bluuebunny/crossref_metadata_2025 huggingface dataset:
339 INTRAVENOUS CANGRELOR VERSUS ORAL TICAGRELOR IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION: A PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Scalia Lorenzo , Sammartino Sofia , Greco Antonio , Mauro Maria Sara , Calderone Dario , Agnello Federica , Legnazzi Marco , Laudani Claudio , Capranzano Piera , Capodanno Davide , Tamburino Corrado
Published: December 2022

Background

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), potent oral inhibitors of the adenosine diphosphate (ADP)–activated platelet P2Y12 receptor (i.e., prasugrel, ticagrelor) are recommended in addition to acetylsalicylic acid, given as a loading dose as soon as possible, and followed by a maintenance dose. However, the onset of action of oral P2Y12 inhibitors is relatively slower in STEMI patients. In comparison with oral P2Y12 inhibitors, cangrelor has several pharmacokinetic advantages due to its intravenous route of administration, including platelet inhibition within minutes. There is no randomized study so far comparing cangrelor with ticagrelor. The aim of this study was to investigate the comparative effectiveness of intravenous cangrelor and ticagrelor pre-treatment in STEMI patients undergoing primary PCI.

Methods

We looked for patients with STEMI undergoing primary PCI at a single high-volume center who were naïve from oral P2Y12 inhibitors at presentation and who received cangrelor (in-lab) or ticagrelor pretreatment. The primary endpoint of the study was a composite of all-cause death, myocardial infarction (MI), definite or probable stent thrombosis and unplanned repeat revascularization within hospital discharge. Secondary outcomes were represented by individual components of the primary composite endpoint, cardiovascular death, non-cardiovascular death, and major bleeding within 72 hours from PCI. Propensity score matching was used to account for potential confounders.

Results

A total of 396 patients with STEMI (October 2019-March 2022) met the eligibility criteria and entered the analysis; of them, 186 (47%) received intravenous cangrelor. The ticagrelor loading dose was administered before invasive coronary angiography in 210 patients (53%). In the unadjusted analysis, no statistically significant difference between cangrelor and ticagrelor was observed with respect to the primary composite outcome (odds ratio [OR], 1.49, 95% CI, 0.79 to 2.82; P=0.22) and all the other secondary outcomes. Consistently, after propensity-score matching of 133 matched pairs of patients receiving cangrelor or ticagrelor, no significant differences emerged with respect to the primary outcome (OR, 1.12, 95% CI, 0.44 to 2.85; P=0.81) and all the other secondary outcomes.

Conclusion

In patients with STEMI undergoing primary who were naïve from oral P2Y12 inhibitors at presentation cangrelor and ticagrelor yielded similar results. Thanks to its pharmacologic characteristics, cangrelor could be especially useful in the acute setting.
88 INCIDENTAL DIAGNOSIS OF MASSIVE MOBILE LEFT VENTRICLE THROMBI FOLLOWING COVID-19 INFECTION IN A HEART FAILURE PATIENT
Authors: Maiolo Giulia , Mapelli Massimo , Celeste Fabrizio , Conte Edoardo , Palermo Pietro , Mancini Elisabetta , Agostoni Piergiuseppe
Published: December 2022

A 71-year-old woman, known to have a non-ischemic dilated cardiomyopathy with reduced ejection fraction (EF), and a previous transcatheter edge-to-edge mitral valve repair (MitraClip), was admitted after a routine echocardiogram showing new onset multiple, highly mobile, left ventricle (LV) masses. The patient, fully vaccinated against Sars-Cov-2, experienced a paucisymptomatic COVID-19 infection 1 month before, followed by a full recovery. A transthoracic echocardiogram performed 3 months before showed no LV masses. On admission she was completely asymptomatic with no clinical signs of heart failure or systemic embolization. A multimodality imaging evaluation (contrast ecocardiography, cardiac computed tomography, cardiac magnetic resonance) confirmed a severe dilation of the LV with severe EF reduction, and 3 mobile LV masses; the largest mass was adhered to the middle portion of the anterolateral wall (maximum diameter 49×15 mm). mm). A diagnostic endomyocardial biopsy and cardiac surgery were excluded due to prohibitive embolic/procedural risk and an anticoagulant treatment with warfarin was started with a progressive reduction of the masses’ dimension at transthoracic echocardiography. Thus, a diagnosis of exclusion of LV thrombosis was made. After 2-week a complete resolution of the masses was documented with no clinical or embolic events. Cardiovascular complications of the coronavirus disease have been documented both in the acute phase and in convalescence; one such complication is the formation of LV thrombus; the pro-thrombotic nature of COVID-19 infection is well known: the coagulation activation mechanism is currently uncler, but it might be correlated to excessive inflammation, COVID-induced hypoxia, direct cytopathic effects on the cardiac endothelial cells, immobilization. This case demonstrates how vulnerable patients, i.e. those with heart failure, may experience thrombotic complications following non-severe COVID-19 infection and despite having completed the vaccine course. Although currently unconfirmed by dedicated clinical trials, more assiduous echocardiographic monitoring could yield a benefit in selected patients; current guidelines do not support the use of anticoagulation prophylaxis for non-severe COVID.19, but further studies regarding anticoagulant prophylaxis for COVID-19 patients with chronic heart diseases, including DCM, are warranted.
528 OUTCOMES IN DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH SGLT2-I: THE SGLT2-I AMI PROTECT REGISTRY
Authors: Paolisso Pasquale , Bergamaschi Luca , Gragnano Felice , Gallinoro Emanuele , Cesaro Arturo , Sardu Celestino , Mileva Niya , Foà Alberto , Armillotta Matteo , Sansonetti Angelo , Amicone Sara , Impellizzeri Andrea , Esposito Giuseppe , Morici Nuccia , Oreglia Jacopo Andrea , Casella Gianni , Mauro Ciro , Vassilev Dobrin , Galiè Nazzareno , Marfella Raffaele , Santulli Gaetano , Calabrò Paolo , Pizzi Carmine , Barbato Emanuele
Published: December 2022

Background

Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) receive intense clinical interest in patients with and without type 2 diabetes mellitus (T2DM) for their pleiotropic beneficial effects.

