bluuebunny/crossref_metadata_2025 huggingface dataset:
588 Prognostic impact of early vs. deferred angiography in MINOCA patients
Authors: Armillotta Matteo , Sansonetti Angelo , Amicone Sara , Angeli Francesco , Fabrizio Michele , Stefanizzi Andrea , Bergamaschi Luca , Paolisso Pasquale , Magnani Ilenia , Donati Francesco , Foà Alberto , Rinaldi Andrea , Casella Gianni , Galiè Nazzareno , Pizzi Carmine
Published: December 2021

Aims

Although an early invasive strategy (coronary angiography performed <24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (<24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA.

Methods and results

From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of < 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (<24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography.

Conclusions

We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.
80 The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction
Authors: Tonet Elisabetta , Ariza-solé Albert , Serenelli Matteo , Formiga Francesc , Juan Sanchis , Pavasini Rita , Diez-villanueva Pablo , Vitali Francesco , Bonanad Clara , Grazzi Giovanni , Carol Antoni , Chiaranda Giorgio , Pompei Graziella , Cardelli Laura Sofia , Caglioni Serena , Gibiino Federico , Volpato Stefano , Campo Gianluca
Published: December 2021

Aims

To investigate the prognostic role of sex and physical performance on long-term mortality in older adults hospitalized for acute coronary syndrome (ACS).

Methods and results

The analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed with the Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality. The study included 1388 patients, 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 (730–1168) days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (P < 0.001). SPPB values emerged as independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR: 0.73, 95% CI: 0.56–0.96). Sex and physical performance showed a significant interaction (P = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival.

Conclusions

Two key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality and (ii) women with preserved physical performance have a better outcome compared to men.
730 Prediction of type 4a myocardial infarction with the angiography-derived haemodynamic (added) index
Authors: Viscusi Michele Mattia , Mangiacapra Fabio , Rinaldi Raffaele , Colaiori Iginio , Sticchi Alessandro , Paolucci Luca , Russo Massimo , Nusca Annunziata , Melfi Rosetta , Ricottini Elisabetta , Gallo Paolo , Ussia Gian Paolo , Grigioni Francesco
Published: December 2021

Aims

Percutaneous coronary intervention (PCI) is frequently complicated by type 4a myocardial infarction (MI). We assessed the usefulness of the angiography-derived haemodynamic index (ADDED) index in predicting type 4a MI in patients with chronic coronary syndrome (CCS) undergoing PCI.

Methods and results

We enrolled 442 patients treated with single-vessel PCI. The ADDED index was calculated as the ratio of the Duke Jeopardy Score (DJS) to the minimum lumen diameter (MLD) assessed with quantitative angiography analysis (QCA). Patients in the higher ADDED tertile presented higher occurrence of type 4a MI (17.7%, P < 0.0001). At ROC curve analysis, the ADDED index could significantly discriminate between patients with and without type 4a MI (area under the curve 0.745). At multivariate analysis, an ADDED index value >5.25 was the strongest independent predictor type 4a MI.

Conclusions

Our results support the role of the ADDED index as a predictor of type 4a MI in patients with CCS treated with elective PCI.
539 Frequency related left bundle branch block as cause of chest pain: ‘painful LBBB syndrome’
Authors: Stronati Giulia , Torselletti Lorenzo , Urbinati Alessia , Ciliberti Giuseppe , Barbarossa Alessandro , Principi Samuele , Silenzi Marco , Falanga Umberto , Compagnucci Paolo , Casella Michela , Russo Antonio Dello , Guerra Federico
Published: December 2021

Aims

A 47-years-old man presented to our cardiology ambulatory due to sudden chest pains, mainly on exertion. His only relevant cardiovascular risk factor was a familiarity for coronaropathy. In 2013 he had undergone a coronary angiography which was negative for stenotic lesions. Since then he was treated with beta-blockers and Ivabradine with mild improvement of the pain.

Methods and results

While his previous Holter-ECG reported sinus rhythm [heart rate (HR) 60 b.p.m.] and no alterations of atrioventricular nor of interventricular conduction, his ECG during his examination in our ambulatory showed sinus rhythm (HR 80 b.p.m.), normal atrioventricular conduction but presence of complete left bundle branch block. We therefore performed an ergometric test. His baseline ECG (HR around 65 b.p.m.), at the start of the test, showed no left bundle branch block and the QRS complex was narrow. During the test, at the heart rate of around 85 b.p.m., the ECG showed a complete left bundle branch block. At the same time the patient complained of typical chest pain. The ergometric test was submaximal as it was stopped at the beginning of the third Bruce stage due to the patient’s chest pain. No ST segment alterations were found. During the recovery phase, we noted that the left bundle branch block disappeared when the heart rate was below 75 b.p.m. A new coronary angiography was performed and again it showed no stenotic lesion. We therefore concluded our diagnostic workup and diagnosed a frequency related ‘painful left bundle branch block syndrome’.

