bluuebunny/crossref_metadata_2025 huggingface dataset:
774 Young adults with acute coronary syndrome: still a long road ahead
Authors: Ielapi Jessica , Rosa Salvatore De , Deietti Giuseppe , Critelli Claudia , Panuccio Giuseppe , Cacia Michele Antonio , Luca Emilia De , Strangio Antonio , Sorrentino Sabato , Polimeni Alberto , Sabatino Jolanda , Pilò Antonio , Spaccarotella Carmen , Mongiardo Annalisa , Indolfi Ciro
Published: December 2021

Aims

Acute coronary syndrome (ACS) are a leading cause for mortality and morbility worldwide. Despite ACS usually affects the older population, it also occurs in younger individuals. Young ACS patients (YACS) have a significantly worse prognosis compared to their age-mates in the general population. Despite YACS are characterized by a different risk profiles compared to their older mates, many aspects still remain elusive. Aim of this study was to describe the clinical profile of young adults with Acute Coronary Syndrome.

Methods and results

Young patients (≤50 years) with the first diagnose of Acute Coronary Syndrome admitted to the Magna Graecia University Hospital were enrolled in the ongoing GENEPAMY registry. Over 7 years, a total of 675 eligible patients with Acute Coronary Syndrome aged 44 ± 8 years were included. Men accounted for 84.9% of all patients. Overall, 11.9% of patients had diabetes, 69.1% hypertension, 17.6% obesity, 93.6% dyslipidemia, while 75.5% were smokers. In the overall cohort, 44.1% were first diagnosed with STEMI, 45.9% with NSTEMI, while the remaining had been admitted for Unstable Angina. Cardiogenic shock was present at admission in 2.7% of cases. Multivessel disease was present in 39% of cases and was significantly less frequent in women (P < 0.001). Thrombolysis was administered as the initial treatment in 15.1% of cases but was ineffective in 66.7% of patients. Percutaneous coronary angioplasty was performed in 79.1% of patients, while 1.9% of patients underwent surgical myocardial revascularization. Spontaneous coronary dissection was present in 0.7% of men and 17.2% of women (P < 0.001). At admission, 98.9% of patients had been treated with ASA, 17.9% with clopidogrel, 49.1% with ticagrelor and 28.4% with prasugrel. A complete revascularization was achieved in 81.6% during the index hospitalization but was significantly more frequent in women compared to men (86.3% vs. 80.8; P < 0.001).

Conclusions

Our data highlight that YACS present a peculiar clinical profile. In particular, the high cardiovascular risk profile demands attention. Finally, despite most patients were men, young women with ACS present several relevant differences compared to men, needing a more careful clinical management.
197 Angio-based index of microcirculatory resistance for the assessment of the coronary resistance: a proof of concept study
Authors: Marrone Andrea , Gibiino Federico , Scollo Ennio , Tebaldi Matteo , Biscaglia Simone , Erriquez Andrea , Campo Gianluca
Published: December 2021

Aims

The study of coronary microcirculation has gained increasing consideration and importance in cath-lab. Despite the increase of evidence its use still remains very limited. QFR is a novel angio-based approach for the evaluation of coronary stenosis. The aim of our study was to use the QFR assessment in stable patients to recreate the IMR formula and to correlate the result of the two techniques.

Methods and results

From 1 June 2019 to 29 February 2019, 200 patients with CCS and indication of coronary artery angiography and referred to the cath-lab of the University Hospital of Ferrara (Italy) were enrolled. After baseline coronary angiogram, quantitative flow ratio, fractional flow reserve and index of microcirculatory resistance evaluation were performed. Pearson correlation (r) between Angio-based index of microcirculatory resistance (A-IMR) and IMR 0.32 with R2 = 0.098, P = 0.03: McNemar test showed a difference between the two test of 6.82% with 95% CI from −12.05% to 22.89%, which is not significant (P = 0.60). Bland and Altman plot showed a mean difference of 23.3 (from −26.5 to 73.1). Sensitivity, specificity, NPV and PPV were 70%, 83.3%, 75% and 70% for A-IMR value > 44.2. The area under the ROC curve for A-IMR was 0.76 (95% CI: 0.61–0.88, P = 0.0003).

Conclusions

We have validated for the first time the formula of the A-IMR, a tool for the calculation of microvascular resistance which does not require the use of pressure guides and the induction of hyperemia
350 Effect of pre-hospital treatment for STEMI patients undergoing primary PCI
Authors: Fabris Enrico , Menzio Sara , Gregorio Caterina , Pezzato Andrea , Stolfo Davide , Aleksova Aneta , Vitrella Giancarlo , Rakar Serena , Perkan Andrea , Van’t Hof Arnoud W. J , Sinagra Gianfranco
Published: December 2021

Aims

The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab.

Methods and results

We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P < 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P < 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P < 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively).

Conclusions

This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.
363 Old but fashioned: IVUS and chromaflo guidance for definition of thrombosis mechanism
Authors: Venturi Gabriele , Scarsini Roberto , Pesarini Gabriele , Pighi Michele , Ribichini Flavio
Published: December 2021

Aims

Plaque rupture and plaque erosion are the main causes of coronary thrombosis. While the first one involves fibrous cap disruption, the second one is caused by loss of endothelial continuity. In selected cases with evidence of plaque erosion, antithrombotic therapy without stenting has been suggested as a possible option. OCT is considered the gold standard for definition of thrombosis mechanism and has recently been included in algorithms for evaluation and management of patients with ACS. Also, high definition IVUS was compared with OCT in defining plaque erosion showing promising results. However, the cost and the large amount of contrast medium needed for OCT performance make these diagnostic tools of scarce applicability in daily practice.

