bluuebunny/crossref_metadata_2025 huggingface dataset:
P350 LOOKING FOR RED FLAGS
Authors: Bianco S , Piscione M , Castaldo G , Polito D , Crispino S , Nafisio V , Grigioni F , Ussia G , Prati F , Gatto L
Published: May 2023

Case report: a 81 years old man with systemic hypertension, dyslipidemia, past smoking habit, was admitted to the ER of our hospital with acute decompensated heart failure. Since July he complained of worsening of dyspnea and paroxysmal nocturnal dyspnea. His blood pressure was of 155/80 mmHg, the HR was of 78 bpm in atrial fibrillation. He reported past myocardial infarction at the age of 32, thenceforth he underwent periodic cardiac check–up. From 2013 he had developed atrial fibrillation. He had suspended Amiodarone because of dysthyroidism, rate control was obtained with Bisoprolol. In 2015, he underwent coronary angiography for a positive scintigraphy showed absence of lesions. During the same hospitalization there was evidence of nocturnal bradycardia (35 bpm). In 2016, a cardiac MR showed subendocardial and intramyocardial fibrosis at mid–basal wall resembling post ischemic events. He underwent past carpal tunnel syndrome surgery. During the actual hospitalization, the EKG showed atrial fibrillation (78 bpm), complete left bundle branch block (both already known). Serum and urinary light–chain assessment and determination of immunoglobulin light chains levels were negative for AL amyloidosis. The echocardiogram documented: hypertrophy of the interventricular septum, mildly reduced LV systolic function (EF=43%). Invasive coronary angiography showed absence of lesions. CMR showed: left ventricular size at the upper limit of normal with hypertrophy of the interventricular septum and the anterior wall, diffused left transmural LGE, focal fibroadipose infiltration of lower basal SIV. During the hospitalization multiple episodes of non sustained ventricular tachycardia occurred, so that a CRT–D device was implanted in secondary prevention. There was a strong suspicion of cardiac amyloidosis so that definitive diagnosis was obtained by the use of 99m Tc scintigraphy coupled with haematologic tests (already done, resulted negative). Scintigraphy showed myocardial uptake of the radiotracer greater than the bone (Grade 3 Perugini score).

Conclusion

cardiac amyloidosis is a restrictive cardiomyopathy. Early diagnosis is really important, firstly, because new treatments, such as a TTR stabilizer, have transformed this once incurable disease to a treatable condition. Secondly, diagnostic tools now allow earlier and more accurate non–invasive diagnosis. It is crucial to put the attention on red flags which have to be found to rise the clinical suspicion.
P352 EXPLORATORY ANALYSES FROM APOLLO–B, A PHASE 3 STUDY OF PATISIRAN IN PATIENTS WITH ATTR AMYLOIDOSIS WITH CARDIOMYOPATHY
Authors: Cappelli F , Kale P , Maurer M , Fontana M , Grogan M , Fernandes F , Palacek T , Taylor M , Hung R , González–duarte A , Puolsen S , Donal E , Perfetto F , Tsujita K , Yu W , Sarswat N , White M , Yureneva E , Jay P , Vest J , Gillmore J
Published: May 2023

Introduction

Transthyretin–mediated (ATTR) amyloidosis is a progressive and fatal disease. Patients with hereditary or wild–type ATTR amyloidosis frequently develop cardiomyopathy (CM). Patisiran, an IV RNAi therapeutic that inhibits synthesis of wt and variant TTR, is approved for the treatment of hATTR amyloidosis with polyneuropathy.

Methods

In APOLLO–B, patients were 18–85 yrs old with evidence of cardiac amyloidosis by echocardiography, ATTR amyloid deposition on tissue biopsy or fulfilling nonbiopsy diagnostic criteria for ATTR amyloidosis with CM, and had prior hospitalization for heart failure (HF) due to ATTR amyloidosis or clinical evidence of HF. Patients were randomized 1:1 to patisiran IV 0.3 mg/kg or placebo Q3W for 12 months. The primary endpoint was change from baseline in 6–MWT at Month 12 (M12) with patisiran vs placebo. Exploratory parameters at M12 included changes in cardiac biomarkers, echocardiography and Tc scintigraphy.

Results

APOLLO–B enrolled 360 patients (patisiran, n=181; placebo, n=179): median age, 76.0 yrs; male, 89%; wtATTR, 80%; on tafamidis at baseline, 25%. Patisiran showed a significant benefit compared with placebo in 6–MWT (median [95% CI] change from baseline: patisiran, –8.15 [–16.42, 1.50]; placebo, –21.35 [–34.05, –7.52]; HL estimate of median difference: 14.69 [0.69, 28.69]; p=0.0162). Patisiran demonstrated favorable trends in change from baseline of NT–proBNP (mean fold change ratio [95% CI]: 0.80 [0.73, 0.89]; p=1.825×10–5) and troponin I (mean fold change ratio [95% CI]: 0.87 [0.80, 0.95]; p=0.0011) at M12 vs placebo. Patisiran also demonstrated a trend towards benefit in change from baseline of most evaluated echocardiographic parameters at M12 vs placebo. Patisiran–treated patients evaluable for scintigraphy (n=37) experienced a reduction (37.8%) or no change (62.2%) in Perugini grade at M12 compared with baseline. Among placebo patients (n=28) at M12, none experienced a reduction from baseline in Perugini grade, and 1 (3.6%) increased in grade. Patisiran demonstrated an acceptable safety profile; AEs were mostly mild or moderate in severity, and there were no cardiac safety concerns.