Conclusions

‘Painful left bundle branch block syndrome’ is defined as the presence of typical chest pain together with left bundle branch block, in the absence of signs of myocardial ischaemia. The pain improves once the conduction defect disappears. The mechanism of the syndrome is not known although it seems to be related to dyssynchrony of the myocardium. It may often be frequency related.
417 Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis
Authors: Aimo Alberto , Fabiani Iacopo , Giannoni Alberto , Mandoli Giulia Elena , Pastore Maria Concetta , Vergaro Giuseppe , Spini Valentina , Chubuchny Vladyslav , Pasanisi Emilio Maria , Petersen Christina , Poggianti Elisa , Taddei Claudia , Castiglione Vincenzo , Latrofa Sara , Panichella Giorgia , Sciaccaluga Carlotta , Georgiopoulos Georgios , Passino Claudio , Cameli Matteo , Emdin Michele
Published: December 2021

Aims

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

Methods and results

We evaluated 423 consecutive patients undergoing a diagnostic workup for CA in two referral centres from 2015 to 2020. CA was diagnosed in 261 patients (62%; ATTR-CA, n = 144, 34%; AL-CA, n = 117, 28%). Patients with CA had an impaired function of all cardiac chambers, particularly those with ATTR-CA. Peak left atrial longitudinal strain (LA-PALS) was the only STE parameter that predicted CA and ATTR-CA independent of laboratory and standard echocardiographic variables (Model 1). It also predicted ATTR-CA among patients with unexplained hypertrophy regardless of a diagnostic score (IWT score). Patients with either LA-PALS or LA-peak atrial contraction strain (PACS) in the first quartile (LA-PALS <6.65% or LA-PACS <3.62%) had an almost 4-fold higher likelihood of CA and ATTR-CA regardless of Model 1. Among patients with unexplained hypertrophy, those with LA-PALS or LA-PACS in the first quartile had an almost 9-fold higher likelihood of ATTR-CA irrespective of Model 1, and a 2-fold higher likelihood of ATTR-CA beyond the IWT score.

Conclusions

STE measures of all two chambers are abnormal in patients with CA, particularly in those with ATTR-CA. LA strain holds independent diagnostic significance. Among patients screened for CA, those with LA-PALS <6.65% and/or LA-PACS <3.62% have a high likelihood of CA and ATTR-CA.
430 Diagnosis and management of a case of biventricular arrhythmogenic cardiomyopathy: a case report
Authors: Gionti Luigia , Imparato Livio , Viggiano Aniello , Losi Maria Angela , Gargiulo Giuseppe , Mancusi Costantino , Dellegrottaglie Santo , Scatteia Alessandra , Esposito Giovanni
Published: December 2021

Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disorder characterized by fibro-fatty replacement of myocardium which may affect the right ventricle (‘dominant right’ variant), the left ventricle (‘dominant left’ variant) or both (‘biventricular disease’ variant). Despite of ACM is one of the main causes of sudden cardiac death (SCD) in young people and athletes as well, the diagnosis of this complex clinical entity still remains a challenge. We report on a case of a 29 years old non-athletic woman with family history of SCD and a long-standing personal history of palpitations leading to frequent accesses to the Accident & Emergency Department. Her echocardiogram was normal while twelve leads ECG revealed negative T waves in the right precordial leads (V1–V3) and post-excitation epsilon waves. ECG Holter monitoring recorded frequent (up to 17 000 in 24 h) polymorphic premature ventricular contractions (PVCs) seldom organized in couplets or triplets. She was followed-up in our clinic and started on Propanolol 40 mg bid with slight relief of symptoms and reduction of PVCs. Cardiac magnetic resonance (CMR) showed regional dyskinesia of both ventricles and RV dilatation. Moreover, tissue characterization findings revealed the presence of diffuse subepicardial late gadolinium enhancement (LGE) of the LV. Genetic analysis was performed and a variant of uncertain significance (VUS) in Desmoplakin was identified. Non sustained monomorphic ventricular tachycardia was induced during electrophysiologic study by programmed ventricular stimulation. In light of these results, we diagnosed biventricular ACM and, after carefully discussion with the patient, a subcutaneous implantable cardioverter defibrillator (ICD) was implanted. The present case should be a persisting reminder that must be considered more than just a single diagnostic tool when dealing with arrhythmic presentations especially in young patients and the importance of contrast CMR along with genetic testing in order to aid clinicians in the demanding selection of the best candidates for ICD implantation.
125 Sex differences in myocarditis natural history
Authors: Castrichini Matteo , Merlo Marco , Baggio Chiara , Gagno Giulia , Maione Davide , Porcari Aldostefano , Barbati Giulia , Adamo Luigi , Mestroni Luisa , Sinagra Gianfranco
Published: December 2021

Aims

The role of sex in determining the profile and the outcomes of patients with myocarditis is widely unexplored. Our study seeks to evaluate the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis.