Methods and results

We herein describe the case of a young man acceding to the Cath Lab with the diagnosis of NSTEMI. After baseline angiography and IVUS confirmed presence of Thrombus (Figure 1A and B), thromboaspiration was successfully performed (Figure 1D). The definition of thrombosis mechanism, revealing plaque rupture, was then performed with IVUS and ChromaFlo devices (Figure 1C and E). Also, IVUS was used to optimize stent implantation.

Conclusions

Although requiring further confirmations, we believe that in selected cases IVUS and ChromaFlo could provide a more applicable first-line diagnostic tool to define thrombosis mechanism. 363 Figure 1Baseline angiographic and IVUS evaluation confirming presence of coronary thrombus (A, B). After successful performance of thromboaspiration (D), plaque rupture was revealed by IVUS and ChromaFlo (C).
478 Clinical outcomes of patients at very high stroke risk undergoing watchman implantation
Authors: Magnocavallo Michele , Rocca Domenico Giovanni Della , Lavalle Carlo , Carola Gianni , Mohanty Sa , Trivedi Chintan , Bassiouny Mohamed , Al-Ahmad Amin , Burkhardt David J , Gallinghouse Joseph G , Sanchez Javier E , Horton Rodney P , Natale Andrea , Chimenti Cristina
Published: December 2021

Aims

Left atrial appendage occlusion (LAAO) with the Watchman device is an effective alternative to oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolic risk. We sought to evaluate the safety and effectiveness of LAAO for stroke and bleeding prevention in patients at very high stroke risk.

Methods and results

Data were extracted from a prospective database of 488 AF patients who underwent LAA closure with a Watchman device. Periprocedural complications, thromboembolic (TE), and bleeding event rates among patients with a CHA2DS2-VASc ≥ 5 were reported. Predicted annual rates of TE or major bleeding events were compared to the annualized observed risk of the population. Overall, 209 patients with a CHA2DS2-VASc ≥5 (CHA2DS2-VASc: 6.0 ± 1.0; HAS-BLED: 3.7 ± 1.1) were included in the study. The mean age was 78 ± 6 years and 52.2% (n = 109) were males. Watchman implantation was successful in all patients. Overall procedure-related complication rate was 3.3% (n = 7). Two major complications were observed (1.0%): one pericardial tamponade requiring surgery and one major bleeding event at 3 days post-procedure. The incidence of minor complications was 2.3% (n = 5). Specifically, two patients experienced a pericardial effusion that required drainage and three had a groin hematoma. During a mean follow-up duration of 12 ± 5 months (193 pt/years), six TE events (2.9%/annualized rate: 3.1%) were documented after a median of 6.3 months (IQR: 2.2–9.6). Based on the estimated annual TE risk according to the CHA2DS2-VASc score (8.5%), the % risk reduction after LAAO was 63.5%. Four major bleeding events [1.9% (median time to event: 2.1 months; IQR: 1.0–3.4)] and five minor bleeding events occurred (2.5%) during follow-up. Compared to the expected rate of bleeding events as assessed by the HAS-BLED of the population (8.03%), LAAO led to a 42% reduction of bleeding risk.

Conclusions

In a population at very high TE risk, LAAO with the Watchman device was a safe and effective approach, and led to a 63.5% of stroke risk.
59 Anxiety and palpitations in patients with cardiac implantable electronic devices (CIEDs) and the added value of remote monitoring (RM) in the COVID-19 pandemic: an Italian single-centre experience
Authors: Strisciuglio Teresa , Ammirati Giuseppe , Pergola Valerio , Addeo Lucio , Rapacciuolo Antonio
Published: December 2021

Aims

Mood disorders are common in patients with cardiac implantable electronic devices (CIEDs). The COVID-19 pandemic may have further undermined their emotional well being exacerbating physical symptoms such as palpitations. We investigated the occurrence of anxiety and palpitations in CIEDs patients during the pandemic. In those with remote monitoring (RM) available, we evaluated whether these symptoms were associated with arrhythmic events.

Methods and results

The generalized anxiety disorder (GAD) 7-items questionnaire and the frequency of palpitations were assessed by telephonic interview. Overall 152 CIEDs patients agreed to be interviewed (119 males, age 69 ± 14 years). The RM was available in 54/152 (36%). Thirty-seven (24%) and 43 (28%) patients had anxiety and palpitations, respectively, and 23 (15%) patients had both. Women were more likely to have symptoms than men (50% vs. 20%; P < 0.01 for anxiety and 53% vs. 24%; P < 0.01 for palpitations). Among patients with palpitations the RM was available in 17/43 (40%) and revealed true arrhythmic events in 7/17 (41%) patients: eight non-sustained ventricular tachycardias (NSVT), two supra-ventricular tachycardias (SVT), four sustained ventricular tachycardias (VT). The RM enabled to detect in six patients a device malfunctioning: in two increased impedance in the shock lead, in three increased capture threshold for the LV lead and in one the battery reached the end of life.

