bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review on MX2 (M = Mo, W and X = S, Se) layered material for opto-electronic devices
Authors: Sharma Rohit , Laishram Radhapiyari , Gupta Bipin Kumar , Srivastva Ritu , Sinha Om Prakash
Published: May 2022

After discovering the steppingstone of two-dimensional (2D) materials, i.e. graphene, researchers are keen to explore the world of 2D materials beyond graphene for new frontiers and challenges. Due to bandgap limitation, graphene does not fit for the logic and optoelectronic applications which need well defined on/off ratio. Recently, single-layer (SL) and few-layer (FL) transition metal dichalcogenides have emerged as a new family of layered materials with great interest, not only for the fundamental point of view, but also due to its potential application in ultrathin modern devices. As the transition metal dichalcogenides (TMDs) have a direct bandgap in their single layer, which falls under the visible region of the electromagnetic spectrum and has better physical and chemical properties, making them a suitable candidate for logic and optoelectronic applications. This review includes the recent extensive development on the synthesis and transfer strategies of MX2 (M = Mo, W and X = S, Se) 2D nanostructures of semiconducting TMDs. Further, this review covers the electronic and optoelectronic applications of these nanostructures along with progress in Van der Waal structures. The advantage and unambiguity of these materials are also discussed.
Pile-up mitigation using attention
Authors: Maier B , Narayanan S M , de Castro G , Goncharov M , Paus Ch , Schott M
Published: May 2022

Particle production from secondary proton-proton collisions, commonly referred to as pile-up, impair the sensitivity of both new physics searches and precision measurements at large hadron collider (LHC) experiments. We propose a novel algorithm, Puma, for modeling pile-up with the help of deep neural networks based on sparse transformers. These attention mechanisms were developed for natural language processing but have become popular in other applications. In a realistic detector simulation, our method outperforms classical benchmark algorithms for pile-up mitigation in key observables. It provides a perspective for mitigating the effects of pile-up in the high luminosity era of the LHC, where up to 200 proton-proton collisions are expected to occur simultaneously.
Correction to “A finite basis theorem for difference-term varieties with a finite residual bound”
Authors: Kearnes Keith , Szendrei Ágnes , Willard Ross
Published: May 2022

There is a gap in our proof [Trans. Amer. Math. Soc. 368 (2016), pp. 2115–2143, Lemma 6.2]. We direct readers to a paper that fills the gap.
Arterial myeloperoxidase in the detection and treatment of vulnerable atherosclerotic plaque: a new dawn for an old light
Authors: Nadel James , Jabbour Andrew , Stocker Roland
Published: May 2022

Intracellular myeloperoxidase (MPO) plays a specific role in the innate immune response; however, upon release into the extracellular space in the setting of inflammation, drives oxidative tissue injury. Extracellular MPO has recently been shown to be abundant in unstable atheroma and causally linked to plaque destabilization, erosion, and rupture, identifying it as a potential target for the surveillance and treatment of vulnerable atherosclerosis. Through the compartmentalization of MPO’s protective and deleterious effects, extracellular MPO can be selectively detected using non-invasive molecular imaging and targeted by burgeoning pharmacotherapies. Given its causal relationship to plaque destabilization coupled with an ability to preserve its beneficial properties, MPO is potentially a superior translational inflammatory target compared with other immunomodulatory therapies and imaging biomarkers utilized to date. This review explores the role of MPO in plaque destabilization and provides insights into how it can be harnessed in the management of patients with vulnerable atherosclerotic plaque.
Myeloid CD40 deficiency reduces atherosclerosis by impairing macrophages’ transition into a pro-inflammatory state
Authors: Bosmans Laura A , van Tiel Claudia M , Aarts Suzanne A B M , Willemsen Lisa , Baardman Jeroen , van Os Bram W , Toom Myrthe den , Beckers Linda , Ahern David J , Levels Johannes H M , Jongejan Aldo , Moerland Perry D , Verberk Sanne G S , den Bossche Jan van , de Winther Menno M P J , Weber Christian , Atzler Dorothee , Monaco Claudia , Gerdes Norbert , Shami Annelie , Lutgens Esther
Published: May 2022

Aims

CD40 and its ligand, CD40L, play a critical role in driving atherosclerotic plaque development. Disrupted CD40-signalling reduces experimental atherosclerosis and induces a favourable stable plaque phenotype. We recently showed that small molecule-based inhibition of CD40-tumour necrosis factor receptor associated factor-6 interactions attenuates atherosclerosis in hyperlipidaemic mice via macrophage-driven mechanisms. The present study aims to detail the function of myeloid CD40 in atherosclerosis using myeloid-specific CD40-deficient mice.

Method and Results

Cd40flox/flox and LysM-cre Cd40flox/flox mice on an Apoe−/− background were generated (CD40wt and CD40mac−/−, respectively). Atherosclerotic lesion size, as well as plaque macrophage content, was reduced in CD40mac−/− compared to CD40wt mice, and their plaques displayed a reduction in necrotic core size. Transcriptomics analysis of the CD40mac−/− atherosclerotic aorta revealed downregulated pathways of immune pathways and inflammatory responses. Loss of CD40 in macrophages changed the representation of aortic macrophage subsets. Mass cytometry analysis revealed a higher content of a subset of alternative or resident-like CD206+CD209b− macrophages in the atherosclerotic aorta of CD40mac−/− compared to CD40wt mice. RNA-sequencing of bone marrow-derived macrophages of CD40mac−/− mice demonstrated upregulation of genes associated with alternatively activated macrophages (including Folr2, Thbs1, Sdc1, and Tns1).

