bluuebunny/crossref_metadata_2025 huggingface dataset:
P306 COVID–19 RELATED PERICARDITIS. CLINICAL IMPLICATIONS AND ROLE OF CARDIAC REHABILITATION IN SUBSEQUENT LONG–COVID SYNDROME
Authors: Parato V , Galieni M , Marcelli S , Fioroni A
Published: May 2022

Acute pericarditis is considered one of the cardiovascular complications of COVID–19.

Aim of the Study

The aim was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion in patients with COVID–19.

Methods

The investigation is a retrospective observational study enrolling patients admitted to ICU of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS–Cov2 induced severe acute respiratory syndrome. N.170 patients, admitted from 1st april 2020 to 30th april 2021, were enrolled. All patients presented a variable picture of bilateral ground glass opacifications at HR– Chest CT. Some patients underwent oro–tracheal intubation+invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9–GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients.The diagnosis of acute pericarditis was defined by different degrees of pericardial effusion. All patient were divided in two groups: 1) pericarditis group (A); 2) pericarditis–free group (B).

Results

Of 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67,6 + 13,3 (females: 70,5 + 16,2; males: 66,4 + 11,7). Of 170, n. 60 patients had a diagnosis of acute pericarditis (32,2%) and were included into Group A [age 69,2 + 12,6; 39 (65%) males aged 69,3 + 10,6, 21 (35%) females aged 69,1 + 16,0]. Of 60, only 6 had a pericardial effusion >10 mm (10%); the remaining group A–patients (90%) had a mild pericardial effusion (<10 mm). No patient had tamponade picture. Group B (pericarditis–free) included 110 patients, aged 66,7 + 13,7, 80 (72,7%) males aged 65,0 + 12,1, 30 (27,3%) females aged 71,4 + 16,6. Group A–patients had more days of intubation and a prolonged hospital stay compared with group B, with a significant difference (p < 0.02 and p < 0,03 rispectively). N. 21 of 60 group A patients underwent a 7 weeks of CARDIAC REHABILITATION (CR) because of a LONG–COVID picture. In these patient a 6MWT was performed before and after CR. A significant increase of the walked distance after CR was found (from 352 + 21 to 498 + 31 – p < 0.03 – delta=41%).

Conclusion

Pericarditis is a frequent cardiovascular complication of COVID–19 (32,2% in our study) with clinical and prognostic implications. CR is essential for long–term recovery in these patients.
P310 CARDIAC AMYLOIDOSIS: INITIAL MONOCENTRIC EXPERIENCE
Authors: Magnano R , D‘Alleva A , Di Marco M , Forlani D , Pezzi L , Vitulli P , Fulgenzi F , Verrengia E , Corazzini A , Paloscia L
Published: May 2022

Cardiac amyloidosis is a group of diseases characterized by the accumulation in the interstitial space of amorphous material consisting of amyloid fibrils and, until recently, considered rare, with poor therapeutic prospects and burdened by a poor prognosis. However, both for amyloidosis from immunoglobulin light chains (AL) and for transthyretin amyloidosis in its wild type and mutated forms, there has been a significant increase in diagnostic capabilities. The aim of this work is to show the characteristics found in our population affected by cardiac amyloidosis.

Materials and Methods

We enrolled 18 patients observed over 12 months. The mean age was 63 ± 5, 14 patients were male. 8 patients in NYHA Class I – II, 10 patients in NYHA Class II – III. On the ECG in 88% of cases low QRS voltages in the peripheral leads. Among the conduction disturbances: 1st degree AV block in 45%, EAS in 33%, BBSn in 17%, occurrence of isolated BEV and BESV in 90%; 1 patient presented with AF. Defibrillator was implanted in 3 patients for detection of TVS and TNnS. In the whole population, the echocardiogram showed concentric parietal hypertrophy with a granular sparkling appearance; the mean FE was 55 ± 3%, the diastolic filling pattern was altered in type I in 42%, type II in 33% and type III in 25% of patients, respectively. In 92% of cases the left atrium was dilated. In 87% of cases there was an involvement of the valves in particular in 64% of cases we found calcifications of the aortic valve and in 66% mitral insufficiency. In 42% of patients there was an increase in the thickness of the atrial septum as well as the free wall of the right ventricle. Finally, signs of non–buffering pericardial effusion were found in 33% of patients.

Results

In our study population, 15 patients had multiple myeloma and presented with cardiac AL–type amyloidosis; among these 3 also presented renal involvement. In 3 patients, on the other hand, after positive bone scan and genetic screening, we diagnosed cardiac amyloidosis due to transthyretin mutation for which therapy with Tafamidis was undertaken. 3 patients died.

Conclusions

Our population presented echographic and echocardiographic characteristics comparable to those reported in the literature.
P317 FATAL EVOLUTION IN A YOUNG WOMAN DUE TO AMYLOIDOSIS HEART FAILURE IN A RARE MULTIPLE MYELOMA DISEASE
Authors: Magistro A , Cicco S , Marozzi M , Narcisi V , Carrieri A , Longo S , Giliberti T , Melaccio A , Solimando A , Lauletta G , Vacca A , Ria R
Published: May 2022

Introduction

Immunoglobulin (Ig) D (IgD) monoclonal gammopathy is a rare subtype of multiple myeloma (MM) associated with a worse prognosis. Ig light chains amyloidosis is a disorder characterized by extracellular deposition of Ig light chains in various tissues, leading to organ dysfunction.

