bluuebunny/crossref_metadata_2025 huggingface dataset:
P380 ORAL ANTICOAGULATION THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND CANCER: A LITERATURE REVIEW
Authors: Cereda A , Franchina G , Laricchia A , Spangaro A , Rocchetti M , Minardi A , Sala E , Ponti L , Marini C , Lucreziotti S
Published: May 2023

Introduction

Cancer and atrial fibrillation (AF) are two very frequent conditions that share common pathophysiological and epidemiological features. Spontaneous coagulation is associated with malignant neoplasia as well as prothrombotic potential due to the overexpression of procoagulants. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult. The use of direct oral anticoagulants (DOACs) is now first line anticoagulation in common clinical practice, but no specific study addressing the use of DOACs in cancer patients has been published to date. In this review we aimed to retrieve all studies comparing the use of DOACs to warfarin.

Methods

We searched for all relevant articles published in English. Articles included RCTs sub–studies and observational trials comparing the use of DOACs therapy to warfarin in cancer patients with AF. Efficacy outcomes comprised three efficacy endpoints: ischemic stroke (IS), systemic embolism (SE) and venous thromboembolism/pulmonary embolism (VTE/PE) and five safety endpoints: cerebral bleedings (CB), minor bleedings (mB), gastrointestinal bleedings (GI–B) major bleedings (MB) and overall mortality (OM). Not all endpoints were available for all the retrieved articles.

Results

We retrieved 3 RCTs sub–studies and 7 observational studies for a total of 219952 patients. DOACs patients have lower risk of ischemic stroke; Odds Ratio (OR) 0.65 (95%IC 0.48–0.98). Both SE and VTE/PE did not significantly differ between the two groups OR 0.61 (95%IC 0.26–1.42) OR 0.49 (95%IC 0.22–1.07), respectively. All safety endpoints except for overall mortality were significantly lower in the DOACs group: CB OR 0.42 (95%IC 0.27–0.66), mB OR 0.62 (95%IC 0.45–0.87), GI–B OR 0.65 (95%IC 0.45–0.95), MB OR 0.55 (95%IC 0.45–0.95). Overall mortality did not statistically differ between the two anticoagulation strategies OR 0.75 (95%IC 0.46–1.22).

Discussion

Overall DOACs may be an effective and safe option for cancer patients suffering from atrial fibrillation.
P388 OUT OF HOSPITAL CARDIAC ARREST ( OHCA) OUTCOME : ARE THERE GENDER DIFFERENCE ?
Authors: Bolognesi M , Bricoli S , Pelizzoni V , Rossi L , Biagi A , Ferraro S , Aschieri D
Published: May 2023

Background

Sudden cardiac death ( SCD) from cardiac arrest ( SCA) represents 25% out of all deaths. Despite the advance in resuscitation and prevention of SCA, out of hospital arrest ( OHCA) accounts only a 10 % of survival . Coronary artery disease is the major underlying etiology . Females have lower incidence of SCD. However data regarding OHCA outcome in female are controversial.

Methods

We considered consecutively 3124 OHCA survivors resuscitated from emergency medical System or bystander In Piacenza between from January 2013 to June 2022 and we e evaluated the etiology and outcome, considering sex and gender disparities.

Results

Out of 3124 SCA occured in 10 years, 1371(43%) were females with average age 82 ±12 years and 1753 ( 57%) males with average age 75 ±14 years ( p<0,0001) . The survival of our population was 10% with better results in males ( f 3,1% vs 14% m p<0,0001) 1268 females and 1482 males were treated at home. 2366 ( 75%) patients,1091 ( 46%) female and 1275 ( 54%) males,developed an initial non shockable rhythm and 323( 25%), 242 (74%) females and 81 (26%) males ventricolar fibrillation ( FV) . In the group with FV as initial rhythm, the survival was 40% . Considering etiology in the group with FV as initial rhythm, females had less incidence of coronary artery disease ( 5 f vs 48 m, p=0,004) and myocardial infarction (f 1 vs 33 m, p=0, 001). The survival wasn’t different between females and males in this group.( 22 f vs 64 m, p=0,8). Female had more frequently non shockable rhythm ( 79 % f vs 72 % m, p< 0,001) and were found more frequently at home ( 92% vs 85% p < 0,001).

Conclusions

In our OHCA population, the survival was 10% in according with literature Female were older and they had less survival, because initial rhythm registered during SCA were non shockable rhythms. They were found at home,with a delay in the first aid . This can be due to a gender disparities.
P390 CARDIAC INVOLVEMENT IN A VERY RARE CASE OF CUTIS LAXA
Authors: Pezzi L , Di Marco M , Magnano R , Verrengia E , D‘Alleva A , Forlani D , Vitulli P , Fulgenzi F , Paloscia L
Published: May 2023