Conclusions

We here show that absence of CD40 signalling in myeloid cells reduces atherosclerosis and limits systemic inflammation by preventing a shift in macrophage polarization towards pro-inflammatory states. Our study confirms the merit of macrophage-targeted inhibition of CD40 as a valuable therapeutic strategy to combat atherosclerosis.
Clinical experience with dual pathway inhibition therapy: case series and mini review
Authors: Geisler Tobias , Branch Kelley , Nikol Sigrid
Published: May 2022

Background

Dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice daily plus aspirin has demonstrated reductions in major adverse cardiovascular and limb events in eligible patients with chronic coronary artery disease (CAD), peripheral artery disease, or both. Patients with polyvascular disease, heart failure, renal impairment, or diabetes can benefit particularly from this therapy. We present our clinical experience to elucidate practical issues regarding the selection of patients eligible for DPI and the timing of initiation.

Case summary

The first patient was at high risk of recurrent cardiovascular events due to his history of multi-vessel CAD, myocardial infarction, heart failure, and diabetes. Following a period of post-myocardial infarction dual antiplatelet therapy, he was transitioned to DPI therapy. The second patient was at high risk of cardiovascular events due to his history of polyvascular disease, diffuse CAD, and diabetes. He was hospitalized for unstable angina, which was medically managed because no target lesion was identified. DPI was initiated a day after admission. The third patient was at high risk of cardiovascular events due to an extensive history of polyvascular disease, revascularization, and renal impairment. Although the patient was asymptomatic at routine follow-up, DPI was initiated to reduce the risk of further cardiovascular events.

Discussion

In eligible patients who are at high risk of cardiovascular events, DPI therapy with low-dose rivaroxaban should be considered. Treatment can be started at various times, including at the end of dual antiplatelet therapy, at routine follow-up, or after new events or diagnoses.
C49 SACUBITRIL–VALSARTAN IMPROVES LONGITUDINAL STRAIN AND EJECTION FRACTION IN MICE TREATED WITH DOXORUBICIN THROUGH NLRP3, MYD88 PATHWAYS RESULTING IN A REDUCTION OF MYOCARDIAL IL–1Β, IL–6, TNF–Α, G–CSF AND GM–CSF LEVELS
Authors: Quagliariello V , Iovine M , Buccolo S , Paccone A , Maurea N
Published: May 2022

Introduction

Doxorubicin–mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sacubitril–valsartan (LCZ 696) is a combination drug, made up of neprilysin inhibitor sacubitril and angiotensin II receptor blocker valsartan, used for the treatment of heart failure in patients with a reduced ejection fraction.

Purpose

We hypothesized that LCZ 696, administered during doxorubicin, could improve cardiac function and cardiac inflammation in preclinical models Methods Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of doxorubicin (200 nM) alone or in combination with LCZ–696 (100 mM) for 72 h. After the incubation period, we performed the following tests: cell viability, apoptosis and necrosis; expression of malondialdehyde and 4–hydroxynonenal and concentration of intracellular Ca2+. Moreover, pro–inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of TLR4/MyD88; mTORC1 Fox01/3a; NF–κB). C57Bl/6 mice were untreated (Sham, n = 6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n = 6), LCZ–696 at 60 mg/kg (LCZ, n = 6) or doxorubicin combined to LCZ–696 (DOXO–LCZ, n = 6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd88, NF–kB and 13 chemokines (IL–1α, IL–1β, IL–2, IL–4, IL–6, IL–10, IL–12, IL17–α, IL–18, IFN–γ, TNF–α, G–CSF, and GM–CSF) were quantified.

Results

LCZ–696 exerts cardioprotective effects, enhancing cell viability of 48–54.6% compared to only doxorubicin–treated cells (p < 0,001 for all); LCZ 696 decreased NLRP3, MyD88 and NF–kB expression in cardiac cells. In preclinical study, LCZ 696 improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of NLRP3, MyD88 and NF–kB in cardiac tissues was seen in DOXO–LCZ group compared to DOXO mice (p < 0.001). Cardiac expression of IL–1β, IL–6, TNF–α, G–CSF and GM–CSF were significantly reduced after treatment with LCZ–696 indicating anti–inflammatory properties.

Conclusion

LCZ–696 exerts direct beneficial effects in cardiomyocytes exposed to doxorubicin. In preclinical models, LCZ–696 reduced inflammation and cytokine expression involved in doxorubicin–mediated cardiotoxicity.
C50 CARDIO–ONCO–HAEMATOLOGY IN CLINICAL PRACTICE. A “CHANGELING” CASE: MORE THAN PARADOXICAL BUBBLES
Authors: Bisceglia I , Mistrulli R , Cartoni D , Buffa V , Battistini R , Proia A , Rigacci L , Petrolati S
Published: May 2022

