bluuebunny/crossref_metadata_2025 huggingface dataset:
525 PROGNOSTIC RELEVANCE OF DEMOGRAPHIC FACTORS IN CARDIAC MAGNETIC RESONANCE-PROVEN ACUTE MYOCARDITIS. A COHORT STUDY
Authors: Cannata Antonio , Roy Roman , Rios Antonio Jordan , Ferone Emma , Cassimon Barbara , Sadler Matthew , Rind Irfan , Rosmini Stefania , Piper Susan , Giacca Mauro , Mcdonagh Theresa , Scott Paul , Bromage Daniel
Published: December 2022

Aims

Acute myocarditis (AM) is a heterogeneous condition with variable estimates of survival. Contemporary criteria for the diagnosis of clinically suspected AM enable non-invasive assessment, resulting in greater sensitivity and more representative cohorts. We aimed to describe the demographic characteristics and long-term outcomes of patients with AM diagnosed using non-invasive criteria.

Methods and Results

A total of 199 patients with cardiac magnetic resonance (CMR)-confirmed AM were included. The majority (n=130, 65%) were male and the average age was 39±16 years. Half of patients were White (n=99, 52%) with the remainder from Black and Minority Ethnic (BAME) groups. The most common clinical presentation was with chest pain (n=156, 78%), with smaller numbers presenting with breathlessness (n=25, 13%) and arrhythmias (n=18, 9%). Patients admitted with breathlessness were sicker and more often required inotropes, steroids, and renal replacement therapy (p<0.001, p<0.001, and p=0.01, respectively). Over a median follow-up of 53 (IQR 34–76) months, 11 patients (6%) experienced an adverse outcome, defined as a composite of all-cause mortality, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) therapy. Patients in the arrhythmia group had a worse prognosis, with a nearly 7-fold risk of adverse events (hazard ratio [HR] 6.97; 95% Confidence Interval [CI] 1.87–26.00, p=0.004). Sex and ethnicity were not significantly associated with the outcome.

Conclusions

AM is highly heterogeneous with an overall favourable prognosis. Three quarters of patients with AM present with chest pain and this is associated with a benign prognosis. AM presenting with life-threatening arrhythmias is associated with higher risk of adverse events.
583 DEFORMATION MAP OF LEFT VENTRICULAR STRAIN: COMPARISON BETWEEN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND CONTROLS WITHOUT SIGNIFICANT CORONARY ARTERY STENOSIS
Authors: Del Franco AnnaMaria , Wierzbowska-drabik Karina , Zampieri Mattia , Palinkas Eszter Dalma , Chiti Chiara , Duraj Iwona , Olivotto Iacopo
Published: December 2022

Background

Hypertrophic cardiomyopathy (HCM), being characterized by enhanced contractility, positively responses to treatment with myosin inhibitors which could promote reverse remodelling. Additionally, speckle tracking analysis highlights left ventricular (LV) contractile alterations in HCM, although the pathophysiological meaning and the effect of the target-therapy are still unclear.

Aim

To analyse global and regional longitudinal peak systolic strain in patients with HCM in comparison to age-matched control group without HCM and with known coronary artery anatomy.

Methods

We examined 37 HCM patients (33 with asymmetric septal and 4 with apical hypertrophy) and 67 age-matched controls without HCM or significant coronary stenoses, with transthoracic echocardiography with analysis of segmental and global left ventricular strain (GLS) by AFI method in 16-segment LV model.

Results

Patients with HCM showed higher values of interventricular septal thickness, left atrial diameter and LV ejection fraction, whereas controls presented higher BMI and resting heart rate. In deformation analysis, GLS values were lower in HCM (15.9 ± 4.2 vs 18.4 ± 3.5%, p = 0.002) as well as segmental strain was significantly impaired in marker regions for studied form of HCM, in particular septal, inferior and inferolateral basal and mid segments as well as apical inferior segment for HCM with asymmetric septal hypertrophy; 4 patients with apical form of HCM showed severely impaired strain in all apical segments.

Conclusions

Deformation analysis shows a significant impairment of global and segmental strain values in patients with HCM, in particular for hypertrophic segments. This finding does not definitely imply a certain contractile dysfunction, and further investigation on the effect of myosin inhibitors on strain analysis is strongly recommended.
302 CHALLENGING DECISION IN INCIDENTAL APICAL HYPERTROPHIC CARDIOMYOPATHY DIAGNOSIS
Authors: Fazzini Luca , Angius Simone , Caggiari Ludovica , Cossu Stefano , Contini Francesca Valeria , Martis Alessandro , Pasqualucci Daniele , Valentino Luigi , Corda Marco , Dessalvi Christian Cadeddu
Published: December 2022

Introduction

Apical hypertrophic cardiomyopathy (ApHCM) compared with normal HCM is less frequent, it's more associated with atrial fibrillation (AF) and it has different sudden cardiac death (SCD) risk factors. Authoritative recommendations and guidelines on diagnosis, family screening and especially patient risk stratification don't exist. Taking decisions on ICD implantation can sometimes be challenging.

Patient presentation

A 66-year-old male with a history of arterial hypertension was admitted to our cardiology department because during the last night, while he was driving his car, he would have lost consciousness having a car accident. He rapidly felt well even though he doesn't remember what happened a few minutes shortly before and immediately after the event. No witnesses. Due to traumatic chest pain he went to emergency department where an electrocardiogram was performed with evidence of negative T waves and ST-segment depression on V3-V6 leads.

