bluuebunny/crossref_metadata_2025 huggingface dataset:
P91 MYOCARDITIS ASSOCIATED WITH CAMPILOBACTER J. INFECTION IN TWO BROTHERS: A COMMON FATE?
Authors: D’Arco G , De Angelis E , Ragosa N , Aloia A
Published: May 2023

Myocarditis is an inflammatory process of the heart muscle and represents a potential complication of different infectious and non–infectious pathogens. Bacterial infections are more rarely counted than viral ones among the causes of myocarditis and, for example, few cases of myocarditis associated with Campilobacter J. infection are described in the literature. J. Piero, 28 years old, arrives in ED for oppressive chest pain. He does not report any CV risk factors, he had diarrhea in recent days after eating chicken meat. CRP rise and increase in myocardionecrosis enzymes are found in blood chemistry; ECG within limits; echocardiogram: mild left ventricular dysfunction due to hypokinesia of the basal middle segments of the lateral wall (EF 50%). Giulio is hospitalized in the UTIC for suspected myocarditis confirmed in the study with CMR after 1 week according to the Lake Louisse criteria: myocardial edema and early enhancement in the lower basal site of the LV. A few hours later, Piero‘s brother, Giulio, also went to the ED for atypical chest pain and diarrhea; immediately undergoes a cardiological examination with subsequent hospitalization in the cardiology department with a diagnosis of: suspected myocarditis. In fact, even Giulio in the blood chemistry tests shows: increase in PCR and myocardionecrosis enzymes, albeit with an electrocardiogram and an echocardiogram within normal limits. The MRI performed after about one week shows myocardial edema in the lower lateral area of ​​the left side confirming the diagnosis of myocarditis. In both cases, a gastrointestinal film array was performed during hospitalization which highlighted the presence of Campilobacter J. as a pathogen present in the faeces and antibiotic therapy with azithromycin was started for both Piero and Giulio. The CMR of Piero and Giulio, performed in Follow up, shows: subepicardial post–inflammatory scar of the basal inferior lateral wall of the left ventricle withb persistence of a subtle late impregnation of modest entity. The presented clinical case involving two brothers with myocardial involvement after campylobacter J. enteritis supports a hypothesis of "genetic predisposition" at the basis of the myocarditis process. Subsequent clinical evidence and scientific studies are needed to evaluate the genetic background of myocarditis, which is still unknown today.
P95 A RARE CASE OF INFECTIOUS AORTITIS
Authors: Amato F , Mainardi C , Meneghin S , Graziano F , Licchelli L , Famoso G , Cacciavillani L , Pergola V
Published: May 2023

Aortitis is an inflammatory process affecting the arterial wall. There are infectious and non–infectious forms. While the non–infectious forms can be linked to arteritis of the large vessels, the infectious forms are a rare but fearful complication of infective endocarditis. In this case the most affected pathogenic species are gram positive bacteria such as streptococci and enterococci. An 81–year–old patient, hypertensive, with permanent atrial fibrillation, subjected to previous aortic valve replacement (with Intuity 27 mm bioprosthesis for severe stenosis in 2016) and with previous pulmonary embolism in 2021, was admitted to emergency department for oliguria and worsening ankle swelling in December 2022. The haemodynamic parameters at the hospital admission were stable. A transthoracic echocardiography was performed, which highlighted a vegetation of about 2 cm on the aortic bioprosthesis with mild stenosis and negligible intraprosthesis regurgitation. A cerebral and thoraco–abdominal CT angiography showed multiple thromboembolic outcomes involving the splanchnic vessels, kidney and spleen. The patient was then subjected to transesophageal echocardiography which highlighted the presence of vegetation on the bioprosthesis with diameters of 12x12 mm; moreover, aneurysmal dilatation of the aortic root was found with the presence, both anteriorly and posteriorly of the wall, of a thickening of about 1 cm which extended up to the sino–tubular junction. The patient‘s hospitalization was also complicated by intestinal subocclusion without urgent surgical indications.The patient‘s case was discussed collectively and it was decided, in the light of the high risk of intestinal ischemia (linked to the thromboembolic occlusion of the splanchnic vessels) not to subject the patient to cardiac surgery. In a recent publication of a case report with literature review, 12 cases were reported, all treated surgically, of which 2 died. Our patient, unable to undergo surgical therapy, represents the first case treated with medical therapy alone. To date, the patient is still hospitalized, in stable haemodynamic conditions, with a unfavorable long–term prognosis.
P97 AORTIC PSEUDOANEURYSM AS PRESENTATION OF INFECTIVE ENDOCARDITIS FOLLOWING VALVE IN VALVE TAVR: THE IMPORTANCE OF A MULTIMODAL DIAGNOSTIC APPROACH
Authors: Ciampi C , Ossola P , Grieco N , Di Matteo I , Musca F , Giannattasio C , Oliva F
Published: May 2023

Transcatheter aortic valve implantation complicated by infectious endocarditis (TAVI–IE) is an uncommon clinical event with a death rate of 24–46%. Despite several risk factors (young age, sex male, CKD, concurrent PM implantation, residual aortic insufficiency and valve–in–valve implantation) have been reported, the identification of this clinical scenario remains a diagnostic challange due to less sensivity and specificity of echocardiography ascribed to possible imaging artifacts or to a localization of the infectious process that cannot always be evalueted.

