bluuebunny/crossref_metadata_2025 huggingface dataset:
P95 PERI–PROCEDURAL COMPLICATIONS AND LONG–TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTER REGISTRY
Authors: Magnocavallo M , Della Rocca D , Van Niekerk C , Gilhofer T , Ha G , D‘Ambrosio G , Galvin J , Urbanek L , Lavalle C , Schmidt B , Geller C , Lakkireddy D , Di Biase L , Price M , Mansour M , Saw J , Horton R , Gibson D , Natale A
Published: May 2022

Background

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thromboembolic events. CKD concomitantly contributes to several pathophysiological changes predisposing towards a pro–haemorrhagic state.

Objective

To evaluate the impact of kidney function on peri–procedural complications and clinical outcomes in AF patients undergoing left atrial appendage occlusion (LAAO) with a Watchman device.

Methods

2124 consecutive AF patients undergoing Watchman implantation at 8 different centers were categorized into CKD stage 1 + 2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary efficacy endpoint included a composite of cardiovascular (CV) mortality, stroke, transient ischemic attack, peripheral thromboembolism (TE), and major bleeding.

Results

A non–significant higher incidence of major peri–procedural adverse events (1.7% vs. 2.3% vs. 4.1% vs. 4.3%) was observed with worsening baseline kidney function (p = 0.14). The mean follow–up period was 13 ± 7 months [2226 patient–years (PY)]. In comparison to CKD stage 1 + 2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log–rank p–value= 0.04), CKD stage 4 (log–rank p–value= 0.01), and CKD stage 5 (log–rank p–value= 0.001) (Fig. 1A). A non–significant increase in event rates for stroke/TIA and clinically relevant bleeding was observed among the four groups. LAAO led to a TE risk reduction of 72%, 66%, 62%, and 41% in each group (Fig. 1B). The relative risk reduction in the incidence of major bleeding was 58%, 44%, 51%, and 52%, respectively (Fig. 1C).

Conclusion

Patients with moderate–to–severe CKD had a higher incidence of the primary composite endpoint. The relative risk reduction in the incidence of TE and major bleeding was consistent across CKD groups, irrespective of the very different risk profiles at baseline.
P151 RIGHT VENTRICULAR MECHANICS IN PATIENTS AFFECTED BY PULMONARY VALVE STENOSIS, BEFORE AND AFTER PERCUTANEOUS PULMONARY VALVULOPLASTY
Authors: Sirico D , Spigariol G , Mahmoud H. T , Basso A , Reffo E , Biffanti R , Sabatino J , Di Candia A , Castaldi B , Di Salvo G
Published: May 2022

Aim of the Study

To evaluate the mechanical changes of the right ventricle in patients undergoing balloon pulmonary valvuloplasty using transthstandard transthoracic echocardiography (TTE) and speckle–tracking echocardiography (STE) and to investigate the correlation between haemodynamic and echocardiographic parameters before and after treatment.

Materials and Methods

43 pediatric patients (19 males), mean age 3,2±4,9 years with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent TTE and STE with analysis of right ventricle global longitudinal strain (RVGLS) one day before and after the procedure. For each patient were collected invasive parameters during balloon valvulopasty.

Results

After the procedure, there was an immediate reduction of both peak–to–peak transpulmonary gradient (Dp post) and ratio between the systolic pressure of right and left ventricle (RV/LV ratio) with a drop of 29,3±14,67mmHg and 0,43±0,03, respectively. Post–procedural echocardiography showed peak and mean transvalvar pressure gradient drop (50±32,23 and 31±17,97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, following the intervention it reached 29% with a statistically significant increase (p = 0,007). However, moderate and severe regurgitation remained stable after the procedure. There was a significant improvement of Fractional Area Change (FAC) after the procedure (40,11% vs 44,42%, p = 0,01). TAPSE (p = 0,60) and longitudinal strain (p = 0,31), did not improve significantly after intervention. Finally, pre–procedural invasive RV/LV ratio showed good correlation to echocardiographic transvalvular peak and mean pressure gradient (R = 0,375, p = 0,019 and R = 0,40, p = 0,012, respectively), as well as with FAC (R = 0,31 p = 0,05), TAPSE (R = 0,62 p < 0,001)and RVGLS (R = 0,46 p = 0,01)

Conclusions

Percutaneous balloon pulmonary valvuloplasty represents an efficient and safe procedure. Right ventricular global systolic function improved following afterload reduction, while longitudinal systolic function did not show improvement immediately after intervention. Finally, invasive preprocedural RV/LV ratio demonstrated better correlation with echocardiographic evaluation of stenosis degree and right ventricular function compared to invasive peak–to–peak pressure gradient. Therefore, RV/LV ratio should be preferred for the assessment of pulmonary valve stenosis.
P154 EVOLUTION OF ECHOCARDIOGRAPHIC AND CARDIAC MRI ABNORMALITIES DURING FOLLOW–UP IN PATIENTS WITH PREVIOUS MIS–C DIAGNOSIS
Authors: Sirico D , Basso A , Sabatino J , Reffo E , Cavaliere A , Biffanti R , Cerutti A , Castaldi B , Zulian F , Da Dalt L , Di Salvo G
Published: May 2022

Background

Cardiovascular manifestations in the acute phase of MIS–C are frequent. However, there is lacking evidence regarding late cardiological follow–up of this cohort of patients. The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS–C, assessed by standard echocardiography (TTE), speckle tracking echocardiography (STE), and cardiac MRI (CMR).

