bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution characteristics and prediction model of farmland soil organic carbon in eastern China
Authors: Liu Shutian , Xie Xiansheng , Wang Xiaochuan , Feng Xinxin , Hou Xianda , Wang Shuojin , Lin Keyu , Huang Mei , Jia Shugang , Hou Yanlin , Dou Sen
Published: May 2022

Soil organic carbon (SOC) plays a key role in soil improvement, carbon sequestration, and increasing crop yield. In this study, the distribution characteristics and the influence of hydrothermal conditions on farmland SOC content in eastern China were studied. The results showed that the spatial heterogeneity of SOC content in eastern China was obvious. In the area with the mean average temperature (MAT) below 10.42 °C, the SOC content was negatively correlated with MAT and ≥10 °C accumulated temperature, but positively correlated with the ratio of precipitation to temperature (P/T). In the area with the MAT between 10.42 °C and 20.75 °C, the SOC content was negatively correlated with mean average precipitation (MAP), MAT, P/T and ≥10 °C accumulated temperature. In the area with the MAT above 20.75 °C, the SOC content was negatively correlated with MAT and ≥10 °C accumulated temperature, but positively correlated with MAP and P/T. In the area with the MAP below 400 mm, the SOC content was negatively correlated with P/T, but positively correlated with MAP, MAT and ≥10 °C accumulated temperature. In the area with the MAP between 400 mm and 800 mm, the SOC content was negatively correlated with P/T, but positively correlated with MAT and ≥10 °C accumulated temperature. In the area with the MAP more than 800 mm, the SOC content was negatively correlated with MAP, MAT, P/T and ≥10 °C accumulated temperature. Based on the above results, a model for predicting SOC content was established. This is of great significance for the rapid estimation of SOC content on a regional large scale.
C5 IMPACT OF ATRIAL HIGH RATE EPISODES ON PROGNOSIS IN PACEMAKER PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Matteucci A , Bacà M , Cappuccio C , Pignalberi C , Magris B , Meo A , Aquilani S , Colivicchi F
Published: May 2022

Background

The occurrence of high atrial rate episodes (AHRE) is growing in importance due to the increasing number of patients with implantable cardiac electronic devices (CIED). As a result, clinicians need to balance the benefits of a pharmacological therapy against the risks involved. To date, there are no clear evidence on the long–term effects of AHRE, nor are there any specific recommendations to help physicians make the most appropriate treatment choice.

Methods

We enrolled 732 patients with CIED followed in the Arrhythmology department of San Filippo Neri Hospital, in Rome and with remote home monitoring. Only patients with single–chamber, dual–chamber and biventricular pacemakers (CRT–P) were included. All patients had post–implantation follow–up at 6 months and one year. The minimum follow–up duration considered was 24 months. Patients with permanent pre–implant atrial fibrillation were excluded.

Results

Among the enrolled cohort, AHRE were found in 170 (23.2%) patients. The occurrence of AHRE was significantly related to older age (p = 0.001 HR 1.02 CI 95%), lower ejection fraction (p = 0.027 HR 0.98 CI 95%) and severe mitral valvulopathy (p = 0.003 HR 1.7 CI 95%). The presence of AHRE increased the risk of cryptogenic stroke only for episodes over 24 hours (p = 0.02 HR 1.6 CI 95%) and increased mortality (HR 1.32 CI 95%), although not significantly (p = 0.132).

Conclusion

AHRE are associated with adverse events and may increase mortality in patients with CIED. Their monitoring and detection is necessary for an appropriate management of treatments. Randomised studies are needed to clarify the criteria for thromboembolic prevention in the context of AHRE.
C13 COMPARISON OF MINIMALLY INVASIVE VERSUS CONVENTIONAL THORACIC AORTIC OPERATIONS: EARLY AND MID–TERM RESULTS IN A SERIES OF 624 PATIENTS
Authors: Berretta P , Galeazzi M , Chiuselli G , Codecasa R , Alfonsi J , Braconi L , Rapisarda F , Bonacchi M , Malvindi P , Stefano P , Di Eusanio M
Published: May 2022

Objective

Despite minimally invasive techniques have gained wider clinical application in cardiac surgery, current evidence on mini thoracic aortic surgery is still limited. The aim of this study was to compare early and mid–term outcomes of patients undergoing proximal thoracic aortic interventions through mini–sternotomy (MS) versus full sternotomy (FS).

Methods

Data from 624 consecutive patients undergoing proximal aortic operations through MS (n = 214, 34.3%) and FS (n = 410, 65.7%) at 2 aortic centers, were analysed. Patients with prior cardiac operations and active endocarditis, and those who underwent emergency operation and combined procedures were excluded. Treatment selection bias was addressed by the use of propensity score matching (MS vs FS). After matching, 2 well–balanced groups of 202 patients each were created. Surgical procedures involved aortic valve replacement/repair and ascending aorta replacement in 190 patients (47%), aortic root replacement in 110 patients (27.2%) and isolated ascending aorta replacement in 104 patients (25.7%).