Clinical case

Sixty day after TAVI valve–in–valve procedure, during a rehabilitation recovery, an 80 years old female patient presented intermitted fever with an elevation of flogosis index. In suspicion of urinary tract infection, antibiotic therapy with ciprofloxacin has been started and at the same time the patient has been transferred to our center. At the admission time a blood colture resulted positive for Staphylococcus epidermidis. A complete echocardiogram(TTE+TEE) has been performed and showed an aortic bioprothesis with normal morphology, position and shape and normal gradient at continuos doppler analysis(17/30 mmHg). The distal part of the ascending aorta has not been evalueted due to a masking phenomenon caused by prostetich cage artifact. Considering the high probability of infective endocarditis, a chest CT was performed and showed a 22x11x18mm pseudoaneurism in the extreme distal point of the cranial part of the prosthesis. Therefore, the patient underwent to an emergency cardiac surgery with replacement of the ascending aorta with a prosthetic graft and the aortic valve with a new bioprothesis. The diagnosis of infected pseudoaneurysm was confirmed by the hystologic examination and after 22 days since the intervention, the patient was transferred to the sending rehabilitation center with an indication to continue Daptomicin therapy, started during the recovery, for 6 weeks. Even with non–suggestive ecocardiographic evidence, the presence of positive blood colture test in patients with endocarditis risk factors, need a multimodal imaging approach to diagnosis (for instance, CT or PET) in order to provide prompt and appropriate therapy.
P106 AN INTRIGUING CASE OF INOCA IN THE CATH–LAB
Authors: Cosenza M , Cesari A , Vella C , Ghizzoni G , Ferri L , Russo F , Biondi F , Colombi R , Agricola E , Slavich M , Montorfano M
Published: May 2023

A 63–year–old woman presented to our Center for a longstanding history of typically radiating oppressive chest pain, with both resting and exertional episodes,mostly occurring early in the morning and exacerbated by cold.Two years before for a treadmill test positive for electrocardiographic (EKG) criteria of exercise–induced ischemia, she underwent coronary angiography which was found negative for epicardial obstructive coronary artery disease.Given the suspicion of coronary microvascular disease,empirical antianginal therapy with Ranolazine was started at that time,with transient improvement of symptoms. She presented to our Center for a 6 month history of recurrence of symptoms. Her antianginal therapy with Ranolazine was up titrated to 750 mg BID and Verapamil (40 mg TID) was added to her usual therapy given the suspicion of coronary vasospasm as additional component in the pathogenesis of her symptoms,as suggested by the anamnestic recall.Moreover a 24–hour–Holter monitoring was performed with subsequent finding of several episodes of horizontal ST–segment depression(up to 3 mm),mainly on awakening,in the absence of significant arrhythmias.The patient underwent coronary angiography for the assessment of coronary physiology. On angiography, the absence of epicardial obstructive coronary artery disease was confirmed, with the finding of extensive coronary fistulas originating from the left coronary system and communicating with the left ventricular cavity.After induction of maximal hyperemia, the clinical suspicion of coronary microvascular disease was confirmed (CFR 1.9).In addition, reduced coronary flow reserve in the left anterior descending (LAD) territory compatible with both microvascular dysfunction and coronary steal was documented (RFR 0.91;baseline FFR:0.94,after systemic adenosine:0.79).Given the clinical suspicion, vasoreactivity test with intracoronary acetylcholine (2–20–100–200 mcg) was also performed,which was positive for epicardial spasm at mid–distal LAD and concomitant onset of chest pain and ischemic EKG changes(diffuse ST–segment depression) with prompt regression after intracoronary nitrate administration.Taken together,clinical and instrumental findings suggested the diagnosis of mixed angina by combination of three mechanisms:microvascular disease,epicardial spasm and coronary steal due to extensive coronary artery fistulas.The patient was discharged with Ranolazine and Diltiazem at maximum tolerated dose with clinical benefit.
P108 FIVE YEARS RESULTS OF BIORESORBABLE VASCULAR SCAFFOLDS VERSUS CONVENTIONAL DRUG–ELUTING STENTS. A META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Meco M , Guido B , Fouladvand F , Agosteo E
Published: May 2023

Background

Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug–eluting stents (DES) by dissolving once they have restored lasting patency.

Objectives

Compare the safety and efficacy after five years, of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease in randomized controlled trials (RCT).

Methods

Data collection: We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated log–term results (at least 60 months) of BVS versus DES in patients underwent percutaneous coronary intervention. Outcome: The primary outcomes were target lesion failure (TLF), stent thrombosis, myocardial infarction, all–causes mortality, and cardiac mortality Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented odds ratios (OR) for dichotomous outcomes (Generic Inverse Variance random effect model) with 95% confidence interval (CI).

Results

Five full texts met inclusion criteria. A total of 4994 patients were included (2927 patients randomized to BVS and 2067 patients randomized to DES), Target lesion failure: At five years of follow–up, the number of TLFs was significantly higher in patients randomized to BVS (OR 1.23 (1.04–1.45) p=0.02). Stent thrombosis: at 5 years the number of stent thrombosis is significantly higher in patients randomized to BVS (OR 3.06 (1.93–4.87) p<0.0001) Myocardial infarction: also in this case the number of myocardial infarctions is significantly higher in patients with BVS (OR 1.40 (1.13–1.73) p=0.002) All–cause mortality: there were no differences between the two groups (OR 0.89 (0.71–1.12) p=0.33) Cardiac mortality: no difference between the two groups (OR 0.81 (0.58–1.13) p=0.21.

