bluuebunny/crossref_metadata_2025 huggingface dataset:
P126 RADIOTHERAPY AND THE HEART: IN SEARCH OF ARIANNA‘S THREAD
Authors: Irma B , Federico A , Raffaella M , Camilli M , Canale M , Russo G , Turazza F , De Felice F , Matera S , Cartoni D
Published: May 2023

Background

Radiation therapy (RT) is widely diffused in the treatment of cancer; but it could lead to various negative consequences on the cardiovascular system, even several years after treatment end. They include also valvular heart diseases, arrythmias, coronary artery diseases, heart failure, pericardial diseases, systemic and pulmonary artery diseases. We report an interesting case about RT cardiotoxicity different manifestation occurred in the same patient. Case report: 79 years old patient, history of previous testicular seminoma when he was 54 years old (1997), treated through surgery and RT with betatron (total body cobalt). In 2008 aortic valve replacement with mechanical prothesis; in 2017 first hospitalization for heart failure during atrial fibrillation. In subsequent years, recurring episodes of atrial fibrillation (2 unsuccessful attempts at electrical cardioversion), and heart failure exacerbations with mild reduced ejection fraction, treated through medical therapy improvement. At follow–up echocardiogram (03/19) finding of ejection fraction mild reduced (45%), right sections increased in volumes, tricuspid valve moderate regurgitation. In January 2022, at the last cardiac check–up, he reported worsening dyspnoeic symptoms, and occasional episodes of retrosternal pain in last months. It was performed Coro–TC observing a 60% stenosis at distal tract of right coronary; in addition, patient underwent a transoesophageal echocardiogram which documented further reduction in left ventricle ejection fraction, and worsening tricuspid regurgitation to a severe degree, with anulus dilatation and partial failure of leaflets coaptation, which appeared fibro–elastic; inferior vena cava ectasia, Paps 40–45 mmHg circa. Holter–ECG showed atrial fibrillation for all 24 hours, plus 2000 BEV. The case was discussed in Heart Team, and an indication was placed for Triclip intervention.

Discussion

Nowadays great achievements of anticancer therapies improved patients’ survival, consequently increased the number of anticancer therapies complications; therefore, an accurate cardiac screening for early diagnosis and effective treatment of CV adverse effects is necessary. Several distinct factors contribute to determine the onset cardiotoxicity insurgence, such as the type of cancer, its anatomical localization; radiation techniques applied, total and fractional radiation doses; patient’s age and his comorbidity and risk factors for cardiovascular diseases.
P188 OUTCOMES OF TRANSVENOUS LEAD EXTRACTION IN OCTOGENARIANS USING BIDIRECTIONAL ROTATIONAL MECHANICAL SHEATHS
Authors: Migliore F , Pittorru R , Dell‘Aglio P , De Lazzari M , Iliceto S , Bertaglia E , Gerosa G , Tarzia V , Carretta D
Published: May 2023

Background

Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, date on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited.The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid–term outcome after TLE.

Methods

The study population comprised 83 patients [78% male; mean age 85±3 years; (range 80–94 years)] with 181 target leads.All the leads (mean implant duration 112±77 months [range 12–377) were extracted exclusively using the Evolution RL sheaths (Cook Medical,Bloomington,IN,USA).

Results

The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3% respectively. Failure of lead extraction was seen in 1.7% of leads.The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty–day mortality after TLE was 6%. During a mean time follow–up of 22±21 months, 24 patients (29%) died. No procedure–related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35;95%CI 1.87–10.13;P=0.001), LVEF ≤35% (HR 7.89;95%CI 3.20–19.48;P<0.001), and TLE for systemic infection (HR 4.24;95%CI 1.69–10.66;P=0.002).

Conclusions

At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in octogenarian with long lead dwell time Patient’s age should not influence the decision to extract or not the leads, although the 30–day and mid–term mortality are significant, especially in the present of specific comorbidities.
P194 DESTRUCTIVE AORTIC VALVE ENDOCARDITIS WITH INVOLVEMENT OF THE MITRO–AORTIC CURTAIN: A SUCCESSFUL “UFO” PROCEDURE
Authors: Testa S , Ottaviani A , Bendetti C , Gallina S , Renda G , Ricci F
Published: May 2023

Infective endocarditis is a relatively rare disease with an estimated mean incidence of 3.6–7.0 cases per 100,000 subject–years. Aortic bicuspid disease, the most frequent congenital anomaly, is one of the main risk factors. Heart failure, uncontrolled infection (fistulas, abscesses, persistently positive blood cultures) and systemic embolization are among the most feared complications of endocarditis: these cases constitute an indication for emergency/urgent cardiac surgery. An example of extremely demolitive surgery is the Commando or "UFO" procedure, which consists in the double replacement of the aortic valve and the mitral valve with reconstruction of the mitro–aortic junction. The clinical case concerns a 36–year–old man who went to the emergency room for high fever with shivering. Having been found positive blood cultures for MSSA and having emerged mitro–aortic vegetation by echocardiogram, a diagnosis of infective endocarditis was made. During hospitalization, multi–organ cardioembolic phenomena (e.g. splenic, cerebral) with hemorrhagic cerebral infarction occurred: therefore, in accordance with current guidelines, a conservative treatment was temporarily opted for. However, in the following days the deterioration of the clinical–haemodynamic picture was such as to require emergency cardiac surgery. The patient was thus subjected to Commando or UFO procedure with reconstruction of the mitral–aortic junction. Severe bi–ventricular dysfunction was found for the first time at post–operative echocardiographic control, with the need for mechanical support to the circulation (AV ECMO, Impella). The remainder of the hospitalization was characterized by a progressive recovery of ventricular function (LVEF 16% to 44%), therefore patient was discharged in discrete hemodynamic compensation, despite the multiorgan sequelae (hepatic, neurological, renal).
P207 DIAGNOSTIC PATHWAY OF CARDIAC AMYLOIDOSIS. INSIGHTS FROM CUNEO HOSPITAL
Authors: Coppini L , Coletta G , Rossini R
Published: May 2023

Introduction

In the last fifteen years, thanks to the refinement of non–invasive diagnostic techniques, there has been a clear increase in the diagnosis of amyloidosis. From this need arises the establishment of a specific out–patients department in order to guarantee the best path of diagnosis and treatment.