Diagnosis and management

Physical examination didn't show anything relevant. On heart ultrasound he had normal left ventricle ejection fraction with apical hypertrophy (maximum thickness 18 mm). He underwent coronary angiography which showed normal coronaries. During hospitalization a cardiac magnetic resonance was performed; it described apical hypertrophy with some small areas of intra-myocardium delayed enhancement in apex wall. During hospitalizations no arrhythmic alarms were detected.

Discussion

Pharmacological and electrical treatment options are based on classic HCM aiming to reduce symptoms, incidence of atrial fibrillation, ventricular arrhythmias, and sudden death. Concerning ApHCM, left ventricular outflow tract obstruction is usually absent and therefore pharmacological therapeutic benefits may be lower than in classic HCM. Regarding sudden death prevention, we evaluate ICD implantation according to ESC 5-y HCM SCD risk score which doesn't include potential risk markers for SCD in ApHCM such as apical aneurysm, midcavity gradient and midventricular obstruction with SCD risk underestimation. By the way it's still the most used score being aware that could lead to ICD underutilization. In our case, according to HCM risk score 1.74%, negative family screening, no arrhythmic events for 15 days hospitalization, no previous transient loss of consciousness (TLOC) and dynamics of the car accident, we decided to follow-up the patients in our cardiomyopathies outpatient clinic explaining the TLOC with a sleep disorder.
586 BODY WEIGHT AND MICROVASCULAR DYSFUNCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AT LOW CARDIOVASCULAR RISK REFERRED TO POSITRON EMISSION TOMOGRAPHY
Authors: Fumagalli Carlo , Bonanni Francesca , Maurizi Niccolò , Zampieri Mattia , De Gregorio Maria Grazia , Palinkas Eszter D , Sciagrà Roberto , Olivotto Iacopo
Published: December 2022

Introduction

Whether obesity, a modifiable risk factor in patients with hypertrophic cardiomyopathy (HCM), can influence coronary microvascular dysfunction (CMD) is unknown.

Objective

To assess the relationship between body weight and CMD measured with myocardial blood flow (MBF) at positron emission tomography (PET) in patients with HCM.

Methods

All consecutive patients with HCM referred to PET scan from 2010 to 2020 were reviewed. Only patients with PET and cardiac magnetic resonance (CMR) analysis, <60 years old at diagnosis, with no history of diabetes, dyslipidemia, and hypertension were included.

Patients were classified into three groups according to baseline BMI: BMI<25 kg/m2, BMI 25-30 kg/m2, and BMI>30 kg/m2.

Results

Of 1512 patients with HCM, 134 (8.9%) had been referred to a PET scan and 79 (5.2%) met the inclusion criteria (29% were women, median age was 44 [28-53] years). Overall, 52% had a BMI<25 kg/m2, 37% had a BMI 25-30 kg/m2, and 11% had a BMI >30 kg/m2.

At PET, average MBF was 2.08 [1.52-2.40] ml/min/g and was similar among BMI groups (p=0.288) irrespective of fibrosis at CMR. Prevalence of severe microvascular dysfunction was similar (MBF <1.53 ml/min/g: (9 [22%] vs 8 [28%] vs 2 [22%], among study groups, p=0.833). Age at PET and atrial fibrillation were associated with MBF.

Conclusions

Obesity is not associated with worsening of CMD in HCM patients. These findings support the hypothesis that the worse symptomatic profile in obese HCM patients is due to increased prevalence of obstruction rather than accentuation of structural phenotype. Thus, the symptomatic handicap associated with obesity may be reversible following appropriate weight-reduction strategies
915 PHENOTYPIC EXPRESSION AND OUTCOMES OF CARDIOMYOPATHY CAUSED BY TITIN TRUNCATING VARIANTS: TRANSLATIONAL INSIGHTS
Authors: Perotto Maria , Radesich Cinzia , Paldino Alessia , Ferro Matteo Dal , Sinagra Gianfranco
Published: December 2022

Background

Titin truncating variants (TTNtv) represent the most prevalent genotype underlying dilated cardiomyopathy (DCM). Recent molecular studies provided initial evidence about different pathogenic mechanisms produced by different mutation sites of the truncating variant (A-Band vs non-A-band), possibly related to the presence or absence of truncated titin (TTN) peptides. However, to date, clinical studies on DCM patients carrying TTNtv failed to demonstrate any relevant clinical difference according to the titin band affected. We hypothesized this lack of variation could be partially explained by the selection bias of including only DCM phenotype patients. Thus, we studied the clinical phenotypes and outcomes of our entire population of subjects with pathogenic TTNtv regardless of phenotypic expression at the onset.

Methods

We retrospectively analyzed a population of pathogenic TTNtv carriers, enrolled in the Trieste Heart Muscle Disease Registry. TTNtv were classified according to their site (Z disk, I band, A band, A-M junction, M band) and further grouped for analysis in A-band and non-A band. Variables were expressed as mean±SD, median and interquartile range, or counts and percentage, as appropriate. Kaplan-Meier curves were estimated for the composite endpoints of (i) heart failure-related death, heart transplant, and destination left ventricular assist device implantation and (ii) first major ventricular arrhythmia (MVA, defined as SCD or life-threatening ventricular arrhythmia) and compared by the log-rank test.

Results

154 TTNtv carriers were included in the study, of whom 66% were probands. The most prevalent phenotype was DCM (92%). The mean age of subjects at diagnosis was 43±16 years and 70% were males. There was no difference between groups in the first composite outcome of heart failure-related death, heart transplant, and destination left ventricular assist device implantation. Instead, major ventricular arrhythmias were significantly more frequent in the non-A-band group, in which 47% (n=14) of TTNtv carriers experienced MVA as compared to 19% (n=20) of subjects in the A-band group (p=0.001). Interestingly, we observed a tendency in MVA occurrence at a higher mean left ventricular ejection fraction (LVEF) in the non-A-band group as compared to the A-band group (42±13% vs 35±9%, respectively).