Case

A 29–year–old woman was admitted for dyspnea and tachycardia for moderate efforts. Lab revealed hypogammaglobulinemia with a monoclonal IgD K paraprotein. There was an increase in K free chains, with a dramatic increase in K/λ free chains Ratio. Proteinuria was 1360 mg/24h with a free K chains Bence Jones Protein. An increase in values of Troponin–I (137,5 pg/mL) and NT–proBNP (12527 pg/mL) pointed towards heart involvement. Furthermore, the ECG showed low voltages in the peripheral leads. Echocardiogram showed a moderate concentric left ventricular hypertrophy with diffused myocardial speckled pattern, an ejection fraction (EF) of 53% and PAPs of 71 mmHg and pericardial effusion. Chest CT scan showed bilateral pleural effusion. Spine MRI and whole body PET/CT indicated areas of osteolytic lesions. Plasma cells infiltration (85% CD138, MUM1 and K chains positivity) was present at bone marrow biopsy. Amyloid deposition was detected in abdominal fat tissue sample. Total bone scintigraphy excluded a transthyretin heart deposition. Thus, amyloidosis associate to IgD MM was diagnosed. In few days heart failure worsened (hs–cTnI 156,6 pg/mL; NT–proBNP 26583 pg/mL, EF 48%,) and the patient began complaining non–productive cough, dyspnea, and columnar edema of the lower limbs. She was not eligible for bone marrow transplantation, so daratumumab, bortezomib, melphalan and prednisone were administered. Despite serological improvement after a short five days course of therapy, she worsened with a further reduction of EF (35%). Blood gas analysis showed hypoxemia and lactate increase quickly turned into a cardiogenic shock. She died by cardiac arrest, just three weeks after admission.

Discussion

The present case is remarkable for age and gender of the patient as well as the rapid onset and fast worsening of symptoms, which were related to secondary heart amyloid deposition. Symptoms associated to cardiac amyloidosis are expressions of right heart involvement. The early good results of the therapy did not turn the evolution of disease. The fatal and overwhelming progression of the myocardial involvement led to the patient’s death in less than one month.
P319 SOMETHING MORE OF SIMPLE CARDIAC CONDUCTION DISORDERS
Authors: Barbati G , Scodro M , Rossillo A , Caprioglio F
Published: May 2022

Background

Cardiac amyloidosis (CA) is an infiltrative disease caused by extracellular deposition of amyloid fibrils. Possible cardiac manifestations include heart failure with preserved ejection fraction (EF), aortic valve stenosis, microvascular coronary artery disease, atrial fibrillation (AF), ventricular arrhythmias, and cardiac conduction disorders (CCD). We report a case of advanced CCD in a patient first diagnosed with wild–type transthyretin amyloidosis (ATTRwt).

Case Report

An 88–year–old man went to Emergency Room for chest pain with minimal elevation of troponin I and increase in NTproBNP. The patient reported a recent syncope with ribs fractures. The medical history showed hypertension, paroxysmal AF, carotid atherosclerosis, vascular encephalopathy and prostate cancer. Troponin I monitoring showed plateau values and there were no clinical signs of heart failure. ECG showed regular sinus rhythm with marked first degree atrioventricular block, right bundle branch block and left anterior fascicular block (Fig. 1A). Cardiac telemetry recorded brief phases of atrioventricular dissociation (AVD). Transthoracic echocardiography showed severe left ventricular concentric hypertrophy (LVCH) with granular–sparkling appearance and preserved EF, reduced global longitudinal strain with apical sparing (Fig. 1B), mitral–aortic valve degeneration and dilation of the ascending aorta. Given the advanced CCD with AVD and the recent syncope, the patient underwent a dual–chamber pacemaker implantation. In consideration of the echocardiographic suspicion of CA, following Gillmore’s diagnostic algorithm (GDA), serum electrophoresis and assay of serum free light chains were performed and resulted normal, while 99mTc–DPD bone scintigraphy was positive for significant radiotracer cardiac uptake (Perugini grade 3) (Fig. 1C). Based on this result, we carried out the search for transthyretin gene mutations which resulted negative, and therefore the diagnosis of ATTRwt was made.

Discussion

Advanced CCD in patients with transthyretin CA are present in about 9.5% of cases at the time of diagnosis, especially in older patients. It is therefore essential, in case of concomitant LVCH, to suspect the presence of CA as the cause of CCD by searching for the disease red flags and following the GDA to non–invasively confirm or exclude the diagnosis of CA. A correct and timely diagnosis of CA makes it possible to treat the disease and its complications, improving the prognosis.
P320 LEFT DOMINANT ARRHYTHMOGENIC CARDIOMYOPATHY: HOW TO STRATIFY THE ARRHYTHMIC RISK? EARLY ONSET CLINICAL CASE
Authors: Di Domenico A , De Raffele M , De Carolis B , Vitali F , Guardigli G , Balla C
Published: May 2022

Introduction

Arrhythmogenic cardiomyopathy (ACM) is a genetic disease characterized by the progressive replacement of myocardiocytes by fibroadipose tissue that becomes a susbstrate for ventricular arrhythmias with risk of sudden cardiac death. Arrhythmogenic cardiomyopathy can manifest itself through three different phenotypes: the classic phenotype, the most frequent, involving only the right ventricle, the biventricular variant with possible right or left dominance and the rare variant involving only the left ventricle. We present a case of left ventricular arrhythmogenic cardiomyopathy.