Methods

Since 2018 we have begun to suspect cardiac amyloidosis in hospitalized patients with heart failure with preserved ejection fraction and clinical and/or instrumental red flags: left ventricular hypertrophy unexplained by other causes, biatrial enlargement, minimal pericardial effusion, history of carpal tunnel, low voltages in peripheral leads, elevated values ​​of cardiac biomarkers. In these patients we excluded AL amyloidosis by searching for monoclonal components and at the same time we performed a myocardial scintigraphy with diphosphonates. In the case of positive scintigraphy, patients are taken care of at our cardiology rare disease outpatient clinic. We believe that this collaboration is essential for the correct management of the patient with amyloidosis, especially in an area like ours where there is a high prevalence of a mutation, val30met, with prevailing initial neurological involvement.

Results

From 2019, 156 patients underwent bone scintigraphy with diphosphonates. The average age is 78 years. 87 scintigraphies were positive (Perugini 2–3), 47 patients were diagnosed with TTRwt amyloidosis, 3 with TTRv amyloidosis, 38 are awaiting genetic testing. 34% underwent organ biopsy (of which 10 patients underwent salivary gland biopsy, 3 patients underwent periumbilical fat biopsy and 1 patient underwent BEM at another center. 25% underwent cardiac MRI. 7 patients underwent started in Tafamidis.

Conclusions

Amyloidosis is a frequently underdiagnosed disease. An early diagnosis is crucial to undertake, in cases that allow it, a specific therapy: chemotherapy in the case of AL amyloidosis or disease–modifying drugs in the case of TTR. The experience of our center has shown us how a multidisciplinary approach and a specific diagnostic path are crucial to achieve an early diagnosis in order to establish therapeutic paths that can modify natural history of the disease.
P210 PLATELET REACTIVITY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME AND ATRIAL FIBRILLATION
Authors: Sammartino A , Toso A , Leoncini M , Grippo G , Nieri M , Musilli N , Maioli M , Bellandi F
Published: May 2023

Background

Previous studies showed that incidence of antiplatelet therapy resistance is higher in elderly patients. There is a paucity of data about the response to antiplatelet therapy in patients with atrial fibrillation (AF). The purpose of this study is to analyze platelet reactivity during dual antiplatelet therapy (DAPT) in elderly patients (≥ 75 years) with acute coronary syndrome (ACS), stratifying them by the presence or absence of AF.

Methods

From the PRATO–ACS registry we selected 160 patients (81±5 years; 45% female) treated with DAPT (Aspirin 100 mg daily and Clopidogrel 75 mg daily). At discharge they were tested with the VerifyNow assay to measure platelet reactivity in aspirin (aspirin–reaction unit – ARU) and in clopidogrel (P2Y12–reaction unit – PRU). Low response to aspirin was defined as ARU ≥550; low response to clopidogrel was defined as PRU ≥ 208; high response was defined as PRU values ≤ 85.

Results

The ARU and PRU values for patients divided according to the presence of AF are shown in the Figure 1.

Conclusions

In this series of elderly ACS patients, AF was associated with higher residual platelet reactivity under both clopidogrel and aspirin. AF patients were significantly more clopidogrel low responders than non–AF, while non–AF patients were significantly more high responders. No difference was found for aspirin low responders between AF and no AF patients.
P216 DAPAGLIFLOZIN USE IN HFREF PATIENTS: A SINGLE CENTRE COMPARISON BETWEEN REAL–LIFE AND DAPA–HF DATA
Authors: Mapelli M , Capovilla T , Mattavelli I , Salvioni E , Marongiu A , Maranzano G , Paganin C , Vignati C , Palermo P , Sinagra G , Agostoni P
Published: May 2023

Background

Practice guidelines recommend Sodium–glucose co–transporter–2 inhibitors (SGLT2–i) for patients with heart failure with reduced ejection fraction (HFrEF). Our study aimed to describe our population of patients with indications for Dapagliflozin, to compare it with the DAPA–HF trial population and assess the possible prognostic evolution.

Methods

We retrospectively analysed clinical data of the first 100 HFrEF patients treated with Dapagliflozin at our heart failure clinic (Centro Cardiologico Monzino) from September 2021.

Results

Table 1 shows patient characteristics in our study (n = 100) and in the DAPA–HF trial (n = 2373). Our patients had a mean age of 69±11 years, mean left ventricular ejection fraction of 31,1±8,0%, New York Heart Association class II (78%), class III (21%) and class IV (1%). 64% of our patients performed cardiopulmonary exercise test (CPET), with mean peak VO2/kg of 14,3±4,5 ml/min/kg and mean VE/VCO2 slope of 39,1±10,5. In our study, compared to the DAPA–HF trial population, there were fewer diabetic patients (14,1% vs 41,8%, p < 0,001), a larger number of patients with implanted cardioverter defibrillator (ICD) (59,6% vs 26,2%, p < 0,001) and cardiac resynchronization therapy (CRT) (22,2% vs 8,0%, p < 0,001). Furthermore, our population had a higher percentage of patients already on optimised therapy with Sacubitril/Valsartan (86,9% vs 10,5%, p < 0,001) and mineralocorticoid receptor antagonists (82,8% vs 71,5%, p < 0,001), along with beta–blockers (97,9% vs 96%, p = 0,434).

