bluuebunny/crossref_metadata_2025 huggingface dataset:
170 WHEN THE HEART GETS DRUNK
Authors: Contini Francesca Valeria , Pietro Spissu Paolo Marco , Fazzini Luca , Caggiari Ludovica , Angius Simone , Pittau Roberta , Dessalvi Christian Cadeddu , Montisci Roberta
Published: December 2022

A 53-old male with arterial hypertension, obesity (BMI 32) and gout presented to our Emergency department symptomatic for dyspnea, complaining about reduced functional capacity (NYHA III), gain of weight e increased abdominal circumference. In the days after we discovered a history of potus (2 liter of wine/day).

At a first physical examination we confirmed clinical features of heart failure with pulmonary congestion and ascites. The EKG showed atrial fibrillation, 80 bpm.

An echocardiogram showed severely reduced ejection fraction (EF 23%) with diffuse hypokinesia, increased left ventricular mass, deeply increased volumes, with only slightly increased thickness, a mild moderate diastolic dysfunction. Also, the right ventricular was hypokinetic and dilatated.

During the hospitalization the patient underwent coronary angiography, which showed no coronary lesion, e cardiac RMN with no pathological features in both T1 and T2 weighted sequences. No increased uptake of contrast in LGE sequences was evidenced.

We started diuretic therapy and optimized heart failure therapy with clinical improvement.

The management of anticoagulant therapy was difficult because of hepatic dysmetabolic cirrhosis (Child-Pugh Score 8, class B) with contraindication for DOACs treatment.

Moreover the patient performed a gastroscopy, which evidenced an ulcerative gastro-duodenitis and erosive gastritis confirming the temporary DOACs contraindication.

The patient was discharged in hemodynamic stability, with wearable defibrillator and was taken in charge by a multidisciplinary team.

After the normalization of hepatic function the anticoagulation was no longer forbidden so after three weeks we proceeded to successful electrical cardioversion.

An echocardiogram was performed after 6 months with almost completely recovery of systolic function (EF 62%) and a slightly reduction of chamber dilatations.

The patient denied alcohol consumption throughout the period.

This case demonstrates that alcoholic cardiopathy if it's diagnosed at the beginning can be partially reversible. This case presents a challenging clinical setting due to the frequent comorbidities requiring a multidisciplinary approach. Achieving a significant patient compliance is also crucial for long term lifestyle changes.
580 INCIDENCE AND FACTORS ASSOCIATED WITH DE NOVO ATRIAL FIBRILLATION IN PATIENTS WITH WILD-TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS - A MULTICENTER STUDY
Authors: Fumagalli Carlo , Zampieri Mattia , Argirò Alessia , Musumeci Beatrice , Tini Giacomo , Di Bella Gianluca , Cipriani Alberto , Porcari Aldostefano , Canepa Marco , Merlo Marco , Sinagra Gianfranco , Rapezzi Claudio , Olivotto Iacopo , Perfetto Federico , Cappelli Francesco
Published: December 2022

Purpose

We described the incidence and ECG factors associated with de novo atrial fibrillation (AF) in patients diagnosed with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) to drive tailored arrhythmia screening.

Background

Data on the incidence rate and factors associated with de novo AF in patients with ATTRwt CA is limited.

Methods

Multicenter, retrospective, observational cohort study performed in six referral centers for CA. All consecutive patients diagnosed with ATTRwt-CA between 2004 and 2020 with >1-year follow up (FU) were enrolled in the study and were divided into three groups according to presence of AF: (1)patients with ‘known AF’; (2)patients in ‘sinus rhythm’ and (3)patients developing ‘de novo AF’ during FU. Incidence and factors associated with AF in patients with ATTRwt were the primary outcomes.

Results

Overall, 266 patients were followed for a median of 469 days: 148 (56%) with known AF, 84 (31.6%) with sinus rhythm, and 34 (12.8%) with de novo AF. Age and gender were similarly distributed. At multivariable analysis, PR (Hazard Ratio[HR]: 1.008 95% C.I. 1.001-1.016), QRS (HR: 1.022 95% C.I. 1.002-1.043) and left atrial dilatation>50mm (HR: 3.429 95% C.I. 1.565-7.329) were associated with de novo AF at FU. Patients presenting with at least two risk factors (PR>200ms, QRS>120ms or LAD>50mm) had a higher risk of developing de novo AF compared to patients with no risk factors (HR 14.918 95% C.I. 3.242-31.646).

Conclusions

Incidence of de novo AF in patients with ATTRwt is 20.7%/year. Longer PR and QRS duration and left atrial dilation are associated with arrhythmia onset.
285 BIVENTRICULAR TAKO-TSUBOSYNDROME ASSOCIATED WITH SYNCOPE AND UNCONSCIOUSNESS
Authors: Mallardi Adriana , Ruggieri Roberta , Cuonzo Maria , Grimaldi Nicola , De Luca Viviana , Giannoccaro Viviana , Santoro Francesco , Brunetti Natale Daniele , Bonfantino Massimo Vincenzo
Published: December 2022

A 58-years old woman came to the emergency department due to syncope; she had been found lying on the ground in her residence. At the admission the patient was unconscious but had preserved blood pressure 120/80 mmHg. CT brain scan was negative for hemorrhage. Admission ECG showed a 52 b/m sinus bradycardia, elevated antero-septal ST segment and prolonged QT interval. Diagnosis of antero-septal STEMI was made and a coronary angiogram performed via right femoral access showed mild atheromasia in the absence of angiographically significant lesions. Bedside echocardiogram showed severe left ventricular dysfunction (LVEF 35%) with akinesia of apical and mid-ventricular segments. The right ventricle presented a marked hypocontractility of the apical region and a preserved kinetics of the basal portion (TAPSE 22 mm). There was also a moderate mitral regurgitation and a mild tricuspid regurgitation with a sPAP of 50 mmHg (40+10).

