bluuebunny/crossref_metadata_2025 huggingface dataset:
P311 TAKOTSUBO CARDIOMYOPATHY RELATED TO MRNA SARS–COV2 VACCINE
Authors: Ricci G , Citarelli G , De Laura D , Degennaro L , Ligurgo L , Sassara M , Corriero F , Musci S , Desario P , Rutigliano D , Basso P , Parisi G , Buquicchio F , Conca C , Disabato M , Caldarola P
Published: May 2022

54–year–old woman with a family history of systemic sclerosis, with no significant cardiological history. She underwent anti–Covid vaccination in February and March 2021 with Spikevax (Moderna) and a booster dose (Spikevax) on 09/12/21. A few hours after this last administration, the patient presented with palpitations, asthenia, and intermittent chest tightness. In the following days, because of dyspnea for mild exertion, she went to the emergency department. ECG showed low QRS voltages in the peripheral leads, poor septal r wave growth and negative T waves in inferior leads and from V3 to V6. Echocardiography showed akinesia of apical and middle segments, LVEF 40%, mitral obstructive systolic anterior motion, moderate mitral regurgitation and mild pericardial effusion. In blood tests: increase in myocardiospecific enzymes and NTproBNP, modest increase in indices of inflammation. The patient was admitted to Cardiology Unit, where coronary angiography showed coronary arteries free from stenosing lesions and Takotsubo–like appearance on ventriculography. Cardiac MRI confirmed alterations in parietal kinetics, hyperintensity in the STIR sequences referable to apical and middle segments edema compatible with Takotsubo cardiomyopathy (CMT). Capillaroscopy excluded scleroderma pattern. The patient presented a progressive reduction of troponins and, the echocardiogram before discharge showed improved LV systolic function, regression of mitral obstructive systolic anterior motion with reduction of mitral regurgitation. Rare case reports of CMT after influenza vaccination [1] and a similar case to the one we described after Spikevax vaccine [2] and ChAdOx1 nCov–19 (AstraZeneca) [3] have been presented in the literature. The underlying pathophysiological mechanism appears to be related to a stress–induced systemic reaction with a predominantly adrenergic sympatho–vagal imbalance [4]. In this clinical setting, cardiac MRI can offer added value in the diagnostic process, especially to exclude post–vaccine myocarditis, which in our case seemed unlikely given the immediate onset of symptoms.
P313 TAKOTSUBO SYNDROME – FOCAL VARIANT
Authors: Manca F , Cocco D , Pistis L , Serra E , Loi B , Corda M , Pilleri A
Published: May 2022

Takotsubo syndrome (TTS) is a cardiomyopathy induced by physical and/or emotional stress, characterised by transient changes of the regional motion generally extending beyond the territory distribution of one single coronary vessel. The classic form of TTS presents, in 43.7% of cases, with ST segment elevation and in about 80% with cardiac apical ballooning. In 1.5% of TTS cases, however, regional changes in motion are observed which may mimic an acute coronary syndrome. We describe the case of a 77–year–old woman with hypertension and hypercholesterolemia. The patient came to the ER due to polytrauma secondary to an accidental fall. During hospitalisation, the patient complained of a sudden onset of a retrosternal aching chest pain radiating to the back and right shoulder, associated with neurovegetative symptoms. An electrocardiogram showed a normofrequent sinus rhythm and T–negative waves in the infero–lateral region. Upon cardiology consultation, a transthoracic echocardiogram was performed showing a left ventricle with akinesia of the middle and apical segments of the inferolateral wall with compensatory hyperkinesis of the other segments. When an acute coronary syndrome was suspected, urgent coronary imaging was performed, showing coronary arteries without significant stenosis, while ventriculography confirmed the alterations in ventricular motion. Blood chemistry tests showed a phasic increase in myocardial necrosis enzymes and, in particular, in HS troponin values (max value 2714 ng/L). Therapy with an ace–inhibitor and a beta blocker was introduced; seriate echocardiographic controls showed a progressive normalisation of the alterations in motion. A TTS diagnosis was therefore made, according to InterTAK 2018 diagnostic criteria. This case is of particular interest as it is a prime example of a rare variant of TTS: the clinical presentation, the ECG alterations and the regional akinesia may lead to a clinical suspicion of ACS. A good knowledge of the TTS, including the focal variant, enables the cardiologist to make a correct diagnosis and to initiate suitable therapy.
P315 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN A PATIENT WITH TAKAYASU’S ARTERITIS: THE CORONARY VASOSPASM AS A MISSING LINK BETWEEN THE IMMUNE SYSTEM AND ACUTE PSYCHOLOGICAL STRESS
Authors: Mapelli M , Pires I , Amelotti N , Guglielmo M , Conte E , Agostoni P
Published: May 2022

Background

Takayasu’s arteritis (TA) is a systemic inflammatory disease that affects aorta and its major branches. There are several cardiac manifestations of TA and, recently, an association with Takotsubo syndrome (TTS) was reported

