bluuebunny/crossref_metadata_2025 huggingface dataset:
P92 ADVANCED CIRCULATORY SUPPORT IN A PATIENT WITH ISCHEMIC HEART DISEASE, SEVERE AORTIC STENOSIS AND CARDIAC TAMPONADE
Authors: Crimi G , Zecchino S
Published: May 2022

The use of mechanical left ventricle assistance device in the context of severe aortic stenosis is far from routine. The clinical case we’re presenting highlights the possibility of achieving therapeutic success through appropriate patient selection and choice of the most useful strategy based on the clinical scenario. Our patient is a 70 years old man with several cardiovascular risk factors (DM2, hypertension, active smoker, overweight), CKD IV; his clinical history is characterized by NSTEMI in 2010, treated with PCI and subsequent implantation of 2 DES (on LAD and RM), and by an hospital admission in 2019 for AHF with diagnosis of severe AS. He refused any invasive treatment for underlying valvopathy. In January 2021, a dual–chamber pacemaker implant was required due to the finding of 3rd degree AV block: again, TAVI was refused. A few days after the last discharge, a new ER admission was necessary: the patients had dyspnea (NYHA III–IV) with severe EF depression (50–>25%) and slight troponin elevation: no significant lesions were discovered by coronarography exam. The patient finally agreed to start examinations preparatory to TAVI. After resolution of AHF and approximately 14 days after coronarography, the patient developed pericardial effusion to tamponade, of possible uremic etiology: in addition to compression on the right chambers, echocardiography showed a further dramatic decline in EF (10–15%); despite placement of pericardial drainage and IABP, the initiation of advanced amine support and mechanical ventilation, the patient was classified Intermacs 2. Following a collegial discussion (interventional cardiologist, cardiac surgeon and anesthesiologist), it was decided to perform procedure in the cath–lab in order to undertake an advanced support strategy as birdge–to–therapy: – Valver valvuloplasty with increasing balloon size (18 mm – 20 mm – 23 mm – 25 mm). Rapid pacing was performed through previously implanted PMK, resulting in subsequent hemodynamic benefit (mean gradient 45–>25 mmHg); – Placement of Impella CP (P8, output 3–3.2 L/min). The following post–procedural hospitalization, despite the need for antibiotic therapy and multiple transfusions, was characterized by a progressive hemodynamics improvement until feasibility of weaning from both mechanical and amine therapy and discharge to the rehabilitation center in anticipation of TAVR procedure, which will then be successfully performed in October 2021.
P97 VALIDATION OF THE ACADEMIC RESEARCH CONSORTIUM HIGH BLEEDING RISK CRITERIA IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND METANALYSIS OF 10 STUDIES AND 67,862 PATIENTS
Authors: Esposito L , Baldi C , Silverio A , Di Maio M , Cancro F , Buccheri S , De Luca G , Sarno G , Bellino M , Verdoia M , Vecchione C , Galasso G
Published: May 2022

Background

The Academic Research Consortium for High Bleeding Risk (ARC–HBR) has recently proposed, by consensus, twenty clinical criteria for the assessment of the bleeding risk after percutaneous coronary intervention (PCI). A major criterion was defined as any individual clinical condition conferring in isolation a risk for major bleeding ≥4% up to 1 year after PCI; instead, a minor criterion was considered to confer a bleeding risk of < 4%. The aim of this meta–analysis was to assess the performance of the ARC–HBR criteria in stratifying the risk of bleeding and ischemic events after PCI.

Methods

MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC–HBR criteria in patients treated with PCI. The primary outcome measure of this meta–analysis was major bleeding.

Results

The analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non–HBR group (RR, 2.56, 95% CI 2.28–2.89). The average C–statistic was 0.64 (95% CI 0.60–0.68), indicating modest discrimination. The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all–cause death was higher in HBR vs. Non–HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88–1.16). When assessed in isolation, the mean cumulative incidence of major bleeding at 1 year exceeded the cut–off value of 4% for all the major criteria and for two out of six minor criteria, including age ≥75 years and moderate chronic kidney disease (CKD) (Figure).

Conclusion

The ARC–HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. These findings corroborate the ability of ARC–HBR major criteria in identifying PCI patients who are more likely to develop adverse events, but also suggest caution in the decision making of patients with isolated minor criteria, including age≥75 years and moderate CKD.
P109 CORONARY FLOW VELOCITY RESERVE REDUCTION IS ASSOCIATED WITH CARDIOVASCULAR, CANCER, AND NONCANCER, NONCARDIOVASCULAR MORTALITY
Authors: Tuttolomondo D , Suma S , Botti A , Gaibazzi N
Published: May 2022

Background

Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high–dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non–CV conditions. We aimed to assess whether CFVR is associated with all–cause death, but more specifically with CV, cancer, and non–CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables.

Methods

One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow–up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality.

Results

A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR < 2 was significantly associated with each category of cause–specific mortality. A CFVR < 2 or ≥ 2 separated a group of patients with 8–year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality.

