bluuebunny/crossref_metadata_2025 huggingface dataset:
C29 SEEING BEYOND APPEARANCES: INTRACORONARY IMAGING TECHNIQUES IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD)
Authors: Desario P , Rutigliano D , Basso P , Palumbo V , Ricci G , Sublimi Saponetti L , Locuratolo N , Caldarola P
Published: May 2022

Over recent years, mainly due to a broad use of coronary angiography and intracoronary imaging techniques (IIT), SCAD has emerged as a no longer rare cause of acute coronary syndrome (ACS). Early diagnosis is extremely important to avoid potentially lethal complications; nevertheless, considerable uncertainty remains about optimal acute and post–discharge management. Current endorsed therapeutic strategy lean towards an initial conservative approach, relegating percutaneous or surgical coronary intervention to high–risk coronary anatomy or in case of hemodynamic instability. We report our experience in the field by presenting a clinical case of a 36–year–old woman admitted to emergency department with acute, anginal pain started 24 hours earlier, referring no medical history, except for a syncopal episode occurred four days earlier, in correspondence of a mournful event. She was hemodynamically stable, with work–up significant only for elevated troponin level of 3649.5 ng/ml (n.v. <11). Coronary angiogram showed atherosclerotic–like changes limited to right coronary artery (RCA), with focal subcritical stenosis at its proximal segment (Fig 1). In the absence of major precipitating factors for atherosclerotic coronary disease, SCAD was suspected. IVUS and OCT were performed, with evidence of dissection and intra–mural haematoma (Fig. 2), extending from proximal RCA to posterior descending branch take–off, compressing the true lumen. Considering both anatomical (coronary ostium not involved) and clinical (patient asymptomatic and hemodynamically stable) factors, conservative treatment with low dose aspirin and beta blocker was prescribed. After three days of hospitalization occurred a single episode, lasted 5 minutes, of anginal pain associated with ST elevation in inferior leads, managed with nitrates administration; subsequent cardiac computed tomography angiography excluded disease progression (Fig.2). On the 23rd day, due to angiographic evidence of SCAD partial healing (Fig.3), the patient was discharged. This case highlights the importance of keeping in mind the possibility of SCAD, especially when healthy young women with prior emotional stress present with ACS. IIT allow to shed light on the true mechanism of ACS without significant obstructive coronary disease. Finally, in case of conservative approach, close in–hospital monitoring is mandatory, given the highest probability of complications in the first days after clinical onset.
C30 IMPACT OF CORONARY ANATOMY AND RESIDUAL SYNTAX SCORE ON ARRHYTHMIC EVENTS IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY
Authors: Meynet I , Quadri G , Tricomi L , Tomassini F , Rolfo C , Franzè A , Zanda G , Piedimonte G , Minniti D , Varbella F
Published: May 2022

Background

ICD implantation is a cornerstone for primary prevention in patients with ischemic cardiomyopathy and impaired left ventricular function; reduced ejection fraction alone, however, doesn’t seem enough to discriminate which patients will really experience arrhythmic events in the follow up. We hypothesized that coronary anatomy and the extent of residual coronary lesions, measured with syntax score, could be a better predictor of the outcome in this setting.

Materials and Methods

Data of all patients implanted with single or dual chamber ICD in primary prevention for ischemic cardiomyopathy from 2011 to 2020 were retrospectively collected, together with follow up data obtained from clinical visits and ICD remote monitoring. Residual syntax score (RSS) was calculated for each patient, taking into consideration the last coronary angiography performed before ICD implantation.

Results

110 patients were included in our registry. 90.1% were male, mean age was 66±7 years. 23.6% ICD were dual chamber devices. 96 (87.2%), 8 (7.3%) and 6 (5.5%) presented respectively with low (0–22), intermediate (23–32) or high (≥33) RSS. After a mean follow up of 4.4±2.9 years, 31 patients (28.2%) died; 20 patients (18.2%) and 27 patients (24.5%) received any appropriate ICD therapy, either shock or ATP. 12 patients (10.9%) experienced inappropriate shock. The composite outcome of death or any appropriate therapy (MACE) was observed in 47 patients (42.7%); left main or left descending artery stenosis were predictors of MACE (p = 0.026 and p = 0.040 respectively). Intermediate or high RSS was the only predictor of appropriate shock (p = 0.046).

Conclusions

Coronary anatomy and residual coronary stenosis quantified with syntax score are promising predictors of arrhythmic events during the follow up in patients with ischaemic cardiomyopathy and ICD implanted in primary prevention.
C32 TRANSCATHETER LEAK OCCLUSION WITH ENDOVASCULAR COILS FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE: PROCEDURAL SUCCESS AND OUTCOMES BEFORE AND AFTER LEAK CLOSURE
Authors: Magnocavallo M , Della Rocca D , Lavalle C , Mohanty S , Carola G , Bassiouny M , Al–Ahmad A , Burkhardt D , Gallinghouse J , Lakireddy D , Horton R , Di Biase L , Natale A
Published: May 2022

Background

Whether residual peri–device leaks after left atrial appendage occlusion (LAAO) portend a higher risk of thromboembolism (TE), it is still a matter of debate.

Objectives

We report the TE risk in patients with incomplete LAA closure before and after leak closure with endovascular coils.

