bluuebunny/crossref_metadata_2025 huggingface dataset:
P248 THE SCORE TELEHFCOVID19, ONE MONTH FOLLOW UP : A TELEHEALTH APPROACH TO MANAGE ELDERLY PATIENTS WITH CHRONIC HEART FAILURE DURING COVID–19 PANDEMIC
Authors: Salucci C , Girardi E , Orso F , Herbst A , Migliorini M , Ghiara C , Virciglio S , Camartini V , Tognelli S , Fortini G , Di Bari M , Baldasseroni S , Ungar A , Marchionni N , Fattirolli F
Published: May 2022

Background

Due to the total lockdown during COVID–19 pandemic, clinicians were forced to organize telephone visits or tele–monitoring. We developed a standardized multiparametric questionnaire, suitable for telephone administration to older heart failure (HF) patients and/or their caregivers.

Purpose

To compare clinical characteristics of the three groups (green, yellow, red) of patients classified by baseline TeleHFCovid19–Score and evaluate its ability to predict one–month in elderly patients with chronic HF.

Methods

The TeleHFCovid–19 score was obtained from a multiparametric questionnaire administered, from April 2020, during televisits to patients (or caregivers), which were divided in progressively increasing risk groups: green (0–3), yellow (4–8) and red (≥9). The primary study outcome was a composite of death from cardiovascular causes and/or hospitalization for HF, which individually were secondary outcomes.

Results

We enrolled 146 patients. Mean age was 81±9 years, females were 40%. In all the study population there was a high prevalence of self–reported adherence to guidelines–recommended drug treatments and behavioural measures, as well as a broad intake of diuretic therapy. Patients in green group had lower use of high dose loop diuretic (p < 0.001) or thiazide–like diuretic and had reported less frequently dyspnoea at rest or for basic activities, new/worsening extremities oedema or weight increase (all p < 0.001). Through scheduled phone contacts we were able to improve the overall clinical status of our patients even over a short (1 month) follow–up.The primary composite outcome of CV death and/or HF hospitalisation occurred in 8.2%, with a significantly lower prevalence in the green than in the yellow and red groups, and when analysing separately, we found that death for CV causes occurred more frequently in the red group than in the other two, while HF hospitalisations were significantly less frequent in the green group than in the red or yellow. ROC analysis confirmed the high sensibility and specificity of our score (AUC=0.883, 95% CI 0.806–0.959) with a score <4.5 (very close to green group cut–off) that identified lower–risk subjects (p < 0.001).

Conclusions

The TeleHFCovid19–Score score was able to correctly recognize a low risk, green group. Therefore, the score could be used to identify low risk patients which could be followed remotely, reserving a tighter on–site clinical follow–up to higher events risk patients.
P254 THE ROLE OF GENDER IN CONGESTION STATUS EVALUATION IN PATIENTS WITH ACUTE HEART FAILURE
Authors: Potenza A , Scicchitano P , Basile M , Piscopo A , Landriscina R , Sasanelli P , Trotta F , Sanasi M , Paolillo C , Ciccone M , Caldarola P , Massari F
Published: May 2022

Background

The evaluation of congestion play a central role in the management of patients with acute heart failure (AHF).The impact of gender on congestion in patients with HF is still a matter of debate. The objective of this analysis was to evaluate the impact of gender on congestion status at admission of patients hospitalized for AHF.

Methods

We consecutively enrolled 487 patients with AHF (50% female). We assessed peripheral edema, jugular venous distention (>10 cm), B–type natriuretic peptide (BNP), hydration status (by means of bioimpedance analysis), and estimated plasma volume (by means of the Duarte’s formula [D–ePVS] and Kaplan–Hakim formula [KH–ePVS]).

Results

Home medications and body mass index were not different between women and men. Women were older (79 yrs vs 77 yrs, P = 0.005), showed better left ventricular ejection fraction (mean 50% vs 38%, P < 0.001), and increased plasma concentrations in blood urea nitrogen (40 mg/dL vs 25 mg/dL, P = 0.02) and serum creatinine (1.5 mg/dL vs 1.5 mg/dL, P = 0.8). At physical examination, the number of patients with peripheral edema and jugular venous distention was not significantly different between women and men (53% vs 45% and 60% vs 55%, respectively). BNP levels (median 1100 pg/mL vs 994 pg/mL) and hydration status (78% vs 79%) were similar in women and men, while ePVS was higher in women (D–ePVS 6.0 ± 1.6 dL/gr vs 5.1 ± 1.5 dL/gr, P < 0.001; KH–ePVS 7.9% ± 13% vs –7.3 ±12%, P < 0.001).

Conclusions

The evaluation of congestion in AHF using physical examination and multiparametric approaches was similar between women and gender. Women rather showed higher plasma volume as compared to male individuals.
P258 HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS HOSPITALIZED FOR PAROXYSMAL ATRIAL FIBRILLATION. A CAUSE OF WORSE CLINICAL OUTCOMES?
Authors: Tufano N
Published: May 2022

Introduction

Among patients admitted in hospital for heart failure (HF), prevalence of heart failure with preserved ejection fraction (HFpEF) increases over time . Atrial fibrillation (AF) can lead to worsening of cardiac function and symptoms of HF. Aim of this observation was to evaluate differences on clinical course and outcomes in patents hospitalized for paroxysmal AF episode and a pre–existing HFpEF rather than paroxysmal AF patients without HF.