Case Presentation

A 58–year–old Caucasian female, with history of severe asymptomatic aortic regurgitation (AR) with a recently documented normal LV systolic function and TA in remission under corticosteroids, was admitted in the emergency department with chest pain following an acute intense stressful event. ECG showed sinus tachycardia, T wave inversion in left precordial and lateral leads, and a QTc of 487 ms (Figure 1). Laboratorial evaluation presented high–sensitivity troponin I of 3494 ng/L and B–type natriuretic peptide of 4759 pg/mL. The transthoracic echocardiogram revealed severe dilation of LV with moderate systolic dysfunction, due to apical and midventricular akinesia (“apical ballooning” pattern), and severe AR (Figure 2). The coronary angiography showed normal coronary arteries. An acetylcholine provocative test showed spasm of both the left anterior descending and circumflex arteries, accompanied by chest pain and ST depression in ECG, reverted after intracoronary nitrates administration (Figure 3). The patient was switched to diltiazem and heart failure drug therapy was started. A cardiac magnetic resonance revealed severe dilation of the LV, apical hypokinesia, ejection fraction to 53%, signs of myocardial edema and increased extracellular volume in apical and mid–ventricular anterior and anterolateral walls, and absence of myocardial late gadolinium enhancement, compatible with TTS. Patient was discharged clinically stable, without signs of HF, with progressive reduction of troponin and BNP. A final diagnosis of myocardial infarction with nonobstructive coronary arteries (MINOCA) due to TTS and coronary vasospasm in a patient with TA was done

Discussion

TA is a rare disease and there are reports of its association both with TTS and coronary vasospasm. Besides that, coronary vasospasm may also be involved in the pathophysiology of TTS. Moreover, in this patient we could not exclude the role coronary diastolic hypoperfusion due to AR in the elicitation of coronary vasospasm. Therefore, although the mechanisms behind these pathologies are not yet fully studied, this case supports their relationship

Conclusion

We presented a case of a patient with TA admitted with MINOCA due to TTS and coronary vasospasm
P318 RIGHT HEART CHANGE IMPACTS ON SURVIVAL IN PATIENTS AFFECTED BY CARDIAC AMYLOIDOSIS: A SINGLE CENTRE STUDY
Authors: Cicco S , Solimando A , Susca N , Inglese G , Melaccio A , De Fazio G , Vacca A , Ria R
Published: May 2022

Amyloidosis is due to deposition of an excessive amount of protein in tissues. Cardiac Amyloidosis (CA) is an inauspicious prognostic factor and leading sudden death. We retrospectively analyzed 135 systemic amyloidosis, admitted between 1981 and 2019. 54 patients (46.30% F, aged 63.95±12.82) presented CA at baseline. In 53 patients, it was associated with a multiorgan involvement, while in one there was a primary myocardial deposition. We compared this group with the 81 patients (49.30% F, aged 58.33±15.65) who did not meet criteria for CA. CA presented a decreased SBP (p = 0.036), while nCA had an increased proteinuria (p = 0.02). TnI and NT–proBNP were significantly increased compared to nCA (p = 0.031 and p = 0.047, respectively). In CA patients we found an increased LDH compared to nCA (p = 0.0011). CA patients were also found to have an increased interventricular septum thickness compared to nCA (p = 0.002), a decreased Ejection Fraction (p = 0.0018) and Doppler velocity E/e’ ratio (p = 0.0095). Moreover, CA patients had an enhanced right atrium area (p = 0.0179), right ventricle basal diameter (p = 0.0112) and wall thickness (p = 0.0471) compared to nCA, and an increased inferior cava vein diameter (p = 0.0495) as well. TAPSE was the method chosen to evaluate systolic function of the right heart. In CA subjects very poor TAPSE levels were found compared to nCA patients (p = 0.0495). Additionally, we found a significant positive correlation between TAPSE and lymphocyte count (r = 0.47; p = 0.031) as well as Gamma globulins (r = 0.43, p = 0.033), Monoclonal components (r = 0.72; p = 0.047) and IgG values (r = 0.62, p = 0.018). CA patients had very poor survival rates compared to controls (30 vs. 66 months, p = 0.15). Mean survival of CA individuals was worse also when stratified according to NT–proBNP levels, using 2500 pg/mL as class boundary (174 vs. 5.5 months, respectively p = 0.013). In much the same way, a decreased right heart systolic function was correlated with a worse prognosis (18.0 months median survival, not reached in subjects with higher values than 18 mm, p = 0.0186). Finally, our data highlight the potential prognostic and predictive value of right heart alterations characterizing amyloidosis, as a novel clinical parameter correlated to increased LDH and immunoglobulins levels. Overall, we confirm the clinical relevance of cardiac involvement suggests that right heart evaluation may be considered as a new marker for clinical risk stratification in patients with amyloidosis.
P321 CASE REPORT AND LITERATURE REVIEW: THE HAPPINESS FOR ITALY’S VICTORY AT THE EUROPEAN SOCCER CHAMPIONSHIPS COSTS AN “HAPPY HEART SYNDROME”
Authors: Fazzini L , Caggiari L , Raffo A , Spissu M , Contini F , Pittau R , Montisci R
Published: May 2022

Patient Presentation

A 52 y/o female with history of arterial hypertension, diabetes mellitus, Bentall‘s previous intervention, presented to emergency department complaining dyspnea and oppressive chest pain which arose during celebrations for Italy‘s victory at the European soccer championship. According to increase in cardiac troponin level and ECG findings of subendocardial ischemia she was admitted to our Coronary Care Unit for acute coronary syndrome suspicious.

Management

transthoracic echocardiography (TTE) showed reduced left ventricle ejection fraction (LVEF 37%) with apical and left ventricle medium segments akinesis associated with basal segments hyperkinesis with typical apical ballooning aspect. According to these findings, Takotsubo syndrome (TTS) suspicious overtook acute coronary syndrome. Despite low probability of coronary disease, she underwent coronary angiography which was normal. Eight days later, TTE showed completely recovery with normal LVEF. At the routine blood test we found not known hyperthyroidism without detectable antibodies; thyroid ultrasound showed some cystic lesion without any nodule. Thyroid scintigraphy was normal. Antithyroid medications were started and one month later complete normalization of thyroid hormones occurred. The patient was event–free after correction of the hyperthyroidism.