Conclusions

Exploratory analyses after 12 months provide further evidence for the potential benefit of patisiran treatment on cardiac biomarkers and manifestations of cardiac amyloid involvement in patients with ATTR amyloidosis. The long–term impact of patisiran will be assessed in the ongoing APOLLO–B open–label extension.
P360 INFLAMMATION AND LIPID METABOLISM IN YOUNG PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Meringolo F , Panattoni G , Proietti G , Jacomelli I , Lanzillo C , Calò L
Published: May 2023

Background

Inflammation and lipid metabolism play a central role in pathogenesis of atherosclerosis. High sensitivity C–reactive protein (hsCRP), Lipoprotein(a) [Lp(a)] and other inflammation markers are well–established markers of cardiovascular (CV) diseases and are associated with adverse CV outcome after acute coronary syndrome (ACS).

Methods

The study enrolled patients ≤ 55 years of age referred to Cardiology Department of Policlinico Casilino with ACS. In order to evaluate inflammation and lipid metabolism in young patients presenting with ACS, we design an acronym to describe biochemical tests measured: ACS–Lip. Biochemical tests include: A – Apolipoprotein A (ApoA), A – Apolipoprotein B (ApoB), C – hsCRP, C – Cystatin C, S – Suppression of tumourigenicity 2 (ST2). Lip – low–density lipoprotein cholesterol (LDL), high–density lipoprotein (HDL) cholesterol and triglycerides (TG), – Lp(a), Interleukin 6 (IL–6), plasma glucose, glycosylated hemoglobin Type A1c (HbA1c) levels were also determined.

Results

A total of 20 patients (85% males, mean age 45.5 ± 7.7 years old) were enrolled from July 2020 to March 2022. Hs–CRP was ≥3 mg/L in 100 % of patients. Mean LDL cholesterol level at admission was 117 ± 56 mg/dL, while mean HDL cholesterol was 38 ± 11 mg/dL. Mean Lp(a) level was 42.9 ± 36.1 mg/dL. Elevated Lp(a)>30 mg/dL was documented in 55% of patients. Lp(a) level distribution in the study population is reported in Figure 1. Additional parameters are reported in Table 1.

Conclusion

In our experience, elevated levels of Lp(a) and of markers inflammation display a detailed profile of patients presenting with ACS at a relatively young age, identifying patients with high risk of recurrence of cardiovascular events. This result focus on the potential use in clinical practice of efficacious Lp(a)–lowering drugs and on the role on inflammatory mediators both as indicator and therapeutic target.
P362 SHORT TERM EFFECTIVENESS OF A NOVEL NUTRACEUTICAL FOR THE MANAGEMENT OF HYPERCHOLESTEROLEMIA IN PATIENTS WITH LOW TO MODERATE CARDIOVASCULAR RISK: A MULTICENTER PRIMARY CARE OBSERVATIONAL
Authors: Natale F , Loffredo F , Molinari R , Covino S , Limatola M , De Luca L , Mollo N , Pezzullo E , Alfieri R , Cimmino G
Published: May 2023

Purpose: Increasing evidence reinforces the benefits of reduction of low–density lipoprotein (LDL–C) levels on cardiovascular outcomes. Different targets are suggested based on cardiovascular risk (CVR). According to the current European guidelines, a goal of LDL–C≤ 115mg/dL is desirable for patients with low–moderate CVR. However, a high percentage of these patients are far from this target. Nutraceuticals are “food supplements” that may help to achieve this goal in this population. In this retrospective analysis, we evaluate the effects of dietary supplementation with a novel monacolin/berberine/bergamot nutraceutical formulation on plasma lipid levels of subjects with low–moderate hypercholesterolemia who are not treated with conventional drug or other dietary supplements.

Patients and Methods

526 adult patients with hypercholesterolemia were retrospectively selected from the database of participant family practitioners according to prespecified criteria. All selected patients had a baseline and 30–day value of total cholesterol (TC), LDL–C, high–density lipoprotein cholesterol, triglycerides, C–reactive protein, and transaminases and have started a dietary supplementation with this novel nutraceutical. Similarly, 104 subjects with comparable clinical features but not treated with any supplements were also selected.

Results

At 30–day, the administration of nutraceuticals was associated with a significant reduction of LDL–C (124 ± 14 vs. 100 ± 13 mg/dL, Δ 24.5mg, p–value <0.0001) and TC levels (210 ± 56 vs. 187 ± 60, p–value < 0.0001), in the absence of a significant change of transaminase levels. No side effects were reported in the database during the observation period.

Conclusion

This novel nutraceutical is an effective dietary supplement to achieve a significant and early LDL–C reduction.
P367 LONG–TERM BENIGN EVOLUTION OF SARS–COV 2 VACCINE RELATE MYOPERICARDITIS
Authors: Ballatore F , Costantino J , Alfarano M , Ajmone F , Manguso G , Maggio E , Ciaramella P , Vizza C , Chimenti C
Published: May 2023

Background

Myopericarditis following vaccination for Sars–CoV2 disease (COVID–19) is a described entity, but its long–term evolution is not yet clear.

Methods

Patients diagnosed with myopericarditis after COVID–19 mRNA vaccine represented our population. Clinical evaluation, laboratory tests, noninvasive tests, echocardiography, and cardiac magnetic resonance (CMR) were performed at baseline, six months, and twelve months.