Conclusions

The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.
P115 UNEXPECTED FORMS OF CARDIAC COMPRESSION AB EXTRINSIC
Authors: Faleburle A , Khoury G
Published: May 2022

75–year–old man with a history of atrial fibrillation and hypertension, arrived in the emergency room after car accident (car against tree) three hours after taking Rivaroxaban. After performing a chest CT scan in the emergency room (evidence of fractures of 4 ribs and the body of the sternum) he was admitted to Emergency Medicine where, two hours later, a cardiological evaluation was requested due to sudden desaturation. For the echocardiographic evidence of an image that compressed ab extrinsically the right sections of the heart with complete collapse of the right ventricle, urgent chest CT angiography was required which highlighted a gross sliding hiatal hernia with intrathoracic transposition of fat and large parts of the gastric fundus. It was decided to carry out an evaluation by colleagues in thoracic surgery to proceed with any surgical treatment of the pathology.

Discussion

A hiatal hernia consists of part of the stomach moving up into the chest through an opening in the diaphragm. It can be of three types: sliding, the most common, in which the hernia enters and exits the thoracic cavity. It is not a permanent condition, as the affected portion of the stomach is mobile above and below the diaphragm depending on the pressure exerted on the abdomen; it is more common in obese people; Paraesophageal hernia, in which the upper part of the stomach (bottom) is trapped in the chest cavity, to the side of the esophagus. Mixed hernia, simultaneous presence of sliding hernia and paraesophageal hernia, more rare. Prolapse of a small part of the stomach through the esophageal hiatus of the diaphragm is a fairly common condition. However, the herniation of a larger component is very rare and is often misleading. Rare cases have been described in the literature in which the herniation was associated with a tumor component (GIST) and cases resulting from abdominal surgery. It is often associated with typical symptoms of hiatal hernia in a more pronounced form (belching, abdominal bloating and heartburn); in addition, there have been reports of cardiac–like chest pain. However, it is of fundamental importance to make an early diagnosis in order to be initiated into an adequate therapeutic–surgical approach. As soon as the picture of the thoracic trauma stabilized, our patient was referred for corrective surgical therapy.
P119 PERI– MYOCARDITIS A RARE CASE OF ESCHERICHIA COLI INFECTION, A BACTERIUM THAT SHOULD NOT BE UNDERESTIMATED
Authors: Manes M , Rosselli F , Musacchio D , Ibello L , Ianni M , Domenico B
Published: May 2022

Myopericarditis is defined as inflammation of the heart muscle and pericardium, which can be caused by infectious agents, toxins, or immunological reactions. The most recognized cases are secondary to cardiotropic viral infections. Escherichia coli rarely causes myopericarditis and is secondary to the septic dissemination of bacteria or myocardial toxicity of endotoxins. We describe a case of bacterial sepsis due to Escherichia coli which caused myocardial damage with pericardial effusion. 32 year old woman without cardiovascular risk factors, suffering from congenital immunodeficiency for IG type A, B–cell NH lymphoma undergoing chemotherapy treatment, Hashimoto‘s thyroiditis. The patient arrives for dyspnoea and fever. The ECG showed mild PR depression and an over diffuse ST in all leads with low voltage QRS and increased TNI. PA 120/70 mmHg, HR 74 b / m, FR of 15 acts / m. ETT showed diffuse hypokinesia with FE40% and moderate, circumferential, corpuscular and hyperechoic pericardial effusion without signs of cardiac tamponade. CRP, ESR, Procalcitonin, Leukocytes were elevated, hypothyroidism and low gamma globulin values. The serology of pericardiotropic viruses is negative. Chest x–ray of mild bilateral pleural effusion. Urine culture was performed for pollakiuria, dysuria, fever: positive for Escherichiacoli. After gamma globulin replacement therapy, levothyroxine and targeted antibiotic therapy, the patient presents clinical and laboratory improvement and improvement in FE with persistence of pericardial effusion. Pericardiocentesis is performed with drainage of 800 ml of serous–looking liquid with coarse fibrin shoots. Cytological examination of the liquid shows a blood serum aspect with a carpet of granulocytic inflammatory elements. The patient was discharged after therapy with colchicine, prednisone, levothyroxine sodium, indomethacin, ramipril, omeprazole. The ECG showed an evolved ischemic type pattern.

Conclusion

Very rare cases of Escherichia coli cystitis complicated by myo–pericarditis have been described in the literature. Presumably hypothyroidism and congenital IgA immunodeficiency contributed to favoring and worsening the formation of the effusion. However, further studies are still needed to clarify the mechanisms of myocardial damage, although reversible during this type of bacterial infection.
P120 A STRANGE HEART MURMUR
Authors: Nunziata L , Ambrosino S , Carbone L , Ruggiero V , Laezza A , Prisco A , Nardiello V , Miele R , Terracciano F , Falato S , Granata F , Maresca G , Volpicelli M , Muto C , Capasso M , Caliendo L
Published: May 2022