39–year–old female, without cardiovascular risk factors. At the end of pregnancy she complained of progressive dyspnoea and so she was admitted to the emergency room. Blood tests showed elevated D–dimer and LDH values. A chest CT scan was performed showing a mediastinal mass of about 15 cm encompassing the ascending aorta, the left brachiocephalic trunk and the superior vena cava, both of which appeared thrombosed. Therapy with low molecular weight heparin was started. The patient underwent a mediastinal biopsy, which documented a primary mediastinal non–Hodgkin‘s lymphoma. The baseline cardiological evaluation showed a preserved ejection fraction (60%) at echocardiogram (ECHO). The first cycle of chemotherapy with R–CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine) was started. After an episode of hypoesthesia of the left upper limb, that regressed spontaneously within a few hours, she performed MRI that showed multiple areolas compatible with ischemic disease. Following these results the patient was submitted to an ECHO with saline solution injected through the right brachial vein that documented evidence of early opacification of the left atrium and subsequent opacification of the right sections (after 3 cardiac cycles) (Fig. 1–2). This finding suggested a right–to–left shunting, via the bronchial lower district to the left atrium (pulmonary veins). This suspicion was confirmed by CT angiography, which showed occlusion of the superior vena cava with passage of contrast into azygos and early opacification of peribronchial venous circles (Fig. 3). A patency of foramen ovale was ruled out by injection of saline solution through the femoral vein. After the second cycle of chemotherapy, ECHO showed diffuse hypokinesia and reduced EF to 50%. It was then decided to proceed with the third cycle according to the intensified R–DAEPOCH scheme, except for doxorubicin, because of the cardiotoxicity developed by the patient. A cardioprotective therapy was also started with bisoprolol and ramipril with rapid titration. At subsequent radiological controls, a progressive reduction of the mediastinal mass was found and after just one month, the echocardiogram showed a complete recovery of the EF. Contrast injection confirmed presence of a veno–venous shunt. Cardio–oncology is an intriguing and complex discipline that requires the development of local multidisciplinary teams for challenging situations that patients with cancer may ask us to address.
C69 EFFECTIVENESS AND SAFETY OF DISTINCT ANTIPLATELET REGIMENS AFTER TRANSCATHETER LEFT ATRIALE APPENDAGE OCCLUSION: A SINGLE CENTER REAL–WORLD EXPERIENCE
Authors: Gurgoglione F , Barocelli F , Vignali L , Maini A , Solinas E , Tadonio I , Benatti G , Coli S , Pelà G , Grassi F , Lina D , Niccoli G , Cattabiani M
Published: May 2022

Transcatheter left atrial appendage occlusion (LAAO) has emerged as a reliable tool to prevent thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation (AF) in the absence of mitral stenosis/valve prosthesis and contraindication to oral anticoagulation (OAC). Antiplatelet therapy (APT) is required after device implantation to prevent device–related thrombus (DRT). Previous studies provided conflicting results on the optimal APT regimen after LAAO. Thus, herein we aimed at assessing the comparative effectiveness and safety of distinct APT regimens. We conducted a real–world single–center observational study including consecutive AF patients that underwent LAAO at the University Hospital of Parma between October 2010 and June 2021. Clinical follow–up included all successfully implanted patients. Primary endpoint was net efficacy outcome, a composite of any ischemic or hemorrhagic event. Secondary endpoints were ischemic (any of the following: ischemic stroke, transient ischemic attack [TIA], DRT, systemic embolism) and hemorrhagic (major [≥3] bleedings according to Bleeding Academic Research Consortium [BARC] classification) complications alone. We enrolled a total of 130 patients (median age 77.0 [72.7;81.0] years; 78 [60.0%] men). History of hemorrhagic stroke in OAC (74 [56.9%]) was the main indication for LAAO. Technical procedure success was achieved in 123 (94.6%) patients. According to multidisciplinary team evaluation, immediately after LAAO, 39 (31.7%) patients received short (≤ 1 month)–dual APT (DAPT) consisting of cardioaspirin and clopidogrel, 35 (28.5%) long (>1, ≤12 months)–DAPT and 49 (39.8%) single APT (SAPT). At a median follow–up of 32 months, the incidence of primary endpoint was significantly lower in short–DAPT group (3 [7.7%] vs. 7 [20.0%] in long–DAPT vs. 14 [28.6%] in SAPT, p = 0.049], mainly driven by a lower occurrence of bleeding endpoint (0 [0.0] vs. 4 [11.4%] in long–DAPT vs. 9 [18.4%] in SAPT, p = 0.020) without differences in the incidence of ischemic endpoint (p = 0.916). Finally, comparison of the Kaplan–Meier curves showed that short–DAPT group had a higher primary endpoint–free survival (p = 0.015) compared to the others. In summary, our study highlighted that short (≤ 1 month)–DAPT regimen after LAAO is associated with better outcomes, mainly driven by reduction of major bleedings. Strong evidences arising from randomized trials are warranted to support these findings.
C89 A CASE OF MYOPERICARDITIS RECURRENCE AFTER THIRD DOSE OF BNT162B2 VACCINE AGAINST SARS–COV–2 IN A YOUNG SUBJECT: LINK OR CASUALITY?
Authors: Mapelli M , Amelotti N , Andreini D , Baggiano A , Campodonico J , Moltrasio M , Majocchi B , Mantegazza V , Vignati C , Ribatti V , Catto V , Sicuso R , Pontone G , Agostoni P
Published: May 2022

Background

The rate of post–vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against Sars–Cov–2, reporting a very low incidence. Although a direct cause–effect relationship has been described, in most cases the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post–vaccine disease relapse.

