bluuebunny/crossref_metadata_2025 huggingface dataset:
P283 PROGRESSION OF PULMONARY ARTERIAL HYPERTENSION OR LEFT HEART DISEASE? DO EXERCISE!
Authors: Baratto C , Caravita S , Villella F , Sganzerla P , Perego G , Badano L , Parati G
Published: May 2022

An 80–year–old man, diagnosed with idiopathic pulmonary arterial hypertension (PAH) in 2012 and treated with sildenafil, experienced his first hospitalization for heart failure in June 2019. He had several cardiovascular risk factors (overweight, hypertension, diabetes) and comorbidities (ischemic heart disease, and mild chronic obstructive pulmonary disease), whose progression was excluded. Since this event, he complained a progressive deterioration of the exertional dyspnea (NYHA III), with overt signs of fluid overload, right chambers dilation and high NTproBNP (1366 ng/L). However, the center taking care of this patient neither decided to fully re–evaluate him nor to escalate PAH–treatment due to his clinical profile (high suspicion of left heart disease, LHD). He then came to our pulmonary hypertension (PH) center where we decided to perform a cardiac catheterization, which showed the persistence of precapillary PH with high pulmonary vascular resistance, PVR (7.6 WU), low cardiac output, CO (2.2 L/min/m2), high right atrial pressure, RAP (12 mmHg). Pulmonary artery wedge pressure (PAWP) and left ventricular end–diastolic pressure (LVEDP) were at the upper limits of normal (13 mmHg and 16 mmHg, respectively) (Figure 1). Based on these “borderline” PAWP values, with an intermediate–high pre–test probability of left heart disease, we performed an exercise test with concomitant gas–exchange analysis on a cycle ergometer in the cath lab (Figure 2). Exercise induced a steep increase in pulmonary pressure (TPR 9 WU), unrelated to an exaggerate increase in PAWP or LVEDP (whose peak values reached 20 mmHg, with a PAWP/CO slope <2 mmHg/L/min), but entirely dependent on the precapillary component. Transpulmonary gradient (TPG)/CO slope was high, leading to an absent reduction in PVR (6.4 WU at peak), associated to severe increase in RAP (27 mmHg at peak, RAP/PAWP 1.4) (Figure 3). CO reserve was reduced (at peak 3.4 L/min/m2), due to both reduced increase in stroke volume and chronotropic incompetence. Accordingly, functional capacity was moderately–severely reduced (peak oxygen consumption was 8 ml/kg/min, 39% of predicted), with exercise hyperventilation. Once excluded LHD as the responsible of clinical worsening, and in consideration of the high–intermediate risk profile of this patient, we upgraded the PAH–specific therapy by adding macitentan, obtaining a subjective clinical improvement and a 3–years period of clinical stability.
P302 ENDOTHELIALITIS AS A POSSIBLE CAUSE OF MYOCARDIAL INJURY DURING COVID–19 INFECTION
Authors: Verde M , Nkwenze Kwenze S , Cartoni D , Chin D , Cortese A , Frollano E , Grieco A , Guerrini S , Petrolati S , Taberini L , Macali L , Stolfi A , Di Biase E
Published: May 2022

A 53–year–old woman was admitted for chest pain for over two weeks, fever, dry cough, fatigue and myalgia. Chest pain increased in supine position and inspiration. Nasopharyngeal swab was positive for SARS–CoV–2 RT–PCR assay. Admission ECG displayed mild ST–segment elevation (0,5 mm) in inferolateral leads and echocardiogram showed normal left ventricular volume, mildly decreased left ventricular EF (52%) and no regional wall motion abnormalities. Blood tests exhibited elevated values of high–sensitivity troponin I (818 pg/mL), proBNP (19.190 pg/mL), CRP (42 mg/dL), D–Dimer test (1090 ng/mL) and WBC (13000/uL, N 89%, L 7%). IL–6 resulted slightly increased (18 ng/mL). ECG after 24 hours showed T wave inversion in inferolateral leads. Coronary CT angiography revealed normal epicardial arteries. A new echocardiogram, after five days, showed infero–basal hypokinesia, improved global EF (57%) and minimal pericardial effusion. Aspirin and fondaparinoux were started. Myopericarditis was suspected and high dose steroids were administered. After a few days, symptoms improved and ECG, echocardiographic abnormalities and troponin levels were normalized. At 6 weeks follow–up the patient was asymptomatic, ECG and echocardiogram were both normal. Instead cardiac MRI showed signs of endothelial injury: presence of interstitial oedema in the inferoapical and anteroseptal wall (STIR–T2–weighted), without late gadolinium enhancement. We measured blood levels of endothelial dysfunction markers: soluble ICAM–1, VCAM–1 and von Willebrand factor (vWF). They all resulted elevated as compared to a laboratory pool of normal serum (535 ng/ml, 265 ng/ml, and 1659 ng/ml, respectively). Our case was suggestive of myopericarditis related to Sars–Cov–2, but echocardiogram and MRI did not show signs of myocarditis permanent damage. However MRI showed interstitial oedema and hyperemia, typical signs of endothelial injury. Moreover we found high levels of soluble endothelial adhesion molecules, vWF, ICAM–1 and VCAM–1, likely expression of the microcirculatory endothelial dysfunction due to myocardial endothelialitis.