Objectives

To investigate in-hospital and long-term prognosis in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic (OAD) agents (non-SGLT2-I users).

Methods

In this multicenter international registry all consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled and, based on the admission anti-diabetic therapy, divided into SGLT-I users versus non-SGLT2-I users. In-hospital outcomes included cardiovascular death, recurrent AMI, occurrence of arrhythmias, and contrast-induced acute kidney injury (CI-AKI). Long-term outcomes were cardiovascular mortality, recurrent AMI, heart failure (HF) hospitalization, and their composite (MACE).

Results

The study population consisted of 646 AMI patients (with or without ST-segment elevation): 111 SGLT2-I users and 535 non-SGLT-I users. The use of SGLT2-I was associated with a significantly lower in-hospital cardiovascular death, arrhythmic burden, and occurrence of CI-AKI (all p<0.05). During a median follow-up of 24±13 months, cardiovascular mortality, HF hospitalization and the composite endpoint were lower for SGLT2-I users compared to non-SGLT2-I patients (p<0.04 for all). After adjusting for confounding factors, the use of SGLT2-I was identified as independent predictor of HF hospitalization (HR=0.46; 95%CI:0.21-0.98; p=0.041) and MACE occurrence (HR=0.57; 95%CI:0.33-0.99; p=0.039).

Conclusions

In T2DM AMI patients, the use of SGLT2-I was associated with a lower risk of adverse cardiovascular outcomes during index hospitalization and long-term follow-up. Our findings provide new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.
416 DESMOPLAKIN CARDIOMYOPATHY PRESENTING WITH CARDIAC ARREST IN A PATIENT WITH MYOCARDIAL NON-COMPACTION AND LEFT ACCESSORY PATHWAY
Authors: Ragnatela Ilaria , Santoro Francesco , Vitale Enrica , Cetera Rosa , Santacroce Rosa , Margaglione Maurizio , Brunetti Natale Daniele
Published: December 2022

Introduction

Desmoplakin is a human protein which plays a key role into desmosomes structure. Desmoplakin gene mutations can cause the so-called "desmoplakin cardiomyopathy", a form of arrhythmogenic cardiomyopathy. Its clinical history is characterized by severe ventricular arrhythmias, episodic myocardial injury and left ventricular systolic dysfunction associated with fibrosis.

Case Presentation

A 12-years-old male came to our inherited cardiomyopathy ambulatory for cardiological evaluation due to a previous history of cardiac arrest when he was infant (30 days newborn) and palpitation. Previous medical history included eczematous dermatitis and occasional hyperglycemia.

During cardiological evaluation EKG was unremarkable, echocardiography revealed myocardial noncompaction in apical and mid-ventricular regions of the left ventricle's infero-lateral wall (end systolic ratio 2:1) and evidence of direct blood flow into deep intertrabecular recesses by colour doppler.

Due to history of palpitation an EP study was performed that showed a lateral left-sided accessory pathway that was ablated during the same procedure.

A genetic molecular analysis with exome sequencing (NGS, next generation sequencing) was performed and revealed a heterozygous genetic variant in DSP (Desmoplakin) gene on chromosome 6 (c.4046 G>A pSer1349Asn). Familiar screening revealed the same genetic variant in his father and his brother, both had no cardiological events.

Conclusion

Desmoplakin cardiomyopathy may have a severe clinical presentation with cardiac arrest. A multidisciplinary approach is suggested for a tailored management of these patients.
373 ADONHERS (AGED DONOR HEART RESCUE BY STRESS ECHO) PROTOCOL FOR HEART DONATION FROM MARGINAL DONOR HEARTS: MONOCENTRIC RETROSPECTIVE STUDY ON RECIPIENT'S SURVIVAL AFTER 10-YEAR FOLLOW-UP
Authors: Mandoli Giulia Elena , Barilli Maria , Ghionzoli Nicolò , Cameli Matteo
Published: December 2022

Backgorund

Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular function.

Purpose

In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts.

Methods

Data collected from 2006 and 2014 of patients who received orthotopic Htx from marginal heart donors (group 1) and were retrospectively analysed and compared with recipients of acceptable heart donors (group 2). Bedside standard echocardiography and dipyridamole stress echo was performed for the selection of marginal hearts > 55 years old or < 55 with comorbidities/mildly dysfunctional left ventricle. Clinical, laboratory and instrumental features of the two groups of recipients were evaluated and patients with homogenous baseline characteristics were selected to reduce biases among the two groups. Follow-up through routine heart transplant surveillance included visit, echocardiography, blood tests, serial endomyocardial biopsies and coronary angiography.