Conclusions

Among TTNtv carriers referred to a tertiary center, those with a mutation in the non-A band seem characterized by higher arrhythmic risk. This novel finding highlights the importance of considering the site of TTN truncating variants to guide the most appropriate clinical management for each patient.
333 MASSIVE PERICARDIAL EFFUSION IN HYPOTHYROIDISM: A CASE REPORT
Authors: Pasero Guido , Pollina Alberto Vincenzo , Carugo Stefano , Tumminello Gabriele , Bertoletti Alessandra , Vicenzi Marco
Published: December 2022

Chronic massive pericardial effusion (PE) without cardiac tamponade is relatively rare. Of all possible etiologies of PE, hypothyroidism is an uncommon one.

We reported a case of a 75-year-old woman, admitted at E.R. with confusion and unresponsive status, with diffuse face and lower limb'swelling . First-level examinations were performed: blood gas analysis showed hypoxia, respiratory acidosis and severe anaemia; the EKG revealed slow atrial fibrillation with ventricular rate of approximately 40 bpm and low QRS voltages. Echocardiogram showed massive PE, without sings suggestive of cardiac tamponade. A CT-scan of the brain, chest and abdomen was performed to exclude major active bleeding or neoplastic formations, and confirmed the presence of massive PE. Eventually, the effusion was drained with a pigtail catheter through a sub-xiphoid approach. Meanwhile blood tests results revealed a TSH level of 115 mIU/L (normal range 0,28–4,3 mIU/L) and fT4 level of 0,4 ng/L (normal range 8,0–17,0 ng/L). Severe, previously unknown, hypothyroidism was then diagnosticated and specific treatment with L-thyroxine was started.

PE formation in hypothyroidism is due to several pathophysiologic mechanisms that include increased capillary permeability, extravasation of hygroscopic mucopolysaccharides, increased volume of albumin distribution, reduced lymphatic drainage, along with an increase in salt and water retention. The fluid accumulation in the pericardial space is a slow, chronic process, leading to huge effusions with no cardiac tamponade.

PE may represent a severe complication of hypothyroidism, which should be taken into account in the differential diagnosis of the underlying cause. Echocardiogram is the best diagnostic tool, able to provide useful information about location, volume and hemodynamic impact of the effusion. Pericardiocentesis is not normally required to establish an accurate etiological diagnosis, which in most cases can be obtained simply on the basis of the clinical history and simple blood tests. Treatment is aimed at targeting the specific cause, thus, in our case, replacing the missing hormone.
442 OVERWEIGHT AND TAKOTSUBO SYNDROME: SHORT- AND LONG-TERM OUTCOME. RESULTS FROM A MULTICENTER PROSPECTIVE REGISTRY.
Authors: Ragnatela Ilaria , Santoro Francesco , Vitale Enrica , Cetera Rosa , Mallardi Adriana , Leopizzi Alessandra , Matera Annalisa , Correale Michele , Iacoviello Massimo , Brunetti Natale Daniele
Published: December 2022

Background

Takotsubo Syndrome (TTS) is a clinical condition characterized by an acute transient heart failure with reversible ventricular motion abnormalities. Obesity is related with an increased oxidative stress, which is one of the postulated mechanism of TTS.

Aim of the study

To investigate the association between Body Mass Index (BMI) and in-hospital and long-term follow-up events among patients with TTS.

Methods

178 consecutive patients with TTS at admission were enrolled in a multicenter international registry. According to BMI, patients were divided into two groups: normal-weight (BMI 18.5-25 Kg/m2, N=70) and over-weight (BMI ≥ 25 Kg/m2, N=78). Medical history, clinical data, echocardiographic parameters and in-hospital and long-term follow-up events of all patients were evaluated.

Results

Mean body mass index was 26±5 Kg/m2. There were no significant differences between over- and normal- weight patients in terms of sex, age and cardiovascular risk factors (diabetes, dyslipidaemia, smoking habit) except for arterial hypertension (85% vs 67%, p=0.01). When evaluating non cardiovascular comorbidities, overweight patients had a higher prevalence of chronic pulmonary diseases (38% vs 20% p=0.018).

During hospitalization no differences in terms of admission LVEF and hospital length of stay were found; however, overweight patients had higher rates of in-hospital complications (51 vs 27%, p=0.004).

At follow-up, overweight patients had higher rate of MACE (44% vs 27%, p=0.03), one-year (32% vs 15%, p=0.02) and long-term mortality (37% vs 24%, log rank p=0.01), but no differences in terms of rehospitalizations and TTS recurrence.

Conclusion

Overweight in TTS is associated with higher rates of in-hospital events and long-term mortality and MACE.
793 RECURRENT PERICARDITIS AND COVID-19
Authors: Sciara Pietro
Published: December 2022

Background

Anakinra, an interleukin 1β recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL.)

Clinical case

A 86-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism.

Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred.

Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid.

During hospitalization patient tested positive for SARS-CoV-2. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies.

Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra.

