bluuebunny/crossref_metadata_2025 huggingface dataset:
C22 PROGNOSTIC IMPACT OF PERCUTANEOUS CORONARY INTERVENTION IN CHRONIC DIALYSIS PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: FINDINGS FROM THE LOMBARDY HEALTH DATABASE
Authors: Trombara F , Cosentino N , Genovesi S , Bonomi A , Lucci C , Resta M , Milazzo V , Leoni O , Agostoni P , Marenzi G
Published: May 2023

Background

Patients on chronic dialysis are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence from randomized trials, concerns about possible PCI–related side effects, and multimorbidity. Thus, routine use of PCI for treatment of dialysis patients with AMI remains an unresolved issue.

Methods

We analyzed data of patients on chronic dialysis hospitalized with AMI (both ST–elevation myocardial infarction [STEMI] and non–ST–elevation myocardial infarction [NSTEMI]) from 2003 to 2018, by using the administrative Lombardy Health Database (Italy). Patients were grouped according to whether they were treated or not with PCI during hospitalization. The primary outcome was in–hospital mortality while 1–year mortality was the secondary endpoint.

Results

During the study period, 265,048 patients were hospitalized with AMI in Lombardy. Of them, 3,206 (1.2%) were on chronic dialysis (age 71±11; 72% males). Among dialysis patients, 44% were treated with PCI, while 54% underwent PCI among non–dialysis patients (P<0.0001). Dialysis was an independent predictor of conservative treatment with medical therapy only (OR 0.75 [95% CI 0.70–0.81]). In–hospital mortality in the dialysis cohort was 15%. It was significantly lower in patients treated with PCI than in those not treated with PCI (11% vs. 19%; P<0.0001). One–year mortality was 47% and it was lower in PCI–treated patients (33% vs. 52%; P<0.0001). The adjusted risk of the study endpoints was significantly lower in dialysis patients treated with PCI: OR 0.62 (95% CI 0.50–0.76) for in–hospital mortality; HR 0.63 (95% CI 0.56–0.71) for 1–year mortality. Similar results were found in STEMI and NSTEMI patients considered separately.

Conclusions

Our real–world data showed that in patients with AMI on chronic dialysis, PCI use is associated with a significant in–hospital and 1–year survival benefit. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET)
C29 ANAEMIA AND CONGESTION IN HEART FAILURE: CORRELATIONS AND PROGNOSTIC ROLE
Authors: Scicchitano P , Potenza A , Basile M , Sasanelli P , Massari A , Landriscina R , Cannito A , Abruzzese S , Tangorra M , Caldarola P , Massari F
Published: May 2023

Background

The relationship between anaemia and congestion in HF and its prognostic role are controversial. The aim of this study was to evaluate the relationship between anaemia and biomarkers of central/peripheral congestion in HF and the impact on mortality.

Methods

We retrospectively evaluated 434 acute/chronic HF (AHF/CHF) patients. Anaemia was defined as haemoglobin (Hb) levels < 12 g/dL in women and < 13 g/dL in men. We evaluated brain natriuretic peptide (BNP, central congestion biomarker) and Hydration Index (HI %, bioimpedance vector analysis, peripheral congestion biomarker). The endpoint was all–cause mortality.

Results

Anaemia occurred in 59% of patients with AHF and in 35% with CHF (p<0.001) and showed significant correlation with NYHA functional class and renal function. BNP and HI were significantly higher in patients with than in those without anaemia. Independent predictors of anaemia included BNP, estimated creatinine clearance (eCrCL), and HI. During a median follow–up of 463 days, all–cause mortality rate was 21% which was significantly higher in patients with than in those without anaemia (30% vs 14%, p<0.001; HR 2.6). At multivariate Cox regression analysis BNP, eCrCL, and HI confirmed as independent predictors for mortality (HR 1.0002, HR 0.97, and HR 1.05, respectively), while anaemia did not confirm its predictive value.

Conclusions

Anaemia correlates HF status, functional class, renal function and biomarkers of central/peripheral congestion. Indeed, anaemia was not an independent predictor for mortality. Therefore, anaemia in HF seems rather a marker of disease severity in patients with high congestion burden than a predictor of death.
C31 NEXT GENERATION MYOCARDITIS
Authors: Mistrulli R , Cartoni D , Andreoli F , Lestuzzi C , Paccone A , Gallucci G , Fiscella D , Petrolati S , Bisceglia I
Published: May 2023

