bluuebunny/crossref_metadata_2025 huggingface dataset:
192 GLP1-RA AND HEART FAILURE-RELATED OUTCOMES IN PATIENTS WITH AND WITHOUT HISTORY OF HEART FAILURE: A SYSTEMATIC REVIEW AND METANALYSIS
Authors: Villaschi Alessandro , Pini Daniela , Corrada Elena , Reimers Bernhard , Condorelli Gianluigi , Stefanini Giulio G , Chiarito Mauro
Published: December 2022

Background

GLP1-receptor agonists (GLP1-ra) are recently developed anti-diabetic drugs which have shown promising results in phase-3 cardiovascular (CV) outcomes trials in diabetic patients, demonstrating a reduction in major adverse cardiovascular events (MACE) and, possibly, in heart failure (HF) hospitalizations. However, whether these medications improve such outcomes in patients with a history of HF remains unknown.

Methods

All randomized, placebo-controlled trials of GLP1-ra (and predefined/post-hoc analysis) reporting CV outcomes stratified by HF history were searched in Pubmed from inception to August 31st, 2022. The primary outcome was HF hospitalizations. Secondary outcomes included MACE, CV death and a composite of HF hospitalization and CV death. The analysis was performed after stratifying for HF history. Odds-ratio (OR) and 95% confidence interval (CIs) were used as effect estimated and calculated via a random-effects model. P for interaction between subgroups were calculated via meta-regression analysis and a level of p<0.10 was considered as significant.

Results

Data from 6 trials and a total of 40300 patients (n=20127 GLP1-ra group, n=20173 placebo group) were included. GLP1-ra reduced HF hospitalizations in patients without HF history (OR 0.71, 95% CI 0.51-0.99) but had neutral effect on those with previous HF (OR 1.04, 95% CI 0.88–1.22, p-interaction=0.089). CV death was also reduced by intervention only in the group without history of HF (OR 0.81, 95% CI 0.71–0.92), as well as the composite of HF hospitalizations and CV death (OR 0.80, 95% CI 0.72–0.90). Indeed, no difference between treatment arms was found in the HF group for CV death (OR 0.99, 95% CI 0.82–1.18, p-interaction=0.18) and the composite of HF hospitalization or CV death (OR 1.02 95%CI 0.89–1.18, p-interaction=0.073). MACE reduction was similar in patients with (OR 0.87 95% CI 0.72–1.06) and without HF history (OR 0.84 95% CI 0.76–0.93, p-interaction = 0.75).

Conclusion

GLP1-ra do not reduce HF hospitalization and CV death in patients with history of HF, as the benefit on cardiovascular outcomes provided by this anti-diabetic class of drugs seems to be mainly limited to patients without HF history. Future studies focused on HF patients are needed to confirm such findings and clarify the limited efficacy of GLP1-ra in this relevant group of patients.
1112 DOUBLE RUPTURE OF INTERVENTRICULAR SEPTUM AFTER MYOCARDIAL INFARCTION
Authors: Bonadies Davide , Carpentiero Giovanna , Palumbo Rossana , Grossi Alma , Cristiano Mario , Vassallo Mariagiovanna , Torre Mario , Coscioni Enrico , Galasso Gennaro
Published: December 2022

Ventricular septal rupture (VSR) is a mechanical complication of acute myocardial infarction (MI). VSR and early surgical repair is associated with a high mortality rate and suboptimal results with frequent postoperative residual shunt. Rapid diagnosis and proper management are critical.

We present the case of a 73-year-old patient who came to our Emercency Room (ER) reporting oppressive chest pain and profuse sweating .

The physical examination showed a 4/6 L rude holosystolic murmur in right parasternal location. Electrocardiogram (ECG) showed inferior MI. Hematochemicals tests detected an increase of myocardial necrosis markers. Two-dimensional and three-dimensional transthoracic echocardiography (TTE) showed normal-sized left ventricle with akinesia of inferior and posterolateral walls and akinesia of posterior basal septum with ventricular septal rupture at this level. Coronary angiography showed total occlusion in mid right coronary artery (RCA). An intra-aortic balloon pump (IABP) was inserted to promote hemodynamic stability of the patient and as a bridge. Afterload was reduced using vasodilatators. A preoperative transesophageal echocardiography (TOE) showed the presence of an additional septal rupture into middle posterior interventricular septum. The role of echocardiographic assessment in VSR, therapeutic management, IABP use and timing of surgery are discussed.
43 CARDIAC TROPONINS AND COVID-19: WHAT DO WE KNOW ABOUT HETEROPHILIC ANTIBODIES?
Authors: Campana Pasquale , Forzano Imma , Pepe Marco , Basile Christian , Perillo Errico Federico , Ranieri Alessandro , Conte Maddalena , Parisi Valentina , Sibilio Gerolamo
Published: December 2022

Background

During the Coronavirus disease-19 (COVID-19) pandemic, a significant increase in cardiovascular events and death for acute Myocardial Infarction (AMI) has been widely described. In turn, cardiac troponins represent the main serum diagnostic biomarkers of AMI. However, several mechanisms of troponins elevation other than AMI could be identified such as the analytic interference due to the Heterophilic Antibodies (HA), which represents a less explored and underestimated cause.