Materials and Methods

32 consecutive patients with confirmed MIS–C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected for all patients. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis.

Results

Mean age was 8.25±4years (range 1.3–17.7). Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease–like symptoms, and 5 (15.6%) needed ICU admission. All patients showed an hyperinflammatory state. Tn–I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Median time to STE evaluation was 7 days and to CMR 18 days since fever onset. Mean LVEF at baseline was 58.8±10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (–17.4±4%). Coronary dilation was observed in 9 (28,1%) patients. On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Median time to T1 and T2 evaluation was respectively 48.5 and 207 days. Follow–up data showed statistically significant improvement in left ventricular systolic function compared to acute phase. LVEF improved rapidly at T1 (62.5 ± 7.5 vs. 58.8±10.6%, p value 0.044) with only three patients (10%) below ≤ 55% at T1 and one patient (4%) at T2. LV GLS remained impaired at T1 (–17.2 ± 2.7 vs.–17.4 ± 4, p value 0.71), and significantly improved at T2 (–19±2.6% vs. –17.4±4%, p value 0.009). LV GLS was impaired (>–18%) in 53% of patients at baseline and T1, while only 13% showed LV GLS reduction at T2. CMR, performed 6 months after diagnosis, showed LGE persistence in 33.4% of cases.

Conclusions

Even though, early cardiac involvement significantly improves during follow–up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS–C patients.
P187 DRUCEBO EFFECT IN STATIN THERAPY: MORE ATTRIBUTABLE TO THE PATIENT, THE DOCTOR, OR THE MASS MEDIA?
Authors: Cosmi D , D‘Orazio S , Mariottoni B , Tarquini B , Cosmi F
Published: May 2022

In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient‘s expectations, the doctor‘s preferences and the interference of the mass media rather than the actual pharmacological effect . We evaluated this effect in 9,605 patients treated with statins, in primary (27%) and secondary (73%) prevention. Presumed statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. Table 1 shows the causes of the presumed intolerance and the related SMIS (Statin Myalgia Index Score). Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the dose, with reassessment after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms were also present with the second statin, the patient was advised to take the drug every other day. In patients with unlikely SMIS, the decision to resume therapy was shared with the patient, informing him of the benefits of statins on mortality and morbidity. Probable true intolerance was found in 576 patients (6% of the overall population on statin therapy: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic CPK elevation, 15 transaminase increased, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due to both the patient and the treating physician or other specialist, who are inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non–modifiable by modifying the drug or the doses. Interference from the mass media is common, and it is difficult to distinguish a greater responsibility of one or the other.In patients treated with statins, a drucebo effect is frequently found, which is partly attributable to the patient, partly to the doctor and the mass media, who tend to attribute muscle symptoms to the treatment with statins and to interrupt therapy without taking into account the benefits regarding the reduction of mortality and morbidity found in numerous studies with indisputable evidence of efficacy and safety. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms.
P260 PRELIMINARY EXPERIENCE OF REPEATED LEVOSIMENDAN INFUSIONS IN ELDERLY OUTPATIENTS WITH ADVANCED HEART FAILURE
Authors: Camartini V , Orso F , Herbst A , Virciglio S , Salucci C , Verga F , D‘Errico G , Di Bari M , Ungar A , Fattirolli F , Marchionni N , Baldasseroni S
Published: May 2022

Background

The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF).

Purpose

To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients.

Methods

A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60‘ up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment.

Results

Since November 2020 we enrolled 17 patients with a mean age of 77 years; 12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID–19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate; in one case drug infusion was suspended (Figure 1). The main complication observed was marked non–symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease–modify treatment, according to HF guidelines (Figure 3).

Conclusions

In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines–directed medical therapy.
P296 HIDDEN PERICARDIAL CONSTRICTION IN A PATIENT WITH CHRONIC PERICARDIAL EFFUSION AND “UNEXPLAINED” DYSPNEA
Authors: Caravita S , Baratto C , Ghiso P , Torlasco C , Senni M , Sganzerla P , Perego G , Badano L , Parati G
Published: May 2022