Conclusions

Patients with CIEDs were likely to experience anxiety and palpitations during the COVID-19 outbreak and the RM has been pivotal to ascertain the occurrence of arrhythmic events and device malfunctioning in symptomatic and asymptomatic patients as well.
287 Acute and late echocardiographic and cardiac MRI findings in multisystem inflammatory syndrome in children
Authors: Sirico Domenico , Basso Alessia , Reffo Elena , Cavaliere Annachiara , Castaldi Biagio , Sabatino Jolanda , Meneghel Alessandra , Martini Giorgia , Da Dalt Liviana , Zulian Francesco , Di Salvo Giovanni
Published: December 2021

Aims

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the acute and late cardiac abnormalities in patients with MIS-C, evaluated by speckle-tracking echocardiography (STE) and cardiac MRI (CMR).

Methods and results

Twenty-three (13 M, 10 F) patients with confirmed MIS-C diagnosis were recruited. All children underwent standard TTE, STE with analysis of LV global longitudinal strain (GLS). Seventeen (75%) were evaluated with CMR. All children received standard therapy. During follow-up echocardiography and CMR were repeated. Mean age was 8.1 ± 4 years. The majority (78.2%) was Caucasian. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission and three required inotropic support. Short-term survival was 100%. All patients showed a hyperinflammatory state. Tn-I was abnormal (>34 ng/l) in 15 patients (65.2%), BNP was elevated in 20 (86.9%). Median time to STE evaluation was 8 days and to CMR 18 days since fever onset. Mean LVEF and RVEF were, respectively, 59 ± 10% and 45 ± 7%. Coronary dilation was observed in six (26.1%) patients. STE showed reduced mean LVGLS (−17 ± 4.3%). LVEF on CMR was 60 ± 13%, LGE with non-ischaemic pattern was evident in 6/17 patients (35.2%). Median time to follow-up was 49 days for echocardiography and 200 days for CMR since disease onset. STE showed improvement of LVGLS (−18.8 ± 2.2%), while CMR displayed persistence of LGE in two patients and reduction or absence in two of the six patients previously diagnosed.

Conclusions

The elevation of myocardial necrosis markers, the myocardial injury testified by reduced LVGLS and the presence of LGE on CMR in about a quarter of the patients support the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis of MIS-C. Early follow-up shows improvement of STE and CMR findings corroborating the evidence of excellent short-term survival.
590 ACE-I and ARBS do not influence the chest CT presentation and 1-year survival of COVID-19 patients: Italian multicentre registry
Authors: Birtolo Lucia Ilaria , Infusino Fabio , Depaoli Alessandro , Cimino Sara , Prosperi Silvia , D’Ascenzo Fabrizio , Colaiacomo Maria Chiara , Andreoli Chiara , Forleo Giovanni Battista , Schiavone Marco , Valentina Lario Chiara , Monosilio Sara , Ricci Paolo , Catalano Carlo , Ceccarelli Giancarlo , D’Ettorre Gabriella , Galardo Gioacchino , Pugliese Francesco , De Ferrari Gaetano Maria , Maestrini Viviana , Mancone Massimo , Fedele Francesco
Published: December 2021

Aims

A possible interference between ACE-i or ARBs with ACE-2 receptor and SARS-CoV-2 pathway has been raised. Despite data have shown no clinical impact of therapy with ACE-I or ARBs on COVID-19, these drugs are often discontinued upon hospitalization or diagnosis. To evaluate the effects of cardiovascular risk factors (CVRF) and prior outpatient therapy with RAAS inhibitors on the chest CT severity score performed within 24 h of diagnosis of SARS-CoV-2 infection (before stopping medications or starting specific therapy for COVID-19) and on 1-year survival.

Methods and results

This is a multicentre, prospective, observational study. All admitted patients diagnosed with SARS-CoV-2 infection who performed chest CT within 24 h of arrival were consecutively enrolled from 1 March to 1 June 2020. A severity score was attributed to Chest CT by two radiologists in blind to the patient’s clinical information and a cut-off value of 19.5 was considered to define severe radiological pneumonia. A 1-year telephone follow-up was performed in order to evaluate the determinants of 1-year survival. 590 patients with a mean age of 63 ± 14 years were included. Seventy-three (12.4%) patients were treated with ACE-I, 85 (14.4%) with ARBs and 62 (10.5%) with CCB. Cox regression analysis showed that male gender (OR: 1.4; 95% CI: from 1.02 to 2.07; P = 0.035), diabetes (OR: 1.6; 95% CI: from 1.03 to 2.7; P = 0.037), age (OR: 1.02; 95% CI: from 1.008 to 1.033; P = 0.001), and obesity (OR: 3.04; 95% CI: from 1.3 to 6.7; P < 0.001) were independently associated with a severe CT score. Of note, while prior outpatient therapy with ACE-I and ARBs was not independently associated with severe CT score, therapy with CCB was independently associated with a severe CT score (OR: 1.9, 95% CI: from 1.05 to 3.4, P = 0.033). Severe chest CT severity score (OR: 1.05; 95% CI: from 1.02 to 1.08; P < 0.001), P/F ratio (OR: 0.998; 95% CI: from 0.994 to 0.998; P < 0.001), and older age (OR: 1.06; 95% CI: from 1.03 to 1.1; P < 0.001) were independently associated with mortality at 1-year follow-up. Neither ACE-I, ARBs, and CCB were associated with mortality at 1 year follow-up.

Conclusions

ACE-I and ARBs do not influence the chest CT presentation of COVID-19 patients at the time of diagnosis. Furthermore, ACE-I and ARBs do not influence 1-year survival of COVID-19 survivors.
216 The ‘inflammatory perfect storm’: a case of COVID-19 pneumonia complicated by pulmonary embolism
Authors: Colangelo Maria , Colangelo Lidia , Paone Paola , Ceravolo Roberto
Published: December 2021

Aims

The inflammatory ‘cytokine storm’ that distinguishes COVID-19 pneumonia is associated with a state of systemic hypercoagulability, which leads to thrombotic complications on the venous, arterial, and microvascular side. Indeed, in patients with COVID-19, systemic inflammation, coagulation activation, hypoxemia, and immobilization expose a high risk of pulmonary embolism, which significantly worsens the prognosis of these patients.