Methods

126 patients consecutively hospitalized in our Cardiology Unit from january 2017 to december 2020 for paroxysmal AF were retrospectively evaluated. Of them, 67 presented without heart failure, 59 with a previously known HFpEF. For each patient, demographic and clinical characteristics, comorbidities, instrumental data and clinical outcomes (percentage of cardioverted arrhythmia, length of hospitalization) were collected. To examinate the relationship between characteristics of patients and clinical outcomes, test of Student or chi–square–test were performed.

Results

Patients with AF and HFpEF were significantly older (76,7 vs 72,9 y.) and presented more comorbidities (on average 4 vs 3 morbidities) rather than AF patients without HF. Hospitalization were significantly longer (on average 6 vs 5 days) for HFpEF group rather than no–HF patient group. Percentage of cardioverted AF were significantly lower in HFpEF (66,2%) rather than in patients without HF (86,6%). Age was significantly correlated with lenght of hospitalization in HFpEF patients, but not in no–HF patients. Instead comorbidity was not correlated with days of hospitalization in HFpEF patients, whereas correlated significantly in no–HF patients. Finally, percentage of cardioverted arrhythmya was not correlated with number of comorbidities, both in HFpEF and in no–HF patients.

Conclusions

our hospitalized patients for a newly onset AF and known HFpEF presented worse clinical outcomes rather AF patients without HF. These worse outcomes seem at least in part due to differences on age and comorbidities between the two groups.
P259 INCIDENCE OF HOSPITALIZATIONS FOR HEART FAILURE DURING THE COVID–19 PANDEMIC IN PATIENTS FOLLOWED BY THE VULTURE ALTO BRADANO (VAB) HEART FAILURE OUTPATIENT CLINIC
Authors: Caivano M , Gubelli S , Manta R
Published: May 2022

Purpose

Patients hospitalized for heart failure (HF) often have worse prognoses than patients who avoid hospital care. It is well known that during the first wave of the COVID–19 pandemic, in all specialty branches there was a reduction in planned hospitalizations to make room for COVID–19 patients and it happened that patients often did not access care for fear of infection. The Heart Failure Outpatient Clinic of the VAB never stopped its activity during the pandemic and continued to follow patients both with telephone counseling and with scheduled visits following the government‘s anti–Covid regulations. The aim of this study is to evaluate the incidence of hospitalizations for heart failure in Basilicata and in the VAB area during the Covid 19 pandemic.

Methods and Results

Hospitalization data for HF from the Basilicata Region database and the database of patients followed by the HF outpatient clinic of the VAB were searched and compared. In 2019, hospitalizations for DRG 127 across Basilicata were 1865; in 2020, they were 1329, a reduction of approximately 27% since the start of the pandemic. In contrast, in the VAB, hospitalizations went from No. 294 in 2019, to No. 203 at the end of 2020 with a decrease of about 31%. In the same period, deaths from all causes observed among patients followed at the VAB outpatient clinic remained unchanged (N°35 in 2019, N°34 in 2020).

Conclusions

As for other Italian realities, also in Basilicata the incidence of hospitalizations for HF during the pandemic, decreased and more consistently in the area of the VAB. It is likely that this reduction is not only due to a reduction in admissions for fear of contagion, but also to the constant support that the medical and nursing staff of the dedicated outpatient clinic managed to maintain. This shows that the management of heart failure must be based on the constant monitoring of symptoms and clinical signs at the outpatient level, firstly to anticipate instabilization and improve the outcome and prognosis of patients, and secondly to help avoid the collapse of hospital facilities already particularly busy during this pandemic.
P261 DIAGNOSTIC STRATEGIES FOR PULMONARY EMBOLISM IN PATIENTS HOSPITALIZED FOR COVID–19: ROLE OF CLINICAL PREDICTION RULES
Authors: Vedovati M , Balducci F , Becattini C
Published: May 2022

Background

Diagnostic strategies for pulmonary embolism (PE) in patients already facing respiratory failure due to COVID–19 is challenging. The use of the conventional diagnostic algorithm and clinical prediction rules (CPR) for PE is controversial in these patents.

Methods

The aim to evaluate the accuracy of currently available CPRs to assess the risk for venous thromboembolism (VTE) in medically ill patients with COVID–19 and algorithms for the diagnosis of PE. Consecutive patients >18 years hospitalized at Santa Maria della Misericordia Hospital (Perugia, Italy) from March 2th, 2020, to September 29th, 2021 were included if they had: 1) confirmed diagnosis of COVID–19 with a molecular testing; 2) chest CT angiography performed for clinical suspicion of PE during the hospital stay. The study outcome was the accuracy of currently available CPRs for PE diagnosis (Wells and Geneva) and for VTE–risk stratification in medically ill patients (IMPROVE, IMPROVEDD and Padua score) to predict the diagnosis of PE as confirmed by a contrast–enhanced CT lung scan.

Results

During the study period, 74 COVID–19 patients who had CT angiography for PE clinical suspicion were included (mean age 68 years, male 64.9%). Thirteen patients (17.6%) had PE confirmed at CT. No significant differences were observed for comorbidities, antithrombotic treatment and mortality between the two groups. D–dimer resulted significantly higher in patients with compared to patients without PE. Poor discrimination was observed for Wells and Geneva scores (AUC 0.596, 95% CI 0.413–0.779, and AUC 0.603, 95% CI 0.439–0.767, respectively), without substantial differences adding d–dimer at conventional cut–off (Table). The IMPROVEDD score had the highest discriminative power among CPRs for VTE (AUC 0.699, 95% CI 0.539–0.860). Scores’ performance improved by increasing the D–dimer cut–off at level of 2000 ng/ml: among diagnostic scores, Wells showed the best discrimination (AUC 0.806, 95% CI 0.674–0.939, negative predictive value 97%); among CPRs for VTE the IMPROVEDD confirmed its accuracy (AUC 0.769, 95% CI 0.633–0.904, negative predictive value 94%).

