bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of novel quaternary Heusler alloys XRuCrZ (X = Co, Ni, Rh, and Pd; Z = Si and Ge) via first-principles calculation for spintronics and thermoelectric applications
Authors: Prakash Roshme , Suganya G. , Kalpana G.
Published: May 2022

The structural, electronic, magnetic, and transport properties of LiMgPdSb-type novel quaternary Heusler alloys XRuCrZ (X = Co, Ni, Rh, and Pd; Z = Si and Ge) have been studied employing the first-principles calculation derived from density functional theory. From the total energy calculations, it is found that all these alloys are stable in the cubic α phase, and spin-polarized calculations show that all the alloys favor a ferromagnetic state. In addition, it is ascertained that XRuCrZ (X = Co and Rh; Z = Si and Ge) exhibits half-metallic ferromagnetic property. In addition, the temperature-dependent transport properties have been studied. The calculated dimensionless figure of merit for CoRuCrSi is 0.43. Our results show that these alloys will be suitable for data storage and energy conversion applications.
Chlorination of arenes via the degradation of toxic chlorophenols
Authors: Liu Mingyang , Yang Xuemei , Dyson Paul J.
Published: May 2022

Significance

Chlorination reactions are widely applied in organic synthesis, with aryl chlorides being key intermediates in the synthesis of many pharmaceutical products. Here, we demonstrate that waste materials such as chlorophenol pollutants can be valorized as chlorination reagents via catalytic transfer of the chloro group during their mineralization for the generation of valuable aryl chlorides. This process adds value to the destruction of chlorophenol pollutants, and the concept could potentially be extended to the valorization of other classes of stockpiles awaiting mineralization.
Phraseological modifications in Sepúlveda’sThe Story of a Seagull and the Cat Who Taught Her to Fly
Authors: Mena Martínez Florentina M.
Published: May 2022

Phraseological modification (PM) is a recurrent stylistic resource in specific types of texts, mainly journalistic texts, advertisements and literature. Since literary works are complete texts, the analysis of PM in these texts can go beyond the mere identification of the changes that the units have undergone, facilitating, in turn, the exploration of their stylistic effects. This paper explores the use of PM in a fable written by Luis Sepúlveda,The Story of a Seagull and the Cat Who Taught Her to Fly. The aim is to determine the extra value that modifications bring to the text by finding out not only the number and types of units modified but also the effects achieved. The results show that the author’s choice of phraseological units (PUs) and modification procedures is not arbitrary. In this text, PM directly relates to distinctive features of fables, namely the humanisation of animals and humour, providing new semantic and symbolic dimensions absent in other fables which lack this pervasive use of modifications. Creative PU variation takes animal humanisation a step further by anthropomorphising animals and distancing them from humans at the same time. This, in turn, sustains the moral lessons of the story.
Friction spot brazing of stainless steel to titanium (grade 1) using aluminum foil
Authors: Mashtizadeh Amirreza , Azizieh Mahdi
Published: May 2022

This paper demonstrates a simple and effective technique for friction spot brazing of stainless steel (st37) to titanium (grade 1). We use aluminum foil as a filler that is placed between the base metals. We evaluate the joints when using different rotational speeds: 1800, 2000, 2200, 2400, 2600, and 2800 RPM. We characterize the joint using scanning electron microscopy, optical microscopy, energy dispersive x-ray analysis, the microhardness of cross-sections, and fractography. We found that the strongest tensile strength joint (6 kN) come from friction spot brazing at 2000 RPM. The joint interface of the 2000 RPM sample contains intermetallic compounds such as FeTi, Fe3Al, FeAl2, and Ti3Al, which increases the tensile strength.
Study on the surface modification and mechanism of multilayer graphene by ion beam irradiation
Authors: Zhou Xuebin , Li Yong , Jiang Zhou , Duan Chaonan , Yu Haidong , Dai Zhengkun
Published: May 2022

To improve the poor dispersion and insufficient interfacial adhesion of reinforced graphene (GN) in copper matrices, the graphene surface is irradiated with a Cu ion beam. To study the mechanism of surface modification of irradiated Cu+2 sample on the surface of graphene, the Raman spectroscopy, x-ray photoelectron spectroscopy (XPS), atomic force microscope (AFM), and transmission electron microscope (TEM) are employed. The results of Raman spectroscopy showed that the value of relative intensity ratio I
D/I
G of the characteristic peaks of unirradiated graphene was 1.2530 where it became 0.8693 after the irradiation process. It showed an 30.6% reduction in the ratio ofI
D/I
Gindicating that the ion beam irradiation reduces the surface defects of graphene and causes obvious modification effects. XPS results showed that the irradiated Cu deoxidizes with the epoxy, hydroxyl, or carboxyl group on the surface of the GN, resulting in Cu compounds attached to the surface of the GN. In addition, irradiation introduces stress on the graphene surface to promote the formation of a wrinkled structure to cause the surface morphology to change, as witnessed by the rougher surface morphology, as compared to the unirradiated area. The TEM results showed a recrystallization on the surface of the GN after the irradiation process. Moreover, it showed that the GN lattice was significantly qualified. Ion beam irradiation improves the quality of the surface of GN lattice, reduces the surface defects of graphene, and displays obvious modification effects.
Cost-effective estimation of single-mode thermal states by probabilistic quantum metrology
Authors: Frigerio Massimo , Olivares Stefano , Paris Matteo G A
Published: May 2022