Case Report

16–year–old male patient in complete physical well–being, with no significant medical history and a negative family history of heart disease and/or sudden cardiac death (Fig. 1). He practiced competitive sports for years with periodic medical–sports visits. In 2017, ventricular extrasystole was detected on the electrocardiogram, for which he performed cardiological investigations. On electrocardiogram: sinus rhythm with QRS fragmented into DIII and aVL and negative T waves from V4 to V6 (Fig. 2). On transthoracic echocardiography, evidence of normal cavity dimensions, ejection fraction at lower normal limits (42%) and left ventricular trabeculation, in the absence of significant valvulopathy. He then performed a cardiac MRI that showed: left ventricle moderately dilated and hypokinetic with widespread alterations of myocardial signal secondary to fibroadipose replacement phenomena, configuring a picture of left ventricular dilation and dysfunction referable to arrhythmogenic left ventricular cardiomyopathy (Fig. 3). The patient was also subjected to genetic analysis aimed at searching for mutations of genes involved in arrhythmic heart disease, which was negative. In light of the absence of conclusive scientific evidence on the implantation of a defribrillator in primary prevention in clinical–instrumental cases such as the present, the risk of infection and the risk of inappropriate discharges, it was proposed the implantation of a loop–recorder in order to monitor and record any arrhythmic events, starting beta–blocker therapy. The possibility of continuing competitive physical activity was therefore denied.

Conclusions

Currently, guidelines on ACM and diagnostic criteria focus mainly on the right variant, so there are no clear indications to stratify arrhythmic risk in left ventricular ACM.
P327 PULMONARY EMBOLISM FROM RIGHT–SIDED VALVE ENDOCARDITIS REVEALING RECTAL NEOPLAS. A “LUCKY” CASE
Authors: Patrassi L , Marinaccio L , Bracco A , Marchese D
Published: May 2022

We describe a case of a 64–years–old man, outwardly healthy, presented with dyspnoea for 2–3 months and weight loss, coincident Co–Vid. Lung CT scan showed massive PULMONARY EMBOLISM. Echocardiography showed LONE PULMONARY VALVE INFECTIVE ENDOCARDITYS with large mobyle vegetations swinging between RVOT and pulmonary artery. Streptococcus Gallolyticus was identified on blood culture (often related with colorectal neoplasm). Given targeted antibiotic therapy, a surgical opinion was obtained: advised trial of medical management. Patient underwent a colonscopy, because of the causing germ: a neoplasm of rectal posterior side was found, hystological examination revealed an adenocarcinoma. MNR demonstrated a solid rectal lesion protruding in the lumen, infiltrating muscle and adipose tissue, but not pelvic organs. Team discussion with surgeons and oncologists: indication at neoadjuvant therapy before heart valve surgery. After 12 days of antibiotics a new TOE and CT scan were performed and revealed enlargement of valvular vegetations with severe pulmonary regurgitation and also PE warsened. After new surgical opinion, has been given indication of valve replacement. A Magna Ease bioprostetic valve was implanted; the native valve appeared completely destroyed and histological exam showed white fragments including cusps, granulocytes and bacteria, no growth at the culture. No complications obseved in the post operative period, regular echo follow up. The patient underwent neoadjuvant therapy and then surgery to remove the colorectal mass. Lone pulmonary valve infective endocarditis is a rare disease (1–2%), especially without history of immunodeficiency or drug abuse, we should look for a cause of persistent bacteraemia. Bacteraemia is a frequent condition in presence of colorectal neoplasm or IBD, mostly enterococchi or S.Gallolitycus. Septic pulmonary embolism is a frequent complication. Following guidelines, surgery should be considered only if there is no response to antibiotic therapy, extended tricuspid valve vegetations, recurrent pulmonary embolism. Valve vegetations> 10mm are predictor of poor response to ab therapy and pulmonary embolism.
P328 L‘ INSUFFICIENZA RENALE CRONICA NELLA PROGRESSIONE DELLA STENOSI VALVOLARE AORTICA
Authors: Pagliani L , Rattazzi M , Buso R , Rivaben D , Nicolosi E , Di Naro A , Cernetti C , Antonini–canterin F
Published: May 2022

Background

Calcific aortic valve disease (CAVD) is the western world’s leading degenerative valve disease affecting nearly 2% of the general population. Considered for a long time as the result of a passive process, nowadays CAVD is referred as an active process mediated by different cell types and involving several molecular mediators and cellular pathways.

Aim of the Study

The aim of this study was to investigate the role played by renal function during the progression of CAVD. Materials and Methods – We enrolled 116 patients affected by CAVD from the Cardiology departments of the Treviso Hospital and the High Specialization Rehabilitative Hospital of Motta di Livenza (TV). For each patient at the time of the recruitment a clinical visit was carried out that included the collection of anamnestic, anthropometric and echocardiographic data. Blood samples were collected from each subject at the recruitment to measure the following biochemical parameters: creatinine, lipidic profile, phospho–calcium metabolism. The GFR was estimated by using the CKD–EPI 2009 equation. To investigate the predictive role of renal function in the progression of CAVD, only patients (n = 49) with at least two transthoracic echocardiograms (TTE) were selected for the prospective analysis. These patients were followed for an average of 18.9 ± 11 months. The rate of progression of valvular disease was assessed in terms of difference in indexed valve area per month (ΔAVA/month).

Results

We observed that fast progressors had a significant reduction of eGFR at baseline as compared to slow progressors (60.62 ± 18.83 ml/min/1.73m2 vs. 77.22 ± 11.46 ml/min/1.73m2, p = 0.001). An increased risk of rapid progression of valvulopathy was found in patients with eGFR < 60 ml/min/1.73m2 (RR = 2.64, IC95%=1.50–4.60, p = 0.001) compared to subjects with normal renal function. A close to significance correlation was also found between values of circulating Pi and ΔAVA/month (r = –0.252, p = 0.084).

