bluuebunny/crossref_metadata_2025 huggingface dataset:
1068 THE IMPACT OF COMMISSURAL ALIGNMENT ON CORONARY ARTERY ACCESS: A META ANALYSIS
Authors: Carabetta Nicole , Boccuto Fabiola , Panuccio Giuseppe , Canino Giovanni , Indolfi Ciro , Rosa Salvatore De
Published: December 2022

Background

The use of TAVR has been spreading out globally due to its favorable safety profile and the excellent efficacy data from randomized controlled trials. With the growing number of treated patients, the attention is rising around specific issues, such as the treatment of intercurrent coronary artery disease. Commissural alignment of transcatheter heart valves (THV) has the potential to reduce the impact of the prosthesis on accessibility of coronary ostia, as misalignment of the neo-commissures could be responsible for partial overlap with coronary artery ostia. However, no definitive evidence is available, despite multiple trials have addressed this issue.

Methods

The aim of this meta-analysis was to investigate the impact of the commissural alignment on coronary filling. We examined the techniques of commissural alignment and their impact on coronary access and coronary overlap. Eligible studies were searched for on Pubmed and SCOPUS and selected using the PRISMA guidelines. The primary endpoint is a composite of severe coronary overlap and failure of transcatheter coronary access. Odds Ratio were used as the metric for comparison between the groups. A random effects meta-analysis was selected as the calculation model.

Results

Six studies with a total of 1213 patients were included in this analysis. Of these patients, 757 patients underwent TAVR with commissural alignment and 456 underwent TAVR without commissural alignment. The composite endpoint of coronary overlap and failure of coronary access occurred in 118 patients undergoing TAVR with commissural alignment and in 124 patients without commissural alignment (OR=0.20, 95% CI 0.08-0.48; p= 0.0003).

Conclusions

Commissural alignment was associated with significantly lower rates of commissure-to-coronary-ostia overlap and failure of coronary access. Therefore, a modified insertion technique could reduce coronary overlap and coronary occlusion, particularly in supra-annular valves. Commissural alignment performed during TAVR could therefore have an important role in coronary re-access and re-intervention especially in younger patients.
683 TWO IS BETTER THAN ONE!
Authors: Circhetta Simone , Ricottini Elisabetta , Nusca Annunziata , Melfi Rosetta , Mangiacapra Fabio , Gallo Paolo , Cocco Nino , Rinaldi Raffaele , Cammalleri Valeria , Bernardini Federico , Nobile Edoardo , Filippis Aurelio De , Viscusi Michele Mattia , Grigioni Francesco , Paolo Ussia Gian
Published: December 2022

Patients suffering from atrial fibrillation (AF) and severe aortic stenosis thus undergoing transcatheter aortic valve implantation (TAVI) have a worse prognosis than those in sinus rhythm. One of the reasons of this is related to the augmented bleeding risk associated with oral anticoagulation (OAC). Left atrial appendage occlusion (LAAO) represents a therapeutic choice to avoid this drug intake and to reduce this kind of adverse outcome. So, a combined procedure of TAVI and LAAO could be an option for TAVI candidates with AF to omit the need for OAC.

The clinical case concerns an 85-year-old man with hypertension and dyslipidemia with a history of recent syncope and permanent atrial fibrillation in therapy with antithrombotic drug. Brain MRI performed during hospitalization showed numerous hemosiderin deposits with microhemorrhagic foci thus contraindicating oral anticoagulation. Severe aortic stenosis has also been found to the transthoracic echocardiogram with a mean gradient of 35 mmHg and confirmed by transesophageal echocardiogram with a planimetric area of 0.8 sq.cm.

Furthermore, given the finding of significative left circumflex artery disease, after Heart Team discussion and the execution of CT scan that demonstrated the feasibility of transcatheter approach, it was decided to perform in a single session percutaneous coronary intervention (PCI) plus TAVI plus left atrial appendage closure (LAAO).

This kind of approach allowed a quick recovery to the patient after a short period of hospitalization. After six months from interventional procedure his NYHA (New York Heart Association Functional Classification) status improved abutting on I/II class.

As described above, it can be deduced that combined approach (TAVI+LAAO) is feasible for certain kind of patients thus avoiding surgical approach and long hospitalization. Furthermore, multimodality imaging is of critical importance to plan a complex procedure and an accurate step-by-step pre-procedural strategical planning is the key for procedural success.
273 CORONARY ARTERIES ANEURYSMS: CASE-BASED DISCUSSION
Authors: Di Caccamo Leandro , Vadalá Giuseppe , Alaimo Chiara , Di Fazio Luca , Ferraiuoli Giovanni , Buccheri Giancarlo , Sucato Vincenzo , Corrado Egle , Novo Giuseppina , Galassi Alfredo Ruggero
Published: December 2022

