bluuebunny/crossref_metadata_2025 huggingface dataset:
130 PROGNOSTIC IMPLICATION OF NEUTROPHIL-LYMPHOCYTE RATIO (NLR) IN MYOCARDITIS: RESULTS FROM A MULTICENTRE, MULTINATIONAL STUDY
Authors: Baggio Chiara , Cannatà Antonio , Scott Paul , Bromage Daniel , Piper Susan , Mcdonagh Theresa , Merlo Marco , Sinagra Gianfranco
Published: December 2022

Background

Neutrophil–lymphocyte ratio (NLR) is an easily obtained inflammatory biomarker. Recently it has emerged as baseline NLR is independently associated with incident cardiovascular (CV) events and all-cause mortality. However, its role in acute myocarditis (AM) has not been evaluated.

Purpose

The aim of the present study was to investigate the prognostic value of NLR in patients with AM.

Methods

All consecutive patients with a diagnosis of AM admitted to two tertiary referral cardiac centres (King's College Hospital, London, UK and Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy) between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e, 2.5).

Results

A total of 260 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=175, 67%) with a mean age of 45±16 years. Main clinical presentation was predominantly infarct-like (n=189, 73%), followed by heart failure (HF) (n=46, 18%) and arrhythmic (n=25, 10%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly lower LVEF (54±11% vs 49±13% respectively, p=0.001). Higher NLR was associated with worse prognosis (Figure 1, p=0.02).

Conclusions

The NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations.
228 PD-1-TARGETED T-CELL CHECKPOINT INHIBITORS-RELATED MYOCARDITIS COMPLICATED BY COMPLETE ATRIOVENTRICULAR BLOCK: A CASE SERIES OF SUCCESSFUL MANAGEMENT
Authors: Collini Valentino , Imazio Massimo , De Biasio Marzia , Lepre Veronica , Burelli Massimo , Taurian Marco , Pellin Lisa , Sinagra Gianfranco
Published: December 2022

Background

Immune checkpoint inhibitors (ICI) have revolutionized the clinical management of a broad spectrum of solid and hematopoietic malignancies over the past decade. ICI are associated with several Immune-related Adverse Events, among which myocarditis and atrioventricular blocks are uncommon but potentially fatal toxicities.

Material and Methods

We describe two patients undergoing treatment with PD-1 checkpoint inhibitors for metastatic cancers who developed myositis and myocarditis complicated by complete atrioventricular block (CAVB). The first patient had a history of metastatic sarcomatoid urothelial carcinoma treated with Pembrolizumab. After two cycles, he developed eyelid ptosis and was hospitalized for syncopal episodes due to CAVB associated with ICI myocarditis.

The second patient had a history of metastatic melanoma and was hospitalized for myocarditis and myositis after the second infusion of Nivolumab.

Results

In the first case, high-dose corticosteroid therapy was promptly initiated, with subsequent rapid recovery of sinus rhythm and rapid resolution of symptoms.

The second patient, despite high-dose corticosteroid therapy, developed CAVB requiring implantation of a definitive PM. After initiation of mycophenolate mofetil and intravenous immunoglobulin therapy, gradual recovery was observed.

Both patients had normal left ventricular function with no wall motion abnormalities. However, speckle tracking echocardiography revealed a normal global longitudinal left ventricular strain (GLS) of -19.8% in patient 1 and a depressed GLS of -14.7% in patient 2, consistent with the different evolution of the two myocarditis.

Conclusions

We recommend a high degree of caution and awareness to all physicians when treating immunotherapy patients. Myocarditis is a relatively rare but potentially fatal event due to its early onset, non-specific clinical presentation and fulminant progression. GLS may be useful in detecting myocardial damage in these patients. Discontinuation of ICI, cardiac pacing, treatment with high-dose corticosteroids and immunosuppressive agents may improve the outcome.
493 A CASE REPORT OF SUBACUTE INFLAMMATORY HEART DISEASE WITH AN ATYPICAL ONSET
Authors: Gonano Nicola , Nuzzi Vincenzo , Pavan Daniela , Piazza Rita , Pecoraro Rosa , Bussani Rossana , Fabris Enrico , Merlo Marco , Sinagra Gianfranco
Published: December 2022

Background

Inflammatory heart disease is a heterogeneous process with variegate clinical manifestations. The acute phase is characterized by a sudden injury involving cardiomyocytes, cardiac conduction system and/or pericardium, with different pathophysiological implications.

Case Summary

A 26-year-old previously healthy woman presented for worsening fatigue and bradycardia. The ECG at admission showed total heart block with infra-Hisian escape rhythm, heart rate was 36 bpm. She reported no history of tick bite or recent inflammatory event; body temperature was 36,8 °C. Laboratory assessment showed persistently raised troponin (28943 -> 32632 ng/l), C-reactive protein was 0,70 mg/l, white blood cells 4,86×10^3/µl, procalcitonin 0,03 µg/l, interleukin-6 was 60,5 pg/ml (n.v. <28,0) and NT-pro-BNP was 312 pg/ml. Borrelia, Salmonella, Ricketsiae, Toxoplasma screening was negative for acute infection as well as any other viral serology. Comprehensive laboratory autoimmunity assessment was negative. Echocardiography revealed normal biventricular volume and kinetics, no valvulopathies and no pericardial effusion. Coronary angiogram was normal. The cardiac magnetic resonance showed extensive oedema and contextual late gadolinium enhancement predominantly in the interventricular septum and mid segment of the anterior wall. Serum angiotensin-converting enzyme concentration was normal. Due to persistent heart block, after 5 days the patient underwent endomyocardial biopsy that showed slight oedema and mild fibrosis without lymphocytic infiltration nor histochemical findings suggestive of active myocarditis. Granulomas were absent. Viral analysis on myocardium was negative. An intermediate dose of steroids was started with a progressive restoration of 1:1 atrioventricular conduction and shortening of QRS up to incomplete right bundle branch block, hence the patient was discharged without pacemaker implantation.