Results

Twenty-two recipients were included in the study. Mean donors age was 41 ± 23, 45 ± 29 years for group 1 vs 36 ± 12 for group 2. The average follow-up was 113 months. Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two population (P> 0.05). Left atrial size was significantly higher in marginal hearts (Optimal: p=0.007; Marginal: p=0.003). Acceptable recipients showed a higher impact of CAV (p= 0.019) together with more elevated values of cholesterol and triglycerides (p = 0.048 and p = 0.012 respectively). No differences concerning cellular or humoral rejection were found between the two groups. Four patients deceased, 3 had received a standard donor heart and 1 was from the marginal donor group, with and overall median time to death of 124 months.

Conclusions

Our small pilot study shows how the evaluation of marginal donor hearts with echo stress result to no affect recipients survival compared with controls of acceptable hearts. A well-controlled selection of marginal hearts could therefore improve the shortage of organs, reducing the long line of patients waiting for a heart.
469 SACUBITRIL/VALSARTAN REDUCES CARDIAC DECOMPENSATION IN HEART FAILURE WITH PRESERVED EJECTION FRACTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Carbone Francesca , Basile Christian , Marzano Federica , Gargiulo Paola , Guarnaccia Teresa , Soriano Simona , Simeoli Luisa , Esposito Gennaro , Monaco Salvatore , Chieffo Antonio , Perrone-filardi Pasquale , Paolillo Stefania
Published: December 2022

Background

The impact of sacubitril-valsartan on heart failure patients with preserved ejection fraction (HFpEF) is uncertain. The purpose of this meta-analysis was to explore the clinical advantages and safety of sacubitril-valsartan in patients with HFpEF.

Methods

PubMed and Web of Science were searched without any restrictions from inception to 08 May 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed.

Results

Four trials, with a total of 7,008 patients were included. Compared with valsartan, sacubitril-valsartan significantly reduced the rate of HF decompensation and of the combined endpoint of HF decompensation and all-cause mortality. All-cause mortality, NYHA class improvement and rate of hyperkalemia were not significantly different between the two groups. Regarding safety, sacubitril-valsartan was more likely to increase the risk of hypotension.

Conclusion

This meta-analysis suggests that sacubitril-valsartan may be an effective strategy to reduce HF decompensation events in patients with HFpEF.
699 HYPERKALIEMIA, USE OF DRUGS TARGETING THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM AND MORTALITY IN PATIENTS FOLLOWED AT A TERTIARY CENTER
Authors: Bernardelli Alice , Mori Sara , Toma Matteo , Vecchiato Veronica , Bertero Edoardo , Semino Tommaso , De Pietro Gianni , Giovinazzo Stefano , Porto Italo , Canepa Marco , Ameri Pietro
Published: December 2022

Background

Hyperkalemia (HK) has been related to increased mortality in patients with heart failure (HF), at least in part because it leads to down-titration or interruption of renin angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists (MRA).

Methods

We reviewed the records of the HF outpatients with ≥2 visits at our clinic between 2014 and 2021 and complete data on therapy, and identified those who had HK at any time after the first visit. The characteristics between these subjects and those without HK were compared by chi-square test, T-test, or Mann-Whitney test. The use of RASi, MRA and beta-blockers at multiple time points was examined by chi-square or Fisher exact test, and the mean dose for each drug class, expressed as percentage of the guideline-recommended dose, by Wilcoxon rank sum test. The trend of RASi dose over time in HK vs no-HK was assessed by two-way ordinal regression analysis, and the association of HK with all-cause death by Kaplan-Meier method and Cox regression analysis.

Results

110 of 690 patients (15.9%) had HK, with the mean potassium concentration being 5.6 mEq/L. Subjects with HK were older [73 (66-79) vs 68 (58-78) years, p<0.001], had more often diabetes (42% vs 27%, p=0.002) and LVEF <40% (77% vs 67%, p=0.03), and had higher creatinine [1.3 (1-1.8) vs 1.1 (0.9-1.3) mg/dL, p<0.001], potassium [4.6 (4.2-5.2) vs 4.2 (3.9-4.5) mEq/L, p<0.001], and NT-proBNP levels [6,480 (2,110-11,000) vs 2,900 (1,115-6,070)], p=0.003] than those without HK. The distribution of RASi, MRA, and beta-blocker was comparable between the two groups at baseline and during follow-up, with the exception of a transient reduction in an early phase (panel A). The mean dose of RASi did not vary significantly between groups and over time (group/timepoint interaction p=0.27; panel B). HK was not associated with all-cause death (panel C; hazard ratio 1.05, 95% confidence interval 0.72–1.52). A sensitivity analysis limited to patients with LVEF <40% yielded similar results (not shown).

Conclusions

The negative impact of HK on RASi and MRA prescription and on prognosis may be mitigated in tertiary centers with expertise in HF treatment.
556 EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITION ON RIGHT VENTRICULAR FUNCTION IN HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Bonvicini Eleonora , Portolan Leonardo , Urbani Giulia , Santino Jannello Elena Maria , Pizzini Jessica , Ciceri Luca , Benini Annachiara , Benfari Giovanni , Piccoli Anna , Ribichini Flavio Luciano
Published: December 2022

Background

Sodium-glucose-transporter (SGLT2)-inhibitors have modified heart failure's prognosis since they are able to reduce the combined risk of cardiovascular death or hospitalization for heart failure. Evidence is available about the contribute of these drugs to LV reverse remodeling. Instead, despite the right ventricular disfunction is often related to the left ventricular one, little is known about the effects of SGLT2-inhibitors on right ventricular function.

