bluuebunny/crossref_metadata_2025 huggingface dataset:
P345 HEALTH LITERACY AS A MEASURE OF NURSING COMPLEXITY OF CARE IN A DEPARTMENT OF CARDIOVASCULAR MEDICINE
Authors: De Rinaldis M , Cristofori E , Iula A , Conte M , Cocchieri A
Published: May 2022

Background

HL plays a fundamental role in patients’ healthcare. According to the American Medical Association, HL can be viewed as a stronger predictor of a person’s health status than age, education level, and race. HL concept has many implications for nursing; they are responsible for identifying the patient’s barriers to their health information’s comprehension and providing specific nursing interventions in minimizing barriers. Moreover, HL assessment is necessary to plan tailored interventions, improve their efficacy through patient–centered communication. As a part of the nursing process, the nursing diagnosis (ND) classifies patients according to their level of nursing dependency and can be predictive for the nursing workload. No studies have been conducted on the relationship between NDs and HL. We aimed to describe the prevalence and distribution of NDs on admission in patients with CDs and to analyze the relationship between HL and NDs.

Method

A retrospective design was used to randomly select 134 patients with CDs in eight cardiovascular and internal medicine units of an Italian hospital from 10 January to 10 May 2021. NDs were collected using a nursing information system (NIS). Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on NIS.

Results

A mean of 3.5 ± 2.3 nursing diagnosis per patient was identified. A statistically significant linear association (Spearman’s correlation coefficient) was observed between HL score and the number of NDs.

Conclusion

HL was associated with the number of NDs.
P348 PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION: DATA FROM NIGUARDA HOSPITAL
Authors: Maloberti A , Ceruti D , Gualini E , Colombo V , Giani V , Milani M , Sun J , Alloni M , Giannattasio C
Published: May 2022

Background

The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive–mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non–invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention.

Methods

559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population.

Results

During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease.

Conclusions

Our study shows a relevant percentage of inappropriate prescriptions of non–invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.
P349 A REPRODUCIBLE SENSOR PATTERN TO SUSPECT COVID19 PULMONARY INFECTION WITH LATITUDETM. CASE REPORT AND LITERATURE REVIEW
Authors: Zanchi S , La Greca C , Di Nanni N , Fogliata E , Zani M , Pecora D
Published: May 2022

A 78 year–old patient with post–ischaemic dilated cardiomyopathy and severely reduced ejection fraction was implanted with a Boston Scientific RESONATE X4 CRT–D and followed by LATITUDETM remote monitoring platform. From the end of January to the end of March 2021 he was hospitalized for COVID19 pneumonia followed by two episodes of acute heart decompensation. We remotely followed the patient and identified a specific Heart Logic sensor pattern linked to the COVID19 pneumonia: an increase of the thoracic impedance combined with an increase of the respiratory rate (RR), S1 heart sound and the nocturnal heart rate (nHR). This pattern differed from the one linked to the subsequent episodes of heart failure, characterized by a decrease of the thoracic impedance and of S1 heart sound combined with a high RR and nHR. We eventually made a literature review on the topic and found that our observations were in line with what was published: an increase in the thoracic impedance in association with an increase in the RR and a decrease in the activity level was present in the majority of published COVID19 patients followed by LATITUDETM remote monitoring platform. Furthermore a recent comparative study found that the thoracic impedance was significantly higher in COVID–19 patients as compared with acute HF patients, suggesting an underlying pathophysiological mechanism related to pulmonary infection.

The present case and the literature review show that LATITUDETM remote monitoring algorithm may become a useful tool to remotely detect SARS–CoV–2 infection, distinguish it from HF and lead to an early hospitalisation for symptomatic patients or to a simple home monitoring.
P354 GENDER DIFFERENCES IN EPIDEMIOLOGY OF A CORONARY CARE UNIT HUB IN COVID ERA
Authors: Frascaro F , Cardelli SL , Bugani G , Sciarra F , Zagnoni S , Canovi L , Dal Passo B , De Carolis B , Zanarelli L , Piscitelli L , Colletta M , Casella G
Published: May 2022

Background

The attention about sex disparities in Cardiology has grown in the last few years. Women are still often under–represented in cardiovascular randomised clinical trials (RCTs) and several studies have shown later diagnosis, less aggressive treatments and poor prognosis among women, even though hospitalized in the coronary care unit (CCU).

Objective

To analyze gender–related differences and their relationships with prognosis among patients admitted to a contemporary CCU Hub.

Methods

Between 1st March 2021 and 30th November 2021, we prospectively collected the data of patients admitted to the II level CCU of Maggiore Hospital in Bologna.