Case Presentation

A 27–year–old man presented to the ED for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. ECG showed a diffuse ST segment elevation and a cardiac echo showed lateral hypokinesia with preserved ejection fraction. Troponine–T was elevated (160ng/l), chest x–ray was normal, and the Sars–Cov–2 molecular buffer was negative. High–dose anti–inflammatory therapy with ibuprofen and colchicine was started; in the 3rd day high sensitivity Troponin I reached a peak (hsTnI) of 23000 ng/L. No heart failure or arrhythmias were observed. A cardiac MRI was performed showing normal biventricular systolic function, areas of LGE with non–ischemic subepicardial pattern at the level of the anterior wall with increased T2 signal, suggestive for a recurrence of myocarditis. A left ventricle electroanatomic voltage mapping was negative (both unipolar and bipolar), while the endomiocardial biopsy showed a picture consistent with active myocarditis. The patient was discharged in good shape, with normal hsTnI values on bisoprolol 1.25mg, ramipril 2.5mg, ibuprofen 600 mg three times a day, colchicine 0.5 mg twice a day. Discussion: We presented the case of a young man with history of previous myocarditis, admitted with a non–complicated acute myopericarditis relapse occurred 4 days after Sars–Cov–2 vaccination (3rd dose). Despite the observed very low incidence of cardiac complications following BNT162b2 administration, and the lack of a clear proof of a direct cause–effect relationship, we think that in our patient this link can be more than likely. In the probable need for additional Sars–Cov–2 vaccine doses in the next future, studies addressing the risk–benefit balance of this subset of patient are warranted.

Conclusion

We described a multidisciplinary management of a case of myocarditis recurrence after the third dose of Sars–Cov–2 BNT162b2 vaccine.
P9 TEMPORAL TREND OF QRS VOLTAGE AMPLITUDE ON SURFACE SENSING IN PATIENTS WITH ARRHYTHMOGENIC CARDIOMYOPATHY IMPLANTED WITH A SUBCUTANEOUS ICD
Authors: Casula M , De Toni C , Pignalosa L , Savastano S , Schintu B , Scalone A , Corda M , Vicentini A , Tola G , Rordorf R
Published: May 2022

Introduction

Previous studies have reported a significant decrease in ventricular sensing amplitude during follow–up in patients with arrhythmogenic cardiomyopathy (ACM) implanted with trans–venous implantable cardioverter defibrillator (ICD). No data are yet available on sensing amplitude values over time for subcutaneous ICD (S–ICD). Low QRS voltage on surface ECG is one of the diagnostic clues in ACM. This, together with the progressive nature of the disease and the not–negligible incidence of inappropriate shocks due to oversensing, raise safety concerns on the use of S–ICD in this population. The aim of this study was to evaluate the trend of QRS amplitude on subcutaneous ECG (S–ECG) over time in patients with ACM implanted with S–ICD.

Methods

We conducted a retrospective analysis on a cohort of consecutive patients with ACM implanted with S–ICD in two Italian tertiary centers, prospectively enrolled in the home–monitoring program. The S–ECGs recorded at the time of first and last data transmission were analyzed. The voltage amplitude was estimated for each QRS complex available, and the values obtained were compared between the two time points (i.e. baseline and last follow–up available). The primary endpoint of our study was the proportion of patients in which the decrease of QRS amplitude during follow–up was statistically significant.

Results

Eleven patients (1 female, 9%) were enrolled in this study. The mean age was 43±10 years. An exclusive right ventricular involvement was reported in 5 patients (46%), 2 patients (18%) had an exclusive left ventricular, and 4 (36%) a biventricular involvement. Three patients (27%) were implanted in secondary prevention. During a median follow–up of 9 months (IQR 6–17), 6 patients (55%, 95%CI 24–84%) experienced a statistically significant reduction in the S–ECG QRS amplitude (Fig. A). Considering these 6 patients, the mean absolute reduction was –0.46±0.32 mV corresponding to a relative reduction of –19%±11%. Moreover, we found a statistically significant correlation between follow–up duration and QRS amplitude relative reduction (r=–0.89, p = 0.018, Fig. B). No patients experienced inappropriate shocks.

Conclusions

In a cohort of ACM patients implanted with S–ICD the majority of patients experienced a significant reduction in the amplitude of QRS voltage during follow–up, confirming a potential safety concern on the use of S–ICD in this population. Further studies are needed to investigate this issue.
P16 ATRIAL FIBRILLATION INCIDENCE IN SARS–COV–2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN–HOSPITAL MORTALITY
Authors: Maloberti A , Giannattasio C , Rebora P , Occhino G , Ughi N , Rizzo J , Fabbri S , Leidi F , Cartella I , Algeri M , Scarpellini S , Rossetti C , Epis O , Molon G , Bonfanti P , Valsecchi M , Genovesi S
Published: May 2022

Background

Among the different CardioVascular (CV) manifestation of the COronaVIrus–related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in–hospital all–cause mortality.

Methods

We enrolled 3435 cases of SARS–CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all–cause in–hospital mortality were considered as outcomes.

