bluuebunny/crossref_metadata_2025 huggingface dataset:
337 RECLASSIFICATION OF GENETIC VARIANTS WITH PREVIOUSLY UNRECOGNIZED PATHOGENIC ROLE IN PATIENTS WITH INHERITED CARDIAC CONDITIONS
Authors: Manzoni Martina , Sommariva Elena , Colombo Gualtiero , Biondi Maria Luisa , Mushtaq Saima , Farina Stefania , Roberto Maurizio , Pizzamiglio Francesca , Casella Michela , Pompilio Giulio , Novelli Valeria
Published: December 2022

Introduction

In the last years, genetic testing for inherited cardiac conditions (ICCs) is expanded and evolved at an incredible rate. This tool may inform treatment options and lifestyle choices to avoid arrhythmia triggers. Furthermore, identifying the genetic underpinning of the disorder improves risk assessment for asymptomatic or pre-symptomatic family members.

However, despite the large numbers of disease-causative genes identified in the last years, only 60% of the patients with a clinical diagnosis of ICCs carry a pathogenic or likely pathogenic variant. The remaining 40% of the cases have an inconclusive or ambiguous test caused by negative results or mainly by the identification of one or more variants of unknown significance (VUS). In this case, the test results are uninformative and clinically irrelevant, increasing uncertainty about medical management.

Purpose

We investigated whether a periodic re-evaluation of the detected VUS, using the American College of Medical Genetics and Genomics (ACMG) criteria, may impact the clinical setting of patients with suspected ICC and their family members.

Methods

We reevaluated 306 consecutive probands with suspected ICC undergoing genetic testing by next-generation sequencing using the Illumina TruSight Cardio Sequencing panel, from 2017 to 2021.

Results

Thirty-five percent of patients carried at least one variant in a gene associated with the phenotype. Of these, 94 had been previously classified as VUS and were not considered clinically actionable. After an average time of 36 months, they were reevaluated and 26.6% of the VUS were reclassified. In particular, 1 was downgraded to Benign and 24 were upgraded to Likely Pathogenic (16) or Pathogenic (8). According to the different phenotypes, the reclassification rate was 45.8% in Hypertrophic cardiomyopathy, 33.3% in Dilated cardiomyopathy, 27.3% in Arrhythmogenic cardiomyopathy, 12.5% in Brugada syndrome, and 50% in Long QT syndrome patients. This reclassification process allowed to recategorize 24 probands as clinically and molecularly diagnosed and to extend the genetic screening to their at-risk family members.

Conclusions

Given the extent of the clinical impact that genetic testing can have, these findings suggest that a periodic reevaluation of genetic test results, particularly VUS, should be a mandatory step in the ICC diagnostic workflow.
588 EXPLORING THE IMPACT OF SEVERE SECONDARY TRICUSPID REGURGITATION ON REST AND EXERCISE HEMODYNAMICS OF PATIENTS WITH HEART FAILURE AND A PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Baratto Claudia , Caravita Sergio , Corbetta Giorgia , Soranna Davide , Zambon Antonella , Parati Gianfranco , Badano Luigi P , Muraru Denisa
Published: December 2022

Background

Both secondary tricuspid regurgitation (STR) and heart failure with preserved ejection fraction (HFpEF) are relevant public health problem in the elderly population, presenting with potential overlaps and sharing similar risk factors. However, the impact of severe STR on hemodynamics and cardiorespiratory adaptation to exercise in HFpEF remains to be clarified.

Aim

To explore the impact of severe STR on exercise hemodynamics and cardiorespiratory adaptation in HFpEF.

Methods

We analyzed invasive hemodynamics and gas-exchange data obtained at rest and during exercise from HFpEF patients with severe STR (HFpEF-STR), compared with 1:1 age, sex and body mass index matched HFpEF patients with mild or no STR (HFpEF-controls).

Results

13 HFpEF-STR (mean age 72 years, 85% females, BMI 28 Kg/m2) and 13 age-, sex-, and BMI-matched HFpEF-controls patients were included. HFpEF-STR had higher (p<0.01) right atrial pressure than HFpEF-controls both at rest (10±1 vs 5±1 mmHg) and during exercise (23±2 vs 14±2). During exercise, pulmonary artery wedge pressure as well as left ventricular transmural pressure increased less in HFpEF-STR than in HFpEF-controls (interaction p-value<0.05). Similarly, cardiac output (CO) increased less in HFpEF-STR than in HFpEF-controls (interaction p-value<0.05) during exercise, due to the lower stroke volume (SV) values both at rest (49±8 vs 78±8, p<0.05) and at peak exercise (55±9 vs 92±9 mL, p<0.05). Despite these differences, the two groups of patients laid on the same oxygen consumption isophlets because of the increased peripheral oxygen extraction in HFpEF-STR (p<0.01). An inverse relationship was found between pulmonary vascular resistance and SV, both at rest and at peak exercise (R2=0.12 and 0.19, respectively).

Conclusions

Severe STR complicating HFpEF impairs SV and CO reserve, leading to pulmonary vascular de-recruitment and relative left heart underfilling, mining the typical HFpEF pathophysiology.