A 75–year–old overweight man, affected by hypertension, diabetes mellitus and atrial fibrillation since 2020. After 3 unsuccessful attempts of electrical cardioversion it was opted for a strategy of rate control with beta blocker and anticoagulant therapy with Rivaroxaban 20 mg. Following episodes of rectal bleeding; adenocarcinoma of the colon was diagnosed. The patient underwent hemicolectomy and started therapy with Pembrolizumab. The anticoagulant was replaced with Edoxaban 60 mg. In August 2022, he was admitted to the emergency department for severe signs and symptoms of heart failure. On ECG, atrial fibrillation with a heart rate of 90 bpm and non–specific changes in ventricular repolarization. The echocardiogram showed a severe reduction of the ejection fraction (FE 30%), which was not present at previous controls. On blood tests, troponins were negative and BNP increased. The patient underwent coronarography which was negative for significant lesions, and heart failure therapy was prescribed. Three months later the patient came to our cardio–oncology outpatient clinic; we repeated the echocardiogram which showed a recovery of the ejection fraction to 45% and planned a cardiac MRI. Cardiac MRI (CMR) showed global left ventricular hypokinesia (FE 42%) and late subepicardial gadoline enhancement in the basal segment of the inferior wall and transmural in the basal segment of the lateral wall without signs of oedema. Report described as compatible with myocarditis. The case was discussed collegially with radiologists and oncologists, and it was decided to discontinue immunotherapy (ICI). Myocarditis is the most common cardiovascular adverse events of ICI therapy, although it has a very low incidence. Generally, myocarditis related to ICI therapy has a high mortality rate and requires discontinuation of ICI. In addition, CMR may have a lower sensitivity in this setting. There is also a possibility of developing left ventricular dysfunction without associated myocarditis in the absence of increase in cardiac troponin and active myocardial inflammation at CMR. Although our case has been defined as myocarditis, it presents some unclear aspects due in part to the early non–diagnosis as a complication of ICI therapy. Although cancer patients taking ICI has expanded considerably in recent years, the evidence on cardiovascular complications is scarce and unknown to the clinical cardiologist.
C56 ACCURACY OF TWO–DIMENSIONAL SPECKLE TRACKING PARAMETERS REFLECTING LEFT ATRIAL FUNCTION IN PREDICTING OUTCOME AMONG OUTPATIENTS AFFECTED BY HEART FAILURE
Authors: Diomede N , Diomede D , Terazzi E , Granatiero M , Romano M , Goffredo G , Di Terlizzi V , Correale M , Ieva R , Brunetti N , Iacoviello M
Published: May 2023

Background

The two–dimensional speckle tracking analysis (2D–ST) is a new useful tool in order to evaluate both atrial and ventricular function. Aim of the study. To evaluate the accuracy of the 2D–ST measures reflecting atrial and ventricular function in predicting the outcome among outpatients affected by chronic heart failure (CHF).

Methods

We enrolled 212 outpatients (age 64±13 years, 77% males, mean left ventricular ejection fraction, LVEF, 38±11%, NYHA class 2.4±0.5) affected by CHF in conventional therapy (sacubitril/valsartan or ACE–inhibitors or Angiotensin II receptor blockers in 85%, beta–blockers in 94%, mineralcorticoid receptor antagonists in 74%, diuretics in 72%, SGLT2 inhibitors in 20%). All patients underwent a medical visit, an ECG and an echocardiographic examination. The following 2D–ST parameters reflecting atrial and ventricular function were analyzed: global longitudinal left ventricular strain (LV–GLS, mean –11.4±3.9%), global longitudinal right ventricular strain (RV–GLS, mean –15.2±5.2%), free wall right ventricular longitudinal strain (RV–fwLS, mean –20.2±5.8%); left atrial reservoir (LAr, mean 19±10.8%), conduit (LAcd, mean –10.–8±6.8) and contraction (LAct, mean –8.1±8.2). Moreover, the early diastolic peak at pulsed Doppler (E) and at the level of septal (e’s) and lateral (e’l) mitral annulus by Tissue Doppler Imaging (TDI) were also evaluated. Then the ratio between E and e’s (E/es, mean 13.9±6.4) and between E and the mean of e’s and e’l (E/em, mean 11.1±5.4) were also calculated. Finally, the ratio between LAr and E/es (LAr/Ees, mean 1.98±1.65) and E/em (LAr/Eem, mean 2.51±1.95) were computed. During follow–up the progression of heart failure, defined as heart failure hospitalization or cardiovascular death, were evaluated.

Results

During a mean follow–up of 13±6, 32 patients experienced death (13) and/or hospitalization (25) for heart failure worsening. The table shows the relationship among echocardiographic variables and outcome At Cox univariate regression analysis and the relative C–index. LAR/Ees showed the greater accuracy (C–index) in predicting heart failure progression.

Conclusions

2D–ST is an echocardiographic approach able to more accurately assess both left ventricular and atrial function. In our series, among the 2D–ST parameters, the ratio between LAr and E/es is characterized by the greater accuracy in predicting heart failure progression.
C65 TRANSTYRETIN CARDIAC AMYLOIDOSIS IN THE ELDERLY PATIENT: ALWAYS A WILD TYPE?
Authors: Costantino J , Ajmone F , Ballatore F , Manguso G , Maggio E , Ciaramella P , Alfarano M , Vizza C , Chimenti C
Published: May 2023

Background

Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome.

Methods and results

In our centre, from January to October 2022, 20 patients older than 75 years received a diagnosis of cardiac ATTR (73% male, 27% female, mean age 83±5). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.070± 0.074 ng/mL) and NT–proBNP (1533±1204 pg/ml), with the absence of a monoclonal component in the blood and urine, and myocardial bisphosphonate scintigraphy positive grade 2/3. All patients showed absence of peripheral neuropathy with the presence of carpal tunnel syndrome in 9 cases. Before starting therapy with Tafamidis all patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 3 elderly male patients (15%) the genetic test resulted positive with 3 different mutations of pathogenetic significance (Val50Met; Ile88Leu; Val142Ile). First–degree relatives (10 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 4 (1 male and 3 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. All of these tests were normal and they were included in an annual follow–up protocol at the to identify an early manifestation of the disease.