Results

145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C–Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn’t present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all–cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)

Conclusion

AF present as the main arrhythmia in COVID–19 patients and its development during the hospitalization strongly relates with in–hospital mortality.
P18 ATRIAL FIBRILLATION IN BETA–THALASSAEMIA: PHYSIOPATHOLOGY AND CLINICAL MANAGEMENT
Authors: Clò S , Marchini F , Sirugo P , Capanni A , Malagù M , Bertini M , Guardigli G
Published: May 2022

Beta–thalassaemia is an inherited blood disorder with worldwide distribution characterized by a defective synthesis of haemoglobin. Transfusions and iron–chelation therapy have radically improved the prognosis of beta–thalassaemic patients, while also allowing the development of new chronic complications, cardiac and non–cardiac (diabetes, dystyroidism, autonomic disorders and many others), among which atrial fibrillation (AF) stands out. Prevalence of AF in patients with beta–thalassemia is dramatically higher than in general population, ranging from 2 to 33%. Studies on this topic are lacking and the scarse available evidence comes from a few observational studies. The underlying pathophysiology of AF in thalassaemic is not yet well understood; responsible mechanisms are many (Figure 1) and different from those recognized in general population. Atrial iron overload appears to be the main “risk factor”, although this arrhythmia may develop even before cardiac siderosis. Clinical presentation is early and mainly paroxysmal, and patients are highly symptomatic. Furthermore, the numerous treatments available for AF (pharmacological and interventional), extensively studied in the general population, are largely unexplored in beta–thalassemia. A specific management is required for these patients (Figure 2); in particular, rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy resides in iron–chelating drugs. Thromboembolic risk is also higher than in the general population and the choice of anticoagulant therapy should be considered early (well pondering the serious consequences of a haemorrhage in this setting), but the risk scores available for patients with AF are not validated in the beta–thalassemia.
P45 OUTCOME AFTER ACUTE TYPE A AORTIC DISSECTION: THE ROLE OF AN AORTIC TEAM AND AN AORTIC REGIONAL NETWORK
Authors: Lechiancole A , Vendramin I , Piani D , Sponga S , De Manna D , Calandruccio R , Brindicci I , Bressan M , Livi U
Published: May 2022

Background

The outcome of acute type–A aortic dissection (A–AAD) repair is strictly related both to surgical factors and patient conditions. Improvement in surgical experience and in diagnosis and treatment protocols could significantly increase survival for patients affected by A–AAD. The aim of this study was to assess the impact on patients outcomes of a standardized integrated surgical approach and of a regional aortic hub and spokes network.

Materials and Methods

From 2004 to 2021, a total of 258 patients underwent repair of A–AAD. In 2010 in our Institution was created the Aortic Team, with cardiac surgeons dedicated on the treatment of aortic pathologies, while in 2017 was created a regional aortic network between hub and spokes in order to standardize the diagnosis and treatment algorithm. Thus, patients were distributed among three periods: 2004–2010 (Era 1, n = 90), 2011–2016 (Era 2, n = 87), and 2017–2021 (Era 3, n = 81).

Results

Baseline demographic characteristics of the groups were similar. Compared to Era1 and Era2, clinical status at time of operation was better in Era3, because of less rates of malperfusion (16% vs 11% vs 4%, p = 0.01) and hemodynamic compromise (34% vs 38% vs 22%, p = 0.07). Patients of Era 3 were less likely to Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while femoral artery was mainly cannulated in Era 1 (91%) (p < 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p < 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p < 0.01). Frozen elephant trunk was mainly performed in Era 3. Operative mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07, p = 0.03 between Era 1 and Era3). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Patients of Era 3 received less re–exploration for bleeding (p = 0.02) and less high inotropic support (p = 0.04).

Conclusions

With increasing experience and a more aggressive approach, including total arch replacement, repair of A–AAD can be more tailored to patients conditions, being performed with low operative mortality in many patients. Moreover, patient care and treatment by a multidisciplinary regional organization allows faster diagnosis and effective clinical stabilization allowing to further improve early and late outcomes.
P67 MAGMARIS FRACTURE AND COLLAPSE DURING PCI: ACUTE TREATMENT AND FOLLOW–UP
Authors: Quadri G , Franzè A , Tomassini F , Rolfo C , Meynet I , Celentani D , Gribaudo E , Tizzani E , Cerrato E , Chinaglia A , Lococo M , Palacio S , Minniti D , Varbella F
Published: May 2022

Resorbable Magnesium Scaffold (RMS) Magmaris represents an attractive alternative to permanent metal stenting in young patients undergoing PCI. Despite the promising long–term results, especially in terms of scaffold thrombosis, no data on acute RMS deployment failure and subsequent treatment are available. A 44–year–old gentleman with history of effort angina was admitted to our Department to perform coronary angiography. The exam showed an intermediate stenosis in the mid–tract of Left Anterior Descending (LAD, Figure 1, Panel A1), functionally significant (Instantaneous wave–free ratio 0.85). After Optical Coherence Tomography (OCT) evaluation (Panel A2), a wire was placed in Second Diagonal Branch (DG2) and predilation with a NC 3.5mm balloon on mid–tract of LAD was performed, followed by 3.5x25mm Magmaris implantation. Multiple runs performed after removing the jailed guidewire on Dg2, showed a remarkable angiographic result (Panel B1). However, OCT showed struts fracture near the distal RMS segment resulting in scaffold collapse as confirmed by 3D–reconstruction (Panel B2, B3). Therefore, scaffold dilatation with NC 3.5mm balloon was performed, followed by Magmaris 3.5x20mm intra–scaffold implantation. Panel C1 and C2 showed good angiographic and OCT results after postdilatation with NC 3.5 and 4.0mm balloon in the distal and proximal part, respectively. A planned one–year angiography (Panel D1) revealed a small aneurismatic enlargement in the previous overlapped segment, while no residual struts were visible at OCT. (Panel D2) To our knowledge we reported the first case of Magmaris acute fracture (probably due to a forced removal of the Dg2 jailed guidewire) treated with a second intra–scaffold RMS. The present case should emphasize the importance of intracoronary imaging guidance while more data are needed to clarify the optimal treatment of acute RMS implantation failure.
P91 HEMODYNAMICS NURSES ARE EVOLVING WITH INTERVENTIONAL CARDIOLOGY
Authors: Dessi A , Lais S , Baratta S , Menconi M
Published: May 2022