Constrictive physiology leads to exertional symptoms related to restrained diastolic filling and intracardiac/intrathoracic dissociation. However, these hemodynamic abnormalities might not be evident in some patients. A 55–year–old woman was referred to our center to perform a right and left cardiac catheterization because of “unexplained” dyspnea. Three years before she was found to have a large idiopathic pericardial effusion. Anti–inflammatory therapy did not result in any improvement. Since then, the patient complained dyspnea NYHA II–III, in the absence of any clinical and imaging sign of tamponade/pericardial constriction. At rest, there was no sign of constriction, but a relative hypovolemic status characterized by low pulmonary and filling pressures and cardiac output (CO) at the lower limits of normal. After a 500 mL saline load and passive legs raising, Kussmaul’s and “M” signs appeared on the right atrial pressure curve (Figure 1), the pulmonary artery wedge pressure (PAWP) – left ventricular end–diastolic pressure (LVEDP) gradient difference between expiration and inspiration was >5 mmHg (Figure 2), and ventricular systolic pressures went out of phase by 180°. Both right and left filling pressures as well as pulmonary pressures steeply increased in a concordant manner by about 10 mmHg after fluid load, in absence of a relevant increase in CO (Figure 3). Physical exercise performed thereafter showed an additional mild increase with a plateau pattern of all pressures, suggesting an upward–shift of the pressure/flow relationship (Figure 3). All these signs suggested a latent constrictive physiology. Despite this, the patient showed an optimal CO reserve coupled with a normal exercise capacity (peak oxygen consumption, VO2, 127% of predicted) that would have argued against our hypothesis. We then performed a diagnostic and evacuative pericardiocentesis. After the drainage of 130 ml of pericardial fluid, LV transmural pressure increased and CO at rest was fully normalized. Moreover, no hemodynamic sign of constriction could be observed even after a 1000 ml saline load. The patient reported disappearance of exertional breathlessness, objectivated by an increase in peakVO2 by 20% as compared with the previous test. Thus, our case underscores how subtle the hemodynamic impact of pericardial effusion can be, with the need of well–tailored diagnostic exams to explain otherwise “unexplained” patients’ symptoms, with potential therapeutic implications.
P300 ACUTE MYOCARDITIS COMPLICATED BY VENTRICULAR ARRHYTHMIAS
Authors: Utzeri E , Santus S , Licciardi M , Mandas M , Campana N , Angius S , Gioi A , Maiani S , Perra F , Marchetti M , Montisci R
Published: May 2022

Background

Many kinds of arrhythmias may occur in patients with myocarditis at any stage of the disease. However, as compared to the other clinical presentations, arrhythmic myocarditis has been poorly described in literature.

Case Report

A 20–year–old girl, without CVRF or comorbidities, presented at the ED because of palpitations and epigastric pain irradiated to left arm. 12–lead ECG evinced elevated HR and aspecific repolarization abnormalities. Blood samples showed high cTn value and normal PCR value. Echocardiography showed a preserved LVEF, without abnormalities. Patient was hospitalized with a diagnosis of suspect acute myocarditis. Following hospital stay has been complicated by recurrent episodes of chest pain with concomitant increase of cTn that finally had presented a sinusoidal trend (peak 12830ng/L). At the same time, continuous ECG monitoring has been showing frequent but short term ventricular extrasystole activity, so B–blocker therapy was optimized. On ECG monitoring, appearance of short runs of asymptomatic mono– and polymorphic NSVT and after a few days appearance of polymorphic NSVT “torsade de pointes” like, symptomatic for presyncope. New changes in kinetics appear on the echocardiogram: hypokinesia of medio–apical segments of lateral, anterior wall septum. Therapy with metoprolol and lidocaine iv was started with subsequent stabilization of the rhythm. CMR presented data suggestive of myocarditis. Patient performed several BEM at different time and centers: diagnostic signs of myocarditis were not be found. Autoimmune and infectious disease screening, abdominal echography and a PET TC total body were been performed to research a potential etiology, without positive result. Patient has been discharged with wearable defibrillator and we waited for the ICD implantation in secondary prevention. Follow–up CMR showed a resolution of inflammation and no signs of fibrosis. Blood samples did not demonstrate a rise of cTn. After discharged, she has not had news onset of ventricular arrhythmias.

Conclusion

The mechanisms underlying the occurrence of ventricular arrhythmias during myocardial inflammation are less clear. Arrhythmias usually being self–limited with no recurrences that follow the acute phase. Management of acute life–threatening arrhythmias is generally supportive and there is a lack of evidence to support the use of specific antiarrhythmic agents. Wearable life vest has been presented as a possible therapeutic option.
P312 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN SARS–COV–2 INFECTION
Authors: Bava A , Daffinà M , Cama G , Dieni D , Barreca F , Calipari N , Sculli M , Dattola V , Luppino A , Battaglia C
Published: May 2022

