bluuebunny/crossref_metadata_2025 huggingface dataset:
WMSA 2: a multiple DNA/RNA sequence alignment tool implemented with accurate progressive mode and a fast win-win mode combining the center star and progressive strategies
Authors: Chen Juntao , Chao Jiannan , Liu Huan , Yang Fenglong , Zou Quan , Tang Furong
Published: May 2023

Multiple sequence alignment is widely used for sequence analysis, such as identifying important sites and phylogenetic analysis. Traditional methods, such as progressive alignment, are time-consuming. To address this issue, we introduce StarTree, a novel method to fast construct a guide tree by combining sequence clustering and hierarchical clustering. Furthermore, we develop a new heuristic similar region detection algorithm using the FM-index and apply the k-banded dynamic program to the profile alignment. We also introduce a win-win alignment algorithm that applies the central star strategy within the clusters to fast the alignment process, then uses the progressive strategy to align the central-aligned profiles, guaranteeing the final alignment's accuracy. We present WMSA 2 based on these improvements and compare the speed and accuracy with other popular methods. The results show that the guide tree made by the StarTree clustering method can lead to better accuracy than that of PartTree while consuming less time and memory than that of UPGMA and mBed methods on datasets with thousands of sequences. During the alignment of simulated data sets, WMSA 2 can consume less time and memory while ranking at the top of Q and TC scores. The WMSA 2 is still better at the time, and memory efficiency on the real datasets and ranks at the top on the average sum of pairs score. For the alignment of 1 million SARS-CoV-2 genomes, the win-win mode of WMSA 2 significantly decreased the consumption time than the former version. The source code and data are available at https://github.com/malabz/WMSA2.
CIForm as a Transformer-based model for cell-type annotation of large-scale single-cell RNA-seq data
Authors: Xu Jing , Zhang Aidi , Liu Fang , Chen Liang , Zhang Xiujun
Published: May 2023

Single-cell omics technologies have made it possible to analyze the individual cells within a biological sample, providing a more detailed understanding of biological systems. Accurately determining the cell type of each cell is a crucial goal in single-cell RNA-seq (scRNA-seq) analysis. Apart from overcoming the batch effects arising from various factors, single-cell annotation methods also face the challenge of effectively processing large-scale datasets. With the availability of an increase in the scRNA-seq datasets, integrating multiple datasets and addressing batch effects originating from diverse sources are also challenges in cell-type annotation. In this work, to overcome the challenges, we developed a supervised method called CIForm based on the Transformer for cell-type annotation of large-scale scRNA-seq data. To assess the effectiveness and robustness of CIForm, we have compared it with some leading tools on benchmark datasets. Through the systematic comparisons under various cell-type annotation scenarios, we exhibit that the effectiveness of CIForm is particularly pronounced in cell-type annotation. The source code and data are available at https://github.com/zhanglab-wbgcas/CIForm.
A-318 SURGICAL APPROACH TO METASTASIZED NEUROENDOCRINE TUMOURS OF THE SMALL INTESTINE: A RETROSPECTIVE EUROPEAN MULTICENTRE STUDY (EUROCRINE® Study Group)
Authors: Lozan O , Musholt T
Published: May 2023

Background

At the time of the diagnosis, up to 60% of NETs are already metastasised. However, due to the rare prevalence and lack of prospective studies, suitable treatment guidelines have yet been established.

Methods

In a retrospective, multi-center, European study, using the EUROCRINE® database, 144 palliative surgeries due to SI-NETs were selected, divided into 3 groups, and analysed. Based on the time of the last follow-up, stage, grading, and surgical treatment, Kaplan-Meier survival curves and Log-Rank tests were used to compare the outcome, overall survival, and quality of life.

The 3 groups are as followed:

Results

Out of 144 surgeries, 9 were performed in emergency settings (A). In 42 only the primary tumour was resected (B). The remaining 93 cases reduced the tumour mass (C). (A) did not show a poorer quality of life in the short term, only one case having early onset postoperative complications, compared to 9 (B) and 22 (C). In 4 cases (A) a R0 Resection was obtained, compared to 10 (B) and 46 (C). 2 cases (A) remained tumour-free in the first follow-up, compared to 3 (B) and 10 (C). No patients were deceased until the first follow-up in (A), 1 patient died shortly after resection in (B), and 1 in (C). As many patients were lost in the long-term follow-ups, overall survival could not be estimated.

Conclusion

(A) has a comparable mortality rate to (B) or (C)

Careful patient selection can greatly improve outcomes.

A more thorough follow-up is required to better estimate the survival rates in 5 or 10 years.
A-293 TROMS (TRAINEE-REPORTED OUTCOME MEASURES): THE NEW FOCUS OF TRAINING IN ENDOCRINE SURGERY
Authors: Lorente-Poch L , Alonso S , Martínez-Santos C , Mercader-Cidoncha E , Gómez-Ramírez J , Arranz-Jiménez R , Muñoz-De Nova J L , Osorio-Silla I , Salvador-Egea P , Cassinello N , Beiras C , Sancho-Insenser J
Published: May 2023

Background

PROMs (Patient-Reported-Outcome-Measures) are an emerging method to assess healthcare quality. Similarly, we propose assessing trainee satisfaction using TROMs (Trainee-Reported-Outcome-Measure) questionnaires. With the aim to improve trainee implication and perception in Endocrine Surgery(ES) we conducted a prospective multicenter study.