Methods and results

In this report, we discuss the case of a 71-year-old female, with no prior medical history, admitted to the emergency department for syncope, dyspnoea, and fever started 48 h earlier. At presentation, ear temperature was 37 °C, oxygen saturation was 96% on oxygen therapy (6 l/min), the patient appeared hypertensive (160/80 mmHg) and tachycardic (114 b.p.m.). Laboratory tests revealed normal white blood cells count (10 000/μl) and increased C reactive protein (5.60 mg/dl), troponin I (0.417 ng/ml), and d-dimer levels (15743 ng/ml). Electrocardiogram showed sinus tachycardia at HR of 120/min, normal atrioventricular conduction time, new onset right bundle branch block, and inverted T waves on DIII. Considering the symptoms, CTPA was performed, revealing massive acute bilateral pulmonary embolism with peripheral ground glass opacities. Those findings were suggestive of COVID-19 pneumonia. Indeed, the patient was positive for SARS-CoV-2 infection, and a diagnosis of COVID-19 pneumonia complicated by pulmonary embolism was made. Treatments included oxygen, subcutaneous low molecular weight heparin (LWMH), and corticosteroids have been administrated according to current international guidelines. Since no haemodynamic instability was observed during hospitalization the patient was discharged on Warfarin therapy for 6 months.

Conclusions

In COVID-19 patients treated in a hospital the incidence of pulmonary embolism (PE) is very high. Patients with COVID-19 infection have respiratory symptoms, which often may not be distinguishable from pulmonary embolism symptoms. So, unexpected respiratory worsening, signs of right ventricular dysfunction on transthoracic echocardiogram, and ECG changes should lead to suspicion of the co-presence of pulmonary embolism. This case report shows how COVID-19 infection can be strongly associated with thrombotic complications. For this reason, the guidelines recommend anticoagulation at standard prophylactic doses in all patients admitted with COVID-19 infection.
618 Clinical conditions and echocariographic parameters associated with mortality in COVID-19
Authors: Silverio Angelo , Di Maio Marco , Scudiero Fernando , Russo Vincenzo , Esposito Luca , Rispoli Antonella , Giano Angelo , Bellino Michele , Alfano Antonia , Citro Rodolfo , Vecchione Carmine , Galasso Gennaro
Published: December 2021

Aims

Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis, and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.

Methods and results

This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020, were included into the study population. The association between baseline variables and the risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses. Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. The mean age was 68.9 ± 13.9 years and male sex was reported in 141 patients (62.4%). Admission in intensive care unit was required for 72 patients (31.9%); in-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < 0.001), tricuspid annular plane systolic excursion (TAPSE, P < 0.001), and ARDS (P < 0.001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs. those without ARDS (HR: 7.66; CI: 3.95–14.8), in patients with TAPSE ≤ 17 mm vs. those with TAPSE > 17 mm (HR: 5.08; CI: 3.15–8.19), and in patients with LVEF ≤ 50% vs. those with LVEF > 50% (HR: 4.06; CI: 2.50–6.59) (Figure).

Conclusions

TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF as well as reduced TAPSE may help to identify patients at higher risk of death during hospitalization. Our preliminary findings need to be confirmed in larger, prospective studies.
622 Long term prognostic impact of right ventricular dysfunction in patients with COVID-19
Authors: Silverio Angelo , Scudiero Fernando , Di Maio Marco , Russo Vincenzo , Cancro Francesco Paolo , Esposito Luca , Sordillo Martina , Muraca Iacopo , Citro Rodolfo , Parodi Guido , Vecchione Carmine , Galasso Gennaro
Published: December 2021

Aims

The characteristics and clinical course of hospitalized patients with Coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19.

Methods and results

This was a retrospective multicentre study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction defined by tricuspid annular plane systolic excursion (TAPSE) value <17 mm in accordance with the current guidelines. The primary study outcome was 1-year mortality. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, P < 0.001) and showed a higher prevalence of coronary artery disease (27% vs. 11%, P = 0.003), heart failure (5% vs. 22%; P < 0.001), chronic obstructive pulmonary disease (13% vs. 38%; P < 0.001), and chronic kidney disease (12% vs. 39%; P < 0.001). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV dysfunction that in those without (55% vs. 50%; P < 0.001). The rate of mortality at 1-year was significantly higher in patients with RV dysfunction as compared with those without (67% vs. 28%; P ≤ 0.001). After propensity score matching, patients with RV dysfunction showed a significantly lower long-term survival than patients without RV dysfunction (62% vs. 29%, P < 0.001). At multivariable Cox regression analysis, TAPSE, LVEF and acute respiratory distress syndrome during the hospitalization were independently associated with 1-year mortality (Table).