Results

The median cardiopulmonary bypass and cross clamp times were 88 and 68 minutes, respectively, with no difference between groups. Overall 30–day mortality was 0.7%, being 1% (n = 2) in patients underwent MS and 0.5% (n = 1) in those underwent FS (p = 0.6). No difference was found in the rates of stroke (MS n = 5, 2.5%; FS n = 5, 2.5%), dialysis (MS n = 1, 0.5%; FS n = 4,2%), bleeding (MS n = 7, 3.5%; FS n = 7, 3.5%), and blood transfusions (MS n = 67, 33.3%; FS n = 57, 28.4%) (Table 1). Patients receiving MS were associated with a lower incidence of respiratory insufficiency compared with those receiving FS (0% vs. 2.5%, p = 0.03). The median intensive care unit length of stay was 24 and 25 hours in MS and FS group, respectively (p = 0.3), and in–hospital stay was 7 days both in MS and FS group (p = 0.9). Three–year survival rate was 96.6% in patients receiving MS and 95.7% in those receiving FS (p = 0.9).

Conclusions

Our findings showed that mini proximal aortic operations can be performed successfully without compromising the proven efficacy and safety of conventional access. In selected patients, MS was associated with very low mortality and morbidity rates. Additionally, MS demonstrated superior clinical outcomes as regards respiratory adverse events, when compared with FS.
C17 SIMPLIFIED MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH A DIRECT VISION TRANSAXILLARY APPROACH: PROCEDURAL AND 30–DAYS OUTCOMES
Authors: Malvindi P , Berretta P , Alfonsi J , Galeazzi M , Bifulco O , Capestro F , Zingaro C , Di Eusanio M
Published: May 2022

Background

Minimally invasive cardiac surgery through right mini–thoracotomy access is nowadays an established approach for the treatment of mitral valve pathologies. Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection and valve exposure. Aim of this study is to review our early results with a minimally invasive approach characterized by a lateral right trans–axillary (TAx) approach and direct vision.

Methods

Prospectively collected data of patients who underwent mitral valve surgery between 2018 and 2021 were reviewed. Among them, 245 patients underwent minimally invasive mitral valve surgery through TAx access. A single incision at the fourth right intercostal space on the anterior axillary line, 3–to–5 cm in length (Fig 1), allowed a 90° direct view exposure of the mitral valve (Fig 2) and the subvalvular apparatus (Fig 3). A transthoracic clamp was invariably used to achieve the cardioplegic arrest.

Results

Mean age of the patients was 63 years and the mean EuroSCORE II was 1.6. Regurgitation was the prevalent mitral valve dysfunction (91%). Mitral valve repair was performed in 87% of the cases using several techniques including a combination of annuloplasty, leaflet resection and sliding, placement of neochordae and repair of the commissures. In patients with degenerative disease, the rate of valve repair was 92%. Tricuspid annuloplasty was associated in 10% of the cases. There was no in–hospital death; the rates of postoperative stroke and TIA were 0.4% and 1.2%, respectively. Median mechanical ventilation time was 3 [0–6] hours with 40% of the patients extubated in theatre at the end of the procedure. Median ICU stay was 24 [21–46] hours. Three patients had superficial complications of the thoracic wound and in 7 cases of the groin incision. After a median time of 7 [6–8] days, all the patients were successfully discharged from the hospital. The pre–discharge echocardiogram revealed none or trace residual mitral regurgitation in up to 96% of the patients who underwent mitral valve repair with a mean gradient across the valve of 3 [2–4] mmHg.

Conclusions

The TAx approach for minimally invasive mitral valve surgery is safe and allows a quick functional recovery. A superb direct view of the mitral apparatus and the ascending aorta, facilitates the exposure and the surgical repair of the valve with no need of any endoscopic nor an endoaortic balloon occlusion system support.
C57 DUAL ANTIPLATELET THERAPY DID NOT PREDICT ALL–CAUSE BLEEDING AT LONG–TERM FOLLOW–UP AFTER ACS: A SUBANALYSIS FROM THE APULIA PONTE ACS STUDY
Authors: Citarelli G , Locuratolo N , De Martino G , Resta M , Sassara M , Ricci G , Cicala M , Piscopo A , Sanasi M , Scicchitano P , Lisi F , Spadafina T , Grande D , Caldarola P
Published: May 2022

Background

Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS.

Methods

This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up.

Results

We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up.