Methods

One hundred twenty–four Watchman patients with a significant (≥3mm) leak (mean age: 74 ± 9 years; 66.9% males; CHA2DS2–VASc: 4.4 ± 1.7; HAS–BLED: 3.1 ± 1) underwent LAA leak coiling. The expected annual TE risk was estimated based on the patients’ CHA2DS2–VASc and compared with the annualized incidence observed before and after coiling (Fig.1B).

Results

The time between LAAO and leak coiling was 8±6 months [83 patients–year (PY)]; before leak closure, 6 (4.8%) patients had a TE event (annualized rate: 7.2%). Coil deployment was successful in all cases [median n. of coils deployed: 5 (IQR: 2–10)]. Procedure time was 79 ± 40 min; the mean volume of iodinated contrast medium used was 80 ± 43mL. The overall complication rate was 2.4% (1 pericardial tamponade, 2 pericardial effusion). Follow–up TEE after 61±14 days revealed complete LAA sealing or a negligible leak in 117 cases (94.4%); the remaining 7 patients had a moderate leak. During 14±6 months post–coiling (145 PY), 1 (0.8%) patient suffered from stroke. The incidence of TE events was significantly lower after leak closure than before coiling (0.8% vs 4.8%; log–rank p = 0.02; Fig.1A). The annualized TE rates were 7.2% before and 0.7% after leak closure (Fig. 1A). According to the expected rate estimated from the patients’ CHA2DS2–VASc (9.8%), LAAO with and without significant leaks yielded to a risk reduction of 26.5% and 92.9% (Fig. 1B).

Conclusions

Transcatheter leak occlusion via endovascular coils was safe. LAA closure led to a significant reduction in TE events.
C34 INDIRECT MITRAL ANNULOPLASTY USING THE CARILLON CONTOUR SYSTEM, SINGLE CENTER EXPERIENCE
Authors: Forlani D , Magnano R , Corazzini A , D‘Alleva A , Di Marco M , Pezzi L , Fulgenzi F , Vereengia E , Vitulli P , Paloscia L
Published: May 2022

Mitral Regurgitation (MR) is both the most common and the most underdiagnosed valvulopathy in Western countries. When MR’s entity is moderate to severe it is highly burdened by incident heart failure causing an important impact on prognosis, in terms of mortality and re–hospitalization. Unfortunately a lot of symptomatic patients are not elegible to reparative or replacement surgery also due to the high procedural risks. Hence, the need for a less invasive treatment has grown, so endovascular repair techniques have been developed such as the CARILLON Mitral Contour System, a percutaneous procedure for reshape the mitral annulus reducing its dilation and mitral regurgitation. This technique is indicated for patients with secondary mitral regurgitation. The CARILLON is a simple and fast procedure with a right jugular approach that requires neither general anesthesia nor anticoagulant/antiplatelet therapy. Four patients including 3 men, aged 37–64 years, suffering from heart failure and moderate to severe secondary mitral regurgitation who were symptomatic in optimal medical therapy, NYHA II – III class, were admitted to our Cardiological Intensive Care Unit from April to September 2021. All patients underwent coronary angiography and three patients had no obstructive coronary artery disease (CAD). All patients underwent transthoracic and transesophageal echocardiography showing severely dilated left ventricles (DTD 70 ± 10mm, DTS 46 ± 21mm, VTD 264 ± 6ml, VTS 204 ± 6ml), severe reduction in ejection fraction (mean EF 24 ± 5%), severely dilated left atrium, mean volume values 47 ± 13ml/m2, moderate to severe mitral regurgitation (vena contracta 6 ± 2mm, EROA 34 ± 9mm2, regurgitation volume 37 ± 12 ml, regurgitation fraction mean 54 ± 4%). After implantation of the Carillon no complications were observed. In the 3–month follow–up, patients reported improvement in symptoms, exercise capacity and NYHA class. At the echocardiographic evaluation we saw improvement in contractile function and left ventricular size, reduction in the degree of mitral regurgitation to mild–moderate. There were no further hospitalizations for heart failure during the follow–up. The data, albeit limited to our little experience, show how the Carillon reduces mitral regurgitation and improves clinical outcomes in terms of exercise tolerance, quality of life and reduction of hospital admissions, which have social and economic relevance.
C37 CONCOMITANT PARTIAL PERICARDIAL AGENESIS, PERICARDIAL CYST AND POSTERIOR MITRAL VALVE LEAFLET HYPOPLASIA: A CASE REPORT
Authors: Bianchi N , Fabbri G , Passarini G , Tonet E , Guardigli G , Campo G , Pavasini R
Published: May 2022

Background

Pericardial agenesis (1) is a congenital developmental disorder of the pleuro–pericardial membranes that is usually asymptomatic. A pericardial cyst (2) is a congenital cyst composed of mesothelial cells originating most often from the right pericardium. Hypoplasia of the posterior mitral leaflet (3) is congenital and it is very rarely diagnosed in adulthood. These alterations are usually sporadic and not associated.

Case presentation

A 53–year–old woman with obesity and bronchial asthma was referred to the emergency department for left hemiparesis and concomitant dyspnoea in new–onset atrial fibrillation. A right frontal ischemic stroke was diagnosed. During the hospitalization transthoracic echocardiography was performed showing a large prolapsed anterior mitral leaflet (AML) with an eccentric and significant regurgitation. Transesophageal echocardiography was performed. It confirmed the severity of mitral regurgitation, due to a large AML prolapse, but also showed a severely hypoplastic posterior leaflet (PML). Swinging motion was also reported in the absence of pericardial effusion. In the past the patient was surgically treated for an anterior pericardial cyst that was excised. Old CT images were reviewed and showed the absence of pericardial sheets along posterior and lateral left ventricle walls, which were not contiguous to the cyst (that was anterior). The patient was finally candidated to surgery for mitral valve replacement.