Methods

Between October 2021 and February 2022, we enrolled 43 consecutive patients affected by heart failure with reduced ejection fraction on optimal medical therapy including ARNI who initiated SGLT2i therapy. All patients referred to our Heart Failure Clinic and were included in our heart failure registry approved by the local ethical committee A transthoracic echocardiography was performed at the beginning of treatment and after 6 months, evaluating left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVi) and tricuspid annular plane systolic excursion (TAPSE). Right ventricular longitudinal strain (RVLS) was assessed in 27 patients, while 16 were excluded for poor acoustic window. Continuous variables are reported as median and interquartile range and compared with the Mann-Whitney U test as appropriate. Statistical analysis was performed with SPSS version 26 (IBM, Armonk, NY).

Results

Median age of the study population was 65,8 years [IQR 56,4-75,1]. Median LVEF was 30% [IQR 24-33]. No other medical or electrical therapies for heart failure were introduced during the study period in this population. There was a significant increase of LVEF (30 [24-33] vs 33 [26-40], p 0.001) and a trend toward decrease of LVEDVi (110 [77.5-127] vs 94.7 [67.7-114.6], p 0.084). Moreover, there were no variations of TAPSE (17.5 [16-20] vs 18 [14 to 19.7], p 0.375), while RVLS showed a significant improvement (-12.3% [-16.6 / -10.6] vs -16.9% [-20 / -11.7], p 0.007) (Figure).

Conclusions

These preliminary data, population on optimal medical therapy including ARNI confirm the role of SGLT2-i in left ventricular reverse remodeling. Of note, these medications seem to improve right ventricular function as well as the left one as demonstrated by the increase of RVLS, which seems to be more sensitive of conventional methods to assess right ventricular function. Larger studies are necessary to confirm the positive effects of SGLT2i on right ventricular function.
522 THE IMPACT OF SPECIALIST CARDIOLOGY INPUT ON OUTCOMES IN PATIENTS ADMITTED FOR HEART FAILURE WITH NORMAL EJECTION FRACTION. A MULTICENTRE STUDY
Authors: Cannata Antonio , Badawy Layla , Anyu Anawinla Ta , Samways Jack , Sweeney Mark , Zackeri Rosita , Scott Paul , Piper Susan , Plymen Carla , Mcdonagh Theresa , Bromage Daniel
Published: December 2022

Aims

Specialist cardiology care is associated with a prognostic benefit in patients with HF with reduced ejection fraction (HFrEF) admitted with decompensated heart failure (HF). However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown.

Methods

Data on patients hospitalised with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality.

Results

A total of 1,413 patients were included in the study. Of these, 23% (n=322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs 79%, p=0.03) and respiratory comorbidities (25% vs 31%, p=0.02) compared to those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (NYHA III/IV 83% vs 75% respectively, p=0.003; moderate-to-severe peripheral oedema 65% vs 54%, p<0.001). Medical management was similar, except for a higher use of diuretics (90% vs 86%, p=0.04) and a longer length of stay for patients who received specialist input (9 vs 4 days, p<0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (HR 0.19, CI 0.09-0.43, p<0.001).

Conclusion

In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but it is independently associated with reduced in-hospital mortality.
504 ACUTE HEART DISFUNCTION IN PATIENT WITH PACEMAKER, ATRIAL FIBRILLATION AND OLD MYOCARDIAL INFARCTION: WHAT IS THE REASON?
Authors: Caruso Davide , Pestelli Stefano , Lonati Andrea , Novelli Cristiano , Lupi Gabriele
Published: December 2022

Patient (pt) 78 years old, ex smoker, with hypertension, dyslipidemia, iperuricemia and overweight. Myocardial inferior infarction with mechanical rivascularization and implant of drug eluting stent on right coronary artery in 2012. Residual ejection fraction of 47% with inferior hypocinesia. Pacemaker DDD implant for 2nd degree atrioventricular block in 2013. Atrial fibrillation from July 2021. Acute nocturnal heart failure with hypoxiemia (PO2 76%) and necessity of non invasive ventilation in November 2021 without worsening of coronary tree at coronarography and echocardiografic finding of EF 47% with inferior and posterior hypocinesia. Troponin I hs 53.6 pg/ml BNP 378 ng/ml. None relevant arrhytmias at pacemaker control. After hospital admission pt done polisonnography with finding of severe obstructive nocturnal apneas and need of CPAP (continous positive airways pressure).

Conclusions

in literature obstructive sleep apnea syndrome (OSAS) can cause heart failure, cardiac ischemic disease and hypertension. In this case a long obstructive apnea could have caused severe desaturation with hypoxiemia and then an acute episode of heart failure.
831 ECHO-API: CORRELATION WITH INVASIVE API AND PROGNOSTIC ROLE IN HEART FAILURE
Authors: De Lio Giulia , Frea Simone , Boretto Paolo , Gravinese Carol , Bellettini Matteo , De Ferrari Gaetano Maria
Published: December 2022

Background

The benefit of invasive hemodynamic assessment in the setting of heart failure (HF) is still controversial. Increased right and left filling pressure have been shown to be associated with adverse prognosis, while reduced cardiac index (CI) has not. For this reason, novel hemodynamic indexes have been developed aiming to better describe the cardiac function in different loading conditions. In this context, the aortic pulsatility index (API) is a hemodynamic variable integrating LV function and loading condition which has the potential to better predict clinical outcome. It is calculated as systolic blood pressure (SBP) minus diastolic blood pressure (DBP) divided by pulmonary capillary wedge pressure (PCWP); the difference between SBP and DBP, known as arterial pulse pressure, correlates with SV, while PCWP is a marker of the degree of pulmonary congestion. API has been shown to predict long-term outcomes in acute decompensated HF and advanced HF cohorts. To the best of our knowledge, hemodynamically-derived API has never been compared to echocardiography-estimated API.

