aβ (1-40) positively correlated with older age and higher levels of CRP and TNFα.
There was no significant difference among patients who received DAPT therapy and those who did not towards age, presence of chronic renal failure, hypertension, nor in the rate of revascularization procedures (both percutaneous coronary intervention and bypass).
Kaplan-Meier analysis showed that higher Aβ ​​(1-40) levels during the 49-month follow-up were associated with higher mortality risk (p&lt;0.0001). Also, at multivariate Cox regression analysis Aβ ​​(1-40) level (HR =1.003 (95% CI, 1.001-1.005), p=0.017 was predictive for mortality, together with older age, higher interleukin (Il)-1β, worse left ventricular systolic function, and GFR ≤ 60 mL/min.

Conclusions
STEMI/NSTEMI patients receiving DAPT at hospital admission, have a significantly lower plasma concentration of Aβ (1-40), which is an independent predictor of long-term mortality.
342 TMAO PLASMA LEVELS PREDICT RECURRENT ISCHEMIC EVENTS IN SURVIVORS OF MYOCARDIAL INFARCTION
Authors: Aleksova Aneta , Janjusevic Milijana , Stornaiolo Mariano , Gagno Giulia , Pierri Alessandro , Fluca Alessandra Lucia , Derin Agnese , Oriana Zhou Xin Ning , Hiche Cristina , D’errico Stefano , Novellino Ettore , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Recent studies have highlighted a direct link between dietary nutrients, microbiota and cardiovascular disease (CVD). In this context, trimethylamine-N-oxide (TMAO), a metabolite derived from the intestinal microbiota, stands out, paving its way as one of the important biomarkers associated with atherosclerosis, increased risk of CVD, recurrent events and adverse outcomes.

Methods
81 patients who survived acute myocardial infarction (AMI), (both STEMI 50 / NSTEMI 31) were enrolled in this study together with 10 healthy individuals. Further, we evaluated the relationship between plasma TMAO levels and cardiovascular events during the follow-up. The measurement of plasma levels of TMAO was performed using liquid chromatography-tandem mass spectrometry (LC-MS).

Results
The median plasma concentration of TMAO were significantly higher in patients with AMI compared with healthy control (1.62 (1.37–2.25) µM. vs 0.55 (0.35–0.74) µM, p &lt; 0.0001). During a median follow-up of 61.74 (59.34–64.24) months, 10 out of 81 patients (12.3%) had a re-infarction. Patients who had another ischemic event had higher TMAO values compared with individuals who did not (2.29 (1.60–6.49) µM vs 1.60 (1.34–2.09) µM, p = 0.026). Further, TMAO values positively correlate with CRP, a pro-inflammatory marker. However, at multivariate Cox regression analysis, plasma TMAO values were not predictive of re-infarction.

Conclusions
The data of our pilot study show that higher TMAO values are associated with the risk of recurrent ischemic event. A future prospective study, including larger cohort is necessary to analyze this issue.
56 ANALYSIS OF A 23,270-PATIENT STUDY: UNSUPERVISED MACHINE LEARNING WITH CLUSTER ANALYSIS IN PATIENTS DISCHARGED AFTER AN ACUTE CORONARY SYNDROME
Authors: Bernardi Marco , Mohammadi Tanya , D´ascenzo Fabrizio , Spadafora Luigi , Testa Alberto , De Filippo Ovidio , De Ferrari Gaetano Maria , Biondi-zoccai Giuseppe 
Published: December 2022

Abstract

Background
Characterization and management of patients with acute coronary syndromes (ACS) remain challenging, and it is unclear whether currently available clinical and procedural features can suffice to inform adequate decision making.