Results

The clinical characteristics of 458 enrolled patients are shown in Table 1. Women represent 32% of the population, are older (p < 0.001) and have been admitted to the CCU mainly for acute coronary syndrome (ACS) (43%) or bradyarrhythmias (23%); men for ACS (57.5%) or heart failure (11.3%). Among patients with ACS, 82% of women underwent coronary angioplasty – both primary and non–primary– versus 88.1% of men (p = 0.276). Females have fewer cardiovascular risk factors and comorbidities than their male counterparts. In CCU, women received similar treatments to men (except for increased use of parenteral nutrition). Similarly, the prevalence of ischemic, haemorrhagic and septic complications was the same between the sexes. The rate of women‘s mortality in CCU was 1.4%, which increases to 4.8% at 30 days, similar to men’s mortality (1.9% versus 3%, respectively).

Conclusions

The study demonstrates that one third of the population of a CCU Hub is represented by women, older and more often hospitalized for ACS. These women receive the same treatments as men, including coronary revascularization. There were no differences about gender prognosis, despite a higher trend towards mortality in females after discharge from the CCU. Therefore, studies where women are more represented are needed, in order to obtain precise indications on how to modulate clinical management according to gender.
P355 THE HYPNOTIC COMUNICATION USE IN CARDIOLOGY SETTING
Authors: Bricco G , Boglione M , Moncalvo C , Bossa S , Coppolino A , Valeri L , Amoroso G , Dogliani S , Pancaldo D , De Benedictis M
Published: May 2022

Between summer 2020 and the end of 2021 the Cardiology facility of the Savigliano hospital trained 2 doctors and 2 nurses in hypnotic communication (IC). IC is a communicative approach, which involves establishing a relationship with the patient and can allow carrying out the planned procedure by bringing the patient into a modified state of consciousness that reverberates on physical and sensory perceptions up to a trans hypnotic. This particular connection with the patient can be represented by a simple communication deepening up to the real trance and allows to overcome the procedures with a reduction in the use of anesthetics and analgesics, with a control of procedural anxiety, up to complete analgesia, but also the management of some particular procedural needs such as the prolonged maintenance of the supine position on an operating room table with the patient awake. All patient has an extremely positive experience. Hypnosis can also optimize the abilities and performances of those who use it. During this period, at the Cardiology facility of the Savigliano we started using IC to perform procedures in the hemodynamics, electrophysiology and transesophageal echocardiography. In the hemodynamics and electrophysiology room, IC has increasingly become the preferred communicative approach to the patient who are going to have a procedure. A total of 123 patients booked for coronary angioplasty were managed in IC, including 5 in emergency, 24 PM implants and defibrillators, 3 electrophysiological studies and a foramen ovale closure procedure. In recent months, an outpatient operator has started performing IC on 10 transesophageal echocardiogram exams. In 70 patients the session was concluded with an anchorage, which is a moment in which the patient is allowed to reproduce the modified state of consciousness independently, to face moments of anxiety, fatigue or other procedures. In the majority of patients, the ratification of the presence of a trance state was positive, in a smaller percentage of cases (about 15%) the ratification was sometimes not evident or if it was, the patient was expelled during the procedure, but in 100% of cases the patient‘s experience was extremely positive both in terms of perceived closeness of the healthcare staff, and in terms of tolerance to the procedure and positive experience of the latter.
P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM
Authors: Palermi S , Brugin E , Compagno S , Pescatore V , Tegon G , Gerbino L , Sarto M , Marin R , Volpato R , Masato M , Panico A , Biffi A , Giada F
Published: May 2022

Background

Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS

Methods

39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training

Conclusions - Results

of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS
P375 RECURRENT CEREBRAL ISCHEMIC ATTACKS IN PATIENT ON DIRECT ACTING ORAL ANTICOAGULANTS FOR ATRIAL FIBRILLATION
Authors: Bresciani B , Elmi G , Romboli E , Tortorici G
Published: May 2022