Exercise pathophysiology of secondary tricuspid regurgitation (STR) in heart failure with preserved ejection fraction (HFpEF).
479 ECHOCARDIOGRAPHIC ESTIMQTION OF CQRDIQC POWER IN CARDIOGENIC SHOCK: CORRELATION WITH INVASIVE HEMODYNAMICS AND PROGNOSTIC IMPLICATIONS.
Authors: Boretto Paolo , Frea Simone , Gravinese Carol , De Lio Giulia , De Ferrari Gaetano Maria
Published: December 2022

Background

Cardiac power output (CPO) is currently used for cardiogenic shock patient's evaluation including shock phenotyping, mechanical circulatory support selection and weaning algorithms. Despite its remarkable prognostic role, CPO use is limited by the need for a Swan-Ganz catheter. Aim of this study was to evaluate the feasibility and accuracy of echocardiographic estimation of CPO compared to RHC-derived measurement. We also aimed to investigate the prognostic role of non-invasive CPO in the specific setting of cardiogenic shock.

Methods

We performed blinded echocardiography in all consecutive heart failure (HF) patients undergoing RHC as a part of their evaluation at Cardiology Department of Città della Salute e della Scienza University hospital in Turin. Echocardiographic CPO was calculated as: (cardiac output * mean arterial pressure)/451. eCPO was subsequently assessed in 80 patients admitted for cardiogenic shock in cardiac ICU of centers participating at the Altshock registry during the first 24 hours from shock onset. Primary endpoint was in-hospital MACE (death, heart transplantation or LVAD implantation during the index hospitalization).

Results

103 HF patients (57.6 ± 11.3 years, 63% males, median left ventricle ejection fraction 25% [IQR 20-51%]) were included in the derivation cohort. Mean invasive CPO was 0.72 ± 0.27 W, while eCPO was 0.74 ± 0.27 W. eCPO showed a good correlation with invasive CPO (Pearson r: 0.96, p<0.001). In the Altshock registry cohort (80 patients, 81% males, mean age 62.5 ± 14.4 years, in-hospital mortality 31.4%) eCPO <0.6 (HR 2,48 [95% CI 1,06 - 5,85], p=0,04), hemoglobin (p=0.005), systolic blood pressure (p=0.05) and SCAI class (p=0.02) were associated with increased risk of in-hospital MACE at univariate analysis. Echocardiographic CPO <0.6 remained significantly associated with MACE also after adjustment at multivariate Cox analysis (HR 2,87 [95% CI 1,03 - 7,96] p=0,043).

Conclusion

Echocardiographic estimation of CPO (eCPO) is feasible and showed a good agreement with invasive CPO. Reduced eCPO during the first 24 hours was associated with increased in-hospital MACE in cardiogenic shock patients.
500 HEMODYNAMIC FORCES AS PREDICTORS OF CARDIAC REMODELING AND OUTCOME IN PATIENTS WTH HEART FAILURE WITH REDUCED EJECTION FRACTION TREATED WITH SACUBITRIL/VALSARTAN
Authors: Castiglione Vincenzo , Fabiani Iacopo , Pugliese Nicola Riccardo , Pedrizzetti Gianni , Tonti Giovanni , Chubuchny Vladislav , Taddei Claudia , Gimelli Alessia , Del Punta Lavinia , Balletti Alessio , Masi Stefano , Cameli Matteo , Emdin Michele , Giannoni Alberto
Published: December 2022

Aims

To evaluate the predictive value of echo-derived hemodynamic forces (HDF) compared to other echocardiographic, biohumoral and cardiopulmonary parameters on: a) angiotensin receptor-neprilysin inhibition (ARNI) response to 6-months treatment; b) cardiovascular events at follow-up.

Methods

Eighty-nine consecutive patients with heart failure with reduced ejection fraction (HFrEF) performed clinical, laboratory, ultrasound, and cardiopulmonary exercise testing. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and/or ≥10% increase in left ventricle ejection fraction over 6 months were considered responders to ARNI. We conducted a clinical follow-up for the composite endpoint of HF-related hospitalization, new-onset atrial fibrillation and cardiovascular death.

Results

Out of 89 patients, 45 (51%) were ARNI-responders. Among several variables evaluated at baseline, only the whole cardiac cycle left ventricle strength (wLVS) calculated from HDF was found to be higher in responders (4.4±1.3 vs 3.6±1.2; p=0.01) and the only independent predictor of ARNI-response at multivariate logistic regression analysis (odds ratio 1.36; 95% confidence interval 1.10–1.67; p=0.004), with good accuracy at receiver operating characteristic (ROC) analysis (optimal cut-off ≥3.7%; area under the curve [AUC]=0.736, 0.607–0.840; p<0.0001). During a median follow-up of 33 months (interquartile range 23-41), 6-month wLVS increase (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off ≥0.5%; AUC=0.811, 0.69–0.90; p<0.0001), stratified prognosis (log-rank p<0.0001) and remained an independent prognostic predictor for the composite endpoint (hazard ratio 0.76, 0.61–0.95; p<0.01), after adjusting for all clinical, functional and conventional echocardiographic parameters (Figure).

Conclusions

HDF analysis helps in predicting ARNI-response and optimizing follow-up and medical/device decision-making in patients with HFrEF.
1111 INTACT FIBROBLAST GROWTH FACTOR 23 TESTED BY A FULLY AUTOMATED ASSAY: CLINICAL CORRELATES AND PROGNOSTIC VALUE IN CHRONIC SYSTOLIC HEART FAILURE
Authors: Vergaro Giuseppe , Castiglione Vincenzo , Del Franco AnnaMaria , Gentile Francesco , Aimo Alberto , Saponaro Federica , Masotti Silvia , Prontera Concetta , Fusari Niccolò , Emdin Michele , Passino Claudio
Published: December 2022

Background and aims

Fibroblast growth factor-23 (FGF23) has been associated with left ventricular (LV) hypertrophy, fibrosis, and heart failure (HF). We aimed to investigate the clinical correlates and prognostic value of intact FGF23 (iFGF23) in HF patients.