Subject Matter

Hemodynamics deals with issues concerning ‘the bloodstream and the vascular system’ and the figure of nurses pursuing their activity within those settings is constantly growing and evolving. Nurses must keep on training in procedures, new techniques, different procedural approaches and required equipment. Furthermore, this training has to develop besides the fundamentals, i.e. throughout briefing and debriefing sections. In fact, patient care is complex and mechanistic and therefore documented and transversal in order to satisfy clinical needs of the on–going process. In the hemodynamics ward in Massa’s Ospedale del Cuore of the Fondazione Toscana Gabriele Monasterio, diagnostics and interventions performed on patients are consistently developing. A hemodynamic patient leads, affects and characterises the nurse who must be able of taking care of their adult patients and pediatric ones until their prematurity.

Objective

Highlighting nursing skills in hemodynamics wards and types of training and care of patients of different age groups during procedural approaches.

Methods and Materials

Shared approval among medical directors of training courses to select for the training plan; mentorship; periodical evaluation of trainee plans; on–the–job nursing training; training courses chaired by experts; simulation of intra–setting emergency; evaluation of panic ranges to detect and it is necessary to act promptly for.

Outcome

In consideration of creating a nursing team capable of facing scenarios and procedures which can include every life stage of patients, it is paramount that a nurse follows the whole process. The procedural activities include the realization of a job description for basic and specialised skills and its observation. Outcomes and steps outlined to carry out care–giving performances are overseen each year. Lastly, it is necessary to know patients in their pre– and post–procedural stage up until the outcome of care–giving treatments.

Conclusions

Hemodynamics nurses are able to face changes and clinical solutions development alongside with a cross–disciplinary team.
P94 LOWER RATE OF MAJOR BLEEDING IN HIGH–RISK PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: A PROPENSITY MATCHED COMPARISON WITH DIRECT ORAL ANTICOAGULATION
Authors: Magnocavallo M , Della Rocca D , Vetta G , Lavalle C , Mariani M , Schiavone M , Carola G , Mohanty S , Bassiouny M , Forleo G , Burkhardt D , Al–Ahmad A , Gallinghouse J , Horton R , Lakireddy D , Di Biase L , Natale A
Published: May 2022

Background

Stroke prophylaxis in very high risk (CHA2DS2–VASc ≥ 5) patients with atrial fibrillation (AF) is one of the major challenges faced by physicians. Specifically, initiating direct oral anticoagulants (DOACs) in these patients poses a therapeutic conundrum due to the concomitant high risk of bleeding. Left atrial appendage occlusion (LAAO) might be a potential alternative for thromboembolic (TE) prevention; however, there are no studies comparing these two strategies in very high–risk patients.

Objective

To evaluate the efficacy of LAAO versus DOACs in AF patients at very high TE risk.

Methods

Data were extracted from two prospective databases including 1053 Watchman and 1328 DOAC patients. Watchman patients with a CHA2DS2–VASc ≥ 5 accounted for 26.3% (n = 277). In order to attenuate the imbalance in covariates, a 1:1 propensity score matching technique was used (co–variates: age, sex, CHA2DS2–VASc and HAS–BLED scores). This method resulted in 554 matched patients (277 patients per group; mean age: 79±7y; 57.4% F; CHA2DS2–VASc: 5.8±0.9). The primary endpoint was a composite of cardiovascular (CV) death, TE events (Stroke/TIA/peripheral embolism) and clinically significant bleeding. The annual TE and major bleeding risks were estimated based on the CHA2DS2–VASc score and compared with the annualized observed risk.

Results

After a mean follow–up of 26±7 months, total events were 55 (9.4 event rates per 100 patient–years) in LAAO group vs. 78 (14.9 event rates per 100 patient–years) in DOAC group. DOACs had a significantly higher risk of the primary endpoint (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.08 to 1.56; p = 0.03). TE events (HR: 1.15; 95% CI: 0.84 to 1.57; p = 0.63) and CV death (HR: 1.13; 95% CI: 0.84 to 1.54; p = 0.63) did not differ between groups. Major bleeding events were significantly lower in LAAO patients (HR: 0.75; 95% CI: 0.51 to 0.82; p = 0.04). The unadjusted estimated risk of TE events was 12.3% with LAAO and 12.4% with DOACs. The annualized incidence of TE was 3.2% with LAAO and 4.1% with DOACs, which led to a risk reduction of 74% and 67%, respectively.

Conclusion

In a large cohort of AF patients at very high TE risk (CHA2DS2–VASc ≥ 5), LAAO showed similar stroke prevention but a significantly lower risk of major bleeding than DOACs during a > 2year follow–up.
P98 CLINICAL CASE: MECHANICAL SUPPORT IN HIGH RISK PATIENT DURING PCI. NURSING ROLE AND SKILLS
Authors: Missana M
Published: May 2022

High risk patient in Cath Lab are more common nowadays. Cath Lab nurse needs to have technical and relational skills to deal with patients in this kind of setting. He needs technical skills to manage complex ventricular assist devices, identifying as soon as possible dangerous situations to prevent it. He needs to deal with the patient in a delicate moment of the caring process, giving constant attention both to the person that is dealing with this experience and the device and monitoring system.
P110 ACCIDENTAL FINDING OF COR TRIATRIUM SINISTER IN AN ADULT: DIAGNOSIS MANAGMENT
Authors: Talarico M , Renne S , Colangelo M , Rizzuti G , Talarico R , Ceravolo R
Published: May 2022