The "Cutis Laxa" is a rare pathology of the connective tissue characterized by redundant skin and diffuse manifestations are identified by other organs (mainly heart and lungs). The low elasticity of the tissue is believed to be attributable to an anomalous elastin formation. Cutis Laxa is usually a genetic disease, but acquired forms have also been described. The case we describe is that of a 34 –year –old young woman with a diagnosis of Cutis Laxa acquired from the age of 15, complicated by a serious impairment at the pulmonary level in the form of marked emphysema and severe asthmatic framework. It came to our observation following the PEA type cardiovascular arrest episode during tracheostomy procedure, promptly resolved by resuscitation maneuvers according to the Als protocol. The echocardiogram was performed by the only belowocostal window by which a 4 –chamber apical projection was viewed, highlighting an anomalous position of the cardiac Hague (lower and media). The left ventricle appeared to be normal endocavity dimensions and parietal thicknesses with preserved indexes of systo–diastolic functionality in the presence of SIV discline; The right ventricle was instead slightly dilated, hypertrophic, with reduced Chinese of the free wall (nappese 18 mm), the tricuspid regurgitation was moderate with indirect signs of increased lung pressures. The echocardiographic appearance was therefore compatible with a chronic pulmonary heart frame, secondary to progressive pulmonary enfisema, and described in literature as the most fearful complication of Cuis Laxa syndrome, associated with an inauspicious prognosis and premature death.
P400 WHEN COMMON VIRAL SYMPTOMS HIDE A PERFECT STORM: A CASE REPORT
Authors: Castaldo G , Piscione M , Bianco S , Mallus M , Grigioni F
Published: May 2023

A 38 years old woman without any cardiovascular risk was admitted to the Emergency Room of our Hospital symptomatic for chest pain and dyspnoea. She referred a recent holiday in Tunisia; she was excellent health until a week before when she developed flue–like symptoms, such as fever, fatigue, abdominal pain, diarrhea and myalgia, like all the family members; the night before the access to the ER, she suffered from weakness of breath. Physical examination revealed venous engorgement and sinus tachycardia with a rate of 102 bpm, blood pressure was about 85/50 mmHg, oxygen saturation in 3L nasal cannula was 92%. The EKG showed a sinus tachycardia without any ST elevation or depression and generalized low voltage. A transthoracic echocardiography revealed circumferential pericardial effusion (3,5 cm) and both right atrium and right ventricle collapse in the setting of cardiac tamponade; EF was 35% (GLS=6%). Our first clinical suspicion was viral pericarditis with pericardial effusion (early cardiac tamponade), in consideration of the anamnestic data, the holiday in Tunisia and the general symptoms. However, an urgent pericardiocentesis was performed and one liter of sero–sanguineous pericardial fluid (exudate) was drained; therefore, there was an immediate haemodynamic improvement. A pigtail was placed using the Seldinger technique. While the first sample of cytology on sero–sanguineus pericardial fluid was negative, the second sample resulted positive for malignancy. Chest CT showed bilateral pleural effusion and a mass which was compatible with a lung cancer. Lung nodule biopsy revealed a lung adenocarcinoma. Immunohistochemistry (IHC) and molecular testing for epidermal growth factor receptor (EGFR) were positive. The patient was affected by metastatic non small cell lung cancer with EGFR mutation, which was responsive to Osimertinib. Three days later, another echo was performed showing almost complete resolution of pericardial effusion and normal LV function (EF= 55%). The patient was transferred to the Oncology Department and then discharged from the Hospital. Before starting Osimertinib, she was suggested to undergo a baseline cardiovascular stratification, EKG and transthoracic echocardiogram, three–monthly echocardiography surveillance with monitoring of GLS (which guides the management of potentially cardiotoxic drugs); close monitoring of magnesium levels is also recommended to minimize the risk of QTc prolongation.
P404 MYOCARDIAL WORK EVALUATION IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: D’Arienzo D , Sperlongano S , Iannuzzi A , Renon F , Del Giudice C , Liccardo B , Pezzullo E , Bocchetti M , Totaro A , Bianchi R , Loffredo F , Cappelli Bigazzi M , Golino P
Published: May 2023

Background

myocardial work (MW) is a novel echocardiographic technique that enables the study of left ventricular performance. It overcomes speckle tracking echocardiography (STE) limitations, dependent on afterload, which is increased in patients with severe aortic stenosis (AS). Aims: To evaluate myocardial performance indexes obtained with MW in patients with AS and indication to percutaneous aortic valve replacement (TAVR) before and after the procedure.

Methods

patients with severe AS and preserved left ventricular systolic function (LVEF) and indication to TAVR underwent complete echocardiographic evaluation the day before and within two days after the procedure. MW indices were calculated considering noninvasive systolic blood pressure (SBP) and corrected for the mean transvalvular aortic gradient.

Results

39 patients (78±6 years, 61.5% women) were enrolled, they presented at baseline preserved LVEF (59.4±8.2%) and reduced global longitudinal strain (GLS) (–16.8±3.3%). Corrected global work index (cGWI) and corrected global constructive work (cGCW) appeared elevated before the procedure, and were significantly reduced within 2 days after TAVR (cGWI –2460.5±839.7 mmHg% vs 1844.4±521.6 mmHg%, p<0.01; cGCW 3061.3 ± 796.0 vs 2277.4 ± 536.5mmHg%, p<0.01). Adjusted global wasted work (cGWW) and adjusted global work efficiency (cGWE) did not change significantly after TAVR (cGWW 262.6±151.8 vs 244.2±129.2 mmHg%, p=0.236; cGWE 90.1±4.5 vs 88.5±5.2%, p=0.079) in the overall population. In the subgroup of patients who had not developed new atrioventricular or intraventricular conduction abnormalities, cGWW also significantly decreased following TAVR (275±152.6 vs 216.3 ± 99.7 mmHg%, p=0.018), with no change in cGWE (89.7±4.8 vs 89.3±5.8%, p=0.838).