Conclusions

The present study showed that reduction of renal function, and in particular the presence of CKD (eGFR values <60 ml/min/1.73m2), is significantly associated with an increased risk of rapid progression of calcified aortic valvulopathy; this risk is further increased by the concomitant presence of increased levels of phosphatemia. Overall, these data indicate the potential predictive role of eGFR on the risk of accelerated calcific valvulopathy in non–dialysed patients.
P330 A CASE OF SEVERE AORTIC STENOSIS IN A YOUNG PATIENT WITH BICUSPID AORTIC VALVE, FAMILIAL HYPERCHOLESTEROLEMIA AND CALCIFICATION AT THE SINOTUBULAR JUNCTION
Authors: Brusamolino M , Muratori M , Apostolo A , Mapelli M , Bonalumi G , Nanci G , Werba J , Pepi M , Mantegazza V , Calligaris G , Formenti A , Agrifoglio M , Agostoni P
Published: May 2022

Background

Familial hypercholesterolemia (FH) is a disorder characterized by elevated LDL–C and premature vascular calcifications. Aortic stenosis (AS) is the most frequent complication of bicuspid aortic valve (BAV), often requiring aortic valve replacement. Cardiac surgery in patients with severely calcified ascending aorta is challenging.

Case Presentation

A 28 year old male from Albania presented to the ED for dyspnea and low–threshold angina. The patient had family history for CAD and a sister with known FH treated with PCSK9–i. He had BAV, known hypercholesterolemia (max cholesterol 660 mg/dL), treated since 2015 with rosuvastatin plus ezetimibe, with reported irregular intake. He was treated with PCI and bioresorbable vascular scaffold on LAD coronary artery. He underwent surgical removal of limb xanthomas. At admission, the patient was asymptomatic at rest. Cardiac auscultatory findings included an ejection murmur in the aortic area. He presented upper and inferior eyelid xanthelasmas, bilateral calcaneal tendon thickening, elbows and knee xanthoma removal scars. Blood tests were unremarkable, except for lipid profile (LDL–C 443 mg/dL, HDL 36 mg/dL, TG 73 mg/dL). The echocardiography showed BAV, severe AS (Vmax 4,2 m/s, MPG 41 mmHg, AVA 0.46 cm2/m2), EF 60%. A coronary angiography excluded significant stenosis in the epicardial coronary vessels. An aortic CT scan showed sinotubular junction with preserved diameters and severe multiple parietal calcifications, ascending aorta with diffuse atheromatous disease. The patient underwent mechanical aortic valve replacement, ascending aorta thromboendarterectomy, non–coronary sinus enlargement patch, double CABG (SVG–OM, SVG–LAD) due to diffuse hypokinesia of the left ventricle after the interruption of extracorporeal circulation. At a 3–month outpatient re–evaluation, due to the unsatisfactory response to the regular intake of rosuvastatin plus ezetimibe (TC 309 mg/dL, TG 52 mg/dL, HDL 34 mg/dL, LDL–C 264 mg/dL), a PCSK9–i was prescribed. Genetic studies for FH are ongoing.

Discussion

This case underlines the importance of aortic evaluation before aortic valve replacement, even in young FH patients, in which severe aortic calcification can influence surgical approach.

Conclusion

We described the multidisciplinary management of a severe symptomatic AS in a young male with FH and sinotubular junction parietal calcifications, which represented a challenging substrate for valve replacement.
P336 ELECTRONIC HEALTH RECORDS
Authors: Soriente L , Fresa V , Ruberto M , Di Muro M
Published: May 2022

Introduction

The crisis connected with Covid–19 has had strong economic and social repercussions. However, during the state of emergency with restricted access to healthcare, healthcare institutions and users have tested the potential of dematerialization of services thanks to digitalization. The PNRR have maintained in the health sector (Mission6 Health) a fixed point on the horizontal strategic axis of digitalization and innovation, focusing on proximity networks, intermediate structures, telemedicine for territorial health care (Community Homes and Community Hospitals) and on the research and digitalization of the NHS (Electronic Health Record and Essential Levels of Assistance).Our proposal identifies an integrated path that, with the active participation of professionals from the Hospital, the Territory, GPs, social services and families, it allows an appropriate and rapid taking in charge of the patient in hospital discharge

Methods

From the SDO office with the Quany we found some indicators of Intensive Cardiology: average weight of ordinary DRG (1.8vs2), average hospital stay (9.05vs9.42), rotation index of beds (51vs39) and pertinence of hospitalizations for acute care / mean hospitalization (9.48 vs 9.38) respectively of 2019–2020 in order to be able to identify critical issues and solutions in the pathways of the frail and improve performance.We used the BPI technique by implementing the Electronic Medical Record and integrating modules that can facilitate a protected discharge by reducing the fragmentation of assistance between the different healthcare structures.We have evaluated the medical–legal questions and identified indicators (average time between arrival of the request and evaluation by the figures involved in the Protected Discharge, time average between evaluation and admission to RSA / Intermediate Care, number of patients discharged with treatment on territory.

Expected Results

The mapping of the revised process by sharing informations (patient‘s condition and social context), determines the most appropriate post–discharge intervention setting while containing costs.Conclusion The process of taking charge of the territory allowing for benchmarking and control of the quality levels of the care provided.
P338 PERCEPTION OF THE BENEFITS AND LIMITATIONS OF TELEVISIT IN A GROUP OF PATIENTS WITH CHRONIC HEART FAILURE
Authors: Zanocco A , Calamelli S , Berton A , Cattarina M , Milan S , Sacca S
Published: May 2022

Telemedicine (T) has now become an indispensable operational tool for the management of patients with chronic conditions, in particular for patients with chronic heart failure (HF).