Conclusions

The accuracy of the currently used diagnostic and predictive scores for PE or VTE in COVID–19 patients is poor. D–dimer improves the diagnostic accuracy of these scores; most of all, it seems to allow a diagnostic strategy with a high negative predictive value, so we can rule out a consistent part of the patients with a low risk of PE.
P264 ROLE OF BLOOD GAS ANALYSIS AND D–DIMER IN RAISING THE SUSPICION OF MASSIVE PULMONARY EMBOLISM IN GERIATRIC PEOPLE: THE EMERGENCY ROOM AS A WINDOW INTO REAL LIFE
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Fumoso F , Lapia F , Preda L , Manzoni F , Brattoli M , Maggioni P , Novelli V , Muzzi A , Lava M , Bressan M
Published: May 2022

Premise

Massive pulmonary embolism is burdened with high mortality. Raising suspicion and recognizing this condition early allows to avoid delays in the diagnostic and therapeutic process.

Purpose

Assess which parameters of blood gas analysis, in the real life of an Emergency Department, correlate with the presence of massive pulmonary embolism to see which ones can help to suspect it early.

Methods

single–center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and YEARS), and for the presentation of the risk of mortality at 30 days (sPESI). We looked at all the blood gas analyzes performed at the emergency room access. We then had all chest CTs retested by an experienced radiologist.

Results

We enrolled 247 patients, with a mean age of 83 years with prevalence of female prevalence (F = 63%). Of these, 85 (34.4%) have massive pulmonary embolism. Lactates do not correlate with the presence of massive pulmonary embolism (p > 0.05). The pCO2 values correlate inversely with the presence of massive pulmonary embolism with excellent statistical strength (p < 0.0001). The reduction in pO2 values also correlates with the presence of massive pulmonary embolism, with good statistical strength (p < 0.005). The increase in pH values also correlates with the presence of massive pulmonary embolism, albeit with a lower statistical strength (p < 0.05). The D–Dimer shows a strong association with massive pulmonary embolism values (p < 0.0001).

Conclusions

The study suggests that the reduction of pCO2 values, with an increase in pH and D–Dimer show a strong correlation with the condition of massive pulmonary embolism. Similarly, the pO2 can play a role in the identification of this condition, while no role would seem to have the alteration of lactates. Taking into consideration these parameters, which are quickly available and easily performed in the various Italian situations, can help to raise the suspicion of massive pulmonary embolism early and direct the patient more quickly towards the therapeutic diagnostic process.
P269 LOCAL ULTRASOUND–FACILITATED THROMBOLYSIS IN ACUTE PULMONARY EMBOLISM: HAS A SPACE?
Authors: Camassa N , Liguori M , Pansini M , Troccoli R , Carretta D , Dachille A , Giardinelli F , Signore N , D‘agostino C
Published: May 2022

Acute pulmonary embolism (PE) has an annual incidence of 48 patients per 100,000 with a mortality rate of 10%, few hours after the onset of symptoms. The use of full dose of thrombolytic agent is currently the treatment of choice in acute PE at intermediate and high risk, although its contraindications are well known. An alternative choice is delivered, via percutaneous femoral or jugular venous access, infusion catheters in the pulmonary artery (PA), in order to perform a local thrombolysis (based on a map of thrombus distribution observed at pulmonary CT), with a lower dose of trobolytic agent (rTPA) in a limited time, with a core for emission of ultrasound waves capable of breaking the mesh of the thrombus. Data from the KNOCOUT PE registry show a reduced frequency of fatal intracranial hemorrhage (ICH 2.5%), compared with the full dose of rTPA. Since February 2021 we have treated 7 patients with PE, all with cTnI, D–dimer and high NT–ProBNP and with pulmonary CT finding of large thrombus burden with pruning of peripheral pulmonary branches compatible with the diagnosis of PE at high and intermediate risk in patients with complex comorbidities (significant PESI and simplified PESI). On admission to the ICU all patients were with BP < 100 mmHg, RR > 20/min, satO2 < 90% and HR > 100 bpm. In echocardiogram all were with impaired RV (RV/LF ratio >1 and TAPSE <15mm). All patients was treated with UHF, 1 in fondaparinux for thrombocytopenia. At time between 4h and 8gg from the onset of symptoms, all patients underwent placement of 1 or 2 catheters in right and/or left PA, 106 cm and 135 cm length with zone of interest between 18/32 cm. When possible, hemodynamic parameters were evaluated: PAPm, cardiac output, and stroke volume to characterize the associated hemodynamic deterioration. 12mg of rtPA per catheter was administered over 12 hours. In 3 patients an echocardiogram was performed at 6 hours. In all at 24 hours, vital and laboratory parameters were measured, and in one patient, right heart catheterization was repeated. In no patient was treatment discontinued early, nor were ICH or minor bleeding recorded. Low dose of rtPA allowed use of the technique in patients with severe comorbidities at the limit of thrombolysis use, in the presence of marked RV distress and severe hemodynamic instability. Trials are in progress to shorten the time and therefore reduce the dose of rTPA with equal effectiveness on the clinical course of acute PE.
P272 PULMONARY THROMBECTOMY WITH CATHETER FOR THE TREATMENT OF ACUTE PULMONARY EMBOLISM: A LOCAL PROTOCOL
Authors: Bongarzoni A , Femia M , Cortellaro F , Peigottu M , Mirarchi G , Tramarin M , Tassinario G , Garagiola M , Allievi L
Published: May 2022