In conclusion, our case report suggests that, in COVID–19, acute myocardial injury associated with clinical and investigational signs of myocarditis can be due to myocardial endothelialitis rather than true myocarditis and that an early management with anti–inflammatory drugs (steroids) can be particularly beneficial in patients with unexplained elevated cardiac troponin.
P304 CASE OF MYOCARDITIS AFTER COVID 19 VACCINATION
Authors: Pancaldo D , Amoroso G , Armando E , Barbero U , Bassignana A , Battisti A , Bricco G , Cavallero E , Coppolino A , Correndo L , De Benedictis M , Dogliani S , Iacovino C , Moncalvo C , Pavani M , Valeri L
Published: May 2022

COVID 19 has so far found the only barrier in the use of mRNA and viral vector vaccines. Among the rare adverse effects related to mRNA vaccines is myocarditis (4.8 cases per million doses) a disease already found in COVID 19 infection but not in the safety studies of the vaccines. Males not older than 30 years (40% of the total), subjected to the second dose inoculation, are most affected. During our recent clinical practice there was a case of a patient with myocarditis, attributable to vaccination for COVID 19. It was a male, twenty–year–old, non–allergic smoker, subjected to second dose of Pfizer–BioNTech vaccine (BNT162b2). On the fifth day after the inoculation, the patient, already asthenic from the previous days, complained of an episode of oppressive chest pain, which lasted about 15 minutes, which returned, more intense the following night, associated with dyspnea, lasted for hours. When the patient went to the emergency room the pain was in regression and there was good hemodynamic compensation. EKG: sinus rhythm, slight diffuse ST segment elevation, more pronounced in the inferior–lateral leads, slight lowering of the P–R segment. Blood tests: troponin, CKMB and PCR increase, negativity of the molecular test for COVID 19. Echocardiography: normal left ventricle, non–dilated right sections, normokinetic right ventricle, normal valves, pericardial hyper–refraction without effusion, normal diastolic relaxation. In the suspicion of myocarditis, the patient was admitted to our intensive cardiological care. With the high–dose anti–inflammatory and beta–blocker therapy the pain gradually disappeared; never fever; EKG showed progressive ST segment improvement and T wave negativization. Never arrhythmic events. Negativity for all infections with common viral pathogens. MRI: hyperintensity (T2 STIR sequences and late enhancement) in the infero–lateral area. Patient discharged in therapy with lysine acetylsalicylate, to be reduced, associated with pantoprazole, and metoprolol and indicated for outpatient checks. In conclusion, the case presented reflects the scientific literature in the type of patient and in the favorable evolution of the disease.
P307 POST–COVID–19 SYNDROME: CAN IT BE CAUSED BY MYOCARDIAL INVOLVEMENT?
Authors: Cariello F , Boncompagni F , Vozza M
Published: May 2022

Objectives

The main aim of this work is the evaluation of the myocardial activity in recovered SARS–COV–2 patients using echocardiography.

Methods

64 recovered SARS–COV–2 patients (28 men and 36 women) were checked within our premises because of persistent symptoms after the peak phase of the infection. EchocoloDoppler has been exploited for each patient to determine the following indicators of left ventricular activity: Biplane Ejection fraction; Myocardial function by means of global longitudinal strain (GLS), global radial strain (GRS) global circonferential strain (GCS), Analysis of longitudinal and circumferential tracking at the level of the three endocardial, middle and epicardial layers and radial at the basal, middle and apical level; Myocardial Work (MW): Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficency (GWE) e Global Work Waste (GWW); assessment of the mitral E/A and E/E’ diastolic function.

Outcomes

In 4 out of 64 patients (3 women and 1 man) a myocardial dysfunction of the left ventricle was highlighted. In 2 out of 64 patients an EF reduction was discovered, while a reduction of GLS GCS GWE and an increase of the GWW was detected in every patient involved in the study. We did not encountered variations of the tracking gradient concerning the layers of the layers with lower valuesat the level of the epicardial layer and higher values at the level of the endocardial one. Every patient involved in the study was affected by a diastolic dysfunction of 1° grade with E/A < 1 and E/E’ < 12 and they did not present significant stenosis after CT scan or angiography. Two of the 4 patients mentioned above had fibrosis areas as detected through RMN.

Conclusions

We confirm that for patients with persistent symptoms after SARS–COV–2 recovery echocardiography assessment is recommended to exclude potential damages. Assessing the functioning status by strain analysis is important to confirm damages, mainly for patients where the EF activity is not significantly varied. The identification of early or soft myocardial damages is key to start treatments and schedule follow–up analysis.
P369 BIOCIRCUIT®: A NEW SYSTEM FOR IMPROVING EXERCISE CAPACITY IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Lordi R , Veronese S , Beggi G , Grazzi N , Piccinini A , Sammali A , Tesini M , Cervellati D , Grazzi G , Capucci A , Pasanisi G
Published: May 2022

Introduction

Cardiovascular diseases is one of the most important public health problems; are among the main causes of morbidity, disability and mortality. Those who survive to an acute form become chronically ill with repercussions on the quality of life and on the economic and social costs. Secondary prevention through an intervention aimed to modify risk factors, in particular the sedentary lifestyle could be effective in the improvement of functional abilities. In this observational study carried out at the ABCardio company in Bologna (Italy), a personalized program of Physical Activity was performed through the innovative Biocircuit technology (Technogym®), on outpatients with a prevalent diagnosis of chronic ischemic heart disease.

Methods

We have analyzed 31 patients (M / F, 25/6) with a mean age of 61 years, and BMI of 26.4 kg / m2. Patients followed a two–month personalized physical activity program consisting in functional assessment at baseline (T0) and at the end of the program (T1) and of 2 weekly training sessions. Evaluation included: lower and upper limb isokinetic test to measure muscle strength, 500–meter moderate walking test to estimate maximum oxygen uptake (VO2max).