Cardiovascular complications are a frequent occurrence in Sars–CoV–2 infection. Takotsubo cardiomyopathy is a possible cause of transient ST segment elevation (1–3% of total cases) and is characterized by a reversible left ventricular dysfunction with coronary arteries free from critical stenosis. The predominant echocardiographic pattern is an akinesia of the mid–apical myocardial segments with preserved kinetics of the basal segments. The incidence of Takotsubo cardiomyopathy showed a marked increase during the COVID–19 pandemic. Three factors mainly contribute to the onset of cardiomyopathy in patients with COVID–19: cytokine storm, adrenergic hyperactivation and microvascular dysfunction. A 79–year–old woman was hospitalized in the Pneumology department of our hospital for bilateral interstitial pneumonia Sars–CoV–2 related. In remote medical history: in 2010 diagnosis of breast cancer with negative follow–up for disease recovery, arterial hypertension, hypercholesterolemia and syndrome of reduced mobility as a result of a previous ischemic stroke. Non–invasive mechanical ventilation with c–PAP was started and, for the detection of anterolateral electrocardiographic anomalies (diffuse symmetrical negative T waves) and an increase in myocardionecrosis markers, echocardiographic evaluation was performed, which revealed an akinesia of the mid–apical segments of the left ventricle with preserved kinetics of the basal segments and severely depressed global systolic function (ejection fraction: 30%). BNP (18.100 pg /mL), interleukin–6 (339 pg /mL) and CRP (136 mg /L) were elevated on blood chemistry tests. In the suspicion of Takotsubo cardiomyopathy (InterTAK Score: 67, probability: 79.8%), cardioprotective therapy with ACE inhibitor, beta–blocker, diuretics, low molecular weight heparin, double antiaggregation and statin was started, deferring coronary angiography to improved clinical conditions. In the following days, due to the respiratory and haemodynamic worsening, the patient was transferred to an intensive setting, where she was intubated and treated with levosimendan and noradrenaline. Serial echocardiograms showed a progressive improvement of the global systolic function (ejection fraction at the last checkup: 55%), with complete regression of the kinetic anomalies, confirming of the diagnostic hypothesis of stress cardiomyopathy. For a pulmonary mycotic superinfection, complicated by iatrogenic pneumothorax, in the following days the patient died.
P314 WHEN TAKO–TSUBO TRAPS… NOT ONLY OCTOPUSES
Authors: Spissu P , Contini F , Licciardi M , Leoni L , Fazzini L , Angius S , Perra F , Secchi S , Marchetti M , Montisci R
Published: May 2022

The case we present involves a 75 years–old woman with no cardiological past medical history, who presented to our attention complaining of sudden onset thoracic pain associated with dyspnea, dry cough, nausea and an episode of vomit. She called 911 rapidly coming to our Hospital. In the Emergency room an EKG showed ST segment depression in the inferior leads and in the blood test a remarkable increase in HS–Troponin level was evident. An echocardiogram showed mid and apical left ventricle segments hypokinesia with moderately reduced Ejection Fraction (45%); notably, right ventricle was increased in dimension with moderate tricuspid regurgitation and mild pulmonary hypertension. Because of this last find, D–dimer was checked and a pulmonary angio– CT was performed which excluded active pulmonary embolism. Next day she underwent coronary angiography which showed no coronary lesion able to explain the clinical and echocardiographic presentation; left ventriculography was also performed showing an increase in end–systolic volume with hypokinesia of the anterolateral, apical and diaphragmatic walls and an Ejection Fraction (EF) of 30%. These findings allowed us to make the diagnosis of Tako–Tsubo syndrome, also known as stress–induced cardiomyopathy. Few days later, a cardiac magnetic resonance (CMR) was performed showing whole apical and antero–lateral mid ventricular hypokinesia with compensatory hyperkinesia of basal segments; T2–weighted sequences were positive at the hypokinetic segments with no specific Late Gadolinium Enhanced (LGE) images. What’s more, an atrial septal defect type “ostium secundum” was clearly evident, causing a left–to–right shunt hemodynamically significant (Qp/Qs of about 2,8) with right atrial and right ventricle dilatation. Pulmonary artery and its main branches were dilated too. After these findings, lady underwent right heart cardiac catheterization that reported a Qp/Qs of 3,24 and a shunt flow of 8,78 L/min, with a cardiac index of 2,5 L/min/m2 and normal pulmonary vascular resistance (0,7 Wood Units). Because of these measures the patient was discharged from our Cardiology Unit and referred to the Interventional Cardiology centre of our city for the percutaneous closure of the hemodynamically significant atrial septal defect.

This case is curious because it shows how things in Cardiology can be deeply and unpredictably connected.
P395 INFECTIVE ENDOCARDITIS: A SUBTLE PRESENTATION
Authors: Corsi E , Bosso A , Venturini E
Published: May 2022

Background

Infective endocarditis is still a serious and deadly disease. Despite improvements in its management, the diagnosis it is not always easy and thus it is still associated with high mortality and severe complications. This is especially true for patients with prosthetic valves, that have higher risk of developing infective endocarditis and more often associated with severe complications and a higher rate of mortality.

Case Description

A 75–years–old woman presented to the ED for persistent low–grade fever and mild dyspnoea. She had an aortic biologic prosthetic valve implanted the year before for severe aortic stenosis. She also complained a persistent back pain, present for about three months and irresponsive to pharmacological therapy and also physiotherapy. Getting back in time, she had been hospitalized few months before for genitourinary tract infection from multi–resistant E. faecalis, treated with antibiotic therapy and then discharged after few days. She underwent a transthoracic echocardiogram in ED that showed an apparently intraprosthetic moderate aortic regurgitation, never described in the previous cardiologic controls. In the strong suspect of endocarditis complicated by systemic embolization, she also underwent transoesophageal echocardiography, that showed dehiscence of the prosthetic valve with severe paravalvular abscess and regurgitation, without rocking motion of the prosthesis. A TC scan and then a spine MRI confirmed the presence of infectious spondylodiscitis, responsible for that persistent back pain. The patient was therefore urgently sent to cardiac surgery: a Bentall procedure (aortic valve and aortic root replacement) was performed. The patient, despite the severity of the sepsis and the cardiac endocarditis, survived the surgery and after 3 weeks of intensive care hospitalization was discharged and sent back to our Department for Cardiac Rehabilitation. Entering the ward, the patient was severely deconditioned, but after about 45 days of hospitalization she was discharged fit, with good functional capacity.