Coronary artery aneurysm (CAA) is an abnormal dilatation of a coronary artery segment; when its diameter is bigger than 20 mm or it is more than four times bigger as compared to the normal vessel size, the coronary artery aneurysm is defined as Giant. However, there are multiple definition of Giant CAA and miss a standardized classification. The reported prevalence of coronary aneurysms in the population underwent coronary angiography, ranges from 0.3% to 5% and often CAA are found in patient with aneurysms in other sites as ascending or abdominal aorta. In half of the cases an atherosclerotic etiology could be recognized; often CAA is found in the context of acute coronary syndrome. Seldom CAA is found at the autopsy of patient died for sudden cardiac death. Up today very few data exist about CAA management and their prognostic relevance; moreover, CAA treatment is not still clearly codified but rather case-based. Indeed, up today there are not published dedicated studies on which is the best medical therapy in example with antiplatelets or anticoagulant agents rather than an interventional approach, by endovascular or surgical technique. In this review, through two clinical cases, it will be described the current evidence about diagnostic tools and treatment options of CAAs.
1050 ULTRASOUND GUIDED CANNULATION OF FEMORAL ARTERY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Di Costanzo Assunta , Sorrentino Sabato , Panarello Alessandra , Spinali Martina , Bellantoni Antonio , Boccuto Fabiola , Mariani Andrea , Manzo Rachele , Molaro Maddalena Immobile , Polimeni Alberto , Spaccarotella Carmen , Mongiardo Annalisa , Esposito Giovanni , Indolfi Ciro
Published: December 2022

Background

Vascular access complications are a significant source of morbidity and mortality after transcatheter aortic valve replacement (TAVR). Ultrasound-guided cannulation (UGC) of central veins or arteries is a widely used approach for patients undergoing invasive procedures. Whether UGC significantly decreases the risk of vascular access complications also for large-bore access procedures, such as TAVR, lacks evidence

Objectives

in this study, we aimed to evaluate the benefits of routine use of UGC in patients undergoing TAVR.

Methods

Data were retrospectively collected from two high-volume TAVR centers from September 2009 to March 2022. UGC was performed using a two-dimensional ultrasound short-axis views, while manual palpation, fluoroscopy, or contralateral angiography were used for the other patients. The odds ratio (OR) for vascular complications was calculated using a multivariate logistic regression model including as dependent variables all relevant baseline and procedural characteristics (forward stepwise selection process). Vascular complications were adjudicated according to the Valve Academic Research Consortium definitions 3.

Results

Out of 874 patients included in the study, UGC access was performed in 177 subjects. Overall mean age was 80.2±5.8 years old, 60% of patients were females, 35.5% had diabetes, 61.4% had dyslipidemia, and 27.8% had chronic kidney disease, with a mean left ventricular ejection fraction of 52.7±9.7%. Looking at the procedural variables Euroscore II was 5.8±5.4, second and third valves generation have been used in 85% of the cases, while suture-based closure devices in 84% of subjects. After adjustment for clinical and procedural variables, routinely use of UGC was associated with a lower rate of total [Odds Ratio (OR): 0.38; 95% confidence interval (CI) 0.15% to 0.95%)] and major vascular complications [Odds Ratio (OR): 0.21; 95% confidence interval (CI) 0.05% to 0.75%)], while no differences were observed for minor vascular complications.

Conclusions

Routinely use of UGC significantly decreases the risk of vascular complications in patients undergoing TAVR. However, a dedicated randomized clinical trial assessing the safety and efficacy of this approach is warranted to confirm our results in this high-risk population.
457 CORONARY ROTATIONAL ATHERECTOMY AFTER TAVI: A PROCEDURAL CHALLENGE
Authors: Motta Silvia Crescenzia , Scalia Lorenzo , Barbanti Marco , Tamburino Corrado
Published: December 2022

Background

Selective cannulation must be ensured especially in patient with coronary artery disease (CAD). Commissural alignment in self-expanding transcatheter heart valve (THV) is fundamental to facilitate subsequent coronary reaccess.

Clinical Scenario

A man of 84 years old, suffering from hypertension, dyslipidemia, diabetes mellitus, third stage of chronic kidney disease and obesity was admitted in our hospital for treatment. He had angina and dyspnea with a third NYHA class. The echocardiogram showed severer aortic stenosis with mean gradient of 48 mmHg and aortic valve area of 0.6cmq with preserved ejection fraction. He was eligible for transfemoral transcatheter aortic valve implantation (TAVI) and he had intermediate risk score. The preprocedural coronary angiogram revealed subocclusive and severe calcified lesion on mid circumflex artery.

Methods

The Acurate NEO 2 size L THV was chosen and was planned to implant the bioprosthesis with commissural orientation correlated to the native commeasures, selecting at the CT scan the projection of cusp overlap (right and left coronary cusp on the right of the screen). The delivery catheter was inserted into the introducer sheath with its flush port facing the six o’clock position and the after crossing the aortic arch and native annulus, the handle of the delivery catheter was torqued clockwise until 1 of the Acurate NEO 2 commissural posts faced the commissural of the aortic root. The final angiogram showed optimal position and orientation of the THV without paravalvular leak. The patient was discharged the next day with a mean gradient of 9mmHg. One month after TAVI, elective PCI was performed. We’ve prepared the lesion with rotational atherectomy, due to severe calcification. Three forward advancements of rotating abrasive burr was performed and subsequently one DES was implanted. The angiogram check showed excellent result with TIMI 3 flow.