Results

The results obtained from the comparison between T0 and T1 in the 31 patients in study show significant improvements in the muscle strength of the lower limbs: Leg press +32.9 kg (p = 0.0003), Leg curl +11.8 kg (p < 0.0001), Leg extension +15.8 kg (p = 0.0002); as well as in upper limb muscle strength: Low Row +10.5 kg (p = 0.0005), Chest press +5.7 kg (p = 0.0007), Shoulder press +6.2 kg (p = 0, 0005). Estimated VO2max was also significantly improved from 26.2 mL / kg / min (T0) to 36.3 mL / kg / min (T1), with a mean increase of 10.1 mL / kg / min (p = 0, 0001). No adverse events occurred during supervised training sessions.

Conclusions

The program, safe and well tolerated by the patients in study, has proved to be effective in increasing exercise capacity in terms of both muscle strength and aerobic capacity. This secondary prevention intervention can be considered useful in reducing residual cardiovascular risk as it induced a significant increase in VO2max.
P371 1 YEAR OUTCOME OF BICARBON AORTIC MECHANICAL VALVE IN LOW–INR REGIMEN: RESULTS FROM SURE–AVR REGISTRY
Authors: Santarpino G , De Feo M , Menicanti L , Corbi P , Nobre A , Scardone M , Luo W , Rajakaruna C , Nicoletti A , Atzeni F , Torella M
Published: May 2022

Background

The drawback of using mechanical valve is lifelong anticoagulation use, and close monitoring is required to prevent postoperative complications, including thromboembolism and anticoagulation–related bleeding. Moderate anticoagulation after mechanical heart valve replacement has been proposed to reduce these risks. The present study aimed to evaluate the safety and feasibility of reduced oral anticoagulation after Bicarbon aortic mechanical valve replacement.

Methods

SURE–AVR is a propsective, multinational registry of patients undergoing aortic valve replacement. Between July 2018 and October 2020, among subjects undergoing AVR with Bicarbon valve in the SURE–AVR registry, 108 were assigned at discharge to low–INr regimen (international normalized ratio 1.5–2.5). Mean INr at discharge was 1.8+/–0.5 and 2.2+/–0.4 at 1 year. in–hospital and post–discharge outcomes up to 1 years were collected. The mean age was 55.5 +/–10.6 years old (range 25–82). Concomitant procedures included coronary artery bypass grafting (14.6%), mitral valve procedure (3.7%) and myectomy (1.9%). The follow–up duration averaged 1 year (361.8 +/– 258 days).

Results

No bleeding events were reported in the late follow up. The low–INR regimen did not affect the thromboembolism rates, since no stroke or transient ischemic attack were reported post–operatively at each time point. No in–hospital or late deaths were reported among the 108 subjects analyzed. In the early period (<30 days), three reinterventions occurred: two because of postoperative bleeding requiring thoracotomy and one due to pericardial effusion. In the late postoperative period two reinterventions with device explant occurred (one for non–structural valve dysfunction and one for endocarditis (1.2%).

Conclusion

The results of the SURE–AVr Registry demonstrated that the proposed Lower–INR Target is safe and feasible after Bicarbon aortic mechanical valve replacement. The low–intensity anticoagulation strategy is associated with a low risk of hemorrhagic events without any increase of thromboembolic complications.
P378 CARDIAC DEATH AND NURSING CARING: A LITERATURE REVIEW
Authors: Canestrale R , Camilloni S , Lizzadro A
Published: May 2022

Background

Brugada syndrome is a genetically determined disease that predisposes to the risk of malignant ventricular arrhythmias and can cause sudden death in young adults with structurally healthy hearts. Currently the main treatment consists in the implantation of the defibrillator (ICD) but new therapeutic profiles emerge from the literature.

Objective

To redefine the recommendations on early diagnosis and treatment of brs (Brugada syndrome). Provide an overview of the orientation and new clinical pathways emerging from scientific literature

Materials and Methods

A critical review of the literature was conducted, on the major MEDLINE data bases through PUB MED, CHINAL, COCHRANE LIBRARY and Google schoolar to narrow the search we used mesh terms from the thesaurus library. RCT, meta–analysis, systematic and scoping reviews in English published in the last 5 years for a total of 31 articles

Results

we estimated an average value of brs in young subjects (between 35 and 65 years) of about 9300 cases per year (∼ 17% of the total): the causes of the phenomenon vary greatly: in older subjects the pathology is more frequently associated with arrhythmic disorders. The review identified ICD implantation as a Class 1 indication in individuals who survived cardiac arrest and had ventricular tachycardia with or without syncope. The radiofrequency ablation technique, on the other hand, involves a preliminary electrophysiological study to identify the epicardial arrhythmogenic substrate. Therefore it seems that epicardial ablation will currently serve as an adjuvant rather than a real alternative to the ICD implant

Conclusions

Currently, no drug therapy can prevent sudden death in patients with brs some drugs are very effective in reducing symptoms or treating arrhythmias induced by ICD, therefore defibrillator implantation associated with different levels of therapeutic education is recommended, Early diagnosis with radiofrequency ablation technique that actually produces a realignment of the ST tract but in fact does not reduce arrhythmogenic events from the results there are no solving techniques other than the ICD impaction. Therapeutic education is an absolutely effective tool to improve the management of ICD–carrying patients with brs.
P381 A CHALLENGING PACEMAKER IMPLANTATION IN THE PRESENCE OF A GIANT RIGHT CORONARY ANEURYSM COMPRESSING THE RIGHT ATRIUM
Authors: Maffè S , Paffoni P , Bergamasco L , Facchini E , Prenna E , Careri G , Franchetti Pardo N , Paino A , Dellavesa P
Published: May 2022