Purpose

To evaluate the accuracy of API obtained with echocardiographic methods (echo-API) compared with the invasive hemodynamic measure obtained with right heart catheterization (RHC) and to explore its prognostic role in a HF cohort.

Methods

Consecutive patients referred for RHC to Città della Salute e della Scienza hospital from May 2019 to August 2022 underwent complete two-dimensional echocardiographic evaluation and RHC. Patients ≥ 18 years with either acute or chronic HF, irrespective of etiology, were included. For the calculation of Echo-API PCWP was estimated using the average E/e’ ratio. The association between echo-API with MACE (composite of death, LVAD implantation or heart transplantation) at 1 year follow-up was evaluated.

Results

112 patients were included in the analysis. They were mostly male, mean age was 57 years and the underlying heart disease was predominantly idiopathic dilated cardiomyopathy (32%), followed by ischemic (30%); mean LVEF was 35,07%.

Mean Echo-API was 3,54. Echo-API showed a significant correlation with invasive API using the Pearson correlation coefficient (r = 0,6591, 95% CI 0,4639–0,7933, p < 0,0001) and showed a linear correlation at Bland-Altman plot. At multivariate regression analysis Echo-API was significatively associated with primary outcome (OR 0.469, 95% CI 0.26–0.84, p 0,011).

Conclusions

Echocardiographically-derived aortic pulsatility index can be obtained in all patients with advanced HF and shows a good correlation with invasive API; it is associated with MACE, representing a useful tool for non-invasive hemodynamic evaluation and risk stratification.
338 PREVALENCE AND PERSISTENCE OF HYPOVITAMINOSIS D AMONG ITALIAN PATIENTS WITH MYOCARDIAL INFARCTION
Authors: Aleksova Aneta , Gagno Giulia , Pierri Alessandro , Fluca Alessandra Lucia , Janjusevic Milijana , Derin Agnese , Oriana Zhou Xin Ning , Restivo Luca , Hiche Cristina , Stenner Elisabetta , D’errico Stefano , Zandonà Lorenzo , Sinagra Gianfranco
Published: December 2022

Background

Hypovitaminosis D is common in the Italian population and has a comparable effect to diabetes mellitus on survival after an acute myocardial infarction (AMI). We aimed to evaluate if the prevalence of hypovitaminosis D changed over time, considering also frequent lockdowns in the last years due to COVID-19 pandemic.

Methods

According to the year of enrollment, we divided our cohort of 1042 patients hospitalized for AMI, into three groups (group 1 with 368 patients enrolled from 2014 till 2016, group 2 with 470 patients enrolled in the period from 2017 till 2019, and group 3 including 204 patients enrolled in the last three years, from 2020 till 2022) and evaluate whether the concentration of vitamin D changed in the last decade.

Results

The median concentration of vitamin D in our cohort of patients with AMI was 18.2 (11.48-25.73) ng/ml). Throughout the three groups (2014-2016, 2017-2019, 2020-2022), the median plasma vitamin D showed a trend toward an increase (17.3 (10.33–24.2) ng/ml, 18.95 (11.6–26.73) ng/ml, and 19.05 (12.5–27.3) ng/ml respectively), which was significant between the group 1 vs 2 and 3 (p = 0.033 and p = 0.004, respectively), while between the group 2 and 3 did not. Despite the trend of increase, the percentage of patients with hypovitaminosis D in each group remained high (61.4%, 53.8% and 52.0% respectively). As expected, samples taken between May and September have significantly higher vitamin D values compared to ones taken from October to April for each group (the group 1: 21.80 (15.55–31.23) ng/ml vs 15.8 (9.22–23.98) ng/ml, p < 0.0001; the group 2: 22.05 (14.10–30.98) ng/ml vs 16.50 (11.03–23.90) ng/ml, p < 0.0001); the group 3: 20.00 (11.90–26.90) ng/ml vs 16.30 (9.75–22.30) ng/ml, p = 0.001).

Conclusions

There has been a trend of increasing vitamin D values over the years, but hypovitaminosis D remains frequent. During the pandemic, vitamin D levels did not decrease due to frequent lockdowns, possibly due to media awareness that emphasized the significance of vitamin D administration against viral infection.
349 INTRAVENOUS CANGRELOR INFUSION IN PATIENTS UNDERGOING COMPLEX VERSUS NON-COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Gragnano Felice , Benenati Stefano , Scalamera Riccardo , Bertero Edoardo , Capolongo Antonio , De Sio Vincenzo , Musumeci Giuseppe , Annibali Gianmarco , Campagnuolo Salvatore , Galasso Gennaro , Silverio Angelo , Bellino Michele , Centore Mario , Menozzi Alberto , Caretta Giorgio , Rezzaghi Marco , De Luca Leonardo , Veneziano Francesco Antonio , Cirillo Plinio , De Rosa Gennaro , Porto Italo , Calabrò Paolo
Published: December 2022

Aims

To compare the clinical characteristics and in-hospital outcomes of patients undergoing complex vs. non-complex percutaneous coronary intervention (PCI) with peri-procedural use of cangrelor.