An 38–year–old man was referred to our hospital for chest pain. He was a smoker but had no other cardiovascular risk factors and had no history of relevant diseases. On cardiovascular examination, a rough grade IV/V systolic murmur was present at the mesocardium. His electrocardiogram showed sinus tachycardia and complete right branch block. On laboratory tests, cardiac biomarkers were negative. A transthoracic echocardiogram showed left ventricle cavity–sized at the upper limits with preserved systolic function and mild concentric hypertrophy. The aortic root was ectatic with tricuspid valve and mild regurgitation. In addition, there was a great spheric cavity in the region of the right sinus of Valsalva that was communicating with the aortic lumen with turbulent flow inside. The Pulmonary Trunk was dilated and there was a strange turbulent flow within it that extended towards the aortic valve. A chest computed tomography (CT) scan was performed in emergency which ruled out an aortic dissection and revealed the presence of an aneurysm of the right sinus of Valsalva. The following day, a transesophageal echocardiogram was performed which confirmed the aneurysm of the right sinus Valsalva and the presence of systodiastolic flow between it and the right ventricular outflow compatible with a fistula. For this reason, the patient was transferred to the Cardiac Surgery Department of another hospital. He underwent cardiac surgery of resection of aneurysmatic tissue, direct suture of the fistula by the combined transaortic / transpulmonary route and reductive plastic surgery of the pulmonary trunk. Aneurysms of sinus of Valsalva are rare cardiac anomalies, which may be either acquired or congenital. A congenital lack of continuity between the aortic media and annulus fibrosis may initiate aneurysm formation. Acquired aneurysms may result from trauma, endocarditis, syphilis, Behcet, Marfan’s syndrome and senile–type dilatation. In our case, the etiology of the aneurysm is not well understood. It could be a congenital aneurysm that has fissured over time creating a fistula with the right ventricular outflow. This fistula caused a significant left–to–right shunt resulting in haemodynamic changes such as pulmonary trunk dilation. We report this case because the concomitant presence of an aneurysm of the right Valsalva sinus and a fistula between it and the right ventricular outflow represents an extremely rare and poorly described event in the literature.
P126 THE DANGEROUS LINK BETWEEN ECTOPIC ADIPOSITY AND HIGH RISK ATHEROSCLEROSIS: A PARADIGMATIC CASE OF STEMI
Authors: Di Ienno L , Cocco M , Squeri A , Conti R
Published: May 2022

Nowadays CCTA has become the first line diagnostic tool in the clinical management of CAD thanks to its outstanding performance in assessing both the degree of stenosis and coronary plaques features, with crucial prognostic implications. Furthermore, CTCA allows an accurate quantification of epicardial fat, which has been shown to be a metabolic active tissue that by means of inflammatory mediators influences the development of high risk plaques and atrial fibrillation. A 70–years–old man underwent primary PCI for an acute STEMI. He was a former smoker with a history of obesity, hypertension, hypercholesterolemia and type II diabetes, without previous major cardiovascular events or significant comorbidities. The coronary angiography revealed diffuse coronary artery ectasia and a thrombotic total occlusion of the proximal portion of the RCA. After intravenous antiplatelet agent administration, balloon angioplasty was performed and three drug eluting stents were implanted. Furthermore, since the coronary angiography showed a calcific contour travelling parallel to the RCA course, in order to rule out a thrombosed coronary pseudoaneurysm, a CTCA was performed. CTCA unexpectedly revealed an enormous fibro–fatty plaque surrounded by a calcific shell in the RCA ostium–proximal segment, with the stents located at one border of the plaque, well expanded inside the vessel lumen. The post–procedural hospital stay was marked by new onset Atrial Fibrillation, unresponsive to pharmacological cardioversion. In contrast with coronary invasive angiography, CT was able to detect a very high plaque burden and a salient ubiquitary epicardial fat volume. In addition, at the site of the culprit lesion, CT showed huge plaque volume with an extreme eccentrically positive vessel remodeling, large low attenuation areas and spotty calcifications, all features known to predict adverse coronary events. This case shows how the combination of metabolic syndrome and ectopic fat accumulation fosters a milieu conducive for high risk atherosclerosis and its clinical complications.
P129 IMPACT OF THE ATHEROSCLEROTIC PABULUM ON IN–HOSPITAL MORTALI–TY FOR SARS–COV–2 INFECTION. IS CALCIUM SCORE ABLE TO IDENTIFY AT RISK PATIENTS?
Authors: Continisio S , Pergola V , Dellino C , Montonati C , Cabrelle G , Previtero M , Perazzolo M , Di Michele S , De Conti G , Motta R , Iliceto S , Mele D
Published: May 2022

Background

Although the primary cause of death in COVID–19 infection is respiratory failure, there are evidences that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognised that COVID–19 is associated with a high incidence of thrombotic complications.

Aim of the Study

evaluate if CAC score was useful to predict in–hospital mortality and complications in patients with COVID infection

Methods

Two–hundred–eighty–four patients with proven SARS–CoV2 infection who had a non–contrast Chest CT at our facility were retrospective analysed for coronary artery calcium (CAC) score. Primary endpoint was in–h mortality. Secondary end–points were need for mechanical ventilation and Intensive Care Unit admission. Clinical and radiological data were retrieved.