Conclusions

Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.
C63 PHENOTYPE – GENOTYPE RELATIONSHIP IN ARRHYTHMOGENIC CARDIOMYOPATHY
Authors: Gueli I , Alderotti B , Todiere G , Grigoratos C , Modena M , Botto N , Vittorini S , Vergaro G , Giannoni A , Aimo A , Passino C , Aquaro G , Emdin M , Barison A
Published: May 2022

Background

Arrhythmogenic cardiomyopathy (ACM) is a primary disease of the myocardium with arrhythmic manifestations and fibro–fatty replacement either of the right (RV) or the left ventricle (LV) at the cardiac magnetic resonance (CMR). Over the last decade, different mutations in cardiac genes associated with heterogeneous phenotypes have been identified.

Aim

To investigate the genotype–phenotype relationships in ACM patients. Firstly, the phenotypic expression was defined in definite mutation carriers. Secondly, the prognostic significance of mutations was assessed across different phenotypes.

Methods

The study population included 281 patients with suspected ACM, based on family history, clinical and electrocardiographic evaluation, echocardiographic and CMR findings (Fig.1), studied at our Institution since 2012. All patients underwent genetic evaluation using Sanger sequencing and NGS of mutations in desmosomal (desmoplakin [DSP], plakophilin–2[PKP2], plakoglobin[JUP], desmoglein–2 [DSG2], desmocollin–2 [DSC2]) or non desmosomal genes. The composite endpoint included cardiac death, sustained and non–sustained ventricular tachycardia (VT), ventricular fibrillation (VF), appropriate defibrillator shock/antitachycardia pacing (ATP).

Results

The genetic test was positive in 113 patients (40%), 82 (73%) for desmosomal genes (41 DSP, 15 DSG2, 15 PKP2, 5 JUP, 6 DSC2), and 31 (27%) for non–desmosomal genes (4 titin, 2 TMEM 43, 2 lamin A/C, 23 others). Gene–positive compared to gene–negative (n = 168, 60%) patients showed a higher prevalence of LV ejection fraction (EF)<50% (14%vs.6%, p<0.011), LV and RV LGE (62%vs.46%, p < 0.001, 20%vs.12%, p<0.02), RV dilatation (27%vs.17%, p<0.041) (Table 1). DSG2 mutations were associated mainly to biventricular (7/15,46%) or RV involvement (4/15,26%), while DSP mutations to LV involvement (24/41,58%). During a median 36–month follow–up (IQ.range 12–56), 55 patients (19%) experienced the composite endpoint (35 non–sustained VT; 11 sustained VT – 3 ATP, 1 defibrillator–shock–; 9 VF, all treated by defibrillator–shock). At Kaplan–Meier analysis, DSP mutations were associated with the worst prognosis (Fig. 3). Conclusion Diverse genotypes were differently associated with LV dysfunction/LGE, RV dilatation/LGE. DSP mutations were associated with higher arrhythmic risk. Genetic screening may result in a better risk stratification, useful for clinical decision–making.
C70 HIGH–SENSITIVE CARDIAC TROPONINS ELEVATION: NOT ONLY A CARDIAC DISEASE. ROLE OF HETEROPHILE ANTIBODIES
Authors: Forzano I , Campana P , Ranieri A , Sforza A , Aversa M , Musella F , Basile C , Perillo E , Ciaramella L , Tagliamonte G , Sibilio G
Published: May 2022

Introduction

High–sensitive troponins I and T (hs–TnI and hs–TnT) represents the main biomarkers of Acute Coronary Syndrome diagnosis when combined with ST–T segment changes at ECG and typical clinical presentation. Elevated serum values of cardiac troponins can also be found in several cardiac diseases such as myopericarditis, pulmonary embolism and heart failure, conversely also in non–cardiac diseases. Among them, the analytical interference due to heterophile antibodies (HA) represent a rare non–cardiac cause of troponins elevation.

Case Presentation

We report a case of a 20–year–old man admitted to our Cardiology department for palpitations and dyspnea, associated with persistently high levels of TnI–HS. He presented no cardiovascular risk factors. During hospitalization the patient was asymptomatic with persistent TnI–HS elevation (1051.4 pg/mL; r.n. 0–34 pg/mL) associated with no CK–MB values changes or typical rise and fall of myocardial damage biomarkers at lab test. Cardiac magnetic resonance excluded myopericarditis or cardiomyopathies in this patient, therefore HA capture test was performed using HA blocking tube reagents. The analytical interference due to HA has been identified with a post–test hs–TnI value of 16.9 pg/mL.