Methods and results

We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis (i.e., endomyocardial biopsy or cardiac magnetic resonance proven) of myocarditis. A sub-analysis was performed after division of population according to the main symptom of presentation (i.e., chest pain, ventricular arrhythmias, and heart failure). Clinical and echocardiographic data were evaluated at diagnosis and at last available evaluation (i.e., median of 30 months). The study outcome measure was a composite of all-cause mortality or heart transplantation. We enrolled 312 patients (187; 60% presenting with chest pain; 19; 6% with ventricular arrhythmias; 106; 34% with heart failure). Most of patients (211, 68% of the whole population) were males, consistently in the three modes of presentation. Despite no clinically relevant differences were found at baseline presentation, males presented a larger indexed left ventricular end-diastolic volume (LVEDVi) (62 ± 23 vs. 52 ± 20, P = 0.011 in males vs. females respectively) at follow-up evaluation. At a median follow-up of 62 months, 36 (17%) males vs. females experienced death or heart transplantation (Log-rank P = 0.037). At multivariable Cox analysis, male sex emerged as a predictor of mortality (HR: 2.358; 1.044–5.322; P = 0.039 and left ventricular ejection fraction (LVEF) < 50% (HR: 8.169; 1.226–54.425; P = 0.030)]. Results were consistent in patients presenting with heart failure and chest pain, while arrhythmic group was too small to be reliably interpreted.

Conclusions

In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favorable long-term prognosis than male, despite a similar clinical profile at baseline.
303 Longitudinal arrhythmic risk assessment based on ejection fraction in patients with recent-onset non-ischaemic dilated cardiomyopathy
Authors: De Angelis Giulia , Merlo Marco , Barbati Giulia , Bertolo Silvia , De Luca Antonio , Ramani Federica , Adamo Luigi , Sinagra Gianfranco
Published: December 2021

Aims

Practice guidelines suggest implantable cardioverter defibrillators (ICD) in patients with left ventricular ejection fraction (LVEF) ≤35% despite 3–6 months of guideline-directed medical therapy (GDMT). It remains unclear whether this strategy is appropriate for patients with dilated cardiomyopathy (DCM), who can experience reverse ventricular remodelling for up to 24 months after initiation of GDMT. We sought to assess the longitudinal dynamic relationship between LVEF ≤35% and arrhythmic risk in patients with recent onset non-ischaemic DCM under GDMT.

Methods and results

We performed a competitive risk analysis on patients with recent onset DCM (≤6 months) and recent initiation of GDMT (≤3 months), consecutively enrolled in a longitudinal registry. We assessed risk of major ventricular arrhythmic events or sudden cardiac death (MVAs/SCD) in relationship to LVEF ≤35% at enrollment, 6-months and 24-months post initiation of GDMT. 544 patients met inclusion criteria. LVEF ≤35% identified patients with increased risk of MVAs/SCD starting from 24-months after initiation of GDMT (hazards ratio: 2.126, 95% confidence interval: 1.065–4.245, P = 0.03). However, LVEF ≤35% at presentation or at 6 months post enrollment did not have prognostic significance. 67% of patients with LVEF ≤35% at 6 months after initiation of GDMT improved their LVEF to > 35% by 24 months. This late LVEF improvement correlated with a lower arrhythmic risk (P = 0.012) and was preceded by a reduction of LV dimensions in the first 6 months of GDMT.

Conclusions

In patients with DCM, risk stratification based on LVEF ≤35% is effective after 2 years of GDMT, but not after 6 months.
589 External validation of the increased wall thickness score for the diagnosis of cardiac amyloidosis
Authors: Monda Emanuele , Palmiero Giuseppe , Lioncino Michele , Rubino Marta , Caiazza Martina , Vetrano Erica , Di Fraia Francesco , Mauriello Alfredo , Cirillo Annapaola , Verrillo Federica , Fusco Adelaide , Dongiglio Francesca , Calabrò Paolo , Golino Paolo , Limongelli Giuseppe
Published: December 2021

Aims

This study aimed to validate the increased wall thickness (IWT) score, a multiparametric echocardiographic score to facilitate diagnosis of cardiac amyloidosis (CA), in an independent population of patients with increased LV wall thickness suspicious for CA.

Methods and results

Between January 2019 and December 2020, 152 consecutive patients with increased LV wall thickness suspicious for CA were included. For all patient, the multiparametric echocardiographic score (IWT score) was calculated. To validate the diagnostic accuracy of an IWT score ≥8 to predict the diagnosis of CA, sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) were calculated. Among the 152 patients included in the study, 50 (33%) were diagnosed as CA, 25 (16%) had severe aortic stenosis, 25 (16%) had hypertensive remodelling, and 52 (34%) had hypertrophic cardiomyopathy. Among the 50 and 102 patients with and without CA, 19 (38%) and 1 (1%) showed an IWT score ≥8, respectively. Overall, the diagnostic accuracy of an IWT score ≥8 for the diagnosis of CA in our population was the following: Se 38% (95% CI: 25–53%); Sp 99% (95% CI: 95–100%); PPV 95% (95% CI: 72–99%); NPV 77% (95% CI: 73–80%); PA 79% (95% CI: 72–85%).