The current COVID 19 pandemic has accelerated the development and application oh this method in daily clinical practice. Up to now, the evaluation of he advantage and disadvantage of televisit by cardiological patients have been very limited. In order to assess the satisfaction and criticalities of this method, we administered a satisfaction questionnaire to 74 patients (49 males and 25 females with an average of 75) followed in our clinic. Of the 74 questionnaire administered, 70 were received. When asked whether the inclusion of T had improved the quality of service 43 patients (61%) answered a lot, 24 patients (34%) sufficiently and 3 patients (4%) not at all. When asked if the organization of the T had been adequate, 50 patients (71%) responded adequately, 19 patients (27%) sufficiently adequate and 1 patient (1%) not at all adequate. When asked about the modalities of connection to the T for 54 patients (77%) they were found to be sìmple, for 13 patients (18%) a little complicated and for 3 patients (4%) difficult, very complicated. When asked what would be proposed to improve the service 7 patients (10%) answered the possible extension of hours also in the afternoon, 3 patients (4%) the provision by the ASL of electromedical devices, 14 patients (20%) the ability to directly request an appointment in T and 38 patients (54%) all options. In detail, 1 patient (1%) requested both the extension of the afternoon schedule and the provision of electromedicals, 4 patients (6%) requested both the extension of the afternoon schedule and the direct request for an appointment, 2 patients (2%) required both electromedical equipment and direct request for an appointment, 1 patient (1%) did not indicate any option. Finally, as regards the degree of satisfaction, 45 patients (64%) were considered totally satisfied, 22 patients (31%) partially satisfied and 3 patients (4%) dissatisfied.

Conclusions

The televisit in the setting of patients with chronic HF, despite the limitations of a limited series, was generally well accepted, easy to access and with some useful operational proposal for public administration.
P339 MENAGEMENT OF CARDIOGENIC SHOCK IN A LOW–VOLUME CARDIOLOGY CENTER
Authors: Biscottini E , Andreoli C , Tutarini C , Quintavalle E
Published: May 2022

Cardiogenic shock (CS) is a desaese burdened by high mortality rates, but lower in high–volume cardiology centers. Early diagnosis and intensive treatment are essential for prognosis. In our low–volume center, for menagement of CS, is used a protocol based on arterial blood gas analysis serial monitoring, invasive blood pressure, echocardiographic hemodynamic parameters; underlying acute ischemia revascularisation; non–invasive mechanical ventilation; use of inotropic/vasopressors drugs and eventually circulatory support by aortic counterpulsation (IABP). Starting from hemodynamic characteristics of the patient, clinician is so supported in his choices in order to achieve an adequate peripheral perfusion. In case of failure to reach targets for each parameter, meaning the persistent shock status, the protocol helps to select patients with low probability of cardiac function recovery and those with age, comorbidities and life expectancy, deserving extracorporeal membrane oxygenation as a bridge to recovery, transplant or ventricular assist device at a high–volume center. The management of CS in our low–volume center could benefit of Impella, an advanced circulatory support allowing the left ventricular unloading and a more likely patient stabilization until the transfer to high–volume center. In low–volume centers, IABP often is the only option avaliable in CS not responsive to inotropic and vasopressors drugs. However, at present, little evidence in literature support its use. A promptly stratification of patient severity prevents to underestimate pre–shock signs and avoids delays causing further hemodynamic worsening. We think that is necessary to build a CS network, similar to that for percutaneous treatment of ST–elevation myocardial infarction.
P353 THE “TIMES” IN COVID–TIME: EXPERIENCE OF A CICU “SPOKE”
Authors: Piemonte F , Carraturo A , Cudemo V , Damiano S , De Angelis A , Forte R , Leccia A , Lirato C , Molaro M , Penna G , Petitto M , Puzio E
Published: May 2022

We analyzed data regarding patients hospitalized in the period 03/09/2020–03/09/2021 in the ICU–Cardiology Division of the “San Giovanni di Dio Hospital” of Frattamaggiore (NA), configured as “Spoke” CICu for the AMI Network of the Campania Region, and we compared them with the same parameters of patients hospitalized during 2019. In particular, we analyzed differences in epidemiologic parameters and, in patients hospitalized for acute coronary syndromes, we evaluated the waiting times for hemodynamic procedures. The total number of hospitalized patients decreased by about 25%, while the mean age of patients and the percentage of hemodynamic procedures were comparable. In particular we noted that, while the percentages of patients hospitalized for acute myocardial infarction were similar in COVID and PRE–COVID era, during the pandemic in patients affected by acute myocardial infarction.the percentages of STEMIs were superior to those of NSTEMIs. Finally, we examined door–to–balloon times. In patients affected by STEMI we found that, even during the pandemic, primary angioplasty was performed on average within 100 minutes, meaning that ultra–fast swabs (mandatory before the procedure) did not produce delay. Moreover, in the pandemic period patients with NSTEMI, despite a stay of about 8 hours in ER to obtain the result of the antigenic swab for SARS–COV2, received coronary arteriography in a shorter time than in the pre–pandemic era (52,8 and 62,4 hours respectively). This analysis seems to show that the pandemic has not affected the access and hospitalization times of patients with acute coronary syndrome, and that, although greatest difficulties have arisen, the times of access to hemodynamics have not been affected by COVID.
P360 HYPERTENSION DURING PREGNANCY
Authors: De Maio J , Caputi A , Martelli A , Bagni E
Published: May 2022