Results

Between January and August 2021, we identified 7 patients with myopericarditis after vaccination with Sars–CoV 2 mRNA. The mean age of the patients was 29 years (IQR: 25.5–53.5 years). and all patients were male. The median time from vaccine administration to symptom onset was 5 days (IQR: 4–7 days); five patients received BNT162b2, two mRNA–1273, and only one patient developed symptoms after the first vaccine dose. The most common symptoms at presentation were chest pain (100%) and fatigue (71.4%). Left ventricular ejection fraction (LVEF) remained preserved in 6 of them while it was found to be slightly reduced in one (median LVEF: 61.3% [IQR: 60–62.9%]). Late Gadolinium enhancement (LGE) was detected by CMR in 42.9% of cases. Treatment was conservative for all patients except one in whom pericardiocentesis was required due to massive pericardial effusion. At the 6–month follow–up all patients were asymptomatic with normal troponin levels, electrocardiographic and echocardiographic parameters and CMR, data which confirmed the complete resolution of the inflammatory state. At the twelve–month follow–up, the CMR confirmed the resolution of the inflammatory picture. Two patients received the booster dose of COVID–19 vaccine without evidence of myopericardial involvement.

Conclusions

COVID19 mRNA vaccination–associated myopericarditis is more frequent in young males and is usually characterized by a benign evolution.
P369 AUTOIMMUNE LYMPHOCYTIC MYOCARDITIS: ONE SIZE DOES NOT FIT ALL
Authors: Panza A , Giordani A , Naso P , Schiavon B , Leoni L , Baritussio A , Rizzo S , Basso C , Masiero G , Tarantini G , Perazzolo Marra M , Cecchetto A , Iliceto S , Marcolongo R , Caforio A
Published: May 2023

Fulminant myocarditis (MF) is an acute onset, rapidly progressive and potentially fatal inflammatory cardiomyopathy which could manifests with cardiogenic shock and incessant arrhythmias. There is often a need for aminic or mechanical support to the circulation in the acute phase, waiting to obtain a histological diagnosis as quickly as possible to establish a specific therapy. Mortality in the acute phases is high, with a worse prognosis than in other forms of presentation of myocarditis, even in the long term. We report the case of a 45–year–old Asian woman suffering from autoimmune hypothyroidism, who had been reporting atypical chest pain for about 3 days, associated with fever, asthenia, and vomiting. On admission, the patient was in cardiogenic shock; an echocardiogram revealed biventricular dysfunction. Pulmonary embolism and acute coronary syndrome were excluded. Blood tests showed a significant troponin rise, neutrophilic leukocytosis, and hypertransaminasemia. Anti heart antibodies (AHA) were negative. Amine support with dobutamine and norepinephrine was then started. The first EKG showed an advanced atrioventricular block with a ventricular escape with the need for emergency temporary PM placement. Right heart catheterization showed pressures in the pulmonary circulation at the upper limits with average resistance and reduced cardiac index. An endomyocardial biopsy (EMB) was performed, subsequently complicated by cardiac tamponade due to lead displacement, treated with urgent pericardiocentesis. At the end of the procedure, the appearance of incoming episodes of complete BAV was highlighted, for which ICD implantation was performed. The biopsy showed virus–negative diffuse acute lymphocytic myocarditis. Cortisone therapy was therefore started, with immediate benefit, until the aminic support was suspended. A follow–up echocardiogram showed a complete recovery of normal biventricular function. In MF, early diagnosis, and the possibility of establishing specific therapy are crucial to reduce mortality. EMB is the only method that allows you to make an etiological diagnosis and exclude a possible infectious genesis. The patient‘s prognosis, in fact, in addition to supportive therapy, depends on the possibility of establishing a targeted treatment as soon as possible, which in virus–negative autoimmune forms consists of an immunosuppressive therapy modulated on the patient‘s histological type and clinic.
P370 INCIDENCE AND MAIN CLINICAL CHARACTERISTICS OF MYOCARDITIS IN PIACENZA PROVINCE IN THE LAST FIVE YEARS
Authors: De Santis N , Bricoli S , Caraffini A , Canu E , Del Giudice F , Ferdenzi E , Bolognesi M , Pisati M , Ferraro S , Pelizzoni V , Aschieri D
Published: May 2023

Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of etiologies, myocardial involvement and clinical presentations ranging from chest pain to extreme conditions such as cardiogenic shock or death. The variability in presentation reflects the variability in histological disease severity, etiology, and disease stage at presentation. The diagnosis may be suspected by clinical and noninvasive features and is confirmed by endomyocardial biopsy by established histologic, immunologic, and immunohistochemical criteria. CMR imaging is a valid diagnostic support which can detect important myocarditis features from evidence of inflammatory hyperemia and edema to myocardial scar. Due to its clinical presentation and the absence of a safe sensitive non–invasive diagnostic tool, the frequency of this condition and its specific etiology is often difficult to identify, and because of this, the cause is frequently unknown. Anyway among the infectious etiologies, viruses are the presumed to be the most frequent pathogens. We analyzed the main clinical features of patients who were hospitalized for myocarditis in our province in the past five years. Since 2018, 53 patients received a diagnosis of myocarditis. Mean age was 38, 40 (75%) of them were males. The vast majority of patients underwent CMR as a part of diagnostic work–up and we found lateral wall as the most frequently involved. Almost half of the patients showed oedema as a sign of acute inflammation and 35% had more than one segment affected. Mean ejection fraction was 60%. 22 of them were discharged as having as “idiopathic”, 18 had a viral cause (of which 2 were clearly COVID–related) with gastroenteritis being the most common clinical presentation. Of note, only one case was associated with COVID–19 vaccination. Figure 1 shows different distribution of the cases per year. Of note, we did not observe an increased incidence in the last 3 years and mean age was similar in the years analysed possibly reflecting a limited effect of COVID and COVID–vaccination related incidence in our population.
P371 CONFOUNDING CARDIAC MARKERS IN A CASE OF COVID–19 MYOCARDITIS
Authors: Polo G , Scarpa D , Castegnaro N , Benetti A , Mione R , Carraro P
Published: May 2023