Results

Patients with coronary calcium had higher inflammatory burden at admission (D–dimer, CRP, Procalcitonin) and higher high–sensitive Troponin I (HScTnI) at admission and at peak. While there was no association with presence of consolidation and ground glass opacities, patients with coronary calcium had higher incidence of bilateral infiltration and higher in–hospital mortality. The main finding of our research is that CAC alone does not completely identify all the population at risk of events in the setting of COVID 19 patients. Peak HScTnI was associated with higher mortality, intensive care unit admission and mechanical ventilation in both univariable at multivariable analysis.

Conclusions

Together with the presence of higher inflammation burden CAC may be a useful marker in identifying patients at risk of cardiovascular complications and in hospital mortality.
P130 A RARE CASE OF LARGE POST INFARCTION LEFT VENTRICULAR PSEUDOANEURYSM UNDERGOING CONSERVATIVE MANAGEMENT
Authors: Di Saverio M , Massacesi C , Rolando M , Iadanza Lanzaro B , Marrangoni A , Gregori G , Napoletano C , Marini L , Gennarelli A
Published: May 2022

Introduction

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction and its natural history is still unclear. Non invasive imaging improves detection ability and differential diagnosis with aneurysm. We present the case of large post infarction left ventricular pseudoaneurysm undergoing conservative management.

Case Report

A 81–years–old woman presented to emergency room complaining dyspnea and epigastric and right hemithoracic pain. Her past medical history included: chronic coronary syndrome, already undergoing CABG; recent inferior STEMI complicated with complete AVB, with ineffective RCA reperfusion attempt and bicameral pacemaker implantation; Paroxysmal AF in antithrombotic prophylaxis with DOAC. The ECG showed sinus tachycardia, HR 114 bpm, electro–induced ventricular complexes. Objectively, fine bilateral basal crackles were detected. Chest x–ray showed pulmonary congestion. The echocardiographic examination revealed: left ventricle with eccentric remodeling and severe depression of the contractile function (EF 35%), coarse neochamber in communication with the basal segment of the lower wall (D: 6.4 cm x 4.9 cm). The narrow neck, with a ratio <0.5 between inlet orifice diameter / neochamber diameter, suggested pseudoaneurysm. Working diagnosis of NSTEMI–ACS was made (usTnT peak: 344 pg / mL, NV: 0–15 pg / mL) complicated by heart failure. Progressive improvement in compensation was achieved through diuretic therapy. To improve diagnostic definition, cardio–synchronized chest CT with contrast medium was performed. The examination confirmed the voluminous neochamber, consistent with pseudoaneurysm, in correspondence with the mid–basal segments of the lower and inferior septal wall, with thinned walls and mass effect on the great cardiac vein, and highlighted the patency of the bypasses. The venous graft to OM was 5 mm distant from the posterior sternal surface. The case was discussed collectively in Heart Team, due to the high operative risk, the surgical option was rejected and a decision was made for conservative therapy. It was titled beta–blocker, ranolazine was introduced, heart failure therapy was implemented, introducing ARNI. The patient was discharged at home and is in follow–up at the outpatient clinic for heart failure. One month after discharge, she is in NYHA functional class II and she is asymptomatic for angor. The pseudoaneurysmatic dimensions are unchanged on echocardiographic control.
P139 CARDIAC PARAGANGLIOMA: THE IMPORTANCE OF MULTIMODALITY IMAGING
Authors: Campisano M , Scapinelli M , Bagni E
Published: May 2022

Cardiac paraganglioma is a rare neuroendocrine tumour secreting norepinephrine and causing severe hypertension, palpitations, tachyarrhythmias; its precise location is very important because the compression of cardiovascular structures may result in ischaemia, arrhythmia and cardiac failure. Surgical resection represents the primary treatment modality. A 40–year–old young woman with history of hypertension, nocturnal tachycardia and sweats with elevated levels of urinary metanephrine underwent abdominal MRI angiography showing normal kidneys and adrenal glands while in the cardiac–mediastinal site a solid neoformation with contrast impregnation confirmed at subsequent chest CT scan with contrast medium and it appeared inseparable from superior vena cava and occupying the atrial chambers. Patient started therapy with an α–adrenoceptor blocker and underwent cardiac MRI documenting the intrapericardial site of the lesion infiltrating atrial septum and PET/CT scan revealing a large area of uptake of the analogue of somatostatin in the mediastinum typical for atrial paraganglioma. Subsequent angiography CT scan of the thoracic aorta and coronary CT scan showed no signs of infiltration on the great vessels and heart chambers but there was not a clear adipose cleavage plane and the mass appeared intensely vascularized by two large vessels arising from the circumflex artery and the isthmic aorta. After specialistic surgical evaluation the patient was treated with ligation of the afferent peduncle to the neoformation and biopsy of the tissue sample was performed. Post–procedure angiography CT scan showed the neoformation unchanged in size with the two unchanged afferent branches. Histological examination of the tissue sample concluded with arteriovenous hemangioma. One month after surgery elevated urinary normetanephrine levels persisted and the mass on echocardiogram was unchanged. Cardiac MRI after three months was unchanged and specialistic surgical evaluation did not suggest reoperation. Six months after surgery cardiac MRI showed mild increase in volume of the intrapericardial lesion and unchanged atrial septum infiltration. The multimodality imaging plays an important role in the diagnosis of cardiac paraganglioma. The arterial ligation, without the completely removal of the lesion, was not conclusive, the mass increased in size and the patient remained symptomatic. Surgical resection is necessary for the complete cure of the syndromes.
P142 PALMITOYLETHANOLAMIDE (PEA) REDUCES INFLAMMATION IN HUMAN CARDIOMYOCYTES AND VASCULAR ENDOTHELIAL CELLS EXPOSED TO DOXORUBICIN AND ANTI–HER2 MONOCLONAL ANTIBODY THROUGH PPAR–Α AND NLRP3–RELATED PATHWAYS
Authors: Quagliariello V , Buccolo S , Iovine M , Paccone A , Maurea N
Published: May 2022