Conclusions

Our patients were slightly older and frailer than those in the pivotal DAPA–HF trial and probably at a more advanced stage of the disease as suggested by the higher prevalence of ICD/CRT and Sacubitril/Valsartan. Based on these results, it may be that the expected prognostic benefit of adding Dapagliflozin to their therapy, in terms of absolute risk, will be lower than in the DAPA–HF trial. Future studies and a longer follow–up are needed to compare death and hospitalisation rates.
P273 THE RATIO BETWEEN LEFT ATRIAL RESERVOIR AND SEPTAL E/E’: A NEW PARAMETER REFLECTING ATRIO–VENTRICULAR FUNCTION WHICH IS ASSOCIATED WITH A WORSE OUTCOME AMONG HEART FAILURE OUTPATIENTS
Authors: Diomede D , Nicolangelo D , Erica T , Michele G , Pugliese R , Alcidi G , Ioannoni S , Barone R , Correale M , Ieva R , Brunetti N , Iacoviello M
Published: May 2023

Background

Two–dimensional speckle tracking (2D–ST) analysis allows to evaluate both atrial and ventricular function. Recently, it has been demonstrated that the ratio between left atrial reservoir (LAr) assessed by 2D–ST and the E/e’ ratio could allow a more accurate estimation of left ventricular filling pressure. Aim of the study. To evaluate if the ratio between LAr and E/e’ is also associated with heart failure progression among chronic heart failure (CHF) outpatients.

Methods

All patients enrolled underwent a medical visit, an ECG and an echocardiographic examination. LAr was assessed by 2D–ST. The early diastolic peak at pulsed Doppler (E) and at the level of septal (e’s) and lateral (e’l) mitral annulus by Tissue Doppler Imaging (TDI) were also evaluated. Then the ratio between E and e’s (E/es) and between E and the mean of e’s and e’l (E/em) were also calculated. Finally, the ratio between LAr and E/es (LAr/Ees) and E/em (LAr/Eem) were computed. During follow–up the progression of heart failure, defined as heart failure hospitalization or death, were evaluated.

Results

Among 256 patients, LAr/Eem and LA/Ees were available in 191 patients (age 64±13 years,80 % males, mean LVEF 39±11%, NYHA class 2.3±0.5). All patients were in conventional medical therapy (sacubitril/valsartan or ACE–inhibitors or Angiotensin II receptor blockers in 85%, beta–blockers in 94%, mineralcorticoid receptor antagonists in 73%, diuretics in 81%, SGLT2 inhibitors in 21%). During a mean follow–up of 13±7 months, 25 patients experienced death (9) and/or hospitalization (21) for heart failure worsening. At univariate Cox univariate regression analysis, both LAr/Eem (HR 0.61; 95%CI: 0.43–0.87; p:0.006) and LAr/Ees (HR 0.43; 95%CI: 0.25–0.71; p:0.001) were associated with the events. However, LAr/Ees showed a greater accuracy than LAr/Eem (C–index 0.76 vs. 0.73) and remained significantly associated with the events at multivariate analysis after correction for age, LVEF, NYHA class and estimated glomerular filtration rate (HR: 0.55; 95%CI: 0.33–0.92; p:0.22). Figure shows Kaplan–Meier curves according with the median value of LAr/Eem (panel A) and LAr/Ees (panel B).

Conclusions

The ratio between LAr and E/es is a new echocardiographic parameter able to reflect both left ventricular filling pressure and worse prognosis among patients affected by CHF. Further studies should evaluate its incremental value in stratifying patients’ prognosis.
P276 LEFT ATRIAL STRAIN RESPONSE TO HEART RATE IN PATIENTS AFFECTED OR NOT BY CHRONIC HEART FAILURE: HEMODYNAMIC CORRELATES
Authors: Corbo M , Di Terlizzi V , Barone R , Goffredo G , Correale M , Pellegrino P , Ieva R , Brunetti N , Iacoviello M
Published: May 2023

Background

and aim of the study. Previous studies evaluated the effects of heart rate (HR) increase on the left ventricular (LV) function, by two–dimensional longitudinal strain, but many authors also assessed the left atrium (LA) function based on speckle tracking imaging (STI). The LA and LV are connected through the mitral annulus and the LA modulates LV filling and performance. The interaction between LA and LV functions during the cardiac cycle (LA–LV coupling) is crucial. We aimed to evaluate the changes in LA strain in response to increases in HR.

Methods

We enrolled 45 patients. 38 were evaluated with LA strain. 31 patients were affected by chronic heart failure (CHF), among whom 18 with implanted cardioverter defibrillator (ICD), 13 with ICD and cardiac resynchronization therapy (ICD–CRT) and 7 without CHF who had a PM implanted. All were in clinically stable conditions for at least 30 days and in conventional medical therapy. Starting from basal values, HR was increased by 10 beats/min programming the implantable devices at higher atrial stimulation frequencies to max 90 beats/min. At each HR, echocardiography was performed and main functional parameters were calculated, including those for LV filling evaluation (i.e. E/e’ ratio). Changes in LA strain measures, i.e. the strain of reservoir (LAr), conduit (LAcd) and contraction (LAct), and in LV global longitudinal strain (LVGLS) were calculated. The ratio between LAr and septal E/e’ was evaluated to estimate LV filling pressures.