Conclusions

our experience shows that 15% of patients older than 75 years and diagnosed with cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage can occur.
C85 COFFEE CONSUMPTION RELATES TO A REDUCTION OF VASCULAR AND HEART DAMAGE IN WELL–CONTROLLED HYPERTENSIVES
Authors: Marozzi M , Di Trani M , Vacca A , Zotti F , Rignani F , Gramigna D , Amodio G , Santoro G , De Benedittis L , Schirosi G , Brosolo G , Catena C , Ranieri G , Sechi L , Nazzaro P , Cicco S
Published: May 2023

Aim

Nutritional interventions might prevent hypertension–related organ damage but are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated heart and vascular damage in well–controlled hypertensives according to coffee consumption.

Methods

We evaluated 316 primary hypertensives (150F, 166M, aged 62.22±10.76) evaluated for target organ damage. The number of coffee cups per day was asked during the visit.

Results

The median coffee consumption was 2 cups per day and patients were subdivided into tertiles: Group 1, 0–1 cups 112 patients (57F, 55M; 64.21±10.91 y.), Group 2, 2 cups, 101 patients (53F; 48 M; 61.95±10.10 y.), Group 3, >2 cups, 103 patients (40F; 63M; 60.32±10.95 y.). No differences were seen in BMI, systolic and diastolic BP. Group 1 had a higher left ventricular mass than the other two groups (p= 0.0008 and p=0.019 respectively) while no difference there was between group 2 and 3. Similarly, Group 1 had a significant reduction in E/e’ ratio (p=0.042 and p=0.019, respectively). No significance was found between Group 2 and 3 for left ventricular mass and diastolic function. Group 3 had an increased intima–media thickness (p=0.004 and p=0.005 vs Group 1 and 2, respectively). Prevalence of carotid stenosis was lower in Group 3 (p=0.011 and p=0.039, respectively) and was comparable in Group 1 and 2.

Conclusion

Coffee consumption at least of 2 cups/day may have a role in prevention of heart remodelling and diastolic dysfunction.
C90 THE ROLE OF PREPARTICIPATION SCREENING IN DETECTING SILENT CORONARY ARTERY DISEASE IN MASTER ATHLETES: A WAY TO PREVENT EXERCISE–RELATED ADVERSE CARDIOVASCULAR EVENTS
Authors: Scarfò G , Rizza A , Bollino A , Besola L , Colli A , Franzoni F
Published: May 2023

Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre–existing lesions. However, long–term exercise is frequently associated with adverse cardiovascular events in 35–year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death. The purpose of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes. Between 2018 and 2019, 420 35–year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular risk factors or previous cardiovascular diseases. After a physical examination, all subjects were submitted to spirometry and ECG stress test. The ECG stress test demonstrated signs of myocardial ischemia (ST depression > 1 mm) in 41 subjects; 3 athletes showed a frequency–dependent left bundle–branch block; 24 subjects had exercise–induced premature ventricular complexes during the ECG stress test. These subjects underwent further evaluations (Tc–99 myocardial perfusion SPECT and coronary angio–CT) to detect the presence of perfusion defects or coronary abnormalities: 26 athletes had an important coronary atherosclerosis with significant stenosis in one or more vessels and later subjected to Percutaneous transluminal coronary angioplasty (PTCA) or to coronary artery bypass grafting (CABG). 5 athletes presented a coronary myocardial bridge and 1 subject was demonstrated to have an anomalous origin of the left coronary. Preparticipation screening in 35–year–older athletes was able to detect the presence of obstructive coronary artery disease (CAD) in the 38% of suspected cases and anomalous origin or intramural coronary course in 8,8% of cases that showed electric abnormalities during the stress test. Despite recent conflicting opinions about the scientific value of the preparticipation screening in young athletes, the present study demonstrated that it was fundamental to early detect silent conditions that could predispose master athletes to adverse cardiovascular events.
P50 ODD CONNECTIONS
Authors: Bellin A , Cutolo A , Vio R , Ronco F , Themistoclakis S
Published: May 2023

A 40 yo man was admitted to the ER due to typical oppressive chest pain at rest; he had no previous medical history and he denied any cardiovascular risk factor, including family history of cardiac disease. He was actually a sportsman, practicing martial arts. The basal ECG showed sinus rhythm, and an early repolarization pattern with no pathological features. Physical examination revealed a continuous cardiac murmur (2/6) along the sternal border and no other pathological signs. Three consecutive HsTnI determinations resulted negative. He was evaluated by the cardiologist, and a bedside echocardiogram resulted unremarkable. Due to the typical characteristics of the symptoms, an exercise ECG was performed, and the results were suspicious for inducible ischemia at high workloads. He was then admitted to our Cardiology ward, where he underwent a coronary angiography that showed a really surprising and unexpected anatomy: numerous coronary fistulas arising from various tracts (mid–LAD, intermediate coronary artery, conal branch of RCA, and distal Cx). A CT coronary angiogram was then performed, showing some ectasic vascular malformations between different coronary arteries, between coronaries and the pulmonary artery, and also a vascular anomaly connecting a bronchial artery with the right pulmonary artery. We subsequently performed a full body CT angiogram and a cerebral MR angiography, that excluded the presence of extrathoracic arteriovenous malformations. This case shows an extremely rare coronary congenital anomaly (accounting for 0.08–0.4% of all congenital heart disease), that generally goes underdetected in the first decades of life of these subjects. In this case, the typical anginal symptoms (probably due to coronary “steal” mechanism) arose suspicion that lead to the, albeit least expected, odd diagnosis. The treatment of symptomatic coronary fistulas is percutaneous/surgical closure. The patient was referred to our Tertiary Centre GUCH department, where a multidisciplinary discussion will decide the best therapeutic strategy.
P53 DOUBLE OUTLET RIGHT VENTRICLE IN PATIENT WITH XP11.23 DUPLICATION AND SYNDROMIC PHENOTYPE: BROADENING OF THE CLINICAL SPECTRUM
Authors: Morreale P , Amato S , Mannino P , Sanfilippo M , Comparato C , Scardino G
Published: May 2023