In probabilistic quantum metrology, one aims at finding measurements that concentrate the Fisher information on the resulting conditional quantum states, i.e. those states post-selected according to the outcome of the measurement. The quantum Cramér–Rao (QCR) bound itself cannot be surpassed this way, but it could be possible to improve the information-cost ratio (where cost refers to the experimental implementation), or even the total Fisher information. In this paper, we propose a post-selection protocol achieving this goal using single-photon subtraction and thermal states of radiation. In particular, we achieve a larger information-cost ratio for the estimation of temperature than the strategy attaining the QCR bound. Our scheme involves only classical states of radiation and this contrasts with (but does not contradict) recent results proving that for unitary quantum statistical models, post-selection strategies can outperform direct protocols only exploiting nonclassical states.
Tribology at the atomic scale with density functional theory
Authors: Ustunel Hande , Toffoli Daniele
Published: May 2022

Understanding the quantum mechanical origins of friction forces has become increasingly important in the past decades with the advent of nanotechnology. At the nanometer scale, the universal Amontons–Coulomb laws cease to be valid and each interface requires individual scrutiny. Furthermore, measurements required to understand friction at the atomic scale are riddled with artificial factors such as the properties of the friction force microscope, effect of the environment, and the type of the substrate. It therefore proves difficult to isolate the actual behavior of interfaces from these effects. Electronic structure methods are an indispensable tool in understanding the details of interfaces, their interactions with lubricants, the environment and the support. In particular, density functional theory (DFT) has given large contributions to the field through accurate calculations of important properties such as the potential energy surfaces, shear strengths, adsorption of lubricant materials and the effect of the substrate. Although unable to tackle velocity- or temperature-dependent properties for which classical molecular dynamics is employed, DFT provides an affordable yet accurate means of understanding the quantum mechanical origins of the tribological behavior of interfaces in a parameter-free manner. This review attempts to give an overview of the ever-increasing literature on the use of DFT in the field of tribology. We start by summarizing the rich history of theoretical work on dry friction. We then identify the figures-of-merit which can be calculated using DFT. We follow by a summary of bulk interfaces and how to reduce friction via passivation and lubricants. The following section, namely friction involving two-dimensional materials is the focus of our review since these materials have gained increasing traction in the field thanks to the advanced manufacturing and manipulation techniques developed. Our review concludes with a brief touch on other interesting examples from DFT tribology literature such as rolling friction and the effect of photoexcitation in tribology.
Novel method for flue gas flow of gas turbines in offshore oil production facilities
Authors: Liu Xianglong , Hu Guang , Zeng Zhi , Zeng Liping , Li Xiaohua , Wang Ping
Published: May 2022

The flue gas flow in gas turbines is an important parameter for determining the accurate capacity of waste heat boilers for recovering the waste heat released by the flue gas of gas turbines in offshore oil production facilities. The theory of flue gas composition ratio pertaining to boiler combustion is applied to calculate the flue gas flow in gas turbines. The given gas fuel composition, fuel characteristic coefficient and tested dry combustion products of gas fuel are used to calculate the excess air factor α using the theory of flue gas composition ratio; thus, the flue gas flow of gas turbines can be obtained. The results show that the value of α of a gas turbine ranges from 7 to 3 with different loads and is significantly greater than the α value of boilers, which is obtained during the burning of gas fuel; moreover, the calculation mode of O

d

2 while considering β coincides more with the actual operation data of gas turbines. This mode is useful for the engineering application of recovering the waste heat released by the flue gas of gas turbines and provides an important guidance to improve the waste heat recovery process in gas turbines.
Machine-Learning–Based Forecasting of Dengue Fever in Brazilian Cities Using Epidemiologic and Meteorological Variables
Authors: Roster Kirstin , Connaughton Colm , Rodrigues Francisco A
Published: May 2022

Dengue is a serious public health concern in Brazil and globally. In the absence of a universal vaccine or specific treatments, prevention relies on vector control and disease surveillance. Accurate and early forecasts can help reduce the spread of the disease. In this study, we developed a model for predicting monthly dengue cases in Brazilian cities 1 month ahead, using data from 2007–2019. We compared different machine learning algorithms and feature selection methods using epidemiologic and meteorological variables. We found that different models worked best in different cities, and a random forests model trained on monthly dengue cases performed best overall. It produced lower errors than a seasonal naive baseline model, gradient boosting regression, a feed-forward neural network, or support vector regression. For each city, we computed the mean absolute error between predictions and true monthly numbers of dengue cases on the test data set. The median error across all cities was 12.2 cases. This error was reduced to 11.9 when selecting the optimal combination of algorithm and input features for each city individually. Machine learning and especially decision tree ensemble models may contribute to dengue surveillance in Brazil, as they produce low out-of-sample prediction errors for a geographically diverse set of cities.
C11 DAE RESPONDER APP IN PIACENZA: AN INTEGRATED RESCUE NETWORK AGAINST CARDIAC ARREST USING THE TECHNOLOGY AVAILABLE FOR DAE RESPONDERS CITIZENS
Authors: Aschieri D , Pelizzoni V , Rossi E , Nani S , Bertocchi S , Bersani E , Ferraro S , Pisati M , Losi G
Published: May 2022