Methods

Patients with systolic HF (left ventricular ejection fraction – LVEF <50%) were prospectively enrolled. iFGF23 was tested with a fully automated immuno-chemiluminescent assay. Patients were divided into iFGF23 tertiles and followed-up for all-cause death, cardiac death, and the composite of all-cause death and HF hospitalizations.

Results

We enrolled 150 patients (82% males; median age 65 years). First, second, and third iFGF23 tertiles were <35.2 pg/mL, 35.2-50.9 pg/mL, and >50.9 pg/mL. Patients in the upper iFGF23 tertile had lower LVEF (p=0.014), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP, p=0.001), and lower peak VO2 (p<0.001). Plasma phosphate, estimated glomerular filtration rate (eGFR), and LV mass index were independently associated with higher iFGF23 levels (all p<0.05). Patients in the upper tertile were at higher risk of all-cause death (p=0.001), cardiac death (p=0.001), and of the composite of all-cause death and HF hospitalizations (p=0.003). iFGF-23 was an independent predictor of all the endpoints after adjustment for age, LVEF, eGFR, and NT-proBNP.

Conclusions

Circulating iFGF23 is associated with renal dysfunction, disease severity and outcome in systolic HF.

Figure. Prognostic impact of FGF23 levels in patients with systolic heart failure (HF). In a cohort of HF patients with systolic dysfunction, higher iFGF23 levels (marker of increased cardiac fibrosis and hypertrophy) were associated with a more severe disease, as expressed by lower left ventricular systolic function, higher circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), lower oxygen consumption at cardiopulmonary exercise test and worse renal function. Moreover, iFGF23 elevation identified patients at higher risk for all-cause and cardiac mortality, and HF hospitalization.
312 VIRTUAL VISITS FOR HEART FAILURE OUTPATIENTS MANAGEMENT: 12-MONTHS EXPERIENCE DURING COVID-19 PANDEMIC PERIOD
Authors: Severino Paolo , D´amato Andrea , Prosperi Silvia , Magnocavallo Michele , Maraone Annalisa , Notari Claudia , Papisca Ilaria , Cestiè Claudia , Francia1 Aurora Labbro , Tomarelli Elisa , Myftari Vincenzo , Costi Bettina , Germanò Rosanna , Mancone Massimo , Fedele Francesco
Published: December 2022

Background

Heart failure (HF) patients are predisposed to recurrences and disease destabilizations, especially during the COVID-19 outbreak period. In this scenario, telemedicine could be a proper way to ensure continuous care. The purpose of the study was to compare two modalities of HF outpatients' follow up, the traditional in-person visits and telephone consultations, during the COVID-19 pandemic period in Italy.

Methods

We performed an observational study on consecutive HF outpatients. The follow up period was 12 months, starting from the beginning of the COVID-19 Italy lockdown. According to the follow up modality, and after the propensity matching score, patients were divided into two groups: those in G1 (n = 92) were managed with traditional in-person visits and those in G2 (n = 92) were managed with telephone consultation. Major adverse cardiovascular events (MACE) were the primary endpoints. Secondary endpoints were overall mortality, cardiovascular death, cardiovascular hospitalization, and hospitalization due to HF.

Results

No significant differences between G1 and G2 have been observed regarding MACE (p = 0.65), cardiovascular death (p = 0.39), overall mortality (p = 0.85), hospitalization due to acute HF (p = 0.07), and cardiovascular hospitalization (p = 0.4). Survival analysis performed by the Kaplan-Meier method also did not show significant differences between G1 and G2.

Conclusions

Telephone consultations represented a valid option to manage HF outpatients during COVID-19 pandemic. They were comparable to traditional in-person visits.

Key words: heart failure; virtual visits; outpatients; COVID-19.
247 HEPATIC T1-TIME, CARDIAC STRUCTURE, FUNCTION AND CARDIOVASCULAR OTUCOMES IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION UNDERGOING CARDIAC MAGNETIC RESONANCE IMAGING
Authors: Bellicini Mariagiulia , Inciardi Riccardo Maria , Di Meo Nunzia , Rondi Paolo , Cersosimo Angelica , Lupi Laura , Pagnesi Matteo , Gavazzi Emanuele , Lombardi Carlo Mario , Targher Giovanni , Farina Davide , Metra Marco
Published: December 2022

Aim

Liver damage is frequently encountered in patients with cardiovascular (CV) disease, due to congestion or metabolic dysfunction-associated fatty liver disease (MAFLD). It has been shown that liver disease is associated with worse outcomes in patients with CV disease. Nevertheless, the association of liver disease with cardiac structure and function and CV events in patients with heart failure and reduced ejection fraction (HFrEF) is poorly known.

Methods

We retrospectively enrolled consecutive patients with HFrEF undergoing Cardiac Magnetic Resonance (CMR) Imaging. In addition to standard cardiac T1-mapping, 3 regions of interest were also defined at the liver parenchyma. Patients were stratified according to hepatic T1 mapping. Linear regression analysis adjusted for demographics and clinical characteristics was performed to cross-sectionally examine the association between hepatic T1-time on CMR and measures of cardiac structure and function. The Kaplan-Meier survival and Cox regression analyses were performed to prospectively investigate the association between hepatic T1-time and the composite adverse outcome of hospitalization for HF or all-cause death.

