bluuebunny/crossref_metadata_2025 huggingface dataset:
P359 ACHIEVING THERAPEUTIC GOAL ON LDL IN HIGH AND VERY HIGH RISK PATIENTS IN A DEDICATED OUTPATIENT CLINIC
Authors: Napolitano B , Maretta A , Spagnuolo V , Balsano M
Published: May 2022

Background

High LDL cholesterol levels represent an important risk factor for development of cardiovascular disease. Reduction of LDL reduces cardiovascular risk. Current guidelines (ESC 2019) recommend ambitious LDL levels for high and very high risk patients. But, in clinical practice, just a part of these patients achieve the ESC 2019 goals (DA VINCI Study).

Patients and Methods

We evaluated, in the first 152 patients, at high and very high cardiovascular risk, consecutively afferent to our dedicated clinic for hyperlipidaemia (Lipid Center CS), the achievement of the therapeutic goal of LDL according to ESC 2019 guidelines. All patients were on lipid–lowering drug treatment from at least twelve months and the last blood tests were no less recent than three months.

Results

Of all patients, 82 were female. The mean age was 65.24±10.33 years. Thirty patients were in secondary prevention. Of all patients, 70% reached the therapeutic goal (77% with very high risk and 68% with high risk). Fifty nine% were taking high–intensity lipid–lowering therapy. Seventy one% were taking combination therapy. Thirty four% were treated with PCSK9 inhibitors.

Discussion

Taking note of the limited number of the sample, our therapeutic results achieved are higher than that achieved in the DA VINCI study in which only 60% of patients from west Europe reached the therapeutic goal. A dedicated clinic for hyerlipidaemia and the high use of combination therapy with intensive drugs and extensive use of PCSK9 inhibitors may justify the results of our study. Our center did not participated in the DA VINCI study.
P362 GENDER DIFFERENCE IN PSYCHOLOGICAL STRESS SYMPTOMS IN CARDIAC OUTPATIENTS AT THE TIME OF COVID–19 PANDEMIC. THE ABC STUDY ON HEART DISEASE
Authors: Berton G , Mahmoud H , Cavuto F , Bagato F , Palmieri R , Stocchero L , Selvestrel E , Allocca G , Lorenzon E , Merotto D
Published: May 2022

Introduction

COronaVIrus Disease 2019 (COVID–19) exerts a significant impact on public health since it has reached a pandemic level in March 2020 and a high rate of negative mental health outcomes has been reported in the Italian general population.

Purpose

We aimed to investigate the pandemic impact on the psychological status of, COVID–19 negative, cardiac patients and if there are any gender differences.

Methods

Consecutive COVID–19 free patients who were presented to the cardiac outpatient clinic of Conegliano general hospital were divided into 2 groups according to their presentation, either before or during the COVID–19 Pandemic. The presence or absence of stress symptoms was established based on the patient’s self–assessment psycho–emotion questionnaire based on a reproduced form of Cohen’s perceived stress scale.

Results

A total of 310 patients were included in this analysis. Patients’ mean age was 65±18.5 years, males were 57% with 128 (41%) and 132 (59%) patients presented before and during the pandemic respectively. Both patients’ groups shared most of the demographic and clinical characteristics. In all patients, stress symptoms were reported in (52% VS 60%; p = 0.15) for patients who were presented before and during the pandemic, respectively. In male patients, stress symptoms were more frequent in patients who were presented during the pandemic (59%) compared to the pre–pandemic presented male patients (43%); (p = 0.03). Yet, no difference in the frequency of stress symptoms was observed in female patients. In an age–adjusted logistic regression analysis, psychological stress was significantly higher in male patients who were presented during the pandemic (Odds Ratio [OR]=2.0; 95% confidence interval [CI]=1.1–3.6; p = 0.03). Although, no significant difference was observed in female patients (OR = 0.8; 95% CI = 0.4–1.7; p = 0.63). Same results were obtained using the fully adjusted model, (OR = 1.9; 95% CI = 1.0–3.5; p = 0.04) and (OR = 0.8; 95% CI = 0.4–1.7; p = 0.64), for male and female patients, respectively.

Conclusion

Psychological stress symptoms has been observed more frequently in male patients seen during the COVID–19 pandemic, with almost double risk compared to the pre–pandemic, independently from baseline clinical characteristics. No difference in the frequency of stress symptoms was observed in female patients.
P363 HIGH–SENSITIVITY TROPONINS FOR OUTCOME PREDICTION IN THE GENERAL POPULATION: A SYSTEMATIC REVIEW AND META–ANALYSIS
Authors: Aimo A , Georgiopoulos G , Panichella G , Vergaro G , Passino C , Emdin M , Clerico A
Published: May 2022

Background

High–sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs–cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease.

Methods

We retrieved all studies evaluating the prognostic value of hs–cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all–cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization.