Methods

The technique of thyroidectomy was split into 4 steps to be sequentially completed by the trainee. A specific TROMs survey was designed and distributed to evaluate trainee satisfaction before and after its implementation. Members of the Endocrine Section of the Spanish Association of Surgeons were invited to participate.

Results

Some 20 Spanish ES Units were involved (October/2021-March/2022), of which 17 trainees answered the poll. Most of them were in their 4th-5thyear of training, 65% were female and only 25% would choose ES as a subspecialty. Hemithyroidectomies performed as main surgeon ranged from 0 to 10 and only 60% felt they were capable of performing it unassisted. When training in a high-volume-unit, they performed a hemithyroidectomy 4 times more frequently. Initial global satisfaction was high in 70% of trainees. After implementation of the 4-step thyroidectomy, surgical items evaluated through TROMs showed improvement with increased number of surgeries performed per trainee as well as their perception of improving their surgical technique with slight increase in reported global satisfaction.

Conclusion

Teaching in ES may be improved by standardised steps and TROMS may well become a valuable tool to assess teaching satisfaction of surgical trainees.
Atrophy in behavioural variant frontotemporal dementia spans multiple large-scale prefrontal and temporal networks
Authors: Eldaief Mark C , Brickhouse Michael , Katsumi Yuta , Rosen Howard , Carvalho Nicole , Touroutoglou Alexandra , Dickerson Bradford C
Published: May 2023

The identification of a neurodegenerative disorder’s distributed pattern of atrophy—or atrophy ‘signature’—can lend insights into the cortical networks that degenerate in individuals with specific constellations of symptoms. In addition, this signature can be used as a biomarker to support early diagnoses and to potentially reveal pathological changes associated with said disorder. Here, we characterized the cortical atrophy signature of behavioural variant frontotemporal dementia (bvFTD).

We used a data-driven approach to estimate cortical thickness using surface-based analyses in two independent, sporadic bvFTD samples (n = 30 and n = 71, total n = 101), using age- and gender-matched cognitively and behaviourally normal individuals. We found highly similar patterns of cortical atrophy across the two independent samples, supporting the reliability of our bvFTD signature. Next, we investigated whether our bvFTD signature targets specific large-scale cortical networks, as is the case for other neurodegenerative disorders. We specifically asked whether the bvFTD signature topographically overlaps with the salience network, as previous reports have suggested. We hypothesized that because phenotypic presentations of bvFTD are diverse, this would not be the case, and that the signature would cross canonical network boundaries. Consistent with our hypothesis, the bvFTD signature spanned rostral portions of multiple networks, including the default mode, limbic, frontoparietal control and salience networks. We then tested whether the signature comprised multiple anatomical subtypes, which themselves overlapped with specific networks. To explore this, we performed a hierarchical clustering analysis. This yielded three clusters, only one of which extensively overlapped with a canonical network (the limbic network).

Taken together, these findings argue against the hypothesis that the salience network is preferentially affected in bvFTD, but rather suggest that—at least in patients who meet diagnostic criteria for the full-blown syndrome—neurodegeneration in bvFTD encompasses a distributed set of prefrontal, insular and anterior temporal nodes of multiple large-scale brain networks, in keeping with the phenotypic diversity of this disorder.
Dual-stream cortical pathways mediate sensory prediction
Authors: Chu Qian , Ma Ou , Hang Yuqi , Tian Xing
Published: May 2023

Predictions are constantly generated from diverse sources to optimize cognitive functions in the ever-changing environment. However, the neural origin and generation process of top-down induced prediction remain elusive. We hypothesized that motor-based and memory-based predictions are mediated by distinct descending networks from motor and memory systems to the sensory cortices. Using functional magnetic resonance imaging (fMRI) and a dual imagery paradigm, we found that motor and memory upstream systems activated the auditory cortex in a content-specific manner. Moreover, the inferior and posterior parts of the parietal lobe differentially relayed predictive signals in motor-to-sensory and memory-to-sensory networks. Dynamic causal modeling of directed connectivity revealed selective enabling and modulation of connections that mediate top-down sensory prediction and ground the distinctive neurocognitive basis of predictive processing.
A comprehensive evaluation of multicentric reliability of single-subject cortical morphological networks on traveling subjects
Authors: Yin Guole , Li Ting , Jin Suhui , Wang Ningkai , Li Junle , Wu Changwen , He Hongjian , Wang Jinhui
Published: May 2023