Results

No significant variation was found in the measurements of E/e‘s and the LAr/E/e‘s ratio when all patients were analysed. However, there was a significant reduction in LA/E/e‘s in patients who did not show HR–dependent worsening in LV–GLS and a significant increase in the other group (figure 1). These results underline the relationship between LA and LV functions and consequently show the AV uncoupling at higher HR. Interestingly, the worsening of both LA and LV function assessed by strain was more evident at the rate of 90 bpm (figure 2).

Conclusions

The increase of HR was associated with both worsening of LA and LV function assessed by STI. This response is associated with an increase in LV filling pressures. These results offer new data about HR related LA–LV coupling and could be useful for guiding the optimal HR responsiveness of the implanted devices.
P278 A RARE CASE OF RECURRENT SARS–COV–2 MRNA VACCINE–INDUCED PERICARDITIS
Authors: Mistrulli R , Orellana S , Cittadini E , Ricci M , Tini G , Musumeci M , Autore C , Tocci G , Pagannone E
Published: May 2023

42–year–old man, former smoker, with allergic asthma. From February 2022, three weeks after the third dose of SARS–CoV–2 vaccine Spikevax (mRNA–1273), he experienced subcontinuous chest pain, worsened by breathing, sometimes with fever over 38°C, treated at home with ibuprofen and antibiotics without clinical benefit. After one month, blood chemistry tests showed increased inflammatory markers (CRP 76.5 mg/dL, ESR 55 mm/h), with negative troponin I. SARS–CoV–2 Polymerase Chain Reaction test was negative. On suspicion of subacute pericarditis, ibuprofen (600 mg b.i.d.) and colchicine (0.5 mg b.i.d.) were prescribed. After a week, he was admitted to hospital for reappearance of fever, chest pain and a syncopal episode. On ECG, negative T waves in DII, DIII, aVF; on echocardiogram, circumferential pericardial effusion (max 12 mm); indices of inflammation were increased; troponin I, auto–antibody and viral pattern were negative. On cardiac MRI: pericardial effusion (max 20 mm) with a fluid–corpuscular appearance, meso–subepicardial patchy areas of late gadolinum enhancement (LGE) at the antero– and infero–lateral wall of the left ventricle. Prednisone 25 mg/day and colchicine 1 mg/day were prescribed, with initial benefit. Two weeks later (April 2022), when the prednisone dose was reduced by half, chest pain with fever and pericardial effusion reappeared. The patient restarted prednisone at full dose (0.5 mg/Kg/day) in addition to colchicine and it was decided to do a very gradual décalage over the next six months. On follow–up cardiac MRI: thickening and enhancement of the pericardial leaflets with resolution of the fluid–filled effusion and mesomyocardial LGE striae. Further episodes of NSAID–sensitive chest pain were occasionally reported during cortisone dose reductions. In October 2022, at a dose of 2.5 mg/day dose of prednisone, there was another recurrence of pericarditis, with subcontinuous chest pain and marked increase in inflammatory indices. It was therefore decided to prescribe IL–1 inhibitor therapy (Anakinra) 100 mg/day subcutaneously for six months (ongoing follow–up). Pericarditis is a rare complication of SARS–CoV–2 mRNA vaccine, generally with a benign course, responsive to evidence–based therapy for acute pericarditis. This rare case of recurrent corticosteroid–dependent and colchicine–resistant vaccine–induced pericarditis emphasizes the importance of early diagnostic recognition and correct treatment in the acute phase.
P281 CARDIAC RICHTER‘S SYNDROME: A RARE CASE OF CHRONIC LYMPHOCYTIC LEUKAEMIA TRANSFORMATION
Authors: Guarnieri E , Ridolfi L , Castiglione V , Donati V , De Caterina R
Published: May 2023

A 71–year–old woman with chronic lymphocytic leukaemia (CLL) presented to our Cardiology clinic complaining of recent–onset chest pain and dysphonia. Physical examination and ECG were normal. A blood test revealed high levels of high–sensitivity troponin T (373 ng/L) and of C–reactive protein (7 mg/dL); blood counts and differential were normal. Transthoracic echocardiography showed a hyperechogenic appearance of the interatrial septum, the interventricular septum and the right ventricular free wall, as well as a mild circumferential pericardial effusion. Cardiac magnetic resonance imaging revealed multiple intracardiac masses involving both ventricles and the interatrial septum, with evidence of oedema and fibrosis. A chest computed tomography showed the presence of multiple cervical, pulmonary, and mediastinal masses, one of which was biopsied through video–thoracoscopy. At the histological examination, the mass mainly consisted of large pleomorphic peripheral CD10–, CD20+/–, CD79a+, PAX5+, BCL2+, BCL6–, c–MYC+ B cells, with high proliferative activity (Ki–67/MIB1+ 80%). A diagnosis of CLL transformation into diffuse large B–cell lymphoma (DLBCL), also known as Richter’s syndrome (RS), was established (Figure). Despite indication for specific haematological chemotherapy, the patient rapidly deteriorated and died few days after the diagnosis. RS is a rare evolution of CLL and of small lymphocytic lymphoma, affecting 2–8% of such patients (transformation <1%/ year), yet is burdened with very poor prognosis (median overall survival 8–16 months). Extra–nodal RS is uncommon, and cardiac involvement has been reported in only 3 cases in the literature (in none with the panel of techniques here used). Despite its rarity, CLL patients with rapidly worsening cardiac symptoms should be suspected of RS transformation involving the heart. The main differential diagnosis of cardiac RS is primary cardiac lymphoma. The characterization of cardiac masses relies on multimodality imaging, but histologic analysis is required to reach a definite diagnosis, which is essential to guide subsequent therapeutic choices.
P286 IMPACT OF PERSONAL PROTECTIVE MASKS ON CARDIORESPIRATORY VARIABLES IN HEALTHY SUBJECTS AND PATIENTS WITH HEART FAILURE: AN INTERIM ANALYSIS
Authors: Mapelli M , Bidoglio J , Salvioni E , Mattavelli I , Gugliandolo P , De Martino F , Vignati C , Campodonico J , Palermo P , Agostoni P
Published: May 2023

Background

protective masks are a powerful mean to contain COVID–19. However, a general feeling that masks alter the normal dynamics of breathing may reduce its application. Patients with heart failure (HF) experience dyspnea even during daily life activities (ADLs). Aim of the study is to evaluate cardiorespiratory parameters during ADLs, cardiopulmonary exercise test (CPET) to highlight differences related to protective masks.