Conclusion

This case shows the subtle but serious evolution that usually controlled infections can have in patients with high risk of endocarditis, as patients with prosthetic valves. This underlines on one hand the importance of antibiotic prophylaxis in this subset of patients, on the other hand the role of multimodality imaging for diagnosis and management of infective endocarditis and its complications.
P402 COVID–19 VACCINATION IN CHILDREN AGED 6–17 YEARS CARRIES A SIMILAR RISK OF FATAL OR LIFE–THREATENING MYOCARDITIS THAN BEING STRUCK BY LIGHTNING
Authors: Aimo A , Cantinotti M , Emdin M , Clerico A
Published: May 2022

Background

To better contrast the Covid–19 pandemics, national authorities worldwide are authorizing vaccination of children and adolescents, despite some concerns of adverse reactions due to their greater response to immune stimulation. Myocarditis is a particularly feared adverse reaction.

Methods

On December 30, 2021 we searched the CDC dataset of all Covid–19 vaccinations in the United States (US), and the VAERS dataset, which reports adverse reactions to vaccines after any Covid–19 vaccine in the US.

Results

Individuals receiving at least one dose were 243,182,423 (0.017% <5 years, 2.745% 5–11 years, 6.571 12–17 years, 67.710% 18–64 years, and 22.958% ≥65 years). The number of fully vaccinated individuals was 205,638,307 (0.005% <5 years, 2.016% 5–11 years, 6.559 12–17 years, 68.085% 18–64 years, and 23.335% ≥65 years). The cases of myocarditis reported in the VAERS dataset were 2,207 (22.247% 6–17 years, 64.522% 18–64 years, 5.754% ≥65 years, 7.476% unknown age); no cases <5 years were reported. Cases of myocarditis classified as “serious events” were 1,590 (26.478% 6–17 years, 63.711% 18–64 years, 5.220% ≥65 years, 4.591% unknown age). The fatal or life–threatening events were 367 (17.711% 6–17 years, 66.757% 18–64 years, 10.899% ≥65 years, 4.632% unknown age). Based on these data, the estimated prevalence of myocarditis among individuals receiving ≥1 dose was 2.17*10–5 in individuals aged 6–17 years, 8.65*10–6 in those aged 18–64 years, and 2.27*10–6 ≥65 years; the prevalence of myocarditis as a serious event was 1.86*10–5 in individuals aged 6–17 years, 6.15*10–6 between 18 and 64 years, and 1.49*10–6 ≥65 years; myocarditis as a fatal or life–threatening event occurred in 2.87*10–6 between 6 and 17 years, 1.49*10–6 in the age range 18–64 years, and 7.16*10–7 ≥65 years. The prevalence data were similar among individuals receiving at least one vaccine dose (data not shown). By comparison, according to CDC data, the odds of being struck by lightning in a given year are around 1 in 500,000 (2*10–6).

Conclusions

While the incidence is slightly higher in the pediatric age than in adult or elderly individuals, it is still equal to 24 cases of “serious” myocarditis per million people aged 6–17 years, and less than 4 cases of fatal or life–threatening myocarditis were reported. The risk of fatal or life–threatening myocarditis is about the same than being struck by lightning.
P406 UNMASKING A PATTERN OF BRUGADA: FLECAINIDE VS AJMALINA
Authors: Gioia M , Caroli G , Milo M , Medico A , Ignone G
Published: May 2022

Brugada syndrome mainly affects men in the third and fourth decade of life. It presents with a typical electrocardiographic pattern, unmasked by sodium channel blocking drugs or hyperpyrexia. A 36–year–old young man, with no reported cardiovascular risk factors or family history of sudden death, had convulsions and loss of consciousness during hyperpyrexia, for which family members alerted the local emergency service. During transport to the hospital, the vital parameters and heart rhythm were normal, but, due to the onset of seizures, the patient was sedated, intubated and hospitalized in intensive care unit (ICU). The ECG performed at the entrance (in the course of hyperpyrexia) showed a dubious type 1 Brugada pattern (Figure 1). The echocardiogram (as well as the subsequent cardiac resonance) showed the absence of cardiac structural alterations. Prompt treatment of hyperpyrexia was recommended, the use of drugs listed on brugadadrugs.org was contraindicated and careful ECG monitoring was recommended. Non–sustained ventricular tachycardia was documented during the hospitalization in ICU. When the clinical picture stabilized with resumption of spontaneous breathing, the patient was transferred to our ICU for continuation of the diagnostic and therapeutic process (Figure 2). From the interview with the patient, a previous paroxysmal tachycardia from atrio–ventricular reentry emerged in antiarrhythmic prophylaxis for several years with Propafenone and subsequently treated with catheter ablation of the right lateral accessory path. Considering the lack of documentation of complex ventricular arrhythmias by the 118 during transport to the hospital and during the stay in the UTIC, the long antiarrhythmic therapy with sodium channel inhibitors, as well as the absence of a typical Brugada pattern during fever, we decide to perform a Flecainide test (2 mg / Kg in 10 ‘), negative result for Brugada type 1 pattern (Figure 2) In the following days, considering the absolute negativity of all the neuroradiological and EEG investigations, not having found the cause of the loss of consciousness during hyperpyrexia, we performed ajmaline test (1 mg / kg in 100 cc of SG5% in 10 ‘) with the identification of the diagnostic pattern type 1 (Figure 3). Finally, the implantation of a subcutaneous cardioverting defibrillator (S–ICD) was performed.
P409 CARDIAC SYMPATHOMIMETIC RESPONSE IN PARKINSON‘S PATIENTS VS HEALTHY ADULTS
Authors: Regolanti R , Bagni O , Cannas P , Raponi M , Denaro A , Alessandri N
Published: May 2022