A 45–year old woman presented at the emergency department for palpitations and fever. The EKG, thoracic x–ray and troponins were normal, only a neutrophil leucocytosis was found. The echocardiography showed a normal bi–ventricular and valvular function and a mobile, linear, mass in the left atrium. In order to exclude an infective vegetation the patient underwent to a 2D and 3D transesophageal echocardiography (Figure 1 and 2) which showed a left ventricle concentric remodelling (iLVmass 62 g/m2; RWT 0.45), preserved left and right ventricle function (LVEF according to Simpson 70%; FAC 50%) and valves function; inter–atrial septum defects were excluded, too. The mass was described as a mobile membrane in the left atrium at 2.11 cm from the mitral valve anular plane, which divided the atrium into two separate chambers with a large fenestration without trans–mitralic flow obstruction, supporting a cor triatrium sinister. We excluded endocarditis (the blood cultures were negative, too) and supra–valvular mitral ring (since the left appendage position in the antero–inferior side of the left atrium). The cardiac MRI showed (Figure 3) (SSFP–FIESTA, IR–GRE T1, STIR T2) confirmed the finding of a left atrium divided in two chamber by a iso–intense membraine from the coumadin ridge between the left upper pulmonary vein and the left appendage to the inter–atrial septum fossa ovalis, incomplete in the infero–lateral part. Venous drenaige and other congenital abnormalities were excluded. Miocarditis was excluded since no fibrosis in IR–GRE T1 and no edema in Triple T2 sequences. Since the non–obstructive cor triatrium sinister, grading IA according the Lucas classification, was confirmed, no surgical treatment was proposed and the patient was discharged without complications.
P131 LOW DOSES OF ADVANCED GLYCATION END–PRODUCTS AND FRUCTOSILATION PRODUCTS PROMOTES PREMATURE CELL DEATH OF HUMAN CARDIAC CELLS EXPOSED TO DOXORUBICIN VIA ACTIVATION OF NLRP3, MYD88 AND P53 DOWNREGULATION
Authors: Quagliariello V , Paccone A , Iovine M , Buccolo S , Maurea N
Published: May 2022

Introduction

Advanced glycosylation end–products (AGEs) are non–enzyme, protein glycosylation products caused by glucose–induced metabolic disorder, and play an important role in aging, cancer, metabolic syndrome and cardiovascular diseases.

Purpose

We aimed to assess whether AGEs and fructosilation products, such as methylglyoxal (MG) and N–carboxymethyllysine (N–CML) could increase susceptibility to cell damages induced by doxorubicin Methods Human cardiomyocytes were pre–exposed for 24h with low doses (50 mmol/L) of methylglyoxal (MG) or N–carboxymethyllysine (N–CML). After, cells were exposed to subclinical concentration of doxorubicin (at 100 and 200 nM) for 48 and 72h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4–hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro–inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of peroxisome proliferator–activated receptor–α; mTORC1 Fox01/3a; transcriptional activation of p65/NF–κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6). Expression of p53 was also performed through western blot method

Results

Pre–exposure to methylglyoxal (MG) but especially to N–carboxymethyllysine (N–CML) increase cell mortality to doxorubicin of 48–53% compared to control. Pre–exposure to N–CML promotes premature death of cardiomyocytes to doxorubicin through NLRP3–driven pathways. Notably, MG and N–CML increased significantly the cardiotoxicity through NLRP3 inflammasome, Myd88 myddosome and cytochrome C–mediated apoptosis. Pre–exposure to N–CML and MG increase the secretion of interleukin–6 that increase cell apoptosis through a paracrine and autocrine mechanism. Induction of IL–6 reduces the expression of p53 resulting in the induction of the apoptotic process.

Conclusion

These observations suggest that AGEs and fructosilation producs promotes premature cardiotoxicity of human cardiac cells exposed to doxorubicin by activation of NLRP3, Myd88–related pathways and downregulation of p53.
P136 OCCASIONAL DIAGNOSIS OF B–CELL LYMPHOMA DURING A SCREENING EXAMINATION FOR HYPERTENSIVE CARDIOMYOPATHY: A CASE REPORT
Authors: Deserio M , Sanguettoli F , Pavasini R , Passarini G , Tonet E , Guardigli G , Campo G
Published: May 2022

Background

Echocardiography is fundamental in identifying early “red flags” of infiltrative cardiomyopathy in patients with monoclonal gammopathy and left ventricular hypertrophy. Nonetheless, definite diagnosis of cardiac amyloidosis requires multimodality imaging such as cardiac magnetic resonance, whole body bone scintigraphy and eventual biopsy in order to determine the disease phenotype.