Background–Aim

A man of 81 years, with previous coronary artery disease, unrecognized myocardial infarction, carrier of implanted pacemaker, presented to the cardiology department for a scheduled hospitalization to treat shortness of breath and symptoms of heart failure. There was no chest pain, ECG poorly assessable for pacemaker–induced rhythm, cardiac troponin I of 35,879 ng/L (cut–off 20). Suspecting an acute coronary syndrome (ACS), the patient undergoes immediate coronary angiography that does not showed any change compared to a previous examination. Meanwhile SARS–CoV–2 research in nasopharyngeal swab by RT–PCR was positive and after a few hours fever appears.

Methods

The authors discussed the case and extensive monitoring of cardiac markers and intensive evaluation of clinical parameters were activated. Troponin I HS, CK–MB, Myoglobin (Beckman Coulter DxI), CK, AST, LDH are determined by routine methods (Beckman Coulter AU700), Troponin T (cTnT–hs Roche Diagnostics) on (Roche Cobas 8000).

Results

All markers (except Troponin T) had the typical pattern of an ACS, in accordance with their characteristic half–life of an acute insult with development of a peak and subsequent decrease in a few days. The peaks recorded were cTnI 35,789 ng/L, CK–MB 72.6 ug/L, CK 800 U/L, AST 1,51U/L, Myoglobin 244 ng/ml, LDH 600 U/L, all at time 0. Troponin T was moderately increased at presentation (3700 ng/L, cut–off 10) followed by a peak of 3,872 after 2 hours stabilizing around 2,800 ng/L for the next days and decreasing after day 7. The final diagnosis was acute COVID–19–related myocarditis.

Conclusions

It has been described that the presentation of a SARS–CoV–2 infection can sometimes simulate a condition of ACS when there is an inflammatory involvement of the heart. In this case all the clinical data pointed towards an ischemic pathology which, however, was excluded in diagnostic imaging. A conclusive assessment with cardiac MRI was not possible due to the presence of the pacemaker, so the diagnosis was made as probable. Among the different markers, Troponin I was found to express a more intense signal and an earlier positive evolution than that of Troponin T. Our report highlights the different evolution of cardiac troponins in this disease.
P375 ACUTE PULMONARY EMBOLISM IN A STABLE PATIENT PRESENTING WITH RIGHT CARDIAC CHAMBERS THROMBOSIS: A TICKING CLOCK SCENARIO
Authors: Procopio A , Belli L , Molisana M , Cicchitti V , Ianni U , Toro A , Di Girolamo E , Zimarino M
Published: May 2023

A 73–year–old male presented to the emergency department with a 1–week history of asthenia and exertional dyspnoea. He reported a recent finding of a not yet characterized renal mass in a not relevant past medical history. At the admission, he was haemodynamically stable. Electrocardiogram showed sinus rhythm without relevant abnormalities. Blood results evidenced only a slight increase of hs–troponin levels and D–dimer. An early point–of–care ultrasound (POCUS) demonstrated normal chambers dimensions and biventricular function but in the right atrium an elongated and mobile mass was documented. The echo–features were very suggestive of a large thrombus and a computed tomography pulmonary angiogram revealed several emboli in the left pulmonary artery. At the admission to our cardiac intensive care unit, according to pulmonary embolism (PE) ESC guidelines1, systemic anticoagulation was started with an aPTT–guided unfractioned heparin (UFH) infusion. Intensive monitoring was set to permit early detection of haemodynamic impairment. Multidisciplinary discussion on management was instituted but, soon after, the patient had a PEA arrest. POCUS demonstrated an extremely dilated right ventricle so rescue fibrinolytic therapy (FT) was attempted during cardiopulmonary resuscitation but the patient died. The intermediate–high–risk profile of PE encompasses a very heterogeneous group of patients, in whom controversy still exists regarding the net clinical benefit of using FT compared to anticoagulation alone. In the largest PEIHTO trial, FT compared to UFH alone prevented death and hemodynamic decompensation but increased major bleedings and strokes2. Data meta–analysis confirmed that in these patients, FT was associated with a lower mortality at the cost of more bleedings3. Current guidelines endorse FT only at the moment of clinical deterioration. Nevertheless, stable patients with “thrombus in transit” represent a niche of potentially rapidly deteriorating clinical scenario with not–predictable timing. In this setting we believe that, waiting for data deriving from interventional approaches, an aggressive therapeutical strategy should be considered, offering more liberally an early FT, especially when absolute contraindications are lacking. Data from registry or trials are strongly requested. 1.Konstantinides SV et al. EHJ 2020;41:543–603. 2.Meyer G et al. NEJM 2014;370:1402–11. 3.Chatterjee et al. JAMA 2014;311:2414–21.
P381 TEAMWORK IS SUCCESSFULL (4): PROGRESSION OF CORONARY ATHEROSCLEROSIS IN A PERIPHERAL T–CELL LYMPHOMA AND PAPILLARY RENAL CELL CARCINOMA SURVIVOR
Authors: Fari R , Di Girolamo S , Masini C , Larocca M , Righini S , Muià N , Pinto C , Navazio A , Besutti G , Tarantini L
Published: May 2023