Despite the prevalence of research on single-subject cerebral morphological networks in recent years, whether they can offer a reliable way for multicentric studies remains largely unknown. Using two multicentric datasets of traveling subjects, this work systematically examined the inter-site test-retest (TRT) reliabilities of single-subject cerebral morphological networks, and further evaluated the effects of several key factors. We found that most graph-based network measures exhibited fair to excellent reliabilities regardless of different analytical pipelines. Nevertheless, the reliabilities were affected by choices of morphological index (fractal dimension > sulcal depth > gyrification index > cortical thickness), brain parcellation (high-resolution > low-resolution), thresholding method (proportional > absolute), and network type (binarized > weighted). For the factor of similarity measure, its effects depended on the thresholding method used (absolute: Kullback–Leibler divergence > Jensen–Shannon divergence; proportional: Jensen–Shannon divergence > Kullback–Leibler divergence). Furthermore, longer data acquisition intervals and different scanner software versions significantly reduced the reliabilities. Finally, we showed that inter-site reliabilities were significantly lower than intra-site reliabilities for single-subject cerebral morphological networks. Altogether, our findings propose single-subject cerebral morphological networks as a promising approach for multicentric human connectome studies, and offer recommendations on how to determine analytical pipelines and scanning protocols for obtaining reliable results.
Differential biventricular adaption to pulmonary vascular disease in patients with idiopathic/heritable and congenital heart disease: a prospective cardiac magnetic resonance and invasive study
Authors: Xu Zhuoyuan , Dou Ruiyu , Zhou Zhen , Zhang Hongsheng , Zhang Chen , Li Qiangqiang , Xu Lei , Gu Hong
Published: May 2023

Aims

Despite shared pathophysiological mechanisms, patients with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH) have a poorer prognosis than those with PAH after congenital heart defect repair. Ventricular adaption remains unclear and could provide a basis for explaining differences in clinical outcomes. The aim of this prospective study was to assess clinical status, haemodynamic profile, and biventricular adaptation to PAH in children with various forms of PAH.

Methods and results

Consecutive patients with IPAH/HPAH or post-operative PAH were prospectively recruited (n = 64). All patients underwent a comprehensive, protocolized assessment including functional assessment, measurement of brain natriuretic peptide (BNP) levels, invasive measurements, and a cardiac magnetic resonance (CMR) assessment. A cohort of age- and sex-matched healthy subjects served as controls. Patients with post-operative PAH had a better functional class (61.5 vs. 26.3% in Class I/II, P = 0.02) and a longer 6-min walk distance (320 ± 193 vs. 239 ± 156 m, P = 0.008) than IPAH/HPAH. While haemodynamic parameters were not significantly different between IPAH/HPAH and post-operative patients, post-operative patients with PAH presented with higher left ventricular volumes and better right ventricular function compared with patients with IPAH/HPAH (P < 0.05). On correlation analyses, left ventricular volumetric parameters were highly correlated with BNP and 6-min walk test distance in this population.

Conclusion

Despite comparable haemodynamic profiles, patients with post-operative PAH had less functional limitation than their IPAH/HPAH counterparts. This is potentially related to the differential biventricular adaptation pattern evident on CMR with better myocardial contractility and higher left ventricular volumes in post-operative patients with PAH, highlighting the importance of ventriculo-ventricular interaction in the setting of PAH.
Long-term follow-up of cardiac magnetic resonance imaging in myocarditis following messenger ribonucleic acid COVID-19 vaccination: a case report
Authors: Kittichokechai Pakaparn , Seripanu Panupong , Laksomya Thanakorn
Published: May 2023

Background

Presently, the association between myocarditis and messenger ribonucleic acid (mRNA) COVID-19 vaccination is well established. From the most current data, cases of myocarditis following COVID-19 vaccination seem to be mild with fast clinical recovery. Nevertheless, the complete resolution of the inflammatory process is still unclear.

Case summary

We report the case of a 13-year-old boy who developed chest pain following the second dose of the Pfizer-BioNTech COVID-19 vaccine with long-term follow-up of cardiac magnetic resonance (CMR) imaging. An electrocardiogram (ECG) revealed progressively ST-segment elevation on the 2nd day of admission with a rapid improvement within 3 hours where only mild ST-segment elevation remained. The peak level of high-sensitivity cardiac troponin T was 1546 ng/L with rapid reduction. Echocardiogram revealed depressed left ventricular septal wall motion. CMR mapping techniques showed myocardial oedema with an increase in native T1 and extracellular volume (ECV). On the other hand, T1-weighted and T2-weighted images and late gadolinium enhancement (LGE) did not detect inflammation. The patient’s symptoms were relieved by oral ibuprofen. After 2 weeks, ECG and echocardiogram were unremarkable. However, the inflammation process was still present based on the CMR by mapping technique. During the 6-month follow-up, CMR returned to normal.

Discussion

In our case, the subtle myocardial inflammation was diagnosed by mapping technique with only a T1-based marker according to the updated Lake Louise Criteria and the inflammation of the myocardium returned to normal within 6 months after the onset of the disease. Further follow-up and larger studies are needed to determine the complete resolution of the disease.
C21 A FLOATING THROMBUS IN THE ASCENDING AORTA, AS A COMPLICATION OF A PERCUTANEOUS CORONARY ANGIOGRAPHY
Authors: Cortese F , Di Marino S , Calculli G , Costantino M
Published: May 2023