Conclusion

The Acurate Neo 2 supra-annular valve platform provides a successful coronary cannulation. Coronary rotational atherectomy for severe calcified lesions after TAVI with Acurate Neo 2 is a feasible strategy
659 LEFT ATRIAL MYXOMA IN A PATIENT PRESENTING WITH ACUTE CORONARY SYNDROME: IS EMBOLISM THE PATHOPHYSIOLOGICAL MECHANISM?
Authors: Oliva Carlo-agostino , Falcone Stefania , Morello Matteo , Ghiringhelli Sergio , Provasoli Stefano , Tamborini Claudio , De Ponti Roberto
Published: December 2022

Background

Cardiac myxomas, though uncommon, do represent the most frequent primary cardiac neoplasms in human beings. Their clinical presentation is mainly due to flow obstruction, cytokines hyperincretion or embolism. Coronary embolism related to the tumor is a rare finding. Here we describe the case of a left atrial cardiac myxoma with an acute coronary syndrome presentation.

Case presentation

A 71 year-old woman referred for chest pain, nausea and vomit. On the previous few months she had developed exertional dyspnea and fatigue. No prior history of cardiovascular diseases was reported. The 12-lead ECG showed no significant alterations. Troponin T values were elevated (224 ng/L, normal assay threshold <14 ng/L). Transthoracic echocardiogram displayed left apical akynesia and a bulky left atrial mass protruding through the mitral valve in systole. Coronary angiography showed complete distal occlusion of the left anterior descending (LAD) coronary artery. Thromboaspiration allowed for the retrieval of small-sized non-thrombotic material in the culprit vessel, without angiographic signs of atherosclerotic disease, thus hinting at the embolic nature of LAD occlusion. The patient was then referred to the surgical theatre for removal of the atrial mass, which showed a 4.3×3.4×3.2 cm translucid, lobulated and gelatinous neoformation attached to the interatrial septum via a 1.5×1.2 cm stalk. The mass was surgically removed and the interatrial septum was repaired with a pericardium patch. Hystology was consistent with left atrial myxoma. The hospitalization course was uneventful.

Conclusion

We reported a case of acute coronary syndrome due to left atrial myxoma. Coronary embolization induced by a cardiac myxoma is rare; however, it should be suspected in patients presenting with myocardial infarction without adjunctive coronary risk factors.
26 CORONARY MICROVASCULAR DYSFUNCTION: IT COULD BE (ALSO) A MAN'S WORLD!
Authors: Persampieri Simone , Baluci Martino , Schaffer Alon , De Martino Leonardo , De Pace Doranna , Lupi Alessandro
Published: December 2022

Introduction

Coronary microvascular dysfunction (CMD) is one of the possible manifestation of ischaemic heart disease with signs and symptoms of myocardial ischaemia, but no obstructive coronary artery disease (CAD). CMD is defined by an impaired coronary flow reserve owing to functional and/or structural abnormalities of the microcirculation and it is associated with adverse cardiovascular prognosis. Women are known to be more likely than men to have angina in the absence of obstructive CAD and CMD has been proposed as one of the major reasons for this presentation. However, also in men, CMD should be recognized, in order to give the best treatment to relieve symptoms and improve patient prognosis.

Index of microvascular resistance (IMR) and coronary flow reserve (CFR) are needed to diagnose CMD and are now easily obtained with pressure wires measurement.

Methods

Since the adoption in our Cath Lab of the PressureWire™ X Guidewire with the Coroventis CoroFlow Cardiovascular System (Abbott) we started to study IMR and CFR in patients with no obstructive CAD and typical angina. No acute coronary syndromes have been studied in our Cath Lab so far. In this brief study we report a descriptive analysis of the first patients studied and of the first period of follow-up, focusing on men.

Results

From January 2022 (date when we received the new software) to April 2022 we studied 24 patients and 8 (33%) were men. Among men, mean age was 58±5 yo and two have been already treated with PCI during the previous 6 months. Mean ejection fraction was 57±2% and mean GFR was 76±20 ml/min/mq. 7 out of 8 patients were affected by dyslipidemia, 5 were smoker, 50% were affected by arterial hypertension and only 1 by diabetes. Mean RFR and FFR in left anterior descending artery were 0.92±0.02 and 0.92±0.03, respectively. In 6/8 (75%) patients IMR derived was >25 and, among them 4 (66%) had CFR<2. After coronary study we tried to optimize medical therapy in all these patients, adding or changing to Zofenopril previous ACE inhibitor therapy, adding or titrating Ranolazine and adding or titrating negative chronotropic therapy (beta blockers or calcium channel blockers). After therapy optimization none of the patients had resumption of symptoms (follow-up from 3 to 7 months).

Conclusions

Even if historically considered a women's disease, we should remember that CMD also affects men. New widespread technologies should be used systematically to rule out CMD and to define patients’ symptoms mechanisms. This would lead to targeted therapy that could improve patient's lives.
47 UNDER THE BRIDGE: OFF-LABEL CANGRELOR FOR PCI PATIENTS UNDERGOING NON CARDIAC SURGERY
Authors: Scalia Lorenzo , Calderone Dario , Agnello Federica , Legnazzi Marco , Mauro Maria Sara , Capranzano Piera , Greco Antonio , Capodanno Davide , Tamburino Corrado
Published: December 2022

Background

Dual antiplatelet therapy (DAPT) reduces the risk of stent thrombosis after percutaneous intervention (PCI), but it is estimated that approximately 5 to 10% of PCI patients undergo major noncardiac surgeries within 12 months from the procedure, which requires DAPT interruption. The interruption of DAPT reduces the risk of perioperative bleeding, but increases the risk of stent thrombosis. Peri-operative “bridge” therapy with cangrelor, a reversible and competitive intravenous P2Y12 receptor inhibitor with rapid on/offset of action, may offer a solution for high-risk patients undergoing major noncardiac surgery who require DAPT interruption. However, the use of cangrelor for this indication is currently off-label.