Conclusions

The reduction in cGWI and cGWC values and thus myocardial oxygen consumption in the immediate post–TAVR is attributable to the reduction in afterload. Left ventricular function abnormalities do not totally regress after the procedure, although the lack of reduction in cGWW could be partly due to the development of atrioventricular or intraventricular conduction defects. Further studies are desirable to define a role of MW in prognostic stratification of patients with severe AS.
P405 IS THE IMPAIREMENT OF MITOCHONDRIAL QUALITY CONTROL MECHANISM INVOLVED IN THE ONSET AND PROGRESSION OF AORTIC VALVE STENOSIS?
Authors: Mikus E , Savini C , Tripodi A , Pinton P , Patergnani S , Fiorentino M , Morciano G
Published: May 2023

Background and aim

Calcific aortic valve stenosis (CAVS) is the most common valvular disease and its pathogenesis is poorly understood. Despite the standards in cardiovascular surgery have improved, the establishment of new therapies is an ambitious goal. In the last 15 years, some studies tried to shed light on the dysregulation of the cellular self–digestion process in CAVS, but the results obtained remained controversial. This work aims to definitively establish the role of autophagy in CAVS, to analyze the involvement of other determinants that impact on the mitochondrial quality control mechanisms and to explore possible paths for pharmacological interventions in the treatment of this disease.

Methods

This study has been performed on 104 patients in which biological samples (cells and serum) have been analyzed using biochemical approaches and then have been correlated to clinical data. AV cusps were obtained from 59 patients unfergoing surgical aortic valve replacement from march 2018 to July 2019. Of them, 44 suffered from aortic stenosis and 15 from aortic regurgitation (control group).

Results

The two population didn‘t differ for baseline pre operative characteristics, except for male sex that was more represented in the AR group (73% vs 43% p=0.05). In CAVS patients, we unveiled a significant deficiency in mitochondrial respiration and in ATP production coupled to increase production of lactates. Moreover, mitochondrial population in the pathologic group was older, with significant alterations in biogenesis and mitophagy pathways. We are also reporting an update about the role of autophagy accompanying the calcification process and the advanced stages of the disease. In fact, we provided evidence for a rapamycin–based therapeutic strategy to eventually revert the process and to report the calcified phenotype back to the wild type one.

Conclusions

Our data suggest that the CAVS phenotype is featured by defects in mitochondrial quality control mechanisms and that autophagy is not activated enough to counteract cell death and sustain cell functions. Boosting autophagy and mitophagy from short– to long–term reverts quite all pathological phenotypes.
P407 MULTIDIMENSIONAL ASSESSMENT OF THE ELDERLY PATIENT WITH SEVERE AORTIC STENOSIS: THE ROLE OF FRAILTY IN THE CHOICE OF TREATMENT (TAVI/SAVR)
Authors: Curri F , Patetta L , Foti A , Gasparini F , Bortoluzzi C , Rossi A , Curreri C , Sergi G
Published: May 2023

Background

Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVI) are treatment options in patients with severe aortic stenosis. International guidelines suggest both traditional risk scores and a Comprehensive Geriatric Assessment (GCA) be determinants in treatment decision–making. The aim of the study is to identify the GCA parameters associated with the decision to perform TAVI instead of SAVR in elderly patients with severe aortic stenosis.

Materials and Methods

Between 2019 and 2022, 66 patients aged ≥75 years were referred to the Cardiology department of Padua Hospital for pre–operative evaluation, including CGA. The CGA consisted of functional status (Activities of Daily Living and Instrumental Activities of Daily Living Scales), cognitive impairment (Mini Mental State Examination, Montreal Cognitive Assessment), mood disorders (Geriatric Depression Scale), physical performance (Short Physical Performance Battery, 6–minute Walking Test, grip strength) and quality of life (Short–Form 36 items Health Survey).

Results

SAVR was proposed to 53% of patients and TAVI to 47%. The mean age was 78.9 ± 4.8 years and 47% were women. TAVI patients were older and had lower scores on both cognitive and motor performance tests than SAVR patients. The geriatric parameters associated with treatment decision–making between SAVR and TAVI were age (OR= 1.64, p < 0.04) and gait speed (OR= 0.09, p = 0.05).

Conclusions

Therapeutic decision–making in elderly patients with severe aortic stenosis is not only influenced by age, but also by a frailty index, gait speed. This could become a simple, quick and inexpensive routine test to effectively stratify patients.
P409 MYOCARDITIS OR RHABDOMYOLYSIS WITH MYOCYTE NECROSIS?
Authors: Cherubini S , Appella M , Mattaroccia G , Castelli F , De Luca L , Gioffré L , Ciolli A
Published: May 2023

Rhabdomyolysis is a clinical syndrome involving skeletal muscle tissue characterized by muscle weakness, myalgias and increased creatine phosphokinase (CPK) levels, usually 5 times up the normal limit. During rhabdomyolysis troponin (TNI) may be released due to mismatch between oxygen supply and demand, cytokine and endotoxin toxicity, presence of heterophile antibodies that cause false positive results and cross–reactivity between TNI isoforms produced by skeletal muscle and TNI isoforms produced by cardiac muscle. The triggering causes are multiple and include viral infections and genetic pathologies involving skeletal muscles. Genetic mutations of filamin C can cause myofibrillar myopathies, a heterogeneous group of neuromuscular disorders characterized by myopathy involving proximal and distal muscles that often occur in adulthood and may be associated with cardiomyopathies. Genetic mutations of filamin C can also be found in healthy adults because some variants have a subclinical expression.