Introduction

Early Defibrillation is the most effective method for resuscitation in patients with out of hospital cardiac arrest(OHCA). The presence of shockable rhythm is an important determinant of survival, therefore, the implementation of systems that increase the likelihood of immediate CPR and rapid defibrillation are vital to improving survival. To this end, in 2017 the DAE REsponder APP (ADR) was developed to alert the trained citizens nearest to the scene and direct them to the closest DAE.

Aim

To evaluate the performance of this application in terms of number of interventions and number of patients saved. Methods: Since 2014, the Emilia Romagna region created a regional portal dedicated to the OHCA the AED REspondER emergency, in which each province registered the automated external defibrillators (AEDs), indicating their geolocation and accessibility. From this system was developed the ADR, which can be used by every citizen through their smartphone. ADR has several functions: alerting the DR citizens closest to the victim, possibility to choose whether to intervene or not, in case of acceptance, navigation to the place and to the AED closer.

Results

In Piacenza 1046 AEDs have been placed and 1212 people are registered as DR.From 2018, 525 blue codes have been activated (out of a regional total of 4457) and 80560 notifications have been sent to DRs: in 145 cases (27.62%)the intervention was accepted, in 19 cases DR arrived before 118 and in 12 cases the AED was applied (63.16%) with 7(55%) patients survived.

Conclusion

The ADR could be considered an effective method to deliver an immediate CPR and increase the chance of survival in case of OHCA.
C23 HOW TO IMPROVE ADHERENCE TO ESC HF GUIDELINES THE PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) PROJECT
Authors: De Gennaro L , Donadeo V , Ruggero M , Tota F , Sergio M , De Laura D , Cavallari D , Resta M , Ricci G , Licurgo L , Buquicchio F , Corriero F , Citarelli G , Parisi G , Campanella C , Mancini L , Locuratolo N , Sublimi Saponetti L , Rutigliano D , Palumbo V , Basso P , Correale M , Brunetti N , Iacoviello M , Caldarola P
Published: May 2022

Background

A careful and integrated follow up after hospitalization for heart failure (HF) may represent a feasible strategy to optimize the adherence to ESC guidelines and reduce the occurrence of adverse events (mortality, re–hospitalizations).

Methods

A strict integration between hospital and local health district proximity office cardiologist through an integrated clinical data sharing software has been implemented in Apulia region, Italy, in order to optimize the management of the HF patient after an hospitalization: the PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) (bridge) project. As until December 2021, 1200 patients with HF have been enrolled in the project, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). Adherence to ESC HF guidelines in HFrEF patients before vs after December 2020 was compared.

Results

In the HFrEF population (56%) the mean age was 63 years, 38% were hypertensive, 15% diabetic, 40% had ischemic heart disease, 42% were previously treated with coronary angioplasty, 56% had an ICD/CRT, 22% had atrial fibrillation. Mean NYHA class was 2.2, mean LVEF 30%, mean NT–proBNP values 4027 pg/mL, mean serum creatinine 1 mg/dL, 91% were taking beta–blockers (BB), 86% mineral corticoid receptor antagonists (MRA), 98% ACE–inhibitors/angiotensin–receptor–antagonists/neprilysin and angiotensin receptor antagonists (ACE/ARB/ARNI), and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs 13%, p < 0.001); in 30% ARNI were prescribed in hospital before discharge. Furthermore, in 10% of the population (most diabetics), sodium glucose cotransporter type 2 inhibitors (SGLT2i) have been prescribed as indicated by the latest ESC 2021 guidelines.

Conclusions

The implementation the PONTE project shows an improved adherence to ESC HF guidelines.
C31 UPDATE ON SUPRA–ANNULAR SIZING OF TRANSCATHETER AORTIC VALVE PROSTHESES IN RAPHE–TYPE BICUSPID AORTIC VALVE DISEASE ACCORDING TO THE LIRA METHOD
Authors: Iannopollo G , Romano V , Buzzatti N , Ancona M , Ferri L , Russo F , Bellini B , Montorfano M
Published: May 2022

Aims

Recent evidences have shown that transcatheter heart valve (THV) anchoring in BAV patients might occur at the raphe–level, known as the LIRA (Level of Implantation at the RAphe) plane. A novel supra–annular sizing method based on the measurement of the perimeter at the raphe–level (LIRA–method) was shown to be safe and effective in 20 consecutive BAV patients with severe aortic stenosis. The purpose of this study was to confirm the safety and the efficacy of the LIRA method in a larger study population.