On blood sampling, high-sensitivity troponin was slightly elevated (3950 pg/ml) and marked hyponatriemia (117 mmol/l) and slight hypokalemia (3.1 mmol/l) were noted. The echocardiogram on the third day showed an improvement in global and segmental kinetics of left ventricle with an estimated EF of 45% and persistence of a mild hypocontractility of the apex of right ventricle. During her hospital stay, her cognitive state gradually improved and she remained asymptomatic without evidence of arrhythmic events on monitoring. The ECG evolved on days with normalization of the ST-T tract, negative T wave in the anterior region and prolonged QTc interval. The pre-discharge echocardiogram showed a recovery of biventricular kinetics with an estimated EF of 50%. The presence of a transient abnormality in biventricular wall motion beyond a single epicardial coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of Tako-tsubo Syndrome defined by Mayo Clinic criteria. The electrocardiogram on the day of discharge showed a 55 b/m sinus bradycardia with a negative T wave from V1 to V4.

Tako-tsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction that improves spontaneously within days or weeks and is often preceded by emotional or physical stress.

Biventricular involvement in TTS is typically identified on imaging studies such as echocardiography and MRI. TTS with RV involvement is associated with a higher rate of in-hospital mortality and long-term adverse clinical events than isolated LV TTS.

In our clinical case, biventricular involvement was associated with a severe clinical presentation (syncope and unconsciousness). This case shows that biventricular Tako-tsubo is a clinical scenario that requires intensive care monitoring and strict cardiological evaluation.
223 THE ROLE OF SARS-COV-2 VACCINATION-INDUCED MYOCARDITIS IN UNMASKING UNDERLYING ARRHYTHMOGENIC CARDIOMYOPATHIES: A CASE SERIES LOOKING BEYOND THE TIP OF THE ICEBERG
Authors: Brusamolino Matteo , Amelotti Nicola , Mapelli Massimo , Baggiano Andrea , Campodonico Jeness , Majocchi Benedetta , Ribatti Valentina , Vettor Giulia , Teruzzi Giovanni , Trabattoni Daniela , Novelli Valeria , Catto Valentina , Basso Cristina , Pontone Gianluca , Agostoni Piergiuseppe
Published: December 2022

Background

Acute myocarditis (AM) is a heart inflammatory disease that may also rarely occur as a complication of COVID-19 vaccines. Inflammation is involved in arrhythmogenic cardiomyopathy (ACM) pathogenesis. Little is known regarding the COVID-19 vaccines influence on ACM relapses. We present two cases of vaccine related AM revealing a pre-existent (silent) ACM.

Cases presentation

Table shows a summary of the patients’ main clinical characteristics.

Discussion

We presented 2 cases of arrhythmic myocarditis-like clinical presentation in patients without previous cardiovascular history, whose timing was temporally related to a dose of vaccine against COVID-19. Subsequent diagnostic workup suggested the possible presence of an underlying silent ACM. In our case series, tissue characterization provided by CMR played a fundamental role as a diagnostic tool, showing in all cases a prominent left ventricle involvement and identifying both the underlying ACM disease and the superimposed myocardial inflammation. We hypothesize that a vaccine-induced AM could have revealed the presence of a pre-existent ACM, on which an inflammatory acute phase triggered the arrhythmic manifestation.

Conclusion

Vaccine-induced AM could reveal the presence of a pre-existent ACM. Our report suggests that a high index of suspicion and a multidisciplinary approach is required, in order to continue the diagnostic process once the acute event has been resolved, as it may have fundamental implication in the patient management. Further studies are required to verify if some of the vaccine-triggered AM represent the ACM first manifestation.
127 APPLICABILITY AND PERFORMANCE OF HEART FAILURE PROGNOSTIC SCORES IN DILATED CARDIOMYOPATHY: THE EXPERIENCE OF AN ITALIAN REFERRAL CENTER FOR CARDIOMYOPATHIES
Authors: Rossi Maddalena , Teso Maria Vittoria , Masè Marco , Barbati Giulia , Stolfo Davide , Merlo Marco , Sinagra Gianfranco
Published: December 2022

Background

Many prognostic risk scores have been developed for ambulatory Heart Failure (HF) patients, but none of these has been validated in Dilated Cardiomyopathy (DCM), that is a peculiar model of HF.

Aims

To evaluate and compare the applicability and performance of major HF risk models in a large real-world population of DCM patients

Methods

This was a retrospective study including 784 consecutive non ischemic DCM patients, both inpatients and outpatients, enrolled in the Heart Muscle Disease Registry (HMDR) of Trieste between January 2000 and December 2017. The following scores designed to estimate 1- to 3-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), simplified-SHFM (Seattle Heart Failure Model), 3-CHF (Cardiac and Comorbid Conditions), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico-Heart Failure), MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes), Barcelona Bio-HF, Krakow score.