Case Report

A 34 years old man came to the Emergency Department (ED) with fever, diarrhoea, asthenia and anuria. His past medical history was characterized by 4 episodes of myocarditis (TNI value increased up to 21 ng/dl, reduced left ventricular ejection fraction to 40%) all occurring in conjunction with acute gastroenteritis. The genetic analysis, performed six months before, showed a heterozygous mutation of the gene coding for filamin C. Blood tests performed in ED showed an increase in CRP values (4.8mg/dl), in transaminases values and a modest increase in troponin values (0.96ng/dl) without electrocardiographic and echocardiographic abnormalities (ejection fraction was preserved). He was admitted to Emergency Cardiology Department with a diagnosis of myocarditis. The CPK value resulted to be 22.503 U/l (n.v. 60 –190 U/l). Cardiac MRI underlined no signs of acute myocarditis. The patient, treated with intravenous fluid therapy, after one week showed clinical improvement and normalization of CPK and TNI values.

Conclusions

in the present case the acute gastrointestinal event was the trigger of rhabdomyolysis and not of an acute myocarditis as initially erroneously interpreted, in a patient carrying a genetic mutation predisposing to myopathies. Follow–up will evaluate whether and to what extent the genetic abnormality will lead to the development of myopathy and/or cardiomyopathy.
P414 AN UNLUCKY CASE OF PNEUMOTHORAX AND CARDIAC PERFORATION
Authors: Massara M , Campanelli F , Giulia S , Josephine S , Martina P , Giada R , Lanari A , Giovagnoli A , Di Noto G , Guerra F , Casella M , Dello Russo A
Published: May 2023

Background

pacemaker (PMK) implantation is a routinary procedure although it isn’t free from complications, some of with could be life–treathing. Case report: A female 84 years old with hypertensive cardiomiopathy and atrial fibrillation on anticoagulation theraphy with Dabigatran was subjected on a pacemaker implantation (29th Sept) for sick sinus syndrome (SSS) after syncope. The day after the implantation a chest radiography showed a left–apical pneumothorax (PNX) without necessity of surgical drain (fig. 1). Few days after (3th Oct) patient showed dyspnoea, desaturation and pain on left hemithorax so a chest CT was performed with detection of massive hydropneumothorax needed surgical drain. After 5 days a check CT was performed (9th Oct) showing resolution of the PNX but documented a circumferential 30 mm pericardial effusion “worthy of cardiological reevalutation” meanwhile the patient was hemodynamically stable. At echocardiographic look there was a pericardial effusion of 15 mm. After the re–evalutation of the CT imeges by a cardiologist, in the suspicion of myocardial perforation, patient were centralized in a cardio–surgery center. Transesophageal echocardiography evidenced a pericardial effusion of 19 mm with initial signs of haemodynamic impact and visualization of the lead in the percardual sac by 15 mm. The patient underwent (11th Oct) extraction of the ventricular lead in median sternotomy and epicardial reimplantation in a hybrid arrhythmological and cardiosurgery operating theater.

Conclusions

cardiac perforation and PNX are two serious but rare complication of PMK implantation with an incidence of 0,1% and 1%, but only anecdotally described together in the literature. The initial finding of PNX which was attributed the syntomatology was a confounding factor that delay the diagnosis of miocardial perforation. The unavailability of a programmer for interrogating the device didn’t allow early documentatio of the alteration of the electrical parameters. In the first CT of 3th Oct no pericardial effusion were reported but, from a retrospective analysis the images were alredy suggestive while they leave no doubts in the second radiological examination (fig 2,3).
P424 MEDIASTINAL ROUND CELL SARCOMA WITH PULMONARY ARTERY STENOSIS: CLINICAL USEFULNESS OF CARDIAC MRI IN CARDIO–ONCOLOGY
Authors: Canale M , Bisceglia I , Gallucci G , Turazza F , Camilli M , Russo G , Lestuzzi C , Paccone A , Fiscella D , Maurea N , Bucciarelli Ducci C , Baldi G , Casolo G , Camerini A
Published: May 2023

Case description: a previously healthy 26–year–old man presented with dyspnea on exertion and dry cough. CT scan revealed a large mediastinal mass with displacement of great vessels and trachea and pericardial effusion. Cardiac MRI showed the huge mediastinal mass, literally leaning on the heart with signs of compression of the pulmonary artery (Figure 1) with the typical D–shape of inter ventricular septum. Pericardial effusion did not compress the RV due to high intraventricular pressure. At baseline echo the mass simulated pulmonary artery stenosis as a consequence of pulmonary artery “ab extrinseco” compression. Surgical biopsy showed Ewing sarcoma lately redefined into undifferentiated round cell sarcoma so the patient started chemotherapy with VAI (vincristine, adriblastine, and ifosfamide) x6 followed by maintenance etoposide and ifosfamide (no anthraciclines for risk of cardiac toxicity). After induction phase MRI showed a partial response to treatment; mediastinal mass further reduced at the end of maintenance (Figure 2). Pericardial effusion disappeared and peak velocity of pulmonary artery went back to normal level at echo. Our patient underwent surgery with en–block removal of mediastinal mass with pericardium and anonymous vein and partial pulmonary upper left lobe resection with R0 resection. Pathology report confirmed an undifferentiated round cell sarcoma (possible embryonal origin, FISH analysis for EWS/FUS genes and 12p negative). Adjuvant mediastinal radiotherapy was delivered. The patient is alive without disease recurrence at one–year follow–up.