Discussion

In heart inflammatory diseases with bradyarrhythmic onset, atrioventricular conduction may be restored with targeted therapy. Multimodality assessment is crucial in the diagnostic and therapeutic work-up of these cases.
871 AN ADVANCED BREATHING DISORDER IN HEART FAILURE: IS THERE AN OVERLAP THROUGH EXERCISE OSCILLATORY VENTILATION AND CHEYNE-STOKES RESPIRATION? A CASE REPORT
Authors: Baracchini Nikita , De Martino Fabiana , Cunha Goncalo , Carriere Cosimo , Merlo Marco , Agostoni Piergiuseppe , Sinagra Gianfranco
Published: December 2022

Case summary

A 60-year-old man, normal-weighted, former smoker with a known non obstructive hypertrophic cardiomyopathy (HCM), severe mitral and tricuspid regurgitation and permanent atrial fibrillation was hospitalized for decompensated heart failure (recent worsening of exertional dyspnoea and appearance of lower limbs oedema). At the admission the ECG documented a permanent AF with normal average heart rate (66 rpm). Blood tests showed only a mildly elevation of BNP (497 pg/ml). Before the valvular repair surgery patient completed the diagnostic work-up with spirometry and cardiopulmonary exercise testing (CPET). The spirometry showed a mixed disorder predominantly obstructive (FEV1 1.8 L/min, 51% of predicted value), consistent with COPD. Also DLCO was moderately reduced. CPET documented a severe reduction in functional capacity (VO2 peak/Kg 9.2 ml/Kg/min, 32% of predicted value, Watt at peak 61), clear signs of cardiac and pulmonary vascular limitation (VO2 Work Slope 7.1, VE/VCO2 Slope 45). Interestingly, during the entire duration of the effort there were an exercise oscillatory ventilation (EOV). Instead, cardiopulmonary registration at rest showed an advanced oscillatory breathing disorder with regular long phases of apnea (average duration of 40 sec). Apnea phases were diurnal and were associated with desaturation at pulsossimetry (SpO2 93-92%).

This rest breathing disorder consisted with the definition of Cheyne-Stokes respiration. Of note, the patient had no previous history of OSAS or central sleeping disorder.

Discussion

Cheyne-Stokes respiration (CSR) is historically considered as a central sleeping disorder, particularly common in patients with heart failure with reduced ejection fraction (HFrEF) with a wide prevalence range between 16% up to 50%. It is also well known its negative prognostic value as it highly impairs quality of life and increases cardiac mortality. Recently, in HFrEF patients emerged that CSR could be also diurnal and sometimes associated to EOV.

The peculiarity of this clinical case lies firstly in the fact that we clearly documented a possible overlap through EOV and CSR, respectively seen as exerctional and rest advanced breathing disorders. Secondly, CSR was previously reported predominantly in case of LVEF < 40%, but this patient had a non obstructive HCM without systolic disfunction (LVEF was 63%). This suggest that CSR and EOV could have the same pathophysiology pathway, with a continuum through each other, regardless the model of HF (reduced vs preserved ejection fraction).

Keywords: Cardiopulmonary Exercise Testing, Exercise Oscillatory Ventilation, Cheyne-Stokes Breathing, Heart Failure, Hypertrophic Cardiomyopathy.
507 LONG-TERM SUBCLINICAL HEART INVOLVEMENT IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES
Authors: Paolini Federico , Stronati Giulia , Brugiatelli Leonardo , Bastianoni Gianmarco , Alfieri Michele , Moroncini Gianluca , Danieli Maria Giovanna , Guerra Federico
Published: December 2022

Introduction

Global longitudinal strain (GLS) is a validated and reproducible technique for the measurement of LV longitudinal deformation. There is strong evidence of the prognostic value of GLS in patients with HF and is associated with cardiac mortality independent of clinical and cardiac status. In the present study, we aimed to assess whether GLS can reliably predict prognosis in patients diagnosed with idiopathic inflammatory myopathies.

Methods

We conducted a prospective observational study enrolling all consecutive patients referred to our clinic between June 2016 and January 2022 with a confirmed diagnosis of IIM and no overt cardiac disease. For each patient, echocardiogram and GLS calculations were done at baseline and at each follow-up. All patients enrolled have been revalued from two to four times during the median 2.5-year follow-up period.

Results

Forty patients (67% female, mean age 56±12 years) were consecutively enrolled. We detected a significant deterioration of the GLS of the LV (from -19.3±3.6%to -16.8±4.6%; p = 0.006) during the follow-up, while the GLS of the RV was unchanged. We also noticed an increase in the filling pressures as estimated through E/E’, which resulted to be statistically significant (6.5±3.9 to 9.0 ±3.5; p = 0.002), underlying a subclinical diastolic dysfunction of the LV. Traditional markers of systolic dysfunction, such as EF and TAPSE, did not show a significant worsening during the follow-up period. Patients developing a reduction in LV GLS >5% during follow-up experienced an increased incidence of cardiovascular-related death (19% vs 6%; p=0.03).