Methods

Consecutive patients treated with cangrelor in 6 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Complex PCI was defined as any of the following: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay.

Results

Among 551 patients enrolled in the ICARUS registry and undergoing PCI between January 2019 and August 2022, a total of 534 (97%) patients had complete information on PCI complexity, of whom 173 (32%) underwent complex PCI and 361 (68%) underwent non-complex PCI. In general, patients with complex PCI had similar clinical features compared with non-complex PCI patients, including comparable prevalence of high bleeding risk (HBR) status according to the ARC-HBR definition (35% vs. 30%, p=0.253), but complex PCI patients presented more often with cardiogenic shock (9% vs. 2%, p<0.001). PCI with ≥3 stents implanted was the most frequent criterion of procedural complexity (62%). The incidence of the primary endpoint of 48-hour NACE (10% vs. 7%, p=0.264) and other clinical endpoints occurring at 48 hours or during hospitalization did not differ between complex and non-complex PCI patients.

Conclusions

Among patients receiving peri-procedural cangrelor, about 30% of cases underwent complex interventions. Notwithstanding higher procedural complexity, short-term clinical outcomes were similar between complex and non-complex PCI patients.
509 RECURRENCE OF ACUTE MYOCARDIAL INFARCTION AFTER MINOCA: INSIGHTS FROM A MULTICENTRE NATIONAL REGISTRY
Authors: Ciliberti Giuseppe , Guerra Federico , Pizzi Carmine , Merlo Marco , Zilio Filippo , Bianco Francesco , Mancone Massimo , Zaffalon Denise , Gioscia Rocco , Bergamaschi Luca , Stronati Giulia , Armillotta Matteo , Sansonetti Angelo , Casella Michela , Foà Alberto , Paolisso Pasquale , Russo Antonio Dello , Gallina Sabina , Fedele Francesco , Bonmassari Roberto , De Luca Giuseppe , Sinagra Gianfranco , Kaski Juan Carlos , Verdoia Monica
Published: December 2022

Background

Myocardial infarction with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Prognosis of this patients could be of concern, in particular for those who experienced recurrent acute myocardial infarction (re-AMI). Moreover, there are limited data on characteristics of re-AMI among MINOCA patients.

Methods

In this retrospective multicentre cohort study involving seven Hub Hospitals across Italy we enrolled consecutive patients 18 years and older discharged with diagnosis of MINOCA according to the IV universal definition of myocardial infarction who experienced hospitalization for re-AMI during follow-up.

Results

A total of 54 patients were included (mean age 66±13). Compared to MINOCA patients without re-AMI (n=695), on first angiography MINOCA patients with re-AMI showed less frequently angiographically normal coronaries (37 versus 53%, p=0,032) and had higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p=0,049).

Twenty four patients (44%) with re-AMI underwent a new coronary angiography and 25% had normal coronary arteries, 12% had mild luminal irregularities (<30%), 21% had moderate coronary atherosclerosis (30-49%), and 42% showed obstructive coronary atherosclerosis (≥50%).

Among patients undergoing new angiography, only 4% had LDL cholesterol under 55 mg/dL, atherosclerosis progression was observed in 11 (46%), 38% received revascularization and 33% experienced a new cardiovascular event (death, AMI, heart failure, stroke) at subsequent follow-up.

Conclusions

In the present study near one out of two patients with re-AMI after MINOCA showed angiographic atherosclerosis progression requiring revascularization in the majority of cases. These patients rarely presented with recommended LDL cholesterol levels and are at risk for further cardiovascular events, indicating a possible underestimation of cardiovascular risk in this population.
893 FUNCTIONAL ASSESSMENT OF INTERMEDIATE CORONARY ARTERY STENOSIS
Authors: Carbone Carlo , De Rosa Maria Luisa , Mitrano Lucia , Di Serafino Luigi , Piccolo Raffaele , Franzone Anna , Cirillo Plinio , Esposito Giovanni
Published: December 2022

Background

FFR represents the gold standard to functionally assess the ischemic potential of intermediate coronary artery stenoses particularly in patients presenting with multivessel disease. However, it is still underused in the current practice. Less invasive techniques have been identified for the evaluation of intermediate stenosis. The Quantitative flow ratio (QFR), based on the angiography with 3D-reconstruction of the coronary artery and computational fluid dynamics, has been showed to well correlate with the FFR. The Angiography-DeriveD hEmoDynamic index (ADDED Index) has also been validated to assess the ischemic potential of intermediate coronary stenosis and was also found to well correlate with FFR. It considers the jeopardized subtended myocardium and the minimal lumen diameter calculated at the angiography. This study aimed to compare the ADDED Index with QFR in terms of diagnostic accuracy.

Methods

A retrospective observational study was conducted. We included all patients presenting with an intermediate stenosis assessed with QFR. Both QFR and ADDED Index were calculated. Correlation was studied using Pearson's r test and linear regression. Receiver operator characteristics curve analysis was also performed.