Conclusions

cardiac MR offer great tissue characterization (differential diagnosis between malignant and benign masses) inside/outside the heart. CMR is non–invasive/non radiation and ideal technique for surgery indication and follow–up imaging.
P432 ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK IN PATIENTS WITH NEPHROLITIASIS: A 10–YEAR PROSPECTIVE STUDY
Authors: Giani A , Macchi F , Caletti C , Comellato G , Lenzi S , Pianegonda M , Postinghel D , Castellucci F , Vecchini F , Chiarini M , Bugnola S , Zamboni M , Fantin F
Published: May 2023

Nephrolithiasis is frequently associated with several cardiovascular diseases, and the pathophysiological connection may rely on some common risk factors. In fact, systemic inflammation, promoting oxidative stress, may lead to arterial wall stiffening (which is considered an independent predictor of cardiovascular risk); however, the same mechanism may also play a role in Randall’s plaques deposition, which is a predisposing step to nephrolithiasis. This study aims to examine the correlation between arterial stiffness and nephrolithiasis, exploring its trend across aging. 82 patients (mean age 45±13 years, 36 males) referred to Geriatrics and Nephrology Outpatient Clinic were prospectively enrolled: at baseline and after 10 years they underwent a clinical evaluation (with particular focus on cardiovascular events and risk factors), and arterial stiffness measurement, obtaining carotid–femoral Pulse Wave Velocity (PWVcf) by arterial applanation tonometry. 66 patients were diagnosed with nephrolithiasis, whereas the remaining 16 formed the control group. At baseline, compared to the control group, patients with nephrolithiasis showed higher systolic blood pressure and PWVcf (128±18 vs 117±16 mmHg, p 0.02 and 7.78±1.53 vs 6.50±1.13 m/s, p 0.001 respectively). After 10 years, patients with nephrolithiasis (p 0.001), but not patients without (p 0.081), had a significant raise in PWVcf, as compared to the baseline evaluation (10.64±3 vs 7.78±1.55 m/s); this trend was confirmed even after adjustment for age and sex. In a backward regression model, considering PWVcf variation over the follow up years (ΔPWVcf) as dependent variable, and age, sex, follow up years, Δ mean arterial pressure, Body Mass Index, hypertension and nephrolithiasis as independent variables, nephrolithiasis was proved to be the only significant predictor of ΔPWVcf, accounting for 6.9% of the variance (p 0.027). In conclusion, the present study outlines an increased cardiovascular risk in patients affected by nephrolithiasis, which is represented by higher baseline PWVcf and wider increase in ΔPWVcf within 10 years. These findings endorse a comprehensive evaluation in subjects with nephrolithiasis, moving beyond the nephrological condition, and considering the patient’s cardiovascular risk profile, to identify, to prevent or to treat any possible organ damage.
P434 PAY ATTENTION TO PARA–AORTIC LYMPH NODES: A PITFALL IN ECHOGRAPHIC ABDOMINAL AORTIC ANEURYSM DIAGNOSIS
Authors: Natale F , Loffredo F , Molinari R , Covino S , Limatola M , De Luca L , Mollo N , Alfieri R , Pezzullo E , Cimmino G
Published: May 2023

A 65–year–old woman was scheduled for coronary angiography during the pre–surgery evaluation because of an abdominal aortic aneurysm (AAA) detected at ultrasound (Figure). The patient referred worsening dyspnoea and asthenia in the last few months, associated with atypical chest pain. Because of these symptoms and taking into account that AAA patients are very high cardiovascular risk, exclusion of coronary artery desease semmed appropriate. At admission, patient showed enlarged lymph nodes at cervical and inguinal region. In the suspicion of a malignant cancer, a contrast enhanced comupter tomography was scheduled, showing an increase in para–aortic, inguinal, cervical and maxillary lynph nodes size in absence of the AAA (figure). After blood tests and haematologic consultation, a final diagnosis of chornic myeloid leukaemia was made. The echo–colour doppler is the first line imaging test for diagnosis of AAA. However, in some cases it might be not sufficient. Para–aortic lymphadenopathy should be considered as a possible pitfall in the differential diagnosis of abdobinal aortic aneurysm.
P437 HEART AND RHEUMATOLOGICAL DISEASE: A PICTURE OF ACUTE HEART FAILURE
Authors: D’ Elia D , Rispoli A , Coppola F , Loria F , Di Feo F , Nigro E , Alfano A , Vecchione C , Galasso G
Published: May 2023

Systemic sclerosis is a connective tissue disease characterized by endothelial dysfunction, hyper reactivity of fibroblasts and immunity abnormality in both humoral and mediated cells. Clinically, in addition to the typical skin involvement, mainly the face and fingers, is frequent involvement of lungs, heart and kidneys. Cardiac involvement, in combination with lung involvement, is considered to be the most important determinant of the prognosis of these patients. Cardiac involvement occurs in 15– 35% of cases but in autopsy surveys the incidence reaches 80%. The case we present concerns a woman of 65 years, admitted in December at the Department of Cardiology of our AOU for an episode of low–output heart failure with epigastralgia, sweating, and breathlessness. The cardiological history was almost silent; instead, it presented a history of chronic thyroiditis and a recent infection with SARS COV 2. The objective examination presented hypokinesis of basal pulmonary fields and pitting edema. The blood tests showed an increase in myocardial necrosis, BNP, creatininemia and inflammatory indices (VES, PCR, beta 2 microglobulin, ferritin, fibrinogen), normocytic normochromic anemia, hypogammaglobulinemia, hyperuricemia and proteinuria and hematuria. The echocardiogram showed severe biventricular dysfunction and moderate–grade mitral insufficiency. A coronary examination was performed that showed epicardial coronary vessels free from significant injury. The cardiac magnetic resonance showed a widespread late enhancement subendocardial of the ventricular and atrial chambers with non–vascular distribution suggestive of pathology on an autoimmune basis. Upon closer examination, multiple small telangiectasias were observed in the face, slight hyperpigmentation of the chest and back, and swelling of the hands. The antibody panel showed positivity of ANA and anti Scl70. The patient was thus addressed to a multi–specialist management in which therefore cardiologist and rheumatologist compare and support the treatment of this pathology with the goal of reducing the high mortality and morbidity that characterizes systemic scleroderma with cardiac involvement.
P438 DIABETES MELLITUS AND HEART FAILURE: A DANGEROUS ASSOCIATION
Authors: Iulianella R , Schirripa V , Perna S , Sciahbasi A , Renda M , Romano C , Castro A , Granatelli A
Published: May 2023