Discussion

Cardiovascular manifestations constitute a major cause of death in myositis. Although these complications rarely occur clinically, subclinical manifestations such as conduction disturbances, ventricular dysfunction, myocardial infarction and arrhythmias are often observed. This risk appears to increase especially in the first years after diagnosis. There is therefore a problem of the early recognition of patients who may develop heart disease. Several studies propose to use magnetic resonance imaging as a gold standard to select patients at risk, but its high cost and limited availability make it difficult to use as a screening test. The GLS, consistently with the estimated filling pressures, has demonstrated a high predictive power of cardiovascular-related death in our study, without a modification of the traditional systolic function values.

Conclusion

The GLS has a high power predictive, it is low cost and highly repeatable, therefore in our opinion, it could play an important role as a screening test in identifying patients with a diagnosis of IIM at higher risk of developing cardiovascular-related death.
80 GENETIC MYOCARDITIS: ADVANCED WORKUP AND TREATMENT
Authors: Peretto Giovanni , De Luca Giacomo , Villatore Andrea , Sala Simone , Di Resta Chiara , Palmisano Anna , Vignale Davide , Campochiaro Corrado , De Gaspari Monica , Rizzo Stefania , Busnardo Elena , Ferro Paola , Gianolli Luigi , Benedetti Sara , Basso Cristina , Dagna Lorenzo , Esposito Antonio , Della Bella Paolo
Published: December 2022

Background

Preclinical data support the rationale for targeting myocardial inflammation in genetic nonischemic cardiomyopathies. However, no consistent clinical reports have been provided so far.

Methods

We describe a series of patients (n=25) with genetic cardiomyopathy and active myocardial inflammation (AMI) proven by multimodal diagnostic workup. Patient-tailored immunosuppressive therapy was empirically started to target myocardial inflammation whenever feasible. Multiple outcomes were retrospectively assessed by a dedicated multidisciplinary disease unit.

Results

Patients carrying desmosomal (DGV), cytoskeletal (CGV) and membrane gene variants (MGV), were 12 (48%), 10 (40%), and 3 (12%), respectively. DGV carriers uniformly presented with myocarditis-like chest pain and ventricular arrhythmias, whereas heart failure symptoms were found only in CGV carriers. Dilated cardiomyopathy phenotype and ring-like pattern on cardiac magnetic resonance allowed the best discrimination among genotypes. AMI was proven by endomyocardial biopsy in all cases, and by noninvasive imaging in 21 (83%). IST was started in 17 patients (71%) with no safety issues. By the end of follow-up (median 69 months, range 21-182), signs of AMI were documented in 6/18 IST receivers (33%) and 4/7 untreated cases (57%). For most genotypes, paucity of adverse events was noted while on immunosuppression as compared to the off-treatment period.

Conclusion

Our preliminary data provide the clinical rationale for the research and targeting of AMI in a spectrum of genetic nonischemic cardiomyopathies.
505 A NEW NEXN GENE VARIANT LEADING TO FOETAL ONSET MIXED PHENOTYPE CARDIOMYOPATHY WITH UNKNOWN PROGNOSIS
Authors: Ratti Angelo , Irene Picciolli , Rinaldi Berardo , Bedeschi Maria Francesca , Colli Anna Maria , Carugo Stefano
Published: December 2022

Background

Idiopathic dilated cardiomyopathy (DCM) is a common cardiac disease phenotype known to result from many different triggers. Among possible etiologies, genetically determined forms have been more and more acknowledged: recent investigations made possible the identification of risk alleles and disease-causing variants encoding for structural components of the cardiac muscle. The NEXN gene encodes the protein nexilin, an essential protein for Z-disk stability. Homozygous NEXN variants are rare and associated with poor prognosis: fetal and perinatal death or severe DCM in infants.

Case description

we present the case of a male infant, born at term, with prenatal diagnosis of cardiomyopathy. Postnatally, DCM with severely reduced systolic function was confirmed (LVEDd 19 mm, +2 z-scores; LVEF 25%), along with biventricular hypertrophy. The infant required medical treatment for heart failure; atrial tachyarrhythmia responsive to amiodarone was associated. Family history oriented for a genetic and familiar form of DCM (consanguinity and sudden death at a young age on both sides). Whole Exome Sequencing revealed in the proband the homozygous variant c.1156dup (p.Met386fs) in the NEXN gene (NM_144573.4), and both parents were confirmed to be carrier of the same variant at the heterozygous state. This NEXN variant has not been described previously. Complete cardiac evaluation was performed in first-degree relatives, including echocardiography and Cardiac Magnetic Resonance; the mother shows early signs of CMP, such as LBBB with mildly reduced LVEF (53%), while the only remarkable finding for the father is mild left ventricular hypertrophy.

Discussion

genetic DCM can have different clinical courses. It is important to reach the diagnosis: family history is essential in raising suspicion, while infectious causes and inborn error of metabolism must be ruled out. Only a few cases of NEXN-related CMP are described in literature; surprisingly, and unlike what was previously described, we observed in our patient a favorable clinical course during time, suggesting a different severity compared to so far known NEXN variants.