Conclusions

treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of conventional pericarditis therapy.
1070 PROGNOSTIC PERFORMANCE OF CARDIAC MAGNETIC RESONANCE IMAGING MARKERS VERSUS COMPLICATED CLINICAL PRESENTATION AFTER AN ACUTE MYOCARDITIS
Authors: Varrenti Marisa , Ammirati Enrico , Sormani Paola , Moro Claudio , D´elia Saverio , Bernasconi Paolo , Raineri Claudia , Quattrocchi Giuseppina , Milazzo Angela , Maestroni Alberto , Valsecchi Maria Grazia , Garascia Andrea , Oliva Fabrizio , Giannattasio Cristina , Camici Paolo G , Pedrotti Patrizia
Published: December 2022

Background

Identifying markers associated with adverse events after acute myocarditis (AM) is clinically relevant to plan follow-up. We aimed to compare the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF)<50% on baseline CMRI, versus complicated clinical presentation (CCP) of AM (defined as the presence of sustained ventricular arrhythmias or LVEF <50% on the first echocardiogram or fulminant presentation).

Methods

We retrospectively assessed 248 AM patients from 6 hospitals with onset of cardiac symptoms <30 days, increased troponin, and CMRI consistent with myocarditis.

Results

Patients had a median age of 34 years (male prevalence of 87.1%) and a median LVEF of 61% on baseline CMRI. Thirteen patients (5.2%) experienced at least one major cardiac event after a median follow-up of 1708 days. Among these 13 patients, 10 (76.9%) had septal LGE, 8 (61.5%) had LVEF<50%, and 12 (92.3%) had a CCP. The best performance was observed for CCP in terms of sensitivity (0.99), and for LVEF<50% in terms of specificity (0.90). The negative predictive value was at least 0.98 for all markers.

Conclusions

Major cardiac events after an AM are relatively low, and septal LGE, LVEF<50% on CMRI, and CCP are significantly associated with events. The most relevant finding is the high NPV of these markers to identify patients without events after an AM. This observation can help clinicians to monitor the patients after an AM, in fact, patients without these markers had an uneventful follow-up.

Figure

A] Acute Myocarditis with complicated clinical presentation (CCP AM) vs non-complicated clinical presentation (NO CCP AM);

B] FE > 50% vs FE < 50% at basal cardiac MRI;

C] Presence of septal late gadolinium enhancemnet (LGE) vs no septal LGE on basal cardiac MRI.
369 PENTRAXIN 3 AS A DIAGNOSTIC AND PROGNOSTIC MARKER OF ACTIVE MYOCARDITIS
Authors: Villatore Andrea , Monno Antonella , Sciorati Clara , Sala Simone , Della Bella Paolo , Manfredi Angelo A , Peretto Giovanni
Published: December 2022

Background

Pentraxin 3 (PTX3) is an acute phase protein, which regulates the outcomes of inflammation. Currently, there are no myocarditis-typical biomarkers that allow a non-invasive diagnosis, and endomyocardial biopsy (EMB) is still the gold standard. Finally, risk stratification is often challenging in these patients.

Aim

To investigate whether PTX3 could be expressed in cardiomyocytes and released during myocarditis, serving as a novel and independent diagnostic indicator of myocardial inflammation, and contributing to prognosis prediction.

Methods

Fifty-five patients with a diagnosis of acute or chronic active myocarditis proven by cardiac magnetic resonance (CMR) and/or endomyocardial biopsy (EMB), were included. First, we evaluated tissue PTX3 expression by immunohistochemistry (IHC). Then, we assessed circulating blood PTX3 by ELISA technique.

Results

On cardiac tissue, PTX3 at IHC did not localize in the interstitium, and showed an inconstant expression in the vascular endothelium, but a marked staining by cardiomyocytes in all myocarditis patients. The only exception was represented by two patients with systemic COVID-19, with SARS-CoV-2 and PVB-19 intracardiac genomes, respectively, who showed a diffuse cardiac PTX3 expression. Remarkably, at semi-quantitative pixel analysis, viral aetiology showed higher levels of tissue expression, rather than the autoimmune one. Circulating PTX3 levels were significantly higher in myocarditis patients than controls, with pathologic values in 87% of myocarditis patients, and none among controls. Remarkably, plasma PTX3 proved to be more sensitive in myocarditis detection than CRP, ESR, troponin T, and NT-proBNP. As regards of prognosis, we observed that patients with heart failure (HF) presentation all had elevated PTX3 levels, as compared with chest pain or arrhythmia. Remarkably, patients with reduced LVEF (<50%) at admission who recovered during follow-up had higher baseline PTX3 levels, rather than those whose systolic function did not improve.

Conclusions

Tissue PTX3 is mostly expressed by cardiomyocytes in patients with active myocarditis on EMB samples. In addition, plasma PTX3 is a sensitive diagnostic and prognostic marker in patients with inflammatory cardiomyopathy.
387 MITRAL VALVE MORPHO-FUNCTIONAL FEATURES DURING THE ACUTE AND RECOVERY PHASE IN PATIENTS WITH TAKOTSUBO SYNDROME
Authors: Vitale Enrica , Santoro Francesco , Cetera Rosa , Ragnatela Ilaria , Mallardi Adriana , Leopizzi Alessandra , Matera Annalisa , Manuppelli Vincenzo , Correale Michele , Iacoviello Massimo , Brunetti Natale Daniele
Published: December 2022

Background

Acute mitral valve regurgitation is known to be associated with a severe prognosis in patients affected by Takotsubo syndrome (TTS). The mechanisms involved are different and related to various pathogenesis such as cordal or mitral anterior leaflet (LAM) systolic anterior motion (SAM) and tethering of the mitral valve.

Aim of the study

to compare mitral valve morpho-functional features and concomitant left ventricle (LV) abnormalities by transthoracic echocardiography in patients during the acute and recovery phase of Takotsubo syndrome.