In February 2021, a PDTA on Pulmonary Embolism (PE) was approved in our hospital, including a chapter describing a protocol for the treatment with catheter thrombectomy (CT) of patients with high and intermediate risk PE. The protocol took into account the recommendations of the ESC 2019 guidelines on PE, and was produced to describe a path to improve the treatment of patients with PE It included: a) thrombectomy with aspiration in patients high–risk patients, with no haemodynamic improvement after administration of systemic thrombolytic therapy (TT) or with absolute contraindication to it; b) thrombectomy with loco–regional ultrasound–assisted thrombolysis (USAT) in patients at high–intermediate risk. 20 patients were treated from February 2020 to September 2021. 55% were men, with an average age of 73 ± 13 years; all patients met the criteria for inclusion in the protocol and signed a consensus document. 2 high–risk patients were treated with thromboaspiration: one patient for absolute contraindication to TT (recent spontaneous brain haemorrhage), the other one for a syncopal episode with head trauma. 18 patients (92%) at high intermediate risk were treated with USAT. For the 90% of patients were used 2 catheters; in 72% the administered dose of rt–PA was 24 mg. The mean value of NT–proBNP was 2,896 ng/l (normal m < 93, f < 144) There was only one major bleeding complication in the high–intermediate risk group (macrohematuria) during hospitalization. The mean RV/LV ratio was 1.48 (± 0.14) at baseline and 0.85 (± 0.14) at 48 hours with a reduction of 43%. The 2 high–risk patients died: one 1 month after the procedure, due to the effects of cerebral haemorrhage, the other one after 10 days due to respiratory complications. The mean FU of 17 patients was 228 days (± 193); during the FU there was a recurrence of PE (6%) after the discontinuation of anticoagulant therapy; there were no haemorrhages. RV dysfunction persisted in one patient (6%) with CTEPH who subsequently underwent pulmonary endarterectomy.

Conclusion

PDTA and teamwork helped to improve the therapeutic decision making in patients with PE at a high and intermediate–high risk, despite the difficulties due to the SARS–COV–2 pandemic. Our experience was found to be in line with what has been published on the efficacy and safety of CT.
P277 SECRET BEYOND THE DOOR. TRIAGE ANALYSIS AND RECOGNITION AT THE DOOR OF ELDERLY PATIENTS WITH PULMONARY EMBOLISM WHO ARRIVE IN THE EMERGENCY ROOM. THE REAL–LIFE EXPERIENCE OF 5 YEARS IN THE EMERGENCY ROOM
Authors: Savioli G , Ceresa I , Novelli V , Pagani M , Belliato M , Grulli F , Fumoso F , Lapia F , Brattoli M , Bressan M
Published: May 2022

Background

The range of symptoms of pulmonary embolism is wide and its recognition difficult.

Purpose

to analyze the efficiency of triage in the EP.

Methods

Single–center retrospective observational study, on all geriatric patients (>75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes.

Results

We enrolled 247 patients, all in need of hospitalization. 44% came for dyspnea, 17% for chest pain, 16% for signs of DVT, 8% for syncope. 5% had only atypical symptoms (dizziness, general malaise, low–grade fever, neurological symptoms …). 45% had concomitant deep vein thrombosis. 50% showed alteration of the ECG tracing, 49% alteration of the shock index. Only 4% showed hypotension, 13% tachycardia and 8% desaturation. 39% arrived with their own vehicle. 32% was allocated to the area with low intensity of care, 68% to the area with medium–high intensity of care. As regards the priority code for the visit, 0% received a non–urgency code (white code or code 5), 27.9% a minor urgency code (green code or code 4) and 3.6% a high priority to the visit with assignment to low intensity of care (low intensity yellow or code 3). 63.15% received an emergency code (urgency or code 2) and 5.3% an emergency code (red code or code 1). The severity code at discharge, given on clinical criteria, was a low severity code (white or green) in 18% of cases, while 76% was considered high severity (urgency, yellow code) and in 6% for very high gravity (red code). 34% showed massive PE, 32% showed organ damage. 41% were considered to be at high risk of short–term mortality according to European guidelines, 8% required intensive care and in–hospital mortality was 7.7%. Under triage is 32%.

Conclusions

The population that arrives in ED due to pulmonary embolism presents extremely varied symptomatological pictures, and an overall high degree of clinical risk and care and therapeutic complexity in spite of the symptoms complained of and vital parameters. Under–riage remains a real problem for ED for this category of patients.
P281 A CASE OF ACUTE PULMONARY EMBOLISM IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION MISSED: PROFITABLE COLLABORATION BETWEEN A SPOKE CENTER AND A HUB
Authors: Bongarzoni A , Marini C , Tassinario G , Garagiola M , D’armini A
Published: May 2022

The case of one patient is described: 78–year–old, obese, suffering from type II diabetes mellitus and arterial hypertension who complained of mild exertional dyspnea for one year. On ECG sinus rhythm 80 bpm, negative T wave from V1 to V4, right bundle branch block. He was sent to the emergency unit for further investigations.