Results

Overall, 106 HFrEF patients were included in the study (mean age 56 ± 14 years, 75% male). Mean hepatic T1-time was 558 ± 70 ms. In logistic regression analysis, left-ventricle (LV) end-diastolic volume (EDV) (p = 0.027), left atrial volume (LAV) (p = 0.015), right-ventricle (RV) EDV (p < 0.001) and RVEF (p = 0.035) were positively associated with hepatic T1-time. Over a mean follow-up of 5 ± 2 years, 32 patients (30%) experienced the composite outcome at a rate of 6.7 per 100 person-year. In Cox regression analysis, higher hepatic T1-time was independently associated with an increased risk of developing the composite outcome (adjusted-hazard ratio 1.07, 95% confidence interval: 1.01–1.12, p = 0.011). In particular, patients with a hepatic T1-time ≥558 ms had a higher risk of adverse outcomes compared to those with a hepatic T1-time <558 ms (log-rank p = 0.02).

Conclusion

Among HFrEF patients undergoing CMR, higher hepatic T1-time was significantly associated with poorer measures of cardiac size and function. Hepatic T1-time was also significantly associated with higher rates of hospitalization for HF or all-cause-mortality. This parameter may be useful to stratify HFrEF patients at risk of adverse cardiovascular outcomes.
261 IMPACT OF BASELINE KIDNEY FUNCTION ON SGLT2 INHIBITOR EFFECTS ON RENAL AND HEART FAILURE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Cavallari Ilaria , La Porta Ylenia , Maddaloni Ernesto , Appetecchia Alessandro , D´onofrio Luca , Grigioni Francesco
Published: December 2022

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce renal and heart failure (HF) events in people with and without diabetes. Although their glycemic efficacy is dependent on kidney function, it remains unclear to what extent baseline kidney function influences the magnitude of SGLT2i cardiorenal effects.

Methods

We conducted a systematic review and meta-analysis of randomized, placebo-controlled trials testing the effects of SGLT2i on renal and CV outcomes (PROSPERO registration number CRD42022325976). Efficacy outcomes, stratified by five estimated glomerular filtration rate (eGFR) categories, included progression of renal disease (as defined in each trial), a composite HF outcome (defined as CV death or hospitalization/urgent visit for HF), and all-cause mortality.

Results

Eleven trials testing five SGLT2i (empagliflozin, dapagliflozin, canagliflozin, ertugliflozin and sotagliflozin) in 77,541 participants were included. The majority of participants (39.8%) had eGFR values between 60 and 90 ml/min/1.73m2, with only 1.3% having advanced kidney disease (eGFR between 20 and 30 ml/min/1.73m2). Overall, SGLT2i reduced the risk of renal disease progression by 41% (HR 0.59, 95%CI 0.54–0.65, p<0.001) and the risk of HF outcomes by 22% (HR 0.78, 95%CI 0.73–0.83, p<0.001). Meta-regression analyses showed a significant direct relationship between baseline eGFR and the magnitude of SGLT2i renal protection (p=0.040). The greatest relative risk reduction was in participants with eGFR values ≥90 ml/min/1.73m2 (HR 0.43, 95%CI 0.32–0.58) and the smallest was in those with an eGFR between 30 and 45 ml/min/1.73m2 (HR 0.64, 95%CI 0.55–0.76). Conversely, the HF outcome showed a non-significant trend to greater benefit in participants with lower eGFR categories (p=0.086). The greatest relative risk reduction was in those with an eGFR between 20 and 30 ml/min/1.73m2 (HR 0.68, 95%CI 0.48–0.96, p=0.026) and the smallest was in those with an eGFR ≥90ml/min/1.73m2 (HR 0.87, 95%CI 0.56–1.35, p=0.52).

Conclusions

SGLT2i reduce risk of renal disease progression and HF outcomes for all eGFR subgroups. However, the opposite trends for the influence of baseline kidney function between renal and HF outcomes suggest different SGLT2i mechanisms for renal and cardiac protection.
652 SUCCESSFUL SURGICAL REPAIR OF LEFT VENTRICULAR PSEUDOANEURYSM IN A PATIENT WITH SUBACUTE ST-ELEVATION MYOCARDIAL INFARCTION
Authors: Chianese Salvatore , Capone Valentina , Salzano Andrea , Bossone Eduardo , Cocchia Rosangela
Published: December 2022

A 65-year-old man was admitted to the emergency department for abdominal pain begun 4 days before. Past medical history consisted of ischemic stroke and diabetes mellitus. Of note, he was not taking any medication. Vital signs: blood pressure 90/50 mmHg, heart rate 50/minute, respiratory rate 18/minute, body temperature 36.5°C; saturation oxygen level 93%. High-sensitivity cardiac troponin was mildly elevated (121 pg/mL). Electrocardiogram showed sinus bradycardia, Q waves with ST elevation in antero-lateral leads consistent with subacute STEMI. Transthoracic echocardiogram (TTE) revealed aneurysmatic expansion of apical left ventricular (LV) walls (ejection fraction 30%) with a large apical thrombus (35×15 mm). Coronary angiography showed complete occlusion of proximal left anterior descending artery and a critical stenosis of right coronary artery; percutaneous coronary intervention with stent implantation on right coronary artery was performed. He received triple antithrombotic therapy with aspirin, clopidogrel, intravenous heparin first and then oral anticoagulation with warfarin. During coronary care unit stay, the patient was asymptomatic and hemodynamically stable. However, a control TTE (day 6) in cardiology ward revealed the presence of pseudoaneurysm with an oval out-pouching (23 × 13 mm) from the apical aspect of LV septum, communicating with the LV chamber through a passage measuring 1.6 cm. Partially organized pericardial effusion was evident around right ventricular free wall (Figure 1). Thus, the patient was immediately transferred to the cardiac surgery department for urgent surgical repair. The LV anterior wall rupture with pseudoaneurysm was then treated with endoaneurysmectomy of the LV with dacron patch and freewall reconstruction with prolene sutures and teflon felt stripes. The patient was finally discharged 3 weeks after surgery with betablockers, ace- inhibitors, diuretics, statins and dual antiplatelet therapy with aspirin and clopidogrel. At one month follow-up visit, the patient was hemodynamically stable with acceptable functional capacity. Figure 1Modified five chamber view (a, b) and three chamber view (c, d) showing apical LV pseudoaneurysm (arrows) with moderate pericardial effusion (arrowhead); color Doppler through the passage (arrow) in 3 chamber view (d). LV, left ventricular.
691 RELATION BETWEEN HIGH-SENSITIVITY TROPONIN I SERUM LEVELS AND MYOCARDIAL ISCHEMIA IN PATIENTS WITH SUSPECTED CHRONIC CORONARY SYNDROME: THE RESET-MI STUDY
Authors: De Vita Antonio , Bruno Isabella , Baroni Silvia , Moretti Giacomo , Tempestini Federica , Telesca Alessandro , Tremamunno Saverio , Felici Tamara , Verrillo Alfonso , Tempesta Valeria , Feudo Vanessa , Lamendola Priscilla , Liuzzo Giovanna , Crea Filippo , Lanza Gaetano Antonio
Published: December 2022