Methods

The research of the following keywords “Heterophilic” or “Heterophile Antibodies” associated with “Troponin”, “Troponin I”, “Troponin T” or “High-sensitive Troponin” have identified 73 works in the most popular bibliographic databases such as PubMed, Scopus, and Web of Science, in which the first was published in 1998. In our systematic review, the inclusion criteria have considered all the works in which clinical information about the patients are described. The results have included 55 papers for an overall population of 128 cases that have presented HA's interference in troponins’ assay. In the great part of the works, HA's capture test has been performed to diagnose this interference. The association between HA and COVID-19 has also been explored with the identification of three works in scientific literature. In addition, we reported a clinical case of a young patient with persistent high serum ultra-sensitive Troponin levels due to HA, during the COVID-19 pandemic.

Results

The results have indicated the most at-risk population in patients with a history of multiple hospitalizations and with poor cardiovascular risk factors, who usually complained of atypical chest pain combined with persistent elevation of cardiac troponins without high CK-MB values.

Instead, only a few data could be isolated in the literature about HA's interference on troponins essay in COVID-19 patients. However, has been widely ascertained how increased serum levels of cardiac troponins have been identified in most of the SARS-COV-2 swabs positive populations, and several cardiac and extracardiac mechanisms may explain this condition.

Conclusions

The description of the most common clinical features of patients with HA's interference could help clinicians to early recognize this phenomenon, reducing the number of instrumental examinations and the hospitalization period of these patients. Therefore, the analytical mistake due to HA could be always considered in AMI differential diagnosis, and the use of HA's capture test in the at-risk population may determine an early diagnosis. Finally, the HA's phenomenon could increase during the COVID-19 period, considering how infections and vaccinations may stimulate heterophile's activity.
308 THE BROKEN HEART: A LEFT VENTRICLE FREE WALL RUPTURE IN MINOCA
Authors: Costantino Roberto , Leopizzi Alessandra , Milo Maria , Martino Roberto , Ignone Gianfranco
Published: December 2022

86 years-old man was admitted to our ICCU for chest pain with an ECG diagnosis of atrial fibrillation and inferior STEMI. He had a history of hypertension and ascending aorta aneurysm (48 mm) with no other known cardiovascular risk factor. He reported few episodes of short-duration chest pain in the last days.

A fast echocardiogram excluded ascending aorta dissection and pericardial effusion but showed hypokinesia of inferolateral left ventricle wall.

Urgent angiography only revealed a moderate stenosis on mid left anterior descending artery associated with slow run-off. No lesions were found on the expected culprit artery.

Due to persisting chest pain and patient's history of ascending aorta aneurysm, an urgent Angio CT was performed, but unexpectedly, during the exam, the patient lost consciousness with asistolia. RCP was practised with ROSC.

CT scan showed mild pericardial effusion with blushing. A free wall heart rupture was suspected by radiologist. Urgent echocardiogram revealed moderate pericardial effusion with a suggestive colour doppler systolic flow originating from an apparent hole in apical inferolateral left ventricle wall.

Rapid hemodynamic failure occurred so pericardiocentesis with amine support and blood transfusions were performed.

Heart team excluded urgent surgery due to extremely high operative risk related to patient's age, hemodynamic impairment and poor expected repair durability consequent to acute phase of rupture.

ICCU observation was made, with liable hemodynamic stability obtained with norepinephrine infusion. In accordance with patient's family other invasive measurements were not taken.

Unfortunately, the patient died the day after.

Only few cases of myocardial rupture in myocardial infarction-non obstructive coronary

artery disease (MINOCA) are reported in literature.

Recurrent chest pain makes plaque complication/embolus resolution a reliable hypothesis. New onset atrial fibrillation might have caused an embolization in coronary artery determining transmural ischaemia, as well as coronary artery plaque rupture/ulceration might have done.

Unfortunately, no further exams to exploit the underneath pathological process could be performed: Coronary intravascular ultrasound, optical coherence tomography, Cardiac Magnetic resonance would be a valid help in prognosis and future treatment.
286 A CASE REPORT OF TYPE II KOUNIS SYNDROME
Authors: Napoli Francesca , Sganzerla Paolo , Giannattasio Cristina
Published: December 2022

Case presentation and management

A 81-years old female presented to the emergency department of our hospital with dyspnea and chest pain. She had a history of chronic kidney disease and left bundle brunch block (LBBB) never further investigated. Non diagnostic ECG was performed in the setting of pre-existing LBBB. HS-T-Troponin level was significantly elevated (986 ng/L). A transthoracic echocardiogram (TTE) revealed inferior and posterior wall hypokinesis. NSTEMI was diagnosed and coronary angiography via the femoral artery revealed subocclusive stenosis of the right coronary artery (RCA) and 80% stenosis of left anterior descending artery (LAD). Coronary stent positioning was performed for the RCA culprit lesion and staged complete revascularization was planned.

Complications

After two days, the patient experienced sharp pain in the right groin and a femoral pseudoaneurysm was diagnosed by Ultrasound Color Doppler. Subsequently anemia suggested the development of retroperitoneal hematoma but it was excluded by contrast CT. Unfortunately, the patient developed acute chest pain, wheezing and erythematous pruritic rash 10 minutes after injection of contrast medium agent. The ECG didn't show any new ischemic abnormalities in the setting of pre-existing LBBB. The peak CK- MB level was significantly elevated (87 ng/mL). New onset apical region akinesia and anterior wall hypokinesia were detected on TTE. Acute coronary syndrome (ACS) was suspected consistent with symptoms, new onset wall motion abnormalities and CK-MB elevations. The patient was diagnosed with allergic reaction and coronary vessel spasm secondary to contrast agent injection in pre-existing atherosclerotic plaque. Due to the high probability of an hypersensitivity reaction to the contrast medium agent we did not perform a new coronary angiography to confirm the diagnosis. Promethazine, Urbason and Nitroglicerin were administered with clinical improvement. The next day we observed recovery of the anterior and apex wall motion abnormalities consistent with coronary vessel spasm.