Discussion

“Happy heart syndrome” (HHS) is a TTS triggered by deep happiness and positive emotions. TTS is an usual form of acute cardiomyopathy characterized by reversible left ventricle apical ballooning which occurs in the absence of significant coronary artery disease. Although the exact cause of TTC remains unknown, several pathogenetic mechanisms have been suggested. Catecholamines seem to play a central role and we know that thyroid hormones interact with sympathetic nervous system so that hyperthyroidism is associated with hypersensitivity to catecholamines. Tako–Tsubo syndrome is usually triggered by negative stressors such as fright, grief, rage, other diseases. The role of positive emotions is not well known neither described. We assume that the mechanisms are similar but triggered by different emotions. HHS seems to be caused by pleasant emotional life events such as birthday party, son’s wedding and so many others. Both positive and negative life events could trigger TTS, nevertheless negative life events trigger TTS in almost 95% of the cases, so “broken hearts” are more frequent than “happy hearts”.
P322 A MISLEADING SAM
Authors: Armillotta M , Sansonetti A , Amicone S , Stefanizzi A , Impellizzeri A , Bergamaschi L , Paolisso P , Foà A , Rinaldi A , Casella G , Galiè N , Pizzi C
Published: May 2022

A 66–year–old woman with a history of anxious–depressive syndrome and osteoporosis, without significant cardiological history, reported onset of cardiopalmus and dyspnoea for a few days due to moderate efforts, in conjunction with a period of strong emotional stress. Due to the persistence of these symptoms and the onset of epigastric pain, she underwent a cardiological examination which found low blood pressure values associated with the presence of a systolic murmur. The ECG showed diffuse changes in repolarization compatible with ischemia. Access to the emergency room (ER) was recommended. In ER, the first high–sensitivity troponin value was significantly high (1542 ng/L). Therefore, in the suspect of ACS, the patient was transferred to the cardiological intensive care unit. Echocardiogram showed akinesia of the mid–apical segments, hypercontractility of the bases (EF 35%) and a SAM (systolic anterior motion) with a dynamic outflow tract pressure gradient of 80 mmHg which resulted in severe mitral regurgitation. During the first days of hospitalization, persistent hypotension was observed requiring intravenous infusion of fluids to maintain systolic blood pressure values between 90–100 mmHg. Coronary angiography showed only severe ostial stenosis of a branch of the first diagonal branch. At the same time, ventriculography was performed which showed basal hypercontractility with muscle salience at the base and systolic obliteration of the outflow tract with a small apical aneurysm. 5 days after admission, another echocardiogram showed the almost complete normalization of the global systolic function (EF 68%) with apical hypokinesia and hypercontractility of the basal segments. However, the SAM persisted with a dynamic outflow tract pressure gradient of 140 mmHg with the presence of multiple and dislocated papillaries, accessory tendon cords and insertion of muscle tendon at the level of the septum. To complete the diagnosis, cardiac MRI was performed which documented a diffuse increase in T2 relaxation times more evident in the apical area, absence of LGE areas and normalization of contractility of the left ventricle with disappearance of the SAM. These findings, together with the absence of significant hypertrophy and the complete regression of the ECGgraphic changes, allowed us to exclude the presence of an unrecognized hypertrophic cardiomyopathy and to diagnose Takotsubo syndrome.
P324 A CASE OF ATRIAL MYXOMA WITH UNUSUAL CLINICAL PRESENTATION
Authors: Rossini D , Amati R
Published: May 2022

Myxoma (mx) is the most frequent adult cardiac tumour, that often poses a difficult diagnostic challenge due to the variety and aspecifity of presenting clinical signs. Alongside the more typical clinical onset caused by intracardiac obstruction and systemic embolization, mainly at cerebral level, a mx may initially manifest itself with nonspecific systemic symptoms such as fever, weight loss, fatigue, skin rash, myalgia and arthralgia. We present the case of a 58–year–old woman diagnosed in December 2018 with idiopathic, serum–negative arthritis of the metacarpophalangeal joint of the first finger of the right hand, treated with methotrexate (Reumaflex 10 mg/week s.c.), hydroxychloroquine sulphate (Paquenil 200 mg/day per os) and corticosteroids cycles; in January 2021, this therapy was suspended by the patient (pt) as ineffective. In April 2021, pt was admitted for bilateral SARS–CoV–2 pneumonia. As dyspnoea and fatigue persisted during moderate physical activity (NYHA class II), the pt underwent a cardiological examination on 13 August, when echocardiographic diagnosis of a left atrial mass with the appearance of a mx was made. Interleukin–6 (IL–6) was assayed for a suspected relationship between the cardiac tumour and rheumatic symptoms and was found to be elevated (490 pg/m)l. On 23 August, cardiac surgery was performed to remove the left atrial mass by right minithoracotomy. Histopathological examination confirmed that the 3.5 x 2.5 x 1.5 cm neoformation was a mx. On 1 September, strong attenuation of joint pain and IL–6 reduction to 107 pg/ml was detected. On 9 October, resolution of rheumatic symptoms and normalisation of IL–6 to 3.7 pg/ml (N.V < 7) occurred. This clinical case is emblematic of the long time that sometimes can elapse between the first clinical manifestation and the diagnosis of mx. Also the widespread use of echocardiography did not significantly reduce the diagnostic delay when cardiac symptoms are absent. In a large number of cases, onset symptoms mimicking autoimmune connective tissue disease are reported for 5% (“Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases” Medicine (Baltimore) 2001 May;80(3):159–729). The monoarticular localisation we describe is however unusual. Finally, our observation confirms that the association between mx and systemic symptoms is most likely due to IL–6 synthesis by tumour cells.
P325 CARDIAC SARCOIDOSIS…TYPICAL CLINICAL PRESENTATION
Authors: Bracco A , Ginocchio G , Patrassi L , Secco E , Marinaccio L , Marchese D
Published: May 2022