Conclusions

RV dysfunction is a relatively common finding in hospitalized patients with COVID-19 and is independently associated with an higher risk of mortality at one-year follow-up.
407 Phenotypic heterogeneity of COVID-19 pneumonia: clinical and phatophysiologic relevance of the vascular phenotype
Authors: Bertini Matteo , D’Aniello Emanuele , Di Ienno Luca , Gibiino Federico , Tavazzi Guido , Volta Carlo Alberto , Contoli Marco , Papi Alberto , Campo Gianluca , Ferrari Roberto , Rapezzi Claudio
Published: December 2021

Recent data support the existence of a distinctive ‘vascular’ phenotype with the involvement of both pulmonary parenchyma and its circulation in COVID-19 pneumonia. Its prompt identification is important for the accurate management of COVID-19 patients. The aim is to analyse the pro and contra of the different modalities to identify the ‘vascular’ phenotype. Chest computed tomography scan and angiogram may quantify both parenchyma and vascular damage, but the presence of thrombosis of pulmonary micro-circulation may be missed. Increased d-dimer concentration confirms a thrombotic state, but it cannot localize the thrombus. An elevation of troponin concentration nonspecifically reflects cardiac injury. Echocardiogram and electrocardiogram provide specific signs of right ventricular pressure overload. This is particularly relevant for the ‘vascular’ phenotype which does not necessarily represent the result of thromboembolic venous complications but, more frequently, it is the result of pulmonary microcirculation thrombosis in situ and needs immediate therapeutic action.
394 Incidence and prevalence of acute myocarditis and pericarditis prior to and during COVID-19 pandemic
Authors: Licordari Roberto , Grigoratos Chrysanthos , Todiere Giancarlo , Barison Andrea , Micari Antonio , Di Bella Gianluca , Aquaro Giovanni Donato
Published: December 2021

Aims

Myocarditis and pericarditis have been proposed to account for a proportion of cardiac injury during SARS-CoV-2 infection. During the COVID-19 pandemic, it is reasonable to expect an increasing trend in incidence of this acute inflammatory cardiac diseases. To examine the incidence and prevalence of inflammatory heart disorders prior to and during the COVID-19 pandemic.

Methods and results

This is a retrospective cohort study examining the incidence and prevalence of acute inflammatory heart diseases (myocarditis, pericarditis) in provinces of Pisa, Lucca and Livorno (total population of 11421285 inhabitants) in two time-intervals: (i) prior to (PRECOVID, from 1 June 2018 to 31 May 2019) and (ii) during the COVID-19 pandemic (COVID, from 1 June 2020 to May 2021). Overall 259 cases of inflammatory heart disease (myocarditis and/or pericarditis) occurred in the areas of interest. The annual incidence was of 11.3 cases per 100 000 inhabitants. Particularly, 138 cases occurred in the PRECOVID, and 121 in the COVID period. The annual incidence of inflammatory heart disease was not significantly different (12.1/100 000 in PRECOVID vs. 10.3/100 000 in COVID; P = 0.22). The annual incidence of acute myocarditis was significantly higher in PRECOVID than in the COVID: respectively, 8.1/100 000/year vs. 5.9/100 000 year (P = 0.047), consisting in a net reduction of 27% of cases. Particularly the incidence of myocarditis was significantly lower in COVID than in PRECOVID in the class of age 18–24 (P = 0.048) (Figure). The annual incidence of pericarditis was not significantly different (4.03/100 000 vs. 4.47/100 000; P = 0.61).

Conclusions

Despite a possible etiologic role of SARS-CoV-2 and an expectable increased incidence of myocarditis and pericarditis, data suggest a decrease of acute myocarditis and a stable incidence pericarditis and both diseases.
301 Long term sequelae after COVID-19: the different impact on the right and left ventricles
Authors: Pelà Giovanna , Aiello Marina , Goldoni Matteo , Cavalli Chiara , Perrino Felice , Mantovanelli Luca , Frizzelli Annalisa , Letizia Davide Maria , Tagliaferri Sara , Pizzi Valentina , Mori Pier Anselmo , Majori Maria , Sverzellati Nicola , Corradi Massimo , Chetta Alfredo
Published: December 2021

Aims

Most patients who had COVID-19 are still symptomatic after many months post infection, but the long-term outcomes are not yet well-defined. The aim of our prospective/retrospective study was to define the cardiac sequelae of COVID-19 infection.

Methods and results

This monocentric cohort study included 160 consecutive patients (64 females, 60 + 12 years) who had been discharged from the ward or from the outpatient clinic after a diagnosis of COVID-19 and subsequently referred for a follow-up visit. Clinical features as well as lab and instrumental data about the acute phase of the disease, such as haemodynamic instability (HI), cardiac biomarkers, d-dimer, C-reactive protein (CRP), high resolution CT (HRCT) score along with information about the follow-up visit, including ECG and Conventional and Doppler Tissue Echocardiographic (DTE) parameters, were recorded. The median follow-up time after symptom onset was 5 months. At follow-up visit, the majority of the patients reported dyspnoea and asthenia. Moreover, echocardiography showed morpho-functional changes of both right (RV) and left (LV) ventricles, such as RV dilation, increased pressure in the pulmonary circulation, and by-ventricular systolic–diastolic dysfunction. When examined using multivariate analysis, independent of age, sex, and co-morbidities, RV and LV changes were significantly associated (P < 0.05) with HRCT score and HI and with CRP, respectively.