Results

We included 24 studies for a total of 203,202 subjects; 11 studies assessed hs–cTnT and 14 hs–cTnI. One standard deviation (SD) increase in baseline hs–cTn was associated with a 23% higher risk of all–cause death (HR 1.226, 95% CI 1.083–1.388, p < 0.001, I2=88.5%); all these studies measured hs–cTnI. In an exploratory analysis on 3 studies with 25,760 subjects, hs–cTn predicted cardiovascular death (HR 1.822, 95% CI 1.241–2.674, p = 0.002, I2=87.2%). After synthesizing 9 studies with 58,565 subjects, hs–cTn predicted cardiovascular events (HR 1.328, 95% CI 1.167–1.513, p < 0.001, I2=93.8%). Both hs–cTnT (HR 1.627, 95% CI 1.145–2.311, p < 0.001) and hs–cTnI (HR 1.260, 95% CI 1.115–1.423, p < 0.001; p for interaction <0.001). Furthermore, in 10 studies with 61,467 subjects, hs–cTn predicted HF hospitalization (HR 1.493, 95% CI 1.368–1.630, p < 0.001, I2=76.6%). Both hs–cTnT (HR 1.566, 95% CI 1.303–1.883, p < 0.001) and hs–cTnI (HR 1.467, 95% CI 1.321–1.628, p < 0.001) were associated with HF hospitalization (p for interaction <0.001).

Conclusions

Hs–cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all–cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.
P365 CARDIOVASCULAR RISK SCORE MAY BE USEFUL IN STRATIFY DEATH RISK IN HOSPITALIZED COVID19 PATIENTS
Authors: Cicco S , Mozzini C , Marozzi M , Carella R , De Fazio G , Vacca A , Cariddi C , Setti A , Pappagallo F , Solimando A , Ria R
Published: May 2022

Background

COVID–19 induce a robust systemic inflammation. Patients with cardiovascular disease (CVD) present an increased death risk. However, many efforts are spent to identify possible predictors of negative outcomes in order to have a more specific clinical setting. CVD score are useful tools in evaluation of risk of cardiovascular events Aim: We evaluated oxygenation and characteristics in COVID–19 according to cardiovascular risk stratification performed using Framingham (FRS) and Atherosclerotic cardiovascular disease (ASCVD) risk scores.

Material and Methods

We evaluated 155 COVID–19 patients (110 males and 45 females, aged 67.43±14.72 yrs). All patients underwent to a complete physical examination, chest imaging, laboratory tests, and blood gas analysis at the time of diagnosis. Seventeen patients died (10 males and 7 females, aged 74.71±7.23 yrs) while the remaining 138 patients (100 males and 38 females, aged 66.07±15.16 yrs) were alive at discharge.

Results

No differences there were in Hb, C–reactive protein nor in d–dimers between the two groups. Compared to alive, died group presents a significant increase in white blood cells (p < 0.05) and d–dimers (p < 0.05). No difference there were in pCO2, SO2, and in alveolar arteriolar oxygen difference (A–aDO2). On the contrary, in died patients there is an increased pO2 (p < 0.05) and a decreased ratio between oxygen inspired and pO2 (P/F; p < 0.05). Died patients have increased both in FRS (27.37±5.03 vs 21.33±9.49, p < 0.05) and ASCVD (40.18±20.36 vs 21.47±17.23, p < 0.05). FRS, but not ASCVD, presents a negative correlation to P/F (r–0.42, p < 0.05) in died while no correlation was found in alive. No other correlation has been found with blood gas parameters or in the phlogosis parameters evaluated in the two groups. ROC curve analysis showed a good performance in prediction of death for both scores (AUC FRS 0.71, ASCVD 0.77) with a good sensitivity (FRS 76.92%, ASVCD 75.00%) and specificity (FRS 65.00%, ASCVD 81.13%).

Discussion

CVD may be considered as a major risk factor for death in COVID–19 patients. The increase risk relates to a reduced lung capacity but it is not related to alteration in gas exchange. Similarly, CV risk results independent from inflammatory state we found. CVD risk score may be useful to stratify patients at admittance for a better treatment
P366 EFFECTS OF EXERCISE REHABILITATION IN PATIENTS WITH LONG COVID–19
Authors: De Marzo V , Barbara C , Maragliano P , Lotti R , Guglielmi G , Porcile A , Russo C , Griffo R , Makikallio T , Hautala A , Porto I , Clavario P
Published: May 2022