Echocardiographic wall motion abnormalities before and after coronary spasm:

Take home message

We presented the case of an allergic reaction leading to the release of inflammatory mediators responsible of coronary vessel spasm causing acute myocardial infarction. It can also be induced by injection of contrast medium like in the presented case. Therefore, clinicians and radiologist should recognize this rare but critical disease to ensure prevention and appropriate management.
534 PROGNOSTIC IMPACT OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN OLDEST OLD STEMI PATIENTS: A MULTICENTER REGISTRY
Authors: Ruzzarin Alessandro , Muraglia Simone , Zilio Filippo , Unterhuber Matthias , Baessato Francesca , Zanon Sofia , Flaim Massimo , Oberhollenzer Rainer , Bonmassari Roberto , Donazzan Luca
Published: December 2022

Introduction

Contrast-induced acute kidney injury (CI-AKI) is a well-known complication of ST-elevation acute myocardial infarction (STEMI) with an adverse impact on prognosis. Elderly patients are at higher risk for cardiovascular events. Moreover, renal function decreases with age. We sought to evaluate the incidence of CI-AKI in very elderly STEMI patients undergoing primary PCI (pPCI) and its impact upon outcomes in these patients.

Methods

We retrospectively evaluated all very elderly patients (i.e. age above 85 years) treated with pPCI for STEMI in two hub-centers between January 2010 and June 2021. We defined CI-AKI as a rise in serum creatinine of ≥0.30 mg/dL over baseline during the first 48h from procedure. Follow-up data were determined from local clinical records during a twelve-months period.

Results

Among 451 patients referred for STEMI at our institutions, 404 patients underwent pPCI.

Overall, the incidence of CI-AKI was 16.3%. There was no significant age difference between CI-AKI and non CI-AKI groups (89.3 ± 2.9 vs 88.6 ± 2.7, p=0.11). Baseline features were similar except for higher prevalence of diabetes mellitus (31.1% vs 18.7%, p=0.03) and chronic kidney disease (CKD) (77% vs 25.7%, p< 0.01) in CI-AKI vs non CI-AKI group. CKD appeared to be strongly associated to higher risk of CI-AKI (OR 9.69, 95% CI: 5.0–18.5; p<0.01).

Time-to-first composite MACE (all cause death, stroke, heart failure hospitalization) tended to be shorter without a significant difference between CI-AKI vs non CI-AKI group (252.3 vs 296.2 days, p=0.06) at one year follow-up,

Conclusions

Underlying CKD is strongly associated with CI-AKI in oldest-old STEMI patients. CI-AKI group had a nonsignificant trend toward a reduction in time-to-first MACE.
42 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON-CULPRIT CORONARY PLQUES
Authors: Sammartini Emanuele , Biccirè Flavio Giuseppe , Debelak Caterina , La Porta Ylenia , Budassi Simone , Varricchione Giuseppe , Romagnoli Enrico , Marco Valeria , Boi Alberto , Fineschi Massimo , Fabbiocchi Franco , Taglieri Nevio , Calligaris Giuseppe , Ozaki Yukio , Arbustini Eloisa , Alfonso Fernando , Prati Francesco
Published: December 2022

Background

Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood.

Purpose

Our study aims to analyse the characteristics of non-culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery.

Methods

We included 1848 non-culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient.

Results

Overall, median age was 66 years (56-74), with 24.6% of women and 53.4% of ACS. At patient-level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion-level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season).

Table 1

Conclusions

Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.
54 EXPLORING FEATURES AND OUTLOOK OF WOMEN DISCHARGED AFTER AN ACUTE CORONARY SYNDROME MANAGED INVASIVELY: INSIGHTS FROM THE 23,072 PATIENTS PRAISE MULTICENTER REGISTRY
Authors: Spadafora Luigi , Zoccai Giuseppe Biondi , Bernardi Marco
Published: December 2022

Background

Acute coronary syndromes (ACS) are a common cause of morbidity and mortality, irrespective of sex. While several studies have focused on ACS at admission or long-after the acute event, limited if any research is available on sex-based comparison of patients discharged after ACS. We aimed at appraising the outlook of women discharged after ACS, exploiting a large multinational registry.

Methods

Details on women enrolled in the PRAISE multicenter registry, a large database spanning 23,702 patients included between 2003 and 2019, were systematically collected. We focused on patient and procedural features, medications at discharge, and 1-year outcomes. The primary endpoint was the composite of death, myocardial infarction, or major bleeding after discharge. Secondary outcomes were the individual components of the primary endpoint.

Results

Characteristics of 17,804 men and 5,466 women discharged after ACS were collected. Several baseline differences were found, including risk factors and history of prior revascularization (all p<0.05). At discharge, men underwent radial access more frequently, and received also more commonly beta-blockers, renin-angiotensin system inhibitors, and statins (all p<0.05). Focusing on antithrombotic therapy, men received more frequently prasugrel, whereas women receive more commonly clopidogrel (all p<0.05). At 2-year follow-up incidence of death, reinfarction, major bleeding, non-fatal major bleeding were significantly higher in women (all p≤0.01). All such differences were however due to residual confounding and did not hold true at multivariable analysis, with the exception of major bleeding, which appeared surprisingly lower in females at adjusted analysis (odds ratio=0.70 [95% confidence interval: 0.52-0.94], p=0.017).