Methods

the LIRA plane method was applied to all consecutive patients with raphe–type BAV disease between November 2018 to October 2021 in our centre. We prospectively sized TAVI prosthesis according to the manufacture recommendations on the basis of baseline CT scan perimeters at the LIRA plane. Post–procedural device success, defined according to Valve Academic Research Consortium–2 (VARC–2) criteria, was evaluated in the overall cohort.

Results

50 patients were identified as having a raphe–type BAV disease at pre–TAVI CT scans. Mean patient age was 80 ± 6.2 years. Three different BAV anatomies (47 patients with BAV type 1 and 3 patients with BAV type 2) were implanted with different types of TAVI prostheses (28 Acurate Neo/Neo 2, 21 Core Valve Evolut R/Pro,1 Lotus) sized prospectively according to the LIRA plane method. In all patients, there was a significant discrepancy between LIRA and virtual basal ring (VBR) (mean perimeter LIRA 73.1 ± 8.3 mm vs mean perimeter VBR 81.5 ± 6.6 mm; p < 0.001). The median prosthesis size was 26 mm (23–27). Pre–dilatation was frequently performed (88%) with a median balloon size of 20 mm (20–23), whereas post–dilatation was applied in 26% of the cases with a median balloon size of 23 mm (22–24). The LIRA plane method appeared to be highly successful (100% VARC–2 device success) with no procedural mortality, no valve migration, residual trivial/mild paravalvular leak with no cases of moderate–severe regurgitation and no cases of mean gradient >20 mmHg pre–discharge. The rate of new pacemaker implantation was 10%.

Conclusions

Supra–annular sizing according to the LIRA plane method confirmed to be safe with a high device success in a larger study population. The application of the LIRA plane method might optimize TAVI prosthesis sizing in patients with raphe–type BAV disease.
C43 A CASE REPORT OF A GIANT RIGHT CORONARY ARTERY ANEURYSM: ROLE OF CONTRAST ECHOCARDIOGRAPHY
Authors: Rabia G , De Rosa F , Pellinghelli G , Piscicelli C , Di Tano G
Published: May 2022

A giant coronary aneurysm is rare entity and it is defined if the diameter is 4–fold greater the reference vessel diameter or if it is > 20 mm in diameter. We report the case of a 73–years–old man without prior history of cardiac disease, admitted in Emergency Department for abdominal pain with normal ECG. Abdominal CT scan showed no pathological findings. At thoracic level it was reported a suspected pericardial cyst (75x80 mm), with partial compression of right chambers (Fig. 1). Echocardiography confirmed the presence of a giant round cystic–appearance lesion characterized by the presence of an anechoic space with internal echogenic swirling flow pattern at the level of right atrioventricular groove with mild compressive effect on right chambers. (Fig. 2). The color Doppler mode showed a faint signal, without a clear evidence of flow origin. A bubble test with agitated saline contrast medium injected through antecubital vein, shows no evidence of contrast uptake by the mass. In order to better characterize the lesion, we use echocardiographic contrast agent (SonoVue®), which showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region (Fig. 2a–2b). At that level it was also possible to sample an ECG–synchronized systo–diastolic pulse–wave (PW)–Doppler pattern (peak velocity 125 cm/s), typical for a coronary artery flow. According to these echocardiographic findings, we supposed a giant right coronary aneurysm. Coronary Computed Tomography Angiography with 3D reconstruction showed a giant aneurysm of the right coronary artery at mid–level, preceded by a mild aneurysm of the proximal tract and two small aneurysms of the circumflex artery and diffuse atherosclerosis diseases with significant stenosis on mid left anterior descending artery (LAD). The coronary angiography confirmed the presence of the giant aneurysm in mild tract of right coronary artery preceded by a small one in the proximal tract andthe two small aneurysm of the circumflex artery and a critical stenosis of mid tract of LAD. The patient underwent surgical treatment of the aneurysm and coronary artery bypass graft (Fig. 3). Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. In case of giant coronary abnormalities, the use of echo contrast agent provides further important information about perfusion and/or flow assessment and it helped to clarify the diagnosis.
C54 METABOLIC SYNDROME IN HEART TRANSPLANTATION: AN UNDERESTIMATED RISK FACTOR?
Authors: Ferrara V , Sponga S , Marinoni M , Valdi G , Di Nora C , Nalli C , Benedetti G , Lechiancole A , Parpinel M , Livi U
Published: May 2022

Background and Aims

Metabolic Syndrome (MS) is a multifactorial condition that increases the risk of cardio–vascular events, it’s frequent in Heart transplant (HTx) candidates and worsens with immunosuppressive therapy.

Aim of the study was to analyse the impact of MS on long–term outcome of HTx patients in our centre.

Methods

MS was defined through the presence of at least 3 of the following factors: Triglyceride ≥150mg/dl or drug treatment for hypertriglyceridemia HDL <40mg/dl for men and <50mg/dl for women Blood glucose ≥100mg/dl or diabetes mellitus Arterial pressure ≥130/80 or hypertensive drug treatment BMI>30. In 349 HTx patients since 2007, mortality and morbidity predictors were evaluated.