Results

A total of 54 patients presenting with either stable angina or acute coronary syndromes were enrolled and finally 62 intermediate stenoses were included. A significant correlation between the ADDED Index and QFR was found (r2=0,32, p <0.001) (Figure 1). At ROC analysis, and with the QFR as reference, the ADDED Index showed a significant and very high area under the curve (0.99 (0.99-1.00), p<0.001), Figure 2) suggesting the high accuracy for the assessment of the ischemic potential of intermediate coronary artery stenoses.

Conclusion

ADDED Index was found similar to the QFR in terms of accuracy for the functional assessment of intermediate coronary artery stenoses.
845 THE PREDICTIVE ROLE OF HIGH-SENSITIVITY CARDIAC TROPONIN T IN THE EMERGENCY ROOM: COMBINING BIOMARKERS WITH CLINICAL DATA LEADS TO THE DIAGNOSIS OF CARDIOVASCULAR DISEASE
Authors: Golino Michele , Marazzato Jacopo , Blasi Federico , Morello Matteo , Chierchia Valentina , Cadonati Cristina , Ghirimorldi Elena , Pellitteri Alessia , Matteo Federica , Licciardello Claudio , Zappa Martina , Ageno Walter , Passi Alberto , Angeli Fabio , De Ponti Roberto
Published: December 2022

Background

Small amounts of high-sensitivity cardiac troponin (hs-cTn) I and T can be detected in healthy individuals or can occur in the absence of any clinical features of myocardial ischemia (myocardial injury). However, it is not possible to clinically distinguish whether and which increase in hs-cTn are due to which mechanisms. Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scanty. Consequently, with this monocentric retrospective study, we aimed at expanding the knowledge of this biomarker in this setting.

Methods

Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing variations were correlated with the clinical presentation and diagnosis. Subsequently, multivariable models were built to assess which clinical and laboratory variables most influenced hospital admissions.

Results

At a first screening, 4660 patients were considered, and 4149 patients were enrolled (Figure 1). Of these, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized according to the following diagnoses: acute coronary syndrome (ACS, 182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values as well as significant hs-cTnT variations were found in the ACS group (p < 0.01). Furthermore, in the latter, the mean percentage of variation of hs-cTnT was higher, while it was intermediate in the non-ACS group, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02–0.39, p <0.01 and OR: 0.9988, 95% CI: 0.9979–0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908–0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000–1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97–132.32, p < 0.01) and eGFR (OR: 1.04, 95% CI: 1.004–1.083, p = 0.03) were significantly associated with the ACS diagnosis.

Conclusion

In our study, differently from the investigated hs-cTnT, only clinical variables predicted hospitalizations in different patients’ subgroups.
536 CHANGES IN MYOCARDIAL BIOMARKERS TO DIFFERENTIATE TYPE 2 MYOCARDIAL INFARCTION FROM TYPE 1 MYOCARDIAL INFARCTION AND ACUTE MYOCARDIAL INJURY: A PROSPECTIVE COMPARISON STUDY.
Authors: Mautone Francesco , Mele Marco , Ragnatela Ilaria , D´alessandro Damiano , Rossi Luciano Umberto , Diomede Nicolangelo , Diomede Davide , Giannetti Laura , Palmieri Gianpaolo , Corbo Maria Delia , Vitale Enrica , Brunetti Natale Daniele
Published: December 2022

Background

According to 4th Universal Definition of Myocardial Infarction (MI), it is possible to differentiate clinically type 2 MI (T2MI) from type 1 MI (T1MI) and acute myocardial injury (AMI). However, in many cases this differentiation may be difficult. To date there are poor data that allow to distinguish AMI, T2MI and T1MI from the changes and the absolute or relative values of biomarkers of myocardial necrosis. We sought to compare T2MI vs T1MI and vs AMI in terms of cardiac biomarkers changes.

Methods

we consecutively enrolled 90 patients (30 with T1MI, 30 with T2MI and 30 with AMI). excluding patients with ST-segment elevation myocardial infarction. The ratio of the peak to the upper limit of normal (RULN) were calculated for both CK-MB and cardiac troponin T (cTnT). Moreover, the ratio of peak cTnT to peak CK-MB was also calculated.

Results

the ratio peak/RULN for cTnI and CK-MB were significantly higher for T1MI in comparison with T2MI (cTnI 100.8 vs 67.1, p < 0.001; CK-MB 2.1 vs 0.66, p 0.003) while there were not significant differences between T2MI and AMI (T2MI 67.1 vs AMI 47.3., p 0.159; T2MI 0.66 vs AMI 0.39, p 0.052). Interstingly, there was a higher rise of cTnT than CK-MB in type 2 compared with type 1 myocardial infarction, so that the ratio of peak cTnT to peak CK-MB was significantly higher for T1MI in comparison with T2MI (T1MI 196.2 vs AMI 20.5, p 0.008).

Conclusions

Both cTnT and CK-MB peaks were higher in T1MI than in T2MI. Furthermore, cTnT rises out of proportion to CK-MB in T2MI. These changes may contribute to a better differentiation between T2MI and T1MI.
323 LONG TERM CARDIOVASCULAR OUTCOMES BY SEX AND SPECIFIC METABOLIC PHENOTYPES POST ACS PATIENTS
Authors: Orlando Luana , Russo Vincenzo , Dattilo Giuseppe , Imbalzano Egidio
Published: December 2022

Background and Aims

Obesity, a major risk factor for acute coronary syndrome (ACS), is a multifaced disease with different metabolic phenotypes and sex-specific features. We evaluated the long-term cardiovascular risk by different obesity/metabolic phenotypes and by sex in ACS patients.