Introduction

Growing evidence highlight cancer and cardiovascular diseases (CVD) share common risk factors, including genetic ones, and underlying pathogenesis. Such paradigm has significant implications for cancer survivors, an exponential growing cohort of patients (Pts), due to notable improvements in survival achieved with new oncological treatments. However, many new agents of targeted– and immuno–therapy can cause cardiac damage, mainly for vascular involvement, a pathophysiological mechanism different from classic chemotherapeutic agents. We present the case of left ventricular systolic dysfunction (LVSD) in a man with metastatic papillary renal cell carcinoma (PRCC) previously exposed to anthracyclines for former peripheral T–cell lymphoma (PTCL). He came to our attention for cardiological assessment before starting immunotherapy (Nivolumab), due to the failure of Tyrosine kinase inhibitor (TKIs) (Pazopanib) treatment.

Clinical case

A 74–year–old Pt with hypertension, severe renal dysfunction, dyslipidemia, and exertional dyspnea (NYHA II) presented at transthoracic echocardiogram (TTE) a normal size chambers with mild concentric hypertrophy and a clinically stable moderate LVSD (LVEF 35–40%) at periodic evaluation. Pt was also performing his radiological follow–up for the estimation of metastases with CT, twice a year since 2016. A retrospective review of these non–contrast and non–ECG–gated CT highlighted an extensive increase in coronary artery calcifications during the last four years, started with the beginning of TKIs therapy. In 2018 only mild LAD calcification was detectable (Figure 1), while in 2022 a severe three–vessel coronary atherosclerosis was present (Figure 3). After multi–disciplinary discussion, an aggressive correction of multiple cardiovascular risk factors (starting Rosuvastatin and adjusting Bisoprolol) was performed and immunotherapy started without any adverse event.

Conclusions

Non–ECG–gated CT routinely performed for monitoring the state of the oncological disease is a useful tool for the evaluation of coronary artery calcific burden and accelerated atherosclerosis. It provides additional information beyond the traditional evaluation of CV risk and must be integrated with clinical and laboratory data.
P383 DAPAGLIFLOZIN REDUCES SYSTEMIC PCSK9 LEVELS IN PRECLINICAL MODELS OF SHORT–TERM DOXORUBICIN CARDIOTOXICITY THROUGH NLRP3 INFLAMMASOME/IL–1Β: A FIRST EVIDENCE OF SGLT–2/PCSK9 CROSS–TALK IN CARDIONCOLOGY
Authors: Quagliariello V , Palma G , Luciano A , Bruzzese F , Paccone A , Iovine M , Maurea N
Published: May 2023

Background

Anthracyclines are an effective and widely used chemotherapy agent in the treatment of multiple solid organ tumors and hematologic malignancies. The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. In recent five years, it was demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9), a lipid metabolism–related protein, is a key orchestrator of immune infiltration in myocardial and cancer tissues and could regulate cardiac fibrosis and inflammation. PCSK9 is a protein with key roles in hepatic low density lipoprotein (LDL) homeostasis. PCSK9 systemic levels are associated to HOMA score and high insulin levels. Dapagliflozin exerts systemic ant–inflammatory properties and cardioprotective effects in diabetic and non–diabetic patients. Purpose: We hypothesized that Dapagliflozin, administered during doxorubicin, could reduce PCSK9 systemic levels in preclinical models.

Methods

Female 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), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO–DAPA, n=6). After treatments, plasma levels of PCSK9, IL–1β and CRP were analyzed through selective anti–mouse ELISA methods. Myocardial and liver expression of NLRP3–inflammasome and IL–1β were analyzed through ELISA method in tissue lysates after treatments.

Results

DAPA associated to DOXO reduces significantly systemic levels of PCSK9 ( –37,5% vs DOXO group, p<0,001). IL–1β and CRP levels were also reduced ( –47,3 and – 28,5 %, respectively; p<0.05 for both). Myocardial and liver IL–1β and NLRP3 inflammasome expression were also reduced in DAPA/DOXO group vs DOXO and control, indicated beneficial metabolic and anti–inflammatory effects of SGLT2i.

Conclusion

DAPA has been shown to reduce systemic levels of PCSK9 in preclinical models of short–term DOXO cardiotoxicity. To the best of our knowledge, this is the first evidence of SGLT–2/PCSK9 crass–talk in cardioncology therefore the overall picture of the study open a new window on the beneficial properties of DAPA against anthracyclines side effects.
P385 CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION IN OCTOGENARIANS: A PROPENSITY–SCORE MATCHING COMPARISON WITH A COHORT OF YOUNGER PATIENTS
Authors: Cecchini F , Shuichiro K , Mugnai G , Bolzan B , Iacopino S , Placentino F , Ribichini F , Sieira J , Sorgente L , Tomasi L , De Asmundis C , Gian Battista C
Published: May 2023

Background

Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia in adults with a current estimated prevalence between 2–4% in the general population. AF prevalence increases with advancing age and it is estimated that nearly 10% of octogenarians may be affected by this arrhythmia. In terms of safety and efficacy, Cryoballoon ablation (CB–A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation (AF). However, CB–A data in octogenarians are still scarce and limited to single–centre experiences. The present multicenter study aimed to compare the outcomes and complications of index CB–A in patients older than 80 years old with a cohort of younger patients.