Clinical Scenario

A 58-year-old man was admitted to ER with increasing dyspnea and oppressive chest pain on exertion. A diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was made and PCI of the left main-left anterior descendent artery segment and the right coronary artery was performed with implantation of four drug-eluting stents. DAPT was prescribed for 12 months with acetylsalicylic acid 100 mg daily and ticagrelor 90 mg twice daily. The day after the procedure, due to gross hematuria with clots formation; the hemoglobin level fell to 8 g/dL and a transfusion was required. Subsequent abdominal echocardiography revealed two bladder neoformations that required further endoscopic evaluation and transurethral resection of bladder tumor (TURBT). In preparation for such invasive procedure, DAPT required interruption despite the high risk of catastrophic consequences.

Methods

After ticagrelor interruption, cangrelor was started intravenously at a rate of 0.6 mcg/Kg/min for 5 days and stopped 2 hours before the TURBT procedure, which was performed with minimal blood loss and no ischemic complications. Cangrelor infusion was re-started 2 hours after surgery at the same initial rate and planned for 12 hours if no sudden bleeding occurred. The day after the TURBT procedure cangrelor was stopped and DAPT was re-initiated with aspirin 100 mg daily and clopidogrel 75 mg daily (after a 600 mg loading dose). The patient was discharged 2 days later without any new bleeding or ischemic event.

Conclusions

Premature discontinuation of DAPT is a strong predictor of stent thrombosis in patients undergoing PCI who require major noncardiac surgery. Cangrelor represents a viable option for managing high-risk individuals who require prolonged P2Y12 receptor blockade with rapid onset and offset of action despite discontinuation of oral therapy. This use is currently off-label due to lack of well powered randomized clinical trials of bridge therapy.
122 A SWORD IN THE STONE - A STEMI AFTER MIAVR
Authors: Scalia Lorenzo , Francaviglia Bruno , Calderone Dario , Mauro Maria Sara , Capodanno Davide , Capranzano Piera , Tamburino Corrado
Published: December 2022

Background

Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions (mini-sternotomy and right anterior mini-thoracotomy approaches) and minimized degree of surgical intrusiveness. Compared with conventional surgery, it has been shown to reduce postoperative mortality, providing faster and shorter recovery, requires less rehabilitations resources and consequently cost reduction. Even though MIAVR has considered as a safe and acceptable surgical technique, higher learning curve and requirement for re-training should be endorsed as procedural limitations. Among procedural related complications, embolic events still remain the most serious.

Clinical case

A 70-year-old man, due to increasing dyspnea and chest pain came to emergency department. His medical history was notable for cigarettes smoke, dyslipidemia, non insuline dependent type 2 diabetes mellitus and hypertension. No abnormal electrocardiografic alterations. A transtoracic echocardiogram was performed showing, Left ventricular ejection fraction 50%, no wall motion abnormalities and thickened, ipomobil and calcified aortic valve cusps assessing a diagnosis of severe aortic stenosis. He was conducted to the cath-lab for a diagnostic coronary angiogram which showed a no-significant atherosclerotic disease. After Heart Team evaluation, MIAVR was the suitable and optimal management indicated for the patient.

Four hours after ending surgical procedure, ST segment elevation suddenly appears on DII, DIII and aVF leads. Emergency coronary angiogram showed an acute occlusion of the proximal circumflex artery.

After several unsuccessful attempts to cross the occlusion with different types of workhorse guidewires, we considered the cause of uncrossability was not a thrombus but a debris calcium embolus detached from valve apparatus.

After failed attempts using FineCross, SuperCross 90° provided adequate support to gaining access and enhancing the penetrating power of guidewire; we put the guidewire distally through the Mo2 with partial flow regain. Then we proceeded to modify the plaque geometry with a NC balloon to help crossing guidewire through distal Cx. So we’ve passed over the lesion gaining Cx periphery with a Fielder XT guidewire and we’ve proceeded to prepare the lesion thorugh progressive NC balloon dilatations. At the end we’ve implanted a 3.5/15 mm DES on mid Cx.

Conclusion

As MIAVR has being more common in the last twenty years, it is useful knowing how to manage any possible related peri-operative complications. Calcific valve is a very uncommon source of coronary debirs embolization. Coronary embolism is associated to worse outcomes: early diagnosis and revascularization must be required. Knowledge of CTO techniques and materials (guidewires, microcatheters) for a “non-CTO” dedicated operators could be useful in several scenarios, such as that encountered in the present case.
759 LEFT MAIN PERCUTANEOUS OR SURGICAL REVASCULARIZATION AND SUBSEQUENT RISK OF ACUTE KIDNEY INJURY: INSIGHTS FROM THE LUCKY REGISTRY
Authors: Terzi Riccardo , Chiarito Mauro , Oliva Angelo , Iaccarino Alessandra , Novelli Laura , Carnabuci Anna Giuli , Regazzoli Damiano , Mangieri Antonio , Sticchi Alessandro , Ferrante Giuseppe , Sturla Matteo , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Condorelli Gianluigi , Barbone Alessandro , Torracca Lucia , Reimers Bernhard , Mehran Roxana , Stefanini Giulio G
Published: December 2022

Background

Recent evidence has rendered percutaneous coronary intervention (PCI) a valuable alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Nevertheless, the optimal management and patients selection is still subject to discussion

Methods

We retrospectively included 431 patients treated with PCI and 324 patients treated with CABG with the primary objective of comparing procedural failure according to revascularization strategy. Secondary endpoints were post procedural and clinically relevant myocardial infarction, in-hospital stroke, major bleeding defined according to the Bleeding Academic Research Consortium (BARC) criteria, death, and 1-year major adverse cardiac events (MACE).