We present the case of an 81 year old man suffering from hypertensive heart disease with dilated evolution, dyslipidemia and previous TIAs; on one occasion documentation of cardioembolic origin of the event: AF paroxysm. CHA2DS2–VASc Score = 6. In therapy with DOAC: Dabigatran 110 mg x 2. Placed in therapy with Mysoline for inconstant tremors of the limbs and doubt of absences. Three days after the start of this therapy, the patient was hospitalized for dysarthria (2 h); NIHSS: 0 and ABCD2 score: 4; Brain CT: not acute lesions; centralization to Hub stroke not indicated and DOAC dosage not performed in the PS; at the verification of the DOAC concentration at the peak, during the infra–hospital intake, values of 123 ng / ml; no changes in blood pressure at onset, unchanged CHA2DS2 Vasc Score and HAS–BLED, unchanged blood tests, verified correct intake (CP count), kept the original packaging of the drug, there were no changes in body weight and there was no associated GE pathology; however, primidone was found to be a drug able to decreasing the plasma levels of Dabigatran as an inducer of P–gp glycoprotein. Tp confirmed with Dabigatran and Mysoline replaced with Clonazepam. Subsequent new hospitalization for dysarthria (2 h); centralized in Hub stroke; NIHSS: 1 (slight deviation of the buccal rim–outcome); pressure rise upon access to the PS; peak DOAC concentration 53 ng / ml; CT angiography of the neck and intracranial vessels with evidence of significant underlying vascular lesion load already in itself a contraindication to reperfusion tp which has been excluded; no brain CT lesions; hypothesized in the acute phase switch to another DOAC that has been performed; switch to Apixaban 5 mg 1 tablet x 2 and potentiation of antihypertensive treatment. NMR program of brain in sedation for claustrophobia. Subsequent new hospitalization for septic state and profound drowsiness; severe alteration of blood tests; subacute ischemic hypodensity in the peripheral territory of the left posterior brain; exitus of the patient. Many patients with AF remain at high residual risk of stroke despite an apparent appropriate dosage of oral anticoagulant drugs. However, a multidisciplinary and integrated investigation strategy of all known risk factors does not always give an effective answer, as in the case presented, and there is a lack of information in the literature regarding management options in such circumstances.
P382 FOLLOW–UP OF PATIENTS SUBMITTED TO TRANSVENOUS LEAD EXTRACTION FOR ENDOCARDITIS OR SEPTIC SHOCK AND THEN RE–IMPLANTED WITH LEADLESS PACEMAKER: SINGLE CENTER’S EXPERIENCE
Authors: Dentico A , Ferrieri A , Epicoco G , Troccoli R , Carretta F , D‘Agostino C , Carretta D
Published: May 2022

Introduction

With increasing of complications associated with pacemakers and defibrillators implants, the number of patients that undergo transvenous lead extraction following an infection increased. Often in pacemaker–dependent patients there is the problem of having to make an early re–implanting after extraction. This study aims to evaluate the incidence of reinfection in patients implanted with leadless PM following extraction.

Materials and Methods

From January 2016 to December 2021, 132 extractions have been performed in our center. Of these post–extracted patients, 21 were then implanted with a leadless. Among the remaining, in 25 were re–implanted with a traditional PM, 27 with a defibrillator, 2 with a loop recorder, 3 are protected with Life Vest waiting for re–implant; 54 are patients who, after cardiological revaluation, or have not re–implanted a new device or have been redirected to the first implant’s center waiting to complete antibiotic therapy. To evaluate the technical efficiency of leadless in post–extracted patients, a comparison was made between these and the leadless PM implanted “de novo”. To demonstrate the reduction of reinfection recurrences, the post–operative of patients re–implanted with leadless has been compared to those re–implanted with traditional PM. To test the patient‘s level of approval to the new implanted device, a questionnaire was administered to the two samples.

Results

A first analysis of the follow–up of the above classes from 2016 to today shows that in patients who have implanted a leadless PM in no case a recurrence of infection has occurred; in patients who have implanted a traditional device, we have seen how some of these had already suffered a revision of pocket, an extraction or leads’ abandonment. The statistics of electrical parameters have demonstrated the effectiveness of the leadless in both classes of patients compared. Finally, the rating index questionnaire has shown greater acceptance of the new implanted device and a better patient–device relationship in patients re–implanted with leadless.

Conclusions

The implant of Leadless Pacemaker in post–extracted patients, when we have eligible patients to implant this device, has proved to be an effective choice in reducing reinfection recurrences.
P399 SVILUPPO DI SINDROME DA IMMUNODEFICIENZA ACQUISITA DOPO SOMMINISTRAZIONE DI VASCCINO ANTI–SARAS–COV2
Authors: Viele A , Trivisonno A , Pierro A , Giannotti G , Paolone P , Colavita A
Published: May 2022