Conclusions

The analytical interference due to HA is a rare and underestimated cause of false–positive results in cardiac troponin essay, however it should be excluded mostly in young patients without cardiovascular risk factors. Persistent hs–TnI and hs–TnT elevation combined with the absence of typical rise and fall of cardiac troponins and with no CK–MB alterations should help the clinician to recognize this analytical phenomenon at the emergency department.
C83 USE OF CANGRELOR IN A 63 YEARS OLD MEN SUFFERING FROM ACUTE INFERIOR ST–ELEVATION MYOCARDIAL INFARCTION AND SEVERE IDIOPATHIC THROMBOCYTOPENIC PURPURA: A CASE REPORT
Authors: Cocozza S , Formigli D , Parente A , Pirozzi E , Franco V , Moscato F , Amico V , Vallone R , Scherillo M
Published: May 2022

A 63–year–old man suffering from systemic arterial hypertension, thalassemic trait, recent right ureteral stent implantation, dysthyroidism and thrombocytopenia presented to the Emergency Department with acute chest pain and ST elevation in inferior leads and 2nd degree atrioventricular block. He suffered from idiopathic thrombocytopenic purpura since February 2020, with baseline platelet level (PLT) <10,000/mm³ requiring treatment with deltacortene 5 mg, tranexamic acid 1000 mg x 3/day and fostamatimib 100 mg x 2/day. Upon arrival in the Cardiology Intensive Care Unit (UTIC) an echocardiogram was performed and confirmed inferior myocardial infarction. First laboratory results were significant for PLT of 9,000/mm³ and Troponin I peaked at 31,838 pg/mL. The patient received Acetylsalicylic acid (ASA) 300 mg iv then was urgently transported to the Cath–Lab. Coronary angiography revealed mid right coronary artery occlusion, subsequently underwent primary percutaneous coronary intervention with multiple pre–dilations and placement of dual 3.5x28mm and 4.0x28mm TiNO bioactive metal stent with excellent angiographic results. A temporary Pacemaker was implanted. It was started Cangrelor bolus 30 µ/kg followed by infusion at 4 µ/kg/min for 6 hours associated with unfractionated sodium heparin at a reduced dosage of 50 IU/kg during the procedure and with a subsequent switch to Clopidogrel after an oral bolus of 300 mg. After 24 hours, the patient removed the temporary PMK for resolution of the AV block. The haematologist consultant advised to increase fosfatimib to 150 mg x 2/day and recommended the use of Human Immunoglobulin iv from the second day of hospitalization for 2 days. The patient was discharged on the seventh day, asymptomatic, with dual antiplatelet therapy (DAPT) with ASA 100 mg and Clopidogrel 75 mg daily and did not experience any bleeding during hospitalization. At a one–month follow–up, the patient is symptomatic and continued to tolerate ASA and Clopidogrel with stable PLT of 11,000/mm³. In treating for STEMI, the treatment regimen consists of DAPT that increases risks for bleeding. In patients with thrombocytopenia, the risk for bleeding is multiplied and there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. The use of Cangrelor proved to be safe and effective during STEMI even in patient with severe thrombocytopenia.
C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP
Authors: Ancona R , Gaio G , Giordano M , Marzullo R , Cappelli Bigazzi M , Palladino M , Scognamiglio G , Sarubbi B , Russo M
Published: May 2022

Background

Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure.

Materials and Methods

We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA>5 mm); Group II (one defect >5 mm and more than one further fenestrations); Group III (multiple fenestrations).

Results

Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P < 0.01) and need of implantations of more than one devices (P < 0.01).

Conclusions

Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.
C88 EFFECT OF SARS–COV2 INFECTION ON ACUTE CORONARY SYNDROME: A RETROSPECTIVE OBSERVATIONAL STUDY
Authors: Cassani G , Vecchi A , Perletti G , Roberto D , Castiglioni B
Published: May 2022

Introduction

In Northern Italy, from October 2020 to April 2021, the second wave of COVID–19 pandemic recorded the highest incidence of infections ever. In this semester, the Lombardy region alone counted 43,318 positive cases and 16,710 deaths. It is well known how COVID–19 leads to a negative prognosis in acute coronary syndrome (ACS). This study aims to analyze the dramatic consequences of SARS–CoV2 infection on patients with concomitant ACS during the worst pandemic period ever recorded in Northern Italy.

Materials and Methods

The study enrolled 255 consecutive patients who have been hospitalized for ACS (STEMI or NSTEMI) from October 2020 to April 2021, both from the hub and spoke hospitals. Two subgroups are compared: the first is composed of patients who have tested positive for at least one molecular SARS–CoV2 swab (at admission or during hospitalization), the other group is composed of patients who have been tested negative to SARS–CoV2 swab. Major clinical data, risk factors (RF), comorbidities, laboratory findings, reperfusion times, drug therapy, complications and in–hospital mortality were systematically collected.

Results

Patients main characteristics are shown in Table 1. No differences have been observed in clinical history, RF and comorbidities in the subgroups. At admission, the incidence of acute pulmonary edema (APE) and respiratory symptoms was significantly higher in the SARS–CoV2 group, respectively 14% (p = 0.005) and 18% (p = 0.017). No differences in the “onset to door” and “door to needle” delays have been recorded. The incidence of the composite in–hospital complications is markedly increased in SARS–CoV2 group. Compared to negative patients, a higher mortality rates (18% Vs. 4%; p = 0.017), higher incidences of acute renal failure (ARF) (18% Vs. 5%; p = 0.037), cardiogenic shock (14% Vs. 3%; p = 0.033) and a wider prescription of inotropes (23% Vs. 10%; p = 0.009) in the SARS–CoV2 cohort.