Results

There was no observed difference in the rates of procedure failure in patients who received PCI compared to patients who received CABG (4.6% vs 3.7%, respectively) odds ratio [OR] 1.26; (95% confidence intervals [CI] 0.58-2.9, p= 0.52.) There was no significant difference in the defined ischemic outcome for PCI vs CABG (0.9% vs 2.4%, respectively) OR 0.37; (95% CI 0.08-1.4), P = 0.09. There was a mild increase in periprocedural myocardial infarction (MI) after PCI (4.2% vs 1.5%) compared to CABG; (OR = 2.8; 95% CI 0.99-9.8, P = 0.034). On the contrary there was a higher risk of major bleeding and transfusions in the patients who had been treated with CABG who has a clinical profile suited for PCI.

Conclusions

PCI did not significantly increase the risk for procedural failure or ischemic events compared to CABG in patients with LM CAD. The higher risk for post-procedural MI after PCI was offset by a higher risk for major bleeding events and transfusion requirements in those undergoing CABG, especially for those who were clinically suited for PCI.
760 IMPACT OF COMORBIDITIES AND PATIENTS PREFERENCE ON THE CHOICE BETWEEN PERCUTANEOUS OR SURGICAL REVASCULARIZATION FOR LEFT MAIN CORONARY ARTERY DISEASE
Authors: Chiarito Mauro , Oliva Angelo , Novelli Laura , Terzi Riccardo , Sturla Matteo , Lacevic Emir , Carnabuci Anna Giulia , Regazzoli Damiano , Mangieri Antonio , Sticchi Alessandro , Ferrante Giuseppe , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Mehran Roxana , Torracca Lucia , Condorelli Gianluigi , Reimers Bernhard , Stefanini Giulio G
Published: December 2022

Background

Recent evidence has rendered percutaneous coronary intervention (PCI) a valuable alternative to coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). Nevertheless, the optimal management and patients selection is still subject to discussion

Methods

We retrospectively included 431 patients treated with PCI and 324 patients treated with CABG with the primary objective of comparing procedural failure according to revascularization strategy. Secondary endpoints were post procedural and clinically relevant myocardial infarction, in-hospital stroke, major bleeding defined according to the Bleeding Academic Research Consortium (BARC) criteria, death, and 1-year major adverse cardiac events (MACE).

Results

There was no observed difference in the rates of procedure failure in patients who received PCI compared to patients who received CABG (4.6% vs 3.7%, respectively) odds ratio [OR] 1.26; (95% confidence intervals [CI] 0.58-2.9, p= 0.52.) There was no significant difference in the defined ischemic outcome for PCI vs CABG (0.9% vs 2.4%, respectively) OR 0.37; (95% CI 0.08-1.4), P = 0.09. There was a mild increase in periprocedural myocardial infarction (MI) after PCI (4.2% vs 1.5%) compared to CABG; (OR = 2.8; 95% CI 0.99-9.8, P = 0.034). On the contrary there was a higher risk of major bleeding and transfusions in the patients who had been treated with CABG who has a clinical profile suited for PCI.

Conclusions

PCI did not significantly increase the risk for procedural failure or ischemic events compared to CABG in patients with LM CAD. The higher risk for post-procedural MI after PCI was offset by a higher risk for major bleeding events and transfusion requirements in those undergoing CABG, especially for those who were clinically suited for PCI.
2 ABSENCE OF MAJOR CARDIOVASCULAR EVENT IN A GROUP OF PATIENTS FOLLOWED FOR MORE THAN ONE YEAR AFTER SEVERE COVID-19 PNEUMONIAE
Authors: Salvotti Francesca , Tosoni Federico , Borghi Erika , Fusco Elena Maria , Volpe Pietro , Zanotti Eros , Scipione Vittorio , Flamminio Gigliola , Pastori Antonella , Pedroni Leonardo , Napoli Federico , Santagiuliana Marzia , Turini Daniele , Leidi Francesca , Manzoni Francesca , Saottini Michele , Geroldi Veronica , De Ciuceis Carolina , Rosei Claudia Agabiti , Rizzoni Damiano , Boari Gianluca E m
Published: December 2022

Introduction

The Coronavirus disease 2019 (COVID-19), doesn't affect only respiratory system, but it also involves other organs including cardiovascular system, possibly causing acute or chronic cardiovascular events. Preexisting cardiovascular diseases enhance COVID-19 morbidity, as well.

Aim

In this retrospective analysis we investigated the onset of cardiovascular events during a time-span of more than one year since hospitalization (384 days).