Methods

The occurrence of the composite outcome of death, non-fatal re-infarction with or without PCI and/or stroke was evaluated in 674 patients (504 men; 170 women), consecutively hospitalized for ACS and followed-up for 7 years, who were stratified in metabolically healthy (MHNW) and unhealthy normal weight (MUNW), and in metabolically healthy (MHO) and unhealthy obese (MUO) groups, as shown in Figure 1.

Results

At baseline, 54,6% of patients were included in the MHNW group, 26,4% in the MUNW, 5,9% in the MHO and 13,1% in the MUO, with no sex-differences in the phenotypes distribution. The overall rate of major outcome (100 person-years) in the reference group (MHNW) was higher in men that in women (RR: 1.19 vs 0.6). The Kaplan-Meier curves (see Figure 2) for cumulative survival free from cardiovascular events according to obesity/metabolic status diverged significantly according to sex (long rank test, P= 0.006), being this effect more prominent in men (P=0.011), than in women (P=0.047). Compared to MHNW, the risk increased in obese men (RR: 2.2; 95% CI 1.11-1.54 in MUO group), whereas in women the risk was confined to the metabolically unhealthy subjects (RR: 3.2; 95% CI 1.23-9.98, MUNW group).

Conclusions

Our data show a sex-specific impact of obesity phenotypes on long-term cardiovascular risk in patients hospitalized for ACS.

Thus, while MHO women seemed to be protected over time, in men, obesity had a stronger impact irrespective of metabolic status.

These data emphasize the importance of assessing metabolic status and implementing systematic metabolic surveillance in patients undergoing coronary revascularization procedures, even if their weight is normal.
297 DEVELOPMENT OF CORONARY ARTERY DISEASE IN A YOUNG ADULT AFFECTED BY TAKAYASU'S ARTERITIS
Authors: Benvenuto Ciro Pollio , Simonini Chiara , Vaccarella Marcello , Ierardi Carolina , Fedele Annalaura , Leone Antonio Maria
Published: December 2022

Large vessel vasculitis, such as Takayasu's Arteritis (TA), are rare inflammatory diseases affecting multiple vascular districts including the coronary arteries, producing either stenosis and/or aneurysms: these lesions can be found in the same patient and also in the same vessel, with potentially devastating effects. Moreover, TA often affects young people, in the midst of their work and social activity.

Ischemic heart disease is the leading cause of cardiovascular mortality in Western countries and is mainly due to coronary atherosclerosis, whose etiopathogenesis is multifactorial and is closely related to the concomitant presence of classic cardiovascular risk factors and inflammation of the vessel wall.

We present the case of a young adult, sportsman, with multivessel coronary artery disease developed in the context of a TA bursted seven years before and currently in clinical remission. This complex case required a careful literature review and a multidisciplinary approach, since the best treatment option for coronary lesions induced by TA has not been established: a “watchful waiting” strategy was eventually adopted, considering the poor outcome of both percutaneous and surgical revascularization in this group of patients.
656 DIFFERENTIAL DIAGNOSIS BETWEEN TAKOTSUBO SYNDROME AND MYOCARDITIS
Authors: Biddau Mattia , Garau Enrica , Marchetti Maria Francesca , Utzeri Elena , Licciardi Marco , Mandas Martina , Maiani Silvia , Cau Riccardo , Saba Luca , Montisci Roberta
Published: December 2022

Background

In the evaluation of specific non MINOCA, the differential diagnosis between Takotsubo syndrome and myocarditis can be challenging.

Purpose

The aim of our study was to evaluate the parameters that can be more useful to distinguish the pathologies.

Methods

All the patients with specific non MINOCA admitted to our service were enrolled. Informations about clinical characteristic, in-hospital outcome and complications were collected. All the patients have made several blood samples for hS-troponin, CRP, NT-proBNP, ECG with calculation of QTc, cardiac echocardiogram at the admission and at the discharge and diagnosis has always been confirmed by CMR.

Results

Between October 2018 and October 2021 51 specific non MINOCA have been hospitalized in our service (26 Takotsubo and 25 myocarditis). Patients affected by Takotsubo syndrome were more frequent older, females (p<0,0001), had a higher global cardiovascular risk (p=0,046) and had more frequently neurological disorders (p=0,041), autoimmune thyroiditis (p=0,02) and have experienced stressful triggers before hospital admission (p=0,003); patients with myocarditis had, instead, more often an infection before hospital admission (p<0,0001). No differences have been found in clinical or electrocardiographic presentation, although observing the evolution of the ECG, a significative prolongation of the QTc in Takotsubo have been noticed (QTc 552 ± 75,1 vs 409,8 ± 27,7 p<0,0001). Peak troponins, NT-proBNP and CRP were significantly different (p=0,002; p=0,008; p=0,003), as were LVEF and WMSI at the admission (p=0,004 and p<0,0001). From the CMR data LGE and T2 mapping were useful to distinguish the two pathologies (p<0,0001; p=0,001). From the analysis of ROC curves a T2 mapping value superior to 62 msec was able to distinguish the two pathologies with a sensibility of 70%, a specificity of 73%, a positive predictive value of 73% and a negative predictive value of 70%.

Conclusion

There are many parameters useful to distinguish the specific non MINOCA: clinical characteristics; blood sample parameters like troponins, CRP and NT-proBNP; ECG, echocardiographic and CRM. T2 mapping can distinguish the two pathologies with a good sensibility and specificity.