Methods

9 healthy subjects (age 59±11, 2F) and 10 HF patients (age 64±11, 2F, EF <45%) underwent a set of tests twice, wearing a protective surgical mask and without it. We performed the following tests: standard spirometry; CPET; a set of tests recorded by a wearable ergospirometer (Cosmed K5), including ADLs), six–minute walking test (6MWT) and two 4–minute treadmill exercises (TREAD2 and TREAD3 at a speed of 2 km/h and 3 km/h, respectively).

Results

Spirometry showed a reduction of forced expiratory volume in 1s (3.29±0.75 L vs 2.65±0.57 L as for healthy subjects, p= 0.002; 2.45±0.6 L vs 1.97±0.54 L as for HF patients, p= 0.002) and forced vital capacity (4.14±0.92 L vs 3.39±0.83 L as for healthy subjects, p= 0.004; 2.93±0.76 L vs 2.59±0.73 L as for HF patients, p= 0.01) in both the groups from no mask to mask. Both healthy and HF patients showed: a trend of reduction of peak oxygen pulse (p<0.005 in healthy) and peak oxygen consumption (VO2); a decrease of tidal volume (Vt) at peak exercise (peak Vt: 2.283±0.449 L vs 1.864±0.359 L in healthy, p= 0.022; 1.6±0.41 L vs 1.448±0.431 L in HF, p= 0.02), with no significative variations of resting and peak ventilation (VE). HF patients experienced a statistically significative decrease of VO2 at the anaerobic threshold (AT) (794±227 vs 682±151 mL · min–1, p=0.01). Task–related VO2 was significantly reduced from no mask to mask in ALDs and 6MWT in the healthy, whereas HF patients experienced a significative reduction more physically demanding tasks. Both healthy and HF subjects showed an increase in the basal and task–related ratio of VE vs carbon dioxide production (VE/VCO2) in the two protocol conditions.

Conclusions

Surgical masks influences cardiorespiratory variables in healthy and HF patients at rest and during both mild and maximal physical activity. The physiological impact of the mask is far from being clinically relevant The use of masks seems to be safe both in the general population and in HF patients. These data should be confirmed in a larger group of patients.
P293 MULTI–DIMENSIONAL EVALUATION IN PATIENTS WITH AORTIC STENOSIS CANDIDATE FOR CARDIAC SURGERY
Authors: Bonanni F , Caciolli S , Berteotti M , Grasso Granchietti A , Cenni N , Tozzetti V , Marchi E , Bandini M , Servoli C , Grandi G , Del Pace S , Gabriele M , Stefano P
Published: May 2023

In patients with severe aortic stenosis, the presence of left ventricular systolic dysfunction is one of the main predictors of adverse events after valve replacement surgery. However, more and more patients are being referred for surgery early and have preserved systolic function at the time of surgery. Within this category, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling after cardiac surgery. Our study aims to identify the variation of Global longitudinal strain (GLS) in patients undergoing aortic valve replacement and any differences compared to classes of diastolic dysfunction.

Methods

From June 2020 to June 2022 we analyzed patients with severe aortic stenosis with an indication for cardiac surgery treatment admitted to the cardiac surgery department of our AOU. All patients underwent an echocardiogram immediately before surgery and in the early postoperative period (mean 7 days). In all cases, the GLS of the left ventricle was calculated and patients were divided into four classes according to the degree of diastolic dysfunction (0–III) according to the most recent international guidelines. The data were analyzed with SPSS 28 software. Analysis of variance was performed with a t–test and ANOVA test.

Results

In the final analysis, 63 patients were included, with a mean age of 70.5±8.2%, of whom 28 were women (44.4%) and 35 were men (55.6%). In 12 patients (19%) ischaemic heart disease with an indication for coronary revascularization was also present. The mean preoperative ejection fraction was 59±9.5%. The mean GLS values before surgery were 15.26±4.3% vs. early postoperative 12.52±2.6%, p<0.0001. GLS values were comparable within the various classes of diastolic dysfunction and preoperative examination (0 14.54±3.6%; I 16.04± 4.1%; II 15.27±4.7%; III 9.27%, p=0.39) and postoperative (0 12.28± 3.2%; 12.81±1.7%; II 12.53±2.9%; III 9.97%, p=0.73).