Conclusions

Our results suggest that COVID-19 may impact RV and LV differently. Notably, the extent of the pneumonia and HI may affect RV, whereas the inflammatory status may influence LV. A long-term follow-up is warranted to refine and customize the most appropriate therapeutic strategies.
282 Follow-up of hospitalized COVID-19 survivors: assessment of short- and long-term cardiovascular sequelae after SARS-CoV-2 infection
Authors: Birtolo Lucia Ilaria , Prosperi Silvia , Monosilio Sara , Cimino Sara , Filomena Domenico , Alfarano Maria , Manzi Giovanna , Neccia Matteo , Papa Silvia , Passarelli Ilaria , De Persis Francesca , Luca Alessandra De , Mei Mariachiara , Di Iorio Martina , D’Antoni Letizia , Di Pietro Gianluca , Francavilla Santi , Improta Riccardo , Marcon Serena , Mariani Marco Valerio , Agnes Gianluca , Piro Agostino , Rizzo Massimiliano , Rachele Edoardo Sebastian , Straito Martina , Tocci Marco , Francone Marco , Galea Nicola , Severino Paolo , Pasculli Patrizia , Colaiacomo Maria Chiara , Petroianni Angelo , Chimenti Cristina , Lavalle Carlo , Badagliacca Roberto , Palange Paolo , Mastroianni Claudio , Catalano Carlo , Pugliese Francesco , Ciardi Maria , Maestrini Viviana , Mancone Massimo , Fedele Francesco
Published: December 2021

Aims

Cardiovascular sequelae in COVID-19 survivors remain largely unclear and can potentially go unrecognized. Reports on follow-up focused on cardiovascular evaluation after hospital discharge are currently scarce. Aim of this prospective study was to assess cardiovascular sequelae in previously hospitalized COVID-19 survivors.

Methods and results

The study was conducted at ‘Sapienza’ University of Rome—Policlinico ‘Umberto I’. After 2 months from discharge, n = 230 COVID-19 survivors underwent a follow-up visit at a dedicated ‘post-COVID Outpatient Clinic’. A cardiovascular evaluation including electrocardiogram (ECG), Troponin and echocardiography was performed. Further tests were requested when clinically indicated. Medical history, symptoms, arterial-blood gas, blood tests, chest computed tomography, and treatment of both in-hospital and follow-up evaluation were recorded. A 1-year telephone follow-up was performed. A total of 36 (16%) COVID-19 survivors showed persistence or delayed onset of cardiovascular disease at 2-months follow-up visit. Persistent condition was recorded in 62% of survivors who experienced an in-hospital cardiovascular disease. Delayed cardiovascular involvement included: myocarditis, pericarditis, ventricular disfunction, new onset of systemic hypertension and arrhythmias. At 1-year telephone follow-up, 105 (45%) survivors reported persistent symptoms, with dyspnoea and fatigue being the most frequent. 60% of survivors showed persistent chest CT abnormalities and among those 28% complained of persistent cardiopulmonary symptoms at long term follow-up.

Conclusions

Our preliminary data showed persistent or delayed onset of cardiovascular involvement (16%) at short-term follow-up and persistent symptoms (45%) at long-term follow-up. These findings suggest the need for monitoring COVID-19 survivors.
288 The effects of cardiovascular diseases and treatment on clinical course of hospitalized COVID-19 patients
Authors: Prosperi Silvia , Birtolo Lucia Ilaria , Revivo Mia Yarden , Monosilio Sara , Cimino Sara , Filomena Domenico , Alfarano Maria , Manzi Giovanna , Neccia Matteo , Papa Silvia , Passarelli Ilaria , De Persis Francesca , De Luca Alessandra , Tanzilli Alessandra , Di Pietro Gianluca , Francavilla Santi , Improta Riccardo , Agnes Gianluca , Marcon Serena , Mariani Marco Valerio , Piro Agostino , Rizzo Massimiliano , Rachele Edoardo Sebastian , Straito Martina , Tocci Marco , Severino Paolo , Lavalle Carlo , Maestrini Viviana , Mancone Massimo , Fedele Francesco
Published: December 2021

Aims

Significant concern has been raised about the effect of pre-existing cardiovascular diseases (CVD), cardiovascular (CV) risk factors and CV therapies on COVID-19 course. On the other hand, COVID-19 could worse pre-existing CVD or trigger the development of new-onset CVD. The aim of this study was to evaluate the relationship between pre-existing CVD, CV risk factors, and CV therapy with the clinical course of hospitalized COVID-19 patients.

Methods and results

Consecutive hospitalized COVID-19 patients admitted to the Cardiovascular COVID-19 Unit at Policlinico Umberto I of Rome between December 2020 and April 2021 were enrolled. All patients underwent a cardiovascular evaluation including troponin, electrocardiogram (ECG), and echocardiogram. Data on medical history, pre-existing CVD, CV risk factors, and therapy were collected. Admission to the Intensive Care Unit (ICU) or Cardiac Intensive Care Unit (CICU), as well as the development of new-onset CVD, were considered as endpoint of the study. Among n = 229 patients enrolled, 22 (10%) died. Nearly half of patients (112, 49%) were admitted to the ICU/CICU. The presence of prior ischaemic heart disease nearly doubled the probability of hospitalization in the ICU/CICU (HR: 2.09, 95% CI: 1.132–3.866, P 0.018). In regards of therapy, beta blockers reduced the likelihood of admission in the ICU/CICU (HR: −1016, 95% CI: 0.192–10.682, P 0.002). However, neither the use of RAAS blockers, heparin or dexamethasone influenced the risk of ICU/CICU admission (respectively, HR: 0.85, 95% CI: 0.498–1.450, P 0.551; HR: 0.768, 95% CI: 0.435–1.356, P 0.363; HR: 0.861, 95% CI: 0.453–1.635, P 0.647). N = 89 patients (39%) experienced a new onset CVD including arrythmias (18.3%) with nearly half experiencing atrial fibrillation, acute coronary syndrome (10.9%), acute pulmonary embolism (5.3%), heart failure (HF) (3%), and myocarditis and pericarditis (1.3%). A pre-existing diagnosis of HF substantially increased the likelihood of new onset CVD (HR: 2.380, 95% CI: 1.004–5.638, P 0.049). However, treatment with heparin or dexamethasone reduced the risk of new onset CVD (HR: 0.482 95% CI: 0.268–0.867, P 0.015; HR: 0.487, 95% CI: 0.253–0.937, P 0.031, respectively).