Results

MS was present in 35% of patients pre–HTx and 47% within the first year of follow–up. Five–year survival in patients with pre–HTx MS was worst (65% vs 78%, p < 0.01), as well as in those with MS in the first year of follow–up (78% vs 89%, p < 0.01). At the univariate analysis, risk factors for mortality were recipient age (HR 1.07, 1.04–1.09, p < 0.01), pre–HTx MS (HR 1.86, 1.29–2.69, p < 0.01), pre–HTx hypertension (HR 2.46, 1.70–3.55, p < 0.01), pre–HTx hypertriglyceridemia (HR 1.50, 1.04–2.18, p = 0.03), chronic renal failure (HR 2.95, 2.03–4.27, p < 0.01), MS and diabetes at 1–year follow–up (HR 2.00, 1.25–3.19, p < 0.01; HR 2.02, 1.27–3.23, p < 0.01, respectively). The last two resulted also risk factors for CAV (HR 1.86, 1.16–2.99, p = 0.01; HR 1.67, 1.03–2.69, p = 0.04, respectively). MS at 1–year follow–up determined a significant higher risk to develop CAV at 5– and 10–year follow–up, compared to patients without MS (25% vs 14% and 44% vs 25%, p < 0.01).

Conclusions

MS is an important risk factor for both mortality and morbidity post–HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow–up in HTx patients.
C55 DAPT IN ELDERLY PATIENTS WITH STEMI OR VERY HIGH RISK NSTEMI: A RETROSPECTIVE STUDY COMPARING TICAGRELOR VS CLOPIDOGREL
Authors: Carfora V , Mazzeo P , Tarsia G , Biscione C , Lopizzo A , Polosa D , Grippo R , Paternò G , Stabile E
Published: May 2022

Background

Elderly patients with acute coronary syndrome represent a growing population. The major problem in this population is the balancing of ischemic and bleeding risk. There are poor data from randomized clinical trials on the treatment of acute coronary syndrome in this population. We aim to analyze the best therapeutic strategy in this population.

Methods

We performed retrospective study at the Cardiology Department, San Carlo Hospital, Potenza.181 patients with an age ≥ 75 years with STEMI or very high risk NSTEMI were selected from 1 January 2018 to 31 December 2019. Exclusion criteria were anticoagulants therapy, end stage renal disease, cancer in progress and cardiogenic shock at clinical presentation. 43 patients had starter dual antiplatelet therapy with acetylsalicylic acid and clopidogrel and 76 with acetylsalicylic acid and ticagrelor. We aimed to evaluate at 12 months follow up the composite endpoints of ischemic stroke and reinfarction, stroke, bleeding events and death.

Results

At the 12–month follow–up, 15 patients died (all–cause mortality of 12.6%). There were 5 strokes (4% of population), 3 in the Clopidogrel group (6.9%) and 2 in the Ticagrelor group (2.6%) without a statistically significant difference (p 0,7463). The composite endpoint of ischemic events, stroke and reinfarction occurred in 12 patients, 6 in each group, (13.9% in the Clopidogrel group and 7.9% in the Ticagrelor group) but this difference, although indicative, is not statistically significant (p 0.2956). The only statistically significant difference occurred for BARC 2, 3 or 5 bleeding events with a significantly less events in the Clopidogrel group (4.6%) than in Ticagrelor group (18.4%) (p 0, 0345).

Conclusion

The elderly patient with STEMI or high–risk NSTEMI represent a group of patients with high ischemic risk but also high bleeding risk. The use of clopidogrel in combination with acetylsalicylic acid should be considered to reduce bleeding events without increasing ischemic events.
C56 THE IMPACT OF STATIN THERAPY ON THE PROGNOSIS OF PATIENTS DISCHARGED AFTER ACUTE CORONARY SYNDROME: A SUBANALYSIS OF THE APULIA PONTE ACS STUDY
Authors: Basso P , Locuratolo N , Carrata F , De Laura D , Cavallari D , Rutigliano S , Trotta F , Basile M , Scicchitano P , Nalin I , Paolillo C , Caldarola P
Published: May 2022

Background

The administration of statin therapy in patients who suffered from acute coronary syndrome (ACS) is fundamental in order to avoid recurrences and adverse cardiovascular events. The long–term adherence and persistence on statin therapy is challenging.

The aim of this study was to evaluate the prognostic impact of a dedicated follow–up outpatient program for patients who were discharged with the diagnosis of ACS on adherence and persistence on statin therapy.

Methods

This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. The following endpoints were considered: all cause death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure, all–cause bleeding.