Methods

24 consecutive patients were enrolled from a multicenter prospective registry of TTS from July 2007 to February 2022. Through transthoracic echocardiography, LV ejection fraction, LV end-diastolic and end-systolic diameters and volumes, left atrium antero-posterior diameter and end-systolic volume, mitral anulus diameter, prevalence of mitral valve regurgitation, of LV outflow tract obstruction (LVOTO), coaptation depth and tenting area were collected during the acute and recovery phase of takotsubo syndrome.

Results

LVEF at admission was 39.6 ± 7.8% vs 60.5 ± 4% at functional recovery (p<0.001). LVEDV, LVESV and LVESVi were found to be higher during the acute phase when compared to the recovery phase (103.8 ± 28.9 vs 89.7 ± 23.4 ml, p=0.012; 59.8 ± 17.2 vs 35.1 ± 10.1 ml, p< 0.001; and 36.1 ± 9 vs 20.6 ± 5.4 ml/m2, p<0.001 respectively).

No statistically significant differences were found between admission and recovery phase in term of mitral annular dimension (32.3 ± 4.6 vs 32.5 ± 4.1 mm, p=0.825), tenting area (2.3 ± 0.6 vs 2.2 ± 0.7 cm2, p=0.445), proximal thickness and length of both of the mitral leaflets, while coaptation depth was higher during the acute phase in comparison to functional recovery (1.1 ± 0.2 vs 1 ± 0.3 cm, p=0.018).

10 patients (41%) presented with moderate/ severe mitral insufficiency and 5 patients of them (20% of the general population) downgraded to mild at recovery.

Among the patients with values of LVEDV higher than 104 mL, LVESV higher than 43 mL, LVESVi higher than 25 mL/m2 and coaptation depth higher than 1.1 cm during the acute phase, 4 out of 5 patients experienced a downgrade of the severity of mitral valve regurgitation.

Conclusions

Left ventricle end-diastolic volume and coaptation depth are statistically different during the acute and recovery phase. Among the patients who experienced a downgrading of the severity of mitral valve regurgitation, higher values of LVEDV, LVESV, LVESVi and coaptation depth during the acute phase were found.
675 FACILITATORS AND BARRIERS THAT CAN INFLUENCE ADHERENCE TO INFECTION PREVENTION AND CONTROL GUIDELINES. A REVIEW.
Authors: Ruggiero Antonio , Chiaretti Ludovica , Chiala´ Oronzo
Published: December 2022

Introduction

Adherence to infection prevention and control (IPC) can be examined in two different ways: towards patients or among healthcare providers. In both cases, adherence to recommendations remains poor. Facilitators and barriers to adherence to evidence-based practice (EBP) can play a key role in establishing effective strategies, but are still poorly explored, especially in cardiac settings.

Methods

A review was conducted using the Medline database. Of 529 articles analyzed, only 14 met the inclusion criteria. Several factors were found in the articles included in the review that could facilitate or hinder adherence to the IPC guidelines.

Results

The main factors identified in the literature reviewed were: organizational factors (safety issues, guideline dissemination, availability of training programmes), environmental factors (social and community environment, work environment, availability of PPE), individual factors (knowledge, attitude, experience, belief, discomfort with PPE use) and factors related to patients and caregivers.

Discussion

The literature highlights the heterogeneity of factors that might influence adherence to IPC in cardiology settings. Although factors related to the organization, environment and healthcare provider knowledge, experience and beliefs were well explained, factors related to patients and caregivers remained rather unexplored. This underlines the need for further knowledge and insights.
1077 THE ROLE OF MILITARY NURSE IN THE CARDIAC AMBULATORY OF MILITARY HOSPITAL IN MILAN
Authors: Fabri Luca
Published: December 2022

Military nurses have a fundamental role in taking care of all military personnel, both in preventive medicine and direct health care, to be effective and competent during his duty, both in national settings and in operations abroad.

The military nursing, in a cardiac ambulatory setting, aim to guarantee, collaborating with the cardiologist medical officer, the fitness for military service, i.e. the possession of physical and psycho-attitudinal requirements needed to carry out military service that requires specific and dynamic efforts that could solicit determined organs or body systems.

Among the different visits that the military personnel have to attend, the cardiac ambulatory is specialized in: Personnel selection for volunteers recruitment;Evaluation for those soldiers that suffered from cardiovascular diseases that has to be visited by Military Legal Medical Facilities;Medical periodic visits for military personnel on duty to check the maintenance of psycho-physical requirements;Medical visits for military personnel ready to be deployed in missions abroad or that are just coming from them;Definition of diagnostic protocol and evaluation of those soldiers that suffered from cardiovascular disease.

In details, the main specific competences of the military nurse in a cardiology ambulatory are: assessment of cardiovascular health (cardiac anamnesis and physical evaluation), diagnostic exams procedures (ECG, supporting in sonography examination, positioning and management of Holter for blood pressure and ECG, cardiopulmonary test), evaluation of medication prescription per cardiovascular disease (antihypertensives, antiplatelet agents, antithrombotic, thrombolytics, antiarrhythmics, with focus on the initiation of therapy, mode of action and interactions).

The military nurse in cardiovascular ambulatory, in addition to the many activities, typical of being a warrant officer deployable in national activities or in operations abroad, must acquire competences and knowledge specific for cardiac setting, through basic training courses, continuous medical education, ensuring a constant synergy with all the équipe members, even at international level, also acting independently in all those complex situations that may arise to meet patients’ needs.
160 CARDIOPULMONARY RESUSCITATION IN MICROGRAVITY
Authors: Li Vigni Myriam Letizia , Satiro Francesco , Vecchiet Arisa
Published: December 2022

Introduction

The increase of human space missions in microgravity conditions has led the scientific community to investigate the potential effects on astronauts' bodies. There is a high incidence of cardiovascular complications, with cardiac arrest being among the most difficult to manage. On earth, guidelines regarding cardiopulmonary resuscitation are constantly updated; however, in microgravity, the literature on the subject is still lacking. The aim of this study is to review the available literature and lay the foundation for further nursing developments in this regard.