Methods

The analysis included 43 patients, who were hospitalized in Internal Medicine Department of Montichiari Hospital (ASST Spedali Civili of Brescia) for moderate to severe SARS-CoV2 related pneumonia treated with high-flow oxygen support (ranging from 40% fraction of inspired oxygen to non-invasive ventilation)

Mean age was 63 years, 28% (12/43) were female and 72% (31/43) were male. Thirty-five percent of the patients suffered from heart diseases, 56% of them were hypertensives and 23% had type 2 diabetes; 12% had chronic kidney disease (CKD) and 5% an active neoplasm. 49% of the sample was obese. Nineteen percent took ACE inhibitors and 19% was on ARBs. Statins were taken by 37% of the patients; an antiaggregant by 21%, and an anticoagulant by 2% (see table)

Results

The follow-up visit included the evaluation of post-covid infection quality-of-life, standard laboratory tests, chest computed tomography, spirometry with evaluation of DLCO. The onset of cardiovascular events during the average period of 384 days was evaluated. None of the 43 patients had major cardiovascular events: coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism.

Conclusions

Even if this study failed to demonstrate new-onset CV events, longer follow-up studies performed to evaluate cardiovascular risk following SARS-CoV1 infection showed persistent hyperlipidemia, cardiovascular system abnormalities, and glucose metabolism disorders in a very high number of patients. Further analyses are needed to further investigate longer term cardiovascular consequences of SARS-CoV2 infection.
293 IMPACT OF FEMALE GENDER ON ACUTE AND MID-TERM MORTALITY IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION DURING THE PANDEMIC ERA
Authors: Barbieri Lucia , Avallone Carlo , D´errico Andrea , Gentile Domitilla , Membo Dagnachew Cigno , Tumminello Gabriele , Carugo Stefano
Published: December 2022

Background

There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. The aim of our study was to evaluate the impact of female gender on acute and mid-term mortality in STEMI patients hospitalized during the pandemic period.

Materials and Methods

Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic. We retrospectively analyzed consecutive STEMI patients hospitalized from 15 March 2020 to 15 March 2021 in our Hub centre in Milan, Lombardy. All clinical, demographic, and procedural characteristics were collected in a dedicated database. Patient follow-up was carried out through clinical visits, telephone calls and remote monitoring through the “Lombardia Regional Registry”.

Results

From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 - 11.2 years vs. 64.7 - 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 _ 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns; 9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory omplications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up.

Conclusions

Our study has shown that female gender in STEMI patients does not represent an independent predictor of mortality both in the short- and in the mid-term follow up. Concomitant COVID-19 infection significantly influenced in-hospital mortality due to the higher rate of respiratory complications in both genders. The impact of COVID-19 on mortality was completely lost at follow-up, where age and a reduced EF remained the only independent predictors, regardless of gender.
382 IMPACT OF AGE ON MORTALITY IN STEMI PATIENTS DURING THE SARS-COV2 PANDEMIC:DATA FROM THE ISACS-STEMI COVID-19 REGISTRY
Authors: Ponti Enrico , Malivojevic Renata , Verdoia Monica , Nardin Matteo , Kedhi Elvin , Suryapranata Harry , Galasso Gennaro , De Luca Giuseppe
Published: December 2022

Background

Several reports have described the negative prognostic impact of ageing in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary angioplasty. During the COVID-19 pandemic, increased mortality was observed in patients admitted for STEMI. However, there are no data on the impact of ageing on the outcome of this high-risk patients during the pandemic.

Objectives

The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 11920 of March until June 30, 2019 and 2020). Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints was 30-day mortality.

Results

Our population is represented by 16083 STEMI patients undergoing mechanical reperfusion, who were divided according to age (< 55 years, n = 4179 (25,98%); 55-65 years, n = 4814 (29,93%); 65-75 years, n = 4016 (24,97%); 75-65 years, n = 2226 (13,84%); >85 years, n = 821 (5,10%). Ageing was linearly and independently associated with in-hospital (figure 1) and 30-day mortality (adjusted p < 0.0001). The COVID pandemic had a significant impact on in-hospital and 30-day mortality (adjusted p < 0.001), that was linearly related to age, particularly for in-hospital mortality (Figure 1).

Conclusions

Our study showed that among STEMI patients undergoing primary angioplasty, age was linearly associated to mortality in both precovid and covid era. The COVID-19 pandemic had a significant impact on mortality, especially in more advanced age.
637 PREVALENCE AND CLINICAL SIGNIFICANCE OF RELATIVE BRADYCARDIA IN COVID-19 INPATIENTS
Authors: Testa Sabrina , Molinari Lorenzo Vilhelm , De Luca Luigi , Pizzoferrato Giovanni , Falasca Katia , Vecchiet Jacopo , Gallina Sabina , Ricci Fabrizio , Renda Giulia
Published: December 2022

Background and aims

Relative Bradycardia (RB) is a poorly understood condition that refers to inappropriately low heart rate response to a given increase in body temperature. Dysfunctional crosstalk between the immune system and the autonomous nervous system has been advocated. It is most often observed in intracellular gram negative and parasitic infections, with a prevalence ranging between 15% and 20%. The aim of this study was to identify the prevalence, clinical determinants and significance of RB in patients hospitalized for SARS-CoV-2 infection and to evaluate its prognostic value for long-covid syndrome during follow-up.