Conclusions

This study reports the first external validation of the IWT score for the diagnosis of CA in patients with increased LV wall thickness. A score ≥8 showed a high Sp, PPV and PA, suggesting that the IWT score can be used to identify CA patients in those with increased LV wall thickness.
118 Undefined left ventricular arrhythmogenic cardiomyopathy: the value of genotyping and histological characterization
Authors: Peretto Giovanni , Casella Michela , Merlo Marco , Rizzo Stefania , Cappelletto Chiara , Russo Antonio Dello , Basso Cristina , Bella Paolo Della , Sinagra Gianfranco , Sala Simone
Published: December 2021

Aims

Etiology identification and risk stratification represent major issues for patients presenting with undefined left ventricular arrhythmogenic cardiomyopathy (ULVACM). To investigate the role of genotyping and histology for ULVACM classification, management, and risk assessment.

Methods and results

We retrospectively analysed a multicentre cohort of patients (screened n = 1037) with ULVACM defined by ventricular arrhythmia (VA) onset, nonischaemic late gadolinium enhancement (LGE) limited to the LV, and no manifest dilated cardiomyopathy (LVEF ≥ 40%). We selected patients undergoing both next generation sequencing (NGS) genotyping and endomyocardial biopsy (EMB) for etiology definition. When feasible, immunosuppressive therapy (IST) was used to target active myocardial inflammation (AMI). The study endpoint was a composite of cardiac death, heart transplantation and malignant VAs (VT, VF, appropriate ICD treatment). The study cohort is composed by 135 ULVACM patients (age 43 ± 14 years, 63% males, LVEF 55 ± 7%). NGS identified pathogenic or likely-pathogenic variants (PVs/LPVs) consistent with ACM in 21 cases (16%), whereas EMB showed AMI in 78 patients (58%), including 13/21 PVs/LPVs + (62%). IST was started in 41/78 AMI patients (53%), including 9/13 PVs/LPVs + (69%). Twenty patients (15%) met the study endpoint by 12 months, and 36 (27%) by the end of the study (60 ± 27 months). Beyond malignant VT onset, AMI was the only predictor of events by 12 months (HR: 5.0, 95% CI: 1.4–18.1, P = 0.007). No prognostic role was found for PVs/LPVs, except for the subgroup (n = 77) with nonsustained VT onset. Among AMI patients, those treated by IST had a significantly lower occurrence of events, both by 12-months (1/41 vs. 16/37, P < 0.001) and later (HR: 0.05, 95% CI: 0.01–0.21, P < 0.001). Results were independently confirmed in PVs/LPVs+ and PVs/LPVs- cases. Excluding the IST population, the association of multiple factors among VT onset, PVs/LPVs, and AMI, resulted in an improved discrimination of arrhythmic risk profiles.

Conclusions

Despite its limited diagnostic yield, the combined genetic and histological workup substantially contributed into ULVACM prognostic assessment. Furthermore, EMB identified suitable candidates for IST, who showed better outcomes irrespectively of their genotype.
23 Psycho-emotional aspects in patients with takotsubo syndrome compared with a control group
Authors: Matera Annalisa , Santoro Francesco , Mallardi Adriana , Leopizzi Alessandra , Vitale Enrica , Brunetti Natale Daniele
Published: December 2021

Aims

Takotsubo syndrome (TTS), also called stress cardiomyopathy, is an acute and transient left ventricular systolic dysfunction. Patients affected are usually postmenopausal woman with symptoms similar to myocardial infarction (angina pectoris, shortness of breath, palpitations, etc.) who experienced sudden emotional or physical stress. Emotional stressors are the mayor trigger in about 40% of cases, therefore an evaluation of psychological profile of these patients may have clinical relevance. Evaluate the quality of life, the level of anxiety and depression, the activities of daily life in patients with TTS in comparison with a control group with similar characteristics who haven’t developed this pathology.

Methods and results

44 patients were recruited: 22 patients with TTS and 22 patients included in the control-group who didn’t develop the syndrome. Patients answered to three questionnaires for the evaluation of daily living activities, (Activities of daily living and Instrumental activities of daily living—ADL and IADL), levels of anxiety and depression (hospital anxiety and depression scale—HADS), and quality of life (36-Item Short Form Health Survey-SF—36). Mean age of the study population was 69 ± 9 years and patients were all female. No differences in term of cardiovascular and no risk factor were found between the two groups. Concerning daily living activities, no differences were present. However, when comparing levels of anxiety and depression, TTS patients had higher levels of anxiety (9.4 ± 5.3 vs. 7.7 ± 4.3; P = 0.3; HADS), meanwhile levels of depression were higher in patients of the control group (6.1 ± 3.4 vs. 6.7 ± 4.7; P = 0.7; HADS). Regarding the quality of life, patients with TTS reported to have reduced energy and had fewer social activities (respectively, 51.2 ± 15.7 vs. 62.8 ± 16.5; P = 0.03; 60.4 ± 29.1 vs. 66.6 ± 30.2 con P = 0.7; SF-36).