Conclusion

This case helps to broaden present knowledge about NEXN variants and their clinical expression in humans, supporting the inclusion of the NEXN gene in the investigation of patients with DCM, in order to understand phenotypes, guide therapy, and provide proper genetic advice.
560 A RARE CASE OF PERICARDIAL SARCOMA
Authors: Ruggiero Rossella , Di Cesare Annamaria , Fabrizio Michele , Di Domenico Assunta , Gardi Andrea , Moriconi Veronica , Gaudenzi Eleonora , Spighi Lorenzo , Piovaccari Giancarlo
Published: December 2022

A 47 years old man, with no previous medical history, presented to the emergency department for dyspnea increased over the prior weeks. The echocardiographic evaluation revealed a severe pericardial effusion. Moreover, a round-shaped, indeterminate mass was detected into the pericardium, partially enhanced after injection SonoVue R contrast. After the pericardiocentesis, to exclude a severe dilatation of the coronary sinus, the patient underwent to a coronary angiography that showed a diffuse vascularization of the region of the mass. A CT-scan were then performed, and confirmed the presence of a well-defined mass placed near to the left atrial-ventricular junction into the pericardium. The magnetic resonance revealed a limited area of infiltration of the lesion into the myocardium. Finally the patient underwent surgical asportation, and the biopsy showed an high-grade sarcoma. Primary cardiac tumors are rare diseases and in the majority of the cases are of benign nature. Among malignant tumor of the heart sarcoma is the most common. Despite their rarity, malignant heart cancers are associated with high mortality and the prognosis is mostly influenced by the localization of the tumor, its biological aggressiveness, and the difficulty in obtaining surgical radicality. Cardiac sarcomas are most likely to arise from the right atrium followed by right ventricle and less often from the epicardium. In these cases, the asportation of the mass can be challenging, and the risk of myocardial narrowing can affect the area of resection.

We reported a rare case of primary cardiac sarcoma mainly localized into the pericardium. Due to its position, the surgical asportation of the tumor was considered complete and our patient was discharge from the hospital without further complication and with a program of chemotherapy.

At six months follow-up no recurrence of disease was observed.
674 FOCUSING ON ADHERENCE TO INFECTION PREVENTION AND CONTROL RECOMMENDATIONS: FACILITATORS AND BARRIERS. AN EXPLORATORY STUDY OF THE ROLE OF HEALTHCARE PROVIDERS IN CARDIOLOGY SETTINGS
Authors: Chiaretti Ludovica , Ruggiero Antonio , Chiala´ Oronzo
Published: December 2022

Introduction

Cardiovascular devices and their associated placement, management and maintenance require adequate adherence to infection prevention and control (IPC) programs, which are paramount to patient and healthcare provider safety. The lack of control of adverse events and complications due to non-compliance with guidelines and recommendations is clearly a potential risk that needs to be known and avoided. Therefore, it is crucial to identify and describe the potential enabling factors and existing barriers to the use of and adherence to infection control guidelines and recommendations by healthcare providers in the cardiovascular setting.

Methods

An observational study was conducted involving 53 healthcare providers from cardiovascular settings. An online survey was used to explore sociodemographic information, attitudes towards evidence-based practice and its application (IPC-COQ), factors influencing adherence to standard precautions (FIASP Adapted), and potential barriers and facilitators.

Results

The sample was mostly composed by female providers (66%) with a mean age of 41 years. The Attitude domain score (IPC-COQ) was 3.87 (+-0.44), while the Utilization domain score was 3.20 (+- 0.61). The overall FIASP score was 2.84 (+-0.44). The main barriers to adherence reported were: poor relationship between health providers and patients, heavy workload, limited availability of PPE; of the facilitators of adherence, the most frequently cited were: interest in infection control in my department, personal motivation to adhere to EPB, peer involvement. A significant relationship was found between the domains IPC-COQ, FIASP and facilitators and barriers.

Discussion

The identification of potential barriers and facilitators to adherence to IPC recommendations in cardiology could serve as a starting point for the development and implementation of guideline and recommendation adherence strategies by healthcare providers. This will naturally support decision-making processes from which to infer which of these factors need to be removed and which need to be strengthened in order to improve the efficiency and utility of IPC programs in cardiology settings.
413 CARDIOVASCULAR CHANGES MICROGRAVITY-RELEATED: SYSTEMATIC REVIEW OF THE LITERATURE
Authors: Vecchiet Arisa , Li Vigni Myriam Letizia , Satiro Francesco
Published: December 2022

Introduction

Microgravity-relevant space is characterized by different environmental conditions than terrestrial space, including microgravity, vacuum/hypovaria, acceleration, extreme temperature, ionizing radiation, and confinement/isolation.

The space environment induces biomechanical and cardiovascular stress during both takeoff and landing, exposing astronauts to the development of cardiovascular disease (CVD). This literature review focuses on cardiovascular changes that can be traced to an aerospace mission. (Baran, R., et All. 2021).

Materials and Methods

A systematic literature review was conducted to assess the cardiovascular changes that occur on the human body in microgravity. The search was performed using PUBMED as the database. The inclusion criteria established, for an article to be used, was the relevance of the topic.

The choice of articles that were subsequently included in the study was based on predetermined questions and inclusion and exclusion criteria in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The quality of the study was assessed by two reviewers and then discussed with a third reviewer using the DIXONWOOD checklist.

Results and Discussion

Baran, R. et all studied cardiovascular changes during spaceflight in vivo and related molecular changes in vitro that, were outside the scope of pre-flight cardiovascular disease. These changes are related to several factors, including the absence of orthostatic pressure, and reduced blood pressure, which results in a depletion of cardiac workload, sometimes leading to cardiac atrophy, i.e., reduced ventricular size in cosmonauts following a mission. In the face of these, the scientific community is investigating through pre- and post-flight simulation tests the adaptation and prevention of the cardiovascular system.

An exposure to microgravity greater than 6 months cascades numerous physiological adaptations. Indeed, there is a shift in body fluids, arrhythmias, and an increase in systolic output (35-46%) and cardiac output (18-41%). Despite these increases, astronauts may enter a hypovolemic state and cardiogenic shock (10-15% decrease in volaemia). (Baran, R., et All. 2021). In addition to this, prolonged stay in Space, exposes, the cosmonaut to syncopal events of cardiogenic origin in the re-entry and post-landing phase. (Meck, J. V., et All. 2001).