We report the case of a 50–year–old man without previous medical hystory who was admitted to our department for recurrent syncopes for several months. Throughout the 24 hours ECG Holter it has been underlined several advanced atrioventricular block episodes, hence the patient underwent to definitive pacemaker implant. After 3 months, due to sustained ventricular tachycardia, the patient incurred a out–of–hospital cardiac arrest; the patient was subjeced to cardio pulmonary resuscitation with the restoration of the sinus rithm following defibrillation. Unfortunatly, due to the resuscitation maneuvers, sternal fracture resulted. During the hospitalization in the Cardiology department, he underwent coronary angiography wich showed non significant lesions. Cardiac Magnetic Resonance was also performed among the tests. The examination was found to be particularly hard to understand due to the presence of the sternal injury that deformed the pectus and affected dynamics of the right ventricle, causing systolic bulging of the subtricuspid region of the right ventricular wall. During the dynamic sequences, there was a mild bi–ventricular reduction in systolic function. In post contrast imaging, extended transmural LGE of the basal interventricular septum and right ventricular wall, as well as multifocal involvement of the left ventricle were found. Examination was not of univolcal interpretation: the patient was tranferred to another Center to perform MR PET wich was found to be strongy suggestive of sarcoidosis, later confirmed by extra cardiac biopsy. For this reason an ICD upgrade was performed along side the immunosoppressive therapy. Sarcoidosis is an inflammatory disease characterized by the presence of noncaseous granulomas in one or more organs or tissues; at the cardiac level it can “mimic” different cardiomyopathies as an insidious diagnosis. The presence of a post–traumatic pectus excavatum leads to dyskinesia of the rignt venticular wall, reduction of the bi–ventricular systolic funcion combine with an extensive late enhancement could suggest arrhytmogenic dysplasia with bi–ventricular involvement. However, by focusing on the clinical presentation (in particular the onset charaterized by unexplained advanced AV block in a young and healthy subjet and subsequent ventricular arrhytmias), through a multimodal and multidisciplinary imaging approach it was posible to diagnose sarcoidosis with cardiac involvement and refer the patient to adequate therapy.
P331 IMPLANT OF THE BALLOON EXPANDABLE BIOLOGICAL PROSTHESIS FOR TAVI (EDWARDS SAPIEN 3 ULTRA) PRE–ASSEMBLED ON EXPANSION BALLOON, IN “OPEN” SITUATION WITH PATIENT IN CEC
Authors: De Remigis F , Benvenuto M , Tomassoni G , Giancola R , Tamagnini G , De Rosa M , Fabiani D , Napoletano C
Published: May 2022

The biological valve prostheses malfunctioning often leads to severe forms of heart failure, whose treatment requires surgical or percutaneous re–intervention. We report the case of a 77–year–old man with a biological aortic prosthesis since 2009 (Elan stentless–21), hospitalized for acute cardiac decompensation related to severe aortic prosthetic insufficiency (likely infective endocarditis with periprosthesis abscess involving the perivalvular fibrous lamina) and coexistence of severe mitral insufficiency. After 25 days of therapy, in stable haemodynamic conditions, surgery was scheduled to replace the aortic prosthesis and the mitral valve, in CEC. The exposure of the aortic valve plane highlighted the rupture of the prosthetic coronary cusp in the absence of prosthetic detachment and perivalvular abscess. After removal of the degenerated cusps, the preparation and implantation of the new biological prosthesis (perimount–Magna–19) was hindered by the excessive presence of calcium–fibrosis in the suture site of the valve ring which did not allow adequate sealing, with multiple peri–prosthetics leaks; the possibility of sutureless prostheses implantation was made impossible by lack of adequate anatomical conditions. In these conditions, the possibility of implanting a biological prosthesis for TAVI, pre–mounted on the expansion balloon (Ewards–Sapien3–Ultra–23mm), in an “open” situation and in CEC, was considered. The implantation of the balloon–expandable prosthesis was performed with direct vision of the aortic annulus and coronary ostia; the insertion of the prosthesis was performed on a standard “J” guide wire positioned in the ventricle; the expansion of the prosthesis was performed in two balloon inflation steps. The intraoperative ecotransophageal echo demonstrated the correct positioning of the biological aortic prosthesis with minimal periprosthetic leak. The presence of severe residual mitral insufficiency suggested a replacement of the mitral valve with biological prosthesis. On day 4 the patient was clinically stable; the transesophageal echocardiogram showed normal functioning of the prostheses. The direct implantation of the expandable biological prosthesis in the cardiac surgery room, in “open” and CEC, after excluding active endocarditic processes and infectious complications, allowed the implantation of a larger prosthesis and to avoid significant perivalvular leaks.
P332 ACUTE HEART FAILURE IN AN ELDERLY, DIABETIC, HYPERTENSIVE PATIENT. A NEVER BANAL CASE UNDERLINES THE ROLE OF EMERGENCY ECHOCARDIOGRAPHY AND AND THE RELIABILITY OF THE ANAMNESIS COLLECTED IN URGENCY
Authors: Savioli G , Fumoso F , Lapia F , Brattoli M , Raffaele B , Martignoni A , Magrini G , Giulia F , Giulia B , Deborah H , Elena S , Di Sabatino A
Published: May 2022