Introduction

Diabetes mellitus is a frequent co–morbidity in heart failure patients reaching a prevalence of about 35% and patients with diabetes mellitus are twice as likely as non–diabetics to develop heart failure. The presence of diabetes is associated with higher rates of cardiovascular morbidity and mortality. In recent years, the introduction of remote monitoring systems has allowed for more careful management of them, although there are no large studies demonstrating their effectiveness in terms of improving prognosis. The aim of our study was to evaluate the prognosis of patients with diabetes mellitus and heart failure undergoing remote monitoring.

Methods

All patients undergoing device implantation for heart failure in our Center were recruited into the study, and the incidence of events (new hospitalizations or hospitalizations) during the period from January 1, 2021 to December 31, 2021 was assessed. Patients were monitored, and direct telephone contact or contact with one of the family members was made for all of them. Data on clinical characteristics and drug therapy were recorded.

Results

A total of 240 patients (73±11 years, 81% male) of whom 74 were diabetic (73±11 years, 87% male) and 166 were nondiabetic (73±10 years, p=0.82, 80% male, p= 0.198) were enrolled in the study. The two groups had no statistically significant differences in terms of clinical characteristics (such as ejection fraction, NYHA class, presence of anemia, rate of wide QRS, or rate of defibrillator implantation) except for a higher incidence of coronary artery disease in diabetic patients (70%) and multivessel coronary disease (67%) than in non–diabetic patients (57% coronary artery disease p= 0.05, and 46% multivessel disease p= 0.02). There were no significant differences in terms of drugs with the exception of higher use of statins in the group of diabetic patients (84%) compared to non–diabetics (64%, p= 0.002). Diabetic patients had almost 4 times higher mortality rates than non–diabetic patients (22% and 6% respectively, p< 0.0001). Differently, hospitalization rates were not significantly different among diabetic patients (24%) compared with nondiabetic patients (28%, p= 0.58).

Conclusions

The association of diabetes mellitus and heart failure represents a dangerous combination associated with an increased incidence of death. Therefore, clinical monitoring strategies and intensity of drug therapy should be particularly implemented in diabetic patients.
P442 BASELINE ALBUMINURIA AND HEART FAILURE DURING HOSPITALIZATION WITH ACS AND LONG–TERM DEATH RISK. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE
Authors: Berton G , Palmieri R , Cavuto F , Cordiano R , Merotto D , Bagato F , Dal Bo A , Preti G , Mahmoud H
Published: May 2023

Background

Both albuminuria and heart failure are known predictors of poor outcomes in patients with acute coronary syndrome (ACS). Purpose: To assess the combined effect of albuminuria and heart failure on the long–term mortality risk prediction 24 years after ACS.

Methods

The present analysis includes 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization. Patients were followed for 24 years or until death.

Results

Virtually all patients completed the follow–up, representing 7066 person–years. Patients‘ mean age was 66 ± 12 years, 70% were males and 482(82%) had died during follow–up. Compared to those who survived, dead patients, were significantly different for many clinical features, they had baseline HF and microalbuminuria more frequently (39 % vs. 5% p<0.0001) and (24 % vs. 7% p<0.0001), respectively, and they showed significantly higher values of 3rd–day albumin–creatinine ratio (ACR) (p<0.0001). The unadjusted Cox regression analysis showed that the presence of either albuminuria or HF at admission with ACS is independently associated with long–term mortality (HR:1.84; 95%CI 1.54–2.20; p<0.0001) and (HR:2.48; 95%CI 2.05–2.98; p<0.0001), respectively.

Results

were similar using the fully adjusted model. Moreover, patients who suffered from both pathologies were at higher risk of death than patients with either.

Conclusions

The Presence of heart failure and albuminuria during ACS is independently associated with long–term mortality with an additive effect.
P445 HEART RATE VARIABILITY AND HYPNOTIC COMMUNICATION
Authors: Cornara S , Somaschini A , Astuti M , Benigni M , Sartelli S , Donka P , Bacino L , Scaglione M , Bellone P
Published: May 2023

Background

Heart rate variability (HRV) can be influenced by the autonomic nervous system and several studies showed that hypnotic communication could modulate the autonomic nervous system. In particular, HRV is related to the activity of the vagus nerve and an increment of the vagal activation has been associated to an improvement in prognosis. It is, however, unclear whether hypnotic communication could influence HRV. Aim of the study The aim of the present study is to evaluate the impact of hypnotic communication on HRV.

Methods

Seven volunteer were included in the present study (5 M/2F) from June to August 2022. Each one of the volunteer underwent 1 hour of ECG registration in normal condition, 30 minutes during depth hypnotic communication and 1 hour after the hypnotic communication. The hypnotic communication was performed via 30 minutes of neutral depth hypnosis; the parameter considered for HRV evaluation were sNN50 (dec), SDNN(ms), SDNNi, RMS SD and the triangular index, analyzed throughout the dedicated software Pathfinder SL (V 1.9.3.13414, spacelabs healthcare Ltd 2021, WA, USA). The variation of each parameter was evaluated by Student T test.