DORV accounts for 2–3% of congenital heart disease (prevalence of 1/10,000). It is a cono–truncal anomaly with variable clinic. In 25–42.5% of cases there are chromosomal anomalies such as trisomy 13, 18, 22q11 microdeletion and possible associated anomalies such as facial and skeletal dysmorphisms, brain anomalies and renal agenesis. duplication Xp11.22–p11.23 was described in 2009 by Giorda and is characterized by intellectual disabilities, speech delay, epilepsy, and EEG abnormalities. We report the case of a patient with dupXp11.23 and major anomalies not reported in the literature. C.B. born from 1st pregnancy at 32+4 w, by cesarean section for fetal bradycardia and polyamnios; At first trimester screening, finding of large ventricular defect and high risk for trisomy 18 and 13. Non–resolving fetal DNA and normal 46XY karyotype. At birth weighing 1750 g, APGAR 1‘:3, 5‘:7,10‘: 8, he was intubated and transferred to intensive care. On physical examination: prominent frontal bumps, facial asymmetry with right hypoplasia, anterior plagiocephaly, microphthalmia, low–set left ear, large both pinnae, macroglossia, hypospadias. He underwent surgery for duodenal atresia and Meckel‘s diverticulum. In the following days poor clinical conditions, poor growth and manifestations of heart decompensation. On auscultation II tone of increased intensity, meso–pulmonary systolic murmur, hepatomegaly. The electrocardiogram showed normal sinus rhythm and signs of left ventricular hypertrophy. On echocardiogram Situs solitus –D loop Levocardia. Patent foramen ovale with middle left–right shunt, dilated left atrium, globular left ventricle, preserved systolic function. Poorly aligned arterial outflows emerging from the right ventricle. Large subpulmonary interventricular defect. Hyperflow flowmetry. Aortic arch dilated in the proximal tract. He therefore started therapy with furosemide. Subsequent monitoring showed poor growth for which cardiac surgery was indicated. This case report contributes to broadening the clinical spectrum of duplication syndrome Xp11.22–p11.23.
P61 VIP–AF. CORRELATION BETWEEN VOLTAGE AND IMPEDANCE MAPPING IN PATIENTS AFFECTED BY ATRIAL FIBRILLATION: A FURTHER STEP TOWARDS SUBSTRATE CHARACTERIZATION
Authors: Ragaini E , Taormina A , Grossi B , Pagani S , Ceriotti C , Poggio L , Valcher S , Stankowski K , Galimberti P , Del Monaco G , Gregusova N , Latini A , Mincione G , Condorelli G , Frontera A
Published: May 2023

Background

Pulmonary veins isolation (PVI) represents the main strategy for paroxysmal atrial fibrillation (AF) treatment. Due to the poor clinical outcomes of PVI in case of non–paroxysmal AF, significant efforts have been made to develop new ablative strategies to modify the atrial substrate. Up to now, in order to characterise atrial substrate, only bipolar voltage maps have been used and impedance mapping has never been evaluated.

Purpose

Our aim is to demonstrate the potential correspondence among atrial wall thickness, bipolar voltage and impedance. Atrial impedance mapping could represent an additional tool for atrial substrate characterization, providing further information on tissue conductive properties and confirming bipolar substrate analysis.

Methods

The study includes the retrospective analysis of 60 electro–anatomical (EA) maps of patients with paroxysmal (40 patients) and persistent (20 patients) AF admitted to our institution for treatment. The clinical procedures have been performed with the support of CARTO3 mapping system. Map points have been collected with Navistar RMT Thermocool ablation catheter in order to enable the evaluation of atrial impedance values. To perform the correspondence analysis between the voltage map and impedance map, the atrial endocardial surface has been divided in six sections. Before ablation, for all patients a computed tomography has been performed in order to evaluate atrial endocardial thickness. Parameters of interest that have been evaluated in this study are EGMs voltage amplitude (mV) and fractionation (> five deflections per signal) and the corresponding impedance value (Ohm) at the considered acquisition point.

Results

In all PAF cases no voltages lower than 0.5 mV have been reported. The corresponding impedance values ranged from 140.6 to 169.9 Ohm, with an average value of 151.5 ± 5.4 Ohm. In PsAF cases, instead, voltage values inferior to 0.05 mV have been reported in the posterior wall, anterior wall and roof in 19/20 patients. In these low voltage areas, long duration fractionated signals have been reported and the average impedance value dropped to 129.1 ± 3.8 Ohm, ranging from 110.2 Ohm to 139.6 Ohm.