Case Report

A 79 year–old male affected by Monoclonal Gammopathy of Undetermined Significance (IgM kappa) underwent a routinary echocardiography examination for arterial hypertension. The exam showed septal hypertrophy (diastolic septum width 13 mm) and right ventricular hypertrothy, E/e’>14 and valvular thickening. Based on these red flags in MGUS, in order to exclude cardiac amyloidosis, a whole body bone scintigraphy was performed: the exam was negative for myocardial uptake. Laboratory tests showed increased free kappa light chain component (61, 9 mg/L (r.v. 3.3–19.4), with lambda resulting 5,46 mg/l (r.v. 5.71–26.3), a k/l ratio of 11.34 (r.v. 0.26–1.65) and absence of Bence Jones proteinuria Subsequent cardiac MRI was performed and two restricted areas of subendocardial LGE were documented on the lateral and apical left ventricular wall without corresponding regional motion abnormalities: the findings were consistent with pathologic accumulation. In relation to the subendocardial localization of the abnormalities, obstructive coronaropathy was excluded by performing a coronary computed tomography angiography (CCTA). Abdominal Fat Biopsy was negative for amyloid protein. Osteo–medular biopsy displayed an IgM kappa lymphoplasmacytic lymphoma. Cardiological findings were, therefore, interpreted as markers of initial myocardial infiltration from a plasmacytoma. Afterwards, patient’s therapy and clinical follow up were managed by the Hematology care.

Discussion

Myocardial infiltration from plasmacytoma is very rare in comparison to Multiple myeloma and it features a more focal, less homogeneous pattern. In this case, recognizing red flags on echocardiography allowed an early diagnosis.
P144 PEMBROLIZUMAB–INDUCED MYOCARDITIS
Authors: Roberta P , Isola U , Marchetti M , Giusti M , Manca F , Montisci R
Published: May 2022

Introduction

Patients treated with Immunocheckpoint Inhibitors (ICI) can develop adverse cardiovascular events, most frequently myocarditis, but also arrhythmias, conduction abnormalities, pericarditis, Takotsubo syndrome, ACS, heart failure, cardiac arrest. Myocarditis occurs early, within the first 3–4 administrations of therapy, and is fraught with a high mortality rate.

Case Presentation

80–year–old patient with renal pelvic carcinoma who underwent nephroureterectomy and subsequent adrenalectomy. Twenty days after the first cycle of Pembrolizumab, the patient is admitted to cardiology for syncope and ECG finding of Left Posterior Fascicular Block (LPFB) and right bundle branch block (RBBB) with significant increase in troponin without any alterations in regional kinetics and normal ventricular function (EF). The patient also complains of widespread muscle pain and severe hyponatremia on blood tests. On ECG monitoring, alternation of RBBB with associated LPFB and Left Posterior Fascicular Block, left bundle branch block, first and second degree atrio–ventricular block (AV block) and on day II appearance of complete paroxysmal AV block controlled with temporary pacemaker implantation. On the 4th day, we documented changes in the segmental motion of the left ventricle (LV) and progressive gradual worsening of the EF. During the hospitalization the patient manifested episodes of general malaise with profuse sweating and marked hypotension with possible SIADH picture. In suspicion of acute myocarditis, peripheral myositis and possible Pembrolizumab SIADH, the patient was treated with high dose methylprednisolone (1000 mg / day) with little benefit. On the 6th day the patient was found in critical condition, severely suffering, hypotensive and oliguric, resigned herself.

Conclusions

Our case highlights how even a single dose of Pembrolizumab can trigger an acute inflammatory pattern affecting the myocardium with prevalent involvement of the conduction tissue even before the appearance of alterations in the kinetics and ventricular dysfunction. During ICI therapy cycles it is therefore important to monitor the ECG and troponin levels in order to be able to diagnose myocardial involvement early. In fact, although this complication is rare, it is burdened by a high mortality rate. The only treatment currently available involves the suspension of immunotherapy and the administration of high–dose methylprednisolone.
P145 A DUAL CARDIAC COMPLICATION FOR … COMBINATION CHEMOTHERAPY FOR KIDNEY CANCER
Authors: Parodi A , Brunacci M , Pestelli S , Merello M , Lupi G
Published: May 2022

We present the case of a 66–year–old patient suffering from metastatic kidney cancer who came to the emergency room complaining of dyspnea. 10 days prior to the event, the patient had received the last administration of chemotherapy which consisted of the combination of pembrolizumab (a monoclonal antibody) and axitinib (a tyrosine kinase inhibitor). The cardiological checks carried out up to that moment had not shown changes in the heart. In the emergency room ECG showed the presence of a sinus rhythm with a complete block of the right branch and no signs of ischemia were evident; blood chemistry tests showed an increase in troponin and BNP values. Echocardiography showed moderate left ventricular dysfunction. Therapy with diuretics, beta–blockers and Ras inhibitors was initiated which allowed for rapid resolution of symptoms. At a follow–up five days later the patient presented asymptomatic but with diffuse inversion of the T waves, a new elevation of troponin and more surprisingly the echo showed, in the presence of moderate left ventricular dysfunction, a mobile formation at the level of the apex of the left ventricle. Unfractionated heparin therapy was initiated since, on the basis of echocardiographic characteristics, the diagnosis appeared to be that of thrombosis and chemotherapy was suspended. In the following days the echo did not reveal any modification of the neoformation therefore in consideration of the characteristics (size and high degree of mobility) and of the oncological prognosis of more than one year we decided to initiate the patient to cardiac surgery for the removal operation. The histological analysis of the neoformation confirmed the thrombotic nature. Repeated echocardiography 15 days after surgery showed an almost complete recovery of the ejection fraction. To our knowledge, tyrosine kinase inhibitors can cause ventricular dysfunction (apoptosis) but, in general, it is not an acute event. Pembrolizumab has caused cases of acute myocarditis requiring discontinuation of therapy. As for the origin of the thrombosis the causes are not clear, it could be an effect of left ventricular dysfunction for myocarditis but it cannot be excluded that it is secondary to the use of one or both chemotherapy drugs.