Background

Although the detection of a rise and/or fall pattern of cardiac troponin (cTn) serum levels in presence of a clinical context of acute myocardial ischemia, represents the main criterion for the diagnosis of acute myocardial infarction (AMI), troponins may increase in various conditions of myocardial injury different from ischemic myocardial necrosis or simply following myocardial ischemia, in the absence of cell necrosis. Some studies found that troponins also increase after physical exertion and other types of stressful stimuli in the absence of obstructive CAD and myocardial ischemia. No previous study, however, investigated the relation between cTn serum levels and the extent of myocardial ischemia in patients with a suspect of CCS.

Methods

We prospectively enrolled consecutive patients undergoing an elective stress myocardial perfusion scintigraphy (MPS) because of a clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups based on the evidence and degree of stress-induced MI at MPS: 1) group 1, no MI (≤4%); 2) group 2, mild MI (5-10%); 3) group 3, moderate-to-severe MI (≥10%). High sensitivity (hs)-cTnI was measured immediately before (T0) and 1 hour (T1) and 4 hours (T2) after the stress test. A successive evaluation of patients was performed at 24 months.

Results

One-hundred consecutive patients (64 males; age 65.5±9.5 years) were enrolled in the study. Serum hs-cTnI concentrations significantly increased after MPS, compared to baseline, in the whole population, from (median, interquartile range) 3.9 (2.5-6.1) ng/L at T0, to 4.2 (2.8-7.3) ng/L at T1 (p<0.001) and 6.7 (3.8-14.1) ng/L at T2 (p<0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p=0.35). Heart rate achieved during the test was the strongest determinant of cTnI increase (p < 0.001). No major adverse cardiac event occurred during follow-up. Only 12 patients (12%) underwent coronary revascularization, whereas angina episodes were reported by 23 patients (23%). There were no significant differences in hs-cTnI increase after the stress test between patients with clinical events at follow-up compared with those who did not report myocardial revascularization or angina recurrence (p=0.21).

Conclusions

In patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and the extent of myocardial ischemia and is mainly related to myocardial work, as indicated by HR achieved during the test.
145 PREDICTION OF NEW ONSET ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION USING THE C2HEST AND MC2HEST SCORES A REPORT FROM THE MULTICENTER REALE-ACS REGISTRY
Authors: Gelfusa Martina , Biccirè Flavio Giuseppe , Tanzilli Gaetano , Prati Francesco , Sammartini Emanuele , Celeski Mihail , Budassi Simone , Barillà Francesco , Lip Gregory Y H , Pastori Daniele
Published: December 2022

Aims

New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of patients at risk of NOAF remains challenging, and various clinical scores of varying complexities have been proposed to predict incident AF. We tested the value of the simple C2HEST score for predicting NOAF in patients with ACS.

Methods

We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The C2HEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mC2HEST score.

Results

We enrolled 555 patients (mean age 65.6±13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p<0.001) and had more prevalent hypertension (p=0.012), COPD (p<0.001) and hyperthyroidism (p=0.018). Patients with NOAF were more frequently admitted with STEMI (p<0.001), cardiogenic shock (p=0.008), Killip class ≥2 (p<0.001) and had higher mean GRACE score (p<0.001). Patients with NOAF had a higher C2HEST score compared with those without (4.2±1.7 vs 3.0±1.5, p<0.001). A C2HEST score >3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19-8.59, p<0.001). ROC curve analysis showed good accuracy of the C2HEST score (AUC 0.71, 95%CI 0.67-0.74) and mC2HEST score in predicting NOAF (AUC 0.69, 95%CI 065-0.73).

Conclusion

The simple C2HEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.
220 MANAGING CARDIAC ARREST SECONDARY TO SPONTANEOUS CORONARY ARTERY DISSECTION: SHOULD WE ROUTINELY CONSIDER ICD IMPLANTATION?
Authors: Rizzello Davide , Gurgoglione Filippo Luca , Giacalone Rossella , Ferretti Marco , Noni Manjola , Pelà Giovanna , Cattabiani Maria Alberta , Benatti Giorgio , Tadonio Iacopo , Ardissino Diego , Niccoli Giampaolo , Vignali Luigi , Solinas Emilia
Published: December 2022

Introduction

Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention.

Methods

We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation.