Conclusions

In our case series, patients with severe aortic stenosis undergoing aortic valve replacement with or without myocardial revascularization show a significant early reduction in GLS regardless of the degree of diastolic dysfunction. An extension of follow–up is needed to assess any differences in the intervention‘s benefit in different diastolic dysfunction subgroups.
P302 SIMULTANEOUS CORRECTION OF SEVERE LOW–FLOW LOW–GRADIENT AORTIC STENOSIS AND ABDOMINAL AORTIC ANEURYSM BY TAVI + EVAR
Authors: Scherillo G , Acerbo V , De Michele G , Raucci G , Signore G , Rotolo F , Scialla F , Panico D , Alfieri A , Martelli E , Riccio C , Cesaro A , Calabrò P
Published: May 2023

We report the case of a 72–year–old man with arterial hypertension, dyslipidemia, type 2 diabetes mellitus, and severe chronic obstructive pulmonary disease. The patient had a previous stroke with occlusion of both internal carotid arteries about 7 years ago. He presented to the emergency department with dyspnea on exertion (NYHA class III), and the echocardiogram revealed a dilated left ventricle with severe reduction of global systolic function (EF 35%), severe low–flow low–gradient aortic stenosis (AVA on VTI 0.526 cmq/mq, SVi 29.7 ml/mq, Gmax 25.6 mmHg, Gmed 16 mmHg), and abdominal aortic aneurysm. Subsequently, he underwent an angio–CT scan that showed an almost completely thrombosed abdominal aortic aneurysm with a maximum diameter of 65 mm and a longitudinal extension of about 11 cm. The patient also underwent coronary angiography, which showed diffuse calcified atherosclerosis, and he was recommended for medical therapy. After a joint Heart Team consultation with cardio–anesthesiologists, cardiac surgeons, and vascular surgeons, it was decided to perform transfemoral transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) in the same procedure (EUROSCORE II > 4%). The patient underwent TAVI followed by EVAR of the aorto–bisiliac arteries through a main access site in the left femoral artery guided by ultrasound, a secondary access site in the right femoral artery for placement of a pigtail catheter on the aortic plane, and a venous access site in the right femoral vein for placement of a temporary pacing catheter at the apex of the right ventricle. First, an Edwards Sapien 3 Ultra 26mm valve was implanted, and then the 14Fr sheath in the left femoral artery was exchanged for an 18Fr sheath for the EVAR, which was placed in the aorto–bisiliac region. Hemostasis was achieved using the Manta system on the left femoral artery and two Proglide devices on the right femoral artery. The procedure was completed without complications, and the patient was discharged 10 days later, asymptomatic and in stable clinical condition, with a recommendation for dual antiplatelet therapy with aspirin and clopidogrel. At the 6–week follow–up, the patient remained asymptomatic with an EF of 40%.

Conclusion

In selected cases, the simultaneous correction of severe low–flow low–gradient aortic stenosis using TAVI and abdominal aortic aneurysm using EVAR can be considered after appropriate discussion and consultation within the Heart Team."
P322 LEFT VENTRICULAR NON COMPACTION: WHATEVER WORKS(?)
Authors: Rosati A , Benvenuto M , Ruggieri B , Lavorgna A , Fabiani D
Published: May 2023

A 36–year–old boy arrived in the emergency room for asthenia, dyspnoea and heart palpitations for several months. In PS he found atrial flutter with high ventricular penetrance complicated by severe left ventricular dysfunction (EF25%). He was therefore hospitalized in the UTIC. The blood tests also documented hepatic suffering and alteration of the coagulation indices. A new echocardium showed marked myocardial trabeculation of the left ventricle, with an appearance referable to non–compact myocardium. Clinical stability was achieved with diuretic therapy, CVE, inotropic support with a course of Levosimendan, and progressive titration of HFrEF–optimized medical therapy. Based on the clinical suspicion, the patient underwent cardiac magnetic resonance, which confirmed the echocardiographic findings, thus documenting a severe impairment of biventricular function, with LVEF of 26% and RVEF of 25%, a moderate increase in LV volumes, with an increase in the thickness of the myocardial trabeculae at the level of the lateral and inferior mid–cavitary segments and at the level of the apical segments, with a maximum trabecular thickness/ myocardial wall thickness of about 2.5, possibly related to non–compact myocardium. Following discharge, the patient underwent periodic check–up and after three months of optimized medical therapy an indication was given for PM–ICD implantation in primary prevention for persistence of EF <35%. Non–compact myocardium is a rare cardiomyopathy characterized by intrauterine arrest of the myocardial compaction process with consequent residual myocardial hypertrabeculae. Clinical manifestations range from heart failure, systemic embolisms, ventricular arrhythmias, and sudden death. The diagnosis is based on two instrumental pillars, echocardiography and magnetic resonance. The absence of well–defined diagnostic criteria is linked to a fundamental aspect of the pathology: although it is recognized as a nosological entity in its own right, the marked ventricular hypertrabeculature can be found both in the paraphysiological field and in other cardiomyopathies, such as hypertrophic and dilated cardiomyopathy. In a practical context, it is important to manage the patient clinically to increase his quality of life, hoping that the genetically compromised myocardium works enough while we try not to get lost in the diagnostic and confusing maze of this pathology.
P330 MANAGEMENT OF HYPERKALEMIA IN A PATIENT WITH HFREF
Authors: Salucci C , Orso F , Verga F , D‘Errico G , Perini E , Cagnoni C , Poletti E , Vatri M , Corti G , Di Bari M , Ungar A , Baldasseroni S
Published: May 2023