Introduction

Palmitoylethanolamide (PEA) is an endogenous fatty acid mediator that is synthetized from membrane phospholipids by N–acyl phosphatidylethanolamine phospholipase D. It is a new analgesic drug with anti–inflammatory effects through the induction of PPAR–related pathways.

Purpose

We aimed to assess whether palmitoylethanolamide co–incubated during doxorubicin and trastuzumab, reduces anticancer drugs–related cardiotoxicity in cellular models.

Methods

Human vascular endothelial cells and cardiomyocytes were exposed to subclinical concentration of doxorubicin (at 100 and 200 nM) combined to trastuzumab (at 100 and 200 nM) alone or in combination with a formulation composed by palmitoylethanolamide 500 nM for 48h. 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).

Results

Palmitoylethanolamide co–incubated with doxorubicin exerts vasculoprotective and cardioprotective effects, enhancing cell viability of 56.3–78.7 % compared to untreated cells (p < 0,001 for all). Notably, PEA reduced significantly the cardiotoxicity through peroxisome proliferator–activated receptor–α –related pathways and NLRP3 inflammasome but without the involvement of calcium homeostasis. Several cytokines and chemokines were also reduced confirming its anti–inflammatory effect.

Conclusion

The present study demonstrates that palmitoylethanolamide protects against vasculotoxicity and cardiotoxicity of doxorubicin and trastuzumab by promoting an anti–inflammatory phenotype, representing a new therapeutic approach to resolve doxorubicin–induced vasculo–cardio toxicity and inflammation.
P143 EDOXABAN EFFECT IN A BREAST CANCER PATIENT WITH LIVER ARTERIAL INFUSION CHEMOTHERAPY (LAIC) AND BOTH JUGULAR VEIN AND HEPATIC ARTERY THROMBOSIS. A UNIQUE CLINICAL CASE
Authors: Fioretti A , Leopizzi T , Mariangela P , Fazio V , Ranieri G , Luzzi G , Gadaleta C , Oliva S
Published: May 2022

41 y–o woman, without cardiovascular risk factors, was diagnosed with breast cancer (pT2N1aMx, G3, ER:70%, PgR:30%, HER–2/NEU:2+, Ki67:60%). Treated (2010) with adjuvant antracyclines, taxanes and hormonal therapy. Subsequently, developed (2012) bone lesions treated with radiotherapy and hepatic metastases (2016) treated with systemic infusions of bevacizumab and taxanes. Started (2017) chemoembolization (CE), due to further liver severe progression configuring a main hepatic disease. Started LIVER ARTERIAL INFUSION CHEMOTHERAPY (LAIC) with 5fluoruracil and concomitant venous systemic chemotherapy (CT) with taxanes and bevacizumab. Developed (2020) arterial catheter–related thrombosis (ACRT) recurrent after urokinase, clopidogrel and enoxaparin, in spite of thromboprohylaxis with aspirin/clopidogrel. LAIC was discontinued and CT with taxanes and trastuzumab was administrated by systemic route. Left jugular deep vein thrombosis (DVT) occured (2021), treated for 8 months with low–molecular–weight heparin (LMWH): firstly with enoxaparin 100 IU/kg twice a day and secondly, because of lack of efficacy and patient’s request for a more manageable therapy, with parnaparin 6400 IU once a day. After 8 months the patient refused any more injectable anticoagulant drugs, asking for oral root of administration. LMWH were replaced by direct oral anticoagulant (DOAC), edoxaban 30 mg/die (weight: 43 kg). After 3 months of edoxaban a duplex ultrasound showed an almost total DVT regression; neither bleedings nor dru–drug interactions with the ongoing CT were detected. Instead, the 3 months follow–up CT–scan revealed persistence of the ACRT, despite of edoxaban.