Conclusions

Patients with Takotsubo syndrome have typical psycho-emotional aspects including higher levels of anxiety and impaired quality of life (as reduced energy and fewer social activities). Further research is needed to better stratify these aspects.
322 Atrial morphological and functional parameters in hypertrophic cardiomyopathy: cardiovascular outcome implication
Authors: Setti Martina , Rizzetto Francesca , Benfari Giovanni , Cavazza Beatrice , Dal Porto Marta , Ribichini Flavio , Rossi Andrea , Cicoira Mariantonietta
Published: December 2021

Aims

The impact of atrial function measured by standard and advanced echocardiographic techniques is emerging in various clinical settings but remains poorly explored in patients with hypertrophic cardiomyopathy (HCM).

Methods and results

Consecutive patients with HCM referred to the heart failure outpatient clinic were prospectively enrolled. Complete clinical and echocardiographic evaluation was performed, including fully automated 2D speckle tracking analysis software (AutoStrain, TomTec). Atrial function was assessed by means of left atrial (LA) volume, LA diameter, a’-TDI, and global peak atrial longitudinal strain (PALS). The primary endpoint was a composite of cardiovascular (CV) events (cardiovascular death or hospitalization, new-onset atrial fibrillation, surgical myectomy, sustained ventricular tachycardia or ventricular fibrillation) during the follow-up. A total of 40 patients with confirmed HCM diagnoses and complete follow-up were included, mean age was 61 ± 14 years, 62% male, ejection fraction 64 ± 8%. LA was frequently enlarged (indexed LA volume 43 ± 14 ml/m2, LA diameter 39 ± 7 mm), and dysfunctional (a’-TDI 7.1 ± 2.2 cm/s, PALS 21 ± 7%). During a mean follow-up of 460 ± 300 days, seven patients had a CV event. Among LA parameters, septal a’-TDI seems to characterize patients with events the most (5.5 ± 2.1 vs. 7.5 ± 2.3, P = 0.03). This was confirmed in an age-adjusted survival model [HR: 0.62 (0.39–0.92), P = 0.03]. The spline curve in the Figure illustrates the relationship between a’-TDI and the age-adjusted probability of CV events; the association began at about 7 cm/s and increased steeply for lower values. Of note, the association between PALS and CV events was highly significant in younger patients (<70 years, P < 0.001).

Conclusions

According to our pilot study, a’-TDI can be considered a simple, feasible, and routinely available parameter of left atrial function, which can help to identify HCM patients at higher risk of CV events.
110 Sex-related differences in clinical presentation and outcome of patients with cardiac transthyretin amyloidosis and light chain amyloidosis
Authors: Zampieri Mattia , Argirò Alessia , Allinovi Marco , Tassetti Luigi , Zocchi Chiara , Gabriele Martina , Andrei Valentina , Fumagalli Carlo , Di Mario Carlo , Tomberli Alessia , Olivotto Iacopo , Perfetto Federico , Cappelli Francesco
Published: December 2021

Aims

We aimed to ascertain whether sex-related differences are relevant to the pathophysiology, presentation, and outcomes in different types of cardiac amyloidosis—a field still poorly investigated. Medical files from consecutive patients diagnosed with cardiac amyloidosis between 2000 and 2020, at Careggi University Hospital, were retrospectively evaluated.

Methods and results

Over this period, 259 patients (12% females) were diagnosed with wild type transthyretin amyloidosis (wtATTR), 52 (25% females) with hereditary transthyretin amyloidosis (hATTR) and 143 (47% females) with light chain amyloidosis (AL). Wt-ATTR women, compared to men, were significantly older at the time of diagnosis and showed higher National Amyloidosis Centre score, thicker normalized interventricular septum, higher diastolic dysfunction and worse right ventricular function. Females with hATTR and AL had lower normalized cardiac mass compared to men. Otherwise, bio-humoural parameters, NYHA class, and ECG characteristics were similar. No differences in outcome were observed with regard to sex.

Conclusions

In conclusion, we did not observe major differences in clinical expression related to sex in different types of cardiac amyloidosis: specifically, outcome was not affected. Nevertheless, women with wtATTR showed a worse profile at diagnosis and evidence suggesting a later recognition of disease compared to men, highlighting the need for a higher index of suspicion in female patients.
271 Treatment of thrombophlebitic necrotic lesions in a patient with syncardia—a case report
Authors: Artiola Gaetano , Pettillo Vincenzo
Published: December 2021

Aims

The 58 years old male patient with an important dilated cardiomyopathy, carrier of ICD, numerous malignant arrhythmias (VT) and without the possibility of a timely heart transplant, underwent emergency surgery by implanting a total artificial heart syncardia. Necrotic tissue was already present on the forearm and in the antecubital region before the surgery; it was caused by extravasation and thrombophlebitis due to continuous intravenous therapies and the lesions were deep down to tendons and bones after a surgical toilet. Years of unstable haemodynamics caused by dilated cardiomyopathy and low cardiac output led to poor peripheral vascularization giving priority to noble structures. Restoration of the tissue using advanced dressings without the use of skin grafts avoiding bacterial infections in a fragile patient.