Discussion

The case report shows a unique case of association between partial pericardial agenesis, pericardial cyst, severe PML hypoplasia with AML prolapse and severe mitral regurgitation. The association of these three anomalies has never been described before. This could indicate a common pathogenetic denominator and therefore the need to look for this combination of structural abnormalities in carriers of even just one of them. Bibliography 1. Lopez D. et al, doi: 10.1016/j.pcad.2016.12.002 2. Khayata M. et al, doi: 10.1007/s11886–019–1153–5 3. Parato VM. et al, doi: 10.4103/jcecho.jcecho_73_17
C38 RIGHT VENTRICULAR FREE WALL LONGITUDINAL STRAIN (RVFWSL) A NEW OUTCOME PREDICTOR IN PATIENTS CANDIDATE FOR TAVI
Authors: Dellino C , Pergola V , Torresan F , Cecchetto A , Fiorencis A , Di Michele S , Tarantini G , Fraccaro C , Iliceto S , Mele D
Published: May 2022

Background

Right ventricular (RV) systolic dysfunction is considered an outcome predictor in various cardiovascular diseases. RV dysfunction, assessed by RV free wall longitudinal strain (RVFWSL) in patients candidate for trans–catheter aortic valve implantation (TAVI), has not been extensively explored as an outcome predictor.

Purpose

Evaluate the prognostic value of pre intervention RVFWSL in patients undergoing TAVI. Methods: retrospective analysis of 100 patients who underwent transfemoral TAVI in our hospital from 2015 to 2019, with at least a pre and post–TAVI echocardiography. Clinical and echocardiographic data before and after TAVI and follow–up data were collected. We considered the value of [23.3]% the cut–off of normality for RVFWSL. The primary end–point was a composite of death from any cause and hospitalization for heart failure.

Results

The median age of the patients was 81 years (79–83) with a functional status NYHA II–III (81%) before the intervention. EF was preserved in most of the patients (median 56%, 55–58), while Right ventricle dysfunction assessed with RVFWLS was reduced in half of the patients at baseline. At a median follow–up of 1023 days (630–1387), the univariate analysis demonstrated a predictive value for a reduced RVFWSL ( < [23.3]%, P = 0.015) and EF < 50% (P = 0.014) before TAVI. Cox regression analysis found that pre–TAVI reduced RVFWSL (HR 2.875, I.C. 95% 1.113–7.425; P = 0.03) and EF < 50% (HR 2.511, I.C. 95% 1.07–5.892; P = 0.03) were independently associated with composite end–point of the study. Moreover, a reduced EF associated with RVFWSL < [23.3]% showed an incremental value in predicting the outcome (P = 0.021).

Conclusions

Among patients with severe aortic stenosis undergoing TAVI, a reduced pre–implant RVFWSL is able to predict long–term outcome.
C40 THREE–DIMENSIONAL FINGER TEST: A NEW ECHOCARDIOGRAPHIC METHOD TO LOCATE THE BEST ACCESS SITE DURING NEOCHORD PROCEDURE
Authors: Vairo A , Alunni G , Franchin L , Fortuni F , Gaiero L , Desalvo P , Avondo S , Marro M , Sebastiano V , De Ferrari G , Rinaldi M , Salizzoni S
Published: May 2022

Background

The NeoChord procedure is a trans–ventricular, beating–heart chordal implantation for severe degenerative mitral valve regurgitation due to prolapse or flail leaflet and it is performed using a dedicated device (DS 1000 system, NeoChord, Inc. St. Louis Park, MN). The use of the transesophageal echocardiography (TEE) is crucial to guide the procedure. Bi–dimensional (2D) imaging completed with simultaneous biplane view during surgeon finger pushing on the LV wall (finger test) is currently used to choose the LV access, which is usually on the mid–distal infero–lateral wall (ILW), between the papillary muscles (PMs) at the inferior level of their insertion on LV wall. This simulation helps the operators to evaluate the safe distance to PMs to minimize the risk of damaging the sub–valvular apparatus during the insertion of the device. We aimed to compare a new 3D method with the conventional one in terms of safety and better localization of the desired entry site.

Methods

During the procedure finger test has been performed with conventional 2D imaging and simultaneous biplane method. It has been completed using the real time 3D TEE placing the sample box in the bi–commissural view of the LV including the PMs and the apex. The resulting 3D volume was subsequently edited to visualize the LV from above (surgical view) to localize the bulge of the operator finger pushing on the desired segment of the LV wall. We asked the first operator, the second operator and the cardiac surgery fellow, separately, to evaluate location of their finger pushing, in terms of desired position and safety of access, both with 2D method and the 3D method to estimate the inter–operator concordance.

Results

From March 2019 to September 2021 42 consecutive cases have been performed using finger test completed with 3D method without complications related to the trans–ventricular access. Regarding the choice of the right and safe entry site, the percentage of agreement between operators was higher using LV real time 3D rendering compared to the conventional finger test [82 + 21% Vs 59% + 29%, IC 95%, p: 0,04].