Conclusions

Summary evidence from the included RCTs showed that DES are much safer and more effective than BVS in long term follow up.
P109 INTRAVENOUS CANGRELOR INFUSION IN PATIENTS UNDERGOING COMPLEX VERSUS NON–COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Scalamera R , Benenati S , Gragnano F , Schettino M , Bertero E , Capolongo A , De Sio V , Musumeci G , Annibali G , Campagnuolo S , Galasso G , Silverio A , Bellino M , Centore M , Menozzi A , Caretta G , Rezzaghi M , De Luca L , Veneziano F , De Nardo D , Cirillo P , De Rosa G , Calabrò P , Porto I
Published: May 2023

Aims

To compare the clinical characteristics and in–hospital outcomes of patients undergoing complex vs. non–complex percutaneous coronary intervention (PCI) with peri–procedural use of cangrelor.

Methods

Consecutive patients treated with cangrelor in 6 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high–bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Complex PCI was defined as any of the following: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay.

Results

Among 551 patients enrolled in the ICARUS registry and undergoing PCI between January 2019 and August 2022, a total of 534 (97%) patients had complete information on PCI complexity, of whom 173 (32%) underwent complex PCI and 361 (68%) underwent non–complex PCI. In general, patients with complex PCI had similar clinical features compared with non–complex PCI patients, including comparable prevalence of high bleeding risk (HBR) status according to the ARC–HBR definition (35% vs. 30%, p=0.253), but complex PCI patients presented more often with cardiogenic shock (9% vs. 2%, p<0.001). PCI with ≥3 stents implanted was the most frequent criterion of procedural complexity (62%). The incidence of the primary endpoint of 48–hour NACE (10% vs. 7%, p=0.264) and other clinical endpoints occurring at 48 hours or during hospitalization did not differ between complex and non–complex PCI patients.

Conclusions

Among patients receiving peri–procedural cangrelor, about 30% of cases underwent complex interventions. Notwithstanding higher procedural complexity, short–term clinical outcomes were similar between complex and non–complex PCI patients.
P112 CLINICAL OUTCOMES OF LEFT ATRIAL APPENDAGE OCCLUSION WITH CONSCIOUS SEDATION WITHOUT ANESTHESIOLOGIST ON SITE: RESULTS FROM A MULTICENTER RETROSPECTIVE STUDY
Authors: Bianco M , Visalli A , Tomassini F , Giacobbe F , Rolfo C , Cerrato E , Franzè A , Zanda G , Pavani M , Piedimonte G , Biolè C , Destefanis P , Palacio Restrepo S , Celentani D , Luciano A , Tizzani E , Chinaglia A , Varbella F
Published: May 2023

Background

Left atrial appendage (LAA) occlusion is an important therapeutic option to prevent cardioembolic stroke in patients with atrial fibrillation (AF) with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) under general anesthesia (GA). In this retrospective study we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without anesthesiologist on site.

Methods

We collected all the LAA occlusion procedures performed from October 2018 to May 2022. All the included patients underwent the procedure for OAC intolerance mainly due to bleeding with irreversible causes. All the procedures were performed with Watchman or Amulet LAA occluders under TOE and fluoroscopy guidance by two expert interventional cardiologists without anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl.

Results

One hundred and fifteen patients (age 76.4 ± 7.6 year) with non–valvular AF (median CHA2DS2Vasc 4.4 ± 1.4) were included in the study. CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl (mean dose 52.8 ± 19.6 mcg) in case of poor tolerance of the procedure despite midazolam. Acute procedural success rate was of 99.2%. One patient suffered a cardiac tamponade, urgent necessity of cardiac surgery and died 5 days after procedure. Two patients (2.6%) had anemia with need for transfusion after interventions. A patient (0.8%) suffered from oropharynx hematoma due to TOE. One case (0,8%) of vascular access site pseudoaneurysm occurred. One case (0.8%) of device thrombosis at 3 months TOE follow–up was reported. One procedure (0.8%) result in large leak device (³5 mm), confirmed at TOE follow–up performed at 3 months follow–up. No thromboembolic complications were reported. One hundred and fourteen (99.2%) patients stopped dual antiplatelet therapy within 12 months. In a follow–up of 10 ± 9 months one case of stroke (0.8%) and one case (0.8%) of transient ischemic attack (TIA) occurred.

Conclusion

LAA occlusion performed under CS and without the presence of anesthesiologist in cath–lab appear to be safe and effective. It can be an attractive alternative to (GA) because of lower medical staff needed and organizational effort required. In our retrospective study the success rate and the incidence of adverse events appear to be comparable with those of previous studies on the topic of LAA occlusion
P116 INTRACARDIAC ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE CLOSURE WITH WATCHMANN FLX DEVICE. A SINGLE–CENTER STUDY
Authors: Varotto L , Sembenini C , Dotto A , Bonanno C , Caprioglio F
Published: May 2023

Introduction

Intracardiac echocardiography (ICE–Abbot ViewFlex) is used increasingly as an alternative to transoesophageal echocardiography (TEE) to guide left atrial appendage closure (LAAC). ICE allows LAAC to be carried out under local anesthesia and can be performed by the interventional cardiologist, as sole operator. Previous works on ICE–guided LAAC are registry studies with self–reported data. We aimed to investigate the efficacy and safety of ICE–guided LAAC with the novel Watchman FLX device (Boston Scientific, Marlborough, Massachusetts) in a single–center study.