Il SARS–CoV2 è trasmesso tra gli umani attraverso particelle respiratorie e l’infezione può determinare un largo spettro di manifestazioni cliniche. Precedenti studi hanno dimostrato il ruolo centrale dell’immunità cellulo–mediata nel limitare la gravità delle infezioni da virus respiratori. I linfociti T–helper CD4+ sono coinvolti in funzioni di coordinazione e regolazione dell’immunità anti–virale: determinano lo sviluppo di anticorpi neutralizzanti ad alta affinità e la differenziazione dei centri germinali a cellule B in cellule della memoria secernenti anticorpi con lunga vita. Nessun dubbio sul ruolo cruciale della risposta a cellule T durante l’infezione da SARS–CoV2 o dopo la vaccinazione. Descriviamo il caso di un paziente di 39 anni, vaccinato con ChAdOx1–S. Dopo due settimane il paziente accusava dispnea e febbricola. Il test molecolare per SARS–CoV2 era negativo; agli esami ematici la PCR era aumentata. La TC del torace escludeva embolia polmonare e rivelava pattern a vetro smerigliato bilaterale, come da flogisi. All‘ecocardiogramma i parametri erano nella norma. L’ECG mostrava tachicardia sinusale. Il paziente veniva dimesso dal PS con terapia cortisonica. Una settimana dopo i sintomi peggiooravano. Una nuova TC torace mostrava difetti di opacizzazione di rami secondari dell’arteria polmonare ed aspetto bilaterale a vetro smerigliato. Si iniziava terapia con EBPM ed antibiotici a largo spettro. Il test molecolare e la sierologia per SARS–CoV2 erano negativi. Negativi i test per Mycoplasma, Chlamydia, Legionella e CMV DNA. L’emocromo mostrava ridotti linfociti (6,8%) con neutrofilia relativa (90,4%), ma normale valore dei bianchi. La TC–HR mostrava aspetto “crazy paving” bilaterale suggestivo per infezione virale o micotica (pattern come da infezione da Pneumocystis Jiroveci). Il test per HIV aveva esito positivo; alla tipizzazione linfocitaria ridotti i livelli di linfociti T–Helper (CD3+/CD4+) e rapporto CD3+/CD4+ 0%. Per il rapido deterioramento del quadro clinico il paziente veniva trasferito in terapia intensiva. Dopo 30 giorni dalla diagnosi di AIDS il paziente giungeva ad exitus. Il ruolo dei linfociti T nello sviluppo di anticorpi neutralizzanti e di cellule della memoria durante l’infezione da SARS–CoV2 è la chiave nella strategia di vaccinazione per ridurre il dilagare della pandemia, tuttavia nel nostro paziente questo meccanismo non ha funzionato rivelando il deficit del suo sistema immunitario da una latente infezione da HIV.
P400 CLINICAL IMPACT OF PROPHYLACTIC ANTICOAGULANT TREATMENT WITH ENOXAPARIN IN CORONAVIRUS DISEASE 2019 (COVID–19)ELDERLY PATIENTS
Authors: Feliziani F , Pilotti R , Cappelli M , Petrelli G , Infriccioli P , Giorgini P , Parato V
Published: May 2022

Introduction

COVID–19 patients are at increased risk of venous thromboembolism. The WHO/ISSrecommends daily prophylactic anticoagulation therapy with low–molecular weight heparins in COVID–19 patients. Our study evaluated the efficacy of a prophylactic therapy with enoxaparin on clinical outcomes in COVID–19 patients.

Methods

This is a retrospective analysis of 125 SARS–CoV–2 patients hospitalized from 16 MARCH 2020 to MAY 7th, 2021. In this phase of COVID–19 pandemic, man and woman in–patients and out–patients received enoxaparin either at prophilattics or therapeutic dosage. Based on these criteria, we examined 85 patients who received PROPHILATTICenoxaparin (group E, Enoxaparin) and 40 subjects undergone THERAPEUTIC Enoxaparin (group T, Therapeutic). Of them, 95 patients were hospitalized after Sars–Cov2 positive swab and 30 received prophilatic dosage at home.

Results

After applying a propensity score matching for age and gender, considering hospitalized patients, there were no significant differences between the two groups (E, T). During hospitalization, a significantly higher percentage of patients of E group developed ARDS (37 vs 13, p = 0.0001) and needed for non–invasive ventilation No significative difference between the two groups was found about incidence of intubation (20 in E vs. 19 in T group; p = 0.4) and pulmonary embolism (17 vs 5, p = 0.4). In–hospital death occurred in 17 E group patients and in 10 T group patients (p = 0.251). No difference on 30–days mortality was found between two groups (p = 0.287). N. 15 patients of T group experienced emorragic events and interrupted enoxaparin therapy. N. 17 of them experienced adverse events (mailny thrombocitopenia).

Conclusions

Among patients with SARS–CoV–2 infection, a therapeutic dose of enoxaparin is not associated with prognostic benefit and did not affect in–hospital and 30–days mortality. A risk–adapted approach to reduce the dose of anticoagulation agent should be considered in selected COVID–19 patients with evidence of coagulopathy. In summary, current data suggest the use of therapeutic–dose LMWH to reduce VTE, it, may increase bleeding, and should be avoided in hospitalized patients with severe COVID–19 in critical care settings.. Lastly, randomized trials in this patient population are still ongoing and novel antithrombotic strategies in critically ill COVID–19 patients are needed.
P401 REMOTE COUNSELING ROLE DURING COVID–19 PANDEMIC IN SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME
Authors: Lordi R , Veronese S , Ferro A , Piccinini A , Piva T , Zerbini V , Raisi A , Mandini S , Grazzi G , Sassone B , Pasanisi G
Published: May 2022

Introduction

Patients affected by acute coronary syndrome are usually referred to center–based secondary prevention programs where they are enrolled in physical activity programs and received indications about cardiovascular risk factors control. COVID–19 pandemic induced the emanation of restrictions in people’s mobility, ban on gathering and the obligation of social distancing. This made it difficult to maintain such group meetings in presence.