Results

We enrolled 2476 patients (mean age: 67.2±12.0 years). At 1–year follow–up optimal medical therapy was reached in most of patients: 84.1% were on beta–blockers, 63.1% on ACEi/sartans, 92.1% on dual antiplatelet therapy, 99.5% on statins, 16.1% on ezetimibe, and 9.9% on PCSK9 inhibitors. At multivariate regression analysis, heart rate, baseline creatinine values, and statin therapy were independent predictors of the composite endpoint all cause death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, while heart rate and statin therapy remained predictors of the composite endpoint death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure (Figure 1).

Conclusions

Statin therapy confirmed their therapeutic role in secondary cardiovascular prevention protocols. The need for continuing long–term statin therapy after ACS is fundamental in order to ameliorate the prognosis of patients.
C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY
Authors: Merlo M , Pagura L , Porcari A , Cameli M , Vergaro G , Musumeci B , Biagini E , Canepa M , Crotti L , Imazio M , Forleo C , Cappelli F , Favale S , Di Bella G , Dore F , Girardi F , Tomasoni D , Pavasini R , Rella V , Palmiero G , Caiazza M , Albanese M , Igoren Guarrucci A , Branzi G , Caponetti A , Saturi G , La Malfa G , Merlo A , Andreis A , Bruno F , Longo F , Rossi M , Varra‘ G , Saro R , Di Ienno L , De Carli G , Giacomin E , Spini V , Limongelli G , Autore C , Olivotto I , Badano L , Parati G , Perlini S , Metra M , Emdin M , Rapezzi C , Sinagra G
Published: May 2022

Background

Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.

Aim

To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.

Methods

This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).

Results

Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.

Conclusion

Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.
C67 CARDIOVASCULAR RISK CLASSIFICATION AND LIPID LOWERING TREATMENT PRESCRIPTIONS IN A REAL–WORLD: INSIGHT FROM ITALIAN COMMUNITY COHORT
Authors: Di Lenarda A , Garavaglia A , Poli S , Peruzzi E , Scagnetto A , Cappelletto C , Barbati G
Published: May 2022

Background

Lipid lowering treatment (LLT) and LDL–C target across CV risk categories might prompt consideration on further lower LDL–C levels advocated by last EAS/ESC guidelines.

Aim

The aim of the study was to provide current prevalence, clinical characteristics, LLT across different CV risk classes at the time of publication of current ESC/EAS Guidelines. Short–term prognosis was also addressed.

Methods and Results

This community–based study enrolled 6851 patients (mean age 71 years) with an LDL–C measurement and cardiological evaluation from 01–Jan–2018 until 31–Dec–2018. Of those, 4578 (67%) patients were at very high risk, 1494 (22%) at high risk, 420 (6%) at moderate risk, and 359 (5%) at low risk according to EAS/ESC 2019 guidelines. Dyslipidemia was present in three quarter of patients, and 3888 (57%) received LLT. High Efficacy (potency to reduce LDL–C ≥ 50%) LLT was prescribed in 21% of patients (23% and 10% in very high and high risk categories). There was a statistically significant difference between CV categories with respect to demographic, CV risk factors, and comorbidities. Patients at very high risk were more frequently elderly with a high proportion of patients affected by atherosclerotic CVD (ASCVD) and non–cardiac comorbidities. 394 (9%) patients at very high risk and 102 (7%) patients at high risk presented LDL–C at target. Among very high risk patients, 439 (10%) were treated with ezetimibe. At 24 months of follow–up, death occurred in 676 (8%) patients. In survival curves, adjusted for age and comorbidities, an increased risk of death and CV hospitalization was confirmed in the high risk and very high risk categories. Similar trend was confirmed considering composite endpoint of myocardial infarction and stroke.

Conclusion

In a contemporary population the strategy to achieve the ambitious LDL–C target of current Guidelines continue to be largely suboptimal and LLT is widely underused. This underlines the huge unmet need when assessed more aggressive LDL–C target advocated in current EAS/ESC guidelines.
C73 PICK YOUR THRESHOLD! HOW TO CALCULATE THE ANAEROBIC THRESHOLD TO STRATIFY HEART FAILURE PROGNOSIS: A COMPARISON BETWEEN ABSOLUTE VALUE, PERCENTAGE OF PEAK VO2 OR PERCENTAGE OF PREDICTED MAXIMUM VO2 IN A LARGE MULTICENTER COHORT OF HFREF PATIENTS WHO UNDER
Authors: Elisabetta S , Mapelli M , Bonomi A , Mattavelli I , De Martino F , Vignati C , Gugliandolo P , Agostoni P
Published: May 2022

Background

The anaerobic threshold (AT), identifies the moment during a maximal exercise when hyperventilation occurs in response to the introduction of an anaerobic metabolism. Its value is indicative of the subject‘s training and/or health, it can be used to guide training, rehabilitation or to define appropriateness to undergo major thoracic or abdominal surgery, and it is related to heart failure (HF) prognosis. AT can be expressed as absolute value or as the percentage of predicted maximum VO2 (VO2AT%pred). However, it is not uncommon to find papers that refer AT to the peak VO2 value achieved (VO2AT%peak), rather than its predicted value, but a direct comparison of the prognostic power of these different variables is missing. In this work, we aim to compare the risk–identifying ability of the AT value when expressed in these three different ways in a large population of HF patients. This will help identify which is more correct to use in assessing patient prognosis, especially when peakVO2 is not reached appropriately.