Methods and results

A Pubmed search for advanced dressings was performed and a Webinar on the Wound Hygiene technique was attended. In the first instance, a polyurethane foam dressing was used and the wound on the forearm showed major improvements, subsequently with the synergistic help of the ‘Wound Hygiene’ technique and dressings based on connectivine, the tissue healed. The wound located in the antecubital region had continuous biofilm formation and a VacTherapy was planned for this. After 7 days, the conditions worsened and for this reason it was decided to use the Aqua Cell Ag +. This dressing with the silver helps in the formation of granulation tissue and it also prevents infections ‘trapping’ bacteria inside it.

Conclusions

The use of dressings with the Wound Hygiene technique led to the formation of new tissue without the need to perform a skin graft in a patient with a total artificial heart and without bacterial infections.
35 Electrophysiology and electrostimulation: experience
Authors: Santucci Stefano , Negossi Davide , Emanuelli David , Paoloni Valentina , Biondi Federico , Santucci Matteo , Marzuolo Cinzia
Published: December 2021

In the last 50 years, cardiac electrophysiology has undergone rapid technological development which has led to a numerical increase in both patients who have been able to benefit from the therapies of rediscovery and rhythm control, and of the devices. The activity of an electrophysiology and electrostimulation room is based on the intensive use of ionizing radiation even if electrophysiology studies, ablation, and cryoablation techniques have benefited from the support of computerized electroanatomical mapping systems with consequent dose reduction. Over the years, the instruments to be managed inside the room have increased both in complexity and numerically. Starting from the biventricular PM, we go through the implantation of subcutaneous defibrillators up to the transseptal ablations. Patient management requires additional skills that each member of the team must possess. Continuous training and updates are of fundamental importance. The purpose of this work is our experience based on the activity now more 10 years.
162 Whole-body cryotherapy treatment modulates the innate immune response in non-professional football players
Authors: Selleri Valentina , De Gaetano Anna , Zanini Giada , Malerba Mara , Pinti Marcello , Tripi Ferdinando , Mattioli Anna Vittoria , Savino Gustavo , Nasi Milena
Published: December 2021

Aims

Whole-body cryotherapy (WBC) is a recently widely strategy used for muscle recovery after injury that can to activate inflammatory response. WBC consists of short exposure, of about 2-3 minutes, to dry air at cryogenic temperatures up to -190 °C. The aim of our study is to analyze WBC effects on metabolic, hormonal, and immunological responses of non-professional football players (NPFPs).

Methods and results

Nine male NPFPs (age: 20 ± 2 years) on the same team are recruited and, in particular, they played and trained each day before, during, and after WBC treatment. We collected NPFPs blood samples immediately before WBC and after 5 once-day sessions, then we evaluated a set consisting of 50 analytes, including hormones profile, haematologic parameters, and serum chemistry. We proceeded with monocytes (Mo) phenotyping and then we investigated the concentration of some plasmatic markers with anti-inflammatory effects (IL2RA, IL1RN) or typically increased during inflammation [CCL2, IL-18, free mitochondrial DNA (mtDNA)]. WBC treatment (WBC-t) lead to a decrease not only in mean platelet volume, mean corpuscular haemoglobin, and ferritin levels, but also in testosterone and estradiol levels, even if they remain within the normal ranges. This treatment is also responsible for total Mo increased and, in particular, a reduction of classical Mo has been demonstrated in parallel with an increase of non-classical ones. Moreover, each Mo subset shows lower expression of CXCR4. Considering pro-inflammatory molecules, IL1RA showed a tendency to decrease, while IL1RN and IL18 decreased in plasma after WBC-t. Conversely, circulating mtDNA levels appeared unaltered by treatment.

Conclusions

The differences detected in monocyte subset after WBC-t suggest that, in this condition, Mo could be redistributed into the surrounding tissue. In addition, CXCR4 reduction in Mo subsets could be due to their differentiation process. Hence, WBC could promote Mo differentiation through a mechanism that is still unknown. Since WBC seems to regulate the innate immune system in the enrolled NPFPs, it could have a role in tissue repair beyond a beneficial anti-inflammatory effect.
625 Cluster analysis of weather and pollution features and its role in predicting acute cardiac or cerebrovascular events
Authors: Testa Alberto , Anticoli Sabrina , Pezzella Francesca Romana , Mangiardi Marilena , Di Giosa Alessandro , Marchegiani Giada , Gaspardone Achille , Versaci Benedetta , Versaci Francesco , Zoccai Giuseppe Biondi
Published: December 2021

Aims

The impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised. The aim of this study was to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events.