Conclusion

The study confirms the negative prognostic impact of COVID–19 infection on ACS, recording a significantly higher rate of all major complications, both related to ischemia with multiorgan failure and interstitial pneumonia. Higher incidence of APE, cardiogenic shock and ARF has been observed in SARS–CoV2 positive subgroup, which is corroborated by a quadrupled risk of in–hospital mortality in the COVID–19 cohort.
P1 ATRIAL TACHYCARDIA IN PATIENT WITH TRANSFUSION–DEPENDENT BETA THALASSEMIA AND SEVERE HEMOCHROMATOSIS: A CASE REPORT
Authors: Marchini F , Sirugo P , Clò S , Capanni A , Malagù M , Bertini M , Guardigli G
Published: May 2022

Background

Beta thalassemia is the most common inherited disease and it’s characterized by the reduced synthesis of the beta–globin chains of the hemoglobin. Patients usually need long life transfusions since the disease leads to chronic hemolytic anemia. Iron chelation therapy is essential to prevent the chronic iron overload, which is responsible for heart failure, supraventricular and ventricular arrhythmias up to sudden cardiac death.

Case Report

A 31 year old female patient suffering from transfusion–dependent beta thalassemia has rarely taken iron chelation therapy during the years. Because of that, she developed a severe iron overload and heart failure. Furthermore, she started suffering from several episodes of supraventricular tachycardia and she was referred to our cardiological institution for medical help. She was initially treated with a pharmacological rhythm control strategy, which was ineffective. Then, even if the cardiac iron overload wasn’t completely resolved, we decided to perform an electrophysiological study and catheter ablation of atrial tachycardia. After the ablation, the patient had no more relapses during the follow up and she started to be more adherent with the iron chelation therapy.

Discussion

Cardiovascular complications are among the main causes of morbidity and mortality in patients suffering from beta thalassemia. Despite the wide use of iron–chelation therapy, today it’s still possible to find patients with severe iron overload. Furthermore, thalassemic patients have a high arrhythmic burden, especially for supraventricular arrhythmias. The best rhythm control treatment is represented by iron chelation therapy but there are still many doubts and open questions about the optimal pharmacological and interventional strategy. This clinical case shows how the interventional approach with catheter ablation can be an useful tool for rhythm control during the acute phase, even when the cardiac iron overload is still present.
P25 SUBCUTANEOUS–ICD IN PATIENTS WITH HEART FAILURE: RESULTS FROM A MULTICENTER, EUROPEAN ANALYSIS
Authors: Schiavone M , Gasperetti A , Mitacchione G , Angeletti A , Vogler J , Laredo M , Breitenstein A , Gulletta S , Fastenrath F , Kaiser L , Compagnucci P , Palmisano P , Ricciardi D , Santini L , De Bonis S , Piro A , Pignalberi C , Pisanò E , Hakmi S , Arosio R , Casella M , Lavalle C , Badenco N , Della Bella P , Dello Russo A , Curnis A , Tondo C , Steffel J , Viecca M , Kuschyk J , Tilz R , Biffi M , Forleo G
Published: May 2022

Background

Data on patients with heart failure (HF) with a subcutaneous implantable cardioverter defibrillator (S–ICD) are scarce.

Objective

Aim of this study was to assess clinical outcomes of the S–ICD in HF patients in a real–world analysis from the largest European retrospective S–ICD registry (ELISIR).

Methods

All consecutive patients undergoing S–ICD implantation at several European institutions were used for the current analysis. The population was classified into two groups: the HF (classified as HF with reduced and mid–range ejection fraction – HFrEF and HFmrEF) vs the no–HF cohort. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device–related complications during follow–up were assessed

Results

A total of 1409 patients from the ELISIR registry were included; HF patients represented 57.3% of the entire cohort (n = 701, 86.9% HFrEF; n = 106,13.1% HFmrEF). Over a median follow–up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p = 0.689). 133 complex ventricular arrhythmias were adequately recognized and treated, with similar rates of appropriate shocks (9.2% vs 9.8%, p = 0.689). Inappropriate and effective shocks–free survival has been represented in Figure 1 (Kaplan–Meier estimates). At multivariate analysis (Figure 2), age (HR = 0.974 [0.955–0.992], p = 0.005), LVEF (HR = 0.954 [0.926–0.984], p = 0.003), arrhythmogenic right ventricular cardiomyopathy – ARVC (HR = 3.364 [1.206–9.384], p = 0.020) and smart pass + (HR = 0.321 [0.184–0.560], p < 0.001) remained associated with inappropriate shocks. Moreover, a low number of patients (n = 76) experienced device–related complications, more frequently in the HF cohort (6.2% vs 3.8%, p = 0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p = 0.381), pocket infection (1.9% vs 0.8%, p = 0.107), pocket hematoma (3.2% vs 2.8%, p = 0.668).