Conclusions

Thromboembolism is the second leading cause of death in malignancy. Venous thromboembolic events are prevalent compared to the arterial ones. However, in active cancer hypercoagulable burden is common to both kind of thrombosis and sometimes occur simultaneously. In this case, a young woman with advanced breast cancer treated with CE and LAIC developed both DVT and ACRT. According to inefficacy and patient’s preference, we replaced LMWH with edoxaban. Arterial thrombosis was persistent although treated with several antithrombotic agents, whereas edoxaban resulted effective in the DVT regression. The take home message of this case report is that DOACs could be a feasible, efficient and safe anticoagulant choice for venous cancer related thrombosis.
P147 RECOVERY OF CHEMOTHERAPY RELATED ACUTE HEART FAILURE BY THE COMBINED USE OF SACUBITRIL VALSARTAN AND WEARABLE CARDIOVERTER DEFIBRILLATOR. A NOVEL WINNING COMBINATION IN CARDIO–ONCOLOGY
Authors: Canale M , Coviello K , Solarino G , Del Meglio J , Simonetti F , Venturini E , Camerini A , Maurea N , Bisceglia I , Tessa C , Casolo G
Published: May 2022

Effective anticancer treatments have dramatically improved the outcome of cancer patients but cardiac toxicity reduces their clinical efficacy in a non–negligible percentage of patients. Sacubitril/valsartan is a new paradigm in the treatment of chronic heart failure with reduced ejection fraction due to the enhancement of natriuretic peptides’ properties when coupled with a blocking effect on the AT1 angiotensin receptors. As with other clinical conditions of heart failure with potentially reversible declines in cardiac function, the wearable cardioverter defibrillator is a valid tool for protection against sudden death until recovery occurs. We report a case series of four patients with chemotherapy–related acute cardiac failure with severely reduced cardiac function. They were successfully treated with sacubitril/valsartan while being protected from malignant arrhythmias by the use of a wearable cardioverter defibrillator until the recovery of cardiac function. Sacubitril/valsartan was confirmed to be effective in anthracycline–related cardiac toxicity and the wearable cardioverter defibrillator should be considered as a support tool even in the oncology patient.
P165 CARDIOVASCULAR RISK FACTORS AND HYPOGONADISM INFLUENCE ON CARDIAC OUTCOMES IN AN AGING POPULATION OF BETA–THALASSEMIA PATIENTS: LOOKING AT THE HEART OF THE PROBLEM
Authors: Ajassa M , Gaglioti C , Longo F , Piga A , Ferrero G , Barbero U
Published: May 2022

Background

β–thalassemia major (β–TM) is a hereditary genetic disease hindered by many comorbidities due to transfusion–related iron. Despite iron chelation therapy increased the life expectancy up to 50 years today, Iron–related heart disease is still a leading complication, with an expected change in cardiac disease drivers with the ageing of these patients. This study aims to evaluate the distribution and prevalence of cardiovascular risk factors in a population of thalassemia major patients, and their relationship with observed cardiovascular events and potential modifying factors.

Methods and Results

One–hundred fifty–nine β–TM patients older than 18 years of age were included in this study. Mean age was 40.9 ± 8.4 years. Low serum lipid levels with low HDL levels were noted, with 28% having diabetes mellitus and 62% with hypogonadism; Splenectomy was reported in 70%. During the observed period, 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received a diagnosis of diastolic dysfunction, 38% had a left ventricular ejection fraction <55%, and 21.4% showed supraventricular arrhythmias. Cardiovascular risk was then assessed using two algorithms (CUORE and Pooled Cohort Risk Equation – PCRE) and was generally low despite the high burden of cardiac–related events. Patients with hypogonadism (who showed lower cardiac T2* value than those without; p < 0.001) showed a statistically significant correlation with the occurrence of cardiovascular events.

Discussion

The β–TM population has a relatively low mean age, but shows a particular metabolic profile associated with numerous comorbidities: an increased prevalence of diabetes mellitus, low HDL values and frequent hypogonadism, which tends to be associated with increased iron deposition in the myocardium. The cardiovascular risk estimated by specific algorithms (CUORE and PCRE) was generally low, probably due to the young age of the cohort and derivation pitfalls when applied to this specific population, but the prevalence of cardiac events was not negligible.

Conclusions

The chronic accumulation of iron in the heart and the specific metabolic profile, mainly observed in patients with hypogonadism, allows us to define β–TM as a condition with high cardiovascular risk from many points of view (iron–related myopathy, atherosclerosis and arrhythmias), which requires better stratification tools and specific follow–up program.
P169 LEFT–DOMINANT ARRHYTHMOGENIC CARDIOMYOPATHY (LDAC)
Authors: Manca F , Cocco D , Pistis L , Serra E , Corda M , Marco M , Pasqualucci D , Cossa S , Pilleri A
Published: May 2022

Arrhythmogenic cardiomyopathy (ACM) is characterised by myocardial structural alterations with fibro–adipose replacement/infiltration, most frequently affecting the right ventricle. Malignant arrhythmias represent the most dangerous clinical manifestation.