Conclusions

Exposure to microgravity conditions results in significant changes in cardiovascular function. Further clinical studies in larger samples are, however, needed to understand and prevent microgravity exposure-related CVD.

For future applications and theoretical-practical investigations, there also emerges the need, in view of increasingly longer and riskier missions̀ health teleconsultations, for the presence of the health care team on board the shuttle or at the bases alreadỳ present in Earth orbit.
376 CARDIAC CONTRACTILITY MODULATION: A NEW THERAPY FOR HEART FAILURE
Authors: Pettillo Vincenzo , Artiola Gaetano
Published: December 2022

Introduction

Cardiac Contractility Modulation is a therapy for chronic Heart Failure patients with EF 25-45% in sinus rhythm with QRS < 130 ms clinically symptomatic (NYHA Class > II) despite optimised medical therapy. It is made possible by the implantation of the OPTIMIZER SMART® device. The CCM works by delivering a non-excitatory high-energy bipolar signal, synchronised with local electrical activity (or cooperating with another pre-existing CIED), in the absolute ventricular refractory period, by means of two actively fixating leads, positioned in the interventricular septum and spaced at least 1-2 cm apart.

Purpose

Assessment and feedback of the CCM therapy process in patients with dilated cardiomyopathy. Educational update for health professionals. Patient education.

Method

A Pubmed search correlated with clinical data and field experience was performed.

Results

Patients with severe Dilated Cardiomyopathy already on optimised medical therapy. The mechanism of action demonstrated a remodelling of the left ventricle with a so-called 'metabolic' therapy. In CCM therapy, electrical stimulation is delivered to the heart muscle during the absolute refractory period. In this phase, electrical signals activate the mobilisation of calcium ions in cardiomyocytes. CCM signals applied during the absolute refractory period cause an increase in cytosolic calcium during systole, resulting in improved cardiac contraction without an increase in oxygen consumption.

Conclusions

CCM therapy has shown to improve contractility and cardiac performance improving the quality of life of patients undergoing this treatment by reducing symptoms of fatigue and dyspnoea; it has reduced the number of hospitalisations for moderate to severe heart failure. Healthcare professionals recognise The typical ECG of a patient implanted with a CCM device shows a 'spike' in the absolute refractory period of the cardiac cycle: the 'R wave' of the QRS complex without being alarmed. The patient has been trained to be autonomous in charging. OPTIMIZER SMART® is recharged externally with a weekly rechargeable battery through a mini induction charger, rechargeable by itself.
320 THE POTENTIAL ROLE OF ECHOCARDIOGRAPHY IN THE PRE-PARTICIPATION SCREENING: RESULTS OF AN OBSERVATIONAL RETROSPECTIVE STUDY
Authors: Donati Federica , Guicciardi Claudio , Lodi Elisa , Modena Maria Grazia , Palermi Stefano , Biffi Alessandro , Fernando Frederick
Published: December 2022

Introduction

Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include history collection, physical examination and baseline electrocardiogram. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs.

Aim of the Study

The aim of the present paper was to evaluate the potential role of echocardiogram in identifying life-threatening cardiovascular abnormalities that might be undetected by commonly used PPS.

Methods

We retrospectively reviewed a corporate wellness program - database and analyzed data recorded from 2017 to 2022 to compare two medical models: a “standard” PPS including medical history, physical examination, electrocardiogram (ECG) and exercise stress test (EST); an “advanced” PPS comprising history, physical examination, ECG, EST and echocardiography. The primary outcome of the study was to assess the efficacy of the advanced PPS in detecting CV abnormalities compared to the “standard” PPS.

Results

We analyzed data from 500 subjects (420 male, 33.69 ± 7.9 mean aged) enrolled for the first time in the corporate wellness program between 2017 and 2022. 339 (67.8%) subjects had no pathological findings at “standard” PPS and, even if would have not required further evaluation including echocardiogram, performed the ultrasound exam anyway (“advanced” PPS): 31 (9.1%) showed some abnormal findings at echocardiography.

Conclusions

Even if with some limitations, performing a screening echocardiogram could help to detect subjects with some form of cardiovascular morpho-functional abnormalities, otherwise difficult to diagnose with “standard” PPS protocol.
887 THE EFFECTS OF CONCURRENT AEROBIC PLUS RESISTANCE EXERCISE ON BLOOD PRESSURE VALUES AND VARIABILITY AND ARE BLUNTED IN HYPERTENSIVE SUBJECTS WITH NONDIPPING NOCTURNAL BLOOD PRESSURE PROFILE
Authors: Caminiti Giuseppe , Marazzi Giuseppe , Perrone Marco Alfonso , Iellamo Ferdinando , Sposato Barbara , Franchini Alessio , Di Carlo Roberto , Volterrani Maurizio
Published: December 2022

Background

The purpose of this study was to investigate the effects of 12-weeks of concurrent aerobic plus resistance exercise training (CT) on short –term blood pressure variability (BPV) and BP values in hypertensive patients with nondippper BP nocturnal pattern and underlying coronary artery disease.

Methods

The study included 64 patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (29 pts) and nondipping (35 pts). Before starting CT and at 12 weeks patients underwent ergometric test, assessment of 1-repetiton mximun (1RM), and 24/h BP monitoring (24-h ABPM).