Hyperkalimia (HK) is a condition that occurs very frequently in patients with heart failure (HF). HK often limits and discourages the implementation and optimization of RAASI therapy in patients with HFrEF. The introduction of the new K–binders drugs has made it possible to overcome this obstacle by allowing optimization of therapy even in patients with persistent hyperkalemia. Mr. AB aged 83 years cognitively intact and autonomous ( Katz‘s BADL and Lawton‘s IADL preserved; MMSE 29/30). February 2022 accessed DEA for aggravating exertional dyspnea; at that time echocardiogram finding reduced left ventricular systolic function, FE 35%. March 2022 performed elective coronarography: coronary tree free of critical lesions, confirmed on echocardiogram reduced FE. Post indication to undertake Sacubitril/Valsartan, beta blocker and SGLT2i therapy. For moderate CKD (eGFR 33 ml/min) with tendency to hyperkalemia not initiated MRA. April 2022 the patient was taken to our Heart Failure Outpatient Clinic–UTIG– AOU Careggi. June 2022 considered improvement in renal function and Kaliemia in optimized range GDMTs therapy with Potassium Canreonate 25 mg/day. At control EEs in July 2022 found hyperKalemia with K values 5.5 mEq/L but stability of renal function. Reduced therefore the dosage of Potassium Canreonate (25 mg every other day) with indication to repeat blood tests soon. September 2022 despite reduction in MRA dosage further increase in Kaliemia values to 5.8 mEq/L. Suspended Potassium Canreonate and started Sodium Zirconium Cyclosilicate therapy initially at loading dosage of 10 g three times daily for two days then continued with maintenance dosage of 5 g. At follow–up performed the following week K 4.5 mEq/L. Re–introduced Potassium Canreonate 25 mg/day with initial tight control of potassium values that remained stably at optimal values. Hyperkalemia is an obstacle in titrating HFrEF, especially in elderly patients with CKD. However, we have new drugs available that may allow the implementation of guideline–recommended treatments by controlling potassium values.
P337 THREE–DIMENSIONAL RIGHT VENTRICULAR ARTERIAL COUPLING IN HEART FAILURE: PROGNOSTIC COMPARISON WITH TRADITIONAL METHODS
Authors: Sforna S , Biagioli P , Mengoni A , Zuchi C , Lupi A , Grassano D , Scapicchi C , Gobbi F , Maltempi M , Scarpignato A , Tritto I , Carluccio E
Published: May 2023

Background

Right ventricular (RV) contractile function and pulmonary artery (PA) pressures influence outcomes in patients with heart failure (HF). Analysis of RV–arterial coupling (RVAC) from pressure–volume loops is not routinely performed. Several non–invasive RVAC methods by echocardiography have been described in patients with HF. The aim of this study was to compare the prognostic impact of these RVAC methods in HF patients.

Methods

One–hundred–sixty patients with chronic HF underwent standard, speckle–tracking (STE) and three–dimensional (3DE) echocardiography. RVAC was assessed by calculating: a) tricuspid annular plane systolic excursion (TAPSE) to noninvasively measured PA systolic pressure ratio (TAPSE/PASP), b) RV free wall longitudinal strain (RVFWLS) by STE to PASP ratio; and c) by 3DE, by measuring PA effective elastance (Ea), RV maximal end–systolic elastance (Emax), and RVAC (PA Ea/RV Emax) using simplified formulas including mean pulmonary artery pressure (mPAP), stroke volume and end–systolic volume. The primary endpoint was a composite of all–cause mortality and/or HF hospitalization.

Results

During a median follow–up time of 17.9 months, 35 events occurred. At univariable analysis, TAPSE/PASP ratio < 0.43 (HR: 4.36 [95%CI: 2.18–8.65, P<0.0001]), RVFWLS/PASP ratio < 0.50 (HR 8.07 [95%CI: 3.12–20.82, P<0.0001]), and 3D–RVAC > 1.13 (HR: 4.34 [95%CI: 1.80–10.46, P<0.0001]) were all significantly associated with outcome. After adjusting for MAGGIC risk score and natriuretic peptides levels at multivariable analysis, TAPSE/PASP ratio was no longer predictive of adverse outcome.

Conclusions

Non–invasively assessed RV–arterial coupling by 3D echocardiography and RV free wall longitudinal strain appears to be a more powerful predictor of outcome in heart failure than traditional index.
P345 INTERMEDIATE–TERM RESULTS OF A NEW AORTIC BIOPROSTHESIS IN PATIENTS AT INCREASED RISK OF EARLY SVD
Authors: Paduvakis I , Cerillo A , Stefano P , Petrini F , Manca A
Published: May 2023

Background and aim

Biological prosthesis are increasingly been used in young patients to avoid anticoagulation. The Edwards Inspiris aortic bioprosthesis is extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the haemodynamic performance and clinical outcome of the Inspiris bioprosthesis in patients aged < 50 years.

Methods

Between May 2018 and May 2022, 58 patients aged 41±7.8 years underwent AVR with the Edwards Inspiris bioprosthesis. Twenty–three (39.65%) were younger than 40, and 7 (12.06%) had a BMI >30 kgm2. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 25 (43.10%) patients. There were 10 redo patients (17.2%).

Results

Major complications included bleeding (4), respiratory failure (1) and BAV requiring PMK (1). Two patients died (3.45%). The mean follow up was 29.6±12.3 months (range 10–51). Late valve–related events included endocarditis (2) requiring reoperation. There were no thromboembolic events, valve thrombosis or SVD cases. At follow up, all except one patient reported a significant improvement of their symptomatic status (96.29% were in NYHA II) and quality of life. The mean interval to return to the normal activity was of 5.37±3.3 months.

Conclusion

Our study demonstrates promising results at up to 4 years in a cohort of very young patients. Further studies with longer follow–up are needed.
P346 MINIMALLY INVASIVE APPROACH FOR THE SURGICAL TREATMENT OF COMBINED MITRAL AND AORTIC VALVE DISEASE
Authors: Fiorentino M , Mikus E , Tripodi A , Sangiorgi D , Calvi S , Tenti E , Panzavolta M , Tizzano F , Savini C
Published: May 2023

Background

Minimally invasive approaches are more and more used for isolated aortic or mitral valve procedures. However, minimally invasive combined mitral and aortic valve surgery is still uncommon. We report our experience performing multiple valve procedures through a right–sided mini–thoracotomy.

Methods

From November 2013 to July 2022, 32 patients underwent aortic and mitral valve surgery through right anterior thoracotomy.