We describe the case of a 78–year old male who acceded to high intensity medicine ward for acute heart failure after some days management in the emergency room, with acuity stabilization. In his history all atherosclerosis‘ risk factors were present (diabetes mellitus type 2, arterial hypertension, dyslipidemia and kidney chronic disease) together with no active IgGk multiple myeloma, diagnosed the month before. A previous echocardiogram demonstrated aortic valve calcifications, preserved ejection fraction and mild mitral valve failure. the emergency echocardiography service was activated and the patient received echocardiography on first day. Echocardiography revealed severe aortic insufficiency secondary to erosive endocarditis of 15 mm in diameter, increased left ventricular filling pressures, and increased estimated right ventricular pressures. empirical antibiotic therapy was immediately undertaken and were carried out blood cultures.from the emergency echocardiography service the cardiology service was activated for a trans–esophageal echocardio execution which confirmed the findings Streptococcus gallolyticus was isolated. only after performing the echocardiogram did the patient remember having had fever for a few days, more than a month before the first symptoms of heart failure. In the next days, colon adenocarcinoma‘s diagnosis was made. Notably Streptococcus gallolyticus‘s infections are frequent in immunocompromised patients and its most common clinical manifestation is infective endocarditis.This kind of infection is usually connected with colon rectum cancer, mostly in patients that have already started chemotherapy. When endocarditis regards people who don‘t make use of intravenous drugs or that haven‘t congenital or acquired valves defects, the most involved one is the aortic valve. This is especially true in elderly patients.That could be explained by aortic valve damage caused by shear stress and atherosclerotic process, that always involves aortic valve‘s endothelium. This damage manifests itselves as calcium endothelium overload and aortic valve stenosis. All of these factors transform the aortic valve into the perfect target for bacteremia.The patient underwent aortic replacement surgery, because of acute massive aortic valve failure, that impaired patient‘s hemodynamic, and proper antibiotics therapy was started, with benefit. Finally, the colon cancer was treated with surgery, no chemotherapy was needed.
P335 AORTIC VALVE INFECTIVE ENDOCARDITIS COMPLICATED BY SUPERIOR MESENTERIC ARTERY ACUTE TROMBOSIS
Authors: Viele A , Cuzzola B , Porchetta N , Paolone P , Giannotti G , Trivisonno A , Pierro A , Colavita A
Published: May 2022

The infective endocarditis (IE) has a significant impact on mortality rate in the first year after diagnosis, despite the improvements in early diagnosis and therapy. Embolic complications cause worsening of patient’s prognosis and they occur in the 20–50% of cases, with a risk of new embolic events after the initiation of antibiotic therapy rated between 6 and 12%. Echocardiographic characterization of vegetation has an important role in the definition of the embolization risk, it is documented that vegetation with dimension more than 10 mm are at higher risk. Several characteristic of the patient (diabetes, previous embolization, atrial fibrillation) determine the increase of the embolization risk, as well as the initiation of antibiotic therapy. We describe the case of a 64 y.o. man with chronic coronary syndrome (previous PCI) and previous Bentall–De Bono intervention for ascending aorta aneurysm. Patient was under anticoagulant therapy with DOAC due to atrial fibrillation. He was admitted to the emergency department for intermittent fever during the last three months, dyspnea and fatigue. Blood test showed neutrophilic leukocytosis and increased value of inflammatory markers. Transthoracic echography revealed an hyperechoic image on the ventricular side of the aortic prosthesis. The diagnosis of infective endocarditis was confirmed with transesophageal echocardiography, and empiric antibiotic therapy was initiated. Cardiac surgeon suggested follow up and new evaluation after three weeks of therapy. Clinical course was complicated by acute abdomen. The CT exam revealed dilation of a distal tract of superior mesenteric artery (maximum axial diameter was 10 mm) associated with distal thrombosis extended for 6 mm. The transthoracic echocardiogram showed absence of the vegetation on aortic prosthesis previous documented. Therapy with intravenous infusion of unfractionated heparin was administrated for three weeks, but the control TC showed persistence of the thrombotic occlusion of superior mesenteric artery so the case was discussed with Vascular Surgery team. They decided to treat patient with embolization and aneurysmectomy surgery (cultures were negative). This clinical case demonstrates that embolic complication of infective endocarditis, even on proper antbiotic therapy and close monitorization, are unpredictable and can cause the worsening of patient’s clinical course.
P337 SPORTS CARDIOLOGY NURSE IMPORTANCE IN YOUNG SPORTSMEN SUFFERING FROM ACUTE HEART DISEASE PREVENTION AND REHABILITATION. PILOT EXPERIENCE: REMOTE MONITORING DURING THE SARSCOV–2 PANDEMIC
Authors: Follero P , Tagliamonte G , Follero D , Vassallo M , Sibilio G
Published: May 2022