Conclusion

Our study supports the association between left atrial thickness, voltage amplitude and impedance values. This allows the correct substrate evaluation in case of uncertain bipolar values thanks to additional information provided by impedance mapping.
P78 PSYCHIATRIC PATHOLOGIES PREVALENCE OF IN TAKOTSUBO SYNDROME
Authors: Cariello F , Bencardino G , Sacra C , Romano A , Trigiani G , Ienco V , Macrì L , Gioia M , Deietti G , Ventura G
Published: May 2023

Background

Tako Tsubo syndrome (TTS) is characterized by transient alterations of ventricular kinetics (ATC) in the absence of obstructive epicardial coronary artery disease.

Materials

39 cases of TTS that came to our observation from 2005 to 2019 are described, the diagnosis was made on the basis of evidence of ATC, ECG alterations, increase necrosis markers in the absence of obstructive coronary disease, excluding myocarditis.

Results

39 patients (PZ) (35 females and 4 males) diagnosed with TTS had an average age of 61 ± 13.21 years and symptoms at onset were mainly angina in 28 PZs (72%), dyspnea was present in 8 (20%) and syncope in 3 (8%). ECG changes were characterized by ST depression and/or negative T waves in 30 patients (77%), in 9 (23%) the ST segment was elevated. ATV involved apical segments (SAP) in 27 PZ (69%), 4 (10%) the basal segments (SBA), 2 (5%) the middle segments (SME) and 6 (15%) had focal points abnormalities (FOC). The average Ejection Fraction (FE) on admission was 36.85%, in PZ with ATV of SAP 33.96%, when involved SBA 41%, SME 43.5% and FOC 44.83%. Haemodynamic conditions were stable in 33 pts (84%), 3 pts (8%) presented cardiogenic shock, 3 (8%) pulmonary edema. Arrhythmias were present in 1/3 of the cases. Atrial fibrillation in 38%, extrasystolic arrhythmia in 30%, one patient with sustained ventricular tachycardia, and three patients with total BAV (23%) of which one in shock. In 10% of cases (4 PZ) there was a subvalvular aortic gradient at discharge disappeared. In 8% (3 PZ) was a recurrent TTS. 92% of the PZ reported a psychophysical stress in the 24 hours preceding the event, and a psychiatric pathology was present in 90%. However, only in 60% of cases the psychiatric diagnosis was known on admission, in the remaining 40% the diagnosis was made subsequently, and among the PZ being treated only in ¼ of the cases was it judged adequate.

Conclusions

In our series, SAP involvement was associated with lower EF values and greater hemodynamic compromise. Involvement of SME, SBA or FOC was associated with higher EF values and less hemodynamic compromise. A psychiatric pathology was present in over 90% of the PZ even if in 40% of the cases it was not ascertained at the time of admission, and in 75% of the PZ in which the diagnosis was known, the treatment was not adequate.
P79 MITRAL VALVE ENDOCARDITIS COMPLICATED BY INFERIOR INFARCT AND MULTIPLE DISTAL EMBOLICATIONS
Authors: Ruggiero A , Benvenuto M , Lavorgna A , Palazzolo M , Romano S , Fabiani D
Published: May 2023

A 41–year–old woman with history of drug addiction was ammitted at emergency department (ED) with the following symptoms: hyperpyrexia, shaking chills asthenia and anorexia for about 10 days; the hematochemical tests performed in urgency showed an increasing inflammatory markers and severe anemia. On suspicion of infective endocarditis, a transthoracic echocadiogram was performed which revealed a mobile isoechoic mass adhered to the anterior mitral leaflet (LAM), compatible in the first hypothesis with endocardiac vegetation. Hemocultures were drawn and empiric antibiotic therapy was setted. Following clinical conditions’s worsening, the patient underwent contrast–free total body Computed Tomography (CT) with the detection of multiple pulmonary, splenic and renal septic emboli associated with a cerebral hemorrhagic focus. Transesophageal echocardiography (TEE) confirmed the presence of a 29 mm mobile vegetation on the atrial side of the LAM and the LAM’s perforation at the A3 level with associated severe eccentric regurgitation jet. Therefore, during hospitalization, coronary septic embolization was suspected due to the onset of a severe epigastric pain and the electrocardiographic finding of ST–elevation in the inferior leads associated with troponin’s increase. In consideration of the high bleeding risk and the septic state, conservative therapy was indicated. After a month of targeted antibiotic therapy, once clinical stabilization was obtained, a control TEE was performed and showed the disappearance of the endocardial vegetation and the persistence of the valve flap perforation and the eccentric jet. Once the regression of the septic state, a coronarographic study was performed and it showed no significant stenosis. The patient underwent mitral valve plastic surgery with the direct suture of the LAM and ring implantation in mini–thoracotomy. After a short period in intensive care, she continued her hospitalization in cardiac surgery department without complications. Careful clinical management of the acute phase and antibiotic therapy, empirical and targeted, allowed the patient to undergo cardiac surgery in the best possible conditions, reducing the risk of complications.
P107 EARLY TRANSITION FROM CANGRELOR TO ORAL P2Y12I IS NOT ASSOCIATED WITH INCREASE OF ADVERSE EVENTS
Authors: Rizzo F , Mandurino Mirizzi A , Tondo A , Fischetti D , Quarta L , Corlianò L , Mussardo M , Cafaro A , Germinal F , Picciolo A , Colonna G
Published: May 2023

Intro Cangrelor, an intravenous P2Y12 receptor inhibitor (P2Y12i), characterized by rapid onset and offset of antiplatelet action, is approved by guidelines for patients P2Y12i naïve undergoing percutaneous coronary intervention (PCI). Cangrelor infusion duration and time of transition to oral P2Y12i are still debated, although there is a general indication to an infusion of at least 2 hours. The aim of our study is to evaluate the efficacy and the safety of an early transition to oral P2Y12i strategy.