In recent works, it has been observed that cardiac sympathetic innervation contributes to the hemodynamic adaptations of the cardiovascular system, in relation to numerous needs. Orimo et al, through the use of scintigraphy with MIBG, showed in Parkinson‘s patients a marked reduction in myocardial uptake of MIBG corresponding to cardiac sympathomimetic denervation, in relation to the severity of the disease.

The aim of this work was to evaluate the morpho–functional variations of the heart at a programmed sympathomimetic stimulus (dopamine test), both in healthy patients and in those suffering from Parkinson‘s disease.

Materials and Methods

At the University Cardiology “La Sapienza” of Rome, Pontine Polo, 10 patients affected by PD (age 56±5,5, of which 6 M and 4 W) and 10 healthy (54±6,4, of which 6M,4W)were tested in the absence of cardiovascular FR; all patients performed: blood chemistry, ECG, chest x–ray, Eco–TSA, tilt test, echocardio– Dopamine (2D–stress) and MIBG Scintigraphy. 2D–stress echocardiogradia was assessed by t–student of F.acc + EF + left and right diastolic times + GLS + Tapse + PAPS at 10, 20.30.40 µ dopa and their correlation (r–pearson) in the two groups.

Discussion

The observation of the data in the two groups of patients, in the absence of ongoing and remote cardiological pathology, showed a behavior of the values in the range both in basal conditions and during dopa stimulation. The comparison of the two groups both basal and during progressive dose stimulation that a statistical difference (P < 0.05) is observed on both systolic and diastolic function. The comparison in the two groups in the different stimulus phases showed a parallel growth behavior but with a different speed (Dp / Dv). There is no single explanation for these results: certainly the central role is played by the poor representation of post–ganglionic nerve endings as well as by the significant reduction of cardiac adrenergic receptors in Parkison.

Conclusion

The small number of patients and the data observed, stimulates researchers to continue the study, to better understand which pathophysiological mechanisms underlie these observations and verify the presence of an inverse relationship between PD and all those cardiological pathologies caused by catecholaminergic hyperstimulus.
P412 SCAD: A PLANET TO DISCOVER IN THE UNIVERSE OF ACS
Authors: Bertolini D , Armillotta M , Bergamaschi L , Bertelli M , Di Nicola F , Sansonetti A , Donati F , Pizzi C , Galiè N
Published: May 2022

We hereby present the case of a 36–year–old woman with neither a history of cardiovascular disease nor any cardiovascular risk factors. Her only past medical history included a pregnancy from in vitro fertilization and endometriosis treated with progestin. She was admitted to A&E for sudden onset severe stabbing thoracic pain, which occurred at rest and was exacerbated by respiratory efforts, and with spontaneous resolution shortly after admission. While the ECG did not show any signs of ischemic, blood tests revealed a minor rise in inflammatory markers and a significant rise in troponin values, the latter consistent with acute myocardial injury.

Given the clinical suspicion of myopericarditis vs acute coronary syndrome, the patient was admitted to cardiac intensive care unit. Bedside echocardiogram performed shortly after admission demonstrated minor pericardial effusion and regional wall motion abnormalities. Thus, the patient underwent urgent coronary angiography, which revealed pronounced vasospasm at the proximal segment of the circumflex artery, which subsided after administration of nitrate, as well as spontaneous dissection of the mid left anterior descending artery extending to its apical branch. Since no high–risk features were identified (single vessel, mid–distal coronary lesion, no symptoms of persistent ischemia), revascularisation was not attempted and conservative therapy was undertaken. During the following days, genetic evaluation and further diagnostic tests were performed to exclude vascular abnormalities in other anatomical sites, which all resulted negative. Outpatient follow–up with CT coronary angiogram demonstrated full patency of left anterior descending artery with spontaneous resolution of the former dissection.