Giant coronary artery aneurysm is an uncommon disease, treated with surgerical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential haemodynamic effects and may cause problems when we need to implant a cardiac device. We present a 85–year–old patient, with a previous myocardial infarction and double coronary artery bypass graft in 1995. In 2013 he was hospitalized for heart failure and severe mitral insufficiency, with cardiac surgery indication. Preoperative coronary angiography revealed a giant right coronary aneurysm (65x75mm). The aneurysm was partially thrombosed and in close contact with the posterior sternal wall; it was decided to treat it by coil embolization in order to avoid damage during the initial stages of cardiac surgery (sternotomy and isolation of the pericardium). Subsequently, the replacement of the mitral valve with a bioprosthesis was performed without complications. In 2019 a chest CT scan, in an asymptomatic patient, showed an enlarged coronary aneurysm (85x90mm), completely thrombosed, compressing the right atrium, for which a conservative approach was maintained. The patient was hospitalized in May 2021 following 3 syncopes, with cranial trauma. The EKG shows sinus rhythm with first degree AV block and complete left bundle branch block. Chest CT confirmed the aneurysm, unchanged from 2019 (Fig 1). Transthoracic and transesophageal echocardiography confirmed compression of the mass on the right atrium, reduced to a very small cavity (Fig 2). A stress echocardiogram with dobutamine, performed to evaluate a possible hemodynamic effect of atrial compression, showed no changes in diastolic ventricular filling, arrhythmias, pressure drops, or significant symptoms. Based on these assessments, the syncopes and EKG changes, we implanted a VVIR ventricular pacemaker. The procedure was hampered by the difficulty of passing the lead through the compressed right atrium in order to reach the tricuspid plane and then enter the right ventricle; only after numerous attempts, and with the help of simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure without complications (Fig 3). This case demonstrates the usefulness of the echocardiogram, in particular contexts, in cardiac electro–stimulation procedure
P396 OUR CERTIFIED SYNCOPE UNIT EXPERIENCE; FROM DIAGNOSTIC APPROPRIATENESS TO DEVICE IMPLANTS, FROM PATIENT EDUCATION TO THE IMPACT OF THE COVID–19 PANDEMIC. REPORT ON TWO “DIFFICULT” YEARS
Authors: Scapinelli M , Boccedi M , Guerra A , Caputi A , Merighi S , Bagni E
Published: May 2022

Syncope is a frequent medical problem with an incidence of about 6.2/1000 people/year, with important impact on the patients quality of life and often difficult to diagnose and manage; in this regard, the Syncope Units certified by the Italian Group for the study of syncope were created. The following describes our experience over the last 30 months characterized by significant difficulties due to the COVID–19 pandemic. Our Syncope Unit, included in the OU of Cardiology, includes 3 doctors, 3 cardiology technicians, 2 nurses; the activity is three times a week in terms of clinic and HUTT (Head up tilt test). In 2019, 54 HUTTs were performed on patients with an average age of 67 years 50% male, with indication of vasovagal syncope (VVS) for 78% of cases, presyncope and other indications for the remaining 21%, requested by other services. The HUTT was positive for cardioinhibitory and sinus–carotid syncope with indication for Pacemaker implantation (with closed loop stimulation algorithm – CLS) for 22% of cases. In 12% of patients, an ECG–Loop recorder (ILR) was indicated, but 42% of these refused this procedure. In 2020, 32 HUTTs were performed, the same average age, with 86% indication of VVS syncope. The indication for a pacemaker implant was 15% as well as for an ILR implant. 33 to 38% of patients were educated, providing dedicated material, on the prevention of syncope. About 4% of patients refused to undergo the HUTT after the explanation of its performing modalities. The first 6 months of 2021 showed a similar trend to that of 2019. The data show a good appropriateness of the indications to the HUTT and a subsequent PM implantation rate similar to the data available in the literature. The device with CLS has shown benefits in reducing syncopal recurrences at 6 months by over 25%; only 3% of the ILRs were followed by PM implantation. The HUTT, despite of low sensitivity and specificity, is confirmed as a valid VVS characterization tool but sometimes the patient frightened by its performing methods. The COVID–19 pandemic significantly impacted our activity, related to the outpatient in office activities stop and to the shift of operators in COVID areas. We had a 40% reduction in visits and HUTTs performed with consequent missed and/or delayed diagnoses.
P416 A NOT–SO–RARE COMPLICATION OF CONNECTIVE TISSUE DISEASE
Authors: Bonadies D , Palumbo R , La Manna M , Santopietro M , Sorvillo G , Visco V , Vigorito F , Ciccarelli M , Galasso G , Vecchione C , Soriente L
Published: May 2022

Pulmonary hypertension is a not–so–rare complication of connective tissue diseases and is usually related with an inauspicious prognosis.We present the case of a 67–years–old woman hospitalized for progressive dyspnea. Two–dimensional echocardiography showed numerous features related to pulmonary hypertension (PH) with moderate Mitral Regurgitation. The right cardiac catheterization confirmed mixed PH (pre and post capillary) without chest angio–TC evidence of pulmonary thromboembolism. Thanks to optimized medical therapy (B–Blocker, ACE–i and diuretics), there was a significant clinical improvement documented at discharge. After 1 year, due to recurrence of dyspnea, she was admitted to our medical unit. Her clinical examination showed some of the characteristics of a connective tissue disease. Compared to previous echocardiography, a moderate to mild reduction of MR was documented. Chest CT scan revealed interstitial lung disease likely related to patient’s underlying pathology. Immunological screening tests detected the presence of antinuclear (ANA) and anti–topoisomerase (ATA) antibodies. Right heart catheterization documented a worsening of PH with only pre–capillary component. On the basis of the above findings, a diagnosis of CREST syndrome complicated with PH was made, and the patient was started on oral combination of macitentan and riociguat. The frequency of this complication in connective tissue disease, the need for screening tests and different treatment approaches of pre and post capillary pulmonary hypertension is discussed.
P418 CARDIOMETABOLIC ALTERATIONS IN OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Giofrè F , Arturi F , Ventura M , Pelle M , Cloro C , Zaffina I , Forte V , Lucà S , Melina M , Clausi C , Sciacqua A , Arturi F
Published: May 2022