Methods
Details on patients discharged after an ACS were obtained by querying an extensive multicenter registry, detailing patient features as well as management details. Clinical outcomes included fatal and non-fatal cardiovascular events at 1-year follow-up. After missing data imputation, two unsupervised machine learning approaches (k-means and Clustering Large Applications [CLARA]) were used to generate separate clusters with different features. Bivariate and multivariable-adjusted analyses were performed to compare different clusters for clinical outcomes.
Findings: 23,270 patients discharged after ACS were included. Two clusters were identified by k-mean algorithm (k1 and k2), and two clusters by CLARA algorithm (C1 and C2). Differences in 2-years outcomes between k1 and k2 and between C1 and C2 were substantial. K2 cluster (N=21,988) in comparison with k1 cluster (N=1,282) had significantly higher occurrence of death (9.5% vs 3.8%, p&lt;0.001), reinfarction (7.2% vs 3.7%, p&lt;0.001), and major bleeding (6.0% vs 3.0%, p&lt;0.001). Similarly, C1 cluster (N=11,268) showed a worse prognosis than C2 cluster (N=12,002): death (4.8% vs 3.5%, p&lt;0.001), reinfarction (4.5% vs 3.4%, p&lt;0.001), and major bleeding (3.6% vs 2.8%, p=0.001). Most associations did not hold at multivariable analysis based on supervised learning techniques, with the exception of major bleeding (odds ratio=1.37 [95% confidence interval 1.02-1.83] for the k1/C1 subcluster vs k1/C2 subcluster, p=0.039.

Conclusions
A machine-learning based clustering approach is effective at face value to inform on the prognosis of patients with ACS managed invasively. These findings can be leveraged to inform decision-making in this setting, but also highlight the potential role of cluster analysis in first-in-man, and preapproval studies of medical devices.
194 THROMBOEMBOLIC ACUTE ST ELEVATION MYOCARDIAL INFARCTION AFTER TRANSCATHETER VALVE IMPLANTATION
Authors: Caggiari Ludovica , Angius Simone , Corda Marco , Contini Francesca Valeria , Fazzini Luca , Dessalvi Christian Cadeddu 
Published: December 2022

Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment of severe symptomatic aortic valve stenosis and is an effective and less invasive treatment option compared with conventional surgical aortic valve replacement (SAVR) for patients considered inoperable or at high surgical risk. Thromboembolic and bleeding complications negatively impact recovery and survival after TAVI. This case describes one of the few reported TAVI-associated myocardial infarction due to thrombosis of the prosthetic aortic valve.
A 82-years-old woman, suffering from severe symptomatic aortic stenosis, underwent TAVI. Before the procedure, coronary artery disease was excluded by invasive coronary angiography.
Since the time of the discharge the patient didn't assume any therapy with aspirin or other antithrombotic drugs. A month after TAVI she complained persistent epigastric pain and was admitted to our department for anterior ST elevation myocardial infarction. Coronary angiography highlighted a monovascular coronary artery disease with thrombotic occlusion of the first diagonal and of the distal left anterior descending coronary artery. In consideration of the thrombotic load thyrofiban was started and it was performed a chest contrast CT which confirmed the diagnostic suspicion of bioprosthetic valve thrombosis. She was first treated with unfractionated heparin (UFH) and then oral anticoagulant therapy with warfarin was started. Echocardiograms (echo) showed a severely reduced systolic function (EF 25%) and high trans-prosthetic gradients (mean transprosthetic pressure gradient of 30 mmHg). On the 8th day after hospitalization she complained chest pain with evidence of moderate pericardial effusion. Epistenocardica pericarditis was therefore diagnosed and the patient started acetylsalicylic acid therapy with progressive clinical, instrumental and laboratory improvement. After 10 days of anticoagulation therapy, she underwent a transesophageal echocardiogram which turned out negative for bioprosthetic valve thrombosis. The predischarge transthoracic echocardiography showed severely reduced systolic function (EF 30%) with a mean transprothesic gradient of 12 mmHg; the circumferential pericardial effusion was mild-moderate but not haemodynamically significative. Therapy at discharged included warfarin and aspirin. Ten days after an echo showed a reduction of the pericardial effusion, an improved systolic function (EF 42%) and mean transprothesic gradient not changed significantly since discharge.
Prosthetic valve thrombosis has been reported in up to 40% of patients after TAVI and this case hightlights the importance of antithrombotic therapy after this procedure. Therapeutic anticoagulation appears to be the only non-invasive treatment for resolving valve thrombosis but it is not clear how long this therapy should last for the prevention of prosthetic valve thrombosis.
57 ISCHEMIC HEART SCOMBROID SYNDROME: FURTHER EVIDENCE FROM ALL OVER THE WORLD
Authors: Perfetti Silvia , Ferrazzo Giuseppe , Andò Giuseppe , Costa Francesco , Pistelli Lorenzo , Restelli Davide , Campanella Francesca , Borgi Marco , Koniari Ioanna , Kounis Nicholas G , De Gregorio Cesare 
Published: December 2022