Results

During the follow-up (5,83 ± 4,9 years) 191 patients (20% of the population) met the

primary composite endpoint (158 deaths, 30 heart transplantations and 3 LVAD implants). Due to the high quote of missing parameters, only four of the prognostic models (MAGGIC, CHARM, 3-CHF and simplified-SHFM) could be tested in the final statistical analysis.

The observed-to-predicted mortality ratios suggested an overestimation of mortality by all scores.

The prognostic accuracy of the scales was suboptimal in DCM patients for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores, worse for 3-CHF (AUC 0,677) and simplified-SHFM (AUC 0,667) scores, with the MAGGIC and simplified-SHFM respectively providing the best and worst performance.

Conclusions

The performance of HF prognostic risk scores is suboptimal for DCM patients. The need for new precise risk models tailored for this disease has to be considered.
258 CORONAVIRUS DISEASE 19 VACCINATION-RELATED PERICARDITIS: A SINGLE TERTIARY CENTER EXPERIENCE
Authors: Collini Valentino , Imazio Massimo , De Biasio Marzia , Sinagra Gianfranco
Published: December 2022

Background

Vaccination represents a cornerstone of prevention in the COVID-19 pandemic. Rare adverse events including acute pericarditis and myopericarditis have been reported.

Material and Methods

All consecutive patients referred to our referral center for pericardial diseases following COVID-19 vaccination from 1st April 2021 to 15th April 2022 were included. Acute pericarditis and myopericarditis were diagnosed according to ESC guidelines. Patients with SARS-CoV-2 infection were excluded from the study.

Results

Twenty-four patients (79% males) aged 39.7 ± 19.8 years were referred to our center with pericarditis after receiving COVID-19 vaccination. 13 (54%) patients were diagnosed with myopericarditis. The mean time between vaccination and symptoms onset was 7.0 ± 4.9 days and the most frequent symptom was pericarditic chest pain (83%). Respectively, 50% and 33% of patients presented after the second and the third dose of the vaccine. Almost all patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine. Five patients (21%) experienced a recurrence of pericarditis. No patient died or developed constrictive pericarditis. Mean follow-up was 8.0 ± 3.2 months.

Conclusions

COVID-19 vaccine-related pericarditis typically manifest with mild clinical signs, in young males, a few days after the second or third vaccine dose and are commonly characterized by a rapid complete recovery. Despite these rare side effects, the benefits of COVID-19 vaccination clearly outweigh the limited risk of pericarditis and myocarditis, and vaccination is strongly recommended to prevent COVID-19 infection, transmission and related complications.
472 PROGNOSTIC VALUE OF CPET REPETITION DURING FOLLOW-UP OF DILATED CARDIOMYOPATHY
Authors: Baracchini Nikita , Zaffalon Denise , Merlo Marco , Baschino Samantha , Barbati Giulia , Pezzuto Beatrice , Agostoni Piergiuseppe , Sinagra Gianfranco
Published: December 2022

Background

although cardiopulmonary exercise testing (CPET) is a recognized tool for prognostic stratification in patients with dilated cardiomyopathy (DCM), there are no data about the prognostic value of its repetition during follow-up in this setting. The aim of this study was to test the prognostic value of repeating CPET during follow-up, among a large cohort of DCM patients.

Methods

in this multicenter, retrospective study, we analyzed DCM patients who consecutively performed at least two CPET during a clinical stable phase of disease. All patients performed CPET and echocardiogram within 10 days. The study end-point was a composite of death from all causes, heart transplantation, implantation of durable left ventricular assist device, life-threatening ventricular arrhythmias or hospitalization for HF.

Results

216 DCM patients were enrolled (52±12 years, 78% male, NYHA I-II 82%, LVEF 32±9%, 94% on ACE inhibitors, 95% on beta-blockers); the duration of the disease at the time of first CPET was 68 months. The interval between the two CPETs was 15 (11;23) months. During a median follow-up of 38 months from the second CPET, 108 (47%) patients went through the end-point. Time-dependent ROC curves revealed that to repeat during a follow-up of 12 months both CPET and echocardiogram gives a more accurate prognostic stratification than basal echocardiography + basal CPET. Despite an higher AUC (0.91 vs 0.85) there were no significant different accuracies (95% CI: 83.6 - 98 vs 75.5–96.5; p-value: 0.2) between the repetition of CPET plus echocardiogram vs. the repetition of the echocardiogram alone. Among patients who experienced the study outcome, there was a substantial stability of echocardiographic values (relative variation of LVEF +2.7%, LVEDV +1.3%) but a significant worsening of functional capacity (relative variation of percentage predicted VO2 peak +6%, p-value: 0.002). Conversely, there were a significant improvement in echocardiographic values and CPET values in events-free patients (LVEF relative variation -8.6% p-value: 0.002; ppVO2 peak relative variation -6.8%, p-value: 0.002).