Background

Obesity and Obstructive Sleep Apnea Syndrome (OSAS) has been recognized as two of the major cardiac risk factors and they often coexist in one patient. OSAS increase the risk of as myocardial infarction, heart failure and arrhythmias. On the other hand, obesity is and independent predictor of cardiovascular mortality since it causes insulin resistance, dyslipidemia, sympathetic hyperactivation, chronic inflammation and endothelial dysfunction.

Aim

To evaluate cardiometabolic profile, echocardiographic alterations and the presence of arrhythmias in obese patients with Obstructive Sleep Apnea Syndrome and non obese patients.

Patients and Methods

67 obese patients (37 male/30 female) and 52 non obese patients (40 male/12 female) were enrolled. All subjects underwent anthropometrical evaluation and a venous blood sample for biochemical and hormonal determinations including fasting plasma glucose, fasting plasma insulin, Hba1c and OGTT to 5 hours. The insulin resistance was evaluated by HOMA–IR. All the patients underwent echocardiographic examination, polysomnographic evaluation, in order to diagnose the OSAS, and a simultaneous 12–lead Holter ECG to evaluate the presence of nocturnal arrhythmias.

Results

As expected, we found a better antropometrics profile in non obese patients. Obese patients display a severe OSAS compared to non–obese patient as shown by higher values of AHI (26.37 ±24.95 vs 16.58 ±14.07; P < 0.05), TC90 (19.61 ±24.45 vs 8.63 ±17.80; P < 0.05) and ODI (40.55 ±27.41 vs 21.06 ±22.78; P < 0,05). In obese patients we also found a significant reduction of both ejection fraction (55.54 ±7.97 vs 66.52 ±8.95; P < 0.05) and A–wave (0.75 ±0.17 vs 0.83 ±0.19; P < 0.05). In 20% of obese patients, 12–lead Holter ECG showed the presence of cardiac pause > 3 sec during apnea. In obese population alone we demonstrated a significant negative correlation between AHI and E–wave (r= –0.3; P = 0.04) and a positive correlation with interventricular septum (r = 0.38; P = 0.01) and left ventricular mass (r = 0.32; P = 0.02). Post–hoc analysis shown how these findings maintained statistical significance even when the obese patients were stratified in subgroups according to the severity of OSAS.

Conclusions

Our data, even if preliminary, seem to indicate that OSAS is not only linked to obesity but it also acts as a negative factor on the cardiometabolic risk.
Diagnostic value of Peguero Lo Presti Electrocardiografic Index for diagnosis of Left Ventricle Hypertrophy in correlation with cardiovascular magnetic resonance
Authors: Sanchez Contreras C , Sierra Fernandez CR , Mendoza Gonzalez CA , Zavala Garcia G , Garcia Arias M R
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The gold standard for the diagnosis of left ventricular hypertrophy is cardiac magnetic resonance (CMR). Nonetheless, electrocardiogram is the most widely used screening test due to convenience, availability and low cost. There are more than 35 electrocardiographic indices to diagnose left ventricular hypertrophy among them stand out: Cornell, Sokolow-Lyon and the Index of Peguero- Lo Presti.

Methods

Retrospective cohort study that included 190 cardiovascular patients from January 2015 to December 2019 in a National Cardiology Center. We described demographic and electrocardiographic indices and correlate them with CMR information. A bivariate analysis was performed with association tests as Pearson, Chi square and Fisher’s exact 2x2 test.

Results

Our population included predominantly males (64.6%), with median age of 52 years, ischemic heart disease (74%), diabetes mellitus 2 (74%), dyslipidemia (67.9%), valvular heart disease (62.6%) and hypertension (51.6%.). Ventricular mass average140 grams, with a mean LVEF 52%. Electrocardiographic indices: Peguero Lo-Presti (75.3%) positive for left ventricular hypertrophy, Cornell Index ( 51.6%), Sokolow index (41.1%), RaVL (27.9%) and RDI (21.1%). Quantitative analysis: Peguero Lo-Presti index average 35.1 mm, Sokolow index: 30.9 mm, Cornel index: 25 mm. The most sensitive criteria to determine left ventricular hypertrophy was Peguero Lo-Presti 59.3% (95 CI 41.4% - 55.5%), followed by Cornell 51.6% (95% CI 44.5% - 58.6%), Sokolow Lyon 41.1% (95% CI34.3% to 48.2%).

Conclusion

Peguero- Lo Presti criteria are more sensitive than other electrocardiographic criteria for the diagnosis of left ventricular hypertrophy
Association between excessive supraventricular ectopic activity and future diagnosis of atrial fibrillation in patients with cryptogenic stroke
Authors: Gogos C , Zarvalis E , Pantelidis P , Davora F , Karakanas A , Pitetzis D , Moschovidis V , Kantartzi V , Stamatiadis N , Stamos K , Sachpekidis V , Deretzi G , Rudolf J , Styliadis I
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The relationship between the excessive supraventricular ectopic activity (ESVEA) and the subclinical atrial fibrillation (AF) in patients with cryptogenic stroke is yet not fully understood.

Purpose

The aim of this study is to examine the prognostic significance of ESVEA for the development of AF in those patients.