Methods and results

We retrospectively enrolled 97 consecutive patients aged ≥ 80 years who underwent PVI using the second–generation CB–A. This group was compared with a younger cohort of patients using a 1:1 Propensity score matching. After the matching, 70 patients from the elderly group were analyzed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow–up of 23 [18 – 32.5] months was 60.0% in the elderly group and 71.4% in the control group (p = 0.17). Phrenic nerve palsy (PNP) was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients for the elderly group and in 5 patients (7.1%) of the younger group (p = 0.51). Only 2 (1.4 %) major complications occurred: 1 (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage and 1 (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period (BP) and the need for electrical cardioversion (ECV) to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses.

Conclusions

The present study showed that CB–A PVI is as feasible, safe and effective among octogenarians as it is in younger patients.
P386 ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH SEVERELY DEPRESSED EJECTION FRACTION. META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Meco M , Belli G , Fouladvand F , Agosteo E
Published: May 2023

Introduction

Atrial fibrillation (AF) and severely depressed ejection fraction (SDEF) are two conditions that often coexist. AF increases overall mortality in these patients. The current available guidelines do not provide a clear consensus regarding the best management approach. We conducted this meta–analysis in order to determine if catheter ablation for AF is superior to medical therapy in this patients.

Methods Data collection

We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated AF catheter ablation in patients with SDEF (lower than 35%). Outcome: The primary outcomes were left ventricular ejection fraction (LVEF), 6–minute walk test (6MWT) distance, AF recurrence, and mortality Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented as a mean difference for continuous outcome measures (inverse variance random effect model), and odds ratios (OR) for dichotomous outcomes (Mantel–Haenszel random effect model) with 95% confidence interval (CI).

Results

Four full texts met inclusion criteria. A total of 665 patients were included (324 patients randomized to catheter ablation and 341 patients randomized to medical therapy), with a mean follow–up of 15.2 months. Arrhythmia recurrence: AF catheter ablation was effective and significantly more patients were in sinus rhythm at the end of the follow–up (OR 14.51 (4.9–42) p < 0.001) LVEF: compared to medical therapy, AF catheter ablation was associated with a significant increase in LVEF outcome (MD 5.17 (2.06–8.27) p 0.001) 6MWT distance in meters: The mean increase in 6MWT distance was higher in the AF catheter ablation group compared to the medical therapy group (MD 32.7 (13.2–52.3) p 0.001) All–Cause mortality: the risk of death from any cause was significantly lower in the AF ablation arm (OR…).

Conclusions

Summary evidence from the included RCTs showed that AF catheter ablation significantly increases LVEF, 6MWT distance, sinus rhythm maintenance, and overall mortality.
P393 EDOXABAN: NEW PERSPECTIVE IN A PATIENT WITH CANCER–ASSOCIATED THROMBOSIS COMPLICATED BY BRAIN METASTASES. A RARE CLINICAL CASE
Authors: Fioretti A , Leopizzi T , Pizzutilo P , La Forgia D , Oreste D , Marech I , Strippoli S , Fanizzi A , Scicchitano P , Lillo A , Aloisio A , Zito A , Massafra R , Catino A , Mannarini A , Luzzi G , Oliva S
Published: May 2023

Herein, we present the case of a 58 y–o Caucasian man with unremarkable cardiovascular history and a strong family history for cancer. He was diagnosed with lung adenocarcinoma IVb (pleura, pleural effusion, lymph nodes), PDL1: 2% TPS and absence of actionable driver mutations on DNA and RNA NGS (only ERBB2 mutation). Started first–line chemotherapy with cisplatin–pemetrexed regimen and immunotherapy with pembrolizumab. He developed common/superficial femoral and popliteal deep vein thrombosis (DVT) and pulmonary embolism (PE). The patient started low–molecular–weight heparin (LMWH) namely enoxaparin 1 mg/kg x 2/d (weight: 65 Kg). After 1 mo, CT showed PE resolution. Due to DVT persistence and patient’s preference for oral administration, LMWH was replaced with direct oral anticoagulant (DOAC) namely edoxaban 60 mg 1 cp/d. After 2 mo, resolution of common femoral and popliteal vein thrombosis with partial recanalization of superficial femoral DVT were detected. However, he developed brain metastases treated with WB radiotherapy. We decided for edoxaban full dose long–term anticoagulant treatment with monthly cardioncological surveillance. After 6 mo since cancer diagnosis, the patient was still adherent to DOAC therapy, although in a maintenance combined regimen pemetrexed–pembrolizumab based, without both drug–drug interactions and brain bleeding.