Methods

The population analyzed counts 7746 patients with HF with history of reduced EF (<40%), recruited between 1998 and 2020 within the MECKI score project. All patients underwent a maximal cardiopulmonary exercise test (CPET), executed in using a ramp protocol on an electronically braked cycle ergometer.

Results

The present study considered 6157 HF patients with identified AT during the CPET, with a median follow up of 1528 days (689–1826). The main characteristics are reported in Figure 1. Figure 2 shows stratification of patients according to these 3 variables divided in tertiles, considering cardiovascular death (combination of cardiovascular death, urgent transplant or LVAD implantation) as an end point. Comparing the AUC of the three variables considered, we found similar values between VO2AT and VO2AT%pred, while the peak VO2AT% value was significantly lower (p < 0.001), as shown in Figure 3A. Moreover VO2AT%pred is the only variable to maintain a comparable ROC to the peakVO2 one, with the others being significantly lower (Figure 3B).

Conclusions

VO2 at AT should always be expressed as % of predicted maximal VO2 to be reliable in predicting prognosis in HF patients. Moreover, evaluating a sub–maximal exercise, VO2AT%pred is the only variable to maintain a comparable prognostic power to the peakVO2 one.
C74 ESCALATION AND DE–ESCALATION OF MECHANICAL CIRCULATORY SUPPORT IN PATIENT WITH CARDIOGENIC SHOCK DUE TO ELECTRICAL STORM
Authors: Sorini Dini C , Maccherini M , Bernazzali S , Righini F , Biagioni G , Valente S
Published: May 2022

We describe a case of a 63 year–old man with familiar dilated cardiomyopathy, with severe left ventricle dysfunction (EF 20%) and severe mitral regurgitation.A progressive worsening of functional status was detected (peak VO2 11 ml/kg/min, NYHA III) with some episodes of VT interrupted by bicameral ICD,for which the patient was referred to our center and included in the heart transplant (HT) list. In the following months sustained VT with hemodynamic impact were recorded, with consequent worsening in class INTERMACS 2. The patient underwent to endocardial and epicardial VT ablation, complicated with electrical storm with deterioration towards cardiogenic shock (INTERMACS 1), requiring vaso–inotropic drugs,mechanical ventilation and femoro–femoral VA–ECMO.The patient was centralized in our ICCU, where he maintained a adequate MAP, SvcO2 50% and active diuresis but at echocardiography left ventricle appeared dilated with high filling pressure, X–ray and pulmonary ultrasonography showed congestion, lactate value rapidly increased (5 mmol/mol), renal and hepatic function worsened (creat 2 mg/dl, bil 2.8 mg/dl). After multidisciplinary discussion an escalation of mechanical circulatory support (MCS) was performed, changing ECMO configuration: an arterial cannula was positioned in the right axillary artery and venting cannula positioned in the apex of the left ventricle. The hemodynamic and respiratory parameters quickly improved,the right pulmonary catheterization showed good pulmonary resistence,organ perfusion improved and neurological status was intact, therefore the patient was inserted in emergency list for HT. After few days a de–escalation of MCS was performed,removing venous cannula and oxygenator, changing the circuit in para–corporeal left ventricle mid–term support as bridge to transplantation. The patient maintained conscious, in spontaneous breathing,able to perform physiotherapy and spontaneous nutrition. The de–escalation of MCS allowed to reduce potential complications of MCS and achieve the HT intervention in a better general and functional condition. After 36 days the patient underwent HT with positive outcome.

Conclusion

MCS are device that require a continuous re–assessment a re–modulation to ensure in the early stages the optimization of haemodynamic support, perfusion of vital organs and unloading of the Vsx and in the following stages an adjustment to long–term strategies (bridge to recovery, bridge to VAD, bridge to heart transplantation).
C76 A PARTICULAR CASE OF MULTIORGAN FAILURE
Authors: Pistoresi S , Sorini Dini C , Di Florio A , Cesareo F , Gentilini R , Valente S
Published: May 2022