Free–floating thrombus of the ascending aorta is a rare disease entity which carries a potential risk of distal embolization with catastrophic consequences. We present the case of a 46–year–old patient with floating thrombus in the ascending aorta, likely caused by catheter injury, after a percutaneous coronary angiography with stent implantation at the circumflex artery and no antiplatelet agents. A 46–year–old female patient was admitted to the emergency room with acute chest pain radiating to the left arm for the past 3 days. She reported a history of cigarette smoking and a ST–elevation myocardial infarction with stent implantation at the level of the circumflex artery about 1 month before. The patient was not taking any antiplatelet therapy for explicit refusal. Transthoracic echocardiography showed an isoechoic lesion in the ascending aorta and no other abnormalities of the cardiac structure and function and of the valve systems. Transoesophageal echocardiography confirmed the presence of a coarse (17 mm 14 mm) isoechoic formation, with a large base of implantation at the level of the non–coronary aortic cusp, extending approximately 45 mm into the aortic vessel with a floating attitude (Panels A–C). Computed tomography angiography showed a pedunculated mass measuring 22 mm 22 mm 45 mm in ascending aortic lumen (Panels D and E). Intact intima and normal size of ascending aorta with no signs of aortic dissection or intramural haematoma were also reported. The patient underwent a thrombectomy (Panel F) and aortic replacement. A histopathologic examination revealed the mass to be a fibrin thrombus. The post–operative course was uneventful. No recrudescence or concomitant visceral or vascular embolism was observed. The patient was discharged with dual antiplatelet agents.
C77 GENDER GAP IN TIME TO ST–ELEVATION MYOCARDIAL INFARCTION DIAGNOSIS: A RETROSPECTIVE COHORT STUDY
Authors: Tavecchia G , Milani M , Tognola C , Garatti L , Villanova L , Colombo C , Scavelli F , Viola G , Oliva F , Sacco A
Published: May 2023

Introduction

Timely reperfusion with primary percutaneous coronary intervention (pPCI) in patients with ST–elevation myocardial infarction (STEMI) must be the standard of care, irrespective of gender. Current guidelines mandate a door–to–balloon time of less than 90 minutes from STEMI diagnosis to wire crossing. However, coronary artery disease is characterized by relevant gender differences in terms of anatomy, pathophysiology, and clinical presentation. Female’s symptoms could be deceitful, and diagnosis could be delayed. Aim of our study was to evaluate the presence of gender differences at our Centre in diagnosing and treating STEMI.

Methods

We retrospectively analyzed a cohort of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit of ASST Great Metropolitan Hospital Niguarda (Milan) between January 2014 and July 2022. Clinical parameters were collected and waiting times from symptoms onset and ECG recording to pPCI were compared between sexes.

Results

489 STEMI patients were included in our study, 384 men and 105 women. Median age was higher in women (75 years vs 61 years, p < 0.05) as was the incidence of arterial hypertension (70% vs 52.9%, p < 0.05). Women smoked less frequently than men (20.9% vs 39.1%, p < 0.05). Median waiting times from symptoms onset to balloon and from ECG recording to balloon were higher in females (320 vs 240 min, p < 0.05 and 111 vs 80 min, p < 0.05). After stratifying patients by age, chest pain to balloon times were higher in women aged > 65 compared to men in the same age category (320 min vs 292 min, p < 0.05). Regarding younger patients, ECG to balloon and chest pain to balloon times were always longer in females but without reaching statistical significance. A trend towards increased in–hospital mortality was noticed in females (7.6% vs 3.3%, p = 0.05).

Conclusion

Our study suggests that a gender gap may exist in diagnosing STEMI, with longer times from symptoms onset to balloon and from ECG recording to balloon in female patients. This may lead to increased in–hospital mortality in women.
P12 COMPLEX LEAD EXTRACTION: A PERCUTANEOUS MULTIDISCIPLINARY APPROACH
Authors: Taravelli E , Peirone A , Menardi E , Fratini E , Balderi A , Rossini R
Published: May 2023

Introduction

The infection represents one of the most serious complications of implantable cardiac systems (ICDs and PMs) and is associated with increased mortality and significant expenditure of financial resources. The incidence, which ranges from 0.6 to 3.4%, depends by the patient characteristics, the type of implanted system, and from other factors related to the procedure itself. When diagnosed, it is recommended extraction of the system. A 77–year–old patient, hypertensive, obese, former tobacco user, suffering from chronic ischemic heart disease and carrier of bicameral PM since 2019 for BAV grade III. In June 2022 decubitus of the PM pocket. Considering the negativity of coltural tests and the absence of fever, it was decided to use a conservative approach by doing a curettage of the pocket and by repositioning the device at the submuscular level. After about a month, a reappearance of decubitus with exposure of the PM case occurred, therefore, a complete extraction of the leads and removal of the device was performed. The surgery, performed under general anaesthesia, was complicated by the fracture of both leads at the level of the anonymous vein. With the introduction of dedicated ligature through the right femoral vein, it was possible to successfully extract the ventricular lead stump. During the recapture of the atrial stump, a migration of the stump into the right ventricle and then into the pulmonary circulation to a terminal branch of the right pulmonary artery occurred. The recovery of such stump was possible with the help of interventional radiologists and through the use of a dedicated material (“Gooseneck ligature catheter”). Subsequent implantation of temporary PM by the right jugular given the absence of underlying spontaneous rhythm.