Methods

After hospitalization for acute coronary syndrome in Cardiology Unit of the AUSL of Ferrara, patients equipped with electronic devices were allowed to participate to remote counseling meetings on the digital platform LifesizeC. To improve participation, meetings were organized monthly (in order to gradually include new discharged patients) and involving caregivers (if patients weren’t able to access the web app). Information on regular physical activity benefits were provided. In particular, the F.I.T.T. principle (Frequency, Intensity, Type, Time) has been explained and Borg’s exertion scale was illustrated to be used in autonomy. Furthermore, there were provided recommendations about the need of a proper warm– up/cool–down, the possibility to wear a heart rate monitor and the early recognition of symptoms and warning signs. To complete health education, there were given information about correct nutrition, risk factors control and correct assumption of pharmacological therapy.

Results

All patients showed interest in the topics analyzed, asking various questions during the meetings. They also stated that they were strongly motivated to undertake regular physical activity having received convincing explanations on its usefulness and safety.

Conclusions

Remote counseling meetings obtained a high approval rating and the moments of discussion with the speakers were particularly well attended. The prescription of physical exercise in secondary prevention can follow innovative telemonitored approaches, which could be maintained even after COVID–19.
P403 KOUNIS SYNDROME ASSOCIATED WITH COVID–19 INFECTION: CAUSE OR COINCIDENCE?
Authors: Orlando L , Trapani G , Vatrano M , Imbalzano E
Published: May 2022

Background

Histamine fish poisoning, known as scombroid syndrome, is a foodborne disease caused by histamine toxicity that results from eating specific types of spoiled fish. In some cases it can lead to the development of life–threatening anaphylactic reactions. In literature is widely recognized and accepted the possibility of correlated coronary involvements, cases described are rare, but even more rare if combined with the novel human coronavirus disease Covid–19 infection, the fifth documented pandemic since the 1918 flu pandemic. In this report, we describe a case of acute coronary syndrome in infected patient with Covid–19, for the first time. The occurrence of acute coronary events with allergic or hypersensitivity reactions has been described as the Kounis syndrome, but in few cases it has been associated with scombroid syndrome.

Case Report

A young woman came to our Emergency Department with erythematous lesions, mild itching, nausea, diaphoresis and weakness, after a meal with canned tuna. Her clinical situation worsened and she developed acute coronary syndrome due to vasospasm. After first negative result for rapid oropharyngeal swab test of SARS–CoV–2 RNA, waiting for molecular oropharyngeal swab during her hospitalization, a few days later she tested positive for SARS–CoV2 infection. Acute coronary syndrome in patients with scombroid syndrome is rare to find and more rare if associated with Covid–19–infection. This case demonstrated a linkage of Histamine fish poisoning with Kounis syndrome and SARS–CoV–2 infection, allowing us to foster the treatment decision–making process. Why should an emergency physician be aware of this? This syndrome can represent a life threatening, if not promptly and early known. An emergency physician must have this knowledge, to evaluate accurately the anamnesis of affected patients. Only a circumspect anamnesis can lead us to correct diagnosis and change our decision–making process for treatment.
P430 TUMORAL THROMBOTIC MICROANGIOPATHY: A RARE CAUSE OF ACUTE PULMONARY HYPERTENSION
Authors: D‘Addazio M , De Gaspari M , Porcelli G , Perazzolo Marra M , Mancuso D , Basso C
Published: May 2022

Introduction

Among the causes of acute pulmonary hypertension, the occlusion of the little pulmonary vessels caused by tumoral microemboli, even from an unknown neoplasm, is an infrequent condition with a very poor prognosis.

Clinical Case

A 55–years old woman with no relevant past medical history presented to the Emergency Department with dyspnea at rest, desaturation, palpitations and a brief episode of chest pain, after several days of fatigue and exertional dyspnea. ECG showed sinus tachycardia and signs of right ventricle pressure overload with inverted T waves in V3–V4 and in the inferior leads (Fig. 1). On laboratory tests there were high D–dimer values and a slightly elevated TnI. Blood gas analysis showed hypoxemic hypocapnic respirstory alkalosis. An Echocardiogram revealed severe dilatation and dysfunction of the right ventricle and signs of high probability of pulmonary hypertension (Fig. 2). Pulmonary CT scan ruled out embolism and showed irregular thickening of the interstitium and mediastinal lymphoadenopathy. Then, a rapid clinical deterioration happened, refractory to inotropes infusion and larger volumes of oxygen. The programmed diagnostic pathway cannot be pursued. On day 4, there was respiratory distress and pulseless electrical activity cardiac arrest during endotracheal intubation. ECMO mechanical support was positioned but on day 7 the patient died. Autopsy, made to discover the cause of pulmonary hypertension, revealed the presence of a colonic invasive adenocarcinoma with micropapillary pattern and thoracic and pelvic lymph–nodal metastases. Microscopic evaluation of the lungs showed a widespread neoplastic vascular invasion with microthromboemboli (Fig. 3).