Methods

This is a rigorous study of patients undergoing LAAC with the Watchmann FLX device. Procedures were guided by ICE from left atrium with local anesthesia. Atrial fibrillation (AF) patients with CHA2DS2VASc score ≥2 and a clinical indication for LAAC were eligible for the study. Procedural preplanning with either cardiac CT or TEE within 7 days prior to LAAC was mandatory, to exclude the presence of LAA thrombus. ICE was used to guide the transseptal puncture and intraprocedurally was carried out with a single transseptal access directly from the left atrium to guide the procedure and device implantation. The primary outcome was the rate of significant peri–device leaks (>5 mm) at 45–days TEE. Safety outcome was a composite of periprocedural complications.

Results

Twenty–four patients were enrolled over 2 years. Mean age was 75±8 years, CHA2DS2VASc score 4.0±1.3 and HASBLED score 3.4±0.9. The incidence of the primary outcome of significant peri–device leak (>5 mm) was 0,04%; all patients had effective LAAC at 45–days. All patients had a Watchman FLX implanted and technical success was 100%. The number of devices per case was 1.0±0.2. ICE successfully guided assessment of device release criteria, including mean device compression of 21%, which was within the recommended 10–30% range. No subject required conversion to TEE. The only procedural complications were 3 access site bleeds. There were no episodes of stroke, transient ischemic attack, systemic embolization, pericardial effusion, device embolization or device–related thrombus during the procedure or 45–days follow–up.

Conclusions

ICE can be used to successfully guide LAAC with Watchman LFX with excellent procedural success, a high rate of effective LAAC and minimal peri–procedural complications. The efficacy and safety results are comparable to those reported for TEE–guided Watchmann FLX implantation.
P117 TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH CHRONIC THROMBOCYTOPENIA: PREVALENCE AND IN–HOSPITAL OUTCOMES
Authors: Zuin M , Bilato C , Pasquetto G , Rigatelli G
Published: May 2023

Background

Thrombocytopenia represents an important issue in patients undergoing Transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. We performed a systematic review and meta–analysis to establish the pooled prevalence and the in–hospital outcomes of Chronic thrombocytopenia (cTCP) in patients after TAVR.

Methods

PubMed and Scopus databases were systematically searched for articles, published in any language, from inception through September 15, 2022, reporting the prevalence of cTCP in patients who underwent TAVR and providing data on the hospital outcomes. The pooled prevalence and the outcomes were evaluated pooling the adjusted odds ratio (OR) with the related 95% confidence interval (CI) using a random– effect models. Statistical heterogeneity between groups was measured using the Higgins I2 statistic

Results

Overall, 1,402,431 patients (mean age 87.2 years, 45.1% females) where hospitalized for TAVR. Among them, cTCP was observed in 7.0% of cases (95% CI: 1.7–24.5%, p<0.0001, I2:84.5%). No significant differences were observed for in–hospital mortality and stroke comparing patients with cTCP to those without (OR: 1.07, 95% CI: 0.62–1.82, p=0.802, I2: 79.6% and OR: 0.90, 95% CI: 0.67–1.21, p=0.48, I2: 0%, respectively). Conversely, cTCP subjects showed a significant higher risk of vascular complications (OR: 1.72, 95% ci 1.37–2.16, p<0.0001, I2:0%), acute kidney injury (OR: 1.60, 95% CI: 1.16–2.20, p=0.004, I2:81.4%) and cardiac tamponade (OR: 3.31, 95% ci: 1.85–5.94, p<0.0001, I2: 0%) (Figure 1).

Conclusions

cTCP is present in about 7% of patients underoing TAVR and was results associated with an increased risk of vascular complications and cardiac tamponade during the periprocedural period.
P118 DEGENERATION OF PROSTHETIC HEART VALVES: EXCITING CHALLENGE IN CATH LAB
Authors: Leonardi D , Del Sole P , Scarsini R , Lunardi M , Mammone C , Tavella D , Pesarini G , Ribichini F
Published: May 2023

Background

Prosthetic Heart Valves are always more frequent in the clinical practice. Particularly, sometimes more than one native valve is affected and needs to be surgically treated. On the other side, replaced prosthesis could also degenerate over time, leading to worsening symptomatic heart failure. There are no many cases of combined percutaneous approach to both aortic and mitral prosthetic valve deterioration: our aim is to display a case of this complex clinical setting. Case: A 76–year–old man with previous surgical mitral and aortic valve replacement, respectively through Hancock (27 mm) and Mitroflow (21 mm), was referred to our Centre for dyspnoea on mild efforts. Echocardiography revealed severe degeneration of both prosthetic valves, with moderate mitral stenosis (mean pressure gradient – MG – 6 mmHg) and severe central regurgitation, and high transaortic pressure gradients (MG 58; peak pressure gradient – PG – 103 mmHg). Pulmonary hypertension, mild right ventricle dysfunction and reverse flow in hepatic veins were evident.