Pregnancy is a physiological condition and a delicate period too; that’s why it’s essential to support the woman. It is important to contact the specialists in Gynecology and rely on other specialists to deal with any morbid conditions that arise during gestation. In this regard, heart disease is the main cause of maternal morbidity and mortality in pregnancy. The surveillance of women with cardio–vascular disease must therefore be guided by the so–called “pregnancy heart team”. In particular, arterial hypertension affects 5 to 10% of pregnant women. The cardiovascular risk is continuously increasing. What are the reasons of this? First of all, the increase of the age of the future mothers. Furthermore, the fact that women, like the general population, are increasingly obese, hypertensive and diabetic. Cardiovascular diseases do not represent an absolute contraindication to pregnancy, except in a few cases, in particular, in severe pulmonary hypertension. However, it is essential to follow the patients according to personalized protocols with close collaboration between gynecologist and cardiologist. Our hospital references for the southern area of the province of Modena; in agreement with our gynecologist we saw the opportunity to collaborate even more closely and start a way dedicated to pregnant women. In 2021, about 30 women between 20 and 40 years old were sent to our attention, with predominantly arterial hypertension or notable symptoms. Patients were referred to us and underwent evaluation. We performed 50% EKG and examination, 50% transthoracic echocardiogram, 60% blood pressure Holter, 10% 24 hour Holter EKG. Seventy percent of the patients came from African race and the remaining from Caucasian. There was also a link with the socio–cultural level of the patients, in most cases they were overweight. In the meantime, hygienic–sanitary therapy and, if not sufficient, medical therapy has always been set up. The drug we preferred was Methyldopa under close monitoring for the comforting data from the technical data sheet on its use. To date, there have been no adverse events or complications reported to us. Further studies are needed to evaluate the effectiveness of interventions to reduce both the risk of recurrence of hypertension in future pregnancies and that of long–term cardiovascular complications.
P367 EFFECTS OF BIOARGININA® C SUPPLEMENTATION IN SECONDARY PREVENTION OF POST–COVID 19 HIGH CARDIOVASCULAR RISK PATIENTS
Authors: Ratti G , Di Tommaso C , Monda C , Fulgione C , Martone O , Ratti F , Fulgione L , Tammaro P , Mallardo M
Published: May 2022

Background

Post COVID–19 syndrome is characterized by chronic fatigue, shortness of breath, dry cough, headache, cognitive difficulties. The complexity of the clinical feature can be explained by a pre–existing endothelial dysfunction (particularly in the patient with high cardiovascular risk) exacerbated and/or linked to viral infection. In the cardiorespiratory rehabilitation program (RCR), the introduction of nutritional supports, vitamins and aminoacids, can be considered a useful approach to post–Covid syndrome. There are observations of positive results with the use of association of oral L–arginine + liposomal vitamin C (Bioarginina®C, 1.66g 2 bottles / day).

Aim of the Study

to evaluate the effects of the use of combination of oral L–arginine + liposomal vitamin C (Bioarginina®C, 1.66g 2 bottles/day) on the functional capacity measured with the six minute walking test (6MWT) of subjects during RCR post COVID 19.

Methods

50 patients with high cardiovascular risk (38 M and 12 F), with mean age 58 ± 7 years, (Group A) undergoing integration with two bottles of L arginine and liposomal vitamin C were examined above for 90 days during the RCR cycle. These had been positive to molecular COVID–19 nasopharyngeal swab test for a period ranging from 15 to 30 days. As a control population, the results obtained with standard treatment in 30 patients with high cardiovascular risk (17 M and 13 F) (mean age 61 ± 8 years) (Group B) after RCR post COVID 19 infection, were examined. The ability to perform normal daily activities was analyzed with the six minute walk test (6MWT) which measures the distance that a subject can run on a flat surface, walking as fast as possible in six minutes, including any interruptions that patient deems necessary. The statistical analysis was performed with the Student‘s T test for paired data. A value of p < 0.05 was considered statistical significant.

Results

At 3 months, improvement in 6MWT values was observed in both groups in Group A: 289 ± 96 m vs 419 ± 105 m (p < 0.0001) – Group B: 280 ± 88 m vs 332 ± 98 m (p < 0.021). However in Group A, these was more significant.

Conclusions

Our data confirm the improvement in the physical performance of post COVID 19 patients with introduction of nutritional supports with L–arginine and liposomal vitamin C.
P387 THE PROGNOSTIC ROLE OF ST2L AND SST2 IN PATIENTS WHO UNDERWENT CAROTID PLAQUE ENDATERECTOMY: A FIVE–YEAR FOLLOW–UP STUDY
Authors: Scicchitano P , Marzullo A , Cortese F , Ciccone A , Angiletta D , Pulli R , Massari F , Caldarola P , Ciccone M
Published: May 2022

Background

Soluble suppressor of tumorigenity (sST)–2 plasma concentrations are related to atherosclerosis. The aim of the study was to assess the prognostic impact of sST2 and its membrane–associated form (ST2L) in patients with carotid atherosclerotic plaque who underwent endarterectomy (CEA).

Methods

82 consecutive patients (age range: 48–86 years) who underwent CEA were enrolled. Anthropometric, clinical, instrumental, and laboratory evaluations were gathered. Thirty–seven (45%) patients were symptomatic for cerebrovascular diseases. Patients underwent a five–year follow–up. Phone calls and the analysis of national and regional databases were adopted in order to evaluate the occurrence of the primary outcome (all–cause mortality). The populations was divided according to survival status.