Conclusion

Three–dimensional finger test is easy to perform and decreases inter–operator variability of image interpretation facilitating the surgeons to choose the best entry site in term of anatomical localization and safety.
C42 MULTI–CHAMBER SPECKLE TRACKING IMAGING AND DIAGNOSTIC VALUE OF LEFT ATRIAL STRAIN IN CARDIAC AMYLOIDOSIS
Authors: Aimo A , Fabiani I , Giannoni A , Mandoli G , Pastore M , Vergaro G , Spini V , Chubuchny V , Pasanisi E , Petersen C , Poggianti E , Taddei C , Castiglione V , Latrofa S , Panichella G , Sciaccaluga C , Passino C , Cameli M , Emdin M
Published: May 2022

Background

Amyloid deposits in all cardiac chambers, impairing their function. We investigated for the first time if a speckle–tracking echocardiography (STE) analysis extended to all 4 chambers might hold additive diagnostic value for CA and its subtypes (amyloid transthyretin [ATTR–] and light–chain [AL]–CA).

Methods

We evaluated 423 consecutive patients undergoing a diagnostic workup for CA in 2 referral centres from 2015 to 2020.

Results

CA was diagnosed in 261 patients (62%; ATTR–CA, n = 144, 34%; AL–CA, n = 117, 28%). Patients with CA had an impaired function of all cardiac chambers, particularly those with ATTR–CA. Peak left atrial longitudinal strain (LA–PALS) was the only STE parameter that predicted CA and ATTR–CA independent of laboratory and standard echocardiographic variables (Model 1). It also predicted ATTR–CA among patients with unexplained hypertrophy regardless of a diagnostic score (IWT score). Patients with either LA–PALS or LA–peak atrial contraction strain (PACS) in the first quartile (LA–PALS <6.65% or LA–PACS <3.62%) had an almost 4–fold higher likelihood of CA and ATTR–CA regardless of Model 1. Among patients with unexplained hypertrophy, those with LA–PALS or LA–PACS in the first quartile had an almost 9–fold higher likelihood of ATTR–CA irrespective of Model 1, and a 2–fold higher likelihood of ATTR–CA beyond the IWT score.

Conclusions

STE measures of all 4 chambers are abnormal in patients with CA, particularly in those with ATTR–CA. LA strain holds independent diagnostic significance. Among patients screened for CA, those with LA–PALS <6.65% and/or LA–PACS <3.62% have a high likelihood of CA and ATTR–CA.
C45 LATE CARDIAC OUTCOMES IN PATIENTS AFTER COVID–19: A CARDIAC MAGNETIC RESONANCE STUDY
Authors: Leonardo F , Figini F , Pederzoli L , Geremia G , Landi P , Pingitore A
Published: May 2022

Background

Myocardial injury can occur in patients with coronavirus disease (COVID)–19. Cardiac magnetic resonance (CMR) provides information on functional and morphological cardiac parameters, as well myocardial tissue characterization. Actually, there are few data on late cardiac outcomes in patients after COVID–19.

Aim of the Study

To assess late functional, morphological and myocardial tissue parameters in patients positive to COVID–19 Methods 55 patients (age 50±16 yrs, Female n = 17) with a prior diagnosis of COVID 19, without a previous history of cardiac disease were enrolled in the study. Of these, 35 were hospitalized. The time interval between COVID–19 diagnosis and CMR was 418±28 days. Cardiac function and myocardial tissue characterization have been evaluated with the current CMR techniques. In particular, the presence of late gadolinium enhancement (LGE), as a sign of myocarditis outcome has been evaluated.

Results

LGE was present in 19 patients (34.5%). In all cases, LGE was localized at the level of lateral wall of left ventricle within the myocardium or at the subepicardial level (non–ischemic pattern). Left and right ventricular (LV, RV) ejection fraction were within normal values (mean±SD 65±5% and 65±7%, respectively), as well as volumes (LV endiastolic and endsystolic volumes 71±15 and 27±8 ml/m2; RV endiastolic and endsystolic volumes 72±15 and 25±9 ml/m2). In one case, LGE was associated to regional wall hypokinesia. Among the hospitalized patients, the following factors were associated to the presence of LGE: prone position during assisted ventilation, duration of hospitalization. LGE was present in 67% of patients put in prone position, against 33% of patients not pronated (p = 0.009 Fisher‘s exact test). Duration of hospitalization was 9±5 and 16±7 respectively in patients without and with LGE (p = 0.007)

Conclusion

LGE, as an outcome of myocarditis, is present in a significant number of patients with a history of COVID–19, but it is not associated with dilatation or global and regional dysfunction of left ventricle. LGE is mainly present in pts with more severe clinical presentation of COVID–19
C48 PROGNOSTIC IMPACT OF ECHOCARDIOGRAPHIC RESTRICTIVE FILLING PATTERN IN PATIENTS AFFECTED BY HYPERTROPHIC CARDIOMYOPATHY AND PRESERVED SYSTOLIC EJECTION FRACTION
Authors: Priotto F , Albani S , Mabritto B , Luceri S , Pizzuti A , Bongioanni S , Tomasello A , Buongiorno A , Parrini I , De Rosa C , Ricotti A , Scacciatella P , Musumeci G
Published: May 2022

Background

“Restrictive phenotype” is an uncommon presentation of Hypertrophic Cardiomyopathy (HCM), associated with severe functional limitation and poor prognosis. For this reason, current therapeutic aims are prevention of complications through periodic follow–ups and diagnostic investigations, up to the ICD placement.

Objectives

The primary aim of this study was to evaluate the impact of the restrictive filling pattern in HCM on the incidence of complex composite outcome included arrhythmic events, events related to heart failure and general events, correlating it to clinical and imaging data.