Results

The first intervention was Valve–in–Valve Transcatheter Aortic Valve Implantation (ViV TAVI) with CoreValve Evolut PRO+ (23 mm), followed however by recoil determining moderate aortic stenosis (MG 25, PG 47 mmHg). Hence, as both the left prosthetic valves needed treatment, we decided to plan an elective percutaneous procedure aimed to treat both of them. Aortic ViV cracking was successfully obtained through non–compliant Atlas Gold Balloon (22 mm). Then, transseptal puncture by Brockenbrough needle and SL0 dilator sheath system was used to gain access to the left atrium. Finally, after interatrial shunt pre–dilation, Edwards Sapien 3 Ultra (26 mm) was applied as Mitral ViV during rapid ventricle pacing. Echocardiography showed relevant decrease of aortic pressure gradients (MG 11, PG 19) and downgrading of mitral regurgitation from severe to mild, despite unvaried persistent moderate mitral stenosis and signs of chronic severe pulmonary hypertension. The patient was dismissed in 3 days, after adjusting medical therapy.

Conclusions

Dysfunction of prosthetic heart valves is challenging to be approached, particularly when involving more than one. The expertise of the Centre assumes great importance in this delicate clinical setting. More explanations are further needed to define type and timing of percutaneous intervention aimed to the treatment of multiple prosthetic valves.
P120 NEW MALIGNANT MUTATION IN HYPERTROPHIC CARDIOMYOPATHY
Authors: Moscardelli S , Santangelo G , Bursi F , Rusconi D , Guazzi M
Published: May 2023

A 62–year–old man diagnosed with non–obstructive hypertrophic cardiomyopathy and dual–chamber pacemaker wearer since the age of 40, for third–degree atrioventricular block, came to our attention for atrial fibrillation (AF) episodes (one complicated by cardiogenic shock and multiorgan failure) and flutter with high ventricular response. For a progressive worsening of the systolic function, and the onset of multiple episodes of sustained ventricular tachycardia, an upgrade to the defibrillator was performed, which, in the following months, intervened appropriately for recurrences of ventricular arrhythmias. The patient was admitted to our ward for exacerbation of heart failure. The echocardiography showed moderate concentric hypertrophy with mild ventricular dilatation and ejection fraction 33%, inferior and inferoseptal wall, and apex akinesia with thrombotic apposition. Due to a sudden deterioration of the clinical conditions, the patient died. After genetic counseling the patient‘s family agreed to genetic testing in the proband. This highlighted the presence of a missense mutation, i.e. the substitution of the cysteine ​​residue with a serine, in the codon 905 of the MYH7 gene, encoding the cardiac isoform of myosin heavy chain. The mutation is probably pathogenetic as it falls in the region where most of the missense variants are clustered and statistically associated with the HCM phenotype. Only in one previous case of HCM was detected a mutation of the same codon, Cys905Phe. Several studies have reported that AF tends to be more prevalent in patients carrying MYH7 mutations and is associated with a substantial risk of heart failure–related mortality, stroke, and severe functional disability. Knowledge of the entire spectrum of MYH7 mutations, especially those related to a high arrhythmic burden or SCD, combined with an accurate clinical and molecular characterization of the patient, can improve the genotype–phenotype correlation by clarifying the mechanism of HCM and allowing a better clinical and therapeutic decision–making of patients.
P122 CONTRAST–ENHANCED ECHOCARDIOGRAPHY IN BETTER STUDYING (OR EXCLUDING) HYPERTROPHIC CARDIOMYOPATHY. TWO CASES
Authors: Parato V , Gizzi G , Ianni U
Published: May 2023

Aim of this case–series report is to elucidate the potential role of contrast echocardiography (C–Echo) to optimize and improve the study of patients with Hypertrophic Cardiomyopathy (HCM). However, this report is also aimed to demonstrate the role of C–Echo in excluding a HCM diagnosis. Case 1. A young male patient, 27 y–o, presented to our Emergency Department (ED) because of chest pain and dyspnea. He referred a diagnosis of HCM without LVOT obstruction. Trans–Thoracic Echocardiogram (TTE) demonstrate a severe hypertrophy of interventricular septum with a maximum diastolic thickness of 25 mm. There was no a significant LVOT gradient. Contrast enhanced echocardiography, by left ventricle opacification (LVO) (Sonovue, Bracco Imaging, Milan, Italy), demonstrated: an interventricular septum thickness of 32 mm (7 mm more than TTE measurement); a clear touching of mid–ventricular walls with a max systolic gradient of 40 mmHg (figure 1). This aspect was no clearly detectable by TTE alone. Case 2. A young male patient, 31 y–o, presented to our ED because of palpitations. At 12–leads ECG he presented a sinus rhythm with frequent monomorphic premature ventricular complexes (PVC). A TTE was performed. It put a suspicion of left ventricle (LV) APICAL HCM, because of an apical diastolic thickness of 26 mm. A contrast enhanced echocardiography by LVO (Sonovue, Bracco Imaging, Milan, Italy) was planned. It allowed to excluding a HCM by demonstrating a LV apical false tendon mimicking endocardial border (figure 2). LV false tendons are fibromuscular bands that traverse LV cavity and are generally considered to be benign. Thay may also contain conduction tissue (Purkinje fibers) and have been identified as a source of ventricular arrhythmias. They are most commonly located near the LV apex.