Results

Statins were administered in 81% and 87.5% of survivors and non–survivors, respectively. sST2 levels were higher in non–survivors as compared to survivors (117.0 ± 103.9 vs 38.0 ± 30.0ng/mL, p < 0.001) and in symptomatic individuals as compared to asymptomatic (80.3 ± 92.1 ng/mL vs 45.4 ± 41.4 ng/mL, p = 0.02). ROC curve analysis identified sST2 cut–off: > 98.44 ng/mL as the best predictor for mortality. At one year follow–up, survival rate decreased up to 20% in patients with sST2 higher than the cut–off value. At multivariate regression analysis sST2 (HR: 1.012, 95% CI: 1.008–1.016, p < 0.0001) and triglycerides plasma levels (HR: 1.008, 95% CI: 1.002–1.015, p = 0.0135) remained significantly associated to all–cause death.

Conclusions

sST2 may act as independent prognostic determinant of all–cause mortality and symptomatic cerebrovascular diseases in patients with carotid atherosclerotic plaque who underwent CEA.
P392 A MULTIMODALITY IMAGING DIAGNOSIS OF A CHALLENGING CASE OF CONCOMITANT GROUP 1 PULMONARY HYPERTENSION AND PARADOXICALLY LOW–FLOW, LOW–GRADIENT AORTIC STENOSIS
Authors: Martini M , Zupa F , Mancuso D , Baritussio A , Famoso G , Perazzolo Marra M , Iliceto S , Rigato I
Published: May 2022

A 76 year old woman was admitted to our hospital for self–limiting dyspnoea (NYHA class III) in oxygen dependence and frequent lipothymia following Valsalva manoeuvres. She was previously admitted to a Spoke Centre for heart failure (HF) with preserved ejection fraction (EF) and a new diagnosis of “pre–capillary pulmonary hypertension (PH)”. Despite a diagnosis of PH of unclear aetiology, she was started on macitentan without being reassessed for functional capacity due to Covid emergency; because of worsening symptoms, she was admitted to our Hub Centre. Resting ECG showed right axis deviation, right ventricle (RV) hypertrophy, first–degree atrioventricular block and right bundle branch block. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) volume with preserved EF (diastolic volume= 37 ml, EF = 88%), severe right atrial and RV dilation with flattening of the interventricular septum, estimated pulmonary artery systolic pressure (PASP) of 124 mmHg, and moderate calcific aortic stenosis (peak aortic velocity 3.3 m/s, mean gradient 25 mmHg, valve area 1.1 cm2). Right and left heart catheterization showed severe pre–capillary PH (mean pulmonary pressure 60 mmHg, mean wedge 11 mmHg, pulmonary vascular resistance 14.41 WU), a severe aortic valve stenosis (aortic valve area 0.68 cmq and peak–to–peak gradient 25 mmHg, slight reduction of cardiac index 2.04 l/min/mq) and no significant coronary artery disease. The degree of aortic stenosis was considered as moderate–severe by integrating data of transesophageal echocardiography (planimetric area 1cm2) and assessment of calcium score (1615 Agatson units). Pneumological causes, chronic thromboembolic PH, rheumatologic diseases, HIV infection, paraneoplastic origin and veno–occlusive disease were all ruled out as potential PH causes and a diagnosis of Idiopathic pulmonary arterial hypertension (IPAH) was finally made. The Heart Team established the best therapeutic option was a transcatheter aortic valve replacement (TAVI) allowing better haemodynamic tolerability of PH therapy. The patient underwent TAVI and was started on PH therapy; a complete atrio–ventricular block developed after the procedure, requiring permanent pacemaker (PM) implantation. Unfortunately, few days later, the patient died following pacemaker’s lead dislocation.

Conclusion

PH has a diverse aetiology, and prognosis is generally poor, especially in patients with severe comorbidities.
P398 A CASE OF MIS–C: SARS–COV2 AND MYOCARDITIS IN PEDIATRIC AGE
Authors: Orrù L , Urru M , Stara R , Marini E , Congia M , Scano F , Campagnolo A , Marini A , Montis S , Masnata G , Zanda M , Binaghi G , Cossa S , Mura S , Porcu M , Corda M , Perrotta D , Tumbarello R
Published: May 2022