Results

There was no statistically significant variation of sNN50 (dec), SDNN(ms), SDNNi, RMS SD among the normal condition, the hypnotic communication and the post hypnotic communication. There was a statistically significant variation of the triangular index (Fig.1) and of heart rate (Fig. 2).

Conclusion

Hypnotic communication could increase HRV, assessed as triangular index (the index suggested by European society of cardiology (ESC) and American college of cardiology (ACC) to measure HRV). The absence of a statistically significant variation between the normal condition and hypnotic communication could be explained by the deep modification in the respiratory pattern and heart rate induced by hypnotic communication; those parameter could mask the increment in the vagal activity due to hypnotic communication, that is unmasked in the post–hypnotic period in which the heart rate and the respiratory return to normal value. Further studies are needed to understand whether the increment in HRV due to hypnotic communication could show an improvement in prognosis in cardiopathic patients, as it has been demonstrated for the HRV increment due to muscular training.
P446 INDEPENDENT EFFECTS OF TYPE 2 DIABETES AND OBESITY ON CARDIOPULMONARY PERFORMANCE IN SUBJECTS AT HIGH CARDIOVASCULAR RISK
Authors: Nesti L , Pugliese N , Armenia S , De Biase N , Balletti A , Tricò D , Natali A
Published: May 2023

Background

Both obesity and type 2 diabetes (T2D) are associated with effort intolerance and heart failure. Since the two conditions often coexist and overlap, their distinct effect on cardiopulmonary performance remains to be elucidated.

Methods

Patients at high cardiovascular risk, free from any clinical or instrumental evidence of heart disease, with a wide range of body mass index (BMI) values, and with or without T2D underwent combined echocardiography–cardiopulmonary exercise test (eCPET). Patients were divided in T2D and controls, as well as in lean (BMI <25 kg/m2), overweight (BMI 25 – 30 kg/m2), and obese (BMI >30 kg/m2).

Results

A total of 206 patients was analyzed, divided in 109 patients with T2D and 97 controls. Increased BMI is associated with multiple cardiovascular dysfunctions including chronotropic insufficiency, subclinical systolic dysfunction (reduced global longitudinal strain, GLS), and impaired systolic reserve, achieving significantly lower oxygen uptake and workload. Obesity is associated with reduced lung volumes and mild ventilatory alterations at peak exercise, irrespective of diabetes. T2D patients showed more frequent LV concentric remodeling, worse systolic and diastolic performance at rest with diminished ameliorations during exercise, and worse sympatho–vagal balance as expressed by the higher prevalence of chronotropic insufficiency and delayed heart rate recovery. Nonetheless, when divided in BMI subclasses, the differences between T2D and controls were only evident among lean subjects. In fact, while no difference between T2D and controls was evident among overweight and obese patients, lean individuals with T2D display worse cardiopulmonary performance than lean controls, achieving lower workload and lower VO2peak, revealing systolic dysfunction (lower GLS) and higher LV filling pressures (E/e’). Unlike glycated hemoglobin, strong linear relationships were proven between fat mass and oxygen uptake, workload, systolic, and diastolic indices.

Conclusions

T2D affects LV dimensions and geometry, systo–diastolic functions, autonomic balance, cardiopulmonary capacity, and exercise tolerance, independently of the presence of obesity. Nonetheless, increased BMI is an even more powerful independent negative determinant of systolic function, autonomic balance, and effort tolerance. These early alterations might partly explain the increased risk of developing heart failure associated with diabetes and obesity.
P447 TRANSCATHETER PACING SYSTEM IMPLANT: IS IT A MATTER OF GENDER?
Authors: Barletta V , Lepone A , Tamborrino P , Parlato A , Parollo M , Mazzocchett L , Sbragi S , Canu A , Di Cori A , De Lucia R , Segreti L , Bongiorni M , Zucchelli G
Published: May 2023

Background

The use of a leadless pacing system, like Micra Transcatheter Pacing System (M–TPS), is nowadays a convincing alternative to transvenous pacemaker. PURPOSE: The study aimed to investigate feasibility and long–term electrical outcomes of M–TPS implant in a real–world population and to estimate sex differences in leadless pacing.

Methods

All patients undergone M–TPS implantation in our Institution from May 2014 to October 2022. Device follow–up was scheduled at discharge, after 1 month from procedure and then every 6 months. Electrical performance was checked. Major complications were defined as life– threatening events, requiring surgical intervention or any event causing significant hemodynamic instability or resulting in death. Study population was divided between genders to analyze potential differences and those observed during the follow–up (FU).