Methods

This study is an experimental, multicentric, retrospective and non–randomized analysis, including all patients over the age of 18 suffering from classical HCM, excluding phenocopies and systolic dysfunction. Patients were followed up and selected by specialized Centers of Trieste and Turin and divided by degree of diastolic dysfunction, particularly on the basis of the presence or absence of the restrictive filling pattern.

Results

A total of 367 patients with HCM were included. Restrictive filling pattern was present in 23 patients (6.3%). This subgroup of patients was younger than all other patients (P < 0.001); percentage of ICD patients suffering from severe diastolic dysfunction at follow–up is significantly higher than patients without restrictive filling pattern (39.1% vs 4.1%, P < 0.001). On average, left atrial volume has larger sizes in restrictive filling pattern (109.7ml, SD 43.06 vs 82.8ml, SD 35.81, P = 0.003). Patients with restrictive filling pattern, compared to other patients, are more subjected to heart transplantation (8.7% vs 0.3%, P = 0.009) and hospitalized for heart failure (21.7% vs 7.8%, P = 0.028). Restrictive pattern was not an independent predictor of adverse events at the multivariable analysis. In our cohort, the independent predictors were found to be the left atrium diameter and the presence of LGE on CMR.

Conclusions

In patients with HCM and preserved EF, the evidence of a restrictive diastolic pattern identifies a poor prognosis subgroup. Severe diastolic alteration was not associated with a significant independent role either for events related to heart failure, or for arrhythmic events during a median follow up of 7 years. However, the high rate of ICD implantation in patients with severe diastolic dysfunction suggests a high clinical perception of adverse events in this subgroup.
C51 SAFETY AND EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION ON CONCOMITANT TREATMENT WITH DRONEDARONE
Authors: Vio R , China P , Marras E , Cutolo A , Valle R , Grassi G , Saccà S , Chinellato A , Themistoclakis S
Published: May 2022

Background

The use of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is associated with bleedings. Interactions with dronedarone may increase this risk, but data on concomitant treatment of DOACs with dronedarone are limited.

Aim

The primary endpoint was to compare the survival free from the composite endpoint of clinically relevant bleeding, thromboembolic event and death, between AF patients on treatment with dronedarone and different DOACs. The secondary endpoints were to compare the survival free from i) clinically relevant bleeding and ii) clinically relevant major bleeding.

Methods

A retrospective study was conducted at the Local Health Unit “Ulss3 Serenissima” of Venice, Italy, from January 1st 2016 to December 31st 2020. The eligible population included AF patients with concomitant prescriptions of DOACs and dronedarone. Patients were divided in 4 groups (rivaroxaban, apixaban, edoxaban, dabigatran).

Results

165 patients were included: 46/165 (28%) on rivaroxaban, 66/165 (40%) on apixaban, 45/165 (27%) on edoxaban, and 8/165 (5%) on dabigatran (Fig.1). Over a median follow–up of 339 days, 14/165 (8%) met the primary composite endpoint: 8/165 (5%) had clinically relevant bleedings, of which 1/165 (0.6%) was a clinically relevant major bleeding, 2/165 (1%) had TIAs, and 5/165 (3%) died. We found no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups (log–rank test p = 0.19 and p = 0.69, respectively) (Fig. 2A–B). However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users (p = 0.003) (Fig. 2C). At a secondary analysis, DOACs contraindicated by 2015 EHRA guide (dabigatran, edoxaban 60 mg), and not by 2018/2021 EHRA guides (rivaroxaban, dabigatran, edoxaban 60 mg), were associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding (log–rank test p = 0.03 and p < 0.001, respectively) (Fig. 3).

Conclusions

In our study, there was no difference in survival free from the primary composite endpoint and from clinically relevant bleeding between groups of coadministration. However, survival free from clinically relevant major bleeding was significantly lower in dabigatran users. DOACs contraindicated by 2015 EHRA guide (and not by the latest 2018/2021 EHRA guides) are associated with lower survival from either clinically relevant bleeding or clinically relevant major bleeding.
C52 THE BIG FOUR: RESPIRATORY FAILURE, RENAL INSUFFICIENCY, HAEMORRHAGE AND SEPSIS, HOW DO THEY IMPACT ON CICU PATIENT?
Authors: Canovi L , Zanarelli L , Cardelli L , Dal Passo B , Frascaro F , Piscitelli L , De Carolis B , Gibiino F , Vitagliano A , Sciarra F , Zagnoni S , Pallotti M , Colletta M , Casella G
Published: May 2022

Background

The current rise in life expectancy in the general population leads to changes in baseline characteristics of Cardiac Intensive Care Unit (CICU) patients, increasing the risk of non–cardiac complications during the hospitalization.

Objectives

Evaluate epidemiology and prognostic impact of major non–cardiac complications (respiratory failure, renal insufficiency, haemorrhage and sepsis) during CICU stay. Methods: Retrospective analysis of CICU patients at Ospedale Maggiore of Bologna between March and November 2021.