Conclusions

CIED extraction surgery is burdened with a high risk of complications even serious ones, including lead rupture and distal fragment embolization. A multidisciplinary approach with shared choices and techniques allowed the resolution percutaneous resolution of a complex picture.
P48 PATIENT SELECTION FOR TRANSCATHETER TRICUSPID ANNULOPLASTY: CASE PRESENTATION
Authors: Cammardella A , Russo M , Ranocchi F , Pergolini A , Bruno N , Nazzaro M , Musumeci F
Published: May 2023

Clinical case

We describe the case of an 87–year–old woman, BSA 1.7 m2, affected by arterial hypertension, atrial fibrillation, COPD, stage III chronic renal failure. The patient underwent aortic valve replacement with a biological prosthesis. The patient had good quality of life. n the last year, the patient had had two hospitalizations for right heart failure, with a home dose of Furosemide of 250 mg/day. A transthoracic echocardiogram, performed in outpatient setting, showed massive tricuspid regurgitation (ERO 0.8 cm2), TAPSE 21 mm, S TDI 0.12 cmc/sec, LVEF 55%, sPAP 40 mmHg (RHC). The TRISCORE (specific risk score for tricuspid pathology) was equal to 8%, therefore at a high preoperative risk. The case was collectively discussed in the Heart Team and we decided for transcatheter treatment of the isolated tricuspid pathology. A transesophageal echocardiogram confirmed the severity of the tricuspid regurgitation, characterized by multiple jets of which the prevalent central and posteroseptal. The coaptation gap was 10 mm, with partial retraction of the septal flap. Therefore, the possibility of an edge–to–edge treatment was excluded and the screening for annuloplasty device evaluation (Cardioband) continued. Cardio–CT showed feasibility for Cardioband with adequate implant safety and distance from the right coronary artery. Therefore, a Cardioband (Edwards Lifesciences) was implanted in the tricuspid position. The procedural time was 220 minutes. The final result was tricuspid regurgitation less than grade 2 (R vol 30 mL/beat, EROA 0.2). The patient was discharged on the 4th postoperative day. At the 30–day follow–up, he was in NYHA class I–II, with a furosemide dose of 75 mg/day, in the absence of peripheral edema.

Conclusions

Patients with isolated tricuspid regurgitation are, in most cases, not treated due to the high postoperative surgical risk. In recent years, transcatheter technologies have been a valid solution in the event of inoperability. Where a treatment on the valve leaflets is not feasible, tricuspid annuloplasty represents a valid alternative.
P51 PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE IN CHILDREN :SINGLE CENTER EXPERIENCE
Authors: Marzullo R , Gaio G , Giordano M , Palladino M , Ancona R , Cappelli Bigazzi M , Della Cioppa N , Russo M
Published: May 2023

Background

Transcatheter patent foramen ovale (PFO) closure is a validated strategy to prevent recurrent cerebral events in adult patients; limited data are available for children.

Methods

This is a retrospective analysis including pediatric population underwent to percutaneous treatment of PFO in our center.

Results

From 2006 to 2021, 21 transcatheter PFO closures have been performed in children (mean age: 14 +3 years; female: 58%, weight: 59 + 20 kg). Indications for the closure of PFO consisted in the occurrence of cryptogenic ischemic events for 18 patients (86%), in disabling migraine symptoms for 2 patients (9,5%) and in prophylactic measure to prevent paradoxical embolism in high risk abdominal surgery for 1 patient (4,5%). Transcatheter PFO closure was performed under general anesthesia with transesophageal ultrasound guidance. Complex anatomies of PFO included atrial septal aneurysm in 4 cases (with accessory fenestration of atrial membrane in 2 of these cases) and long and stiff PFO tunnel in one case. Single device was used in 20 procedures. ASD closure device was required for 5 cases because of anatomic characteristics of PFO. In one case of large multifenestrated atrial septal aneurysm, percutaneous treatment was performed using both PFO closure device and ASD closure device. No peri and/or post procedural complications have been reported . All patients were treated with Acetylsalicylic acid and Clopidogrel for the first six months after the procedure.

Conclusions

Transcatheter PFO closure is a safe procedure in pediatric patients in high volume center that should be used for preventing recurrent cerebral events also in children.
P69 SHORT–TERM EFFECT OF DAPAGLIFLOZIN ON LEFT VENTRICULAR LONGITUDINAL FUNCTION IN PATIENTS WITH HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION
Authors: De Masi De Luca G , Longo S , Barba F , Papadia P , Accogli M , Palamà Z , Romano S , Sciarra L
Published: May 2023

Background

It is known that sodium–glucose cotransporter 2 (SGLT2) inhibitors have been shown to confer important clinical benefits in patients with congestive heart failure (HF). Several evidences show SGLT2 influence the longitudinal systolic function of the left ventricle after medium and long term follow–up (FUP) in patients with HF. The aim of this study is to demonstrate how dapagliflozin can modify the global longitudinal strain (GLS) in a population of patients with systolic congestive heart failure (HFrEF) evaluating possible correlations with the basal functional capacity.

Methods

Clinical and echocardiographic data were retrospectively analyzed in 60 HFrEF patients treated with dapagliflozin, within a dedicated outpatient HF clinic. Pre–treatment data were correlated with to clinical and instrumental FUP date that was generally performed after two months of treatment. The clinical and instrumental data consisted of the NYHA functional class, the left ventricular ejection fraction (LVEF) and the GLS.