We describe the case of a 38–year–old man who came to the Emergency Room of our hospital due to polytrauma. Following the unexpected ECG finding of signs of necrosis in the infero–lateral area and negative T waves in the antero–lateral area, a cardiological examination was performed. The patient, a smoker, had non–contributory family and personal history of cardiovascular diseases and sudden cardiac death. However, he reported several unspecified episodes of “absence seizures”. The transthoracic echocardiogram showed mild reduction in global left ventricular systolic function (EF 45–50%) due to regional changes in motion extending beyond the territory distribution of one single coronary vessel. Holter–ECG showed a Sustained Ventricular Tachycardia (SVT) symptomatic for syncope. A coronary angiography was therefore performed, which excluded any significant coronary stenosis and a cardiac MRI revealed the presence of fibro–adipose replacement of the left ventricle and, to a lesser extent, of the right side of the interventricular septum. Medical therapy with Bisoprolol, Ramipril, Spironolactone was initiated and an ICD was implanted as secondary prevention. No endomyocardial biopsy was carried out due to the high risk of the procedure; genetic testing proved to be negative. A diagnosis of borderline arrhythmogenic cardiomyopathy was therefore made. This case is of special interest as ACM with predominant left ventricular involvement (LDAC) is a rare cardiomyopathy. Diagnosis is made difficult by the presence of phenocopies and by the fact that the diagnostic criteria in use mostly focus on the forms with predominantly right–sided involvement. In the case of suspicious ECG changes, SVT or resuscitated cardiac death with imaging compatible with cardiomyopathy, it is important to raise the diagnostic suspicion of LDAC.
P170 VALUE OF ELECTROCARDIOGRAPHIC SCREENING FOR EARLY DETECTION OF ARRHYTHMIC AND MALIGNANT HEART DISEASE IN CHILDREN
Authors: Elhyka A , Fumanelli J , Di Salvo G , Iliceto S , Leoni L
Published: May 2022

Background

Twelve–lead electrocardiography (ECG) is a tool that can identify cardiac conduction abnormalities that predispose to sudden cardiac death (SCD) in completely asymptomatic subjects. The rate of sudden cardiac death in childhood is estimated at 1–1.5 cases per 100,000 individuals and 10–15% of events occur during physical activity. We evaluated the importance of the electrocardiogram performed in childhood in the early diagnosis of asymptomatic electrocardiographic changes suggestive for electrical or structural heart disease potentially at risk of sudden death.

Materials and Methods

we analyzed 623 patients aged 0–16 years who were referred to the pediatric arrhythmology clinic in Padua Hospital between October 2013 and March 2020. Patients were referred to our second–level clinic after a first electrocardiographic alteration found out in ECG screening performed for sports activity. All patients were evaluated with clinical history and ECG. Then, depending on the suspected pathology, Holter ECG, ergometric test, echocardiogram, MRI were performed for adequate risk stratification.

Results

Of the 623 patients evaluated, 393 (63%) were referred by sports medicine, 179 (29%) by the hospital pediatric clinic or family pediatrician, and 51 patients (8%) were referred for familiarity. 45% of patients (280) were referred for suspected WPW; 124 patients (20%) for many BEV and suspected ARVD; 85 patients (14%) for suspected long QT, 31 patients (5%) for suspected Brugada pattern; 7 patients (1%) for suspected CPVT; 8 patients (1%) for electrocardiographic changes with suspected HCM; 1 patient (0.01%) for suspected short QT and 88 patients (14%) for other arrhythmic disorders not at risk of sudden death. The diagnosis of WPW was confirmed in 280 patients (100%), LQTS in 45 patients (52%), SQTS in 1 patient (100%), S. of Brugada in 8 patients (25%), CPVT in 5 patients (71%), HCM in 8 patients (100%) and ARVD in 6 patients (5%).

Conclusions

Our study demonstrates that electrocardiographic screening in childhood allows early diagnosis and treatment of life–threatening arrhythmic heart disease.
P183 DAPAGLIFOZIN ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH TYPE 2 DIABETIC MELLITUS AND CHRONIC HEART FAILURE
Authors: Lamaida N , De Luca E , Cutolo M , Cerciello A
Published: May 2022

Heart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. Another novelty in HF therapy is dapagliflozin, a sodium–glucose transporter–2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA–HF trial, when added in other guideline recommended therapy.

Material and Methods

A prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 ±10 years) (20 males and 10 females) was conducted. Diabetic (2TDM) patients of NYHA status II–III, previously treated with ARNI, β–blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin 10 mg was added as an adjunct therapy for 2TDM but also as a novel therapy of HF in diabetic patients. Clinical examination and complete echocardiographic evaluation were performed at baseline and 30 days after the addition of SGLT2i to their treatment. 2D echocardiography and Doppler measurements were used for the evaluation of left ventricular function, and more specifically, peak early (E–wave) and late (A–wave) transmitral filling velocities and their ratio E/A, deceleration time of E velocity (DTE) . To classify diastolic dysfunction according to the ASE/EACVI guidelines published in 2016, transmitral E and A waves velocities, septal and lateral E’ tissue velocities, indexed left atrium volume and peak velocity of tricuspid regurgitation were collected.

Results

After 30 days of therapy with dapagliflozin, blood pressure was reduced significantly and the echocardiographic parameters of diastolic function were improved. More specifically, after 6.1±3.6 months of treatment E/A ratio decreased from 1.7 ±1.5 to 1.01±0.70 (P < 0.05), the E/Ea ratio decreased from 13.5± 6.3 vs. 10.2± 5.2 (P < 0.05), tricuspid regurgitation peak velocity decreased from 3.0±0.4 to 2.4± 0.5m/s (P = 0.03) and left atrial volume decreased from 53 ±29.3 to 40.3±11.5ml/m2 (P < 0.05). Subsequently, both left–ventricular diastolic function and filling pressure improved significantly (P < 0.05, ).