Materials and Methods

A literature review was conducted by consulting Pubmed as the database. The research question was, "How is CPR performed on the astronaut suffering from cardiac arrest during space flight?" As inclusion criteria, we considered all relevant studies in the literature in the last 10 years, using MeSH terms.

Results and Discussion

The studies reviewed showed that there are 5 possible methods of cardiopulmonary resuscitation in the space environment (Consensus of 2015) : the Reverse Bear Hug Method; the Side-Straps Method; the Evetts-Russomano Method; the Handstand Method; and the Waist Straddle Method. Mackaill et all, through a simulation on a parabolic flight, a dummy and 10 different operators, demonstrated that the Russomano maneuver is capable of sustaining the cardiac circulation by conferring effective manual chest compressions. Hinkelbein et all, drafted a first guideline regarding resuscitation maneuvers. The results of the study also show that defibrillation and ventilation appear to be techniques that have not yet been investigated. The belief remains that BLSD and ALS protocols can be applied in the same manner as applied on Earth. Schimtz et all, with an RCT study that included 15 volunteers and a simulation dummy placed underwater (an environment similar to space characteristics), studied 2 different resuscitation techniques, comparing the Schimtz-Hinkelbein Method and the Cologne Method. The former method demonstrated a better depth and frequency of repetitions of manual compressions. Subsequently, Forti and his collaborators, highlighted the application of automatic mechanical compression devices generating effective compressions.

Conclusion

To date there is little evidence to state with certainty that exclusively one method of cardiopulmonary resuscitation is effective in the aerospace environment. Since the emergency of cardiac arrest is a major problem there is a need to study these processes more thoroughly and entrust health care professionals with the management, practice and theory of such space dynamics also in view of the arrival of the nursing presence during missions in space.
516 SAFETY OF PCSK9I IN A SINGLE COUNTRY, MULTICENTER, OBSERVATIONAL STUDY: A POST-HOC ANALYSIS OF THE AT-TARGET-IT STUDY
Authors: Buonocore Davide , Basile Christian , Calabro´ Paolo , Marzano Federica , Asile Gaetano , Abbate Vincenza , Vicidomini Francesca , Paolillo Stefania , Catalano Angelo , Merlini Piera Angelica , Iannuzzo Gabriella , Ciccone Marco Matteo , Paloscia Leonardo , Varbella Ferdinando , Brunetti Natale Daniele , Indolfi Ciro , Gargiulo Paola , Filardi Pasquale Perrone
Published: December 2022

Introduction

PCSK9 inhibitors (PCSK9i) significantly decrease LDL cholesterol (LDL-C), either as monotherapy or in addition to the maximally tolerated dose of statin and/or ezetimibe. Yet, few data are available in real-world observations.

Purpose

AT-TARGET-IT is an Italian multicenter registry involving 9 Italian centers, designed to assess efficacy, adherence, and persistence of PCSK9i, as well as prescribing doctors’ behavior in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH). The aim of the present analysis was to assess differences between evolocumab and alirocumab on safety in patients on PCSK9i in a real-world single country observational study.

Methods

From June through November 2021, we enrolled patients with PCSK9i first prescription from 6 months before inclusion through starting of PCSK9i use. Clinical and demographic characteristics, concomitant therapies, blood chemistry, were recorded at the time of first prescription and at the latest observation preceding inclusion in the study.

Results

Of 798 patients enrolled, 566 (70.9%) patients took Evolocumab and 232 (29.1%) Alirocumab (of them, 117 patients Alirocumab 75 mg and 115 Alirocumab 150 mg). The LDL-C values reductions did not significantly differ between Evolocumab and Alirocumab groups (65.1% for Evolocumab; 64.5% for Alirocumab, p=ns). Regarding safety events, after a median observation period of 19.3 months (6; 57), 19 patients (2.4%) had acute coronary syndrome, 18 (2.3%) hospitalization for CV causes, 3 (0.4%) stroke, 6 (0.8%) new-onset heart failure (HF) and 68 (4.9%) the composite endpoints of ACS, CV hospitalization, new onset HF, new onset chronic kidney disease, stroke and cerebrovascular insufficiency. Comparing events between patients in Alirocumab and in Evolocumab, no significant difference was found between the two groups. Combined endpoint of adverse events occurred more frequently in patients in Alirocumab (27; 11.6%), in comparison with those in Evolocumab (41; 7.2%) (p=0.044) (Figure).

Conclusion

AT-TARGET-IT study shows that between evolocumab and alirocumab there was a statistically significant difference on the combined endpoint of adverse events.
380 CARDIAC AND VASCULAR IMPAIRMENT IN PATIENTS WITH MILD PSORIASIS: A LONGITUDINAL STUDY
Authors: Cocuzza Federica , Carciotto Gabriele , Pistelli Lorenzo , Parisi Francesca , De Murtas Elisabetta , Poleggi Cristina , Campanella Francesca , De Sarro Rosalba , Vinciguerra Paolo , Imbalzano Egidio , Di Bella Gianluca , Micari Antonio , Dattilo Giuseppe , Casale Matteo
Published: December 2022

Backgrounds

Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated reaction and hyperproliferation of keratinocytes. It is typically associated with several comorbidities; in particular, there are numerous evidence of a link between this condition and cardiovascular (CV) disease. Nevertheless, little is known about its role as an independent cardiovascular risk factor.