Results

after CT Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group (-1.2 mmHg and -1.4 mmHg respectively) while they were unchanged in the nondipping group (-0.2 mmHg and -0.1 mmHg). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group (-8.3 mmHg and -8.5 mmHg respectively) while were unchanged in the nondipping group (-1.2 mmHg and -0.7 mmHg). Nighttime systolic BP and BPV was unchanged in both groups.

Conclusion

the effects of CT on BP and BPV are blunted in hypertensive subjects with nondipping BP pattern. Further studies are needed in order to find out more effectives training modalities for these patients
814 SLEEP DISORDERS AND DYSBIOSIS: CULPRITS IN CARDIOVASCULAR DISEASES
Authors: Pala Barbara , Pennazzi Laura , Tifi Priscilla , Volpe Massimo , Tocci Giuliano
Published: December 2022

Introduction

Primary prevention of cardiovascular disease, the leading cause of death worldwide, has become a mainstay in addressing this considerable global challenge. It has become clear that the gut microbiome plays a vital role in human metabolism, immunity, and reactions to diseases, including cardiovascular disease. Growing evidence suggests that sleep quality can be influenced by the Gut Microbiome (GM), since probiotic supplementation has been found to improve subjective sleep healthy. Disruption of sleep and sleep/wake functions has been associated with both short (increased stress responsivity or psychosocial issues) and long term health consequences, including cancer and cardiovascular diseases. Emerging evidence suggests that disturbance of circadian rhythm, which incorporates essential physiological and humoral functions in a 24-hour cycle, could be an understudied risk factor for cardiovascular disease. While impaired sleep quality is a significant contributor to circadian rhythm disturbance, the evidence regarding sleep interventions and their effect on cardiovascular events is lacking. We conduct a literature review to synthesize a body of evidence on the interaction between sleep and GM in order to achieve robust and broad conclusions and implications with the cardiovascular system.

Methods

We reviewed the literature on the relationship between sleep, gut microbiome and cardiovascular disease, from January 2017 up until August 2022.

Results

The human GM can influence health through a bidirectional communication channel linking the brain and gut, the Brain-Gut-Microbiome Axis (BGMA). Many authors have described several underlying factors that could be involved in sleep-disorder, such as the immune system, the vagus nerve (VN), the neuroendocrine system, and bacterial metabolites. Furthermore, several interventions targeting the GM have been proved to be beneficial for amelioration of sleep problems: gamma-amino butyric acid (GABA) produced by the intestinal microbiota may influence the central nervous system through the VN and have an influence on sleep, as some studies reported

Conclusions

Sleep health may constitute a novel cardiovascular risk factor and target for preventive intervention. More research and well-designed studies are needed to better evaluate the role of the microbiome in the multi-directional relationship between sleep, diet and CVD. From our analysis GM provides a wide range of potential therapeutic targets. Challenges ahead include the development of therapeutic interventions that target reversing gut dysbiosis, at an early stage, combined with good sleep behavior, which may open new horizons to prevent cardiovascular disease.
482 A CASE OF RIGHT SIDE INFECTIVE ENDOCARDITIS IN PATIENT WITH VENTRICULAR SEPTAL DEFECT
Authors: Bruno Noemi , Grieco Martina , Galea Nicola , Tanzilli Gaetano , Torromeo Concetta
Published: December 2022

A 25-years old white female was admitted to our emergency department presenting with dyspnea, fever, cough and nausea. Her medical background included a small ventricular septal defect (VSD) (congenital) with a left to right shunt, micropolicistic ovary syndrome, Sars Cov 2 infection on January 2022, history of cutaneous infection after sternal piercing in the last three years. Patient showed onset of fever, headache and nausea since 20 days and had a history of ampicillin and cephalosporin usage for 15 days for comunitary pneumonia.

Upon arrival in the emergency room, physical examination revealed temperature 38°C, crackles on down right lung fields, regular but tachycardic rhythm, 3/6 holosystolic murmur in the third left intercostal space, also skin redness around the piercing zone. Laboratory test showed increasing of WB (white blood cells), C-reactive protein (CPR) and procalcitonin. Because of worsening of respiratory conditions, CT chest was performed, showing tree in bud sign, with pulmonary pattern suggestive of staphylococcal “emboligenous-like” infectious state. According to patient's clinical history and CT results, she was referred to transthoracic echocardiogram (TTE) demonstrating the presence, on the right side of the small VSD, of a isoechoic large mass (20x 13 mm) with irregular margins attached to the right ventricular wall near the ostium of the VSD, compatible with vegetation; septal tricuspid valve leaflet involvement could not be ruled out. Methicillin-susceptible Staphylococcus aureus (MSSA) was detected six times from blood cultures; therapy with oxacillin 2 gr every 4 hours combined with daptomycin 750 mg daily was started. Cardiac MRI performed after few days, documented the infective involvement of the ventricular and atrial side of the septal leaflet with moderate tricuspid regurgitation (TR).

Congenital heart disease (especially Tetralogy of Fallot, bicuspid aortic valve, aortic coarctation, ventricular septal defect) is a lifelong risk factor for infective endocarditis (IE). Size of VSD is generally not correlated with IE that is directly correlated with turbulent flow; tricuspid valve involvement is mostly seen in VSD, often complicated by pulmonary embolism. In this predisposing situation, skin infection of the piercing zone could have caused transient bacteremia which led to the formation of vegetations in the highest turbulence flow zone.
574 DOUBLE VASCULAR COMPLICATION IN THE SITE OF PUNCTURE AFTER TAVI: A CASE REPORT
Authors: Calvelli Pierangelo , Polimeni Alberto , Sorrentino Sabato , Mongiardo Annalisa , Torella Daniele , De Rosa Salvatore , Riverso Vincenzo , Giamundo Angelo , Lombardo Vincenzo , Serratore Serena , Indolfi Ciro
Published: December 2022

Hemorrhages represent one of the most frequent complications during TAVI. Their rapid recognition and a prompt treatment are necessary to avoid hemorrhagic shock, which can lead the patient to death in a short time.