Results

Baseline characteristics, cardiovascular risk factors and comorbidities of the patients are reported in Table 1. During the CICU stay, 19.7% of patients suffered from acute respiratory failure, needing for ventilation; 15.0% had renal insufficiency (considered as need for haemodialysis, glomerular filtration rate according to Cockcroft–Gault < 60 ml/min, serum creatinine rise > 25% from baseline); 1.8% reported major haemorrhages (defined as serum haemoglobin < 8 g/dl or need for blood transfusion); 1.7% developed sepsis (positive blood cultures). Mean CICU stay for complicated patients was 6 days, intra–CICU mortality was 1.7% (8 deaths) and 30–days mortality was 7.0% (32 deaths). At univariate logistic regression analysis, acute respiratory failure was the only complication associated with a statistically relevant increase in 30–days mortality (OR 2.37, CI 95%, 1.05–5.34; p = 0.038), although, also the other complications had a negative prognostic effect: haemorrhage (OR 1.58, CI 95%, 1.77–14.16; p = 0.681), renal insufficiency (OR 1.47, CI 95%, 0.56–3.87; p = 0.432) and sepsis (OR 1.25, CI 95%, 0.33–5.87, p = 0.850).

Conclusions

Epidemiology and baseline characteristics of CICU patients are changing. Older age and frailty make non–cardiac complications more likely to happen. Acute respiratory failure has the worst prognostic effect on mortality. This fact suggests that CICU Cardiologists should improve their management of these major non–cardiac complications.
C60 12–LEAD POST–ROSC ELECTROCARDIOGRAM DISCRIMINATES SURVIVAL TO HOSPITAL DISCHARGE. A SUB–ANALYSIS OF THE PEACE STUDY
Authors: Gentile F , Baldi E , Schnaubelt S , Caputo M , Clodi C , Bruno J , Compagnoni S , Benvenuti C , Domanovits H , Burkart R , Primi R , Ruzicka G , Holzer M , Auricchio A , Savastano S
Published: May 2022

Background

Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.

Methods

We analysed all the post–ROSC ECGs collected from January 2015 to December 2018 in three European centres (Pavia, Lugano and Vienna). For every ECG, the main features were analysed and filed in the database together with the pre–hospital data collected for every patient according to the Utstein style.

Results

We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53–70 years); 121 from Pavia (32.7%), 38 from Lugano (10.3%) and 211 from Vienna (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95% IC 1.1–2.4), p = 0.007], QRS wider than 120 msec [HR 1.87 (95% IC 1.3–2.7), p < 0.001], ST elevation in more than one segment [HR 1.7(95% IC 1.2–2.5),p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95% IC 1.1–2.9), p = 0.03] and a right bundle branch block [HR 1.8 (95% IC 1.1–2.8), p = 0.01] were all associated with death before hospital discharge. In multivariable Cox regression, adjusted for the ROSC–to–ECG time, age older than 62 years [HR 1.6 (95% IC 1.1–2.3), p = 0.01], QRS wider than 120 msec [HR 1.7 (95%IC 1.2–2.5), p = 0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2–2.5), p = 0.004] were independently associated with death before hospital discharge. By considering these latter three risk factors, the rate of survival to hospital discharge was significantly influenced by their number [no risk factor: 80.8%; 1 factor: 71.2%; 2 factors: 61.9%; 3 factors: 34.4%; p < 0.001, p for trend <0.001]. With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1–3.5), p = 0.037 e HR 5.1(95%IC 2.6–10.1), p < 0.001 respectively].

Conclusions

Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post–ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
C61 MULTIDISCIPLINARY MANAGEMENT IN A CASE OF EOSINOPHILIC MYOCARDITIS WITH CHURG STRAUSS SYNDROME: FROM ECG TO ENDOMYOCARDIAL BIOPSY
Authors: Amelotti N , Mapelli M , Pires I , Guglielmo M , Majocchi B , Catto V , Campodonico J , Vignati C , Baggiano A , Ribatti V , Moltrasio M , Vettor G , Sicuso R , Pontone G , Basso C , Agostoni P
Published: May 2022

Background

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg–Strauss, is a rare multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia (PE). Cardiac involvement may include eosinophilic myocarditis and it is a serious manifestation of EGPA.

Case Presentation

A 67–year–old woman presented to the emergency department with 2–weeks history of dyspnea, orthopnea and asthenia. She had history of asthma, PE, adjuvant radiotherapy after right mastectomy (July 2021). The patient was diagnosed with new onset atrial fibrillation in the previous month. At admission, the patient was hemodynamically stable and with signs of congestion. Complementary exams showed sinus rhythm and T–wave inversion on lateral leads; PE (2010/uL), elevated troponin and BNP values; and severe biventricular systolic dysfunction with diffuse hypokinesia and apical akinesia. The patient was admitted to the ICU and was treated with intravenous diuretics and levosimendan. Optimal HF therapy was introduced. Serial echocardiography revealed partial recovery of LVEF and blood analysis showed a decrease in troponin levels, with persistent eosinophilia (6330/uL). Computed tomography (CT) excluded significant coronary disease, and showed bilateral basal ground–glass opacities, areas of air–space consolidation and bilateral reticular–nodular pattern. Cardiac magnetic resonance revealed increased T2 values/signs of myocardial edema in anterior wall, interventricular septum and apex and no late gadolinium enhancement, compatible with myocarditis. An endomyocardial biopsy (EMB) was performed and confirmed the diagnosis of eosinophilic myocarditis. Oral corticosteroids were started. Paranasal CT scan showed signs of chronic sinusitis, without polyposis, and antineutrophil cytoplasmic antibodies were positive, making the diagnosis of EGPA, according to ACR criteria.

Discussion

In a patient presenting with new onset heart failure and with history of asthma and eosinophilia, it is important to suspect eosinophilic myocarditis, as this is a rare but reversible life–threatening condition. EMB plays an important role in the diagnosis and should be done promptly.