Moving from the first COVID–19 pandemic to the chronic phase of COVID–19, more than 50 long–term detrimental effects have been recognized in the so–called long COVID–19 syndrome. The exact mechanisms underlying the exercise capacity reduction and functional limitations are unknown, however, rehabilitation could play a pivotal role. The aim of this study was to evaluate whether a combination of aerobic and resistance training performed in the same session for 8 weeks could be well–tolerated and effective in long COVID–19 patients with reduced exercise capacity [(<85% of predicted peak aerobic capacity (VO2peak)] at 3–month from hospital discharge after COVID–19. The exercise training program included 3 exercise sessions per week. Each session included: a) aerobic exercise (starting at 30 min and increasing to 60 min) with 5 min warm–up and 5–min cool down; b) nine major muscle group resistance exercises (for the lower extremity: leg extension/flexion, abduction/adduction, and leg press; for the upper extremity: push–up/pull–down; for the core muscles: abdomen, back). The intensity of aerobic exercise was defined according to VO2peaktest results targeting the 80% level of lactate threshold in Watts. Resistance training load was determined for each muscle groups according to the results of the maximal dynamic strength testing (1RM; one repetition maximum) and was confirmed and updated after 4 weeks by defining new 1RM values. Resistance training prescription loading was defined as 40% of 1RM, 2 sets (3 sets for last two weeks) and 12 repetitions for each muscle group. The duration of a single training session was approximately 90 min. Out of 220 patients screened, 50 patients (aged 55.8±9.7 years, 15 women, body mass index 26.6±5.2 kg/m2) were enrolled. Mean exercise training sessions was 66.1±34.0; none of the patients dropped out from the study. VO2peak increased 15% and peak ventilation 9% (p < 0.001 for both). After the training program, mean percentage of VO2peak significantly increased (+14.2%, p < 0.001). Muscle strength increased markedly for all major muscle groups ranging from 16% to 33% increase (p < 0.010). An exercise rehabilitation with combined aerobic and resistance exercises for 8 weeks increases markedly both cardiorespiratory and musculoskeletal fitness in long COVID–19 patients. These results may highlight the importance of regular exercise rehabilitation aiming to promote daily activities, independent living, and better quality of life.
P368 PHYSICAL AND PSYCHOLOGICAL RECONDITIONING IN LONG COVID SYNDROME: RESULTS OF AN OUT–OF–HOSPITAL EXERCISED–BASED CARDIOVASCULAR REHABILITATION PROGRAM
Authors: Compagno S , Palermi S , Pescatore V , Brugin E , Tegon G , Sarto M , Marin R , Calzavara V , Nizzetto M , Scevola M , Albertin C , Biffi A , Giada F
Published: May 2022

Background

Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID–19 infection. Natural history and treatments of this syndrome are still poorly understood, even if evidence suggests the potential role of physical rehabilitation in improving symptoms in these subjects.

Aim

The aim of the present study was to evaluate safety, effectiveness and feasibility of a multidisciplinary, out–of–hospital, exercise–based cardiac rehabilitation (EBCR) program, of two months duration, in improving symptoms and physical and psychological parameters in patients with LCS Methods Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test (CPET), quality of life (QoL) and psychological appraisal before and after an EBCR program.

Results

At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the EBCR program, COVID–19 residual symptoms significantly decreased and significant improvements in upper and lower limb muscular strength, CPET parameters, perceived physical and mental health, depression and anxiety were observed.

Conclusions

The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a multidisciplinary EBCR program could promote their physical and psychological recovery
P370 INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE
Authors: Lordi R , Veronese S , Piccinini A , Ferro A , Zerbini V , Piva T , Raisi A , Mandini S , Grazzi G , Sassone B , Pasanisi G
Published: May 2022

Introduction

COVID–19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym’s closure and the need to stay home didn’t allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home–based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home–based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara.

Methods

On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm–up, strenght and balance exercises alternate to indoor walking, cool–down. Patients received an explicative iconographic via e–mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection.

Results

All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred.

Conclusions

Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID–19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.
P374 MANAGEMENT OF A HOSPITAL NURSING OFFICE FOR AF AND CONTROL OF DIRECT ORAL ANTICOAGULANT THERAPY IN THE COVID EMERGENCY PHASE
Authors: Pagliani L , Colledan C , Bertoldo I , Magoga J , Modolo M , Visintin E , Nicolosi E , Di Naro A , Denas G , Antonini–canterin F
Published: May 2022

Anticoagulant therapy is the gold standard treatment in thromboembolic prevention in AF patients. Starting from the indications from the regional indications that give the therapeutic diagnostic path, a divisional clinic dedicated to the diagnosis and treatment of AF was born in our territory. The aim of the team (Cardiologists, Nurses, GPs, administrative secretariat) was to monitor the number of patients treated with DOACs through AIFA therapeutic plans; Verify adherence to regional guidelines, analysis of therapy adherence; Prepare a protocol for the management of complications and emergencies; Ensure that the departments and services authorized to prescribe NOA take charge, in collaboration with general practitioners who since June 2020 have become active prescribers and also actors in the follow–up of patients; Taking care of the training of the prescribers themselves and the education of patients through hospital meetings dedicated to guided counseling and, finally, monitoring the pharmaceutical expenditure of the NOA on the total prescription of the local health unit of competence in compliance with the regional indicators. In our hospital the pilot project started in 2017 (3726 currently in FU). In the three–year period 2017–19, an average of 700 therapeutic plans were collected for renewal / first prescription per year (58.3 plans / month) to be monitored in subsequent years. In the two–year period 2020–2021, which saw the difficulty of organizing activities due to the pandemic emergency, 903 and 790 PTs were analyzed with an average of 70 plans / month, keeping almost 75% of face to face visits compared to telemedicals set up in the pandemic context.