Abstract

Objective
Scombroid syndrome (SS) is a long-standing poisoning illness caused by ingestion of improperly stored fish food (usually tuna fish) contaminated by Gram-negative bacteria. The main pathogenetic feature is toxicity by the high histamine (and/or other toxin) levels within the fish muscle. Scombroid syndrome accounts for approximately 5% of food toxicities at emergency department in the USA. It consists of gastrointestinal symptoms, sickness, at times (head) rash or flushing, peppery taste, hypotension, and other symptoms. Cardiovascular complications are infrequent, but acute coronary syndromes (ACSs) have been described in some patients on admission to hospital. We identified those cases as with ischemic heart scombroid syndrome (IHSS).

Methods
An accurate literature search for IHSS in case series and single reports, published as by the end of July 2022, was performed. Herein main clinical features are summarized.

Results
From 1997 to 2022, 18 studies were found describing 25 patients aged 42±15 years, 14 women (56%), likely to have IHSS. Countries of origin are depicted in the Figure nearby. Apart from typical clinical presentation of SS, chest pain, oppression and hypotension were complained by almost all patents. Symptoms and signs of ACS started 10 to 180 minutes from the meal. Four patients (mostly before 2015) required advanced life support or mechanical ventilation. Widespread ST-depression (first in the inferior leads) was the most frequently reported ECG feature (approximately in 90% of cases). Hospitalization was required for unstable patients or those admitted for coronary angiography. However, this latter was performed only in 10 cases (40%), and only in 3 (12%) a culprit lesion was identified and treated. Therapy consisted with antihistamine drugs, fluids and circulatory support, symptomatic drugs, and steroids in some cases. All patients were discharged from hospital with uneventful follow-up.

Conclusions
To date, 25 published cases of IHSS have been recognized, mostly from Italy, but reports are from all over the world. As in typical SS, myocardial ischemia begins shortly after raw or cocked (tuna) fish ingestion. However, due to unfamiliarity with the syndrome, diagnostic misinterpretation is possible. IHSS can be classified as a transient (usually benign) ACS, caused by coronary vasospasm in response to a nitroxide-mediated histamine-induced tissue hypoperfusion, in a similar way to type-I Kounis syndrome. Based on current knowledge, coronary angiography is mandatory in patients with a history of coronary artery disease and/or allergic diathesis, persistent symptoms or unresponsive to emergency treatment.
110 ANEURYSMECTOMY AND SURGICAL ABLATION: WHEN?
Authors: Rizzi Jacopo Giulio , Savonitto Giulio , Franzese Ilaria , Ruggiero Danilo , Rauber Elisabetta , Zecchin Massimo , De Luca Antonio , Mazzaro Enzo , Sinagra Gianfranco 
Published: December 2022

Abstract
A 60-year-old man with a previous myocardial infarction was admitted to our ICU for acute pulmonary edema in the context of an acute antero-lateral non-ST elevation myocardial infarction. Echocardiography showed severe left ventricular (LV) dilatation with extensive wall motion abnormalities, large apical aneurysm and severe systolic dysfunction. Coronary angiography showed a triple-vessel disease with proximal occlusion of the left anterior descending artery.
During the hospitalization, multiple episodes of drug-resistant monomorphic ventricular tachycardias occurred, requiring repeated DC Shock.
After Heart Team discussion, the patient underwent coronary artery bypass grafting, LV restoration according to the procedure described by Guilmet and surgical cryoablation.
The Guilmet septoexclusion is indicated when the interventricular septum is more involved than the free wall. After aneurysm incision, cryolesions were applied at the septum and at the transitional zone of the scar and viable tissue. Thus, the anterior free wall was sewn obliquely to the septum. Finally, the edges of the incision, anterior and septal, were sewn together to assure a definitive hemostasis (overcoat technique).
After surgery, an implantable cardioverter-defibrillator was implanted in secondary prevention.
The postoperative course and subsequent cardiological follow-up were characterized by a gradual clinical improvement with mild increasing in LV function and reduction in ventricular arrhythmias.
Nowadays, combined aneurysmectomy and endocardial ablation are rarely performed, but should be considered in patients with LV aneurysm who manifest drug-resistant ventricular arrhythmias. Encircling cryoablation in a remodelled ventricle is safe and effective in reducing ventricular arrhythmias which are a negative prognostic factor.
78 FOUR YEARS ECHOCARDIOGRAPHIC FOLLOW-UP OF A LEFT VENTRICULAR PSEUDOANEURYSM
Authors: Passaniti Giulia , Deste Wanda , Cannizzaro Maria Teresa , Tosto Giuseppe Giovanni , Tamburino Corrado 
Published: December 2022