Conclusions

Women are treated less aggressively with apparently worst outcomes 2 years after discharge for ACS managed invasively. On the basis of these findings, we should change our approach and adopt a more aggressive management of women with ACS.

Figure 1. Sex-based comparison of clinical outcomes 2 years after discharge for an invasively managed acute coronary syndrome (ACS) (all p<0.05).
289 DIAGNOSTIC PATHWAY OF PATIENTS WITH CHRONIC CORONARY SYNDROME AFTER THE ISCHEMIA TRIAL PUBLICATION
Authors: Spagnolo Marco , Laudani Claudio , Occhipinti Giovanni , Agnello Federica , Legnazzi Marco , Scalia Lorenzo , Mauro Maria Sara , Rochira Carla , Finocchiaro Simone , Greco Antonio , Capodanno Davide
Published: December 2022

Introduction

Patients with chronic coronary syndrome (CCS) can initially undergo an invasive (i.e., early referral to invasive coronary angiography [ICA]) or a conservative (i.e., anatomical or functional testing before ICA) management. The ISCHEMIA trial showed no difference between these two strategies in CCS patients with moderate-to-severe ischemia. The aim of our study was to assess whether the results of the ISCHEMIA trial impacted on the management of CCS patients.

Methods

Trends in the management of patients with CCS in our centre, according to the ISCHEMIA trial publication date, were analyzed and patients categorized into pre-ISCHEMIA (before March 2020) and post-ISCHEMIA (from July 2020 to February 2022) groups, with an in-between blanking period of three months. The primary outcome was incidence of referral to ICA by coronary computed tomography angiography (CCTA). Secondary objectives included the incidence ischemia test-referred ICA, incidence of CCTA-referred ICA and subsequent percutaneous coronary intervention (PCI), incidence of ischemia test-referred ICA and subsequent PCI and incidence of CCTA-referred ICA without subsequent PCI. Differences between the pre-specified subpopulations (age ≥75 years, diabetes, chronic kidney disease [CKD], peripheral arterial disease [PAD], gender male, unstable angina, active smoking status, body mass index [BMI] >30, hypertension, family history of coronary artery disease [CAD], atrial fibrillation [AF], prior percutaneous coronary intervention [PCI], prior coronary artery bypass grafting [CABG]) and the general population of the study were tested using a regression analysis.

Results

A total of 2,365 patients were included, 487 (20.6%) and 1,878 (79.4%) in the pre-ISCHEMIA and post-ISCHEMIA groups, respectively. There were no notable between-group differences in baseline characteristics. The primary outcome occurred more frequently in the post-ISCHEMIA group (73.5% vs. 32.5%; p<0.01). Compared to pre-ISCHEMIA, the post-ISCHEMIA group displayed less referrals to ICA by ischemia testing (31.6% vs. 52.5%; p<0.01) and more ICA referrals by CCTA with subsequent PCI (8.3% vs. 12.0%; p<0.01). There were no within-group differences in ischemia test-referred ICA and PCI, and CCTA-referred ICA without subsequent PCI. A regression analysis between the primary endpoint incidence in the general population compared to the incidence in the pre-specified subpopulations showed no significant difference in the p values for interaction.

Conclusions

In the first two years from publication, the ISCHEMIA trial significantly impacted on the decision-making algorithm for patients with CCS, increasing referral to ICA by CCTA and diminishing ICAs indicated by an ischemia test.
952 SAFETY OF CLASS IC ANTIARRHYTHMIC DRUGS IN CORONARY ARTERY DISEASE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Turturiello Dario , Cristiano Ernesto , De Lucia Carmine , Bessi Riccardo , Paganini Edoardo , Lupo Pierpaolo , Deambroggi Guido , Foresti Sara , Ali Hussam , Cappato Ricccardo
Published: December 2022

Introduction

Class IC antiarrhythmic drugs (AADs) currently represent a cornerstone in the therapy of atrial fibrillation (AF). They also play an important role in the treatment of idiopathic ventricular arrhythmias. Following the results of the CAST study flecainide and by extension the other class IC AADs were contraindicated in patients with ischemic and structural heart disease, because of their proarrhythmic effect and the consequent increase in mortality observed in the study.

Recent studies, carried out on patients with chronic coronary heart disease, have shown a good safety profile for this class of drugs.

Methods

The aim of our study was to evaluate the mortality and the mortality rate in patients affected by ischaemic heart disease who take Class IC AADs. A systematic review and meta-analysis was conducted using Pubmed and Embase databases, following the PRISMA guidelines, to collect literature data reporting Class IC AADs safety in patients affected by coronary artery disease.

Results

The final analysis included four studies accounting for a total of 3643. In the Classe IC AADs group the events (all cause death) were observed in 104/1170 patients, while in the control group were observed in 338/2473 patients, showing an ODDS ratio of 1.431 (IC 0.748-2.740), p value 0.279 (TABLE 1A). The event rate per year was 5,5% in the CLASS IC AADs group and 5,1 in the control group, with an ODDS ratio of 1.524 (IC 0.807-2.879), p value 0.194 (TABLE 1B).