Conclusion

We described a multidisciplinary management of a case of a patient with eosinophilic myocarditis and EGPA, presenting with severe acute biventricular dysfunction.
C66 LONG TERM FOLLOW–UP OF PATIENTS WITH BIOPSY– PROVEN DIAGNOSIS OF MYOCARDITIS AND VENTRICULAR ARRHYTHMIAS
Authors: Lavalle C , Magnocavallo M , Mariani M , Vetta G , Della Rocca D , Alfarano M , Piro A , Natale A , Fedele F , Vizza D , Frustaci A , Chimenti C
Published: May 2022

Background

The diagnosis and management of patients with myocarditis with ventricular arrhythmic (VA) onset is one of the major challenging issues faced by physicians.

Objective

We aimed at evaluating the natural history of patients with an endomyocardial biopsy–proven diagnosis of myocarditis with a VA manifestation at the time of diagnosis.

Methods

From January 2013 to October 2021, 243 consecutive patients with unexplained VAs underwent a complete diagnostic work–out, including endomyocardial biopsy. All patients with a biopsy–proven diagnosis of myocarditis were included in the study.

Results

104 patients were enrolled (mean age: 54 ± 16 years; 75% male). The presenting arrhythmic manifestation was syncope/aborted sudden death in 21 (20.2%) patients, sustained ventricular tachycardia (VT) in 16 (15.4%), nonsustained VT in 29 (27.9%) and frequent premature ventricular complexes in 38 (36.5%). Patients with severe systolic dysfunction (Ejection Fraction<35%) were 63.5%. Late gadolinium enhancement (LGE) and myocardial oedema were detected at cardiac magnetic resonance (CMR) in 91.8% and 30% patients, respectively. Thirty–eight (36.5%) patients received an implantable cardioverter defibrillator (ICD) for primary (n = 14; 36.8%) or secondary (n = 24; 63.2%) prevention of sudden cardiac death (SCD). The mean follow–up was 69 ± 32 months: cardiovascular (CV) death was 15.4% while the recurrence of sustained Vas was 27.9%. Among ICD patients, 13 (34.2%) had an appropriated therapy of the device and arrhythmic storm occurred in 3 (23.1%) of them. The combined endpoint of sustained VA/ICD therapy/CV death occurred in 35.6%. The most important independent predictor of VAs was the presence of LGE [Odds Ratio: 9.100; Confidence of Interval: 1.125 – 73.609; p–value: 0.04].

Conclusion

Among patients with a diagnosis of myocarditis and VAs, 35.6% had recurrences of VA/ICD therapy/CV death during follow–up. The presence of LGE at CMR stratifies the risk of VA recurrence.
C68 RESTING HEART RATE AND ARTERIAL STIFFNESS: A LONGITUDINAL PROSPECTIVE STUDY IN A POPULATION OF HYPERTENSIVE PATIENTS
Authors: Maloberti A , Fumagalli S , Garofani I , Ghidini S , Ruzzenenti G , Bombelli M , Giannattasio C
Published: May 2022

Objective

The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow–up period.

Methods

We enrolled 572 hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). Anamnestic, clinical and laboratory data, BP and cfPWV (complior) were assessed at baseline and after a median follow–up time of 3.7 ± 0.5 years.

Results

At baseline the mean age was 53.9 ± 12.7 years, SBP and DBP were 141.2 ± 17.8 and 86.5 ± 10.5 mmHg, HR was 65.6 ± 10.9 bpm and PWV was 8.6 ± 2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p < 0.001), during follow–up, PWV increased (ΔPWV 0.5 ± 2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82 ± 2.22 vs. 0.27 ± 2.25 m/s, p = 0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p < 0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p = 0.017).

Conclusions

In hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow–up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.
C71 USE OF THE 6–MINUTE WALKING TEST (6–MWT) AS AN ALTERNATIVE TO INCREMENTAL ERGOMETRIC TESTING FOR THERAPEUTIC EXERCISE PRESCRIPTION IN CARDIOLOGICAL REHABILITATION
Authors: Rossini D , Dardi O , Bonaguidi E , Meoni L
Published: May 2022

According to the guide lines and statements from scientific societies, the determination of exercise intensity at the beginning of a cardiac rehabilitation (CR) program should include a cardiopulmonary test as the optimal standard and an incremental “symptom–limited” ergometric test (ET) as the minimal standard. However, the preliminary ergometric evaluation is often not done, because of patient’s (pt) inhability to perform ET, temporary contraindications to ET or difficulties related to organization. Therefore, we assessed whether it is possible to set an effective and safe work intensity for each pt, using a submaximal test such as the 6–MWT,

Methods

Thirty pts (20 M and 10 F; mean age 61 ± 10.1 yr) consecutively referred to an outpatient CR after cardiac surgery (15 pts) or acute coronary syndrome (15 pts) were enrolled. Eligible pts after assessment of balance and gait with the Tinetti scale (score ≥ 19), performed both a 6MWT and a ET on the cycle ergometer within one week of enrollment. By t–test for paired data, watts at ET peak (W peak) were compared with W peak calculated by the two formulas of Hill and that of Luxton using anthropometric data and the result of the 6–MWT (Holland AE et al. Estimating peak work rate during incremental cycle ergometry from the 6–minute walk distance: differences between reference equations. Respiration 2011;81:124–128). In addition, we tested whether the maximum heart rate (max HR) achieved at 6–MWT falls within the training frequency calculated using the Karvonen formula (THR).