According to the data, therefore, there is a strong need for diagnostic and health assistance paths. Despite the emergency period and despite a framework in which territorial medicine could have helped the clinical and bureaucratic effort, no resistance to the care burden has occurred and on the contrary the constant increase in patients makes the complexity and difficulty of a correct clinical classification and management support for patients with AOC needs
P376 INTRACAVITARY ABLATION OF PARASYMPATHETIC ATRIAL GANGLIONATED PLEXUS, A NEW APPROACH FOR SINUS BRADYCARDIA IN YOUNG PATIENTS
Authors: Cherubini S , Castro A , Follesa F , Centurion Aznaran C , Albano B , Ciolli A
Published: May 2022

Sinus bradycardia might be a severe clinical problem, if symptomatic pacemaker implantation is needed. In younger patients this will lead to several battery changes, higher infectious risk and psychological issues. When sinus bradycardia seems related to vagal hypertone, intracavitary ablation of atrial ganglionated plexus has recently been proposed as an alternative to pacemaker implantation in symptomatic younger patients. A 44–year–old patient was admitted to the emergency department for lipothymia and fatigue. The ECG showed marked sinus bradycardia with a heart rate of 35 bpm and continuous ECG monitoring revealed episodes of Mobitz I second degree AV block and 2:1 AV block. The transthoracic echocardiography was normal. In order to reduce the effect of vagal hypertone on the heart, catheter ablation of parasympathetic atrial ganglionated plexus was performed. In the right atrium the electrophysiological study showed fragmented potentials near caval vein openings and coronary sinus osthium, while in the left atrium these were found in the posterior wall close to the pulmonary veins and near the left part of coronary sinus. Catheter stimulation of these zones determined asystolic pauses and induction of atrial fibrillation with spontaneous resolution. Catheter radio–frequency ablation was performed, at the end of the procedure increase of heart rate at 70 bpm was observed and atrial fibrillation was no more inducible during pacing. Atrioventricular Wenckebach point recorded before the procedure was 730 ms and it passed to 430 ms. At continuous ECG monitoring the heart rate remained higher than 65 bpm all over the hospitalization, without any other meaningful arrhythmias. Ablation of parasympathetic atrial ganglionated plexus is still an experimental technique but it is proving to be very interesting and promising. In the case we described the patient took a real advantage from the procedure that was measurable both with the improve of heart rate and reduction of Wenckebach point. During the procedure we associated the site of fragmented potentials with the position of each plexus; stimulation of these sites evocated a strong vagal response, confirming that fragmented potentials can be used to localize the plexus. Some authors affirmed that ablation only on right atrium might be sufficient; however, we preferred to ablate in both atria in order to make the procedure more effective. More studies are needed to identify the correct site.
P377 CHALLENGING RISK STRATIFICATION IN BRUGADA SYNDROME: A CASE OF VENTRICULAR TACHYCARDIA IN A LOW–RISK PATIENT
Authors: Marcon L , Zannoni J , Tundo F , Moltrasio M , Majocchi B , Fassini G , Riva S , Casella M , Tondo C , Ribatti V
Published: May 2022

A 22–year–old healthy athlete was referred to our hospital for electrocardiographic findings consistent with intermittent type–1 Brugada pattern. A routine electrocardiogram (ECG) performed during a check–up showed sinus rhythm, normal PR interval and QRS duration, rSR’ with a coved type ST–segment elevation in V2 lead (Figure 1).The patients denied history of syncope or palpitations and his family history did not show sudden cardiac death or Brugada syndrome (BrS). Transthoracic echocardiography was normal and a 12–lead Holter monitoring revealed the intermittence of the type–1 Brugada pattern. The patient was hospitalized for further investigation. On admission, ECG showed a type–2 Brugada pattern; therefore, Ajmaline challenge test (1 mg/kg injection in 10 minutes) was performed and resulted positive. Subsequently, the patient underwent an electrophysiological study (EPS) which was negative for induction of sustained arrhythmias. The protocol adopted consisted of double extrastimuli programmed electrical stimulation until refractoriness (drive 600/220 ms and 400/210 ms), at double sites (right ventricle apex and right ventricular outflow tract). Furthermore a genetic test was performed using next–generation sequencing, showing a heterozygous mutation in the SCN5A gene, encoding for sodium channel alpha subunit (variant c.5363delA), not previously described in the literature. Since the low arrhythmic risk, the patient was implanted with a loop recorder (ILR, Medtronic Reveal LINQ), entering a program of home monitoring. After a 15–months follow–up, an episode of ventricular polymorphic tachycardia lasting 2 minutes and 11 seconds, associated with lightheadedness and palpitations, was detected by the remote monitoring (Figure 2). The patient was therefore hospitalized. During the in–hospital stay a cardiac magnetic resonance was performed to exclude other underlying diseases, identifying an enlarged right ventricle (EDVi 114 ml/m2) and abnormal free wall motion (Figure 3), thus reaching one major criteria of arrhythmogenic cardiomyopathy (however not sufficient for the diagnosis). The patient was then implanted with a subcutaneous implantable cardiac defibrillator (Boston Scientific EMBLEM MRI S–ICD). We presented a case of complex arrhythmic risk stratification in a possible overlap of an arrhythmogenic cardiomyopathy and a Brugada Syndrome in a young athlete who experienced a sustained ventricular tachycardia during loop–recorder monitoring.
P379 CARDIAC CONDUCTION DISEASE IN YOUNG PEOPLE: DON‘T FORGET THE GENES
Authors: De Carolis B , Di Domenico A , Gualandi F , Vitali F , Bertini M , Guardigli G , Balla C
Published: May 2022