Methods

Our prospective observational monocentric study enrolled consecutive patients who received Cangrelor during PCI (bolus + infusion iv starting at time of PCI). Clopidogrel and Prasugrel were administered immediately upon discontinuation of Cangrelor infusion, while Ticagrelor was started up to 30 min before Cangrelor was discontinued. Transition was defined as early when Cangrelor infusion duration was less than 2 hours. Endpoints of interest were major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), stroke and target vessel revascularization (TLR) and stent thrombosis (ST). Safety endpoints were bleeding events divided as major events (BARC 3–5) and minor events (BARC 1–2).

Results

133 patients were enrolled: mean age was 69,3±11 years, men were 97 (73%), diabetics 24 (18%). 112 (84%) presented with acute coronary syndrome (tab1). 90% of interventions were done by radial approach, 19% of patients received Clopidogrel as oral P2Y12i. In–hospital MACE were 3, in absence of fatal events; 2 cases of MI (type 4a). The only case of ST was observed with OCT performed during staged PCI of non culprit lesion, with patient totally asymptomatic, without troponin increase and on Clopidogrel as oral P2Y12i. There were 2 BARC 3 events. Patients who received early transition strategy did not presented significant differences of ischemic/bleeding events (tab2).

Conclusions

Cangrelor demonstrated efficacy and safety in patients undergoing PCI. An early transition strategy to oral P2Y12i was not associated with an increase in both efficacy and safety adverse events in this early phase of our study.
P137 STEMI IN YOUNG MAN: A "CHALLENGE" CASE OF SPONTANEOUS CORONARY DISSECTION
Authors: Centola M , De Carlini C , Saltafossi D , Mollichelli N , Moro C , Provenzale G , Loffreno A , Iacuitti G , Giulia B , Russo V , Rogagka R , Spina M , Achilli F
Published: May 2023

A 21–years old male patient presented to the emergency department complaining chest pain in the night. There was no family history of cardiovascular events; he did not have any known risk factors and denied drug abuse. Pathological history was positive for allergic asthma. On admission, he was paucisyntomatic. The physical examination was normal. Blood pressure was slightly elevated. The EKG showed sinus rhythm, ST segment elevation in high lateral leads and reciprocal ST depression in inferior leads. The echocardiogram showed anterolateral and mid–apical septal akinesia of the left ventricle with ejection fraction of 45%. The urgent coronary angiography showed suspected coronary artery dissection of the first diagonal branch with TIMI flow grade 2 and myocardial brigde of the middle segment of the left anterior descending artery (fig.1). An initial conservative management with beta–blockers, dual antiplatelet therapy, statin and ACE–inhibitors was adopted: the patient was asymptomatic and the EKG became normal during the coronary angiography. In addition the young age, the suspicion of Spontaneous Coronary Artery Dissection (SCAD) and TIMI flow grade 2 in the culpit vessel provided support of conservative treatment. The hospital stay was unremarkable. Troponin T peak value was 1542 pg/ml (n.v. < 13 pg/ml). Thrombophilia screening showed mild hyperhomocysteinemia and homozygous MTHFR mutation. Autoimmunity screening was negative. The subsequent echocardiogram showed mid–distal hypokinesia of the anterolateral, inferolateral and anterior wall of the left ventricle with normal ejection fraction. The CT angiography of the cerebral and abdominal vessels was normal. The cardiac magnetic resonance imaging (MRI) confirmed a recent acute myocardial infarction of the mid–apical portions of the anterior and anterolateral wall and normal global contractile function of the left ventricle (fig. 2, 3). At 30 days follow up, the echocardiogram remained unchanged; the coronary AngioCT scan confirmed the dissection of the ostium and proximal section of the first diagonal branch; the cardiac MRI showed transmural fibrosis of the anterolateral wall with normal left ventricular ejection fraction. SCAD is an under–reported pathology. It can lead to acute coronary syndromes and life–threatening consequences. Diagnosis and treatment are still under debate. The presented clinical case, effectively treated with conservative therapy, represented a "challenge" in the acute phase.
P139 RETURN TO THE ORIGINS: WHEN THE THROMBOLYSIS SAVES THE ANGIOPLASTY
Authors: Palazzolo M , Carlà A
Published: May 2023