This clinical scenario represents an example of an uncommon and thus often overlooked cause of acute coronary syndrome with yet limited evidence on optimal therapeutic and follow–up strategies.
Investing in Late-Life Brain Capital
Authors: Dawson Walter D , Smith Erin , Booi Laura , Mosse Maia , Lavretsky Helen , Reynolds Charles F , Cummings Jeffrey , Brannelly Patrick , Hynes William , Lenze Eric J , Manes Facundo , Ayadi Rym , Frank Lori , Chapman Sandra Bond , Robertson Ian H , Rubenstein Lori , Jraissati Jorge , Ibáñez Agustin , Fillit Howard , Jeste Dilip V , Rao Anitha , Berk Michael , Storch Eric A , Santuccione Chadha Antonella , Eyre Harris A
Published: May 2022

Within many societies and cultures around the world, older adults are too often undervalued and underappreciated. This exacerbates many key challenges that older adults may face. It also undermines the many positive aspects of late life that are of tremendous value at both an individual and societal level. We propose a new approach to elevate health and well-being in late life by optimizing late-life Brain Capital. This form of capital prioritizes brain skills and brain health in a brain economy, which the challenges and opportunities of the 21st-century demands. This approach incorporates investing in late-life Brain Capital, developing initiatives focused on building late-life Brain Capital.
Selecting and modelling remnant AGNs with limited spectral coverage
Authors: Quici Benjamin , Turner Ross J , Seymour Nicholas , Hurley-Walker Natasha , Shabala Stanislav S , Ishwara-Chandra C H
Published: May 2022

Quantifying the energetics and lifetimes of remnant radio-loud active galactic nuclei (AGNs) is much more challenging than for active sources due to the added complexity of accurately determining the time since the central black hole switched off. Independent spectral modelling of remnant lobes enables the derivation of the remnant ratio, Rrem (i.e. ‘off-time/source age’); however, the requirement of high-frequency (≳5 GHz) coverage makes the application of this technique over large-area radio surveys difficult. In this work, we propose a new method, which relies on the observed brightness of backflow of Fanaroff–Riley type II lobes, combined with the Radio AGN in Semi-Analytic Environments (RAiSE) code, to measure the duration of the remnant phase. Sensitive radio observations of the remnant radio galaxy J2253-34 are obtained to provide a robust comparison of this technique with the canonical spectral analysis and modelling methods. We find that the remnant lifetimes modelled by each method are consistent; spectral modelling yields Rrem = 0.23 ± 0.02, compared to Rrem = 0.26 ± 0.02 from our new method. We examine the viability of applying our proposed technique to low-frequency radio surveys using mock radio source populations, and examine whether the technique is sensitive to any intrinsic properties of radio AGNs. Our results show that the technique can be used to robustly classify active and remnant populations, with the most confident predictions for the remnant ratio, and thus off-time, in the longest lived radio sources (>50 Myr) and those at higher redshifts (z > 0.1).
The initial conditions for young massive cluster formation in the Galactic Centre: convergence of large-scale gas flows
Authors: Williams Bethan A , Walker Daniel L , Longmore Steven N , Barnes A T , Battersby Cara , Garay Guido , Ginsburg Adam , Gomez Laura , Henshaw Jonathan D , Ho Luis C , Kruijssen J M Diederik , Lu Xing , Mills Elisabeth A C , Petkova Maya A , Zhang Qizhou
Published: May 2022

Young massive clusters (YMCs) are compact (≲1 pc), high-mass (>104 M⊙) stellar systems of significant scientific interest. Due to their rarity and rapid formation, we have very few examples of YMC progenitor gas clouds before star formation has begun. As a result, the initial conditions required for YMC formation are uncertain. We present high resolution (0.13 arcsec, ∼1000 au) ALMA observations and Mopra single-dish data, showing that Galactic Centre dust ridge ‘Cloud d’ (G0.412 + 0.052, mass = 7.6 × 104 M⊙, radius = 3.2 pc) has the potential to become an Arches-like YMC (104 M⊙, r ∼ 1 pc), but is not yet forming stars. This would mean it is the youngest known pre-star-forming massive cluster and therefore could be an ideal laboratory for studying the initial conditions of YMC formation. We find 96 sources in the dust continuum, with masses ≲3 M⊙ and radii of ∼103 au. The source masses and separations are more consistent with thermal rather than turbulent fragmentation. It is not possible to unambiguously determine the dynamical state of most of the sources, as the uncertainty on virial parameter estimates is large. We find evidence for large-scale (∼1 pc) converging gas flows, which could cause the cloud to grow rapidly, gaining 104 M⊙ within 105 yr. The highest density gas is found at the convergent point of the large-scale flows. We expect this cloud to form many high-mass stars, but find no high-mass starless cores. If the sources represent the initial conditions for star formation, the resulting initial mass function will be bottom heavy.
European Physico-theology (1650-c.1760) in Context
Authors: von Greyerz Kaspar
Published: May 2022