Introduction

Heart rhythm disorders in young individuals are often associated with mutations in genes encoding ion channels. A frequently encountered mutation is in the SCN5A gene, which encodes the alpha subunit of the sodium channel. Mutations in this gene can be expressed through a wide spectrum of phenotypic manifestations including rhythm disturbances, structural cardiac changes and/or overlap syndromes (long/short QT syndrome, Brugada syndrome, sinus node syndrome, progressive cardiac conduction disorder, dilated cardiomyopathy and arrhythmogenic cardiomyopathy).

Case Report

23–year–old boy with no relevant history. During the induction of anaesthesia for a surgical intervention of nasal polyposis, episodes of asystole with a maximum duration of about 6 seconds were documented. During the hospital stay, a syncopal episode followed, with electrocardiographic monitoring showing a sinus arrest of approximately 16 seconds (Fig. 1). Echocardiography and cardiac resonance ruled out the presence of structural alterations. In view of the documented bradyarrhythmia, the clinical findings and the absence of secondary causes, a dual–chamber pacemaker implant was performed. The patient was subsequently admitted for ectopic atrial tachycardia (Fig. 2) symptomatic for heart palpitations, treated with medical therapy. After careful reconstruction of the family tree (Fig. 3), a positive family history of bradyarrhythmias emerged (grandfather and sister of the paternal grandfather were pacemaker carriers). A blood sample was taken for genetic analysis and a mutation in the SCN5A gene (ex28 c5207 A>G) was detected. The genetic study was extended to first–degree relatives (still in progress). During follow–up visits the patient reported subjective well–being and at pacemaker interrogation evidence of 29% atrial pacing, in the absence of ventricular pacing.

Conclusions

When faced with a young patient with a conduction disorder, once possible secondary causes have been excluded, genetic analysis should be included in routine examinations because it helps to define an adequate clinical–instrumental follow–up and to identify, at an early stage, the possible progression of the disease and/or the onset of concomitant structural heart disease. Family genetic screening is also essential in order to identify patients at risk of developing the disease.
P383 THIRD–DEGREE ATRIOVENTRICULAR BLOCK AND HYPERCALCEMIA: NOT ALWAYS JUST THE HEART
Authors: Reggi A , Russo M , Rubboli A
Published: May 2022

A 81–year–old lady was admitted to the ER due to anorexia, fever and oliguria. Previous medical history was unknown as she had arrived in Italy one month before and her son was not aware of it. Upon arrival she was soporous and bradicardic. Physical examination consisted of mild pulmonary rales, diffuse abdominal pain and leg edema. ECG showed a third–degree atrioventricular block with narrow QRS and average heart rate of 40 bpm with no signs of ischemia. X–ray showed mild congestion. She was admitted to CCU. Blood tests showed hypoglicemia (53 mg/dL), anemia (Hb 9.9g/dL), low platelet count, renal dysfunction (creatinine 1.43mg/dL), high C–reactive protein, normal potassium but high calcemia (13 mg/dL). To investigate hypercalcemia parathyroid hormone was dosed and was in range, so a CT scan was needed to rule out pancreatitis, cancer or bone lesions. Also a cardiac echo was done: it showed a hypertrophic left ventricle with preserved contractility, no significant valvular dysfunctions, normal right sections with pulmonary hypertension, no pericardial effusion. While performing the subcostal view however multiple formations were seen at the hepatic level. CT scan confirmed multiple pathological conglomerating lymphadenopathies in the abdomen towards the femoral region, reaching 5 cm of diameter; no bone lesions were found. Inguinal lymph node biopsy was performed. Due to persistent complete AV block along with persistent hypercalcemia and hypoglycemia despite medical therapy, considering the electrolyte imbalance not corrigible due to a malignancy a pacemaker was implanted. The result of the lymph node biopsy was consistent with a form of Diffuse Large B–Cell Lymphoma. This case highlights how a 3–rd degree AV block may present with non–specific symptoms. When it is found it may not always represent a pure cardiac problem as sometimes it is the epiphenomenon of a systemic disease. Particularity of this case is that cardiologists are less used to take into consideration calcium balance. Nevertheless, although infrequent, hypercalcemia is a cause of significant conduction disease. After having looked for it, searching for its etiology is mandatory as some could be reversible and thus the AV block as well. For this reason, when a complete AV block is found ruling out hypercalcemia is fundamental, taking into consideration that the conduction disease may represent the first red flag of an unknown malignancy
P384 SUDDEN CARDIAC ARREST: LET’S LOOK BEYOND CORONAROPATHY
Authors: Canovi L , De Carolis B , Di Domenico A , Berloni M , Gualandi F , Bertini M , Guardigli G , Balla C
Published: May 2022

Introduction

Sudden cardiac arrest (SCA) is a high mortality event. Up to 70% of SCAs are caused by an acute coronary syndrome; nevertheless, it is essential to consider also non–ischemic causes while evaluating a post–SCA patient.