Results

Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter-defibrillator (S-ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD. Evaluating risk of SCAD recurrence and sudden cardiac death The management of SCAD patients complicated by malignant ventricular arrhythmias and cardiac arrest is challenging. Looking at published registries, it appears that SCAD patients are more likely to suffer from ventricular arrythmia or sudden cardiac death than non-SCAD MI patients. The risk-benefit ratio of ICD implantation in these patients remain uncertain . Evaluation of scar burden with CMR can help stratify the global arrhythmic risk, especially as extensive myocardial scar with a residual impaired LVEF increases the risk of future arrhythmic events. In our series, only one patient underwent S-ICD implantation, and the decision was mainly driven by the finding of underlying arteriopathy affecting other vascular territories, suggesting a potentially higher rate of SCAD recurrence. For this particular subset of patients, we propose an algorithm that combines predisposing factors and myocardia injury quantification data that could be useful for the estimate of the risk of malignant arrythmias, as well as the risk of recurrence of SCAD, but needs to be validated in larger case studies.

Conclusions

The acute management of cardiac arrest related to SCAD deserves specific consideration. The residual myocardial damage, predisposing and precipitants factors should be evaluated in order to estimate the SCAD recurrence and sudden cardiac death risks.
222 INFARCT-LIKE MYOCARDITIS IN A PATIENT WITH CORONARY ARTERY DISEASE PRESENTING WITH CHEST PAIN: LOOKING BEYOND THE SIMPLEST DIAGNOSIS
Authors: Amelotti Nicola , Brusamolino Matteo , Mapelli Massimo , Baggiano Andrea , Vignati Carlo , Campodonico Jeness , Mattavelli Irene , Salvioni Elisabetta , De Martini Stefano , Agostoni Piergiuseppe
Published: December 2022

Background

A significant proportion of patients with acute myocarditis (AM) presents with chest pain as their first symptom, with ST-segment elevation, regional myocardial dysfunction and cardiac enzyme release (“infarct-like” pattern).

Case description

A 68-year-old patient, already known for coronary artery disease (CAD) who underwent a percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation of distal left anterior descending artery (LAD) six months before, presented with chest pain at rest. An ECG showed ST elevation in the infero-postero-lateral leads with specular ST-depression in aVL; hsTnI was 5900 ng/L (UNL < 51 ng/L). A coronary angiography excluded acute thrombosis, and showed a normal right coronary artery (RCA), significant (70%) stenosis of proximal LAD and left circumflex artery, both treated with PCI + DES. A transthoracic echocardiogram (TTE) showed hypokinesia of the middle portions of the inferior, posterolateral and inferior interventricular septum (SIV) walls. According to a research protocol ongoing in our hospital in post-myocardial infarction patients, a cardiac magnetic resonance (CMR) was performed 48 hours later, showing signs of acute non-ischemic myocardial damage (myocardial edema involving the whole infero-septal wall, late gadolinium enhancement with subepicardial – non-coronary - distribution at apical and antero-apical septum). A final diagnosis of infarct-like AM was established. No complications occurred during the hospital stay and hsTnI progressively decreased (at discharge 37 ng/L). A 6-month follow-up CMR showed normal biventricular function and kinesis, and absence of alterations in tissue characterization sequences.

Conclusion

This case highlights how even patients with a known CAD can present with AM mimicking myocardial infarction. Multimodality evaluation, including CMR, can help make the right diagnosis to avoid unnecessary therapies or procedures (i.e. PCI), especially in case of discrepancy between different clinical findings, (i.e. ST-elevation in the inferior leads with a dominant unscathed RCA, non-occlusive stenosis at angiography, echocardiography wall motion abnormalities in RCA territory).
480 ICD AFTER STEMI: WHEN AND HOW FREQUENTLY IS IMPLANTED AND WHICH IS THE RATE OF APPROPRIATE INTERVENTIONS
Authors: Pezzato Andrea , Fabris Enrico , Gregorio Caterina , Cittar Marco , Contessi Stefano , Carriere Cosimo , Lardieri Gerardina , Zecchin Massimo , Perkan Andrea , Sinagra Gianfranco
Published: December 2022

Background

there are limited data of implantable-cardioverter-defibrillator (ICD) implantation after STEMI treated with primary percutaneous coronary intervention (pPCI). This study sought to evaluate when and how frequently is ICD implanted after STEMI, the rate of appropriate ICD-interventions, and the independent predictors of ICD implantation.

Methods

We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients data with those present in the Trieste ICD registry.

Results

1805 consecutive patients treated with pPCI were analyzed. During a median follow-up of 6.7 (IQR 4.3-9.2) years, the probability of ICD implantation at 12 months was 2.3% (95%CI: 1.7-3.1) and it remained stable overtime (at 24 months: 2.5%, 95%CI 2.0-3.5 and at 36 months: 2.6%, 95%CI 2.3-3.8). Mean time before ICD implantation was 35.5 months (95%CI: 34.8-36) . 83.1% of implanted ICD were for primary prevention, and more than half (55%) were implanted in patients with ejection fraction (EF)>35% at the moment of STEMI discharge. During a median follow-up of 5.7 (IQR 3.3-8.3) years after ICD implantation, the probability of appropriate ICD intervention was 9% and 11% after 12 and 24 months respectively. In patients with EF>35% at STEMI discharge (median EF 43%; IQR 40-48), predictors of ICD implantation were male sex, anterior STEMI and troponin peak >100.000 ng/dl.