Discussion

Tumoral thrombotic microangiopathy is a cause of pulmonary hypertension of multifactorial origin and should be suspected in cases of pulmonary hypertension without pulmonary embolism or interstitial lung disease. The rarity of this condition and the absence of an oncological medical history make difficult the diagnostic hypothesis. Besides, the lacking of an effective therapy makes the prognosis poor.
Stereotactic ablative radiotherapy in patients with refractory ventricular tachyarrhythmia
Authors: Molon Giulio , Giaj-Levra Niccolò , Costa Alessandro , Bonapace Stefano , Cuccia Francesco , Marinelli Alessio , Trachanas Konstantinos , Sicignano Gianluisa , Alongi Filippo
Published: May 2022

Stereotactic ablative body radiotherapy (SABR) is an innovative therapeutic approach in patients (pts) with a diagnosis of refractory ventricular tachyarrhythmia (VT) after the use of drugs, radiofrequency catheter ablation, and/or defibrillator (ICD) implant. The current efficacy data of SABR are limited and several prospective clinical studies are ongoing to support the use of ablative radiation dose to control VT. The aim of the current prospective pilot study is to report the efficacy and tolerability of SABR in ICD implanted pts with refractory VT in our centre. Non-invasive electroanatomical mapping (EAM), cardiac computed tomography (CT), and 18F-fluorodeoxyglucose positron emission (FDG-PET)-CT scan were used and combined with a radiation CT scan. A dose prescription of 25 Gy in a single dose was delivered by volumetric modulated arc therapy (VMAT) Linac-based. The primary endpoint was efficacy, defined as a reduction in ICD shocks after SABR treatment, while the secondary endpoint was safety. Six consecutive pts (five males and one female) implanted with an ICD and with three or more VT were enrolled. One pts died after 1 month, due to end-stage heart failure. Two pts experienced ICD shocks in VT 2 and 5 months after treatment. Three pts experienced no more ICD shocks on VT after therapy. Our data suggest the efficacy and safety of SABR treatment in pts with VT. Larger dataset of pts and longer follow-up are otherwise required to validate the impact of SABR as a standardized treatment in these pts.
A case of myopericarditis recurrence after third dose of BNT162b2 vaccine against SARS-CoV-2 in a young subject: link or causality?
Authors: Mapelli Massimo , Amelotti Nicola , Andreini Daniele , Baggiano Andrea , Campodonico Jeness , Moltrasio Massimo , Majocchi Benedetta , Mantegazza Valentina , Vignati Carlo , Ribatti Valentina , Catto Valentina , Sicuso Rita , Moltrasio Marco , Pontone Gianluca , Agostoni Piergiuseppe
Published: May 2022

The rate of post-vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although a direct cause–effect relationship has been described, in most cases, the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post-vaccine disease relapse. A 27-year-old man presented to the emergency department for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. Electrocardiogram showed normal atrioventricular conduction, incomplete right bundle branch block, and diffuse ST-segment elevation. A cardiac echo showed lateral wall hypokinesis with preserved ejection fraction. Troponin-T was elevated (160 ng/L), chest X-ray was normal, and the SARS-CoV-2 molecular buffer was negative. High-dose anti-inflammatory therapy with ibuprofen and colchicine was started; in the 3rd day high-sensitivity Troponin I reached a peak of 23000 ng/L. No heart failure or arrhythmias were observed. A cardiac magnetic resonance was performed showing normal biventricular systolic function and abnormal tissue characterization suggestive for acute non-ischaemic myocardial injury (increased native T1 and T2 values, increased signal intensity at T2-weighted images and late gadolinium enhancement, all findings with matched subepicardial distribution) at the level of mid to apical septal, anterior, and anterolateral walls. A left ventricular electroanatomic voltage mapping was negative (both unipolar and bipolar), while the endomyocardial biopsy showed a picture consistent with active myocarditis. The patient was discharged in good clinical condition, on bisoprolol 1.25 mg, ramipril 2.5 mg, ibuprofen 600 mg three times a day, colchicine 0.5 mg twice a day. We presented the case of a young man with history of previous myocarditis, admitted with a non-complicated acute myopericarditis relapse occurred 4 days after SARS-CoV-2 vaccination (3rd dose). Despite the observed very low incidence of cardiac complications following BNT162b2 administration, and the lack of a clear proof of a direct cause–effect relationship, we think that in our patient this link can be more than likely. In the probable need for additional SARS-CoV-2 vaccine doses in the next future, studies addressing the risk-benefit balance of this subset of patient are warranted. We described a multidisciplinary management of a case of myocarditis recurrence after the third dose of SARS-CoV-2 BNT162b2 vaccine.
Digitalised ECG measure of p-wave duration predicts incident heart failure
Authors: Ostrowska B , Lind L , Sciaraffia E , Blomstrom-Lundqvist C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Uppsala University Hospital

Background and purpose

Early identification of patients at risk of congestive heart failure (HF) may potentially alter their poor prognosis. The aim was therefore to test whether the P-wave and PR-interval, simple non-invasive ECG measures reflecting systolic and diastolic atrial function, could predict incident HF.