Physico-theology harnessed the observation of nature to the recognition of God as Creator and to a demonstration of the compatibility of the biblical record with the new science. The new science emerged from the mid-seventeenth century. The present book offers the first study in English of physico-theology on a European scale. Its main argument is that physico-theology not only grew into an intellectual movement across Protestant Europe from the late seventeenth century onward, but that it was substantially different from the mainstream of traditional natural theology. The most prominent protagonists of the movement were virtuosi, especially clergy and physicians. European Physico-theology … in Context investigates in particular two physico-theological genres: the argument from design and diluvialism (i.e. the connection established between the biblical Flood and the existence of fossils). It also looks at practice in the exchange of natural objects, the establishment of collections, and the scientific efforts in taxonomy which they called for. Religion is not seen as an obstacle to the spread of science but as a factor in enhancing the interest of literate and educated people in acquiring natural knowledge. This can be maintained even though physico-theology was above all a Protestant concern owing to the kind of biblicism that the Protestant scientists and virtuosi brought to bear on their study of nature. After the mid-eighteenth century the movement split up into different currents, but in the Netherlands and Britain its mainstream continued to demonstrate a remarkable vitality, surviving well into the nineteenth century.
Conclusion
Authors: von Greyerz Kaspar
Published: May 2022

The conclusion draws attention to the following themes. First, the discussion of the critique of the argument from design by David Hume and Immanuel Kant drawing a clear line between metaphysics and natural philosophy, a division that physico-theology implicitly rejected. Second, the conclusion recalls the long lease of life which physico-theology enjoyed in Britain, as well as in the Netherlands, in spite of Hume’s and Kant’s interventions. Elsewhere on the continent we can distinguish a diversification of physico-theology in the second half of the eighteenth century into three currents: the continuation of mainstream physico-theology; a tendency to increase Christian apology; and, thirdly, the utilitarian resetting of physico-theology which ultimately resulted in an entirely secularized form of reasoning. However, the course taken by physico-theology after the mid-century should not obscure the fact that the role of European physico-theology in preparing the ground for a positive reception of new scientific knowledge among the educated classes and beyond should by no means be underestimated.
‘To commemorate the English character’
Authors: Reynolds Luke
Published: May 2022

This chapter completes the shift towards materiality, discussing a variety of physical commemorations including Waterloo Bridge, various forms of commemorative naming, official and unofficial medals, household items, clothing, vegetables, and even snuff. By casting a wider net than surveys of military monuments traditionally engage with, this chapter demonstrates that permanent and semi-permanent commemoration in the form of namings and material culture was not only one of the most widespread forms of commemoration but also a virtually uncontested form of nationalization, as Waterloo went from a battle to a bridge, multiple streets, hotels, and businesses. Finally, to demonstrate the ubiquity of Waterloo commemoration in the national conversation, it briefly explores the efforts by satirists to ‘commemorate’ Peterloo using identical methods, thus further enforcing the link between Waterloo and the St Peter’s Field Massacre.
Epilogue
Authors: Reynolds Luke
Published: May 2022

This epilogue is centred around the funeral of the Duke of Wellington in 1852. In the national outpouring of grief that marked Wellington’s death, his funeral, and the two months in between, we see a public demonstration of the shared ownership and nationalization of Waterloo and the culmination of the themes examined in this book. Wellington’s funeral was a national spectacle in every sense, and it highlights just how firmly entrenched Waterloo was in Britain’s national—and civic—identity. The epilogue concludes with a coda discussing the bicentennial in 2015. Between the funeral and the bicentennial, it becomes clear how complicated cultural ownership of Waterloo became and how that cultural legacy is just as significant as its military or political legacy.
LGBTQ Rights Mobilization and Authoritarianism
Authors: Chua Lynette J.
Published: May 2022

LGBTQ (lesbian, gay, bisexual, transgender, and queer) rights and authoritarianism are social phenomena whose features vary across political, social, and legal contexts. Layers of authoritarianism coexist, taking the shape of authoritarian states and enclaves within both authoritarian and liberal states. All these different forms of authoritarianism can affect the living conditions of sexual and gender minorities or their ability and willingness to claim for what is now widely known as LGBTQ rights. However, authoritarian conditions do not solely determine the development of LGBTQ rights. Advocates of LGBTQ rights can sometimes overcome the conditions that constrain rights mobilization and sometimes successfully challenge those that oppress sexual and gender minorities. LGBTQ rights emerge from such acts of mobilization, which are political processes through which actors interpret their encounters with authoritarian conditions and tailor their responses according to who and where they are, including whether or not to use rights.
Women, Peace, and Security
Authors: Chinkin Christine
Published: May 2022

The Women, Peace and Security (WPS) agenda emanates from the ground-breaking Security Council Resolution 1325 (2000) which centres upon bringing women’s experiences of armed conflict into decision and policymaking in the exercise of the Council’s primary responsibility for the maintenance of international peace and security. The chapter asks whether, despite its location within the Security Council, WPS can be understood as an international human rights agenda as envisaged by women activists who lobbied for the adoption of Resolution 1325. It traces the antecedents of WPS through women’s peace and human rights activism throughout the twentieth century. It examines the texts of the first two WPS resolutions, 1325 (2000) and 1820 (2008) in some detail to determine the extent to which they can be understood as human rights instruments and contrasts the Security Council resolutions with General Recommendation No. 30 adopted by the CEDAW Committee, an overtly human rights approach to the same subject matter. It concludes that mobilization today around the WPS agenda is not so much about advancement of women’s rights as retaining the headway made in Resolution 1325.