Results

There was no significant change between baseline and FUP date on LVEF (25.2 ± 9.9% vs 25.6 ± 9.6% p.s.), while GLS showed significant improvement (13.1 ± 3.7% vs 14.3 ± 3.1% p < 0.03). GLS improvement in HFrEF patients with more impaired functional class (NYHA III/IV) was more significant from 10.9 ± 3.4% to 13.1 ± 2.2% (p < 0.01), compared to that in HFeEF patients with less compromised functional class (NYHA I–II) from 13.6 ± 2.4% to 14.1 ± 2.1% (p 0.07).

Conclusions

Dapagliflozin was associated with short term improvement in longitudinal left ventricular myocardial function in patients with chronic congestive systolic heart failure. This improvement is more evident in patients who start from a more impaired functional capacity than in clinically more stable patients.
P130 FINGER ISCHEMIA IN A YOUNG LADY: EXPECT THE UNEXPECTED FROM A PAPILLARY FIBRO–ELASTOMA
Authors: Pernigo M , Dinatolo E , Cirillo M , Mhagna Z , Cozza F , Berti M , Cuccia C , Troise G
Published: May 2023

Case presentation: In December 2022, A 32–y old women presented to the emergency department of our institution for pain and acrocyanosis of the 3rd and 4th finger of the right hand, compared abruptly 10 hours before. Physical examination was otherwise normal, she was apyretic. Her previous medical history was unremarkable, she did not take any medication and was a light smoker. Blood samples including blood count, platelets, coagulation tests, liver and kidney function, and inflammatory markers were normal. An echocardiogram was prescribed to rule out significant cardiovascular disease. The exam showed: normal left and right ventricular dimensions and systolic function, and absence of significant valvular disease. A highly mobile, iso–echoic mass was noted inside the left ventricle, with a major diameter of 8 mm; it was attached to the antero–lateral papillary muscle, not involving the mitral valve leaflets, and it had a frond–like appearance. Findings were consistent with a fibroelastoma (PFE; figure 1, 2). Doppler examination excluded pathology of ascending aorta, right subclavian artery, and demonstrated patency of arteries of the right arm and right hand. The case was compatible with peripheral embolization from the cardiac mass. A cardiac CT scan confirmed the echo findings and ruled out significant coronary disease. The patient underwent cardiac surgery two days later. With median sternotomy and cardiopulmonary bypass, the left ventricle was reached through aortotomy. A multilobular yellowish mass was seen attached to the antero–lateral papillary muscle, and was completely resected (figure 3); chordae tendineae were preserved. Macroscopic examination (figure 3) and histological findings confirmed the diagnosis of PFE. Post operative course was unremarkable.

Discussion

PFEs are benign tumors most commonly involving aortic valve, followed by mitral valve; atypical origins including mitral subvalvular apparatus, as in our case, has seldom been described. Most cases of PFE are asymptomatic, limited in dimensions and discovered incidentally. Interestingly, Raynaud phenomenon was at first suspected as cause of acrocyanosis in our patient, but it was inconsistent with biochemical findings, so that an echocardiogram was prescribed. Echo and CT aspects of the mass were typical for PFE, and it appeared at high embolic risk being pedunculated and highly mobile. Given the peripheral ischemic event occurred, prompt surgical resection was performed successfully.
P135 A CASE OF RIGHT CORONARY ARTERY ANEURYSM COMPLICATED BY ENDOVASCULAR THROMBOSIS
Authors: Benedetti G , Colarusso L , Marchi F , Pizzino F , Chiappino S , Sorbo S , Al Jabri A , Ravani M , Berti S , Paradossi U
Published: May 2023

Coronary artery aneurysm is a rare disorder with prevalence in male population. The most commonly involved vessel is the right coronary artery followed by the anterior descending artery. The most frequent etiologies are coronary atherosclerosis and Kawasaki disease. The treatment of coronary aneurysms with significant stenosis is often surgical, with implantation of covered stents in case of saccular aneurysms. In coronary artery aneurysms without significant stenosis, medical therapy is often the most suitable choice. Case report We present a case of a 68–year–old man with history of hypertension and dyslipidemia, who arrived to our ED with inferior STEMI. Left coronary angiography showed a 75% stenosis of the distal anterior descending artery and subocclusion of the first left marginal artery. Right coronary angiography revealed a severely ectatic vessel (7–8 mm diameter) with intraluminal thrombosis and markedly slowed flow (TIMI 1). Considering the regression of symptoms and ECG alterations, intracoronary bolus of Tirofiban was performed followed by i.v. infusion of 24 hours in association with DAPT. Blood tests did not detect any relevant alterations of coagulation profile but only an heterozygous mutation for MTHFR with slightly altered homocysteine values. Six days later, a second coronary angiography was performed which confirmed the persistence of thrombotic formation into the right coronary artery that was treated with rheolytic thromboaspiration and TIMI 2 final flow. In consideration of the angiographic findings, it was decided not to implant coronary stents. After multidisciplinary team discussion it was decided to associate DAPT with oral anticoagulant therapy (Warfarin 5 mg, INR 2–3) The patient was discharged with indication to continue the triple antithrombotic therapy for 6 months followed by double antithrombotic therapy with ASA and Warfarin.