Clinical Case

A 68–year–old male patient with history of hypertension and dyslipidemia, presenting to the emergency room (ER) for syncope. While waiting in the ER, another sincopal episode happened and ventricular fibrillation was detected, therefore he was treated with a DC shock. At the ECG record after SCA, any acute alteration was seen. At the blood tests, an early rise of myocardial injury markers was found. At bedside echocardiography, a slight apical hypokinesia with hypertrabeculation was reported. Hence, coronarography was performed and a multivasal ateromasic coronaropathy was treated with angioplasty and drug–eluting stenting of left main artery, left anterior descending artery and left circumflex artery. In the following days, other ventricular tachyarrhythmias episodes happened and were treated with DC shocks. Due to ventricular arrhythmias relapses and echocardiographic findings, a cardiac MRI was performed, showing subepicardial fatty infiltration in the mid–apical lateral wall with parietal bulging suggesting left ventricle arrhythmogenic cardiomyopathy. So, a cardiac defibrillator was implanted in secondary prevention. Genetic analysis was run and reported a VUS mutation on RYR2 gene, still under evaluation as a possible cause for the clinical events.

Conclusions

The present clinical case shows that many causes may lead to SCA. Our patient experienced syncopal episodes related to ventricular arrhythmias and an arrhythmic storm which were most likely caused by an ischemic event on the base of an undiagnosed left ventricle arrhythmogenic cardiomyopathy.
P386 OBESITY AND CARDIOMYOPATHY
Authors: Giofrè F , Pelle M , Zaffina I , Lucà S , Forte V , Arturi F , Cloro C , Ventura M , Trapanese V , Sciacqua A , Arturi F
Published: May 2022

Background

Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy.

Aim

To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy.

Methods

383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI<30kg/m2) and obese subjects (BMI>30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI >30<35, 2= BMI >35<40, 3= BMI >40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI).

Results

Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension.

Conclusions

Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.
P389 COVID–19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS
Authors: Maloberti A , Gualini E , Scarpellini S , Algeri M , Biolcati M , Grasso E , Tognola C , Moreo A , Giannattasio C
Published: May 2022

Introduction

SARS–CoV–2 determines a framework of multi–organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Methods

This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid–19 who undergone PWV measurement during the follow–up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results

PWV values were higher in Covid–19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R= –0.302; p < 0.001).

Conclusions

SARS–CoV–2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow–up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long–term cardiovascular risk.
P391 A ‘FAKE’ PERIPARTUM CARDIOMYOPATHY: THE KEY ROLE OF CARDIAC MRI
Authors: Occhiuzzi E , Ranfone F , Ippoliti C , Valentini G
Published: May 2022

K.M. Woman, 47 years old; Moroccan–born, she doesn’t speak Italian. History limited by the language barrier Medical histroy: caesarean section two months prior to admission (pluriparae with 6 births) In home therapy with estrogen–progestin pill Access to the emergency room for thoraco–abdominal pain of not exactly onset with dyspnoea (Killip II) EKG: sinus tachycardia, poor progression of the R wave in the precordial leads with mild ST–elevation in the same leads TTS echocardiographic: slightly dilated left ventricle, hypo / akinesia of the apex in its entirity with LVEF 38%; mild mitral regurgitation. Normal size and fuction of RV, PAPS slightly elevated; no pericardial effusion. Coronarography: mild non–critical atheroma of the main vessels. Occlusion of a small branch of division of OM Ventriculography (suspected Tako–Tsubo): reduced contractile function of the LV in relation to akinesia of the apex in its entirety Chest CT without contrast: diffuse areas of parenchymal nodular thickening  >> lower lobes, thickening of interlobular and intralobular septa, mild pericardial effusion Blood sampling: elevated cardiac troponin hs in the absence of a typical curve for ACS; high inflammation markers Admission to cardiology with diagnosis of acute heart failure in PPCM (vs myocarditis.) Pneumonia. Slow and progressive improvement of the hemodynamic status and of the septic status with diuretic and antibiotic therapy. Prolactin antagonist (cabergoline) therapy and therapy for heart failure was started. During the hospital stay the patient was asymptomatic, not more angor, no arrhythmias on the EKG monitor, hemodynamic stability. Upon completion of the diagnosis, cardiac MRI was performed which modifies the diagnosis: dilated eccentric remodeling of the left ventricle with moderate reduction of global systolic function; akinesia of the lateral segments on the mid–basal, septal and lower apical planes and of the apex which corresponds to LGE ischemic–type enhancement for MI– outcomes. No evident endoventricular thrombi. Faded reactive signs of the pericardium with a slight fluid share Acute heart failure in hypokinetic heart disease with ischemic etiopathogenesis due to undated anterior silent MI (likely due to spontaneous coronary dissection)
P397 PROGNOSTIC VALUE OF CORONARY CALCIUM IN PATIENTS WITH COVID–19 AND SUSPECTED INTERSTITIAL PNEUMONIA: A CASE–CONTROL STUDY
Authors: Carletti R , Galvani M , Gardini E , De Vita M , Dallaserra C , Vizzuso A , Ottani F , Campacci F , Grosseto D , Di Gianuario G , Rinaldi G , Vecchio S , Mantero F , Mellini L , Albini A , Mughetti M , Gardelli G , Piciucchi S
Published: May 2022