Conclusion

The use of S–ICD in HF patients did not result in a higher rate of inappropriate shocks when compared to no–HF patients, even when stratifying for LVEF. Only age, LVEF, ARVC e Smart Pass algorithm were predictors of the primary outcome at multivariate analysis. Despite a lower overall rate of complications in the entire cohort, HF patients experienced device–related complications more frequently.
P36 THE ELDEST HEART TRANSPLANTED PATIENT IN EUROPE: 36 YEARS SURVIVAL AND STILL GOING ON
Authors: Pisani G , Cattadori B , D‘Armini A , Viganò M , Pellegrini C
Published: May 2022

Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti–lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long–term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid–19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long–term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.
P44 PREDICTORS OF MORTALITY AFTER ACUTE TYPE A AORTIC DISSECTION REPAIR IN PATIENTS OF 70 YEARS OF AGE OR OLDER
Authors: Settepani F , Cappai A , Cannata A , Merlanti B , Carrozzini M , Olivieri G , Costetti A , Russo C
Published: May 2022

Objectives

The impact of age on outcomes of acute type A aortic dissection remains controversial. We sought to investigate 30–day and follow–up outcomes of acute type A aortic dissection repair in elderly patients. Survival anlysis was performed and independent risk factors for mortality were searched.

Methods

During a 21–year period (2000–2021), 102 patients of 70 years of age or older were emergently treated for acute type A aortic dissection at our institution. (mean age 75.1 ± 3.8 years, 53.9% male) Preoperative characteristics are displayed in Table I.

Results

Overall 30–day mortality (including operative mortality) was 21.6%. Mortality increased among patients presenting with atrial fibrillation (adjusted odds ratio 10.33, P = 0.02) and visceral malperfution (adjusted odds ratio 70.88, P = 0.005). Survival at 1, 5 and 10 years was 70.2 ± 4.6%, 50.9 ± 5.6% and 24.1 ± 5.6%, respectively (Figure 1). The need to perform concomitant coronary artery bypass grafting was the only independent risk factor for mortality during follow–up. (adjusted odds ratio 2.21, P = 0.04)

Conclusions

Thirty –day and follow–up mortality were extremely satisfactory in elderly patients undergoing acute type A dissection repair. We could detect significant disease and surgery–related risk factors for death. Patients presenting with atrial fibrillation or visceral malperfusion had the poorest 30–day outcome. The need to perform concomitant coronary artery bypass grafting, significantly increased the mortality during follow–up.
P52 “BIOPROSTHETIC AORTIC VALVE REPLACEMENT IN PATIENTS YOUNGER THAN 49”
Authors: Paduvakis I , Cerillo A , Stefàno P
Published: May 2022

Background

Biological prosthesis are increasingly been used in young patients to avoid anticoagulation. The Edwards Inspiris aortic bioprosthesis is extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the haemodynamic performance and clinical outcome of the Inspiris bioprosthesis in patients aged < 50 years.

Methods and Results

Between may 2018 and December 2021, 58 patients aged 41 +/– 7,85 years underwent AVR with the Edwards Inspiris bioprosthesis at our institution. 23 of them (39.65%) were younger than 40, and 7 (12.06%) had a BMI >30 kgm2. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 25 (43.10%) patients. There were 10 redo patients (17,24%). Two patients died (3.45%). Major complications included bleeding (4), respiratory failure (1) and BAV requiring PMK (1). The mean follow up was 26,60 +/– 11,29 months (range 2–43). Late valve–related events included endocarditis (2) requiring reoperation. There were no thromboembolic events, valve thrombosis or SVD cases. At follow up, all except one patients reported a significant improvement of their symptomatic status (96.29% were in NYHA≤II) and quality of life. The mean interval to return to the normal activity was of 5.37±3.3 months.

Conclusion

Our study demonstrates excellent early haemodynamics and promising results at up to 3 years in a cohort of very young patients. Further studies with longer follow–up are needed
P53 SURGICAL CUTDOWN VERSUS PERCUTANEOUS ACCESS IN TRANSFEMORAL TAVI: A RETROSPECTIVE SINGLE–CENTER EXPERIENCE
Authors: Cammardella A , Russo M , Ranocchi F , Nicolò F , Pergolini A , Polizzi V , Musumeci F
Published: May 2022

Background

The transfemoral (TF) approach is the most common route in TAVI, but it is still associated with risk of bleeding and vascular complications. Nowadays, it is not evident a clear superiority of percutaneous (PC) versus surgical cutdown (SC) approach. The aim of our retrospective study is to compare the outcomes of the two different types of accesses.