Methods and results

Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from three tertiary care centre from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for environmental protection, and from the Meteorologic Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rate of acute cardiac and cerebrovascular events with Poisson models. As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated four separate clusters: Cluster 1, including 60 (5.1%) days, Cluster 2 with 419 (35.8%) days, Cluster 3 with 673 (57.6%) days, and Cluster 4 with 17 (1.5%) days, with significant between-cluster differences in weather and pollution features. Notably, Cluster 1 was characterized by low temperatures and high ozone concentrations (P < 0.001). Overall cluster-wise comparisons showed significant overall differences in adverse cardiac and cerebrovascular events (P < 0.001), as well as in cerebrovascular events (P < 0.001) and strokes (P = 0.001). Between-cluster comparisons showed that Cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to Cluster 2, Cluster 3, and Cluster 4 (all P < 0.05), as well as AMI in comparison to Cluster 3 (P = 0.047). In addition, Cluster 2 was associated with a higher risk of strokes in comparison to Cluster 4 (P = 0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events, and strokes for Cluster 1 and Cluster 2.

Conclusions

Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increases risk of acute cardiovascular events, especially cerebrovascular events.
208 Association between cardiovascular data and the development and progression of mild cognitive impairment: results from the retrospective cohort study
Authors: Faggiano Andrea , Difonzo Teresa , Avallone Carlo , Forgione Arianna , Gazzaniga Valentina , Gramegna Chiara , Locatelli Giuseppe , Mallardi Giulio , Nicotra Alessia , Zago Stefano , Carugo Stefano
Published: December 2021

Aims

Mild cognitive impairment (MCI) is characterized by objective evidence of cognitive impairment in one or more cognitive domains in the absence of significant interference in daily-life activities. Anyway, people with MCI are considered to be at heightened risk of further cognitive decline and progression to dementia. To date, few evidence regarding the association between cardiovascular data and MCI are present in the literature. To investigate the association between various cardiovascular data (traditional risk factors and outcomes) and the development and progression of MCI.

Methods and results

The study included 127 patients referred to the Neurological Unit of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan for subjective memory complaints and/or clinical suspect of cognitive impairment. Neuropsychological tests evaluating executive functions and cardiovascular data were collected at baseline and 2-year follow-up. Visit reports and medical records were reviewed to extrapolate the data. The study was conducted between 2012 and 2020. The 51 (40.2%) patients on antiplatelet therapy (94% on aspirin) had a worse baseline degree of cognitive impairment on neuropsychological tests of executive functions and had greater worsening of MCI at 2 years (Table 1). Patients on antiplatelet therapy were significantly older (75.85 vs. 71.7; P = 0.009), more ischaemic (21.6% vs. 1.3%; P < 0.001), hypertensive (90.2% vs. 60.5%; P < 0.001), and dyslipidaemic (62.7% vs. 19.7%; P < 0.001) than patients without antiplatelet therapy. No other single cardiovascular data analysed (presence of hypertension, dyslipidaemia, ischaemic heart disease, diabetes, atrial fibrillation, and anticoagulation therapy) showed a statistical significant association with MCI presence or progression.

Conclusions

The present study suggests that the prevalence and progression of MCI is significantly higher among patients on antiplatelet therapy, who carry a greater cardiovascular burden. Although patients on antiplatelet therapy were older, more ischaemic, hypertensive, and dyslipidaemic than patients without antiplatelet therapy, none of these parameters were associated with MCI presence and/or progression and can therefore be considered a confounding factor.
665 Longitudinal strain impairment in organic mitral regurgitation: look beyond the valve
Authors: Diana Giovanni , Manfredonia Laura , Filice Monica , Ravenna Emanuele , Graziani Francesca , Lombardo Antonella , Lanza Gaetano Antonio , Crea Filippo , Massetti Massimo , Locorotondo Gabriella
Published: December 2021

Aims

Global longitudinal strain (GLS) is a hallmark of cardiac damage in mitral regurgitation (MR). GLS > −18% in patients with severe organic MR (OMR) and normal LV ejection fraction (LVEF) is an independent predictor of postoperative LV dysfunction. While it is known that GLS is impaired in less than severe functional ischaemic MR (FMR), the value of GLS in less than severe OMR is not known. We aimed to determine prevalence and determinants of any GLS impairment in OMR, in comparison to FMR.

Methods

We retrospectively evaluated 51 consecutive patients (33 OMR and 18 FMR) with mild-to-moderate, moderate and moderate-to-severe MR (Table*). Overall, GLS was higher in OMR than FMR (17.9±4.5 vs. 10.3±5.3, P<0.001), with rate of impairment of 45% in OMR and 89% in FMR (P= 0.0024).

Results

However, no significant difference was found in GLS between mild-to-moderate, moderate and moderate-to-severe MR patients within OMR (17.7±4.7 vs. 16.9±3.9 vs. 22.4±3, respectively, P>0.05), as well as FMR (9.8±6.6 vs. 10.7±5.3 vs. 10.4±5.3, respectively, P>0.05) groups. GLS correlated directly with left ventricular (LV) ejection fraction (EF) in both OMR (r=0.69, P<0.001) and FMR (r=0.90, P<0.001), and inversely with LV mass indexed for body surface area (LVMi) in both OMR (r = −0.50, P=0.005) and FMR (r = −0.48, P=0.042). While correlation with LVEF was better for FMR than OMR (Z − 1.95, P=0.026), correlation with LVMi was similar for OMR and FMR groups (Z − 0.082, P>0.05).