Methods

We enrolled consecutive patients hospitalized for SARS-CoV-2 infection from March 2020 to April 2021. We collected clinical parameters including clinostatic and orthostatic blood pressure (BP) and heart rate (HR) at 1,3 and 5 minutes, oxygen saturation, body temperature (BT), routine blood tests, 12-lead ECG, and 48-h Holter ECG. At follow up, clinical symptoms were investigated by novel Malmo POTS Symptoms (MAPS) questionnaire.

Results

Total population included 269 inpatients (mean age 67±17 years, 59% male).Of these, 30 (11%) presented with sinus bradycardia and 37 (14%) RB. RB was more frequently observed in younger male patients with higher BT and heightened CRP levels. There were no significant correlations between BP and HR orthostatic changes and BR during hospital admission or during follow-up. No clinically relevant arrhythmias were revealed during 48-hour ECG monitoring. After mean16-month follow-up, MAPS score was higher in patients with RB (30±19) compared to those without RB (18±21, p=0.001) during index hospital admission. Dizziness, palpitations and fatigue were more frequently reported in patients with RB(p<0.001).

Conclusions

RB is not an uncommon condition during acute COVID-19. SARS-CoV-2 inpatients who presented RB during index hospitalization showed a higher symptom burden during follow-up, as recorded by MAPS score. Further studies are needed to clarify the clinical significance of RB and its value to predict post-acute sequelae of COVID-19.

Spahic et Al., Malmö POTS symptom score: Assessing symptom burden in postural orthostatic tachycardia syndrome JIM 2022 (in press)
879 STUDY OF ATRIOVENTRICULAR CONDUCTION DEFECTS AND ARRHYTHMIAS IN PATIENTS WITH DILATATIVE CARDIOMIOPATHY CLINICAL PROGNOSTIC VALUE OF THE GENETIC ANALYSIS USING NEXT GENERATION SEQUENCING AT THREE YEARS
Authors: Campisi Mariapaola , Di Bella Gianluca , De Gregorio Cesare , De Sarro Rosalba , Luongo Alfredo , Greco Vittoria , Vacirca Veronica , Luigi Alioto , La Rosa Maria Angela , Magliozzi Monia , Antonio Novelli , Silvana Briguglia
Published: December 2022

Background

Dilated cardiomyopathy is one of the most common cardiomyopathies that at the onset shows a with dysfunction, commonly expressed by the reduced ejection fraction (EF) and which can lead to heart transplantation. Cardiac "laminopathies" are part of the complex set of CMD.

In many cases they show a defect in myocardial electrical conduction. Mutations in the Lamina A / C genes have been associated with high arrhythmic risk and sudden cardiac death. In addition to these, there are others concerning the MYH7, TTN, MYBPC3 genes, related to the CMD phenotype and whose meaning is being defined.

Objectives

The project has the goal of evaluating the association of arrhythmic disorders with possible CMD phenotypes and the genetic mutations described above.

Materials and Methods

We studied 33 out of 100 patients screened for CMD on voluntary availability, suffering from different forms without significant coronary lesions. All of them underwent diagnostic-instrumental checks (ECG, Holter Ecg, echocardiogram and enzymatic profile) and followed for a minimum period of 18 months. At the same time at the ordinary check -up, genetic analyses were carried out through the NGS study of a panel of genes related to CMD in collaboration between the AOU

G. Martino di Messina and the Bambino Gesu’ Hospital in Rome.

Results

On 33 patients undergoing a genetic study, variants of uncertain significance (VUS) were identified: variant c.2359 C> T (p.Arg787Cys) in the MYH7 gene reported in VarSome as probably pathogenetic in a symptomatic patient with endomyocardial biopsy CMD +; the variant c.54016G> T in heterozygosity in the TTN gene, in another case, which at the protein level determines the introduction of the premature stop codon not described in scientific literature and classified according to the ACMG guidelines as a probably pathogenic variant; finally pathogenic variant c.949G> A in heterozygosity in the LMNA gene, in a family with a history of sudden cardiac death with manifest CMD in some members with arrhythmias at follow up (ICD). and the presence of a second mutation; c.836G> C in heterozygosity in the MYBPC3 gene, in other members of the same family with better clinical course.

Conclusions

Our study shows that there are VUS associated with cases of CMD. Within these, the presence of mutations in the lamina gene seem to be more closely related to the incidence of arrhythmias. Therefore, further studies are necessary for a better definition of all possible VUS also to carry out a differential diagnosis in the broad spectrum of cardiomyopathies.
263 GENETIC CAUSES OF CARDIOMYOPATHIES IN CHILDREN
Authors: Girolami Francesca , Gozzini Alessia , Passantino Silvia , Calabri Giovanni Battista , Spaziani Gaia , Porcedda Giulio , Bennati Elena , Favilli Silvia , Olivotto Iacopo
Published: December 2022

Background

The genetic background of paediatric cardiomyopathies is only partially resolved, because of their rarity and heterogeneity. However, the assessment of aetiology is of paramount importance in order to define prognosis and therapeutic choices. Moreover, the recognition of genetic causes is the basis for cascade screening in the family.

Aims

This study aimed to identify the genetic causes of cardiomyopathies in children evaluated and followed at our paediatric hospital.

Methods

A validated Next Generation Sequencing (NGS) target panel was performed in a cohort of 76 paediatric patients: 36 Hypertrophic Cardiomyopathy, (HCM), 24 Dilated Cardiomyopathy (DCM), 3 Restrictive Cardiomyopathy (RCM), 2 Left Ventricular Non Compaction (LVNC), 10 Arrhythmogenic Cardiomyopathy (AC) and one with a cardiac arrest. Genetic counselling was offered to parents. Furthermore, 9 patients with negative genes panel were selected for Whole Exome Sequencing (WES).