Methods

From January 2018 to December 2021, 377 patients underwent TF–TAVI. The mean age was of 81,17 ± 8,62 years, with a percentage of female of 55,6%. The mean STS score was of 4,37 ± 2,28. The mean LVEF was of 57,22 ± 9,93%. Forty patients underwent a previous cardiac surgery. Seventeen valve–in–valve procedures were performed. The baseline clinical and echocardiographic data and operative features were prospectively collected. The primary endpoint was 30–day bleeding and vascular complications defined according to VARC–2 criteria. Secondary endpoints were clinical outcomes and in–hospital mortality. The PC group included 246 patients, while the SC group 128 patients.

Results

The baseline characteristics in the two groups were not statistically different, except for male sex (40,9% vs 52,3% p = 0.04) and NYHA Class III–IV (55,8% vs 25,7% p = 0.00) in PC and SC group, respectively (Table 1 and Table 2).

Conclusions

The rates of major vascular complications and major bleeding did not differ statistically between the two groups. The SC approach is associated with a significant lower rate of minor vascular complications, but a higher in–hospital mortality. The choice of the access should probably be based on the operator‘s experience and patient‘s vascular anatomy.
P56 SPONTANEOUS CORONARY ARTERY DISSECTIONS: ANALYSIS OF NON TRADITIONAL RISK FACTORS
Authors: Giacalone R , Ferretti M , Gurgoglione F , Noni M , Pelà G , Vezzani A , Cattabiani M , Benatti G , Tadonio I , Magnani G , Nicolini F , Niccoli G , Ardissino D , Vignali L , Solinas E
Published: May 2022

The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT–RF) have assumed increasing interest, but few data are available. NT–RF include three categories: Sex–related (SR–NT–FR), Sex–predominant (SP–NT–RF) and Gender–related (GR–NT–RF). (Table 1)

Aim of the Study

The objective of our analysis was to evaluate the incidence of NT–RF in Parma SCAD registry population.

Material and methods

We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021

Results

Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT–RF, 51 patients (82%) had at least one of all, with at least one SR–RF (66%) or GR–RF (64,5%). Patients with NT–RF were younger at time of SCAD (mean age 53 vs 66; p = 0.027) and they were predominantly females (48 vs 7 pts, p = 0.004) (Table 2). No differences were found among NT–RF SCAD and nNT–RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST–segment elevation myocardial infarction (43 pts, 72.6%) vs ST–segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT–RF and nNT–RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow–up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT–RF group without statistical significance (NT–RF SCAD 19.6% – nNT–RF SCAD 9.1%; p = 0.4). (Table 3)

Conclusion

SCAD is an emerging cause of myocardial infarction in young and middle–aged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT–RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.
P60 COVID–19 (YEAR 2021) AND ACUTE MYOCARDIAL INFARCTION‘ TIME–DEPENDENT NETWORK: HUB–HEMODYNAMIC UNIT‘S EXPERIENCES
Authors: Ragosa N , Aloia A , Grompone R , Giordano F , Bellarosa I , De Angelis E , Ferraioli D , Di Santi E
Published: May 2022

Objectives

The sudden SARS–CoV–2 emergency, has so far led to over 283 million infections and more than 5 million deaths globally, has put a strain on countries around the world. The result was a difficulty in accessing care both on an outpatient basis which resulted, in regione Campania, in a reduction in hospitalizations for ACS in the period Mar–Jun 2020 (1183) compared to the same period in 2019 (1862) (Agenas data ). The trend was inevitably reversed in the year 2021, with the new availability of access to treatment, due to both the reduction of restrictions and the vaccination coverage of the population, with a marked increase in hospitalizations for ACS as well as in the Hospital “ San Luca ”of Vallo della Lucania (Sa).

Methods

Cardiovascular diseases in 2021 are the leading cause of death in the world with 18.5 million lives lost a year and the leading cause also in Italy for both men (31.7%) and women (37.7%) ) with 230 thousand deaths certified by Istat, after 18 months of pandemic denounce a real war bulletin … The provincial cardiology network plays a fundamental role in the timeliness of the transfer to Hub centers such as the PO San Luca in the management of acute coronary syndromes.

Results

704 coronary angiography procedures and 118 emergency revascularizations (STEMI–NSTEMI at high risk Grace risk score> 140). Periprocedural complications were recorded around 0.5% (35) in line with the literature‘s data, all manageable and related to the femoral or radial puncture access.