Conclusions

Our study found that hospitalized COVID-19 patients who have at least one CV risk factor or pre-existing CVD had a greater likelihood of being admitted to the ICU/CICU and experiencing new onset CVD.
123 Prophylactic anticoagulation and aspirin therapy for hospitalized patients with COVID-19: a propensity score-matched analysis of the hope-COVID-19 registry
Authors: Santoro Francesco , Vitale Enrica , Nunez-gil Ivan , Guerra Federico , El-battrawy Ibrahim , Brunetti Natale Daniele
Published: December 2021

Aims

No standard therapy is currently recommended for moderately ill Corona-virus-19 disease (COVID-19) patients. Potential benefit in terms of survival for anticoagulation were found only in this subset of patients. Aim of this study was to evaluate safety and efficacy of add-on antiplatelet therapy with aspirin over prophylactic anticoagulation (PAC) in COVID-19 hospitalized patients and its impact on survival.

Methods and results

7824 consecutive patients with COVID-19 were enrolled in a multicentre-international prospective registry (HOPE-COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. Study population included only patients treated with aspirin and/or PAC. A comparison of clinical outcomes between add-on antiplatelet therapy and PAC and patients treated with PAC only was performed using an adjusted analysis with propensity score (PS) matching. Of 7824 patients, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC only. Propensity-score matching yielded 298 patients from each group. Mean age was 73 ± 11 years, 67% were male, prevalence of hypertension and diabetes was 79% and 33%, respectively, and 7.5 % underwent invasive ventilation. In the propensity score-matched population, cumulative incidence curves of in-hospital mortality were lower in patients treated with PAC and Aspirin vs. PAC only (15% vs. 21%, Log Rank P = 0.01). At multivariable analysis in propensity matched population of COVID-19 patients, including age, sex, hypertension, diabetes, kidney failure and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (HR: 0.62, CI: 95% 0.42–0.92, P = 0.018).

Conclusions

Add-on anti-platelet therapy with aspirin over PAC in COVID-19 hospitalized patients was associated with lower mortality risk in a propensity score matched population.
534 Takotsubo syndrome secondary to vaccination for SARS-CoV-2
Authors: Torselletti Lorenzo , Giulia Stronati , Corraducci Francesca , Belleggia Sara , Maiorino Francesco , Casella Michela , Dello Russo Antonio , Guerra Federico
Published: December 2021

Methods and results

A 79-year-old woman, with a history of subclinical hypothyroidism, obesity and smoke presented to the Emergency Room with dyspnoea and cold sweating. She had undergone her first dose of COVID-19 Moderna mRna vaccination just four days prior to her admission. She showed elevated HS troponin and elevated BNP at her laboratory exams. Her 12-lead ECG showed T wave inversion in the antero-lateral leads and prolongued QTc. Her transthoracic echocardiogram showed severe ejection fraction reduction due to hypokinesia of the mid-apical segments of the anterior and lateral walls of the heart. The patient was then admitted to the Cardiology ward in order to perform a coronary angiography which sowed no significant coronary stenosis. She was started on appropriate medication and discharged after a six day in-hospital stay. At discharge she showed partial recovery of her ejection fraction (EF 44%). A cardiac magnetic resonance was performed after discharge which showed no late gadolinium enhancement. Such finding allowed us to rule out the diagnosis of myocarditis. Moreover at her 3-month follow-up her ejection fraction had recovered completely. We concluded for the diagnosis of Takotsubo Syndrome secondary to vaccination.

Conclusions

We presented a case of Takotsubo syndrome after vaccination with the Moderna vaccine for COVID-19. Two other similar case reports can be found in current medical literature. Female sex, post-menopausal age and the inevitable psychological stress derived by the pandemic and the vaccination may have triggered the condition.
459 Evaluation of LDL-C reductions by siRNA treatment with inclisiran in patients with diabetes mellitus, metabolic syndrome or neither
Authors: Wright R. Scott , Kallend David , Ray Kausik K , Leiter Lawrence , Koenig Wolfgang , Raal Frederick , Wijngaard Peter , Kastelein John J.P
Published: December 2021

Aims

Patients with diabetes (DM) and metabolic syndrome (MS) have elevated risks for atherosclerotic cardiovascular disease (ASCVD). Aggressive LDL-C lowering reduces risks. Inclisiran, a new siRNA, lowers LDL-C and was evaluated in patients with Type 2 diabetes (DM), metabolic syndrome (MS) without DM or neither (N) in the ORION-10 trial.

Methods

ORION-10 was a double-blind, randomized, placebo controlled trial evaluating inclisiran in 1561 patients with ASCVD on maximally tolerated therapy for lowering LDL-C. 781 inclisiran (INC) participants and 780 placebo (P) patients received 1.5 mL SQ tx at Days 1, 90, then every 6 months until Day 540. We evaluated the time adjusted change in LDL-C from baseline after Days 90–540 in DM (n = 702), MS (n = 455) and N participants (n = 404).