Here the blood chemistry results: D–dimer 1761 (normal <250 ng / ml), NT pro–BNP 9312 (normal <93 ng / l), troponin 21 (normal <14 ng / ml); pulmonary CT angiography demonstrated filling defects referable to bilateral lobar, segmental and subsegmental bilateral thromboembolism. The estimated PASP was 90 mmHg with AcT 55 msec and the presence of a mid–systolic notch on the pulmonary flow profile. A diagnosis of intermediate–high risk PE was made and, according to the local PDTA, written informed consent was obtained, the patient underwent treatment with percutaneous thrombectomy with loco–regional ultrasound–assisted thrombolysis (USAT–rtPA 24 mg in 12 hours). The RV / LV ratio was slightly reduced (1.1) and so was the estimated PASP (60 mmHg). He performed a lung perfusion scan with the detection of areas of diffuse pulmonary hypoperfusion. He was discharged on February 28, 2021, on therapy with Dabigatran 150 mg BID. 3 months later he carried out a cardiological check–up: he was in NYHA II class; the echocardiogram showed RV hypokinesia, TAPSE 15 mm, PASP 76 mmHg. In the suspicion of chronic thromboembolic pulmonary hypertension (CTEPH), he was sent to a HUB centre (Pavia) for a clinical assessment. Several tests were carried out to confirm the diagnosis of CTEPH and on 29 September 2021, the patient underwent bilateral pulmonary endarterectomy.

Conclusion

The case describes a patient with an episode of acute pulmonary embolism on a pre–existing unrecognized thromboembolic pulmonary hypertension, which partially benefited from percutaneous thrombectomy. Cases of CTEPH are infrequent; however, they must be recognized and sent, for a thorough evaluation, to an expert centre, to start the appropriate diagnostic therapeutic path, as in the case reported.
P284 THE RIGHT HEART ADAPTATS TO EXERCISE MORE EFFICIENTLY IN PULMONARY ARTERIAL HYPERTENSION THAN IN PULMONARY HYPERTENSION DUE TO HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Baratto C , Caravita S , Dewachter C , Faini A , Villella F , Perego G , Muraru D , Badano L , Parati G , Vachiéry J
Published: May 2022

Background

Right heart failure (RHF) represents the final step of distinct diseases, differently involving the pulmonary circulation, such as pulmonary arterial hypertension (PAH) and pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF). Exercise may unmask right heart maladaptation as a sign of RHF, but cut–offs for right atrial pressure (RAP) rise during exercise remain to be defined. We hypothesized that PH–HFpEF may present with worse right heart adaptation to exercise than PAH due to increased chamber stiffness and dysfunctional preload.

Aim

We sought to describe the behavior of RAP during exercise in PAH and in PH–HFpEF, and the mechanisms underlying right heart maladaptation.

Methods

We performed a retrospective analysis of data (2007–2021) obtained from patients with either PAH or PH–HFpEF who underwent a right heart catheterization at rest and during exercise. Right heart adaptation to exercise was described using either absolute or cardiac output (CO)–normalized RAP increase during exercise (RAP/CO slope). Patients with non–cardiac dyspnea (NCD) served to define RAP limits of normality. Estimated stressed blood volume (eSBV), as a measure of effective preload, was computed based on hemodynamics using a commercially–available software.

Results

Ninety–four patients were included (32 PH–HFpEF, 32 PAH and 30 NCD). The upper limit of normal for absolute peak RAP and RAP/CO slope were 12 mmHg and 1.55 mmHg/L/min. Compared with PH–HFpEF, PAH patients showed higher systolic, diastolic and mean pulmonary artery pressure (PAP) as well as higher indices of right ventricular afterload both at rest and during exercise, but lower filling pressures and similar CO (Figure 1).In particular, PH–HFpEF had higher peak RAP and higher RAP/CO slope than PAH (Figure 1,2). Additionally, 78% and 91% of PH–HFpEF, as compared with 47% and 44% of PAH had a RAP/CO slope and a peak RAP above normal, respectively (p < 0.001). PH–HFpEF presented with higher increase in eSBV, and higher peak eSBV values than PAH (p < 0.05), despite similar resting levels. RAP/eSBV slope was upward shifted (at a given effective preload, RAP was higher) while CO/eSBV slope was flatter (at a given effective preload, CO was lower) in PH–HFpEF as compared with PAH (Figure 3).

Conclusions

PH–HFpEF display worse right heart maladaptation to exercise than PAH, likely due to a combination of increased right heart stiffness and a more exhausted Frank–Starling reserve.
P285 PROGNOSTIC ROLE OF ELECTROCARDIOGRAPHIC TEMPORAL CHANGES IN PATIENTS WITH ACUTE PULMONARY EMBOLISM. DATA FROM THE ITALIAN PULMONARY EMBOLISM REGISTRY (IPER)
Authors: Zuin M , Bilato C , Bongarzoni A , Zonzin P , Casazza F , Roncon L
Published: May 2022

Background

The potential prognostic role of ECG changes during the course of acute pulmonary embolism (PE) has been poorly investigated over the years.

Methods

Data of patients prospectively enrolled in the IPER registry, having three ECGs (the first perfromed on admission, the second after three days of hospitalization and the third at discharge) were extracted and analyzed.