Conclusions

Coronary aneurysms in the context of ACS are rare findings, often caused by endovascular thrombosis. Thrombolytic therapy, rheolytic thromboaspiration and anticoagulation therapy are valid tools for the successful treatment of such cases.
P151 UTILITY OF MULTIMODALITY IMAGING IN A CASE OF MULTIPLE AORTIC POST–ENDOCARDITIS PSEUDOANEURYSMS
Authors: Bianchi N , Frascaro F , Merani A , Maio D , Guardigli G , Campo G , Pavasini R
Published: May 2023

Introduction

First–line therapy for infective endocarditis is antibiotic treatment to avoid the occurrence of complications such as septic embolization, septic shock (1), pseudoaneurysm or abscess formation (1). A pseudoaneurysm is a cavity that communicates with the vascular lumen and develops as a result of necrosis of the infected tissue (1). Case report: An 81–year–old man with past medical history of aortic valve replacement with bioprosthesis for severe stenosis and re–intervention for infective Enterococcus faecalis endocarditis was admitted to hospital for hyperpyrexia. PET–CT scan was performed. An aortic bioprosthesis hypercaptation suggestive of endocarditis recurrence was found. Blood cultures were positive for Staphylococcus epidermidis. Transesophageal echocardiography was initially negative for vegetations. Therefore, it was decided for a conservative approach with antibiotic therapy. About 2 months later the patient presented in our emergency department with atypical chest pain. At a transthoracic echocardiogram was reported an eccentric paravalvular regurgitation jet on bioprosthesis in atypical position and thickening of the periaortic tissue (Fig 1A). A contrast enhanced cardio–synchronized CT scan was performed confirming the presence of three paravalvular aortic pseudoaneurysms, the largest of 16x8 mm and located on the posterolateral portion of the valvular ring near to the left atrial wall (Fig 1B). Finally, a transesophageal echocardiogram was repeated finding a fistula from the posterior pseudoaneurysm to the left ventricular outflow tract (Fig 1C). The patient underwent re–intervention of aortic valve and ascending aorta replacement.

Conclusions

In this case–report, the use of multimodality imaging allowed adequate diagnosis of fistulizing paravalvular aortic pseudoaneurysms and proper subsequent surgical planning. The results of this case report suggest that following infective endocarditis presence of paravalvular aortic regurgitation with eccentric jet should be investigated with second–level diagnostic examinations for better anatomic resolution, such as cardio–synchronized CT and transesophageal echocardiogram. Bibliography: 1. Okada K et al. doi: 10.1007/s11748–012–0152–x
P200 A POSITIVE CORRELATION BETWEEN THE OVERALL ECHOGENICITY OF CAROTID INTIMA MEDIA COMPLEX AND ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS: BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT
Authors: Natale F , Loffredo F , Molinari R , Alfieri R , Covino S , De Luca L , Limatola M , Mollo N , Pezzullo E , Cimmino G
Published: May 2023

According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness (AS) still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk. Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima–media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color–Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM > 30 showed a significantly increased arterial stiffness and LVMI (P < 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, P< 0.001), and duration of hypertension (r = 0.31, P < 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.
P218 WILD TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS (WTATTR) AND HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF): CAN ANGIOTENSIN RECEPTOR/NEPRILYSIN INHIBITORS (ARNI) BE A THERAPEUTIC OPTION?
Authors: Fowler B , Vincenzi A , Vullo E , Fagnani A , Lettino M
Published: May 2023

Background

wtATTR is associated with high mortality rate, median survival from diagnosis is 43 months and mortality reaches 50% at 4 years. Most patients (pts) present with heart failure and preserved ejection fraction (HFpEF), fewer with HFrEF. Tafamidis is the only modifying–disease agent available in Italy and therapeutic strategy is based on diuretic titration. Beta blockers and therapies for neurohormonal antagonism have raised concerns about their efficacy and safety. The role of ARNI has not been explored. We report our experience of the use of ARNI in pts with wtATTR not eligible to Tafamidis due to advanced NYHA classes.

Cases

4 male pts (median age 81 y.o.) received diagnosis of wtATTR between 2018 and 2019 when Tafamidis was not available. Median left ventricular ejection fraction (mLVEF) at the time was 51%. 2 years later they presented with acute HFrEF (Tab1–T0), NYHA classes III–IV with median systolic blood pressure 105 mmHg. Average N–terminal pro natriuretic peptide (NTproBNP) levels were 13888pg/ml and median estimated glomerular filtration rate (eGFR) was 36 mil/min/1,72m2. mLVEF was 23%. Once congestion was relieved pts started Sacubitril/Valsartan (S/V) with titration of dose. At 6 months follow–up (FU) (Tab1–T1) pts were downgraded to NYHA class II and no symptomatic hypotension was reported. Average NTproBNP levels were reduced to 7.800pg/l, only mild worsening of renal function was reported (median eGFR 31mil/minx1.73m2). Absolute increase of mLVEF (46%) was shown on echocardiography. At 12 months FU (Tab 1–T2) pts were clinically stable in NYHA class II, NTproBNP median values had mildly increased to 9700pg/ml and average eGRF was stable (30mil/minx1.73m2). Echocardiogram highlighted minimal reduction of mLVEF compared to previous result (41%). During FU only 1 of the pts required hospitalization for intravenous diuretic therapy and S/V was temporarily suspended.