Conclusions

The rate of ICD implantation after pPCI is low, however the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantation at follow-up despite a non-severe EF at discharge after STEMI. Among these patients those with high troponin release deserve strict follow-up and full optimal medical treatment.
473 LUNG ULTRASOUND IN CORONARY CARE UNIT, AN IMPORTANT DIAGNOSTIC TOOL FOR CONCOMITANT PNEUMONIA
Authors: Chirico Alfonsina , Basile Christian , Mancusi Costantino , Fucile Ilaria , Mosca Mariangela , Migliaccio Biagio , Gargiulo Giuseppe , Santoro Ciro , Paolillo Stefania , Perrone-filardi Pasquale , Gargiulo Paola
Published: December 2022

Background

In the setting of coronary care unit (CCU), early detection of pneumonia is of para-mount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in detection of pneumonia and compared with chest x-ray (CXR).

Method

We enrolled 110 consecutive patients admitted to CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs no-pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n=34).

Results

Mean age was 70 ± 11 years old, 68% males. Pneumonia was clinically diagnosis in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92% specificity 81%). Chest radiography was positive in 9 patients (sensitivity 43% specificity 95%). Using CT scan as referee LUS exhibit 92% of sensibility and a specificity of 96%. In ROC curve analysis diagnostic accuracy of CXR and LUS for diagnosis of pneumonia was 0.86 (95% CI 0.77-0.94), higher than CXR 0.68 (95% CI 0.55-0.84), p<0.05 (Figure).

Conclusion

Based on the findings of the present study, accuracy of LUS in detection of pneumonia was significantly higher than chest x-ray, with comparable sensibility to CT scan.
916 THE SMARTWATCH DETECTS ECG ABNORMALITIES TYPICAL OF BRUGADA SYNDROME
Authors: Ferraro Daniel , Curcio Antonio , Spaccarotella Carmen , Santarpia Giuseppe , Romano Letizia Rosa , Cardia Giada , Mancuso Cinzia , Purri Ilaria , Indolfi Ciro
Published: December 2022

Introduction

Brugada syndrome (BrS) is a genetic disorder with a characteristic pattern on the electrocardiogram (ECG) that predisposes to lethal arrhythmias and sudden cardiac death (SCD). Precise diagnosis is therefore mandatory.

Aims

We evaluated the feasibility and accuracy of a smartwatch in recording multiple ECG leads and detecting ST-segment changes diagnostic for BrS both in basal condition and after ajmaline infusion.

Materials and Methods

Twelve-leads and smartwatch ECGs were obtained in 32 unselected patients admitted at our institution with type II/III ST-segment elevation suspected for BrS from September 2021 to March 2022. After written informed consent for continuous ECG monitoring during ajmaline test (1 mg/kg, i.v. for 10 min), consecutive ECG strips acquired with both techniques were analyzed before and after drug administration. For each patient smartwatch was tested at three different sites: wrist, abdomen and chest, and intercostal spaces from second to fourth were further studied. The concordance among the results of the smartwatch and standard ECG recordings was assessed using the Cohen κ coefficient and Bland-Altman analysis.

Results

Subjects were 42±15 y.o. on average; 67% were men (n=25), and diagnosis of BrS was reached in 12 cases (37.5%). Concordance was found between the smartwatch and standard ECG for the identification of the following findings: i) a normal/negative ECG (Cohen κ coefficient, 0.89); ii) ST-segment elevation shift (Cohen κ coefficient, 0.934). In addition, the Bland-Altman analysis demonstrated concordance between the smartwatch and the standard ECG in the assessment of the amplitude of ST-segment elevation shift (bias, −0.003; SD, 0.68; lower limit, −0.52; and upper limit, -0.031). The smartwatch power in diagnosing normal ECG showed a sensitivity of 92% (95% CI, 66%-99%) and a specificity of 100% (95% CI, 64%-100%); for detection of ST-segment elevation and BrS diagnosis, sensitivity was 92% (95% CI, 64%-99%) and specificity was 95% (95% CI, 76%-99%).

Conclusions

The findings of this study suggest agreement between the multichannel smartwatch acquisition and standard ECG for the identification of Brugada syndrome-associated ST-segment changes.
640 QRS INDEX TO PREDICT CARDIAC RESYNCHRONIZATION THERAPY RESPONSE: A TRICENTRIC STUDY
Authors: Madaudo Cristina , Prezioso Amedeo , Bonni´ Enrico , Mascioli Giosuè , Pecora Domenico , Ciaramitaro Gianfranco , La Greca Carmelo , Zanchi Simone , Cuccia Claudio , Novo Giuseppina , Corrado Egle , Coppola Giuseppe , Galassi Alfredo Ruggero
Published: December 2022

Background

Several studies have evaluated the role of QRS duration (QRSd) or QRS narrowing as predictor of response to cardiac resynchronization therapy (CRT) in order to reduce non-responders. However, their results have been conflicting. In our study we analyzed retrospectively a cohort of patients from three centers to better correlate the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who underwent CRT implantation.

Methods

We included 398 patients in whom a CRT device was implanted in accordance with current guidelines in our three centres. Baseline clinical variables, echocardiographic parameters and pharmacological therapies were included. QRS duration before and after CRT implantation and QI [(pre implant QRS duration - QRS duration during CRT)/pre implant QRS duration × 100] were measured.

Results

Respect to echocardiographic follow up at 6 months, a significant improvement in all parameters (EF, LVEDV, LVESV) was observed. In 68% of patients, LVESV decreased by 10% or more. QI was significantly related to reverse remodelling (r = + 0.22; 95% CI: 0.11 to 0.32, p = 0.001). The cut-off value of QI that predicted best LV reverse remodelling after 6 months of CRT was 12.25% (sensitivity 65,49%, specificity 75%, area under the curve 0.7, p = 0.001).