Results

Overall, 687 patients (286 males, mean age 69.0 ± 15.5 years) were included in the study. The negativization of electrocardiographic signs of right ventricualr strain (RVS) (Right bundle branch block –RBBB), S1Q3T3 and negative T waves from V1 to V4) followed the same pattern in both non–high (i.e. hemodynamically stable) and high–risk (i.e. hemodynamically unstable) patients, showing firstly the normalization of the S1QT3 pattern followed by the resolution of the RBBB. Conversely, additional NTWs appeared between the first and second ECGs in about 20% of cases and then partially normalized at discharge. Persistence of RVS at the second ECG was associated with a higher risk of death within 30 days only in high–risk patients [HRa: 2.78 (95% CI: 1.05–7.31. P = 0.03), with a sensitivity, specificity, PPV and PPN of 90.0%, 94.1%, 85.7% and 96.0%, respectively. Furthermore, the lack of normalization of the RBBB [HRa: 2.78 (95% CI: 1.05–7.31, p = 0.003)], of the NTW [HRa: 1.63 (95% CI: 1.04–2.55), p < 0.0001] and of the resolution of qR complex in V1 [HRa: 12.5 (95% CI: 3.39–46.4,) p < 0.0001] were independent predictors of poor prognosis in the short term. High–risk patients showing at the second–ECG the persitence of RBBB and NTWs as well as disappearance of the qR complex in V1 had a higher 30–day increased risk of death [HR: 9.44, (95% CI: 5.22–17.05, p < 0.0001]. The C–statistic confirmed in high–risk subjects an improvement in short–term prognostic power using the persistence of all three ECG signs (0.77, 95% CI: 0.51–0.94) or they single presence (0.61, 95% CI 0.42–0.79; 0.70; 95% CI: 0.52–0.88 and 0.74, 95% CI: 0.56–0.96, RBBB, NTWs and qR in V1, respectively).

Conclusions

The persistence of RBBB, NTWs, and qR pattern in V1 after 3 days from the hospitalization for acute PE represent an independent prognostic factors of death within 30 days in high–risk acute PE patients. In terms of prognostic power, the single evaluation of each ECG sign was lower compared to the overall or combined assessment.
P289 EYESHOT OF CARDIAC AMYLOIDOSIS CASES PRESENTED TO A CARDIOLOGY UO IN CENTRAL ITALY IN 2021
Authors: D'Agostino S , Gizzi G , Parato V
Published: May 2022

Introduction

ATTR–related cardiac amyloidosis, caused by the accumulation of insoluble fibrillar proteins derived from transthyretin misfolding, is an often underdiagnosed pathology, especially when neurological involvement is absent or minor. Transthoracic echocardiography represents the first fundamental step in the diagnostic process.

During the year 2021, a total of 9 patients with an echocardiographic feature of hypertrophic heart disease suggestive of infiltrative pathology were referred to our Cardiology unit. Of these patients, 89% were male (8 out of 9), aged between 60 and 88 years (average age of 72 years). The clinic presentation was heart failure in 5 cases (55% of the total), arrhythmic storm in 1 case, history of amyloid polyneuropathy in 1 case and it was an occasional finding in 2 patients who required a cardiological evaluation for other reasons. The 12–lead ECG documented atrial fibrillation arrhythmia in 4 out of 9 cases (44%) and sinus rhythm in the remaining 5 cases (56%). Transthoracic echocardiography revealed left ventricular hypertrophy with granular sparkling aspect of the SIV in all patients, with indexes of global systolic function preserved in 4 out of 9 cases (44%), moderately reduced in 3 out of 9 cases (33%) and severely reduced in the remaining 2 cases (22%). Diastolic dysfunction was present in all patients, with a restrictive pattern in 4 of 9 cases (44%). Myocardial scintigraphy with DPD was performed in 7 patients, which confirmed the suspicion of aTTR amyloidosis in 6 cases (Perugini Score = 2), in the remaining 2 patients the diagnostic procedure was not performed due to severe comorbidities. At present, diagnostic confirmation of aTTR amyloidosis has been confirmed by biopsy in 2 patients; a patient‘s biopsy is currently under analysis; 1 patient is on Patisiran therapy.

Conclusions

Cardiac amyloidosis represents a frequent clinical condition especially in the elderly population. In the light of the most recent therapeutic strategies, a correct and early etiopathogenetic diagnosis is of fundamental importance.
P291 SUBVALVULAR MITRAL APPARATUS REMODELING DURING HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY SURGERY: A 15–YEARS OF EXPERIENCE
Authors: Raffa G , Pilato M
Published: May 2022

Background and Aims

To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles (PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) in a retrospective observational study.

Methods

Seventy consecutive patients (58±12 years, M/F ratio: 41/29) undergoing HOCM surgery from 2007 to 2021 at our institute were reviewed. End points included the involvement of the mitral valve in LVOT obstruction, mortality, and change in clinical and echocardiographic characteristics after HOCM surgery.

Results

Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum were detected in the majority of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were a common findings. Four patients had posterior leaflet redundancy. Secondary chordae (90%), PM and muscularis trabeculae resection and PM splitting and elongation (77%) were added variably to septal myectomy (100%). Nine procedures (6%) on mitral valve leaflets were performed, involving 6 posterior and 3 anterior mitral leaflets. Long–term follow up was 4.6±3.7 years. There was no hospital mortality, and NYHA was reduced from 3±0.6 to 1±0.7 (p < 0.0001), the LVOT gradient from 91±35 to 21±17 mmHg (p < 0.0001), mitral valve regurgitation from grade 3±1 to 1±0.6 (p < 0.0001), and septum thickness from 19±3 to 14±2 mm (p < 0.0001).

Conclusions

The mitral valve apparatus with all its components contribute variably to LVOT dynamic obstruction thus, surgical correction in addition to extended myectomy is recommended to achieve the best outcome.
P294 AN ECHOCARDIOGRAPHIC SCORE OF VALVE DISEASE IN PATIENTS WITH CARDIAC AMYLOIDOSIS
Authors: Aimo A , Fabiani I , Maccarana A , Fontana M , Vergaro G , Chubuchny V , Pasanisi E , Petersen C , Poggianti E , Giannoni A , Spini V , Taddei C , Castiglione V , Passino C , Emdin M , Venneri L
Published: May 2022

Background

Cardiac amyloidosis (CA) affects all cardiac structures, including the valves. We summarized the echocardiographic features of valve disease in a score.