A 62 year old man arrived in PS for typical chest pain radiating to the jugular and associated with sweating for about three hours. History of arterial hypertension and untreated dyslipidemia, family history of CVD. ECG: sinus rithm at rate of 50 bpm with first degree AVB. Inferior ST elevation in inferior leads and ST depression in V2–V3. Echocardiogram: depressed systolic function (EF 48%) in relation to hypo–akinesia of the mid–basal segments of the inferior–posterior–lateral wall. Diagnosed with STEMI inferior–posterior, was sent to the cath lab to undergo to emergency coronary angiography, with findings of non–significant atheromas on IVA and Cx. Multiple unsuccessful attempts to search for the right coronary artery and failure to visualize the aortography in two complementary projections. During the procedure hemodynamic and electrical instability, worsening angor, marked hypotension and extreme bradycardia up to complete AVB with asystole phases. Inotropics and atropine were started, which proved ineffective, and it was therefore decided to proceed with the implantation of a temporary pacemaker. During the placement, the patient presented cardiac arrest from VF (likely an irritating effect from the passage of the lead through the tricuspid) treated with effective DC–shock. Given the technical difficulties in proceeding with mechanical revascularization and given the patient‘s instability, the decision was made to postpone PCI by attempting systemic thrombolysis. Early efficacy of thrombolysis with disappearance of precordial pain, improvement of echo motion and reduction > 50% of the ST–segment elevation to the rare spontaneous QRS displayed at the transient shutdown of the temporary PM. Subsequent emergence of AF at rate of 116 bpm. Approximately 12 hours after thrombolysis: complete ST resolution in absence of Q waves. AngioTC of the coronaries was performed which showed regularl origin of Cdx from the right coronary sinus but higher up and lateralized to the left, with severe lesion in the first segment. So the patient underwent falicitated PCI with detection of ostio–proximal Cdx thrombotic lesion effectively treated with PTCA and drug–eluting stent placement with good final angiographic result. Control echo: preserved global left ventricular motion (FE 55%), hypokinesia of the basal segment of the inferior wall. The remaining stay decurred without any complications and the patient was discharged with indications for a close follow–up.
P143 PLATYPNOEA–ORTHODEOXIA: A CASE REPORT OF A RARE SYNDROME
Authors: Fontana A , Occhiuzzi E , Carducci P , Valentini G , Balsano C
Published: May 2023

A 32–year–old non–smoker Asian female was admitted to the Emergency Department San Salvatore Hospital of L‘Aquila experiencing worsening of dyspnea. Three months earlier the patient had undergone left pneumonectomy. An arterial blood gas analysis performed on air reported: pH 7.53, pCO2 23.7 mmHg, pO2 38.7 mmHg, SpO2 80%. Blood tests were within normal limits, except for a moderate increase in D–Dimer. Considering the diagnostic hypothesis of pulmonary embolism, an Angio CT–scan of the chest was performed and showed no radiological characteristics suggesting parenchymal pathology and no evidence of thromboembolic or other vascular pathology. From the accurate clinical evaluation of the patient, a condition of severe platypnoea was evident: supine decubitus was obliged. Together with the above position variations, a strong desaturation was observed, going from almost normal values (94–96% SpO2), to 80–82% SpO2 when she was sitting up in bed. Based on the data above, a right–left shunt condition was assumed, and a transesophageal contrast echocardiogram was requested. The latter demonstrated patency of the foramen ovale. The first description of a condition very similar to platypnoea–orthodeoxia syndrome following pneumonectomy dates to 1956, by Schnabel et al. A recent pubmed database–EMBASE systematic review identified 8 studies concerning ten patients, 6 male/4 female. The mean age was 62 years. All patients underwent resection of the right lung. The time–interval between the operation and the platypnoea–orthodeoxia syndrome (POS) was from 2 days to 3 years. A PFO was present in 90%. Considering the data, our patient shows at least two peculiarities; the first and most relevant is the young age: in fact, there is only one description of POS in a patient of younger age. The second peculiarity is the left localization of the previous pneumonectomy, much rarer in frequency than the contralateral in the known cases. Partial or total pulmonary resection can rarely be followed by the onset of POS. This syndrome can be severely disabling, so physicians must be prepared for its prompt recognition, maintaining a high degree of suspicion.
P152 CORONARY CT ANGIOGRAPHY A NEW PROMISING TOOL IN HEART TRANSPLANTED PATIENTS: FROM CLINICAL AND ECONOMICAL BENEFITS TO CORONARY INFLAMMATION DETECTION
Authors: Cozza E , Dellino C , Savo M , Amato F , De Conti G , Tarantini G , Motta R , Tessari C , Gerosa G , Iliceto S , Pergola V
Published: May 2023

Background

Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits. Purpose: 1) assess the non–inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non–immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary–fat–attenuation–index (pFAI) at CCTA in the progression of CAV.

Methods

179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022.

Results

CCTA and CA showed similar radiation doses (8.47 [1.46–30] versus 8.15 [1.38–87.34]; p=0.796) and rate of complications (0 (0%) vs 3 (3%); p=0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 ± 12.31 hours; p<0.001), lower costs (120 euros versus 2800 euros; p<0.001) and less contrast agent (60.4 ± 8.7 ml versus 95.68 ± 47.6ml; p<0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p=0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p=0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47–45.81; p=0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (>–70.1HU) and the progression of CAV (p=NS).