Conclusion

It is possible to conclude that, by LV cavity opaciﬁcation optimization of echocardiographic planes and views, C–Echo represents a suitable tool for: 1) a more accurate LV wall thickness (WT) measurement; 2) acquiring additional informations about intraventricular gradients in patients with HCM. In addition, C–Echo allows to exclude a HCM diagnosis in presence of LV apical false tendons.
P124 A TAKOTSUBO SYNDROME MIMICKING AN APICAL HYPERTROPHIC CARDYOMYOPATHY: A CASE REPORT
Authors: Benzoni G , Castelletti S , Ravaro S , Chianca R , Speziali N , Volpi C , Gavazzoni M , Parati G , Fratianni G , Seravalle G , Crotti L
Published: May 2023

A 70–year–old woman was admitted to our Intensive Care Unit (ICU) with high levels Hs–TnT. Coronaries were normal and ventriculography was suggestive for Takotsubo Syndrome (TS). In the acute phase she developed a cardiogenic shock and transthoracic echocardiography (TTE) showed a dilated left ventricle (LV) with iperkinesia of basal segments and biventricular apex and mid –ventricular akinesia, with a severely reduced left ventricular ejection fraction (LVEF 20%). Seven days after admission to Cardiac Rehabilitation Unit, a TTE showed LV apical hypertrophy (max thickness 18 mm), hypokinesia of hypertrophic segments, hypercontractility of basal segments and LVEF 55%. These features could have been suggestive for a coexisting apical hypertrophic cardiomyopathy (HCM). The EKG showed T wave inversions in precordial and inferior leads, not present at admission, this observation being against the presence of a pre–existing unknown HCM. Cardiac Magnetic Resonance (CMR) showed T1 and T2 mapping imagines for oedema in LV infero–lateral, basal segments and apical region, a subepicardial stria of late gadolinium enhancement in infero–lateral basal segment. These patterns were reported as suggestive for myocarditis rather than TS. Recent infectious or autoimmune diseases were excluded. Further TTE showed reversed LV parameters, normal kinesis of all segments, LVEF 66%, with a persistence of negative T waves at EKG.

Discussion

Our patient developed a classical TS with LV apical ballooning and hyperkinesia of basal segments with uncommon right ventricular hypokinesia. A peculiar finding was the transient apical LV thickness that was seen through TTE, mimicking an apical hypertrophic cardiomyopathy. Such a finding has already been described in few case reports; however, the nature and the physiopathology of that apical thickness was never proved. Through CMR we noted that, in the same region where TTE detected apical hypertrophy, there was a consistent amount of oedema which could be the reason of pseudo–hypertrophy findings. Our experience confirms the importance of integrating CMR in the diagnostic algorithm as already supported in consensus statements. In our case CMR played a key–role in the exclusion of a coexisting apical hypertrophic cardiomyopathy.
P134 RECURRENT SCAD IN A PATIENT WITH BICUSPID AORTIC VALVE AND ANOMALOUS CORONARY ORIGIN
Authors: Schettino M , Rezzaghi M , Caretta G , Tonelli G , Arena M , Menozzi A , Porto I
Published: May 2023

Spontaneous coronary artery dissection (SCAD) is recently emerging as an increasingly frequent cause of myocardial infarction and among the main triggering factors we found hypertension, pregnancy, fibromuscular dysplasia and connective tissue diseases (e.g. Marfan syndrome). Recent studies also suggest that even bicuspid aortic valve may be a predisposing condition for the development of spontaneous coronary artery dissection. We report the case of a 45–year–old Caucasian man with no cardiovascular risk factors; his clinical history begins in August 2019, when he was hospitalized for acute coronary syndrome (NSTEMI). Echocardiography showed preserved left ventricular ejection fraction, bicuspid aortic valve (fusion of right and left cusps) with mild to moderate regurgitation without stenosis and mild dilatation of the aortic bulb (38 mm). The coronary angiography showed no significant stenoses and an anomalous origin of the right coronary artery from the common trunk. The patient was discharged two days later with a diagnosis of MINOCA and an indication to perform a coronary CT scan, which confirmed the anomalous origin of the right coronary artery with a retro–aortic course, and a cardiac MRI, which showed myocardial edema of the infero–lateral wall, mainly with sub–endocardial distribution and LGE in the same sites, compatible with ischemic damage. In September 2022 there was a new hospitalization for inferior–posterior–lateral STEMI with coronarographic finding of a large marginal branch collateral stenosis, with recovery of distal caliber. The angiographic pattern was consistent with type II SCAD (no intracoronary imaging has been performed because of vascular tortuosity and lesion distality). A retrospective comparative analysis of the 2019 angiography allowed to find a distal occlusion of the same branch, now healed, also compatible with SCAD. The patient was discharged on single antiplatelet therapy after one week of DAPT with acetylsalicylic acid and clopidogrel and indication to perform a genetic test for connective tissue diseases. The case described prompts the cardiologists to suspect an uncommon etiology (connective tissue disease, bicuspid aortic valve) in case of SCAD detection, especially if associated with anomalous origin of the coronary arteries.
P136 “THERE’S NO TWO WITHOUT THREE”: A STRANGE CASE OF RECURRENT CORONARY EMBOLISM
Authors: Scarpino T , Gerbasi E , Ferraro A , Ciconte V
Published: May 2023