We report the case of a 79-year-old woman affected by severe and symptomatic aortic stenosis, who underwent TAVI in our Cath-lab. Through a right femoral echo-guided arterial access, implantation of a 26 mm self-expandable aortic bio-prosthesis and hemostasis in the site of puncture with 18F Manta vascular closure device were performed. At the end of the procedure, through radial artery, a femoral angiography was performed, showing an important leak of contrast medium upper the site of puncture, without any change in arterial pressure or heart rate. After echo-guided cannulation of left femoral artery with 8F sheath, implantation of endoprosthesis in the site of hemorrhage and hemostasis of left femoral artery with 8F AngioSeal VIP vascular closure device were performed. In cardiac intensive care unit (CICU) low dosage of vasoactive agents and blood were administered, guaranteeing a good arterial pressure. Computed tomography (CT) was performed after two days and confirmed the presence of a retroperitoneal hematoma, without active bleeding.

After six days, the patient left CICU and was admitted to the cardiological ward, starting a gradual mobilization. However, after 48 hours she reported abdominal pain and became rapidly hypotensive, tachycardic and asthenic, requiring readmission in CICU. Serum exams showed low hemoglobin concentration, an abdominal CT was perfomed, showing an active bleeding from left femoral artery and a homolateral retroperitoneal hematoma. The patient was rapidly lead in the cath lab. Angiography confirmed the hemorrage and an endoprosthesis was successfully implanted in the left femoral artery. Blood and vasoactive agents were administered with a progressive improvement in hemodynamic and clinical conditions of the patients. Post-operative course was complicated by fever and empiric antiobiotic therapy was administered until blood culture revealed no bacterial growth. A third CT showed the stability of the hematomas and the absence of active bleeding, allowing hospital discharge of the patient.

Vascular complications are frequent and sneaky during TAVI procedures. A prompt treatment is of paramount importance to prevent hemorrhagic shock. TAVI operators should have experience in the field of peripheral intervention for the management of vascular complications.
1083 RISK STRATIFICATION AND PREDICTORS OF OUTCOME IN ASYMPTOMATIC AORTIC STENOSIS: THE ROLE OF MULTIMODALITY IMAGING
Authors: Colarusso Luigi , De Sarro Rosalba , Licordari Roberto , Zito Concetta
Published: December 2022

Background

Management of asymptomatic severe aortic stenosis is controversial and the decision to intervene requires careful assessment of the benefits and risks in an individual patient. Multimodality imaging approach is becoming an important tool to evaluate the severity and outcome of aortic stenosis (AS).

Aim

To assess the outcome of asymptomatic AS and the usefulness of aortic calcium score (CS) by computed tomography (CT) for solving the dilemma of low-flow, low-gradients (LFLG) severe AS.

Methods

70 (81.4±8.4yrs) prospective asymptomatic patients with AS were followed for 2.77±2.01yrs with a trans-thoracic echo (TTE) every 6 months. End-points were all cause mortality, aortic valve replacement (AVR or TAVR), aortic velocity and gradients progression and symptoms occurrence. Prevalence of LFLG-AS was investigated and these patients underwent CT for CS calculation at the end of follow-up (FU), Figure 1.

Results

Baseline TTE results from the 70 pts were: peak velocity 3.1±0.8m/sec; peak gradient 44±21mmHg; mean gradient 26±14 mmHg; AVA 1±0.3 cm2; DVI 0.31 ±0.1; Svi 33.8±18 ml/m2; EF: 55±9% with an AS being mild in 32.9%, moderate in 28.4%, severe in 27.1%; 36.8% of severe AS were LFLG. During FU, 23 (32.8%) pts died (5.7% LFLG) and 13(18.5%) underwent AVR/TAVR. Predictors of mortality were aortic gradients (p=0.03), AVA (p=0.008), DVI (p<0.001), pulse pressure (p=0.005) and dilated ascending aorta (p<0001). Predictors of AVR/TAVR were: gradients (p=0.003), peak aortic velocity (p=0.02) and dilated ascendent aorta (p=0.01). The best cut-off to predict survival was AVA =1cm2 (100% sensitivity and 80% specificity). In 34 pts ending FU we found an overall progression of AS severity (peak velocity 3.6±0.9m/sec; peak gradient 50±24mmHg; mean gradient 33±15 mmHg; AVA 0.7±0.3 cm2; DVI 0.25±0.08; Svi 36±10 ml/m2; EF 54±10%; p<0.05 for all vs baseline) with 24 (70.5%) pts with severe AS and 10 (29.5%) with not severe AS. 18 (75%) of progressive severe AS were LFLG, 12 asymptomatic and 6 symptomatic and all underwent CS revealing that AS was not severe in 6 (1233±1123 AU; 622±55AU/m2) and true severe in 12 (3388±1188 AU;1858 ±795 AU/m2; p=0.005 and p=0.002, respectively). Symptomatic severe LFLG AS were all true severe according to CS (Figure 1). Table 1 shows the main CS correlations.