We reported a case of a 42–year–old man with no major pathologies, symptomatic for a few days for headache, fever and dysuria. For worsening dyspnea and tachycardia the patient was admitted to emergency room. He was markedly hypoxic with severe left ventricular dysfunction, therefore in the suspicion of myocarditis, the patient was centralized in our ICCU. The patient appeared tachycardic (sinus tachycardia 160 bpm), normotensive but hypoperfused (svO2 40%, lac 5 mmol/l, oliguric) and severely hypoxemic despite mechanical ventilation. In the first hours the condition of severe hypoxia persisted (P/F <100), despite optimization of ventilation and curarization, associated with bilateral interstitial edema, marked leukocytosis and PCT> 100. For this reason cultural exams were performed and large spectrum antibiotic therapy started. After about 4 hours the patient was still hypotensive and hypoperfused, despite support with IABP and vasopressors, therefore femoro–femoral VA–ECMO was implanted. There was a rapid improvement of hemodynamic status, peripheral perfusion and reduction of pulmonary congestion but a marked leukocytosis and PCT> 100 persisted with negative cultures. On the 4th day, during ECMO weaning we assisted to wide and rapid pressure fluctuations (SBP from 250 to 60 mmHg in a few minutes). Therefore total body CT was performed in the suspected pheochromocytoma and this showed a necrotized left adrenal mass of about 9 cm and multiple right cerebral hemorrhagic lesions. Therapy with IV alfa–blockers was promptly started and for the marked hemodynamic instability, in the presence of cerebral hemorrhage, left adrenalectomy was performed with removal of the mass approximately 10 hours after diagnosis. In the post–operative phase there was a stabilization of the pressure profile with complete recovery of the biventricular cardiac function, a rapid reduction in inflammation indices and recovery of renal function. The patient gradually recovered to a state of consciousness with residual hemiplegia. Histological examination confirmed the diagnosis of pheochromocytoma.

Conclusions

The present case represents an example of a catecholaminergic crisis, with fulminant onset and multiorgan dysfunction that initially made diagnosis difficult. Emergency adrenalectomy has conflicting evidence in the literature but in this case it was necessary for pressure instability in the context of cerebral hemorrhage.
P3 LEFT ATRIAL LONGITUDINAL STRAIN AND ELECTROANATOMICAL MAPPING DURING TRANSCATHETER PULMONARY VEINS ISOLATION IN PAROXYSMAL ATRIAL FIBRILLATION
Authors: Siviero V , Previato D , Trento L , Rossillo A , Bonanno C , Caprioglio F , Ribichini L
Published: May 2022

Atrial fibrillation is associated with electro–morphological remodelling of the left atrium which causes abnormalities in atrial structure and function. Several imaging methods are used to find fibrosis of the left atrium comprehending echocardiographic imaging, magnetic resonance imaging and electroanatomic imaging. This study aims to find a correlation between the reduction of left atrium function and low potential area (LPA) at electroanatomical imaging in the whole left atrium (LA) as an expression of structural and electrical LA remodelling.

Methods

Patients undergoing radiofrequency pulmonary vein isolation in the contest of atrial fibrillation ablation were retrospectively screened, echocardiographic and electroanatomical (EAM) imaging were evaluated separately offline.

Results

The study group consisted of 20 patients (70% males, mean age 63 ± 10 years). All patients were in sinus rhythm at the time of the procedure. Mean left ventricular ejection fraction was 60±11%, mean indexed LA volume was 41±10 ml/m2 and mean pre procedural PALS was 26,2±7,6%. We found a negative relation between LA EF and PALS with correlation coefficient (r) of 0,78 (p < 0,0001). EAM were collected before and after the procedure and the LPA pre and post procedure differ significatively. PALS were significantly related with LPA when potential are < 0,5 mV (r=–0,52, p = 0,02), that is the accepted upper limit for LA fibrosis recognition. The results were mainly driven by LPA present in pulmonary veins antrum, and not by LPA in LA. This could be due to the mainly healthy tissues of the atria of our patients (mean LA LPA was 2,5±4,1%). At last post procedural LPA and echocardiographic parameters failed to demonstrate significant correlation as we didn’t detect significant differences between pre and post procedural echocardiographic parameters.

Conclusion

PALS reflects the amount of LPA located prevalently in PVs in patients with low percentage of diseased tissues in LA. Patients with AF with high atrial volumes, low PALS and more extended VP LPA seems to have a higher degree of atrial remodelling, both anatomical and electrical. Moreover, values of post–AF ablation PALS didn’t differ significantly from the pre–procedural ones, this could mean that the structural remodelling takes more time after the electrical remodelling induced by the ablation procedure.
P4 LEFT ATRIAL APPENDAGE ANATOMICAL CHANGES FOLLOWING RADIOFREQUENCY–BASED OSTIAL ISOLATION
Authors: Magnocavallo M , Della Rocca D , Lavalle C , Vetta G , Mariani M , Carola G , Mohanty S , Fengwei Z , Tarantino N , Aung L , Alisara A , Xiaodong Z , Bassiouny M , Gallinghouse J , Burkhardt D , Al–Ahmad A , Rodney H , Di Biase L , Natale A
Published: May 2022

Background

Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal–induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF–induced tissue retraction have never been reported.

Objective

To quantify the anatomical changes of the LAA ostium following RF–based LAAei.

Methods

Thirty–four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and >6 months after (follow–up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity.

Results

Among 34 AF patients (68±7yrs, 73.5% males), the LAA morphology was classified as chicken wing in 15 (44%) patients, windsock in 10 (29%), cactus in 6 (18%), and cauliflower in 3 (9%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 16±7 minutes of RF at a power of 45–47W. Follow–up TEE was performed 257±148 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.04–0.18) and was significantly impaired in all patients. At follow–up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone were –24.4% and –22.5%, respectively. Box–Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig. 1.

Conclusion

RF led to a > 20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.