Purpose

The aim of this longitudinal study is to evaluate the role of Psoriasis as an independent CV risk factor, to establish the relationship between severity and duration of Psoriasis and CV damage and to find reliable markers to stratify CV risk in these patients.

Methods

33 patients affected by mild Psoriasis without comorbidities were enrolled in this longitudinal study and were compared with 33 healthy subjects. The severity of Psoriasis was assessed with the PASI (Psoriasis Area and Severity Index) score: a score <10 was used to classify psoriasis as mild. Both groups underwent an echocardiogram, with evaluation of 2-dimensional strain (2D-SE), and a Doppler of carotid-femoral pulse wave velocity (PWV). The same evaluation was performed at 2-year follow-up.

Results

A total of 66 patients was included: 33 (50%) with mild psoriasis without comorbidities and 33 (50%) healthy subjects. Comparable clinical and echocardiographic baseline characteristics were observed between the two groups, except for Global Longitudinal Strain (GLS), which was significantly lower (p=0.002) in the Psoriasis group (22.39 ± 2.28%) than in controls (24.15 ± 2.17%), and PWV, that was significantly lower (p=0.004) in controls (8.06±1.68 m/sec) than in the psoriasis group (9.23 ± 1.53 m/sec). Significant correlations between GLS, disease duration and patient age at diagnosis were found, as in coronary artery disease (CAD) and cardiomyopathies. At 2-year follow-up, no significant changes in demographic or clinical characteristics were found within the Psoriasis group. The PASI score did not change significantly, no patient needed any systemic therapy (6 needed an increase in topical drugs) and none of the patients developed any conventional cardiovascular risk factor. There were no significant differences in echocardiographic parameters and no CV events occurred.

Conclusions

According to our data, mild Psoriasis determines subclinical cardiac and vascular damage. However, at two-year follow-up, no CV changes in initially healthy patients were found.
720 FRAILTY INFLUENCE ON PHYSICAL AND PSYCOLOGICAL OUTCOMES IN POST-CARDIAC SURGERY PATIENTS CARDIAC REHABILITATION, A SINGLE CENTER STUDY
Authors: Villani Giovanni Quinto , Villani Matteo , Corbellini Daniela , Schettino Valentina , Bettinardi Ornella , Rosi Alessandro
Published: December 2022

Cardiac rehabilitation (CR) is a clinically and cost-effective intervention in post-cardiac surgery patients (PCSp). However the influence of patients frailty on clinical and psychological outcomes in these patients are not well-known.

The aim of our work was to evaluate the effectiveness of a personalized rehabilitative therapy in PCSp divided using the Cumulative Illness Rating Scale (CIRS) in group A (393 low-frail pts, CIRS <3, 230 M, 65±3 yrs) and in a Group B (540 frail pts, CIRS >4, 379 M, 67±10)) evaluating pre and post-treatment the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) and the psychological behaviour (State-Trait Anxiety Inventory STAI-X1, Depression Questionaire QD-R).

At admission the comparison between Group A vs B has shown: a greater loss autonomy in frail patients (BI scale A 51.7±1 vs B 28.7±14, p 0.005; SMWT A 245±25 m vs B 155±18 m, p 0.005)a greater impairment in psychological characteristics in frail patients (STAI-X1 A 18±9 vs B 20±4 p 0.028, QD/R A 3.6±2 vs B4.4±3 p0.001)

At discharge after a similar period of rehabilitation (A 24.7±11.8 days vs B 25.6±10 days, p ns) we observed: a more evident improvement of degree of autonomy recovery in low-frail group ((BI scale A 77.7±18 vs B 67.7±19, p 0.001; SMWT A 485±18 m vs B 341±25m, p 0.001)a similar improvement in anxiety and depression characteristic in both groups (STAI-X1 A 17.8±2 vs B 17.4±4 p ns, QD/R A 3.1±2 vs B 3.4±2 p ns)

Conclusions

In our experience the frailty status does not affect the cardiac rehabilitation in post-cardiac surgery patients in term of ensuring adequate functional recovery (although reduced compared to low-frail patients) but with similar improvement in psychological behaviours.
1067 TELEMEDICINE FOR LIPID LEVELS FOLLOW UP AFTER ACUTE CORONARY SYNDROME
Authors: Mautone Francesco , Ragnatela Ilaria , Di Nunno Nicola , Corbo Maria Delia , D´alessandro Domenico Antonio , Ieva Riccardo , Casavecchia Grazia , Mele Marco , Santoro Francesco , Brunetti Natale Daniele
Published: December 2022

Background

The implementation of guidelines on LDL cholesterol levels after acute coronary syndrome (ACS) is very poor according to registries and surveys. Telemedicine could improve adherence to guidelines and facilitate clinical follow-up of patients with ACS, even with the limitations of Covid-19 pandemic.

Aim of the study

To evaluate the efficacy of telemedicine follow-up in improving adherence to LDL guidelines and improving rates of prescription of PCSK9-inhibitors.

Design and Methods

650 consecutive patients discharged with diagnosis of ACS or Chronic CS were enrolled in the study and followed after 2 and 4 months. LDL levels and lipid lowering drug prescription were recorded. Data from 300 patients with ACS patients and <80 years were analyzed and LDL values of telemedicine followed-up patients (telephone/smartphone app/pc teleconsultation) were compared with controls.