A 12–year–old patient with paucisymptomatic SARS–COV2 infection in November 2020 with negative swab after 10 days. After 3 weeks access to pediatric emergency room for fever, maculo–papular rash on the trunk, conjunctivitis, nausea and abdominal pain: evidence of thrombocytopenia, increased CPK, LDH, AST and inflammation markers. She starts antibiotic therapy for suspected sepsis. After 24 hours asthenia, general illness, hypotension and tachycardia: echocardium with diffuse hypokinesia of the left ventricle (EF 35%); worsening of thrombocytopenia, D–Dimer, BNP and CPK increase, hyponatremia, troponin positivity, ATIII reduction; negative viral markers. On the basis of the most recent literature, the diagnosis of MIS–C is made, a post–infection SARS–COV2 multisystemic inflammatory syndrome. After discussion with the 3rd level SARS–COV2 Pediatric Center, the following therapy begins: iv diuretic, iv cortisone, sc heparin, iv immunoglobulins, Anakinra. For a progressive clinical worsening by cardiogenic shock with evolution to DIC, she is transferred by military plane to the pediatric intensive care of 3rd level SARS–COV2 Center. The patient is subjected to mechanical ventilation, therapy with inotropes (adrenaline and milrinone) and CRRT ultrafiltration in order to reduce the excessive levels of inflammatory mediators responsible for rapid multiorgan failure. After 4 days, haemodynamic parameters improvement (EF 50%); sartan and low dose diuretic have been started because of the presence of diastolic dysfunction. Discharge after 1 month of hospitalization with good clinical and haemodynamic stability. After 6 months from myocarditis onset with cardiogenic shock in MIS–C, cardiac MRI with evidence of EF 57% and small area of delayed enhancement on the anterior IVS with non–ischemic pattern, no longer present by imaging after 1 year by acute event. Currently the patient reports subjective well–being by the regular follow–up without arrhythmias by Holter monitoring. SARS–COV2 post–infection multisystemic inflammatory syndrome (MIS–C) represents a serious complication with possible myocardial involvement also following a paucysymptomatic infection as in the described case. What happened shows us that SARS–COV2 infection is still a devious clinical entity that needs close follow–up in the short and long term.
P404 CAN THE BASELINE NT–PROBNP LEVEL BE USED AS A PROGNOSTIC MARKER IN PATIENTS HOSPITALIZED FOR COVID–19? A SINGLE CENTRE EXPERIENCE
Authors: Baldin G , Di Maio F , Todde N , Volpi N , Basan L , Vannucci V , Ruzittu G , Pisanu A , Seddone S , Bua A , Delogu G , Favuzzi A , Porcu M
Published: May 2022

Background

NT–proBNP is commonly used a reliable prognostic biomarker in heart failure. Although SARS–CoV–2 is primarily a respiratory virus, it can also cause a myocardial injury. Previous observations indicate that COVID–19 patients can show a pathological rise of NT–proBNP during the disease course.

Aim

To assess the in–hospital prognostic significance of baseline NT–proBNP levels in COVID–19 patients.

Methods

We retrospectively analysed the data of one–hundred and ninety–two consecutive patients (mean age 70±15, 54.6 % males), hospitalized in our institution for COVID–19 disease. Demographic parameters, clinical history, pharmacological treatments and laboratory data at the admission were analysed. According to the baseline NT–proBNP levels, the whole population was divided into normal (Group A) and elevated (Group B) NT–proBNP, considering ≥ 125 pg/mL level as the pathological cut off. The length–of–stay, the orotracheal intubation rate, non–invasive ventilation and in–hospital mortality were taken into account as prognostic parameters.

Results

Forty–seven patients and one–hundred and forty–five patients belonged to Group A and Group B, respectively. Group A patients were significantly younger (57±13 vs 74±13 yrs, p < 0.001), with a lower rate of previous cardiac disease (6.4% vs 39.3%, p < 0.001) and atrial fibrillation (4.3% vs 16.7%, p < 0.033) and a better eGFR (94±20 vs 71±29 ml/m’, p < 0.001). No differences were noted between the two groups in the prevalence of diabetes, hypertension, ACE/ARBs treatment. The length–of–stay was similar (20±13 days in Group A vs 22±19 days in Group B, respectively, p=ns). Although patients of Group B showed a higher rate for orotracheal intubation (4.3% vs 13.8%) and non–invasive ventilation (13.8% vs 32.4%,), these differences were not significantly different. The in–hospital mortality was considerably lower in patients with normal baseline NT–proBNP level, as compared to Group B patients (2.1% vs 23.4% p < 0.001). When stratified by quartiles of NT–proBNP, the subgroups showed a prognosis clearly related to the expression of the biomarker.

Conclusion

In patients hospitalized for COVID–19, normal baseline NT–proBNP level identifies a population with a short–term better outcome. This widely diffuse biomarker could be used in the initial phase of admission as a prognostic tool to characterize the in–hospital prognosis.
P407 WHEN A SUPRA–VENTRICULAR TACHYCARDIA SAVES A LIFE
Authors: Parato V , Molisana M , Parato A , Scarano M
Published: May 2022

The Case

A 76–year–old man came to ER because of palpitations and a worsening chest discomfort. His clinical history included hypertension, dyslipidemia, diabetes and gouth. 12–leads ECG revealed a supraventricular tachycardia with heart rate of 190 bpm. It also demonstrated: widespread deep ST depression involving V2–6, I, II, aVL ST elevation in aVR > V1 (Figure 1). Adenosine (6 mg) intravenous administration led to sinus rhythm restoring with symptoms regression. 12–leads ECG after sinus rhythm restoring demonstrated a ST–T segment normalization (Figure 2). Trans–thoracic echocardiogram, acquired in sinus rhythm, showed a picture of left ventricle systolic dysfunction with ejection fraction of 35% due to a severe hypokinesis of mid–apical wall segments. A moderate mitral regurgitation with central jet was visible. An urgent coronary angiography was performed. It demonstrated a LEFT MAIN CORONARY ARTERY (LMCA) very severe (95%) proximal lesion. Patient was sent to urgent coronary artery bypass grafting (CABG).

Discussion

Widespread ST depression (with reciprocal STE in aVR) is a common finding in patients with supraventricular tachycardias such as AVNRT or atrial flutter. The significance of this finding in individual patients is unclear and may be due to: rate–related ischaemia (O2 demand higher than supply) unmasking of underlying coronary artery disease (i.e. tachycardia as a “stress test”) a pure electrical phenomenon (e.g. the young patient with SVT who is relatively asymptomatic and has normal coronary arteries). In this case, primary ECG pattern and then echocardiographic findings suggested a potentially lethal coronary artery disease which was confirmed by coronary angiography.

Conclusion

Sometime a supraventricular tachycardia may be helpful in order to bring out life–threatening disease.