Conclusions

Asymptomatic AS in elderly people is associated with high mortality risk and rapid progression. AVA remains the best predictor of outcome. In severe LFLG AS, calcium score correlates with symptoms occurrence, progression of valve disease, LV hypertrophy and function and also with RV function.
961 RIGHT VENTRICLE-PULMONARY ARTERY COUPLING RATIO AS PROGNOSTIC FACTOR FOR PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TAVI
Authors: Del Sole Paolo Alberto , Fezzi Simone , Mammone Concetta , Flaim Massimo , Lunadi Mattia , Scarsini Roberto , Tavella Domenico , Pesarini Gabriele , Pighi Michele , Ribichini Flavio Luciano
Published: December 2022

Background

Right Ventricle/Pulmonary Artery (RV/PA) coupling has recently emerged as a relevant prognostic factor in patients undergoing transcatheter valvular interventions. The aim of this study is to assess the interaction between RV/PA coupling ratio and the incidence of Acute Kidney Injury (AKI) following TAVI in patients with severe aortic stenosis. Furthermore we investigated the interaction between this novel ratio and adverse events at 24 months follow-up.

Methods

A population of 283 patients was selected from the Verona Valvular Registry (CESC n =1918). RV/PA coupling was estimated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPs) obtained through transthoracic echocardiograms. AKI was defined as an increase in serum creatinine (sCr) of at least 0.3 mg/dL up to 48 hours following TAVI. Major adverse cardiovascular events (MACEs) were defined as the composite occurrence of cardiac death, re-hospitalization for congestive heart failure and stroke.

Results

Mean age was 83.4 ± 5.36 years and 41.3% of patients were female. The median value of TAPSE/PAPs ratio was 0.5667 mm/mmHg and was used as a cut-off. A TAPSE/PASP ratio <0.5667 was found to be associated with a higher incidence of MACE at Kaplan Meyer analysis at 24 months (10.4% vs 3.5%, log p = 0.004) and higher occurrence of AKI (17.0% vs. 7.7%; p=0.027). Notably TAPSE/PAPs interquartile comparison showed higher incidence for AKI in patients in the lowest quartile compared to higher ones (24.2% vs. 8.5%; p = 0.001). Following Cox multivariate analysis, TAPSE/PAPs ratio and diabetes mellitus were found to be independent predictors of AKI.

Furthermore, risk for 24 months MACEs was higher in the population with lower TAPSE/PAPs ratio (HR 2.672; CI 95% [1.195–5.974]; p = 0.017).

Conclusion

RV/PA coupling, as characterized by TAPSE/PAPs ratio, is a promising independent predictor of AKI, also associated with higher risk of major adverse cardiac events at follow-up in subjects undergoing TAVI. These data suggest a possible role for this novel index in risk stratification, assessment of the prognosis, and decision-making in these patients.
738 A RARE CASE OF UNICUSPID AORTIC VALVE WITH SEVERE STENOSIS AND REGURGITATION: CLINICAL PRESENTATION AND MANAGEMENT
Authors: Saro Riccardo , De Luca Antonio , Radesich Cinzia , Pezzato Andrea , Restivo Luca , Korcova Renata , Mazzaro Enzo , Bardari Stefano , Rauber Elisabetta , Merlo Marco , Sinagra Gianfranco
Published: December 2022

A 19-year-old Pakistani migrant, who arrived in our country on foot, presented at emergency department with angina and worsening dyspnoea on exertion. The patient reported an unclear history of aortic valve disease.

Clinical examination revealed a 6/6L systolic murmur with thrill. The electrocardiogram showed sinus rhythm and signs of left ventricular hypertrophy. Chest X-ray reported cardiomegaly and signs of congestion. Troponin I HS was mildly elevated (39 ng/L, n.v. < 18 ng/L).

The patient was admitted to our Cardiology department. Transthoracic echocardiography revealed a mildly dilated left ventricle (LV), with severe hypertrophy, normal kinetics and systolic function (EF 63%), dilated ascending aorta (diam. 41 mm) and severe aortic steno-insufficiency. Transesophageal echocardiography was then performed, revealing a highly calcified, unicuspid unicommissural aortic valve with severe stenosis and regurgitation. A separate origin of left coronary ostia was also documented.

The patient was referred to urgent cardiac surgery. A modified Bentall procedure (mechanical valve and prosthetic conduit) was performed with reimplantation of the coronary ostia. Due to a post-surgical complete atrioventricular block, a dual-chamber pacemaker (DDD) was implanted.

Follow-up echocardiography showed reduction of LV volumes and wall thickness and normal prosthetic function.

Unicuspid aortic valve is a very rare congenital disease, with a prevalence of about 0.02% in the adult population and is frequently associated with ascending aorta dilatation. The treatment is aortic valve replacement. Complete atrioventricular block can occur after surgery, requiring cardiac pacing.
450 USE OF A DOUBLE MITRACLIP FOR SEVERE MITRAL REGURGITATION IN A HEART TRANSPLANT PATIENT
Authors: Santacroce Flavia , Carella Maria Cristina , Acquaviva Tommaso , Lapetina Ornella , Milano Aldo Domenico
Published: December 2022

Despite the progresses made over the recent years on heart transplantation, there are few data in literature about mitral regurgitation in transplated hearts.

We report a case of a 62-year-old Italian man who presented dyspnea for mild exercise two years after orthotopic heart transplantation. He was found to have sever mitral regurgitation and underwent a successful implantation of a double MitraClip with the reduction of the mitral regurgitation and improvement of the symptoms.

Two months later, he was still doing well and a repeted echocardiogram showed good results with only residual mild aortic insufficiency. We found few previously reported cases using the MitraClip to treat mitral regurgitation in adult cardiac transplant patients.