Results

Median (Q1–Q3) age of our population was 71 years (59,5–76) and 59% were females. Median (Q1–Q3) logistic Euroscore was 3.99 (2.52–6.76) and median (Q1–Q3) EuroSCORE II was 2.28 (1.81–5.42). Three patients (9%) were redo operations. Median cardiopulmonary bypass and cross–clamp times were 95 (83–118) minutes and 83 (71–104) minutes, respectively. No conversion to full sternotomy was necessary. In–hospital mortality was 3.1% (1 patient) who died for septic shock and consequent multi–organ failure. 62% of patients required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 8 patients (25%) and 2 patient (6%) required Pace–maker implantation due to third degree AV block. Also, 1 (3%) re–thoracotomy for bleeding was observed. Median (Q1–Q3) intensive care unit and in–hospital length of stay were 2 (2–3) days and 9 (8–11) days respectively. Median follow up period was 5.5 years (1.4–6.3) with 87.5% survival rate (incidence rate of death: 2.8 per 100 patient–years). Re–operation rate was 9.4%.

Conclusions

In our experience, a minimally invasive approach for combined aortic and mitral valve surgery is safe and feasible, with acceptable cardiopulmonary bypass and cross–clamp times and good outcomes. Therefore, it can be an attractive option for patients with double valve diseases. Further studies are needed with a bigger population and a comparison to full sternotomy results.
P395 PULMONARY HYPERTENSION OUTPATIENT CLINIC IN CUNEO: SUMMARY OF THE FIRST TWO YEARS OF ACTIVITY
Authors: Giordana F , Cinconze S , Ferraro I , Coppini L , Bongiovanni V , Perilli A , De Benedetto Fabrizi M , Baralis G , Coletta G , Rossini R
Published: May 2023

Backgroung: Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and may be associated with a variety of cardiovascular and respiratory diseases. PH is defined by a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg at rest,assessed by right heart catheterization (RHC).

Methods

The Cardiology Rare Disease Outpatient Clinic was opened in 2021 in the Cardiology Division of S. Croce and Carle Hospital, Cuneo. In this ambulatory setting, patients with suspected or confirmed PH diagnosis were screened and followed up. The outpatient evaluation included cardiological physical examination, electrocardiogram (ECG) and transthoracic echocardiogram. In case of echocardiographic PH suspicion (intermediate or high probability) a comprehensive work–up was performed with first level diagnostic tools (respiratory function tests with DLCO, high–resolution chest CT, arterial blood gases, blood tests and overnight oximetry or polysomnography). Eventually, lung scintigraphy was performed and work up was completed with RHC with vasoreactivity test with nitric oxide (NO) if indicated. Multidisciplinary team approach proved to be an essential requirement for good practice in this setting.

Results

Between January 2021 and December 2022, 95 patients were evaluated in the PH outpatient clinic; Sixty–one (63%) patients were female, mean age was 66 years. Forty–two (42%) patients were referred from Rheumatology, 9 (9%) from Pulmonologiy, 13 (14%) from Emergency Medicine or Internal Medicine, 20 (21%) from Cardiology, and the remaining 13 (14%) patients from other departments or from other hospitals. Following clinical and echocardiographic evaluation, patients were stratified into low, intermediate and high PH–risk levels. In 23 (24%) patients RHC was performed and in one case it was associated with vasoreactivity test with NO. Eight (8%) patients with chronic thromboembolic PH (CTEPH) suspicion were referred to the Hub Center in Pavia to evaluate pulmonary endarterectomy. Seven (7%) patients were treated with specific therapy for group 1 PH and 3 (3%) patients for CTEPH. Two (2%) patients died during follow–up.

Conclusions

The aim of the dedicated PH outpatient clinic is to screen patients and identify those who need a complete work–up for diagnosis and classification of PH subtypes, in order to select those patients who could benefit from specific PH therapies, and to monitor the response at FU.
P430 SCARE PROJECT: SUDDEN DEATH IN RIMINI
Authors: Saporito D , Marzaloni S , Carigi S , Baldazzi F , Spighi L , Righetti E , Fabbri F , Di Cesare A , Giuliani G , Montomoli J , Santarelli A
Published: May 2023

Sudden death guidelines make emphasis on the need to identify the etihiology of the arrest in survived patients or in their family members. If cardio–pulmonary resuscitation techniques are almost standardized throughout the world, the intra– and post–hospital treatment of the patient changes in the different centers and countries. The local discrepancies related to the survival rate of the patients can instead be considered as an indirect index of the good network in the management of the victims. Given the impossibility of carrying out randomized, controlled and prospective studies, registries represent the only alternative system for collecting and analyzing data in this area. The SCARe (Sudden Cardiac Arrest Registry) project – unique for being multidisciplinary – represents the most effective system for carrying out an epidemiological investigation, optimizing the treatment of patients affected by cardiac arrest, creating collaborations and integrations between hospitals and the territory, identifying diagnostic pathways for study of family members, monitoring the efficiency of the work performed. 646 interventions for "code blue" (out–of–hospital cardiac arrest) carried out in the Province of Rimini from 2019 to 2021 were analysed. There were 318 patients less than 75 yrs old, with a median age of 63 years: only 24% of the victims presented with a shockable rhythm, in 98% of them with ventricular fibrillation; autopulse was used in 20%; 217 patiente died out from hospital, 5 in the emergency room. Of the remaining 72% was hospitalized in Intensive Care, 28% in CCU or Emergency Medicine. A multi–specialist database can evaluate the adherence to the guidelines and the methods of approach of the different professional figures to the patient. Data analysis will allow to increase the survival rate of patients.