Conclusions

CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.
P154 HUMAN CORONARY INFLAMMATION AT CORONARY COMPUTED TOMOGRAPHY IN PATIENTS WITH INOCA
Authors: Tuttolomondo D , Gaibazzi N
Published: May 2023

Background

A new imaging metric using coronary computed tomography angiography (CCTA), addressing the peri–coronary adipose tissue (PCAT) computed tomography (CT) attenuation, has been clinically validated. This method provides information regarding coronary inflammation. It is unclear how coronary inflammation affects microvascular function. The non–invasive evaluation of coronary flowvelocity reserve is widely used in clinical practice using Doppler measurement on the left anterior descending coronary artery (CFVR–lad) during stress–echocardiography (SE).We hypothesize that coronary inflammation affects CFVR–lad and, in the absence of overt CAD, they are significantly correlated.

Methods

We evaluated the relationship between coronary inflammation (by PCAT CT attenuation) and coronary microvascular function (by CFVR–lad) in subjects with no or non–obstructive (diameter stenosis <70%) coronary artery disease (CAD).

Results

Two–hundred and two subjects were enrolled in the study. The relationship between PCAT CT attenuation and CFVR–lad show a significant inverse relationship in the entire group of subjects enrolled in the study (r = −0.32, p < 0.001). Correlation between PCAT CT attenuation and CFVR–lad was significant in subjects with no or mild CAD–lad, while this was not the case in subjects with intermediate CAD–lad. The R and R2 were respectively −0.40, −0.16 in subjects without CAD (p < 0.001) and − 0.35 and − 0.12 in subjects with mild CAD–lad (p = 0.001).

Conclusions

The main finding of the current study is the independent relationship between coronarymicrovascular function, by Doppler CFVR–lad during SE, in subjectswithout severely obstructive CAD in the left anterior descending coronary artery, and the level of local coronary inflammation, by PCAT attenuation measurement on CCTA.
P159 A HOSPITAL ON A HUMAN SCALE: THE VIRTUAL HOSPITAL PROJECT
Authors: Benelli E
Published: May 2023

Person–centered care relies on collaboration between professionals, patients and their families to ensure that patients have the education and support they need to make decisions and be active participants in the diagnosis process and care. Designing healthcare around patients‘ preferences and needs can improve patient satisfaction and also prognosis. The Virtual Hospital project developed at the Fondazione Toscana Gabriele Monasterio pursues the goal of person–centered care through an innovative approach. The project also aims to use some of the same tools developed for patients to improve the psycho–physical well–being of healthcare personnel. The project involves the creation of an app for Android devices that provides access to information material relating to the care pathway, the system for making video calls, cultural content or for relaxation and information on the facility. The interface, which was designed to be easily usable even by elderly subjects, currently contains the following icons: "My heart", "My breath", "My path", "My exams", " Video calls”, “My diary”, “Music”, “Visit museums”, “My hospital”. The Virtual Hospital project also envisages the creation of contents relating to pulmonary, cardiac surgery, pediatric cardiological pathologies, the development of applications for visors (“oculus”) and the creation of a Tranquility room, a space where healthcare personnel can regenerate, reduce stress and find greater fulfillment in their work, improving the quality of care provided to the patient.
P175 PARADOXICAL RESPONSE DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY: A CASE REPORT
Authors: Cariello F , Bencardino G , Sacra C , Romano A , Trigiani G , Ienco V , Macrì L , Gioia M , Deietti G , Ventura G
Published: May 2023

Background

Dobutamine Stress Echo (DSE) is a test widely used in the diagnosis of ischemic heart disease. The purpose of the following work is to describe a clinical case with uncommon behaviour. Case Description: 63–year–old female with dyspnoea on mild exertion, and history of NSTEMI–ACS 5 years prior with Coronary Angiography (CA) finding of 3–vessel coronary artery disease, treated with PCI + stent (DES) of right coronary artery (CDX), untreated disease sub–occlusion of the first marginal obtuse (OM1), and chronic occlusion of the anterior interventricular artery (IVA). We decide for DSE. During 20 mcg/kg/min infusion, the patient reported dyspnoea and paradoxical bradycardia (BP) was documented on the ECG, in the absence of ST changes, with the appearance of akinesia of the basal and mid posterolateral segments and worsening of the inferior hypokinesia, present in basal conditions on Echocardiograms (EC). The BP and the alterations of the ventricular motion (VCA) did not respond to the administration of Atropine (1+1 mg) while the administration of 240 mg of Aminophylline (AM) restored the HR and the VCA to baseline values. The CA demonstrated patency of the CDX with the presence of collateral circulation for IVA and occluded OM1.

Discussion

This case is characterized by the presence of a double paradox: the BP and the Atropine–Resistance (AR). BP during DEB, as demonstrated in previous studies, occurred in 8% of cases, with signs of significant coronary artery disease in 57% of cases. The BP is an expression of ischemia only in just over half of the patients, in the rest of the cases it appeared referable to the Bezold–Jarish reflex, a vagal reflex determined by the stimulation of the intracardiac mechanoreceptors. In our case, the presence of AR seems to exclude the possibility that bradycardia is due to this reflex. The appearance of paradoxical bradycardia during DSE is a rare complication and can lead to premature termination of the test with inconclusive results. In our case, the BP and the AR confirm the positivity of the test also in consideration of the response to the AM antagonist of Adenosine, which accumulates during ischemia.

Conclusions

This uncommon response to DSE, where AR and AM response in addition to BP could identify patients with severe coronary artery disease in whom the ischemic response is driven by adenosine accumulation, rather than a vagal reflex responding to atropine administration.