This is because it is difficult to understand that a “well trained” heart is not necessarily a “healthy” heart, and many malignant arrhythmias are triggered by physical activity. A project on diagnosis and prevention aimed at recognizing acute cardiac pathologies in young sportsmen has been launched using professional nursing figures, who in addition to having acquired relevant skills in the critical, interventional and clinical cardiology area, have also acquired additional skills in the field of the Biomedical and Neuromotor Sciences. The “sport cardiology nurse” can represent a relevant support for athletes’ acute cardiac pathologies prevention and rehabilitation. It takes the young patient throughout the process together with the Doctor: – Outpatient activity (recognition of ECG alterations, preparation of the patient for drug tests, Tilt test, management of complications) – Interventional cardiology activities: implantation of loop recorders and implantable defibrillators. – Rehabilitation and physical, nutritional and psychological education. With the SARS–CoV–2 pandemic, our work has undergone a drastic change. We have worked with telemedicine and activated remote monitoring for implanted cardiac devices. Our experience from January 2020 to today counts the enrolment of 80 patients undergoing ICD implantation, of which 8 subcutaneous, in young athletes. With the video visiting service it was possible to follow young patients who had been diagnosed with acute heart disease, to monitor and identify the onset of symptoms and / or arrhythmias. Remote monitoring is managed by the Sports Cardiology Nurse and the Doctor in charge. Given the results obtained, the project also aims to expand its skills in the environments most attended by young people, such as schools and sports centres in association with local companies in a not too far future. This “Sport Cardiology” aims to train more nursing professionals, to plan interventions aimed at reducing mortality and to spread the basic concepts of health education in the field of prevention.
P340 PARADOXICAL DIVERGENCE BETWEEN RATE OF SURVIVAL AND QUALITY INDICATOR OF CARE IN MYOCARDIAL INFARCTION ACCORDING TO PNE–AGENAS (ITALIAN NATIONAL HEALTHCARE OUTCOMES PROGRAM)
Authors: Casolo G , Del Meglio J , Lilli A , Canale L , Christou A , De Caro F , Bertini L
Published: May 2022

Background

The Italian National Healthcare Outcomes Program (PNE – AGENAS) each year provides quality performance measures for our Hospitals. Some measures refer directly to hard events such as mortality, others are focused over procedures that should be related to subsequent events, including mortality. The rate of PCI performed within 48 hours (48h–PCI) in patients with acute myocardial infarction (AMI) is currently used as a performance measures. An arbitrary standard of 35–40% of 48h–PCI for patients with AMI is considered the goal for a satisfactory practice.

Methods

We analyzed the PNE–AGENAS performance measures for the year 2020. Overall 1652 MI have been recorded in 2020 in Tuscany. We considered those Hospitals with > 100 AMI. We related the 30 day and one–year mortality with the 48h–PCI of the 20 Hospitals identified. Of these latter 13 are Hospitals with a 24h PCI service.

Results

All the hospitals hosting a catheterization laboratory largely overcame the 48h–PCI quality standard although with a wide variation among sites (70,8 – 90.4%). On the contrary all the Hospitals without a cath–lab did not even approach the standard (0–33.%). The analysis of the mortality data both at 30 day and at 1 year showed a wide variability among Hospitals without an appreciable difference. The 30–day mortality rate ranged from 2 to 15% without any relationship with the 48h–PCI. In some cases better survival rates were recorded for those Hospitals with the worse 48h–PCI.

Conclusions

Several factors makes 48h–PCI a useless and even confounding measure of performance. As a matter of fact this measure does not consider the type of MI treated (STEMI vs NSTEMI), nor the presence or not of a cath lab. Also it does not take account for the case mix of the population of AMI treated. Patients with STEMI represents about 30% of the activity of an Hospital with a 24h cath –lab. It is obviously easy for such an Hospital to satisfy the proposed standard as these patients should receive their PCI well before 24 hours. The contemporary organizations do cooperate and are organized as networks. The 48h–PCI should be only used to evaluate these networks, not the single hospitals. In conclusion our analysis by showing the divergent and paradoxical phenomena of better or similar survival in spite of longer or similar 48hPCI highlights the need to abandon this useless and even confounding measure to evaluate the Cardiology practice in the Italian Hospital.
P341 DANTE (DIAGNOSTIC ACUTE PATIENT TOOL IN EMERGENCY) & BEATRICE (BEDSIDE ECHOCARDIOGRAPHIC ASSESMENT FOR IMPROVE CLINICAL EVALUATION) FOR GERIATRIC PATIENTS
Authors: Savioli G , Lapia F , Bosoni T , Alunno G , Rigano G , Coppola L , Fusco A , Lo Bello A , Brattoli M , Fumoso F , Novelli V , Muzzi A , Mugellini A , Martignoni A , Cutti S , Di Sabatino A
Published: May 2022

Objectives

To determine whether comprehensive quantitative bed side echocardiogram could be used as a usual assessment tool in acute geriatric patients and to assess its effect on patient care.

Design

Retrospective. Setting: DEA di II livello IRCSS Policlinico san Matteo.

Patients

Acute ill medical, trauma and surgical patients. A doctor enrolled in the discipline of emergency medicine was assigned to perform bedside echocardiograms of acute inpatients. This work took only geriatric patients into consideration. (> 65aa). Interventions: The Bedside Echocardiographic AssesmenT foR Improve Clinical Evaluetion (BEATRICE), a comprehensive transthoracic echocardiogram was performed.