Conclusion

Class IC AADs doesn't increase the overall mortality and mortality rate in patient affected by icheamic heart disease. These observations await confirmation through randomised clinical trial.
976 APP-BASED DIAGNOSTIC WORKUP OF DYSLIPIDEMIC STATUS IN ISCHEMIC AND NOT ISCHEMIC PATIENTS
Authors: Velato Letizia , Cardia Giada , Romano Letizia , Bartone Anna , Malizia Biagio , Indolfi Ciro , Curcio Antonio
Published: December 2022

Background

Despite many therapeutic resources and technological innovations, coronary artery diseases (CAD) yet represent the first cause of death in industrialized countries. In order to improve outcomes in CAD and other chronic diseases, it has been proposed to implement personalized and continuous home-monitoring through digital applications. Currently, dyslipidemias are considered the ideal target condition for the development of such telemedicine approaches.

Objectives

The main goal is to evaluate the efficacy of a mobile app on the clinical cardiovascular outcomes, by analyzing the adherence to lipid-lowering therapy of dyslipidemic patients, compared to out clinics patients followed under standard work-ups.

Materials and methods

From March 2022 to September 2022, 15 patients were enrolled who were able to benefit from remote monitoring and 8 patients undergoing outpatient monitoring. The two groups were divided into four categories: 8 ischemic patients to whom the mobile app was recommended admitted with a diagnosis of CAD and undergoing PCI (percutaneous coronary intervention), 4 ischemic patients undergoing outpatient follow-up, 7 not ischemic admitted for other procedure for which remote monitoring was proposed, 4 non-ischemic patients with outpatient procedure. the lipid profile was assessed by mobile application and outpatient visit, respectively.

Results

In the evaluation between the group of patients who underwent the diagnostic application procedure and the outpatient group, greater adherence to the use of telemedicine was found in patients aged 40-69 years or who could benefit from the help of family members. Lack of information and experience in using the systems and devices was a significant obstacle in 5 percent of patients all over 78 years of age and in the absence of a family member. Given the many logistical and waiting time problems for hospital visits, 57 percent of patients who underwent a medical examination via the app benefited most from using the remote app. Mean LDL values of 97 mg/dL at one month after discharge were found in 66% of patients particularly the subgroup of ischemic patients who, given the strong correlation between atherosclerotic disease and ischemic heart disease, require closer follow-up, with mean LDL values of 95mg/dL found.

Conclusions

Telemedicine has the potential to improve clinical outcomes in patients with dyslipidemia, although efficacy is influenced by parameters such as age and family support; in the future, telemedicine platforms could be an aid to evaluate new therapeutic opportunities for innovative treatments, such as bempedoic acid. Telemedicine helped patients in understanding the importance of reducing LDL cholesterol.
29 PROGNOSTIC IMPACT OF TARGET VESSEL FAILURE AS FIRST EVENT AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHT FORM 10-YEAR FOLLOW-UP OF THE EXAMINATION EXTEND TRIAL
Authors: Verardi Filippo Maria , Bujak Kamil , Sabaté Manel , Brugaletta Salvatore
Published: December 2022

Background

Outcome after primary PCI for ST-segment elevation myocardial infarction may be very different. Either it may be free of events during years or it may be characterized by many recurrent events. It is unknown whether to have a target vessel failure (TVF) as first event may impact subsequent outcomes during follow-up. We aim to evaluate very long-term outcomes of STEMI patients according to the occurrence of TVF as the first event during follow-up.

Methods

EXAMINATION-EXTEND trial randomized STEMI patients to everolimus-eluting stent or bare-metal stent with 10-year follow-up. All the patients were stratified according to their first event (TVF-First vs. NonTVF-First). TVF was defined as the composite of TV cardiac death, TV myocardial infarction, or TV revascularization. The primary endpoint of this study was 10-year POCE, defined as the composite of all-cause death, any myocardial infarction, or any revascularization.

Results

Out of the 1498 enrolled patients, 161 (10.7%) had a TVF as first clinical event during follow-up. TVF-First patients had higher rates of previous MI or PCI, with less use of manual thrombectomy, and received more BMS with a longer total stent length. On multivariate analysis, manual thrombectomy and bare-metal stent implantation were independent predictors of TVF as first event. Ten-year adjusted POCE was statistically higher in TVF-First patients compared to the NonTVF-First group (31.1% vs 27.5%, adjHR: 1.82; 95%CI: 1.34 - 2.48; p < 0.001).

Conclusions

In our STEMI population TVF occurred in 10.7% as the first event during follow-up. At 10-year follow-up, patients who experienced a TVF as first event exhibited a high risk for subsequent POCE events as compared to patients who did not.
1053 PHARMACOLOGICAL REDUCTION OF OXIDATIVE STRESS COUNTERACTS CARDIAC DISFUNCTION IN A MURINE MODEL OF DYSTROPHIC CARDIOMIOPATHY
Authors: Cattapan Irene , Sabatino Jolanda , Di Candia Angela , Arusei Ruth Jepchirchir , Brugnaro Marco , Di Lisa Fabio , Kaludercic Nina , Di Salvo Giovanni
Published: December 2022

Introduction

Dystrophic cardiomyopathy culminates in heart failure and arrhythmias and is a major burden for Duchenne muscular dystrophy (DMD) patients. Mechanism-driven therapies designed to contrast the development of muscle and cardiac dysfunction are still missing. Antioxidant treatments counteract myocyte injury in mdx mice, a genetic model of DMD, supporting the possible role of enhanced reactive oxygen species (ROS) in the pathophysiology of muscular dystrophies. Previous evidence shows that monoamine oxidases (MAO) represent an important source of ROS, thus contributing to cardiomyocyte damage and dysfunction in different models of heart disease.