Results

Baseline mean LDL levels were 120 mg/dl, 55% of patients were naive of lipid lowering therapy. At second follow-up mean LDL levels were 55 mg/dl (p<0.05 vs baseline) and rates of prescription of statins, ezetimibe and PCSK9-inhibitors were 98%, 79%, and 18% respectively. Rates of subjects with LDL levels below recommended threshold were 4% at baseline, 39% at first follow-up, 53% at second follow-up (p<0.05). Patients followed up with telemedicine showed lower LDL levels at second follow-up (55vs72 mg/dl, p=0.08) and higher rates of subjects below recommended LDL levels (63%vs30%, p=0.05).

Conclusions

Telemedicine follow-up may improve the implementation of guideline recommended LDL levels after ACS.
470 MYOCARDIAL FIBROSIS IN ASYMPTOMATIC PATIENTS UNDERGOING SURGERY FOR MITRAL AND AORTIC VALVE REGURGITATION
Authors: Fragasso Gabriele , Sanvito Francesca , Monaca Giuseppe , Ardizzone Valentina , De Bonis Michele , Pappalardo Federico , Smart Chanel , Montanaro Claudia , Lapenna Elisabetta , Calabrese Maria Chiara , Castiglioni Alessandro , Benussi Stefano , Maisano Francesco , Zangrillo Alberto , Ambrosi Alessandro , Doglioni Claudio , Alfieri Ottavio , Margonato Alberto
Published: December 2022

Background

Chronic heart valve regurgitation induces left ventricular (LV) volume overload, leading to the development of hypertrophy and progressive dilatation of the ventricle to maintain physiological cardiac output. In order to prevent potential irreversible LV structural changes, the identification of the best timing for treatment is pivotal.

Objective

To assess the presence and extent of fibrosis in myocardial tissue in asymptomatic patients with valvular heart disease (VHD) and preserved LV dimensions and function undergoing cardiac surgery.

Methods

Thirty-nine patients were enrolled. Sixteen patients were affected by aortic or mitral regurgitation: they were all asymptomatic, undergoing valve surgery according to VHD European Society of Cardiology guidelines. Twentythree patients with end-stage nonischemic dilated cardiomyopathy (DCM) and severe LV dysfunction undergoing cardiac surgery for implantation of a durable left ventricular assist device (LVAD) served as controls. During surgery, VHD patients underwent three myocardial biopsies at the level of the septum, the lateral wall and LV apex, while in LVAD patients the coring of the apex of the LV was used. For both groups, the tissue samples were analyzed on one section corresponding to the apical area. All slides were stained with hematoxylin and eosin and Masson's trichrome staining and further digitalized. The degree of fibrosis was then calculated as a percentage of the total area.

Results

Of 39 patients, 23 met the inclusion criteria: 12 had mitral or aortic insufficiency with a preserved ejection fraction and 11 had idiopathic dilated cardiomyopathy. Quantitative analysis of apical sections revealed a myocardial fibrosis amount of 10±6% in VHD patients, while in LVAD patients the mean apical myocardial fibrosis rate was 38±9%. In VHD patients, fibrosis was also present in the lateral wall (9±4%) and in the septum (9±6%).

Conclusion

Our case series study highlights the presence of tissue remodeling with fibrosis in asymptomatic patients with VHD and preserved LV function. According to our results, myocardial fibrosis is present at an early stage of the disease, well before developing detectable LV dysfunction and symptoms. Since the relationship between the progressive magnitude of myocardial fibrosis and potential prognostic implications are not yet defined, further studies on this topic are warranted.
1066 THE USEFULNESS OF CEREBRAL PROTECTION DURING TAVR: A METANALYSIS
Authors: Boccuto Fabiola , Carabetta Nicole , Cacia Michele Antonio , Panuccio Giuseppe , Critelli Claudia , Indolfi Ciro , De Rosa Salvatore
Published: December 2022

Introduction

although transcatheter aortic valve replacement (TAVR) represents a milestone in the treatment of degenerative aortic stenosis, stroke remains an important complication compared to surgical aortic valve replacement (SAVR). Multiple magnetic resonance imaging (MRI) studies demonstrated a substantial rate of new cerebral ischemic lesions after TAVR. In order to avoid debris passage into the circulation and to prevent procedure-related embolic stroke, cerebral embolic protection (CEP) devices were developed. However, their safety and efficacy remain controversial. Very recently, new studies provided additional evidence on this topic.

Aim

to assess the entire body of evidence from randomized controlled studies about neurological outcomes after TAVR.

Materials and Methods

a systematic meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, Scopus, and Google Scholar for randomized controlled studies. The following keywords were used for the search: “transcatheter aortic valve implantation” or “stroke prevention” or “embolic protection” and “cerebral protection”. Study groups were defined as a the “CEP group” and the “control group”. Non-randomized studies reporting outcomes with cerebral embolic protection (CEP) during TAVR were excluded to reduce the selection and confounding bias of observational pilot studies. The primary outcome was post-procedural stroke. Secondary outcomes included total lesion volume on MRI and new ischemic lesions on MRI.

Results

nine trials including 4077 patients were eligible for analysis and included to the meta-analysis. Of those, 2203 patients were randomized to cerebral embolic protection and 1874 patients to control group. Despite the rate of post-procedural stroke was higher in the CEP arm (2.27%) compared to the control arm (2.87%, p<0.001), the use of cerebral embolic protection was not associated with a significantly lower risk of stroke (OR=0.82, 95% CI 0.59-1.15; p=0.255). Cumulative meta-analysis revealed a trend towards a lower impact on stroke prevention with more recent trials.

Conclusions

use of cerebral embolic protection devices during TAVR is a safe procedure. However, the current outline of results from all randomized controlled trials available does not support its routine use, as no significant reduction of stroke risk was evident. The use of these devices might be considered in selected high-risk patients, such as in the setting of heavy calcified cusps or atherosclerotic aortic lesions.