Conclusion

in a large population of clinically stable DCM patients, the systematic repetition of echocardiography or both CPET and echocardiography showed no significant prognostic impact, in presence of stable or worsened echocardiogram. Nevertheless, when there is a clinical variation of symptoms or a failing in the reverse remodeling process, 1-year repetition of CPET can identify higher risk patients.
1078 RECURRENT FLARES OF MYOCARDITIS: A CHALLENGING CASE
Authors: Ravera Francesco , Angelini Filippo , Gobello Giulia , Toso Elisabetta , Pidello Stefano , Dusi Veronica , Raineri Claudia , De Ferrari Gaetano Maria
Published: December 2022

A 38-year-old woman with curly hair was admitted at the Emergency Department of our Hospital for typical thoracic pain associated with dyspnea and palpitations. Electrocardiogram showed sinus rhythm, 65 bpm, low voltages in the peripheral leads with fragmented QRS complex in the inferior leads and negative T-waves in anterior leads. Initial high-sensitivity cardiac troponin level was 46326 ng/L (n.v. < 16 ng/L). At presentation the patient was treated with Anakinra (anti-interleukin 1) and Metoprolol 200 mg/die because of a past medical history characterized by multiple myocarditis recurrences since 2012. Various therapies had been tested (Aspirin, Ibuprofen, Colchicine, Prednisone, Azathioprine), with a good efficacy of Mycophenolic acid, recently stopped to plan a pregnancy.

Transthoracic echocardiography documented normal left ventricle (LV) ejection fraction and no alteration wall motion abnormalities; cardiac-MRI demonstrated LV late gadolinium enhancement with a non-ischemic subepicardial “ring-like” pattern. Endomyocardial biopsy was performed, and the ultrastructural analysis showed mitochondrial hyperplasia with focal swelling and marked alterations of intercalated disks. A high ventricular extrasystolic burden was registered at EKG monitoring.

Gene sequencing revealed a pathogenetic variant of the gene coding for Desmoplakin. This is involved in the anchoring of intermediate filaments to desmosomal plaques and its pathogenetic variants are associated with an inflammatory and fibrotic LV predominant cardiomyopathy with an arrhythmogenic evolution (see Padua criteria).

In the absence of approved therapies, in agreement with the limited available data and considering patient's history, Micofenolic acid was restarted. At 1-, 3- and 6-month follow-up the patient has remained asymptomatic with progressive declining in troponin levels after discharge.
307 A CARDIAC MASS IN A PATIENT WITH GORLIN-GOLTZ SYNDROME: INCIDENTAL DIAGNOSIS OR SOMETHING TO LOOK FOR?
Authors: Tarantini Roberto , Alonge Stefano , Acone Lorenzo , Foti Marco , Toscano Evelina , Poggio Daniele , Mortara Andrea
Published: December 2022

Aims

Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant, multisystem, tumor-predisposing disorder. The primary manifestation of NBCCS is the development of multiple basal cell carcinomas (BCCs) but is also associated with a variety of other benign and malignant tumors. Cardiac fibromas are increased in frequency in patients with NBCCS, developing in approximately 3 percent of affected individuals. They typically present in infancy. They are benign growths, and almost all develop within the ventricular myocardium. Although usually asymptomatic, they can result in impaired left ventricular function and conduction defects, necessitating resection.

Methods and results

we presented a case of a 59-years-old woman with a diagnosis of Gorlin-Goltz syndrome and no history of cardiovascular diseases who underwent a right knee arthroplasty in our hospital. After the surgery the patient was admitted to rehabilitation department. Electrocardiogram that showed sinusal rhythm with inverted T waves in lateral leads and a transthoracic echocardiography examination were performed. Echocardiography showed a large mass within the basal and middle segments of left ventricle lateral wall. Left ventricular ejection fraction was preserved. Cardiac magnetic resonance (CMR) revealed an intramyocardial mass with well-defined borders and several calcifications, hypointense on T1-weighted and T2-weighted images and delayed-contrast hyper-enhancement with hypoenhancing central cores. Based on these imaging features, the mass was suggestive of cardiac fibroma with calcifications. The patients was asymptomatic. Afterwards, a total body CT was performed to exclude other tumours in other sites. This case was discussed with cardiac surgeons and since the patient was asymptomatic with no conduction abnormalities or heart failure signs, urgent surgical intervention was excluded. The patient was discharged with a 3 months follow-up.

Conclusion

our case highlights the importance of echocardiography evaluation before surgery in patients with genetic syndrome like Gorlin-Goltz syndrome. Last guidelines published in 2021 recommend that all patients with NBCCS should be screened with a cardiac ultrasound and if cardiac symptoms occur in a patient with NBCCS, a cardiac ultrasound should be repeated to exclude a late-onset cardiac tumour. Furthermore, CMR plays an important role in characterizing cardiac masses and determining the management.
1124 THORAFLEX HYBRID AS FROZEN ELEPHANT TRUNK
Authors: Artiola Gaetano , Vincenzo Pettillo
Published: December 2022

Introduction

Dissection and aneurysms of the aorta are pathologies that greatly compromise the prognosis of patients. By examining these pathologies in the area under consideration, knowing that they also subject the epiacortic arterial structures to this dilation, an endovascular solution was sought that would reduce the long and risky times of surgery. A hybrid operation that is implemented is that of the Thoraflex™ implant. During cardiac surgery, the replacement of the ascending aorta, whether by dissection or aneurysm, is incorporated with the endovascular implant with this state-of-the-art prosthesis that can circumscribe the problem to the descending thoracic aorta. This device has three outlets that will play the role of the supraortic arteries.

Purpose

Assessment of patients for the treatment of aneurysms and chronic thrombosed dissections of the aortic arch and describe the effectiveness of this treatment.

Method

A Pubmed search related to clinical data and field experience was performed.

Results

Patients with different aortic pathology were treated and evaluated. The recovery, compared to the classic surgery, was faster due to the lower exposure to extra-body circulation and a reduced surgical time.