Abstract

Introduction
Left ventricular pseudoaneurysm is a rare and often fatal complication of myocardial infarction. It has an incidence of 0,2-0,4% of all the STEMI and a very high mortality, particularly in the first month. Symptoms can vary from shortness of breath on exertion, orthopnea, chest pain, fatigue. At least 10% of patients do not present any symptoms and the pseudoaneurysm is diagnosed incidentally during a follow-up appointment.
Signs include persistent ST elevation on EKG and its diagnosis can easily be made with a transthoracic echocardiogram and more in depth with a CT scan and a cardiac MRI. Its treatment is surgical, but the choice is up to the anesthesiologist and cardiothoracic surgeon, depending on patient's comorbidity and surgery risk. Surgical treatment has a high rate of death, reaching even the 37%.

Background
We present the case of a 74 years old patient with an history of chronic hypertension and cerebral vasculopathy, who sustained a STEMI in 2017. Urgent coronarography study was performed, but unfortunately the angioplasty treatment was unsuccessful and the left anterior descending artery could not be recanalized. Therefore, the patient was transferred to the cardiothoracic department in order to undergo bypass surgery: surgery was performed five days after, using left internal mammary artery to the left anterior descending artery and great saphenous vein to the first diagonal. Surgery went well with no complications; the post-operative period passed by without any complications and, after 15 days, patient was discharged with no complains.
Two months later, he was admitted to intensive care unit of a hospital of our town, because of dyspnea (NYHA 3), peripheral edema, moderate-severe mitral insufficiency, moderate pleural and pericardial effusion. He underwent a CT-scan that showed “9×6,4 cm cavity with blood that seemed to have a connection with the postero-lateral wall of the left ventricle”. He also underwent a cardiac MRI that displayed a pseudoaneurysm with an endoluminal thrombus. After an accurate evaluation of the case, the Heart Team decided to do not perform surgery because of the high risk of the patient. Thence, we have been followed him with close echocardiographic exams for more than four years.

Methods
From March 2018 to September 2022, we have been followed the patient with complete echocardiographic follow-ups, done every three-six month.

Results and conclusions
Patient with left ventricle pseudoaneurysm due to an extensive myocardial infarction has been followed in our echo lab for more than 4 years. He has been stable during these years, NYHA II, in a good clinical and hemodynamical state.
855 PREDICTORS OF LATE GADOLINIUM ENHANCEMENT DEVELOPMENT AND EXTENSION IN MYOCARDIAL INFARCTION WITH NON-OBSTRUCTIVE CORONARY ARTERIES
Authors: Amicone Sara , Bergamaschi Luca , Armillotta Matteo , Sansonetti Angelo , Stefanizzi Andrea , Impellizzeri Andrea , Suma Nicole , Canton Lisa , Fedele Damiano , Bodega Francesca , Tattilo Francesco Pio , Angeli Francesco , Rinaldi Andrea , Paolisso Pasquale , Foa´ Alberto , Casella Gianni , Galie´ Nazzareno , Pizzi Carmine 
Published: December 2022

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity and in its complex diagnostic approach cardiovascular magnetic resonance (CMR) plays a pivotal role.

Purpose
To characterize the differences of MINOCA patients with and without late gadolinium enhancement (LGE) at CMR and to identify the predictors for ischemic LGE development and extension.

Methods
We assessed 461 MINOCA cases from January 2016 to June 2021. MINOCA were defined according to the current European guidelines criteria. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR imaging findings, our cohort was divided into two CMR phenotypes based on regional myocardial necrosis detected throughout LGE (“LGE-positive MINOCA”) or regional ischemic injury without LGE (“LGE-negative MINOCA”). Extended LGE was considered as the presence of &gt;2 segments with transmural LGE. Multivariate logistic regression analysis was used to determine the predictors of LGE and extended LGE.