Regarding clinical outcomes at 12 mounths, a statistically significant difference was found between patients with a QI ≤ 12.25%, and those with a QI > 12.25%, in terms of NYHA class worsening (p 0,04). Another statistically significant difference was found analyzing the relation between QI and the causes of deaths, the mean of the QI of patients who died from cardiovascular causes was lower than patients who died of other causes. (p 0,0179).

Conclusions

Therefore decrease in QRSd after CRT initiation was related to greater echocardiographic reverse remodelling and better outcome from death or cardiovascular hospitalization.

Even if larger studies are needed, QI seems to be an easy-to- measure variable that could be used or evaluated to predict CRT response.
960 EARLY ONSET OF SUBTLE LIVER DAMAGE IN TTR AMYLOIDOSIS PATIENTS TREATED WITH TAFAMIDIS
Authors: Agbariah Andrea , Nannelli Chiara , Comunello Andrea , Cemin Roberto
Published: December 2022

Background

misfolded transthyretin amyloid fibrils can deposit in the myocardium causing transthyretin amyloid cardiomyopathy (ATTR-CM). Tafamidis has become recently available for the treatment of ATTR-CM, but to date very few data about its possible side effects have been published.

Aims

to investigate the potential liver toxicity of Tafamidis 61 mg/day in a group of patients affected by wild type ATTR-CM treated in our department.

Materials and Methods

14 consecutive patients with wild-type ATTR-CM were treated with Tafamidis accordingly to the classical recommendations. The patients’ liver function was checked through transaminases and gammaGT determination at baseline and for the first six months and their changes analysed with the non-parametric Wilcoxon test for paired samples.

Results

mean age of the patients included (13 males and a female) was 78 years. Baseline transaminases were all within the normal range (median GOT level 25.0 U/L - IQR 19.0-29.0; median GPT levels 24.0 U/L - IQR 15.0-27.0) and remained stable for the first two months (median GOT at 2 months 25.5 U/L - IQR 19.0-28.0; median GPT at 2 months 22.5 U/L – IQR 16.0-27.0). Median GGT baseline level was 138.0 U/L (IQR 58.0-204.0) and raised to 142.0 U/L (IQR 56.0-270.0) after a two-month therapy (p<0.01). The further follow-up confirmed a similar trend in the first six month of treatment, with a linear and constant increase of gammaGT levels.

Conclusions

even not clinically relevant, the wild-type ATTR-CM patients included in our analysis showed all a subtle increase of gammaGT values after only two months of Tafamidis treatment, which was confirmed at six months. This observation underlines the potential hepatotoxicity of the drug, thus confirming the recommendations of strict and regular liver function analysis provided by the manufacturer.
396 ARE BLOOD LEVELS OF RETINOL BINDING PROTEIN USEFUL IN DIAGNOSING ATTR-CA? A NEGATIVE STUDY, SO FAR
Authors: Barbarossa Alessandro , Coraducci Francesca , Torselletti Lorenzo , Belleggia Sara , Coretti Francesca , Brugiatelli Leonardo , Bastianoni Gianmarco , Alfieri Michele , Paolini Federico , Principi Samuele , Ciliberti Giuseppe , Stronati Giulia , Russo Antonio Dello , Guerra Federico
Published: December 2022

Introduction

Retinol binding protein (RBP) is a protein synthesized in the liver which forms, along with transthyretin (TTR) the retinol-transport-complex. This complex ligates retinol and thyroxine and transports them in the human plasma. TTR is a protein longer and heavier than RBP. It ligates RBP preventing its renal filtration. Our hypothesis is that the relationship between RBP and TTR is dual: TTR avoids renal filtration of RBP, but also RBP itself, functioning as an endogenous ligand, has an action on TTR by stabilizing and avoiding TTR misfolding.

Misfolded TTR proteins form amyloid fibrils rich in beta-cross-sheets that can infiltrate healthy tissues altering their physiology. The infiltration of these fibrils in the cardiac tissue leads to the well-known condition of TTR cardiac amyloidosis (ATTR CA).

Our hypothesis is that the lack of TTR stabilization that can happen with low blood levels of RBP is a risk factor for developing ATTR CA. The main goal of our study is to understand if high or normal values of RBP can help exclude any pathological condition linked to the accumulation of misfolded TTR proteins.

Methods

All patients referred to our Cardiomyopathy Clinic with a clinical and echographic suspicion of CA were consecutively enrolled. All patients underwent a complete diagnostic workup in order to confirm or exclude CA, comprehending lab tests (including RBP4), SPECT, cardiac MR, genetic testing and cardiac biopsy as recommended by current recommendations. At the end of the diagnostic process, patients with ATTR-wt CA were enrolled as cases, and patients with no CA were considered as controls. Patients with ATTR-mutated CA or AL CA were excluded from the present analysis.

Results

Fifty-nine consecutive patients (42 males, age 77+/-13 years) were enrolled. Of those, 27 had a definitive diagnosis of ATTR-wt CA, while 32 had another diagnosis. Mean levels of RBP4 were not different between patients with and without CA (5.4+/-1.9 vs. 5.0+/-1.8 mg/dl; p=ns) as were Troponin I, BNP and NT-proBNP levels (all p=ns). Among patients with a definitive diagnosis of ATTR-wt CA and a positive SPECT, RBP4 levels were similar between Perugini 2 and 3 scores (5.4+/-2.1 vs. 5.6+/-2.0 mg/dl; p=ns).

Discussion

From our findings, it seems that there is no significant correlation between low levels of RBP and the presence of ATTR CA as we found no difference in the distribution of RBP levels between cases and controls. It also did not seem to be a useful marker to stratify the levels of myocardial infiltration as long as there is no difference in RBP between Perugini score 2 and 3.