Conclusions

Thoraflex™ hybrid as frozen elephant trunk presents a cutting-edge option and a valid alternative for the treatment of complex aortic pathologies. It is clear how much, despite the surgery, the risks of stroke, of infections due to the procrastination of the operation are considerably reduced and above all how the mortality rate has been reduced, making the approach to a pathology that is usually treated less complex in an emergency.
11 PRINTING 3D MODELS OF THE HEART: CAN IT HELP IN UNDERSTANDING THE COMPLEX ANATOMY?
Authors: Santucci Stefano , Santucci Matteo
Published: December 2022

The use of 3D printing in the medical field is widespread especially in the dental clinic as a support to orthodontic / implant therapy. In the training of personnel relating to cardiological diagnostic methods, can it be useful to shorten the learning curve of human anatomy?

A light-curing liquid resin 3D printer was used to obtain anatomical models that faithfully reproduce the real anatomy of the individual patient. The starting model was obtained from CT with contrast medium performed on patients. Depending on the diagnostic question, CT may contain complete information on both the arterial circulation and the venous circulation of the heart and the epiaortic vessels. From this information a 3D surface reconstruction is obtained which, once reworked, can be used directly for printing. The model size is limited by the print volume of the printer which may vary depending on the printer model. The model to be printed obtained from CT acquisitions the 3D model will be the representation of the lumen of the vessels and cavities of the heart. The models obtained faithfully represent the anatomical reality of the patient who underwent CT with contrast medium. Actual size is affected by the print volume size of the printer model.

In my experience in university teaching, the models obtained with 3D printing have been found to be very useful for understanding the complex spatial configuration of the anatomy of the heart and great vessels
798 CARDIOVASCULAR EFFECTS OF WHOLE-BODY CRYOTHERAPY IN NON-PROFESSIONAL ATHLETES
Authors: Selleri Valentina , Zanini Giada , Coppi Francesca , Pinti Marcello , D’alisera Roberta , Latessa Pasqualino Maietta , Tripi Ferdinando , Savino Gustavo , Cossarizza Andrea , Nasi Milena , Mattioli Anna Vittoria
Published: December 2022

Whole-body cryotherapy (WBC) is a method of cold therapy widely applied for muscle recovery after injury to counteract the inflammatory response due to specific diseases, characterized by high levels of inflammation. WBC consists of short exposure, of about 2-3 minutes, to dry air at cryogenic temperatures (up to -190°C) in a special chamber. Our study aimed to investigate changes in respiratory rate, oxygen saturation, blood pressure, heart rate and body temperature induced by WBC sessions in athletes.

Ten volunteer middle-distance non-professional runners (age: 38±12 years) received 3 once-a-day sessions of WBC. Subjects underwent blood pressure measurements and ECG recorded before and immediately after the daily session. During WBC we recorded a single lead trace (D1) for heart rhythm control. Moreover, we monitored the 5 vital signs, such as blood pressure, heart rate, respiratory rate, oxygen saturation and body temperature, during, and after all WBC session.

We did not report significant changes in ECG main intervals (PR, QT, and QTc) and in the mean systolic blood pressure during and after WBC [baseline: 118 ± 5 mmHg, changed to 120 ± 3 mmHg during WBC, and to 121 ± 2 mmHg after session]. Mean respiratory rate did not change significantly during WBC as well as oxygen saturation (98 vs. 99%). Mean heart rate changed from 50.98 ± 4.43 bpm (before) to 56.83 ± 4.26 bpm after WBC session (p < 0.05) and body temperature was slightly increased after WBC, however it remains within physiological values. In non-professional athletes WBC did not affect cardiovascular response and can be safely used. However, further studies are required to confirm these promising results of safety in elderly non-athlete subjects.
1149 MACHINE-LEARNING BASED PREDICTION OF IN-HOSPITAL DEATH FOR PATIENTS WITH TAKOTSUBO SYNDROME: THE INTERTAK-ML MODEL
Authors: De Filippo Ovidio , Pancotti Corrado , Camman Victoria Lucia , Bianco Matteo , Gili Sebastiano , Di Mario Carlo , Luescher Thomas , Crea Filippo , Templin Christian , De Ferrari Gaetano Maria , D´ascenzo Fabrizio
Published: December 2022

Background

Takotsubo syndrome (TTS) is burdened by a not negligible rate of an impaired short-term prognosis. Current existing models, based on classical statistical methods, showed only moderate accuracy to predict the risk of in-hospital adverse events following admission for TTS. We sought to design a machine-learning (ML) based model to predict the risk of in-hospital death among patients admitted for TTS, and to provide clusters of TTS patients associated with different risks of adverse short-term prognosis.

Methods

A Penalized Logistic Regression-based ML model for predicting in-hospital death was trained and tested on a cohort of 3482 patients with TTS from the international, multicenter, InterTAK Registry. 33 clinically relevant variables were selected to be included in the prediction model. Model performance was assessed according to area under the receiver operating characteristic curve (AUC). A K-Means clustering algorithm was designed to stratify patients into phenotypic groups based on the most relevant features emerging from the main model.

Results

The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.88 (95%CI 0.87-0.90) and 0.87 (95%CI 0.83-0.91) with respect to in-hospital death prediction in the train and test cohorts, respectively. By exploiting the 5 variables showing the highest feature importance (use of catecholamines, type of triggering factor, left ventricular ejection fraction, white blood cell count, heart rate), TTS patients were clustered into five groups associated with different risks of in-hospital death (29.4% vs 3.9% vs 1.6% vs 1.3% vs 0.7%).