Background

Short–term prognosis of SARS–CoV2 infection is mainly conditioned by the extent and severity of COVID–19 interstitial pneumonia. Coexistence of cardiac disease is however important and independently associated with an adverse outcome. Coronary calcium (CAC), detected at the time of chest computed tomography, can be a useful prognostic tool, as suggested by some cohort studies.

Material and Methods

We performed a retrospective, multi–centre, case–control (1:2) study in 195 COVID–19 patients admitted from 01–03–2020 to 30–04–2020. Cases were consecutive patients died within 30 days or admitted to the Intensive Care Units for invasive ventilation during the hospitalization (primary outcome measure). Controls were age– and sex–matched patients surviving until 30 days without need for invasive ventilation. For each case, we selected two controls, matched by age and sex dividing cases in age strata of 10 years, assuring within each age stratum twice the number of controls with an identical gender proportion. CAC estimation was performed with a with a semi–quantitative score (0 to 30) based on 10 segments and 4 degrees of severity of the calcification. Estimation of interstitial pneumonia, was similarly performed with a semi–quantitative score (from 0 to 20), based on 5 lobes and 5 degrees of severity of interstitial involvement. CT scans were acquired according to a standard protocol for non–cardio–synchronized chest CT, always on a multi–detector scanner with at least 16 layers.

Results

The mean CAC value in cases was significantly higher (p = 0.001) compared to controls: 5,52±1,38 vs 3,28±0,54 (mean value ± 95% CI). The percentage of cases with moderate–severe CAC was significantly higher (p = 0.013) compared to controls (41.5% vs 22.8%, OR 2.27 95% CI 1.20–4.29; primary end–point of the study). In multivariate analysis, independent predictors of outcome were (in descending order): interstitial pneumonia severity score (Wald 8.143, p = 0.004), CC score (Wald 5.569, p = 0.018), and the LDH value on admission (Wald 3.335, p = 0.034).

Conclusions

In our case–control study, the severity and extent of CAC is the main prognostic factor for the occurrence of adverse clinical outcome, beside the severity of interstitial pneumonia. These data suggest that a semi–quantitative estimation of CAC, feasible on any CT detector without the need of dedicated software, is clinically useful for the prognostic assessment of patients with COVID–19 interstitial pneumonia.
P408 CERTIFICATION FOR COMPETITIVE SPORTS ACTIVITY IN A TEENAGER WITH WPW BY VIA INTRAHYSSIAN ACCESSORY PATHWAY
Authors: Stuto A , Armaro B , Cosentino E , Canonico G , Ambu A , Cascone G , Lo Giudice A , Canonico S , Cassarisi S , Ierna S , Basile G , Gulletta S
Published: May 2022

The case of a 12–year–old male, height 160 cm, weight 46 kg, who practices water polo at a competitive level is reported. Negative family history of cardiovascular pathologies, general and cardiovascular physical examination within the limits of normality. On the electrocardiographic trace (ECG) presence of delta wave from ventricular pre–excitation from intrahyssian accessory pathway (Fig. 1). Echocardiography + color Doppler was normal. The subject underwent a cardiopulmonary stress test with an incremental ramp protocol and steps of 20 watts / min. Shutdown at 190 watts for muscle exhaustion with peak oxygen consumption (VO2) = 43.9 mL / Kg / min, Heart rate = 197 beats / minute, BP = 210/70 mmHg, VE / VCO2 slope = 27.6. Normal course of the cronotropic and pressure curve. The ventricular pre–excitation delta wave persisted for the entire duration of the test and in recovery (Fig. 2, Fig. 3). Secondary disturbances of ventricular repolarization characterized by ST segment sub–leveling and negative T wave appeared at high load and persisted in the first minutes of recovery, delta VO2 / delta WR = 12. Given the non–disappearance of the delta wave from ventricular pre–excitation during the maximal stress test, the subject was sent to an electrophysiological study and subsequent ablation of the accessory pathway. The electrophysiological study was negative for inducibility of atrial fibrillation (AF) and ventricular arrhythmias. Safe ablation was impossible given the intrahyssian position of the accessory pathway. Considering the negativity of the electrophysiological study due to non inducibility of supraventricular and ventricular arrhythmias, eligibility for competitive sports was granted.
P420 PLASMA LEVELS OF PARATHYROID HORMONE IN HEART FAILURE: CLINICAL CORRELATIONS AND PROGNOSTIC ROLE
Authors: Potenza A , Scicchitano P , Babbo R , Pinto M , Abruzzese S , Tangorra M , Cannito A , Gesualdo M , Paolillo C , Ciccone M , Caldarola P , Massari F
Published: May 2022