Conclusion

The efficacy of S/V in HFrEF is well known. Our brief study proves that ARNI can be tolerated in frail pts affected by wtATTR with no other therapeutic options, guaranteeing a long hospitalization–free period with improvement in quality of life. The result may be purely due to the natriuretic effect of ARNI in patients so strictly reliant on volemic state. More complicated effects may be mediated by neprilisin on amyloid protein; further studies are warranted to establish the role of ARNI in wtATTR.
P231 CORONARY VASOSPASM REFRACTORY TO MEDICAL THERAPY AND COMPLICATED BY ASYSTOLE, HOW TO MANAGE IT?
Authors: Facchini E , Maffè S , Paffoni P , Prenna E , Bergamasco L , Franchetti Pardo N , Ariotti S , Careri G , Paino A , Dellavesa P
Published: May 2023

Vasospastic angina is a form of angina caused by coronary artery spasm. This usually determines rest chest pain and electrocardiogram changes. In some patients severe ventricular tachyarrhythmias or bradyarrhythmias may develop during myocardial ischemia. Vasospastic angina attacks can be prevented by calcium antagonists and nitrates but artery spasm may be refractory to optimal medical therapy. A 66–year–old woman, affected by Hailey–Hailey disease was brought to the emergency department for hemorrhagic shock after anti–conservative purposes. She underwent emergency surgery for haemostasis of the neck lesion, reinsertion of the subhyoid muscles and right parotidectomy. After surgery an electrocardiogram (ECG) showed inferior and posterior ST–segment elevation, total atrioventricular block (AVB) and torsades de pointes (FIG 1), then evolved in asystole and cardiac arrest . ROSC occurred in 4 minutes. Temporary pacemaker (PM) was placed. Coronary angiography showed right coronary artery and left anteriori descending artery vasospasm, slightly reduced after nitroglycein infusion (FIG 2). Transdermal nitrates and calcium channel blocker were started. Hospitalization has been prolonged due to infectious/psychiatric problems, with necessity of percutaneous endoscopic gastrostomy and tracheostomy, A new episode of vasospastic angina developed during hospitalization with recurrence of total AVB and torsades de pointes. Temporary PM was placed but after 24 hours perforated the right ventricle free wall. Echocardiogram showed small circumferential pericardial effusion. The patient underwent transvenous removal of the right ventricular catheter and two lead DDD PM was implanted. She was discharged with nitrate and calcium channel blocker therapy. No recurrence of angina was documented at 6–months follow–up. The management of this clinical case was complex because it was a form of vasospastic angina complicated by 2 cardiac arrests, unresponsive to medical therapy and with temporary PM that perforated the right ventricle. We therefore opted for a definitive PM implant for protection. Few case report describes definitive PM implantation in fatal bradyarrhythmias during vasospastic angina. To date, the best treatment of coronary vasospasm refractory to medical therapy is debated, pecutaneous revascularization and sympathectomy are considered, treatment methods that we will consider at follow–up in case of (probable) anginal recurrences.
P239 BASELINE HIGH RENAL RESISTANCE INDEX IS ASSOCIATED WITH WORSENING OF RENAL FUNCTION IN PATIENTS UNDERGOING CARDIAC SURGERY
Authors: Goffredo G , Barone R , Di Terlizzi V , Squiccimarro E , Margari V , Di Biase M , Brunetti N , Iacoviello M , Paparella D
Published: May 2023

Renal resistance index (RRI) is a parameter which is easily evaluable by the echo Doppler technique and which has been demonstrated to predict worsening of renal function (WRF) in patients affected by chronic heart failure as well as among those undergoing coronary angiography. The aim of this study was designed to evaluate the role of the RRI in predicting WRF after cardiac surgery.

Methods

Thirty–one patients were enrolled. Their clinical characteristics are shown in Table 1. All patients underwent cardiac surgery. Before surgery, RRI was evaluated according to Peurcelot’s formula by renal interlobular arteries pulsed Doppler. WRF was defined as an increase in serum creatinine of > 0.3 mg/dl associated with a change > 25% or the need of renal replacement therapy due to severe acute kidney injury.

Results

Among the patients in 12 WRF occurred, in 10 a worsening of creatinine serum levels and in 2 a severe AKI requiring RRT were observed. As shown in Table 1, RRI and the presence of peripheral artery disease were the only parameters which were significantly different among patients with and without WRF, whereas no difference in GFR values was observed. Baseline RRI showed a significant AUC of 0.74 (95% CI, 0.55–0.93) whereas baseline GFR of 0.52 (95% CI, 0.28–0.75) was not significant.

Conclusions

Among patients with WRF after cardiac surgery an increased RRI but not a different baseline GFR is observed. This parameter could allow a more accurate stratification of the risk of cardiorenal syndrome worsening among patients candidated to cardiac surgery.