Conclusion

A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed accurate discriminative capability for the prediction of in-hospital death. To support clinical decision-making, TTS patients can be clustered into groups entailing different risks of death based on routinely collected variables.
962 CASE REPORT: ARRHYTHMIC MITRAL VALVE PROLAPSE - STATE OF THE ART AND WHAT'S NEW
Authors: Bandini Marta , Crociani Maria Federica , Sciara Pietro , Di Mario Carlo , Chechi Tania
Published: December 2022

Background

Mitral valve prolapse (MVP) is a well-known pro-arrhythmic condition that involves 2-3% of the general population with an incidence of nonfatal arrhythmic events up to 30% and sudden cardiac death of 2-4% per year. It is assumed that the pro-arrhythmic substrate consists in myocardial fibrosis, secondary to steer-stretch due to the anomalous mobility of the mitral valve apparatus. We still have gaps in the evidences about the arrhythmic risk stratification of MVP and the most appropriate therapy and follow-up.

Clinical case

We present the case of a 40-years-old man with a known MVP due to Barlow disease, who underwent an at-home resuscitated cardiopulmonary arrest. In hospital, an echocardiogram found left ventricular dilatation with diffuse hypokinesia and severe mitral insufficiency. A coronary angiogram showed an undamaged coronary tree. The 24h ECG monitoring showed very frequent ventricular ectopies and non-sustained ventricular tachycardia. The patient underwent valvular surgery and he is now waiting for cardiac defibrillator (ICD) implantation.

Conclusion

We discuss the state of the art in risk stratification of “malignant” MVP; the actual and potential future role of the cardiac magnetic resonance, ICD implantation, sympathetic modulation, and early surgical mitral valve repair, in the primary prevention of sudden cardiac death.
195 INFECTIVE ENDOCARDITIS POST-TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) WITH SYSTEMIC EMBOLIZATION TREATED WITH MEDICAL THERAPY
Authors: Barbera Chiara , Rizzo Sofia , Greco Ylenia , Lentini Giuseppe , Rugiano Gerardo , Gibiino Vincenzo , Uccello Salvatore , Bentivegna Agnese , Milici Anna Lisa , Scandura Salvatore , Tamburino Corrado
Published: December 2022

Introduction

Post-TAVI infective endocarditis is a rare event. The incidence is 3,25%, and it is associate with severe complications and high risk of mortality.

Aim

The aim of the study is to focus on the possibility of alternative therapy except surgery in treatment of a complicated endocarditis, choice taken also thanks to TEE, through it is possible analyze the integrity of the prosthesis, evidence/absence of rupture or ulceration and monitoring the evolution during therapy.

Material and Methods

A 76-year-old female patient who went to TAVI, reported fever, increased phlogosis indices and abdominal pain few days after the procedure. Diagnostic imaging resulted in infection of the aortic prosthesis and in thromboembolisms affecting splenic artery and celiac trunk. At TEE an isoechogenic vegetation (14×8 mm) was described in correspondence of aortic prothesis and high gradient was detected. Thromboembolic events have occurred and thrombo-endoarteriectomia of right femoral artery was performed. Staphylococcus Lugdunensis was found in blood cultures and intravenous antibiotic and anticoagulant therapy was undertaken.

Results

After one month of medical therapy, at TEE significant vegetation reduction was found. Patient was discharged at home, asymptomatic. After 1 month at TTE no sign of endocarditis was detected, blood sample was fine and patient was asymptomatic.

Conclusions

This case is an example of an early infective process involving biological valve post-TAVI, followed by systemic embolization, in which the only medical therapy was successful. Echocardiography has played a fundamental role to choose the strategy of therapy and to monitor its result.
254 DIFFERENT DEGREES OF DEGENERATION OF TRANSCATHETER VALVES IMPLANTED IN THE AORTIC POSITION OR EMBOLIZED DISTALLY: A CASE REPORT
Authors: Cacia Michele Antonio , Cozzi Ottavia , Gohar Aisha , Mangieri Antonio , Lancini Damiano Regazzoli , Stefanini Giulio , Reimers Bernhard , Colombo Antonio
Published: December 2022

While transcatheter aortic valve replacement (TAVR) gradually emerges as first line therapy for aortic disease in most surgical risk groups, structural prosthetic degeneration remains an issue that may must be considered when planning procedures in younger patients. We present the case of a 74 years old female who underwent a valve-in-valve TAVR following degeneration of a previously implanted TAVR which had initially been complicated by distal embolization of two prosthetic valves. The patient initially underwent TAVR in 2010 for severe aortic regurgitation and a porcelain aorta. The procedure was complicated by distal embolization of two prosthetic valves; firstly a 26 mm Sapien valve migrated to the pre-renal abdominal aorta. This was followed by the embolization of a 29 mm CoreValve to the descending thoracic aorta. Finally, on the third attempt, a 29 mm CoreValve was successfully implanted without complication. The patient remained clinically stable until February 2022 when she developed progressively worsening effort angina and dyspnea. Echocardiographic evaluation demonstrated prosthetic aortic valve degeneration with cusp fibrosis and calcification, with severe aortic regurgitation. Interestingly, neither of the embolized prosthetic valves showed signs of deterioration on CT imaging. The valve that had migrated to the abdominal aorta did not show any significant increase in gradient or regurgitation on Doppler evaluation. After careful evaluation and Heart Team discussion, a transfemoral valve-in-valve (ViV) procedure was performed uneventfully with a 23 mm Sapien Ultra implant, that resulted in complete abolition of regurgitation with mild prosthesis-patient mismatch (mean gradient 15 mmHg, EOA 0.8 cm2/m2). Post-procedural CT imaging confirmed a satisfactory result with no signs of dislocation of the previous valve prostheses (Figure 3). The patient was safely discharged on day 4 post-op on oral anticoagulation (due to a history of atrial fibrillation), and was asymptomatic at 30-day follow-up. This case report describes a challenging but successful ViV TAVR implantation.
888 THE USE OF QFR FOR THE FUNCTIONAL ASSESSMENT OF EXTRACRANIAL INTERNAL CAROTID ARTERY STENOSIS
Authors: De Rosa Maria Luisa , Carbone Carlo , Mitrano Lucia , Di Serafino Luigi , Giugliano Giuseppe , Piccolo Raffaele , Franzone Anna , Cirillo Plinio , Esposito Giovanni
Published: December 2022