Methods

The PIVUS (Prospective Investigation of the Vasculature in Seniors) study including all individuals aged 70 years (1016 individuals, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 msec or atrial arrhythmias on baseline ECG were excluded. Cox proportional hazard analysis was used to relate P-wave duration (Pdur), amplitude (Pamp) and PR interval in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.

Results

A total of 107 of 836 (12,8%) subjects at risk, developed HF during 15 years follow-up. The multivariate analysis, showed a strong U-shaped correlation between Pdur and incident HF (p=0.0001), which was significant for a Pdur< 60 msec [HR 2.75 (95% CI 1.87-4.06) at Pdur 40 msec]. There was no significant relationship between incident HF and the PR-interval, or the Pamp. A Pdur<60 msec improved discrimination by 3.7% when added to the confounders described above (p=0.048).

Conclusions

A short P-duration, a simple and easy ECG measure, may potentially be a useful predictor of developing HF, enabling early detection and treatment of HF.
Fever following Covid-19 vaccination in subjects with Brugada syndrome: incidence and management
Authors: Santoro F , Crea P , Pellegrino PL , Cetera R , Gianfrancesco D , D’arienzo G , Bartolomucci F , El-Battrawy I , Brunetti ND
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Fever is a potential side effect of Covid-19 vaccination. Patients with Brugada syndrome (BS) have an increased risk of life-threatening arrhythmias when experiencing fever. A prompt treatment with antipyretic drugs is suggested in these patients.

Aim of the study: To evaluate the incidence and management of fever within 48 hours from Covid-19 vaccination among BS patients.

Methods

163 consecutive patients were enrolled in a prospective registry involving 5 European hospitals with a dedicated inherited disease ambulatory.

Results

Mean age was 50 ±14 years and 121 (75%) patients were male. Prevalence of Brugada ECG pattern type-1,-2 and -3 was 32 %, 44%, 24%, respectively. Twenty-eight (17%) patients had an implantable cardioverter defibrillator.

Fever occurred in 32 (19%) BS patients after 16±10 hours from vaccination, with peak of body temperature of 37.9±0.5 degrees. Patients with fever were younger (39±13 vs 48±13 years, p=0.04). No additional differences in term of sex and cardiovascular risk factors were found between patients with fever and not.

Twenty-seven (84%) out of 32 patients experienced mild fever and five (16%) moderate fever. Pharmacological treatment with antipyretic drugs was required in 18 (56%) out of 32 patients and was associated with resolution of symptoms.

No patient required hospital admission and no arrhythmic episode was recorded in patients with ICD within 48 hours after vaccination.

Conclusion

Fever is a common side effect in BS patients after Covid-19 vaccination. Careful evaluation of body temperature and prompt treatment with antipyretic drug may be needed.
Short-term electrocardiographic atrial remodelling after asd closure with the gco device in a pediatric population
Authors: Fumanelli J , Garibaldi S , Castaldi B , Di Candia A , Cuman M , Pizzuto A , Sirico D , Mirizzi G , Piacenti M , Cantinotti M , Assanta N , Di Salvo G , Santoro G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background and Aim

The GORE® CARDIOFORM septal occluder (GCO) is an atrial septal defect/patent foramen ovale (ASD/PFO) closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance.

Our aim was to evaluate the short and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population.

Methods

We enrolled 39 patients with isolated ASD submitted to trans-catheter closure with GCO from January 2020 to June 2021. EKG was performed before (T0), at 24 hours (T1) and 6 months (T2) after ASD transcatheter closure. P wave dispersion was calculated as the difference between maximum and minimum P- wave duration, PR interval as the interval between beginning of the P wave and beginning of the QRS complex and QT dispersion as the difference between maximun and minimun of QTc intervals. At 6-months from device implantation, the patients were submitted to ambulatory EKG Holter recording.

Results

Patients’ age and BSA were 8.2±4.2 years (IQR 4.2-8.3, median 7.0) and 1.0±0.3 m2 (IQR 0.7-1.7, median 0.9), respectively. The strectched ASD diameter was 16.3±4.5 mm (median 16), resulting in QP/QS of 1.7±0.6 (median 1.5). At the baseline mean P wave dispersion was 40±15 msec and decreased to 30±13 msec (p<0.002) at 24h, without any further change at 6 months (30±13 msec, p<0.002). PR conduction significantly improved at 24 h from device implantation (from 175.0±20.8 to 144.0±22.7 msec, p=0.018) and did not significantly change at 6 months (164.0±19.5 msec, p=NS). QTc dispersion decreased at 24 hours (31.7±.20.3, p<0.02) and at 6 months (28.0±18.1, p<0.002) from device implantation. After device deployment, 2 pts (5%) developed transient, self-limited junctional rhythm and one of them needed a short course of anti-arrhythmic therapy for supra-ventricular tachycardia. No tachy/brady-arrhythmias were recorded at the 6-months follow-up EKG Holter monitoring.