Methods

The study retrospectively included 124patients, hospitalized for a cryptogenic stroke between 2014 and 2015. Twenty-four hour inpatient Holter monitoring, was used to define ESVEA as the presence of ≥20 premature atrial complexes per hour (PACs/h), along with a duration of the longest run of supraventricular tachycardia (LSVR) ≥5 seconds. After approximately 5 years of follow-up, the patients were examined for AF.

Results

The remaining 111 patients(12 died and 1 was lost during follow-up) had a median age of 56 and 13 (11.71%) of them were diagnosed with AF (AF patients). The median value of CHA2DS2-VASc score was 3 and was similar for the two groups (p=0.252). Patients with AF had a significantly higher number of PACs/h and a longer duration of LSVR compared to nonAF patients (16.67 vs. 0.21, p<0.001 and 3 vs. 0 seconds, p<0.001, respectively). The existence of ESVEA was also significantly more prevalent among the AF patients (46.15%, 95% CI: 17.78% - 74.22%) compared to non-AF ones (6.1%, 95% CI: 1.3% - 10.7%, p<0.001). ROC analysis revealed the high diagnostic test accuracy of both PACs/h and LSVR for AF. The area under the curve was 97.2% (p<0.001) for PACs/h and 81.1% (p<0.001) for LSVR.

Conclusions

Excessive atrial ectopy, detected with 24h inpatient Holter monitoring, is a significant indicator of future development of AF, in patients presenting originally with a cryptogenic stroke.
Low-level vagus nerve stimulation during cardiac surgery: smart neuromodulation
Authors: Zwijnenburg RD , Kharbanda RK , Van Schie MS , Van Der Does WFB , Knops P , Taverne YJHJ , Bogers AJJC , De Groot NMS
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): CVON-AFFIP Dutch Heart Foundation

Objective

The goal of this study is to unravel the anti-arrhythmogenic effects of low-level vagus nerve stimulation (LL-VNS) by performing high-resolution and high-density epicardial mapping studies before and after transcutaneous LL-VNS in patients undergoing primary cardiac surgery.

Background

Vagus nerve stimulation has pro-arrhythmogenic and anti-arrhythmogenic properties. LL-VNS has been proven to reduce AF incidence and burden, but the anti-arrhythmogenic effect of LL-VNS remains largely unexplored thereby hampering clinical implementation and optimal patient selection.

Methods

10 patients (90% male, age 75±6 years) undergoing coronary artery bypass surgery (CABG) were included in this study. Epicardial sinus rhythm mapping of the right atrium and Bachmann’s bundle (BB) was performed prior, after acute- and chronic transcutaneous LL-VNS.

Results

LL-VNS did not result in any significant changes in potential fractionation, conduction block, conduction velocity or voltage. Potential duration prolonged from 37.5 [31.0-56.0] ms to 48 [36.0-50.0] ms during acute (p=0.002) and 52.5 [45.8-61.0] ms during chronic LL-VNS (p=0.007).

Conclusions

This is the first epicardial mapping study in humans investigating the effect of LL-VNS on atrial conduction. Compared to no LL-VNS, acute and chronic LL-VNS prolonged potential duration significantly.
Sex differences in atrial electrical properties
Authors: Giammarino L , Hof T , Nimani S , Alerni N , Matas L , Odening KE
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Heart Foundation

Background

Pronounced sex differences are known in the incidence and recurrence rates of atrial fibrillation (AF). In general, men carry a higher risk for AF - particularly at younger age - during which women are protected.

Purpose

In this project, we aimed to investigate electrophysiological properties of the atria that may underlie sex differences in AF development in the younger population.

Methods

First, we assessed sex differences in P-wave morphology (duration: PWD; area: PWA, amplitude) in 12-lead ECG in healthy volunteers (men 31.3±1.6 y, n=10; women 29.8±1.6 y, n=10) and wildtype (WT) rabbits (3-6 months, males n=12, females n=15). We investigated sex differences in atrial action potential (AP) in WT rabbits of both sexes using sharp electrode recording technique (males n=5, females n=6). To elucidate underlying mechanisms, sex differences on atrial inwardly rectifying potassium current IK1 at 37°C were evaluated using whole-cell patch-clamp technique in isolated atrial rabbit cardiomyocytes; to evaluate the long-term effect of sex hormones on IK1, we incubated the isolated cardiomyocytes for 24h with 3 or 10µM of 17β-estradiol (EST) or of dihydrotestosterone (DHT).

Results

Analyzing ECG parameters (figure 1), we observed a prolonged PWD and an increased PWA both in healthy men (p<0.0001) and in male rabbits (p<0.0001) as compared to healthy women or female rabbits, which may theoretically be due to a slower conduction velocity or longer AP duration in males. Intracellular AP recordings (figure 2A) showed a more negative atrial resting membrane potential (RMP, males -83.07±0.3mV vs. females -74.33±2.6mV, p<0.05) and a prolonged atrial AP duration (APD10, 18.20±3.6ms vs. 10.06±1.9ms, p=0.06; APD50, 36.60±6.6ms vs. 20.06±1.9ms, p<0.05; APD90, 91.00±10.3ms vs. 74.00±4.0ms, p=0.13) in males as compared to females. As highlighted in figure 2B, male atrial cardiomoycytes had smaller IK1 current densities, which could be due to high DHT concentration; in line with these findings (figure 2C) 24h DHT incubation of atrial cardiomyocytes from females reduced IK1, mimicking the sex differences observed.