Measurements and Main Results

6–month period, 369 BEATRICEs were performed. The mean patient age was 76.2 (±14.3) years. 95% were hospitalized in medical departments and 5% in surgical ward. In 97.4% of cases BEATRICE was performed in a timely manner. The ejection fraction, cardiac index and the volumetric indices of the left ventricle is reported in 97% of the reports. Estimated stroke volume, longitudinal systolic function with tissue Doppler and atrium study is reported in 99.7%, 98.6% and 98.9% of BEATRICE studies. The study of diastolic and atrium function is reported in 99.3% and 98.9% of the reports respectively. Estimated left ventricular filling pressures are reported in 98.3% of the measurements. Information on the vena cava reported for 98%. Right heart function was assessed for 91.8%. Mean or systolic right ventricular pressures, or both, were also estimated in 91.9% of the reports. The BEATRICE was judged to be useful by the consulting primary care team in over 96% of cases, BEATRICEs allow the modification of therapy or the diagnostic process in over 40% of cases (in 27% of cases they allow to significantly modify the therapy and in 16% of cases they allow to significantly modify the diagnostic therapeutic procedure) and speeding up the diagnostic process in over 30% of cases.

Conclusions

The BEATRICE is feasible and alters care in the intensive care unit by providing clinical data not otherwise available at the bedside. Further studies are warranted to assess the impact of comprehensive echocardiogram–directed resuscitation on patient outcomes.
P344 LEANHEALTHCARE: CLINICAL DOCUMENTATION AS AN EFFECTIVE INSTRUMENT FOR IMPROVING CARE
Authors: Natali B , Baratta S , Vaselli M , Baroni M , Gwynne S , Nardini F
Published: May 2022

Introduction

Lean Thinking is configured as a management methodology aimed at creating value for the patient and at the systematic reduction of inefficiencies (waste). dictates of leanthinking can result in a new proactive approach supporting the clinic.For these aspects, the Lean approach seemed to us to be an excellent tool to tackle such a complex path as that of creating a computerized folder within the Intensive Care Cardiac surgery.

Objective

The aim of the project was to ensure that the lean tools applied to the development of a computerized medical record could give value to the patient, streamline and speed up the work of operators in terms of response times, delivery and fast consultation of diagnostic reports, ensuring speed and completeness in retrieving information, but also in sharing them among professionals. MATERIALS AND

Methods

Always with a view to continuous improvement of care, before starting with the drafting of the computerized medical record, a multisciplinary work group was set up with the use of typical project management and lean tools, ‘‘ analyzed the path, defined the critical issues and proposed solutions. In the section dedicated to the proposed Countermeasures we opted for a step–by–step IT implementation of both the clinical and health parts with adequate equipment that would implement the existing tools.

Results

The results of our work derive from the implementation of Lean Thinking. What we have been able to create is a folder model aligned with the healthcare processes and which supports the clinician‘s decisions, that is, the IT system has been adapted to the healthcare processes and not simply “computerized” the paper record.

Conclusions

At the end of this process, we realized how to analyze the paths and connections between the various operating units according to lean dictates, leading to highlighting those critical issues that slow down the process by not respecting criteria of efficiency and effectiveness. intensive care has been able to respect standards of support, planning and evaluation of care.
P346 HEALTH LITERACY ASSESSMENT AND HOSPITAL LENGTH OF STAY: A RETROSPECTIVE STUDY
Authors: Cristofori E , De Rinaldis M , Iula A , Conte M , Cocchieri A
Published: May 2022

Background

Cardiovascular diseases (CDs) were the leading cause of death worldwide in 2020. The risk of increasing CD is related to low Health Literacy (HL). HL can be defined as the individual’s ability to understand and process health information. Low HL has a risk ratio of 1.90 on mortality and 1.35 on readmission. A low level of HL was related to poorer use of health care services. Several inconsistencies were found about the relationship between HL and Length of stay (LOS). Although CDs are increasing because of the aging population, HL is often underestimated in the hospital setting. For this reason, HL assessment is important to identify patients at risk of poor HL. Therefore, this study aimed to describe the HL level in inpatients with CDs and to analyze the relationship between HL and LOS

Method

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

Results

The mean age of the sample was 71.28 (SD 13.19); 59% were male. HL‘s mean score was 2.43 (SD 1.2). A statistically significant linear association (Spearman’s correlation coefficient) was observed between the HL score and LOS. Patients with inadequate HL were 50.7% and had a longer LOS than patients with adequate HL (mean 9.1 ± 7.1 Vs 7.2 ± 5.9 days respectively, p = 0.05).

Conclusion

HL is poor and has been shown to be associated with LOS. These results should be confirmed after considering other variables through multivariate analyses. These findings suggest that the adverse effects of low HL may extend into the inpatient cardiovascular setting
P350 CARDIOLOGY SPECIALISTS OPERATING IN THE VENETO REGION: AN ANALYSIS COVERING THE PERIOD BETWEEN 2013 AND 2019
Authors: Zuin M , Picariello C , Rigatelli G , Roncon L , Bilato C
Published: May 2022

Background

The continuous aging of the population and the impact of cardiovascular diseases in terms of morbidity and mortality require a continuous and constant increase in health personnel throughout the country. The aim of the study is to evaluate the trend of cardiologist specialists available for the population living in the Veneto Region between 2013 and 2019.

Materials and Methods

Data regarding the population living in Veneto region during the study period as well as the absolute number of cardiologists referred to 1000 inhabitants and the regional old–age index were extracted from the ISTAT portal (dati.istat.it) and then processed. The temporal variation in the number of cardiologist specialists operating in the Veneto region was evaluated with the Jonckheere–Terpstra test.