Results
The final cohort included 175 MINOCA: 121 (69.1%) constituted the LGE-positive group. The mean time delay between acute clinical presentation and CMR was 6 ± 2.9 days. At admission, MINOCA LGE-patients more frequently presented angina and ST segment elevation (24% vs 7.4%, p = 0.01), compared to the LGE negative ones. Furthermore, the LGE positive group had a significantly greater infarct size, measured by peak hs-Troponin I values and left ventricular function. The only predictor of LGE was the peak troponin value (OR 1.64, 95% CI 1.18–2.28, p = 0.003), while predictors of extended LGE were ST-segment elevation at admission (OR 7.44, 95% CI 1.57–35.22, p = 0.01), peak troponin values (OR 1.07, 95% CI 1.02–1.13, p = 0.01) and the presence of non-obstructive coronary artery disease at coronary angiography (OR 5.49, 95% CI 1.20–25.09, p = 0.028).

Conclusion
The presence and extension of LGE at early CMR evaluation is an important feature in the setting of MINOCA. In addition, simple baseline characteristics (such as ST elevation, peak troponin value and LVEF) may aid the identification of a greater ischemic necrosis burden at CMR and therefore these high-risk MINOCA subjects could be benefit from a stricter management effort.
1025 PROGNOSTIC IMPACT OF STATINS AND DUAL ANTIPLATELET THERAPY ON LONG-TERM PROGNOSIS IN MINOCA PATIENTS
Authors: Armillotta Matteo , Sansonetti Angelo , Bergamaschi Luca , Stefanizzi Andrea , Angeli Francesco , Fabrizio Michele , Amicone Sara , Impellizzeri Andrea , Suma Nicole , Canton Lisa , Bodega Francesca , Fedele Damiano , Tattilo Francesco Pio , Rinaldi Andrea , Paolisso Pasquale , Foà Alberto , Casella Gianni , Galiè Nazzareno , Pizzi Carmine 
Published: December 2022

Abstract

Background
Myocardial Infarction with Non-Obstructive Coronary Artery disease (MINOCA) is a heterogeneous entity with relevant long-term major adverse cardiovascular events (MACE). There is solid evidence that secondary prevention strategies improve prognosis of patients with obstructive myocardial infarction. However, evidence-based treatments for MINOCA are lacking as no published randomized clinical trials have ever exclusively enrolled this population. In fact, treatment recommendations in current guidelines are mainly based on expert opinions and MINOCA patients are frequently discharged with statins and dual antiplatelet therapy (DAPT).

Purpose
To evaluate the effects of statins and DAPT as secondary prevention treatments on long-term outcomes in MINOCA patients.

Methods
We enrolled all consecutive MINOCA patients admitted to our Centre from 2016 to 2021. The diagnosis of MINOCA was made according to the current European Society of Cardiology diagnostic criteria (angiographic conventional cut-off of &lt; 50% coronary stenosis without a clinically apparent alternative diagnosis). Second-level diagnostic work-up including cardiac magnetic resonance was performed to exclude non-ischemic troponin elevation cause.
All-cause mortality and MACE (a composite of all-cause mortality, hospitalization for heart failure, myocardial re-infarction and stroke) were collected during follow-up. The prognostic impact of statins and DAPT at discharge was assessed. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis.

Results
278 MINOCA patients were enrolled, of whom 203 (73%) were discharged on statins and 123 (44.2%) on DAPT. After a median follow-up of 36 ± 14.8 months, the overall all-cause mortality was 11.8% and the composite endpoint (MACE) was achieved in 28.4% of the entire population. Kaplan-Meier curves showed that patients treated with statins had a significantly lower rate of all-cause mortality (9.3% vs 18.2%, p=0.04) and MACE (24.6% vs 39.2%, p=0.02). On the other hand, rates of death (9.8% vs 13.2%, p=0.4) and MACE (23.6% vs 31.6%, p=0.1) were similar in MINOCA patients treated with DAPT or single antiplatelet therapy.

Conclusions
Among MINOCA patients, DAPT at discharge neither reduced long-term all-cause mortality nor MACE. In contrast, statin treatment provided beneficial effects on long-term outcomes. These results should be considered preliminary and require confirmation from randomized clinical trials.