Conclusions

Sex impacts on atrial electrophysiology, resulting in sex differences in P-wave morphology, AP parameters and ionic current densities. Delayed (early) repolarization in males may be causatively linked to the observed changes in P-wave morphology. The reduction of IK1 observed in males may be due to testosterone, since this reduction was observed even in female cardiomyocytes when incubated with DHT.
Recurrent variant of unknown significance in KCNH2 classified through functional characterisation
Authors: Copier JS , Bootsma M , Wilde AAM , Bertels RA , Bikker H , Christiaans I , Koopmann TT , Lommerse AAJ , Bezzina CR , Verkerk AO , Barge-Schaapveld DQCM , Lodder EM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO Talent Scheme)

Background

Variants in KCNH2, the gene encoding the hERG channel and responsible for the cardiac rapid delayed rectifier K+ current (IKr), have been linked to Long QT Syndrome type 2 (LQTS2). The KCNH2-p.S906L variant has been found in eight, small unrelated families with variable clinical pictures and incomplete penetrance of LQTS2.

Purpose

Due to the small size of the families, co-segregation analysis is limited. Functional studies were performed to evaluate the effect of the variant on channel functionality. Thereby assessing if KCNH2-p.S906L leads to functional changes explanatory for the phenotype.

Methods

Clinical data of the patients and family members were collected thereby, creating an overview of the phenotype. The biophysiological properties of the hERG channel were assessed by manual whole-cell patch-clamp, using HEK293a cells expressing (i) the wild type (WT) KCNH2, (ii) KCNH2-p.S906L alone (homozygous, hm) or KCNH2-p.S906L in combination with WT (heterozygous, Hz).

Results

Assessment of the clinical data of the patients and family members shows an incomplete and low penetrance of the LQTS2. All carriers were heterozygous for the variant. In carriers of the KCNH2-p.S906L variant, LQTS2 severity was very variable, ranging from asymptomatic, to life-threatening arrhythmic events. The KCNH2-p.S906L variant reduced current density in a dosage-dependent manner compared to KCNH2-WT. The current density was reduced by 63, and 54% in KCNH2-p.S906L-Hm and KCNH2-p.S906L-Hz, respectively. Changes in gating properties were absent, except for activation kinetics in KCNH2-p.S906L-Hm. In these cells, an increase in the time constant, and a positive shift in voltage dependency of activation were observed.

Conclusions

Both the reduced current density and changes in activation kinetics suggest the variant to result in a moderate loss-of-function of the hERG channel, fitting with the observed LQTS2. These observed functional changes in hERG combined with the reduced penetrance in the affected individuals suggest that this variant in KCNH2 is a risk factor for LQTS2.
Additional features in Brugada Syndrome stratification: frequent PVC and QRS duration
Authors: Couto Pereira S , Brito J , Silverio Antonio P , Velente Silva B , Alves Da Silva P , Simoes De Oliveira C , Garcia B , Lima Da Silva G , Carpinteiro L , Cortez-Dias N , Pinto FJ , De Sousa J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Brugada syndrome (BrS) is a channelopathy with high prevalence of malignant arrhythmic events. The risk stratification in patients (pts) with Brugada electrocardiographic (ECG) pattern is of major importance, to prevent sudden cardiac death (SCD). A higher risk is evidenced in spontaneous type 1 pattern when compared with induced type-1 pattern, as so other electrocardiographic features have been explored aiming to detect additional prognostic factors.

Purpose

To evaluate the association of QRS duration and frequent premature ventricular contractions (PVC) with malignant arrhythmic events.

Methods

Prospective single-center study of consecutive pts with BrS, with spontaneous or induced type 1 pattern included from 2003 to 2021. All pts were enrolled in a protocol including annual non-invasive assessment with ECG and 24-hours Holter monitoring. Primary endpoints were defined as SCD or appropriate shocks in the context of ventricular tachycardia or fibrillation (VT/FV) during follow-up. Cox regression and Kaplan-Meier survival analyses were used to determine the association between the baseline ECG and Holter characteristics and the long-term risk of arrhythmic events.

Results

A total of 117 pts was included, 75 (65%) with a spontaneous type 1 pattern and 44 (33%) with an induced type 1 pattern. The mean age was 47±13years and 38 (32.5%) were male.

During a median follow-up of 4.1±0.3 years, the primary endpoint occurred in 8 (6.8%) pts, with sudden cardiac death in 3 (2.6%) and appropriate shocks due to VT/FV in 5 (4.3%). Pts who suffered arrhythmic events had presented at the study inclusion higher QRS duration (124±18 vs. 108±16ms, p= 0.014) and more frequent PVCs on 24-hour Holter (169±297 vs. 29±198; p = 0.001) - Figure 1. Indeed, the presence of QRS ≥119ms was associated with a 7-fold higher risk (HR: 7.250, 95% CI 1.619-32.461, p = 0.010) and the presence of more than 6 PVC on 24-hour Holter was also associated with a 5-fold higher risk of malignant arrhythmic events (HR 5.376, 95% 1.186-24.260, p = 0.029).

Conclusion

QRS duration and frequent PVC may established themselves as additional risk factors. In our cohort, they were both predictors of arrhythmic events during follow-up and thus can further complement BrS risk stratification.
Comparison of 24-hour holter monitoring with wire-free, single lead ECG patch monitor in the diagnosis of cardiac rhythm abnormalities
Authors: Saggu D , Devidutta S , Yalagudri S , Bhogu A , Bhogu R , Narasimhan C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Monitra Healthcare Private Limited

Aim

There is increasing interest in the development of small, portable ECG patch devices to overcome the cost, patient inconvenience and relatively low diagnostic yield of the ‘gold standard’ Holter monitoring in arrhythmia detection. One such portable device, (study device), is a small, wire-free, adhesive, water-resistant single lead ECG monitoring patch with 24 bit sensor resolution for better p wave capture. The aim of this study was to assess its diagnostic utility compared to standard Holter monitor.