Results

By target genes panel analysis we identified a pathogenic or likely pathogenic variant in 32/76 patients (42%). Most genotyped patients had a sarcomeric aetiology and MYH7 (11/32, 34%), MYBPC3 (7/32, 22%) and thin-filaments genes (9/32, 28%) resulted the most mutated genes. 11/32 (34%) patients had a complex genotype. In one patient we found the rare coexistence of two independent monogenic diseases (Osteogenesis Imperfecta and HCM) due respectively to COL1A1 and MYH7 variants. Moreover, we identified five syndromic cases (5/32, 16%): three patients with Noonan Syndrome (one with SOS1 variant and two with PTPN11 variants), one boy with Danon Disease (with LAMP2 variant) and a newborn with Alström Syndrome (due to ALMS1 variants). By WES we identified a de novo variant in FLNC gene in a 7 years old child RCM, a Noonan Syndrome due to biallelic LZTR1 variants in a 9 years old child, two PLEC1 variants in a newborn with DCM and Epidermolysis bullosa, and a de novo NKX2-5 variant in a child with RCM.

Conclusions

A definitive molecular diagnosis could be obtained in a substantial proportion of children (42%). The genetic test results had direct implications for clinical management, to suggest therapeutic interventions. Moreover, predictive genetic testing in family members resulted very important for clinical follow-up and to establish the recurrence risk for subsequent pregnancies.
965 PROGNOSTIC VALUE OF CARDIOPULMONARY EXERCISE TESTING IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS
Authors: Silverii Maria Vittoria , Argiro Alessia , Baldasseroni Samuele , Zampieri Mattia , Fumagalli Carlo , Mazzoni Carlotta , Di Mario Carlo , Perfetto Federico , Fattirolli Francesco , Olivotto Iacopo , Cappelli Francesco
Published: December 2022

Background

ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated.

Methods

In this study 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University hospital, Florence).

Results

Fifty-seven patients (76%) had wild type ATTR. Median age was 80 (75-83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1±4.1 ml/kg/min) and %ppVO2 (68.4±18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12-31) months the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO2 was a stronger predictor for the composite outcome than peak VO2. %ppVO2 and NTproBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO2 was 62% (sensitivity: 71%; specificity: 68%; AUC:0.77, CI: 0.65-0.88). Patients with %ppVO2 ≤ 62%and NTproBNP >3000pg had the worse prognosis with 1- and 2-year survival of 69±9% and 50±10%, respectively.

Conclusions

CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit of targeted therapy.
884 IMPLEMENTATION OF THERAPEUTIC STRATEGIES IN HFREF PATIENTS EQUIPPED WITH A DIGITAL APP
Authors: Augusto Florinda Maria , Curcio Antonio , Volpe Lorenzo , Romano Letizia Rosa , Cardia Giada , Fiore Davide , Malizia Biagio , Indolfi Ciro
Published: December 2022

Background

The comprehensive management of patients affected by heart failure with reduced ejection fraction (HFrEF) should pursue the goals of improving quality of life and reducing hospitalizations. Disease amelioration and cardiovascular mortality reduction are currently obtained by following guidelines-directed medical therapy (GDMT) that includes beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), diuretics and mineralocorticoid receptor antagonists (MRAs); recently, sodium-glucose cotransporter-2 inhibitors (SGLT2Is) have been added on top of previous drugs, but real-world data are yet missing. Whether clinical management of patients affected by HFrEF bearing either implantable cardioverter/defibrillators (ICD) or cardiac resynchronization therapy devices (CRT-D) with a digital application (App) might further reduce hospitalization for HF independently of GDMT yet needs to be addressed.

Materials and methods

From February 2021 to June 2022 a total of 28 patients with HFrEF in GDMT previously undergone ICD/CRT-D implants were remotely monitored at our institution. Patients were instructed to download a dedicated application (MYTRIAGEHF) on their smartphones/tablets. Clinical data were retrieved monthly, through the App, according to data sent from answering to the following questions: i) shortness of breath; ii) feet, legs or ankles swelling; iii) feeling tired; iv) fatigue, lack of energy; v) weight gain in the last 3 days; vi) inconstant intake of diuretic therapy. Medical therapy was optimized accordingly.

Results

Satisfaction and regular use of the app was reported by 18/28 patients; most data came from ICD-implanted subjects (n=12, 75% dual chamber; 25% single chamber), while remaining were CRT-D. Eleven percent of App-users received SGLT2 inhibitors on top of medical therapy. Remarkably, only one patient of the non-App group was treated with SGLT2 inhibitors on top of medical therapy. Remaining non-App users as well as patients not in therapy with SGLT2 inhibitors are lost at follow-up; they presented with ischemic etiology in most cases and significantly reduced ejection fraction compared to App-group.

Conclusion

Our cohort demonstrated that implementing therapy with SGLT2 inhibitors and/or digital applications that follow patients remotely are valuable tools for the optimization of HFrEF clinical condition. Although cause and effect cannot be decisive from this study, the utilization of remote monitoring for therapy adjustments requires further investigation. The use of digital technologies to ensure a more personalized decision-making process will lead better care assistance.