Conclusions

Thromboembolism is the second leading cause of death in malignancy. In this clinical case, a man with advanced lung cancer developed extended cancer–associated thrombosis (CAT). However, the appearance of brain metastases has posed a clinical dilemma: to continue or to withdraw the anticoagulant therapy and, also, which drug to choose between LMWH and DOAC. Literature is limited on the use of DOACs in cancer patients with brain metastases. Besides, current guidelines neither advocate contraindication to DOAC, nor suggest caution as requested for gastrointestinal and genitourinary sites of cancer. We decided to proceed with edoxaban therapy, despite chemotherapy combined to immunotherapy were still ongoing and the concurrent appearance of brain metastases, with good results in efficacy, patient’s adherence and, mostly, safety. In conclusion, in regard to our clinical experience, we point out DOAC as a reliable and manageable therapeutical choice in CAT, also in active cancer patients with brain metastases receiving chemo–immunotherapy.
P394 PULMONARY HYPERTENSION IN SEARCH OF GROUP
Authors: Camassa N , Graziadei M , De Tommasi E , De Michele L , Mannarini A , Xhelo A , Lucarelli N , Ceglie M , Tandoi F , Rendina M , Vella S , Sabbà C , D’Agostino C
Published: May 2023

Episode of haemoptysis in a 25–year–old woman with the following medical history: surgical closure of Botallo‘s duct at the age of 5 months, coeliac disease, growth retardation, polycystic ovary, visus alterations. In the emergency room CT angiography of the chest showed the presence of subpleural parenchymal consolidation in the right lower lobe, with associated ground–glass opacities, cardiomegaly, severe pulmonary artery dilatation and hepatomegaly with intrathoracic involvement by a hernia of Morgagni on the right side. A porto–systemic shunt with an intrahepatic course was also noted in the duct at the VIII segment with an autonomic outlet in the right atrium. The patient was transferred to the Internal Medicine ward. Objective examination revealed an elf facies with hypertelorism, short stature, bradypsychism. On interview she reported dyspnoea on light exertion and frequent lipohymic episodes. Haematochemical examinations showed increased of bilirubinemia mainly indirect, Transaminases and of NTproBNP and normal ammonium levels. Blood gas analysis showed a tendency to respiratory alkalosis with oxyaemia at lower limits. Because of the suspicion of a syndromic picture, a genetic examination was performed. Cardiological evaluation showed a high ultrasound probability of pulmonary hypertension (PH). Transferred to cardiology, catheterisation confirmed pulmonary arterial hypertension (mPAP 64mmHg) precapillary (wedge 4mmHg) with high PVR (11 Wood Units) not responsive to nitric oxide. In addition, there was a superior vena cava protruding into the coronary sinus and an extrahepatic shunt with an isolated outlet in the RA without gradient. The hepatobiliary surgery consultation concluded for Abernethy syndrome, which is a rare congenital syndrome characterised by an extrahepatic portosystemic shunt in which the blood from the splanchnic and lienal circulation bypasses the portal vein and the liver, draining into the systemic circulation via an abnormal conduit. PH is a rare complication of this syndrome, maintained by hyperafflux, vasoactive mediators and the formation of microthrombi and intimal fibrosis in the pulmonary circulation. An HR–CT excluded venulo–capillary plexiform disease. Macitentan 10 mg/day was introduced, then continued at home for the benefit shown and follow–up at the Pulmonary Work Group was initiated. This PH, due to its association with an extremely rare pathology, required the collaboration of a diverse group of specialists.
P397 AN UNUSUAL SYMPTOMATIC PERICARDIAL EFFUSION AT THE 24TH GESTATIONAL WEEK
Authors: Condello C , Gasparetto N , Possamai M , Busato E , Gherlinzoni F , Zanatta P , Cernetti C
Published: May 2023

Background

pericardial diseases during pregnancy are rare. The most common are hydropericardium – typically in the third trimester, with spontaneous resolution – and pericarditis. Echocardiogram is the imaging method of first choice for diagnosis.

Clinical case

a 38–year–old woman, at gestational week 24, came to the Emergency Department due to anxiety, shortness of breath, cough, gastroesophageal reflux, inappetence, and sialorrhea, all of which started with the pregnancy and worsened overtime. She underwent cardiological evaluation because of troponin discovered via blood test. The evaluation highlighted mild pericardial effusion. Hence, she was admitted to the Cardiology Department, where a progressive increase of effusion – from mild to severe (in particular in front of apical and posterior segments) without hemodynamic impact – was noted. Corticosteroid therapy was started without clinical improvement and the patient displayed orthopnea, diaphoresis, and oliguria. Through an echographic re–evaluation an hypervascular mass was identified in parasternal view. After a multidisciplinary discussion, a CT scan of thorax and abdomen with contrast (MRI was impracticable due to orthopnea) was carried out with evidence of a mediastinal solid lesion (11,5 x 7 mm) compressing superior vena cava, trachea and principal bronchial branches suggestive of lymphoproliferative disease. A pericardiocentesis was perfomed with evacuation of 400 ml of bloody fluid. The worsening of blood gas test required a tracheal intubation. Therefore, an emergency Cesarean section was executed, and a surgical biopsy of mass was taken with detection of diffuse large B–cell non–Hodgkin‘s lymphoma. Hgh doses of corticosteroids and chemotherapeutic drugs were administered and the patient was extubated after two days. After four therapeutic cycles, a PET–CT scan confirmed remission of the disease.