Background

In asymptomatic patients with haemodynamically significant internal carotid artery stenosis, if endarterectomy cannot be considered, a selective invasive angiography is indicated before deciding for percutaneous revascularization. Sometimes, the angiographic assessment of the stenosis might be discordant with the non-invasive assessment, usually performed with Doppler. Therefore, the use of an angiography-based method that allows a functional assessment of the stenosis could be useful to help the diagnostic-therapeutic process. The aim of this study was to evaluate the diagnostic accuracy of Quantitative Flow Ratio (QFR) in the assessment of extracranial internal carotid artery stenosis.

Materials and methods

This registry prospectively enrolled asymptomatic patients with an indication to perform a selective angiography of the supra-aortic trunks. The systolic peak velocity obtained by colour Doppler ultrasound was used to determine the hemodynamic significance of the carotid stenosis (PSV> 120 cm / sec), whereas it was defined angiographically significant a stenosis with a %DS > 60%, according to NASCET criteria (%DSNASCET). After three-dimensional reconstruction of the angiographic data, QFR, Area Stenosis (AS%) and the minimum luminal area (MLA, mm2) were obtained.

Results

30 consecutive patients were enrolled, and 60 carotid arteries analysed, 8 of which were excluded because of previous percutaneous (n = 3) or surgical (n = 5) revascularization. On linear regression analysis, an inverse linear correlation was observed between QFR and PSV values ​​(r2 = 0.71, p <0.001) and% DSNASCET (r2 = 0.79, p <0.001) (Figure 1). Similarly, the MLA values ​​showed a significant correlation with both PSV and% DSNASCET (respectively, r2 = 0.67 and r2 = 0.75, p <0.001), as well as AS values, which also showed a significant correlation with both PSV and% DSNASCET (respectively, r2 = 0.68 and r2 = 0.88, p <0.001). The QFR and the% DSNASCET showed a comparable and high diagnostic accuracy (AUC = 0.99, p <0.001) using PSV as a reference, with a cut-off value of 0.95 for the QFR (Figure 2). However, considering the% DSNASCET cut-off values, the QFR showed higher diagnostic accuracy, sensitivity and negative predictive value as compared with % DSNASCET.

Conclusions

This study showed the feasibility of QFR for the assessment of extracranial internal carotid artery stenosis. It was effective indeed for predicting the functional significance of the stenosis considering the Doppler as standard of reference. However, whether revascularization of the carotid stenosis should be guided by QFR rather than the angiography alone has still to be evaluated.
410 “SHARK-FIN“ ECG: NOT ALWAYS A STEMI!
Authors: Marrone Andrea , Piscitelli Laura , Zagnoni Silvia , Colletta Mauro , Casella Gianni
Published: December 2022

Background

Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. The International Registry of Acute Aortic Dissection (AAD) shows that only 5% of AAD patients present with ECG evidence of acute myocardial infarction, and prognosis is ominous due to the additional myocardial damage and missed or delayed diagnosis. The shark fin waveform is an uncommon but high-risk ECG pattern formed by fusion of QRS, ST-segment, and T waves. It is associated especially with the sub-occlusion of the left main coronary artery or proximal left anterior descending artery with a high risk of death due to cardiac arrest and cardiogenic shock.

Case presentation

A 61-year-old man was admitted to our cardiac cath-lab for typical chest pain and suspected acute ST segment elevation myocardial infarction (STEMI). A triangular pattern known as the ‘shark-fin’ sign in the precordial and inferior leads, and mirroring ST-segment depression in dI and aVL was detected. Unexpectedly coronary angiography revealed normal epicardial vessels, but a very-regular-shaped staining of the aortic sinus was observed. This finding was suspicious for acute aortic dissection. Bedside 2D-echocardiography within the cath-lab demonstrated an intimal flap in the aortic root and arch, with mild aortic regurgitation. Contrast-enhanced computerized tomography (CT) confirmed our diagnosis of Type A aortic dissection (AAD) highlighting the same dissection flap revealed by angiography arising from the left coronary cusp of the aortic root. The left main trunk was not directly involved, but the dissection extended from the ascending to the distal aorta involving both left and right external and internal iliac arteries with a thrombotic occlusion of the right femoral-iliac axis There was also a right inferior-pole renal infarction. Thus, the patient was immediately submitted to heart surgery.