Background

A 68 year–old woman with rheumatic heart disease underwent surgery replacement of aortic and mitral valves with mechanical prostheses 20 years ago, and since then has been in VKAs therapy. One year after the operation, she was hospitalized for ischemic stroke without relics. For detection of 2:1 block on the ECG Holter/24h a PM was implanted. After 4 years, she had an acute coronary syndrome (ACS) with VF (treated with DC–Shock). Coronary angiography (CA) showed no coronary stenosis. It was replaced PM to ICD. In 2017, she had a TIA and a mitral prosthesis dysfunction was detected from EET with hemidisk thrombosis. After CA, mitral valve replacement was performed but on the 2nd day after surgery she had an anterior STEMI caused by the occlusion of LAD. PTCA and stenting were performed. In October u.s. the patient was referred to the Emergency room for typical angina. An inferior–posterior STEMI was revealed to ECG. CA highlighted embolic occlusion of Cx and good result of prior LAD’s stenting. After multiple and ineffective attempts, invasive recanalization’s procedure was interrupted considering both patient’s high bleeding risk and embolic aetiology. Excluded prosthetic thrombosis and thrombophilic anomalies, patient was discharged in clinical stability with SAPT+ VKAs therapies.

Discussion

Coronary embolism (CE) represents 3% of ACS because the coronary arteries are protected from embolism thanks to their acute’s angle origin from the aorta. Embolism origin is various and it can originate from left (LAA, LVx, valvular, prosthetic structures) or right heart sections (paradoxical embolism in the case of PFO),generally during AF. In our case, prosthetic origin is the most probable embolic source as demonstrated by cerebral ischemic (TIA/stroke) and coronary events (first anterior then inferior–posterior STEMI) after valves surgery. Treatment consists of restoring antegrade flow without DES implantation, using if possible intracoronary thrombolysis or thromboaspiration. In secondary prevention, embolism sources removal and anticoagulant therapy are mandatory. In our case we recommended SAPT+VKAs with strict INR’s control (range 3.5–4).

Conclusions

Although CE is a rare and potentially fatal phenomenon it should be suspected in the absence of coronary atherosclerosis and in the presence of predisposing conditions such as those mentioned above. This case demonstrates that CE can occur in absence of prosthetic thrombosis with suboptimal INR control.
P158 REMOTE FOLLOW–UP OF ISCHEMIC HEART DISEASE AFTER MYOCARDIAL INFARCTION: PRELIMINARY RESULTS OF A TELEVISIT PROJECT IN THE CARDIOLOGY OF G.B. GRASSI HOSPITAL IN ROME
Authors: Pastena G , Bocchino M , Paraggio L , Ferranti F , Scardala R , Sorrentino C , Romano M , Ammirati F
Published: May 2023

Introduction

In literature there are few studies reported on follow–up of post infarction using telemedicine.

Objective and Methods

Considering recent pandemic and thanks to the development of digital also in its regulations, it was decided to organize a televisit service with a dedicated team (cardiologist, nurse, cardiology technician) for patients (pt) discharged after a myocardial infarction. The platform of Regione Lazio SISMED has been used to carry out all the necessary procedures (dematerialised recipe, booking, videoconference, digital signature reporting and sending to FSE). We selected pt with: ST elevation myocardial infarction (STEMI), myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) or Takotsubo syndrome, non ST elevation myocardial infarction (NSTEMI) with high–risk, providing a follow–up to 1 and 4 months to monitor cardiovascular events, adherence to therapy, achievement of therapeutic targets and level of satisfaction. An Access file was designed for reporting and data collection.

Results

From 23–11–21 to 2–11–22, we followed 58 pt (average age 64±10 years, 73% males). Figure 1 represents the cardiovascular risk factors and Figure 2 the type and location of the myocardial infarction; at discharge (average stay 7±2 days), the ejection fraction of the left ventricle was 53±9%. At the televisit control at 1 month, 5 pt reported symptoms (4 dyspnea, 1 cardiopalm), all continued the antiaggregant therapy; Figure 3 shows those who have reached the target for LDL cholesterol (average 56±34 mg/dl), blood pressure (average 124±10 mmhg) and blood sugar level (average 107±19 mg/dl); 6 pt had no target LDL cholesterol (three stopped hypolipidaemic therapy). One pt showed intense pallor, asthenia and reduced hemoglobin (6 g/dl): after hospitalization, we found colon diverticulosis with bleeding (he took oral anticoagulant due to prior atrial fibrillation, suspended, with benefit). The 4–month follow–up was performed for 42 pt, with overlapping results, without reospedalizations. No pt died.

Conclusions

The televisit showed itself safe as an option in the follow–up of these pt, with a high approval rating. This was possible through the structuring of a health coordination center with a dedicated team, which also supported pt in the new path.
P169 ONE–MONTH RELAPSE OF UNDIFFERENTIATED SARCOMA IN THE LEFT ATRIUM: A CASE–REPORT AND LITERATURE REVIEW
Authors: Fumarulo I , Camilli M , Bisceglia I , Aspromonte N
Published: May 2023

Background

Primary cardiac tumors are extremely rare and mostly benign; among the malignant ones the most frequent are sarcomas (primary cardiac sarcomas, PCS), commonly located in the left atrium. Echocardiography usually provides initial information about tumor location and its size, although the correct diagnosis may be hindered by similarities to benign myxomas or thrombotic formations. Therefore a multimodality approach, with second level imaging techniques, is frequently needed. Case–report: We report a case of undifferentiated cardiac sarcoma in a 47–year–old woman who underwent surgical resection. One month after the operation the control transthoracic echocardiography (TTE) revealed disease recurrence, confirmed by Positron emission tomography (PET)–computed tomography (CT). The patient underwent chemotherapy and hypofractionated radiotherapy, with significant reduction of mass size after 2 months.