Discussion

Our data support the evidence that SGLT2i ameliorate echocardiographic indexes of diastolic function. The ratio of early diastolic transmitral flow velocity seems to correlate well with LV filling pressures, and may be use das a prognostic tool in patients with HFrEF. We have to emphasize that the diastolic function improvement may be considered an early marker of improvement and adequacy .
P189 DOAC: WHEN DRUG INTERACTIONS MAKE A DIFFERENCE
Authors: Zerillo L , Oppo I , Aveta P , Rotunno R
Published: May 2022

Introduction

Direct oral anticoagulants (DOACs), as substrates of cytochrome P450 and / or P–glycoprotein (P–gp), are susceptible to drug–drug interactions (DDI) by both inducers and inhibitors. Awareness of this aspect is essential when choosing a DOAC, to avoid exposing the patient to an increased risk of bleeding or cardioembolicism.

Description

We report the clinical case of a 41–year–old woman with a history of iron deficiency anemia and primary hypertrophic cardiomyopathy (HCM), who came to our emergency room for an episode of atrial fibrillation with high ventricular rate (HR 140 bpm), datable (<48h) and haemodynamically well tolerated. She was therefore subjected to pharmacological cardioversion with amiodarone, which was found to be effective. Subsequently, she was subjected to interrogation of the defibrillator (ICD), of which the patient was a carrier in primary prevention, with the finding of numerous episodes of AF, lasting up to several hours, paucisymptomatic. An antiarrhythmic prophylaxis with amiodarone and anticoagulant therapy with edoxaban was therefore recommended at discharge. In the following two months, in conjunction with the menstrual cycle, the patient had access to emergency room for metrorrhagia with the need for blood transfusion due to severe anemia (Hb 6 gr / dl). The gynecological tests were negative and she was entrusted to the cardiologist for the management of the therapy. Reassessed on an outpatient basis, given the impossibility of changing antiarrhythmic drugs, as amiodarone is the only molecule recommended for rhythm control in patients with this type of cardiomyopathy, and given the possible interaction between edoxaban and amiodarone (+ 40% plasma DOAC levels ), it was decided to shift to another DOAC: rivaroxaban 20 mg (less interference). In the following twelve months the patient no longer had acute anemia phenomena, the hemoglobin values remained stable and upon interrogation of the ICD device there were no arrhythmic events.

Comment

We have described this case to underline how the possible pharmacokinetic interactions between DOACs and antiarrhythmic drugs are of fundamental importance in daily clinical practice, especially when there are non–reversible causes that increase the risk of bleeding. In this case, the therapy shift vs a DOAC with a documented lower DDI interaction was found to be conclusive.
P190 CAROTID DOPPLER ULTRASONOGRAPHIC AND DAPAGLIFOZIN IN TYPE 2 DIABETIC PATIENTS
Authors: Lamaida N , De Luca E , Cutolo M , Cerciello A
Published: May 2022

Background

Carotid Doppler ultrasonography (USG) is widely used to measure haemodynamic parameters, such as Intima–Media Thickness (IMT) and blood flow velocities (i.e. Peak–Systolic Velocity [PSV], End–Diastolic Velocity [EDV], and Resistive Index [RI]). Dapaglifozin (SGLT2i) have been shown to reduce the risk of cardiovascular disease in type 2 diabetes (T2DM) patients. SGLT2i is a sodium–glucose co–transporter 2 inhibitor that reduces renal glucose reabsorption, thus increasing urinary glucose excretion. This leads to sustained systolic and diastolic blood pressure reduction, through natriuresis. We hypothesized that this agent would also reduce arterial stiffness.

Aim

The purpose of this study was to evaluate cardiovascular disease risk indirectly through USG of carotid artery vascular markers in T2DM patients using dapagliflozin.

Methods and Results

40 patients presenting to our clinic between march 2019 and march 2021 and diagnosed with T2DM were included in the study. These were divided into two groups : 1) a dapagliflozin group of 20 patients and 2) 20 patients non–dapagliflozin control group. Velocity parameters were: peak–systolic velocity (PSV), end–diastolic velocity (EDV), pulsatility index (PI), resistive index (RI). Examination was performed on distal portion of CCA, and we took the mean of both CCA. The mean duration of follow–up was 2.0 years. Mean ages were 55 ± 10 years in the dapagliflozin group and 50 ± 10 in the control group. Common carotid artery, PSV, and EDV parameters were higher while RI was lower (p ˂ 0.01), in the dapagliflozin group than in the control group. Vascular resistance was lower in the group using dapagliflozin for diabetes management. In addition In the dapagliflozin group, the IMT decreased after dapagliflozin therapy (P < 0.01).

Conclusions

haemodynamic parameters were better performing in the group using dapagliflozin for diabetes management. Finally SGLT2i can decrease the IMT in patients with T2DM, which is closely related to cardiovascular benefit in patients with T2DM.