Conclusions

In patients with OMR, GLS may be reduced, despite normal LVEF, in less than severe MR. Prevalence and degree of GLS impairment in OMR is less than in FMR. In OMR, as well as in FMR, GLS impairment is independent of entity of MR, but rather correlates with LVMi, maybe reflecting impact of myocardial fibrosis derived by increased LVMi on GLS.
477 Three cases of Kawasaki disease developed at young age and with a long term follow-up
Authors: Zagarese Giorgia , Varriale Alessandro , Pesarini Gabriele , Cristofaletti Alessandra , Sandrini Camilla , Ribichini Flavio Luciano , Prioli Maria Antonia
Published: December 2021

Kawasaki disease is a relatively new disease and it took years since its first discovery to find and establish precise diagnostic and therapeutic indications. We report three cases of Kawasaki disease diagnosed between 1976 and 1993, which developed vascular complications and which were followed up for more than 20 years. The first case involved a 45-year-old woman who was first diagnosed with Kawasaki disease at age 3 years old. Her condition was complicated in the acute phase by a myocardial infarction and by the development of an apical aneurysm. The second case involved a 30-years-old woman who was first diagnosed with Kawasaki disease at age 6 months. The disease was complicated by coronary aneurysms and by right coronary artery occlusion. The third case involved a 29-year-old male who received a diagnosis of Kawasaki disease at age 1 year old. Echocardiography in the acute phase showed coronary aneurysms. One year later a new echocardiography revealed a thrombosis of the right coronary artery without myocardial infarction. The coronarography confirmed the coronary aneurysms and the thrombosis. All three cases were treated with a medical therapy and were followed up with periodic imaging exams, stress tests, 24-h Holter monitorings and cardiological check-ups. With these three case reports we have highlighted the possibility of finding a population of adult patients who may come to medical attention for acute events, such as myocardial infarction, presenting complicated, and disastrous angiographic pictures: it is plausible that such a population, in addition to cardiovascular risk factors, may have developed a KD in the years of lacking diagnostic and therapeutic options.
808 Frequency and impact of atherothrombotic status in patients undergoing transcatheter aortic valve replacement
Authors: Boccuto Fabiola , Sorrentino Sabato , Carabetta Nicole , Bellantoni Antonio , Giordano Salvatore , Cacia Michele Antonio , Polimeni Alberto , Leo Isabella , Varano Ylenia , Augusto Florinda Maria , Mongiardo Annalisa , De Rosa Salvatore , Indolfi Ciro , Spaccarotella Carmen
Published: December 2021

Aims

Many efforts have been made in the last decade to minimize the risk of bleeding in patients undergoing transcatheter aortic valve replacement (TAVR), such as a less intensive antithrombotic therapy and technical improvement in devices implantation. Conversely, evidence on high atherothrombotic status (HATR) is still lacking in patients undergoing TAVR. Accordingly, in this analysis, we aimed to evaluate frequency and impact of atherothrombotic status in patients undergoing transcatheter aortic valve replacement.

Methods

Patients who underwent TAVR at our Institution from September 2008 to November 2020 were included in this analysis. Out of 407 patients, 6 (1.5%) were excluded as they underwent only balloon angioplasty or for procedural unsuccess. HATR status includes patients with prior percutaneous coronary intervention/coronary artery bypass graft, prior stroke/transient ischaemic attack (TIA), or with a diagnosis of diabetes. Continuous variables following normal distribution were compared with the student’s t-test and categorical data were analysed with the chi-square test. A Cox regression model was used to evaluate the association between HART status and all-cause mortality at one 1-year follow-up.

Results

Compared to patients with low atherothrombotic status (LATR) (n = 238; 59.4%), HART patients (n = 163; 40.6%) were older, more likely female and with a higher prevalence of common cardiovascular risk factors including chronic kidney disease, smoke, and hyperlipidaemia. Between LATR and HATR groups, no differences have been observed, in terms of procedural time, type of devices used (Balloon vs. self-expandable device), or hospitalization length. Compared to LART, HART patients were more likely to be discharged on statin (63.7% vs. 83%, P < 000.1), on dual antiplatelet therapy (50.4% vs.58.9%, P = 0.03), or on oral anticoagulant if required (27.7% vs. 29.5%, P = 0.03). Furthermore, no differences have been observed in terms of in-hospital adverse events, including death, severe bleeding, any conduction disturbances requiring pacemaker implantation, access complications, myocardial infarction, or stroke/TIA. For instance, HART was not a predictor of mortality at 1 year follow-up, even after adjustment for baseline characteristics.

Conclusion

In our population, no differences in procedural and in-hospital adverse events have been observed according to the atherothrombotic profile. HATR patients were more likely to be discharged with more intensive antithrombotic and hypolipidaemic strategies, despite the coexistent high prevalence of bleeding determinants. However, ATR status does not impact 1-year mortality even after adjustment for baseline characteristics.