Conclusions

Type A aortic dissection is a life-threatening disease in which early diagnosis and treatment are critical for survival. Occasionally it could mimic STEMI due to coronary involvement or dynamic obstruction of a coronary ostium. In our experience a bedside echocardiography performed before primary percutaneous coronary intervention (PCI) may confirm the clinical suspicious and avoid dangerous diagnostic delays.
Reconstructing a single-head formula to facilitate logical forgetting
Authors: Liberatore Paolo
Published: December 2022

Logical forgetting is removing some variables from a formula while maintaining its consequences on the remaining variables. This removal may require exponential time on arbitrary propositional Horn formulae, but it only takes polynomial time on single-head propositional definite Horn formulae. Single-head means that no variable is the head of multiple clauses. An algorithm to make a formula single-head if possible is shown. It enlarges the set of formulae admitting polynomial-time forgetting by making them single-head if possible and then running the usual algorithm for forgetting.
77. Demonstration of stable clusters of symptoms in long COVID
Authors: Kenny Grace , McCann Kathleen , O'Brien Conor , Savinelli Stefano , O'Broin Cathal , Tinago Willard , Yousif Obada , Lambert John S , Feeney Eoin , de Barra Eoghan , Sadlier Corinna , Landay Alan , Doran Peter , Mallon Patrick W G
Published: December 2022

Background

Long COVID is a heterogenous condition. We previously demonstrated distinct phenotypes of long COVID, but the impact of later waves caused by SARS-CoV-2 variants on long COVID presentations has not been described.

Methods

We selected individuals with ongoing symptoms > 4 weeks from PCR-confirmed COVID-19 in a multicentre, prospective cohort study. We used multiple correspondence analysis and hierarchical clustering on self-reported symptoms to identify symptom clusters, in individuals recruited during two periods; cohort 1 from March 2020 to April 2021, and cohort 2 from April 2021 to March 2022. We explored differences in symptoms by mapping acute infection to one of four COVID-19 waves in Ireland (table 1) as well as vaccination status, and used Chi2 test to compare symptoms frequencies.

Results

Demographics are shown in Table 2. Cluster analysis of each cohort demonstrated 3 distinct clusters in both cohorts, which shared similar clinical characteristics; a musculoskeletal/pain symptom cluster, a cardiorespiratory cluster and a third less symptomatic cluster (Figure 1).

While symptoms within clusters were similar across both periods, in the cardiorespiratory cluster, the frequency of palpitations decreased (56% vs 16%) and cough increased (14% vs 45%) between reporting periods (both P< 0.01). Furthermore, a greater proportion of palpitations were reported in those with COVID-19 from waves 1 and 2 (35% and 28%) compared to 3 and 4 (both 12%, P< 0.001), and a greater proportion of chest pain in waves 1, 2 and 4 compared to wave 3. There were no differences in other symptoms (Table 3). Additionally there were significantly less palpitations reported in those vaccinated at the time of review (17% vs 31% P=0.002), but not chest pain (30% vs 39% P=0.13). In multivariate analysis, infection in wave 3 and 4 but not vaccination status remained significantly associated with lower reported palpitations (OR (95% CI) 0.28 (0.13–0.97) and 0.5 (0.06–0.87) for waves 3 and 4, both P< 0.05), and wave 3 infection remained independently associated with lower reported chest pain (OR 0.3 (0.25–0.7)).

Conclusion

Three symptom clusters define long COVID across the two cohorts, but characteristics of the cardiorespiratory phenotype have evolved over time with evolution of SARS-CoV-2 variants.

Disclosures

All Authors: No reported disclosures.
78. Longitudinal Analysis of T cells in COVID-19 Survivors with Post-Acute Sequelae of COVID-19 Reveals Associations between Individual Symptoms and Inflammatory Indexes
Authors: LaVergne Stephanie , LaVergne Stephanie , Dutt Taru , McFann Kim , Baxter Bridget , Webb Tracy , Berry Kailey , Stomberg Sophia , Dunn Julie , Henao-Tamayo Marcela , Ryan Elizabeth
Published: December 2022

Background

Many individuals infected with SARS-CoV-2 are left with persistent symptoms of COVID-19. Post-acute sequelae of COVID-19 (PASC) can affect quality of life and functionality. The mechanism underlying PASC is unknown but elevated inflammatory markers several months post infection have been found in those with PASC.

Methods

Individuals diagnosed with COVID-19 were evaluated longitudinally for PASC and persistent symptoms. CD4+ and CD8+ cellular markers and intracellular cytokines were assessed at each follow-up time point and analyzed by individual PASC symptoms reported.

Results

Participants who reported persistent dyspnea, forgetfulness, confusion, and chest pain had significantly higher levels of CD8+Ki67+ cells. Those with dyspnea also had significantly higher levels of CD8+CD38+, CD8+Granzyme B+, and CD8+IL10+ cells. Those who suffered from forgetfulness, chest pain, and joint pain had significantly higher levels of CD4+CD25+ cells.

Conclusion

These findings suggest continued CD8+ T cell and CD4+CD25+ T cell activation and response following SARS-CoV-2 infection in patients with PASC. An increase in T regulatory cells suggests an ongoing attempt to control host inflammation in a subset of these patients. These results shed further light on continued immune system activation and chronic inflammation as a link to symptoms in COVID-19 survivors suffering from PASC.

Disclosures

All Authors: No reported disclosures.