Methods

From 423 patients undergoing a diagnostic workup for CA we selected 2 samples of 20 patients with amyloid transthyretin (ATTR–) or light–chain (AL–) CA, and selected age– and sex–matched controls. The Amyloid VAlve (AVA) score included 31 items related to the mitral, aortic and tricuspid valves (which can be properly assessed in standard echocardiograms), with a value of 1 for each abnormal item.

Results

Patients with ATTR–CA displayed more often a shortened/hidden and retracted posterior mitral valve leaflet (PMVL), thickened mitral chordae tendineae and aortic stenosis than those with AL–CA, and less frequent PMVL calcification than matched controls. Score values were 15.8 (interquartile interval 13.6–17.4) in ATTR–CA, 11.0 (9.3–14.9) in AL–CA, 12.8 (11.1–14.4) in ATTR–CA controls, and 11.0 (9.1–13.0) in AL–CA controls (p = 0.004 for ATTR– vs. AL–CA, 0.009 for ATTR–CA vs. their controls, and 0.461 for AL–CA vs. controls). We compared the AVA and two validated diagnostic scores (IWT and AMYLI). AUC values for the diagnosis of ATTR–CA were 0.782, 0.846 and 0.902, respectively, in patients with ATTR–CA or matched controls, and 0.773, 0.706 and 0.679 in patients with LV hypertrophy (n = 67, 84%) (all non–significant p values).

Conclusions

Patients with ATTR–CA have a prominent impairment of mitral valve structure and function, and higher score values. The AVA score is quite effective in identifying patients with ATTR–CA among patients with CA or with unexplained hypertrophy.
P297 PERICARDIAL EFFUSION WITHOUT HEMODYNAMIC INSTABILITY: WHEN AND TO WHOM THE PERICARDIOCENTESIS?
Authors: Facchini E , Maffè S , Paffoni P , Prenna E , Bergamasco L , Careri G , Franchetti Pardo N , Paino A , Dellavesa P
Published: May 2022

Cardiac tamponade is traditionally considered a clinical diagnosis, but there are pre–tamponating effusions that occur without signs of cardiogenic shock, and in these situations it can be complex to determine when and which patient treat with pericardiocentesis. The clinical case concerns a 90–year–old woman who comes to the emergency room for exertional dyspnea. Upon arrival blood pressure was 150/90 mmhg, heart rate 70 bpm. On chest x–ray, enlargement of the cardiac silhouette was evident (Fig 1). The echocardiogram showed a circumferential pericardial effusion of 2 centimeters with signs of right cardiac chambers compression (Fig 2). Hospitalized in ICU, the clinical situation was complicated by the onset of atrial fibrillation with a high ventricular response (Fig 3) and immediate cardiogenic shock (BP 70/40 mmHg, tachypnea, altered mental status). We proceed with emergency electrical cardioversion, effective in restoring sinus rhythm with almost immediate arrhythmic recurrence; therefore we perform a pericardiocentesis, with regression of the shock status after aspiration of a few cc of serum–haematic pericardial fluid (total 750 cc); spontaneous restoration of sinus rhythm after the procedure. Neoplastic problems were excluded, IgM positivity for influenza A and B on blood tests. The patient presented no further complication, was discharged at home, in sinus rhythm, with negative follow–up so far. This clinical case focuses the question of the indication and timing of pericardiocentesis. We managed a pericardial effusion with ultrasound signs of compression of the right sections, but in the absence of clinical signs of cardiogenic shock / Beck‘s triad. Given the clinical evolution, should we have perform the pericardiocentesis as soon as the patient arrived, in conditions of hemodynamic stability? Interesting are the score index proposed by Halpern et al. and an ESC position statement that serves to identify patients to undergo urgent pericardiocentesis based not only on clinical factors, but also on imaging evaluation. The total score of our case would have been indicative for an immediate pericardiocentesis. In our opinion, the formulation of a triage system for patients with pericardial effusion and hemodynamic stability that can be routinely implemented in clinical practice would be extremely useful.
P298 ACUTE PERICARDITIS AS FIRST MANIFESTATION OF AN EXTRACARDIAC NEOPLASM
Authors: Neglia L , Indennidate C , Narciso M , Cocciolo A , Lardieri G
Published: May 2022

Introduction

Acute pericarditis (AP) may be primary (idiopathic, often presuming a viral origin) or secondary. In secondary forms, the primary disorder (e.g. myocardial infarction, collagen disease, neoplasia) is usually already known when pericardial involvement becomes manifest. However, it has been observed that AP may be the first manifestation of extracardiac neoplastic disease.

Clinical Case

M. 35 yo. Tabagism. In ED for continuous thoracic pain since 4 days, exacerbated by deep breath and supine decubitus. Night sweats. ECG: mild PR depression in DII, mild diffuse ST–segment elevation. WBC 9080/mcL, PCR 129, HsTnI < 2, D–dimer negative. Chest X–ray: swelling of the left hilum deforming the profile of the left arches and mediastinum. Echocardiogram:…hypoechogenic space of approx. 1 cm at the level of the left ventricle with contiguous isoechogenic mass of approx. 3 cm thickness. When AP was diagnosed, treatment with ibuprofen and colchicine was administered with regression of symptoms. CT chest with mdc:…solid mediastinal lesion on the left extended from the aortic arch surrounding the upper part of the left ventricle. PET scan: voluminous area of high and inhomogeneous metabolism corresponding to the known left mediastinal mass to be referred to oncological nature. A biopsy of the lesion was then performed.