Conclusion

pregnancy is not a predisposing condition for pericardial diseases. Although pericardial involvement is benign in most cases, the use of corticosteroid therapy after the 20th week of gestation is indicated in suspected pericarditis to avoid fetal complications from NSAIDs. If there is no response, the use of advanced imaging methods (even potentially dangerous to the fetus) should not be procrastinated.
P401 A CASE OF CORTICO–DEPENDENT AND COLCHICINE–RESISTANT RECURRENT IDIOPATHIC PERICARDITIS: THE ROLE OF ANAKINRA
Authors: Gentile G , Gidiucci R , Gorgoglione M , Meles E , De Carlini C , Bruni F , Bucalo R , Maggiolini S
Published: May 2023

68–year–old female. Arterial hypertension. Diabetes. Hyperthyroidism. History of Polyserositis: 2019 massive right pleural effusion subjected to 2 thoracentesis a few days apart. Also finding of ascitic effusion. Negative etiological investigations On 3/2022 Admission to Cardiology for dyspnea and finding of pericardial effusion. CRP 10.55. On CT chest and abdomen significant pericardial effusion, mild bilateral pleural and peritoneal effusion with liver congestion. Pericardiocentesis was performed due to the absence of improvement in the pericardial effusion and persistence of sinus tachycardia despite therapy (ASA 750 mg x 3 + colchicine). Procedure complicated by Tako Tsubo syndrome. Intra–hospitalization recurrence of pericardial effusion despite NSAID therapy. Prednisone 25 mg per day was associated to therapy on board with improvement of pericardial effusion (maximum of 8 mm). At discharge WBC: 10.8, CRP: 2 (NV < 0.5 mg/dl) 04/26/22 CRP 0.73. Pericardial effusion Resolution. Cortisone tapering continued. 5/24/2022 Dyspnea and tachycardia with recurrence of significant pericardial effusion. Diagnosis of recurrent cortico–dependent and colchicine–resistant idiopathic pericarditis. New Hospitalization. Reverted to prednisone 25 mg (previous effective dose) with no effusion reduction. Anakinra introduction. At discharge: WBC 9500, CRP 0.6. Echo: maximum pericardial effusion of 20 mm. 6/10 Boosted for 3 days prednisone (50 mg/day), reduced ASA to 250 mg x 3 6/17 WBC 11.2; PCR 0.63. echo: pericardial effusion persistence max about 2.5 cm. No signs of cardiac tamponade. Boosting prednisone for a few days is ineffective. 6/24 stop ASA 6/20 stable. Start corticosteroid tapering. 7/20 asymptomatic, stable effusion. CRP 0.87. taperig prednisone again, stop colchicine. 8/18/22 Eco: slight effusion reduction. Stable CRP. Slight weight gain and slight increase in blood pressure probably caused by cortisone intake. –> prednisone reduction. 9/18 stop prednisone 10/18/2022 WBC 8.12 CRP 0.23; +2kg since last visit in August. Perimalleolar succulence. Eco: Stable effusion 2cm max. furosemide 25 mg 1 cp is added in the morning. 06/12/2022 WBC 7.5; CRP 0.52 Eco: stable effusion. Anakinra is reduced to 6 administrations per week.

Conclusions

Anakinra proved to be valid in stabilizing the pericardial effusion allowing to suspend corticosteroids, colchicine and ASA.
P408 PREVALENCE CHARACTERISTICS AND OUTCOMES OF COVID 19 ASSOCIATED ACUTE MYOCARDITIS
Authors: Palazzini M , Ammirati E , Lupi L , Giannattasio C , Soriano F , Pedrotti P , Briguglia D , Mapelli M , Campodonico J , Agostoni P , Leonardi S , Turco A , Guida S , Peretto G , Sala S , Camici P , Marzo F , Grosu A , Senni M , Turrini F , Bramerio M , Marini M , Matassini M , Rizzo S , Basso C , De Gaspari M , Hendren N , Schmidt M , Bochaton T , Piriou N , Ubarri A , Van De Heyning C , Ariza Sole A , Cannatà A , Salamanca J , Lehtonen J , Huang F , Adler E , Metra M
Published: May 2023

Background

Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID–19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in–hospital management, and outcomes for patients with COVID–19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.

Methods

A total of 112 patients with suspected AM from 56963 hospitalized patients with COVID–19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID–19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID–19–associated AM.

Results

AM prevalence among hospitalized patients with COVID–19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty–one cases (57.4%) occurred in the absence of COVID–19–associated pneumonia. Twenty– one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in–hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%).

Conclusions

AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID–19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID–19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
P411 THE ROLE OF CARDIAC MAGNETIC RESONANCE FOR ARRHYTHMIC RISK STRATIFICATION IN A PATIENT WITH MYOCARDITIS
Authors: Fede G , Belluardo P , Guccione N , Abate G , Scollo V , Sulsenti G , Ficili S
Published: May 2023

Myocarditis is an inflammatory disease of cardiac muscle with a variable clinical presentation, ranging from asymptomatic cases to different degrees of left ventricular systolic dysfunction up to heart failure and dilated heart disease. Ventricular arrhythmias (VA) can occur in patients with myocarditis and implantable cardioverter defibrillator (ICD) may be indicated in patients with life–threatening VA who are not in the acute phase of myocarditis and who are receiving optimal medical therapy. Reduced left ventricular ejection fraction (LVEF) below 35%, which is used as the main criterion for stratifying the risk of sudden cardiac death (SCD), has low sensitivity and low specificity for arrhythmic risk stratification in patients with myocarditis. Myocardial scar is the main determinant for VA in these patients. Cardiac magnetic resonance imaging (CMR), using late gadolinium enhancement(LGE), has an excellent ability to determinate the extension and characterization of myocardial scar, indeed CMR can potentially improve SCD risk stratification and indication for ICD implantation in patients with myocarditis. We present a case of a 36 years–old male presenting to the Emergency Department with a monomorphic sustained ventricular tachycardia in whom MRI revealed myocardial–pericardial recurrent inflammatory involvement and worsening disease progression. ICD was implanted in consideration of the high risk of life–threatening arrhythmias.