Conclusions

Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium term follow-up. It might be due to a favourable volumetric remodelling that was not hindered by mechanical impact of the occluding prosthesis and could explain the low rate of arrhythmias found at the mid-term EKG evaluation.
Body Surface Mapping system - a potential diagnostic tool for unmasking delayed right ventricular epicardial activation in ARVC patients and phenotype-negative gene-carriers
Authors: Kommata B , Sciaraffia E , Blomstrom- Lundqvist C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Selanders stiftelsen

Background

Life-threatening ventricular arrhythmias can occur at any stages of ARVC – the detection of early manifestations of the disease may have prognostic implications.

Purpose

The purpose was to explore the usefulness of a 252-leads noninvasive Body Surface Mapping (BSM) system for the detection of delayed epicardial activation in ARVC patients and phenotype-negative gene-carriers (GC).

Methods

Twelve patients with ARVC, 20 GC and 8 genotype and phenotype negative family members served as controls (C) were included. 12-lead ECG, signal-averaged-electrocardiogram, echocardiography, 252-lead BSM recordings and thoracic CT scan were performed in all subjects. The noninvasively reconstructed epicardial signals of the right ventricle (RV) were analysed using the Activation Time Editing tool of the BSM system. Local depolarisation was defined as the steepest negative dV/dt of the local epicardial signal. The time from the start of RV epicardial signals to the earliest local depolarisation (ELD) and to the latest local depolarisation (LLD), were measured for the whole RV and separately for the anterior free wall (AW) and inferior wall (IW). The duration of the activation, defined as LLD-ELD, was calculated for AW, IW and the whole RV.

Results

The ELDs was similar in all study groups whereas the LLD in the IW and whole RV was significantly longer among ARVC patients compared to C. Although the activation durations in the AW and IW did not differ between the groups, the activation duration of the whole RV was significantly longer in ARVC patients. A LLD cut off of 81ms in RV and an activation duration cut off of 49msec in RV discriminated ARVC patients from C with highest sensitivity and specificity. Based on these cut-offs, 35% of GC group had longer LLD times and 70 % had longer activation duration (figure 1).

Conclusions

ARVC patients as well as the majority of GC demonstrated prolonged LLD and/or activation duration times in RV compared to C, suggesting that the 252-leads noninvasive BSM system may be a useful tool for early detection of delayed RV epicardial activations. Larger studies are required to confirm our results.
Heart rate variability and meditation: a meta-analysis
Authors: Bin Waleed K , Lakhani I , Gong M , Liu T , Roever L , Christien Li KH , Rajan R , Qasim Ibrahimi M , Xia Y , Tse G , Chang D , Lee S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Meditation can induce changes in autonomic balance, which can benefit cardiovascular health. The present meta-analysis evaluated changes in heart rate variability (HRV) in meditators.

Methods

PubMed and Embase were searched for primary prospective studies using the search terms ‘heart rate variability’ and ‘meditation’ until January 18th, 2019. The statistical significance of the difference between subgroups is evaluated by the standardized mean difference (SMD), 95% confidence interval (CI), and P-value. I2 value was used to assess the statistical heterogeneity between the included studies.

Results

Twenty-one studies involving 538 meditators (experienced= 209, beginners= 329) and 334 controls (mean age= 40.61, 35% male) were included. Regarding time-domain indices, no statistically significant differences were observed when assessing HRV between i) meditators versus controls (SMD= -0.17; 95% CI: [-0.50, 0.17]; p= 0.30; I2= 0%), ii) pre- versus post-meditation (SMD= -0.41; 95% CI: [-1.10, 0.28]; p= 0.25; I2= 80%) or iii) at baseline versus during meditation (SMD= -0.40; 95% CI: [-0.94, 0.14]; p= 0.14; I2= 72%). Pertaining to frequency-domain indices, analysis of low frequency (LF), normalized low frequency (LFnu) and high frequency (HF) between i) meditators versus controls, ii) at baseline versus post-meditation and iii) at baseline versus during meditation yet again did not show any variations. Seven studies assessed normalized high frequency (HFnu) at baseline versus during meditation collectively demonstrated a significantly higher HFnu during meditation in beginners with notable heterogeneity (SMD= 1.29; 95% CI: [0.09, 2.49]; p= 0.04; I2= 95). Moreover, LF/HF was evaluated by seven studies at baseline versus during meditation. Both meta-analysis (SMD= 0.76; 95% CI: [-0.17, 1.69]; p= 0.11; I2= 94%) as well as subset analysis of experienced meditators (SMD= -0.46; 95% CI: [-0.88, -0.03]; p= 0.03; I2= 0%) revealed a significantly lower LF/HF at baseline.

Conclusions

Short-term changes in HRV indices were observed during meditation, but there is limited evidence for significant long-term effects.