Methods

A prospective comparison of the study device with the standard Holter monitor (EASI full 12 lead ECG analysis using five electrodes) was done on 37 consecutive patients undergoing 24-hour Holter monitoring. All patients received both the study device and Holter monitor concurrently for 24 hours, and outcomes assessed. Each patient served as a control for themselves. The Holter and study device reports were read by two electrophysiologists blinded to the reports of the other corresponding test. The primary outcome was to compare the detection of arrhythmia and conduction disorders over total wear time for both devices. The matched pairs of data from the two devices were compared using McNemar’s test.

Results

Over the total wear time of both devices, the study device detected 75 arrhythmias and conduction disturbances compared to 67 by Holter monitor (P=0.02). The diagnostic yield of arrhythmia and conduction disorders by study device and Holter is given in the table.

Conclusions

The study device ECG patch monitor is comparable to 24-hour Holter monitor. The study device with its 24 bit sensor resolution for better p wave capture resulted in a higher diagnostic yield than the standard 24-hour Holter monitor in the detection of arrhythmias and conduction disorders.

Limitation: This is a single centre pilot study on a small sample size. The findings need to be confirmed on a multicenter larger sample size.
A cardiac magnetic resonance myocardial strain patterns analysis in left bundle branch block
Authors: Santos M , Silva M , Guerreiro S , Gomes D , Rocha B , Cunha G , Freitas P , Abecasis J , Carmo P , Cavaco D , Morgado F , Adragao P , Mendes M , Ferreira A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Recently, a classification with four types of septal longitudinal strain patterns was described using a speckle tracking based strain analysis in echocardiography suggesting pathophysiological continuum of LBBB-induced LV remodeling. Little data exist on feature tracking cardiac magnetic resonance (FT-CMR) in LBBB patients, and whether such patterns could be reproduced in CMR is not established yet.

Purpose

In this study, we aimed to: 1) Assess and reproduce the new strain patterns classification by CMR and 2) Evaluate its association with LV remodeling and myocardial scar in a LBBB cohort.

Methods

Single center registry which included LBBB patients with septal flash (SF) referred to CMR to assess the structural cause of LV dysfunction. LBBB was defined according to Strauss criteria as strict LBBB, non-strict LBBB or nonspecific LV conduction delay.

A semi-automated FT-CMR was used to quantify myocardial strain and detect the four septal longitudinal and radial strain patterns, according to the recent classification (LBBB-1 through LBBB-4) – Figure. Extent of SF was visually scored as mild, moderate, or prominent.

Results

A total of 115 patients were included (mean age 66±11 years; 57% men; 38% with ischemic heart disease). Median duration of QRS was 150± 26ms and majority of the patients (n=90, 78%) were classified as strict LBBB.

In longitudinal strain analyses LBBB-1 was observed in 23 (20%), LBBB-2 in 37 (32.1%), LBBB-3 in 25 (21.7%), and LBBB-4 in 30 (26%) patients. Patients at higher LBBB stages (longitudinal or radial pattern) had more prominent septal flash, greater LV volumes, lower LV ejection fraction and lower absolute global longitudinal, circumferential and radial strain values compared with patients in less advanced stages (p < 0.05 for all) - table.

There was no difference between patterns in clinical characteristics, ischemic etiology, QRS duration and time delay between septal and lateral LV wall.

Late gadolinium enhancement (LGE) was found in 63 patients (54.8%), with a septal location in 34 (29.6%) patients, lateral in 4 (3.5%) patients, septal and lateral in 11 (9.6%) patients. Furthermore, no difference was found for LGE presence, distribution or location between the four strain patterns.

Conclusions

Among patients with LBBB, our study found a good association between longitudinal and radial strain patterns with the degree of LV remodeling and LV dysfunction by FT-CMR analysis. Additionally, myocardial fibrosis didn’t seem to interfere with the staged LBBB classification.
Endocardial and epicardial ECG imaging during sinus rhythm to detect local conduction delay in arrhythmogenic cardiomyopathy
Authors: Boonstra MJ , Te Riele ASJM , Roudijk RW , Kloosterman M , Asselbergs FW , Van Dam PM , Loh P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

Introduction

We recently optimized our ECG imaging (ECGi) method for the estimation of endo- and epicardial activation during sinus rhythm. In patients with arrhythmogenic cardiomyopathy, late gadolinium enhancement (LGE)-CMR can identify regional myocardial injury and the combination of structural and electrical information may provide valuable insight in disease progression and risk stratification. However, the effect of structural disease and local conduction delay on the ECGi estimation of ventricular activation has not been studied.

Purpose

Evaluate the relation between LGE-CMR and non-invasively estimated local conduction velocity (CV).

Methods

8 pathogenic mutation carriers (PKP2/PLN) underwent LGE-CMR for clinical follow up and 67 lead body surface mapping. Subject specific triangulated surface heart/torso/lung meshes were created. ECGi activation sequences were used to determine local CV with the triangulation method. The LGE location was identified according to the AHA 17 segment model. Per segment, variation in CV was computed and local activation timing maps and CV maps were constructed.

Results

Isochronal crowding was observed in subjects in segments with LGE (figure, red boxes) and locally, conduction velocity decreased. Variation in conduction velocity per segment in subjects with extensive LGE presence (>9 segments) was higher 0.031±0.018 vs. 0.026±0.013 m/s/cm2 in subjects without.

Conclusion

Our preliminary results indicate the ability of the ECGi method to identify regions with higher variation in local CV. This increase in CV variability might be used to assess the vulnerability to cardiac arrhythmia. Analysis will be extended towards the RV and subsequently, more subjects will be included.