Conclusions

PCS is a very rare disease, predominantly affecting adults in the fifth decade of life, with a very poor prognosis. Symptoms depend on the size and location of the tumor and may be nonspecific up to the advanced stages. Diagnosis may be suspected by TTE or CT but histological diagnosis is often essential. There is no standard treatment. Surgery is potentially the best treatment option, followed by radiotherapy, chemotherapy and immunotherapy targeted to the specific histologic subtype of the tumor, but further studies are needed.
P172 A RARE CASE OF PLATINUM CARDIOTOXICITY: CASE REPORT
Authors: Maratea A , Mauriello A , Liccardo B , Desiderio A , D‘Andrea A
Published: May 2023

Background

The chemotherapy regime containing the Carboplatin–Gemcitabine combination is frequently used for improving outcomes in patients affected by metastatic breast cancer. Platinum compounds were included in the recent ESC Guidelines on cardio–oncology as potential agents which may lead to myocardial infarction, thrombosis and, rarely, heart failure. In this instance it is essential for a strict cardiological follow–up to be carried out during and after treatment. Case report: We present a clinical case report of a 38–year–old woman who was receiving standard oncology treatment for stage IV breast adenocarcinoma. The patient underwent chemotherapy cycles containing the Carboplatin–Gemcitabine combination, with a good response to treatment. It came to our attention for severe dyspnoea, which arose several days before, not compatible with her oncological situation. Transthoracic echocardiography showed severe left ventricular dysfunction (EF 25%; GLS – 9.2%; NT–proBNP 10000 pg/mL), which was not present during earlier tests, and circumferential pericardial effusions, mainly localised along the free wall of the right ventricle, non–haemodynamically significant. Lung ultrasound also showed the presence of pulmonary congestion and bilateral pleural effusions. In the circumstances, she was admitted to the Cardiac Intensive Care Unit for continuation of diagnostic treatment. She then received endo–venous diuretic treatment and haemodynamically supported with Noradrenaline and inotropic agents. A cycle of Levosimendan was performed with an excellent response. Once haemodynamic compensation was re–established, the patient underwent a cardiac CMR which excluded cardiomyopathies and myocarditis and a coronarography was performed which showed no significant lesions in the coronary arteries. After 18 days of hospitalisation in our department, the patient showed an improvement in EF (EF 38%, GLS –12.5%, NT–proBNP 2000 pg/mL), and then she was referred to the oncologist for immunological treatment.

Conclusions

The diagnosis of cardiotoxicity may not be straightforward due to the aspecificity of the symptoms, its silent progression or because of several comorbidities. Moreover, cardiac damage from chemotherapy is considered reversible if identified early. Treatment is based on the withdrawal of therapy and treatment of symptoms, given that these may be different and unpredictable.
P173 THERAPEUTIC MANAGEMENT OF FLUOROPYRIMIDINE CARDIOTOXICITY: AN ANECDOTAL CASE
Authors: Paccone A , Bisceglia I , Lestuzzi C , Fiscella D , Canale M , Turazza F , Russo G , Gallucci G , Camilli M , Quagliariello V , Maurea C , Maurea N
Published: May 2023

Background

Fluoropirimidine represents one of the staple treatment of metastatic colorectal cancer; chemoterapy–based cardiotoxicity is unfortunately habitual in clinical practice. Raltitrexed could represent a valid alterantive to 5–FU in patients with cardiovascular comorbidities or in which 5–FU Has not been tolerated.

Case Report

Our patient is a 73 years–old woman, who underwent left colon surgical resection due to subocclusion; a whola body staging was not performed. After surgery, patient underwent CT scan,i n which multiple liver, lung and peritoneal metastases were identified. Biomolecular profiling assessment was perfomed (RAS, BRAF Wild type, DPYD*6 heterozigosis mutation). On January 2020, patient began FOLFIRI + PANITUMUMAB scheme as first line treatment (total cycles perfomed: 15). On January 2021, PD was detected though restaging imaging, and patient was subsequently treated with FOLFOX + BEvacizumab as second line. After 5 cycles, patient developed dyspnoea and palpitation; EKG was performed depicting Atrial fibrillation with heart rate: 73bpm, preserved biventricular systolic function and increased BNP and NT–pro–BNP serum concentration. According to patient’s high thromboembolic risk, oral anticoagulation (NOAC) was administered and multidisciplinary discussion was scheduled. NAO were preferred to Vitamin K antagonists due to drug–drug interactions; the treatment–of–choice was Apixaban 2.5 mg bis in die. Given the fact that aforementioned condition could have been attributed to 5–FU cardiologic toxicity, Raltitrexed was administered in lieu thereof 5–FU once synusal rythm was restored (TOMOX scheme). Bevacizumab administration was restored after a longer waiting (ca 2 months); the patient uderwent systematic and serial cardiologic assessment through clinical and EKG consults.

Conclusion

Our case report depicts the undelayable necessity of a Multidisciplinar collaboration in which oncologists and cardiologists could propose personalized treatment strategies which ensure correct antitumoral activities without significant and life–threatening toxicities.