Results

There were no differences in baseline demographics and background therapies between INC and P. Statins were utilized in 89.8% INC and 88.7% of P. High intensity statins were utilized in 67.2% of INC and 68.8% of P; ezetimibe in 10.2% of NC and 9.5% of P participants. INC reduced LDL-C by − 54.4% (−58.3, −50.6 95% CI) in DM, (P < 0.001), −58.6% (−62.3, −54.8), P < 0.001 in-MS and −56.0% (−60.2, −51.7), in N subjects P < 0.001 (see Figure).

Conclusions

Inclisiran potently and durably reduces LDL-C across patients with DM, MS and those with neither, demonstrating potent efficacy and durability across glycaemic categories. Inclisiran may also represent a potent LDL-C lowering treatment for those with DM and MS.
755 Rat engineered heart tissue is a novel in vitro model to evaluate cardiomyocyte proliferation and fibroblast activation after injury
Authors: Ciucci Giulio , Rahhali Karim , Cimmino Giovanni , Golino Paolo , Sinagra Gianfranco , Loffredo Francesco
Published: December 2021

Aims

Adult mammals, including humans, fail to regenerate the majority of the lost cardiomyocytes (CMs) that are replaced with scar tissue after injury. This lack of regenerative response is due to the loss of proliferative capacity of adult CMs which in mice occurs 7 days after birth. An in vitro model that recapitulates these changes has not been developed yet. Using rat engineered heart tissues (rEHTs) we have developed a custom-made cryoinjury system to test the hypothesis that maturation of CMs in EHTs regulates the proliferative response of CMs after injury.

Methods

rEHT were generated using neonatal rat heart cells. A discrete lesion was produced on the mid-section of mature (Day 18) and immature (Day 6) EHTs using a custom-made system based on liquid nitrogen and a 23G needle and medium was supplemented with EdU for 48 h.

Results

Cryoinjury in mature EHTs produces a localized injury, preserving their residual contractile activity that does not recover over time. We observed a significant increase of EdU+CMs post injury (6.3 ± 1.9% vs. 10.1 ± 1.6%) without significant changes in Ki67+ and pH3+ CMs suggesting that cryoinjury in mature rEHTs induces DNA synthesis but not CM proliferation. Injury in mature EHTs induced also significant proliferation and activation of fibroblasts with collagen deposition. Interestingly, cryoinjury performed in immature EHTs stimulated a significant proliferative response in CMs

Conclusions

Similar to adult rodents, we show that cryoinjury induces DNA synthesis in CMs without proliferative response and contractile recovery. On the other hand, cryoinjury in immature EHTs leads to CMs proliferation. Moreover, mature EHT fibroblast response to injury retraces the activation progression of cardiac fibroblast after infarction characterized by proliferation, increase of activation markers, increase of collagen deposition suggesting EHTs as a novel model to investigate the biology of cardiac regeneration upon injury.
24 Gliflozins and ventricular function in patients affected by chronic heart failure with diabetes mellitus
Authors: Fortunato Martino , Mazzeo Pietro , Correale Michele , Paradiso Matteo , Furore Andrea , Fanizzi Angela Ilaria , Tricarico Lucia , Maiellaro Pasquale , Pastore Giuseppe , Alfieri Simona , Lamacchia Olga , Iacoviello Massimo , Biase Matteo Di , Brunetti Natale Daniele
Published: December 2021

Aims

Diabetes is the most common comorbidity of HF patients. SGLT2 inhibitors has been shown to reduce hospitalization in patients with HF. The cardioprotective mechanisms of gliflozines have not been elucidated. The aim of our study was to evaluate the effect of SGLT2 inhibitors on right and left ventricular function in T2DM patients with HF.

Methods and results

One hundred and fifteen consecutive outpatients with CHF and T2DM were screened in the Daunia Heart Failure Registry. Seventy-eight of them were enrolled and followed up between May 2019 and September 2020. All patients underwent conventional, TDI and strain echocardiography in an ambulatory setting, at the beginning and after 3 months of therapy with SGLT2 inhibitors. Seventy-eight consecutive outpatients with CHF and T2DM (mean age 67.4 ± 8.4 years, male: 83%) were enrolled in the study. Thirty-eight of them started the treatment with SGLT2 inhibitors, while the remaining forty continued their original therapy. After 3 months of therapy, LVEF, LVEDD, and LVESD statistically improved (respectively, from 39.68 ± 7.78% to 45.08 ± 9.04%, P: 0.001 and 57.32 ± 9.76 mm to 54.16 ± 6.54 mm, P: 0.01 and from 47.51 ± 1.58 mm to 43.24 ± 8.12, P: 0.0008). Changes in left ventricular function and dimensions were not significant in patients who did not started a therapy with SGLT2 inhibitors. There was a statistically significant reduction of E/E′ (from 16.51 ± 22.55 to 9.73 ± 3.35, P: 0.0007) in patients with treatment with SGLT2i. Moreover, there was an improvement of right ventricular function, due to a statistically significant reduction of PAPs and increase of TAPSE (respectively, from 30.63 ± 8.80 to 24.00 ± 8.35, P: 0.008; from 19.16 ± 2.54 to 21.18 ± 2.84, P: 0.0003) and S′ (10.42 ± 2.09 to 12.91 ± 2.50, P: 0.000) 3 months after the administration of SGLT2 inhibitors therapy vs. the control group.

Conclusions

In a real-world scenario, our results showed that the treatment with SGLT-2 inhibitors in patients with CHF and diabetes is associated with an echocardiographic biventricular function improvement.