Results

Between 2013 and 2019, the resident population in Veneto varied from 4,926,818 to 4,879,133 inhabitants. Cardiology specialists increased from 759 in 2013 to 869 in 2019; in particular, their availability, for every 1000 inhabitants, change from 0.15 to 0.18 with a total increase in the period considered of 0.4% (p for trend = 0.68), despite a continuous aging of the resident population, as evidenced by the old–age index (from 146.8 in 2013 to 173.1 in 2019, p = 0.01). The maximum increase in the number of specialists registered was 0.01 per 1000 inhabitants. (Figure 1).

Conclusions

The availability of cardiology specialists in the Veneto Region, despite showing a slight positive althoug non significaqnt trend in recent years, continues to be lower than the care burden and the type of resident population, often elderly and with multiple comorbidities.
P352 HEALTH SURVEILLANCE FOR ENTRY INTO THE CARDIOLOGY DEPARTMENT IN TIMES OF SARS–COV2 PANDEMIC
Authors: Cappannelli S , Tedesco T , Fischer B , Capponi E , Buccolieri M , Cardile M , Cosmi D , Di Pasquale T , Martinelli S , Pagnotta F , Piccioni N , Rey L , Murrone A
Published: May 2022

Introduction

The SARS–Cov2 pandemic has made it necessary to implement drastic measures to contain the infection and at the same time start a regulated process of protection of health workers (OS) and hospitalized patients (PR).

Objective

To verify the effectiveness of the health surveillance measures for SARS–COoV2 infection put in place to protect the OS and PR in the Cardiology of the Gubbio–Gualdo Tadino Hospital (AUSL Umbria 1).

Material and methods

we conducted a retrospective analysis, in the period 1 April 2020– 30 November 2021, on OS and PR in our Cardiology–UTIC OU. The protocols used for health surveillance provided, in all phases of the pandemic, the well–known general prevention measures (PPE, hand hygiene, distancing, per–triage). In phase 1 of the pandemic, molecular swabs were also carried out every 14 days at the OS and only at the entrance to the PR, in phase 2 antigenic tests every 5 days at the OS and molecular swabs at the entrance and after 48 hours at the PR while in the current phase 3 an antigenic test every 10 days at the OS and PR a molecular swab at T0 and T2 and an antigenic test at the 5th day and subsequently every 5 days.

Results

A total of 320 subjects, a sample of PR (300, 15 patients month) and all OS (20) were analyzed. A total of 2658 swabs were carried out (1088 molecular and 1570 antigenic) and only two positive OS were found in phase 1 of the pandemic alone, while in phase 2 and 3 no OS or PR was positive.

Conclusions

The application of the general rules for the prevention of SARS–Cov2 infection and the definition of precise intra–hospital pathways, together with the application of a hospital health surveillance protocol, has made it possible to significantly limit infections within the OU. In addition, the rapid identification of positive OS allowed for rapid isolation avoiding the spread of infection to PR and other OS. Bibliography: COVID and gender resources. Johns Hopkins Bloomberg School of Public Health. https://coronavirus.jhu.edu/map.html ISS, National Survey on COVID–19 contagion in residential and social health structures, 30 March 2020; Guidelines for health activities in phase 1, phase 2 and phase 3 of the pandemic. Umbria Region.
P358 THE ROLE OF ADHERENCE TO LIPID–LOWERING THERAPIES IN ACHIEVING LIPID TARGET: FINDINGS FROM REAL–WORLD ANALYSIS IN ITALY
Authors: Degli Esposti L , Borghi C , Galvani M , Giacomini E , Manotti P , Marra A , Passaro A , Perrone V , Pieraccini F , Sangiorgi D , Navazio A
Published: May 2022

The objective of the present real–world analysis was to evaluate the impact of adherence to lipid–lowering drugs in reaching the lipid target in settings of clinical practice in Italy.

The analysis was based on administrative and laboratory database of selected Healthcare Units in Italy covering approximately 10% of Italian population. Adult patients prescribed with statin and with at least a low–density lipoprotein (LDL) determination were included between 2012 and 2019. The index date was defined as the first prescription for statin within the inclusion period. Patients fell into 4 clusters collectively exhaustive and mutually exclusive based on their characteristics assessed during the year prior index date. Patients were considered as adherent if they had a proportion of days covered (PDC)≥80%. Among overall patients prescribed statin and with a LDL determination, 1% was with familial hypercholesterolemia, 28% with previous cardiovascular events, 21% with diabetes and 50% in primary prevention. Regardless their risk profile, the increasing of adherence was related to a higher achievement of LDL–target, with an increment of + 53.2% among familial hypercholesterolemia, +43.1% in diabetes and +30% in previous cardiovascular events and primary prevention clusters while progressing from low (PDC<40%) to high (PDC≥80%) levels of adherence. However, while in diabetes and primary prevention clusters 80% and 86% of adherent patients, respectively, had their cholesterol level under control, in the familial hypercholesterolemia and previous cardiovascular events clusters only 46% of adherent patients achieve the lipid target.

The analysis showed adherence to be a key factor for cholesterol control. However, our findings underline a therapeutic need for patients that, although adherent, fail to achieve the lipid target, especially among patients with previous cardiovascular events (that have low level of LDL to achieve) and with familial hypercholesterolemia (that have high LDL basal level), suggesting therapeutic intensification should be applied.