Objectives

we tested whether MAO-induced ROS formation contributes to the progression of pathology in dystrophic hearts.

Materials and methods

wild type (WT) and mdx mice at 3 and 12 months of age were employed. Cardiac function was determined by echocardiography measuring: fractional shortening, ejection fraction and left ventricle strain. Cardiac structure and fibrosis amount were assessed through histology (H&E, Masson's Trichrome). To test whether reduction in ROS burden could ameliorate cardiac structure and function in mdx mice, MAO-B inhibitor safinamide was administered to WT and mdx mice respectively at 3 and 12 months of age.

Results

We found that fractional shortening (FS) and ejection fraction (EF) were reduced by 1.2- and 2-fold at 3 and 12 months of age, respectively, in mdx mice vs their WT counterpart. In addition, left ventricle (LV) strain was impaired in mdx mice already at 3 months of age. This functional impairment was accompanied by a 5-fold increase in fibrosis in mdx hearts, evident already at 3 months. Safinamide administration for 30 days, led to a significant improvement of FS, EF and LV strain in mdx mice. Half of the mice in the safinamide cohort showed reduced levels of myocardial fibrosis.

Conclusions

Taken together, these results suggest that pharmacological MAO-B inhibition improves cardiac function in a genetic model of DMD and may represent a clinically relevant target for the treatment of dystrophic cardiomyopathies.
484 PAPILLARY FIBROELASTOMA OF THE AORTIC VALVE ASSOCIATED WITH MYOCARDIAL INFARCTION, COMPLICATED BY ELECTRICAL STORM AND ENDOVENTRICULAR THROMBOSIS
Authors: Nepitella Alessandro Alberto , Cadeddu Christian , Maiani Silvia , Mandas Martina , Marchetti Maria Francesca , Montisci Roberta
Published: December 2022

Introduction

Papillary fibroelastomas (PFE) are reported to be the most common tumors of the heart valves and are a possible source of systemic embolism, including myocardial infarction.

Case Report

We report the case of a 67-year-old female with no background of cardiovascular disease, admitted to our hospital with worsening dyspnea and chest tightness over the prior 10 days.

The ECG showed a sustained hemodynamically tolerated monomorphic ventricular tachycardia, successfully treated with antiarrhythmic therapy, and ECG in sinus rhythm revealed signs of previous anterior myocardial infarction. Transthoracic echocardiogram showed a severely depressed systolic function (LVEF 19%), akinesia and thinning of the anterior wall and of all middle-apical segments, complicated by left ventricular aneurysm and endoventricular thrombosis. In the ventricular side of right aortic coronary cusp a mobile, pedunculated mass of 12×8 mm was visualized. A subsequent TEE corroborated the suspicion of PFE. She underwent cardiac MRI which showed areas of transmural late enhancement in all akinetic segments. A coronary angiography revealed sub-occlusion of the mid-anterior descending artery with no angiographic evidence of coronary atherosclerosis elsewhere. In view of her reduced LVEF and history of VT, an ICD was implanted. She started oral anticoagulant therapy and complete resolution of the endoventricular thrombosis was evidenced. After several days of electrical instability, characterized by multiple episodes of ventricular tachycardia, the clinical course was characterized by progressive clinical and electrical improvement and she was discharged in good clinical conditions after four weeks. Due to the severe impairment of the systolic function, not susceptible to surgical remodeling and the high operative risk, no indication for surgical removal of the mass was made.

Conclusion

Aortic PFE carry a not negligible risk of acute coronary syndrome, electrical storm and sudden death. It should be considered as the cause of myocardial infarction, and not an incidental finding, especially in patients with no angiographic evidence of coronary atherosclerosis.
558 BIVENTRICULAR PERIOPERATIVE TAKOTSUBO CARDIOMIOPATHY
Authors: Padoan Laura , Sforna Stefano , Parise Antonio , Barengo Alberto , Torlone Francesco , Coiro Stefano , Riccini Clara , Del Pinto Maurizio , Cavallini Claudio
Published: December 2022

Introduction

Perioperative Takotsubo cardiomyopathy (pTC) represents a rare and still not well characterized disease. Biventricular involvement is an uncommon manifestation of TC and is associated with a more severe clinical presentation.

Case report

A 72-year-old male, hospitalized for a laparoscopic left hemicolectomy, was transferred to ICU after having developed severe bradycardia, treated with Adrenalin, and cardiogenic shock during induction of general anesthesia. EKG showed complete atrio-ventricular block, so a temporary PMK was placed. Troponin was raised. Echocardiogram showed severe biventricular disfunction (LVEF 25%, TAPSE 12 mm) with akinesia of medio-apical segments, suggesting a biventricular pTC. Also, there was a reduction of 3D LV longitudinal strain (- 5,8%), particularly of the medio-apical portion, and RV free wall longitudinal strain (- 11%). Coronary angiography resulted negative. Patient's hemodynamic was supported with Noradrenalin and a cycle of Levosimendan, allowing to reach stability. Further echocardiogram showed improvement of biventricular function and longitudinal strain values. Due to the persistency of atrio-ventricular block, a definitive PMK was placed. Patient was discharged after therapy optimization.

Discussion

pTC is a little-known disease, as incidence and etiology are not well definite. Literature suggests a relation between pTC and physical or emotional stress due to surgery to promote an increase of catecholamine release. Other potential factors may be inadequate depth of anesthesia or tracheal manipulation during intubation and catecholaminergic drugs administration. On the other hand, the use of anesthetic volatile agents seems to have a cardioprotective effect. PTC is more common during general anesthesia and when occurs intraoperatively has a worse clinical presentation. Biventricular involvement, which is a rare and severe manifestation of TC, has been reported frequently among pTC patients. To date, due to the lack of a systematic review, there is little knowledge about potential risk factors, prevention strategies and management of pTC.