Results

One hundred ninety–three consecutive patients [148 males, 76.7%, mean age 79 (IQR 73–84) years] were enrolled in the study. There were no statistically significant differences between groups for demographics characteristics (mean age at implant 79 vs 81, p=0.12), except gender. The mean FU was 12 (IQR 1–36) months, maximum 8 years. The implant procedure was effectuve in all patients and no complications were recorded. We observed no differences between groups in procedure duration [40 (IQR 30–60) min vs 40 (IQR 29–50), p=0.64], fluoroscopy time [9 (6–14) min vs 9 (7–11), p=0.81] and single device delivery (65.7% vs 65.9%, p=0.34). Electrical performance, except for pacing threshold at implantation [0.5 (IQR 0.38–0.75) V/0.24ms vs 0.38 (IQR 0.25–0.63) V/0.24ms, p=0.02), was similar between groups at discharge [pacing threshold 0.38 (IQR 0.38–0.63) V/0.24 ms vs 0.38 (IQR 0.25–0.55) V/0.24 ms, p=0.30; impedance 650 (IQR 560–760) Ohm vs 675 (IQR 580–780) Ohm, p=0.71; R wave amplitude 10.1 (IQR 7–16.2)mV vs 9.5 (IQR 7–14.45) mV, p=0.71] and during the FU [pacing threshold 0.5 (IQR 0.38–0.63) V/0.24 ms vs 0.5 (IQR 0.38–0.5) V/0.24 ms, p=0.11; impedance 570 (IQR 490–630) Ohm vs 580 (IQR 510–640) Ohm, p=0.46; R wave amplitude 11.5 (IQR 7.8–15.7)mV vs 12.7 (IQR 9–18) mV, p=0.26].

Conclusion

Leadless pacing therapy is a feasible and safe alternative to conventional pacemakers with comparable electrical performance and outcomes even during a long–term FU. No differences were found between genders making it a good option especially in women who are often considered fragile in surgical procedures.
P453 RECURRENT SYNCOPAL EPISODES IN A YOUNG PATIENT: TO IMPLANT THE PM OR NOT TO IMPLANT THE PM, ALWAYS A DIFFICULT DECISION!
Authors: Scapinelli M , Guerra A , Boccedi M , Caputi A , Bagni E
Published: May 2023

Introduction

Syncope represents one of the main causes of access to the Emergency Department and outpatient visits, accounting for up to 13% of hospital admissions. Although usually benign, syncopal episodes are a source of considerable distress for the patient and family members, particularly when dealing with otherwise healthy young patients. We report the case of a young patient who presented with recurrent syncopal episodes with important psychological and professional implications.

Case Report

A 33–year–old man comes to our Syncope Unit with a long history of repeated syncopal episodes preceded by fleeting warning signs, sometimes with minor trauma, occurring during daily activities, in conjunction with minor injuries or post–voiding but never during exertion. The patient began to limit his activities for fear of syncope and was inhibited from driving work vehicles and performing tasks at height. The various cardiological examinations performed over the years were normal. The study of syncope evoked a syncope with a 13 sec pause on carotid sinus massage while the Head–up Tilt Test was negative. A Loop Recorder (ILR) was then implanted to correlate the syncopal episodes with any slowing or pathological pauses in the heart rhythm. At remote monitoring of the ILR, an asystole of about 16 seconds symptomatic for syncope was documented. In relation to the recurring syncopal episodes, the important professional limitations imposed on the patient, as well as at the explicit request of the patient himself, despite the lacking scientific evidences availables, we proceeded to implant a dual–chamber pacemaker with a frequency response algorithm. In the 4 years after the implant there were no syncopal recurrences and the patient resumed his normal daily and professional activities with a marked improvement also in his psychological setting. After 2.5 years, however, the ventricular lead broke and required its extraction and reimplantation.

Conclusions

The decision to implant the device was not easy, precisely in relation to the possible complications over the years, but this allowed the patient to resume a normal private and professional life. However, an accurate risk–benefit assessment is required, sharing the "weight" of the decision with the patient and his family.
P459 A SUDDEN STROKE AFTER CORTICOSTEROID THERAPY FOR HEART TRANSPLANT REJECTION
Authors: Zanella L , Toscano G , Fabozzo A , Tessari C , Pradegan N , Gerosa G
Published: May 2023

After heart transplant, the immune system of recipient could recognise the transplanted heart as foreign and reject it. To avoid it, immunosuppressive therapy is used, but sometimes it is not enough, in these cases high doses of immunosuppressors must be used. If the rejection is cellular mediated the main therapy is high corticosteroid therapy. A 63–years–old woman presented one year after heart transplant, due to acute cellular mediated graft rejection, detected at follow–up biopsies. High dose corticosteroid intravenous therapy was started. She had history of Chron’s disease treated by monoclonal therapy. Electrocardiography at admission showed a sinus rhythm. In the night of the second day of steroid therapy, she suddenly experienced facial asymmetry and left arm and leg hyposthenia. A cerebral angiographic scan was immediatly performed and it revealed a thrombotic occlusion of right internal carotid artery, from right carotid bifurcation to right internal carotid syphon (Figure 1). A few minutes later a percutaneous neuroradiological transcatheter thrombectomy was successfully performed and the patient had a full recovery without any neurological permanent disfunctions. The protocol for acute cellular mediated hear transplant rejection in our centre is corticosteroid intravenous therapy 1 gram per day for three days, followed by corticosteroids orally 1mg/kg on the fourth day, subsequently gradually reduced of 5mg per day till a dose of 5mg per day that we use to maintain as long–term prophylaxis. Three days after the stroke, the patient experienced high frequency atrial fibrillation, never detected before. She underwent a transoesophageal echocardiography to evaluate the feasibility of an electric cardioversion, but a thrombus in the left atrial appendage was firstly discovered. Therefore, the patient was treated with oral anticoagulants and beta blockers, at the follow–up echocardiography the thrombus was disappeared, and she didn’t experience any other cerebrovascular embolisms. The link between the high dose corticosteroid therapy and the stroke, in a patient with a chronic inflammatory bowel disease and maybe unknow paroxysmal atrial fibrillation, could showed that this therapy could be a trigger for rapid thrombus formation and cerebral embolisms in these patients. This highlights the importance of in hospital monitoring of this patients during high dose steroid therapy, combined to proper diagnosis and treatments of worst complications.