Discussion

AP may be the first manifestation of an unknown extracardiac neoplasm in 4% to 7.3% of cases depending on the series (5% Permanyer–Miralda et al. 1985; 7% Zayas et al. 1995;4 % Imazio et al. 2005). The most frequently associated primary malignancies are lung, breast and lymphomas. The most frequently associated clinical features are a positive history of malignancy, onset with cardiac tamponade, no response to NSAID therapy, and recurrent or incessant course. Direct visualisation of mediastinal masses during transthoracic echocardiographic examinations has already been described. In the present case, AP was the first clinical manifestation of an extracardiac neoplasm, which could be already viewed during first transthoracic echocardiogram. Despite the neoplastic origin, no massive pericardial effusion was present at the time of diagnosis and the patient had a good response to NSAID therapy.
P299 CONDUCTION DISORDERS AS THE FIRST HALLMARK OF ISOLATED CARDIAC SARCOIDOSIS IN A HIGHLY ACTIVE INDIVIDUAL: A CASE REPORT
Authors: Albani S , Muccioli S , Mabritto B , Scacciatella P , Musumeci G
Published: May 2022

A 45–year–old highly active Caucasian individual was admitted to the emergency department complaining of slightly reduced physical performances: he reported a lack of increase of heart rate beyond 80–100 bpm at fitness tracker monitoring during physical activity during the previous week. He used to train 3–4 times/week. He had no previous medical concerns and he didn’t take any medication. Basal electrocardiogram (ECG) showed 2:1 atrioventricular block (AVB) and left axis deviation, with the exception of his 2:1 AVB, the other features on the ECG are common training related changes. Transthoracic echocardiogram was normal. Treadmill exercise test revealed paroxysmal 2:1 AVB and Mobitz I AVB at peak effort, then first degree AVB and isolated and coupled right infundibular premature ventricular complexes (PVC) in the recovery phase: exercise related AV–conduction improvement suggested supra–nodal AVB. Cardiac magnetic resonance (CMR) imaging reported two areas of late gadolinium enhancement (LGE) with midwall/subepicardial distribution: the first one in the basal anterior septal wall extending to basal anterior wall and the second one involving the basal and medium segment of inferior septum and inferior wall. LGE quantification was 6.0 g/m2 (9.5%). Short tau inversion recovery (STIR) acquisitions were negative for oedema (Figure 1). Subsequent FDG–PET imaging confirmed high uptake in the basal anterior septal wall, the anterior wall and in the basal inferior septal area (Figure 2). No other organ involvement was detected. Considering the FDG–PET, LGE and AV–conduction abnormalities, the patient was clinically diagnosed with symptomatic isolated CS. However, a definitive histologic diagnosis was not possible as no myocardial biopsy was performed. High dose corticosteroid therapy was startedand after few days of treatment ECG monitoring revealed an imrovement of cardiac conduction. The treadmill test was repeated and showed conduction improvement during effort, however the test was suspended due to the occurrence of ventricular couples and ventricular bigeminy during effort. For arrhythmic risk assessment, electrophysiological study (EPS) was performed and no arrhythmias were induced. We decided to defer ICD implantation. However, a loop–recorder for continuous arrhythmias monitoring was implanted. At three months, a new CMR was performed and was identical to the previous one, with no significant LGE reduction or increase detected.
P305 ACUTE MYOPERICARDITIS IN 2021: COVID19 RELATED?
Authors: Pasquero M , Ruffini S , Astegiano M , Franco E , Moretti C
Published: May 2022

The term myopericarditis is used when there are primarily pericarditis symptoms with myocardium involvement as evidenced by cardiac biomarker elevation or imaging studies revealing normal wall motion. We report a case of a young 23–years old man, who presented to the Emergency Department with fever and diarrhea lasting 5 days followed by acute chest pain, modified by trunk position. The electrocardiogram (ECG) showed diffuse inferior and anterolateral ST–segment elevation. No signs of hemodynamic instability were detected. Laboratory tests showed WBC 8840/mmc, CRP 53,2 mg/L, TnT 986 ng/L, a mildly altered liver function with AST 92 UI/L, ALT 88 UI/L, GGT 82 UI/L and an altered pancreatic function with amylase 190 UI/L, lipase 267 UI/L. Naso–pharyngeal swab was negative. The patient received COVID–19 mRNA vaccination 4 months before symptoms, with high immune response, detected with IgG dosage (465 BAU/ml). Ecocardiography showed a left ventricle with normal size, function, and segmental contractility. Valvular apparatus in normal range. Hyper–refraction of the posterior pericardium with minimal effusion. The diagnosis of acute myopericarditis was glaring and we treated the patient with high dosage of non–steroidal anti–inflammatory drugs, colchicine and ACE Inhibitors, based on the increased troponin levels (nadir 1439 nl/L), in order to prevent the possible cardiovascular remodeling. On laboratory testing, the deepening of the main causes of viral or autoimmune myopericarditis did not clarify the etiopathogenesis. No arrhythmias occurred on ECG monitoring. Cardiac MRI showed multiple areas of altered signal (T2) and altered uptake in lateral and inferior ventricular segments and in adjacent pericardium. The pain was gone in two days and left ventricle function was still preserved upon discharge. In conclusion we report a successful treatment of acute myopericarditis of unknown pathogenesis, in a healthy young man. As there are described cases of myopericarditis and myositis associated with COVID–19 in the absence of respiratory symptoms, and others related to SARSCoV2 mRNA vaccination, we dutifully excluded both.