Conclusions

Despite multiple cases of pTC have been reported, several characteristics of this entity are not fully understood. However, it must be considered as a part of differential diagnosis in patients with anaesthesia-related decompensation. Biventricular involvement represents an infrequent presentation and its commonly associated with life-threating hemodynamic impairment.
240 A PEDIATRIC CASE OF BIVENTRICULAR END-STAGE ARRHYTHMOGENIC CARDIOMYOPATHY
Authors: Agbariah Andrea , Ermacora Davide , Ruzzarin Alessandro , Milewski Priscilla , Nannelli Chiara , Comunello Andrea , Cemin Roberto
Published: December 2022

Background

Arrhythmogenic cardiomyopathy (ACM) is a rare heart muscle disease characterized by cardiomyocyte necrosis and fibro-adipose substitution which contribute both to the genesis of malignant ventricular arrhythmias and the morpho-functional alterations of the ventricles. ACM has always been considered a right ventricular disease with secondary involvement of the left ventricle, but recently a left dominant phenotype has been also described.

Case report

A 14-year-old patient was admitted to our hospital after out-of-hospital cardiac arrest due to ventricular fibrillation, which occurred when she was at rest. A family history of sudden death and dilated cardiomyopathy was retrieved (her brother died at the age of 18 with a dilated heart), but other family members had never been screened to date. Cardiac magnetic resonance imaging (cMRI) appearance was consistent with biventricular dilatation along with severe systolic dysfunction (left ventricular ejection fraction 20%; right ventricular ejection fraction 25%). It showed also thinning and bulging of the basal free wall of the right ventricle proximal to the outflow tract (up to 4 mm) and multiple foci of subepicardial, mid-wall and transmural late gadolinium enhancement (LGE) in both ventricles. Signs of acute decompensated heart failure and a high arrhythmic burden were present. After cardiopulmonary stabilization, she underwent the implantation of a cardioverter-defibrillator (ICD).

Conclusion

We herein report an uncommon case of biventricular AC (‘definite diagnosis’ according to both Task force criteria 2010 and Padua criteria) with advanced morpho-functional dysfunction occurring already in pediatric age, without any alerting symptom until the cardiac arrest (the typical onset of the ACM in children). It shows how severe biventricular involvement may affect young patients with a rapid progression of the disease. It also stresses the need for a strict follow-up of the family members of a proband since his first diagnosis, highlighting the pivotal role of cMRI in the diagnosis of pediatric disease. This has not been thoroughly studied and lacks sensitive and specific diagnostic criteria.
449 HYPERTROPHIC CARDIOMYOPATHY: A CASE OF CHALLENGING ARRHYTHMIC RISK STRATIFICATION
Authors: Belleggia Sara , Coraducci Francesca , Torselletti Lorenzo , Coretti Francesca , Paolini Federico , Alfieri Michele , Bastianoni Gianmarco , Brugiatelli Leonardo , Principi Samuele , Ciliberti Guseppe , Barbarossa Alessandro , Stronati Giulia , Russo Antonio Dello , Guerra Federico
Published: December 2022

Hypertrophic cardiomyopathy (HCM) is a common disease, mostly inherited, with a prevalence of 1:500. Cornerstone of the clinical management of HCM patients is stratifying the risk of sudden cardiac death (SCD) which is the most frightening complication despite its relatively low incidence (0,9% per year). Although mathematical risk scores, as proposed by ESC, are the most used to assess the probability of arrhythmic complications leading to SCD, they have been associated with low sensitivity, precluding some high-risk patients from prophylactic ICD implantation.

Among the tools at clinicians’ disposal for risk stratification in HCM patients, the latest AHA/ACC guidelines propose an “individual risk markers strategy”, based on the presence of ≥1 clinical feature such as a family history of SCD, extreme left ventricular hypertrophy (LVH), unexplained recent syncope, NSVT, late gadolinium enhancement (LGE) at CMR, systolic dysfunction and LV apical aneurysm.

We present a case that lets us reflect on arrhythmic risk stratification.

P.C. is a 58 y.o. male with a history of septal hypertrophy (19 mm) and T wave inversion but without an established diagnosis of HCM. He did not have any familiar history of syncope or SCD. He came to the emergency department for epistaxis and was admitted to the cardiology unit due to the previously mentioned findings, where he underwent cardiac-CTA and CMR showing myocardial bridge of left anterior descending artery, LVH with apical aneurysm and LGE areas localized on the apex (transmural) and on the interventricular septum (subendocardial). No signs of dynamic LVOT obstruction or atrial enlargement emerged from echocardiography. During the observation, asymptomatic NSVT were recorded on continuous ECG monitoring. According to the ESC risk prediction score (3.7%) ICD was not strictly indicated but considering the CMR high-risk profile (according to the suggestions of AHA/ACC) we proposed an ICD implantation anyways. The patient refused any invasive procedure and was implanted with a loop recorder. At 12 months remote monitoring showed a single episode of self-terminated sustained polymorphic ventricular tachycardia (02:23 mm: ss) symptomatic of pre-syncope. The patient was then immediately reached and admitted for ICD implantation in secondary prevention. According to the patient's will, and the no need for bradycardia therapy, an S-ICD was implanted. Figure 1LV apical aneurysm at CMRFigure 2Remote Monitoring
802 DIAGNOSTIC YIELD AND PREDICTIVE VALUE ON LEFT VENTRICULAR REVERSE REMODELING OF GENETIC TESTING IN DILATED CARDIOMYOPATHY
Authors: Bertero Edoardo , Fracasso Giulia , Eustachi Virginia , Coviello Domenico , Cecconi Massimiliano , Giovinazzo Stefano , Toma Matteo , Merlo Marco , Sinagra Gianfranco , Porto Italo , Ameri Pietro , Canepa Marco
Published: December 2022