Conclusions

In the year 2021, due to the reduction of restrictions and the marked increase in vaccination coverage, there was an increase in the number of hospitalizations for ACS and consequently in the mechanical myocardial revascularizations performed in Emergency (Stemi and Nstemi at high risk with Grace Risk Score> 140) probably linked to the lack of clinical–instrumental follow–up on an outpatient basis and day–hospital admissions in the year 2020 due to Covid–19 restrictions. At the Hemodynamics of the “San Luca” hospital (medium–volume center about 700 procedures / year), 118 emergency revascularisations were performed at 30.12.2021, compared to 82 in the same period of the year 2020.
P64 COVERED STENT IN A CHEST TRAUMA: CONGENITAL CORONARY ARTERIAL FISTULA OR TRAUMATIC CORONARY PERFORATION?
Authors: Marsico F , Carpinella G , Furbatto F , D‘Andrea D , Serino F , Madrid A , Ziviello F , Rumolo S , Crispo S , Mauro C
Published: May 2022

Coronary arterial fistula consists in a communication between a coronary artery and a cardiac cavity. It is tipically a congenital condition, but it can also be a result of invasive cardiac procedure. Although chest truama generally evolve to massive pericardial effusion, in some cases it can determine also a coronary perforation, with a consequent coronary arterial fistula. A 22–year–old male patient, with no cardiovascular history, was admitted after a road accident, reporting pelvis break, 17 costal break, and sternal break, with consequent chest pain. On admission the patient had a heart rate of 100 b.p.m. and a blood pressure of 130/80 mmHg. Elettrocardiogram (ECG) reported ST elevation in antero–septal derivations (V1–V4). Echocardiogram showed a global left ventricular (LV) ejection fraction of 55%, with an apical–septal akinesia, with a minimal anterior pericardial effusion, not emodinamically significant. So, an emergency coronary angiography was performed, showing a fistula of the distal segment of the left anterior discendent coronary (LAD). In this case there were two possible options, a previously unknown congenital coronary arterial fistula, or a traumatic coronary perforation, determining a coronary arterial fistula. Considering the possibility of a traumatic coronary perforation, with the consequent risk of rapid pericardial effusion worsening, the decision was to perform percutaneous coronary intervention (PCI) with a covered stent (Biotronik Papyrus 2.5 x 20 mm, 8 atm), with a good final result, with total occlusion of fistula. At 1 month follow up, the patient was asymptomatic for dyspnea or chest pain, with a heart rate of 70 b.p.m. and a blood pressure of 130/80 mmHg. ECG showed no anomalies in ST–T tract.
P85 THE SUPERPOWERS OF A REAL HEART TEAM: TAVR AND PERIOPERATIVE MANAGEMENT OF A PATIENT WITH COREA DISORDER
Authors: Saccocci M , Diego M , Villa E , Antonio M , Cirillo M , Luca B , Pero G , Buono A , Blasi S , Cuccia C , Troise G
Published: May 2022

Aortic stenosis is the most common valve disease in over75 years old patients.Managing the preoperative assessment and the perioperative course could be problematic in frailty patients.Having a real and solid multidisciplinary heart team(MDHT)is essential.This is how we succeeded in optimizing the treatment of 82–year–old patient affected by Huntington‘s disease(HD) and severe symptomatic aortic valve stenosis.HD is an autosomal–dominant progressive neurodegenerative pathology due to an expanded CAG repeat leading to a mutant protein(huntingtin) and it‘s usually characterized by chorea, dystonia, incoordination, and cognitive decline.Life expectancy in people with a late manifestation of the disorder can be long, raising the challenge of the treatment of concomitant pathology.Surgery was not indicated in this old and frail patient, but preoperative diagnostic imaging was compulsory to explore the possibility of transcatheter valve implantation. Chorea unintentional movements and dystonia make standard CTscan and angiographic analysis impossible.At our weekly institutional MDHT, we decided to overcome the technical difficulties putting the patient under general anesthesia. As we all know, multiple or very long sedations can be detrimental in frail patients.Confident in our solid multidisciplinary collaboration, we decided on an all–in–one procedure.On the procedure day, the patient was transferred to the hybrid OR.An anesthesiologist and a dedicated nurse induced the patient to general anesthesia.Intubated and with complete vital sign monitoring, the patient was moved back and forth to radiology to perform the angioCTscan.A cardiac surgeon and an interventional cardiologist analyzed the CT images deciding on a transfemoral 34mm Medtronic Evolut Pro+ bioprosthesis. The coronary angiography was performed with no evidence of significant stenosis. We proceed to commissural alignment and release of the bioprosthesis. The patient was extubated in the OR. Stable neurological status, total anesthesia time 140min. The patient was safely discharged home on the second postoperative day. Treating complex cases require multiple skills, well–established protocol, strong communication, and routine cooperation between all the involved professional figures. Therefore, the multidisciplinary heart team is not just an overused word without real significant;it is the only way to approach cardiovascular pathology in our everyday practice permitting us to have a real patient–centered vision.