Results

There is a statistically significant difference between W peak and W peak calculated with the Hill formulas (p < 0.0001). On the contrary, the difference is not significant applying the Luxton formula (p = 0.7). The maximum HR values reached at 6–MWT fell within the THR in 63% of cases (confidence intervals 0.46–0.80).

Conclusions

At the moment, we do not have reliable formulas for calculating the workload from a submaximal test in the population of cardiac patients. The Luxton formula deserves to be evaluated on a larger sample. Finally, the max HR at 6–MWT is a good and sufficiently safe parameter for programming an initial therapeutic exercise as it falls within the THR in the most cases and even when it does not, the difference is only a few beats.
C75 PHEOCHROMOCYTOMA–INDUCED CARDIOGENIC SHOCK: A MULTICENTER ANALYSIS OF CLINICAL PROFILES, MANAGEMENT AND OUTCOMES
Authors: De Angelis E , Ravera A , Ammirati E , Tedeschi A , Polito M , Pieroni M , Gentile P , Merlo M , Van De Heyning C , Bekelaarh T , Cipriani A , Camilli M , Sanna T , Sinagra G , Bonnefoy–cudraz E , Bochaton T , Hayek A , Aloia A
Published: May 2022

Background

Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal gland and overproduces catecholamines; it is an infrequent cause of cardiogenic shock (CS). Several case reports have investigated pheochromocytoma–induced CS, but larger studies have not yet been carried out.

Objectives

Our work aims to describe a multicenter experience in the diagnosis and management of patients with pheochromocytoma–induced CS, and to raise awareness around this rare condition. Methods: We enrolled all patients with a diagnosis of pheochromocytoma–induced CS admitted to the intensive care units of 8 European referral Hospitals.

Results

Among the 17 patients (47% males, mean age 49,5 years), we found that pulmonary congestion was the mostly represented clinical feature (82%). The most represented echocardiographic left ventricle (LV) pattern was the reverse Takotsubo (TTS) pattern with apical hyperkinesis associated with basal– to mid–ventricular hypokinesis (47%). Elevated systemic vascular resistances (SVR) were observed. Endomyocardial biopsy of the LV was performed in one patient showing contraction band necrosis, oedema and inflammatory reaction. 76% of patients were treated with dobutamine, 70% needed noradrenaline, 29% adrenaline, 23.5% were treated with levosimendan and 17% with milrinone. Mechanical circulatory support devices (MCS) were necessary for 65% of patients. All patients benefited from pheochromocytoma’s surgical excision, with 4 patients operated on while under ECLS. All patients recovered, excepted one (presenting a severe left ventricular dilatation at admission) who required cardiac transplantation.

Conclusion

Pheochromocytoma is an infrequent cause of CS, with most often a TTS–like presentation. It should be suspected in case of a CS with high initial SVR and rapid deterioration. MCS must be considered in the most severe cases. The main challenge is to stabilize the patient, mostly with MCS, since it remains a reversible cause of CS with a low mortality rate. Adrenalectomy can safely be performed even when the patient is under MCS.
C80 SUDDEN CARDIAC ARREST IN A YOUNG FOOTBALL PLAYER DUE TO DOCUMENTED SPONTANEOUS CORONARY ARTERY DISSECTION
Authors: Buccheri D , Priolo L , Inglese F , Barone G
Published: May 2022

A 28–years–old male presented with sudden cardiac arrest (SCA) while playing soccer. He was quickly resuscitated and transported to the closest cardiology department. He had no ECG or echocardiographic alterations. Coronary angiography (CA) showed a spontaneous coronary artery dissection (SCAD), confirmed by optical coherence tomography (OCT), in the mid portion of left anterior descending artery (LADA). In light of his young age, and the lack of evidence of stenosis on angiography confirmed by an instant wave–free ratio (iFR) analysis that confirmed the absence of myocardial ischemia (value obtained 0.97), the patient was treated conservatively with aspirin, clopidogrel, a statin and a beta–blocker. The patient refused implantation of a cardioverter–defibrillator repeatedly. A repeat CA was performed 6–months later, showing same findings and angiographic images of the known lesion involving the LADA. Therefore, the patient was indicated as unsuitable to play soccer. At 1 year from the index event, the patient had an episode of angina pectoris associated with intensive effort and, because of this, another CA with OCT analysis were performed. On angiography the LADA showed a significant stenosis in the same region where spontaneous dissection was previously documented; finding of hyperreflectivity on OCT suggested fibrosis of the vessel wall, probably caused by anomalous immunity reaction mimicking an autoimmune disease; residual intimal–tear representing the entry–site of the dissection was also detected, and a minimal lumen area of 2.21 mm2 was calculated consistent with angiographic stenosis. PCI was indicated, implanting a 3.0/18 mm drug–eluting stent in the mid portion of the LADA, obtaining good final angiographic result and OCT analysis confirming optimal device expansion, without residual dissection. At 2 month post–PCI the patient had returned to playing football without limitation of physical activities. 1 year post–PCI follow–up the patient is still asymptomatic and healthy. In summary, we present a case of SCAD causing an acute coronary syndrome presenting with SCA, which limited subsequent physical activity. In young patients, mostly women, SCAD episode should be strongly considered in the setting of an acute coronary syndrome. Several articles had reported that medical therapy should be oriented on the pathophysiology of SCAD due to the absence of the classic atherosclerotic burst, limiting interventional therapy when strictly indicated.