Background

Genetic testing is one essential element in the diagnostic workup of patients with idiopathic dilated cardiomyopathy (DCM), and genotype-phenotype correlations are still poorly understood. We assessed the diagnostic yield of genetic testing in a selected DCM cohort including both familial and nonfamilial cases and evaluated phenotypic differences and the relationship of left ventricular reverse remodeling (LVRR) with the presence of pathogenic (P) or likely pathogenic (LP) variants of disease-associated DCM genes.

Methods

From 680 outpatients with heart with reduced ejection fraction followed at our Heart Failure Outpatient Clinic we selected subjects with a diagnosis of DCM before 65 years of age and without secondary causes of DCM including ischemic, valvular, hypertensive, or drug-induced heart disease or myocarditis. All patients underwent extensive clinical, laboratory, and imaging evaluation at the time of diagnosis and during regular follow-up visits and were offered genetic investigations with Next Generation Sequencing (NGS) of 42 disease-associated DCM genes.

Results

Of 680 DCM outpatients, 70 fulfilled the definition of idiopathic DCM and 66 gave consent to undergo genetic investigation (median age at diagnosis 57 years, 68% males). A total of 18 pathogenic/likely pathogenic (P/LP) variants were identified in 16 patients (diagnostic yield 24%), the most common (7, 39% of all variants) involving the TTN gene, followed by lamin A/C (n=3), cytoskeleton Z-disk (n=3), motor sarcomeric (n=2), desmosomal (n=1), and ion channel (n=1) gene variants. At the time of DCM diagnosis, patients with P/LP had a higher left ventricular (LV) ejection fraction (LVEF) compared with subjects (31±11% vs 28±8%, p=0.17). After a median follow-up of 53 (IQR 20-111) months, P/LP-positive patients had lower systolic and diastolic blood pressure and higher plasma natriuretic peptide levels than patients without P/LP variants. Patients without P/LP variants exhibited a larger extent of LVRR, as reflected by the increase in LVEF (+14% vs. +1%, p=0.0008) and decrease in LVEDDi (-3 vs. -1 mm/m2, p=0.03) compared with subjects carrying P/LP variants (Figure).

Conclusions

Our results confirm the high diagnostic yield of genetic testing in selected DCM patients and suggest that identification of P/LP variants in DCM portends poorer left ventricular reverse remodeling in response to guideline-directed medical therapy.
102 ICD IMPLANTATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY (HCM): A LONG-TERM SINGLE CENTER EXPERIENCE
Authors: Buongiorno Antonia Luisa , Blandino Alessandro , Bianchi Francesca , Masi Andrea Sibona , Mabritto Barbara , Luceri Stefania , Bongioanni Sergio , De Rosa Catia , Tommasello Antonino , Parrini Iris , Grossi Stefano , Musumeci Giuseppe
Published: December 2022

Background

Subcutaneous ICD (S-ICD) is a safe and effective tool in preventing sudden cardiac death (SCD) and it has the potential to overcome the limitations of transvenous ICDs. Because of increased left ventricular mass and unpredictable electrical substrate, concerns regarding the safety and efficacy of S-ICD in hypertrophic cardiomyopathy (HCM) patients have been raised.

Material and Methods

We retrospectively collected clinical data from consecutive HCM patients who underwent ICD implantation and were followed at our Cardiology Department from January 2000 to January 2022.

Results

Among 702 HCM patients, 52 (7.4%) received an ICD (female, 30.7%; mean age at implantation, 49 ± 20; primary prevention, 86.5%; S-ICD, 13%; single-chamber ICD, 50%). During a mean follow up of 8 ± 5 years, 27 shocks occurred in 20 (38%) patients of which 11 appropriate shocks (AS) in 9 (17%) patients and 16 inappropriate shocks (IS) in 11 (21%) patients, respectively after 4.3 ± 3 and 5 ± 4 years. AS were due to ventricular tachycardia (7) and ventricular fibrillation (4) and occurred in 9 patients with transvenous ICD vs. 0 in S-ICD patients (100% vs. 0%, p=0.32). IS were due to AF (8), PSVT (3), sinus tachycardia (2), and oversensing (3), with a non-significant trend towards a higher rate in patients with transvenous ICD compared to those with S-ICD (33% vs 14%, p=0.41). Device-related complications (DC) were recorded in 14 (27%) patients and were secondary to lead fracture (6), pocket hematoma (3), pneumothorax (1), device malfunctioning (1), endocarditis (2), and venous thrombosis (1). Compared to S-ICD, transvenous ICD was associated with a non-significant higher risk of DC (31% vs. 0%, p=0.17).

Conclusions

In HCM patients at high risk of SCD, when compared to transvenous ICD, S-ICD is related to a non-significant lower rate of IS and DC, with similar rate of AS. Further randomized studies as well as large prospective registries are needed to confirm these findings.