Background

Circulating concentrations of parathyroid hormone (PTH) increase in heart failure (HF) patients. Plasma concentrations in PTH are related to HF severity, thus considering PTH as biomarkers of HF worsening. The aim of our study was to evaluate clinical correlations and prognostic role of PTH in patients with HF.

Methods

We evaluated 229 HF patients (42% acute and 58% chronic HF). Patients underwent evaluation of NYHA functional class, measurements of bioactive PTH (1–84), B–type natriuretic peptide (BNP), creatinine cleareance, and hydration status (by means of bioimpedance analysis) and all–cause mortality during follow–up.

Results

PTH levels were higher in acute HF as compared to chronic HF (248±180 pg/ml vs 153±133 pg/ml, p < 0.001), and significantly correlates with NYHA class, BNP levels (r = 0.4), creatinine clearance (r=–0.3), and hydration status (r = 0.4). Fifty patients died after a median follow–up of 408 days (IQR: 283–573). The cumulative mortality rate was 22%. At univariate Cox regression analysis, we found a strong and significant association of PTH plasma values at admission to mortality (HR 1.003). The optimal cut–off for death occurrence was: PTH > 249 (AUC=0.65; sensibility 50% and specificity 82% ). At multivariate Cox regression analysis PTH level was no longer associated with death, while BNP, hydration status, and renal function maintained an independent predictive value for mortality (HR 1.0004, HR 1.06, and HR 0.98, respectively).

Conclusions

Our study demonstrated that circulating concentrations of bioactive PTH are related to other biomarkers of HF worsening, i.e. creatinine clearance and hydration status. Although PTH acted as a prognostic determinants of mortality in HF, it was not an independent prognostic biomarkers at multivariate regression analysis.
P429 PROGNOSTIC IMPACT OF ROUTINE SIX–MONTH EXERCISE STRESS TEST AFTER COMPLEX LEFT MAIN BIFURCATION PCI
Authors: Rigatelli G , Zuin M , Gianese F , Bilato C , Roncon L
Published: May 2022

Background/Aim

The prognostic value of the exercise stress after complex stenting of left main (LM) coronary artery bifurcations (LM) disease has been poorly investigated in the modern era.

Methods

We retrospectively analysed the procedural and medical data of patients referred to our center for complex LM bifurcation diseas, treated using either single versus dual stenting [Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT)] techniques between January 2008 to May 2018. The prognostic impact of an exercise test performed at 6 months during the follow–up period.

Results

Five hundred and two patients (316 males, mean age 70.3±12.8 years, mean Syntax score 31.6±6.3) were evaluated. At a mean follow–up of 37.1±10.8 months (range 22.1–47.3 moths), Target lesion failure (TLF) rate was 10.1%. Stent thrombosis and cardiovascular mortality were observed in 1.2% and 3.6% of cases, respectively. A positive exercise test at 6 months of follow–up was detected in 42 out of 502 patients (8.4%) and correlated with angiographic restenosis in 38 patients (7.6%): 7/171patients in Cross–over group (4.1%), 10/61 patients in T or TAP group (16.4%), 15/98 patients in Culotte group (15.3%) and 6/172 patients in NIT group (3.5%). Multivariate Cox regression analysis demonstrated that Age > 75 years (HR 1.45, 95% CI: 1.33–1.58, p = 0.03), dyslipidaemia (HR: 1.68, 95% CI: 1.58–1.72, p < 0.001), eGFR<30 ml/min/1.73 m2 (HR: 1.44, 95% CI: 1.38–1.52, p = 0.04), presence of a triple vessel disease (HR: 1.89, 95% CI: 1.89, 95% CI: 1.84–1.93, p < 0.001), additional ostial LM lesion (HR: 1.75, 95% CI: 1.76–1.81, p < 0.001), additional LM body lesion (HR: 1.33, 95% CI: 1.28–1.36, o < 0.001), a Syntax score > 25 (HR:1.67, 95% CI: 1.61–1.76, p = 0.01), need of Rotablator (HR: 1.66, 95% CI: 1.61–1.75, p = 0.02) and the number of stents implanted (HR: 1.12, 95% CI: 1.08–1.16, p < 0.001) were independent predictors of a positive stress test. Patients reporting a negative exercise test at 6 months of follow–us had a higher freedom from TLF and improved survival compared to those with positive exercise stress test (Figure 1 Panels A and B).

Conclusions

A negative exercise performed after 6 months from complex left main stenting predicted excellent outcomes at 3 years follow–up.