bluuebunny/crossref_metadata_2025 huggingface dataset:
P24 AN UNSUAL ENDOCARDITIS
Authors: Arrigoni P , Ammendolea C , De Leo A , Coscarelli Mezzano S , Sartor R
Published: May 2023

In February 2021 a 28 years old woman presented with effort dyspnea. She refers a history of post caesarean section sepsis treated with antibiotic therapy. At TTE and following TEE: thickening of the interatrial septum, protruding neoformation in the left atrium as well as mitral valve steno–insufficency related to infiltration of the neoformation. The patient was then referred for cardiac surgery in Vicenza. The resection of the neoformation infiltrating the left atrium, interatrial septum, leaflet, annulus and papillary muscles of the mitral valve was performed (minithoracotomy). Finally valve replacement with Hanckock bioprosthesis no. 27 was performed. Extemporaneous histological examination showed a possible intimal sarcoma, which was subsequently confirmed (G3, IV stadium, MDM2+). At CT angiography evidence of vascular involvement (VCI and pulmonary vein) and possible secondary sites. The patient was referred to the regional reference centre (C.R.O. Aviano) where she was treated with six cycles of chemotherapy with EpiADM and Ifofosfamide, resulting in excellent remission of the tumour. At control PET/CT with FDG (01/22) substantial absence of disease. Intimal sarcoma (ISA) is an exceedingly rare undifferentiated sarcoma that arises in the pulmonary artery and less frequently in the aorta or its branches. ISAs behave highly aggressive with a mean patients’ survival ranging from 5 to 18 months. Patients with ISA are mostly of middle age at diagnosis and typically present with non–specific symptoms, which sometimes masquerades as thromboembolic disease. Thus, patients are often diagnosed in an advanced disease stage. Furthermore, ISAs are often reported to be resistant to conventional chemotherapy.
P30 A STONE ON THE HEART
Authors: Viele A , Lombardi M , Trivisonno A , Pierro A , Paolone P , Colavita A
Published: May 2023

We report a case of a 71–year–old female patient presented to our observation with worsening episodes of chest pain associated with cold sweat and spontaneous regression. Seven months earlier, the patient had undergone mitral valve replacement surgery with bioprosthesis for severe insufficiency. Pre–operative coronary angiography had documented the absence of significant lesions of the coronary arteries. Four months after the operation, hospitalisation was necessary due to an infective endocarditis on the prosthetic valve, effectively treated with specific antibiotic therapy. The patient came to the Emergency Department reporting episodes of stress related angina, lasting for a few days. The ECG documented sinus rhythm and non–specific anomalies of the ventricular repolarization phase. The haematochemical tests showed a minimal increase in the HS troponine values. Ultrasound documented normal left ventricular dimensions, no regional kinetic abnormalities with normal global systolic function and good functioning of the mitral bioprosthesis. The patient was admitted in our department of cardiology for further investigations. The next day the patient complained of severe oppressive chest pain with ECG evidence of diffuse ST–T segment depression and elevation in aVR and V1. Blood pressure was 170/90 mmHg and ultrasound showed apex hypokinesia with severely reduced systolic function. Nitrate s.l was administered with gradual improvement of symptoms and normalisation of the ECG. The patient underwent coronary angiography but during the first injection of contrast test, an anomalous stagnation of the contrast was highlighted in the aorta. It was urgently decided to perform aortic CT scan. The examination showed the presence of a voluminous pseudoaneurysm starting from the aortic bulb, partially thrombosed, which compressed the left main and the origin of the circumflex artery. The patient was therefore subjected to cardiac surgery the following day, with a good follow–up result one month after discharge.
P33 VENTRICULAR EXTRASYSTOLES IN YOUNG ATHLETIC PATIENT
Authors: Pesolo M , Casavecchia G , Mautone F , Gravina M , Brunetti N
Published: May 2023

We present a clinical case of a 19–year–old young athletic patient with reported episodes of heart palpitation. The baseline electrocardiogram was negative. Holter ECG documented: "16 single supraventricular extrasystoles normally conducted to the ventricles; 3877 polymorphic, single and repetitive, ventricular extrasystoles; 45 pairs and 4 triplets." In light of the Holter report, he underwent Exercise Testing that documented : "isolated and repetitive polymorphic BEVs, a few pairs and two 4 beats run nsVT " Since the patient had contracted SARS–COVID 19 infection about two months earlier, the first diagnostic hypothesis was to be referred to secondary myocarditis and therefore an indication for cardiac MRI was placed. Cardio–RM documented the presence of mesocardial and subepicardial fibrosis with Late Gadolinium Enhancement distribution pattern of non–ischemic type, in the mid–apical segments of the lateral wall of the left ventricle and in the lateral wall of the right ventricle at the outflow tract, findings compatible in first hypothesis with Arrhythmogenic Cardiomyopathy of the Right Ventricle.
P43 MUSIC THERAPY IN HAEMODYNAMICS: PRELIMINARY STUDY OF THE CHANGE IN VITAL PARAMETERS IN PATIENTS UNDERGOING INTERVENTIONAL PROCEDURES
Authors: D'Antonio L , Liporace P , Bartucca M , Bernardini F , Doganiero C , Rossi M , Vender V , Marelli S , Rossana A , Grigioni F , Ussia G
Published: May 2023

Introduction

Patients undergoing invasive procedures may have abnormal emotional reactivity that can lead to impaired vital signs. Music has been shown to modify physiological responses, but there is insufficient data in the literature to demonstrate the relationship between the improvement in vital signs and listening to music during interventional procedures. The aim of this study is to investigate how listening to music modifies vital signs in patients undergoing coronary angiography.

Methods

Patients admitted to the Campus Bio–Medico University Hospital of Rome for diagnostic coronary angiography were included in the study. During the procedures, patients listened to music selected by an experienced music therapist. The songs belonged to 6 musical genres and were also evaluated for agogic, tempo, and tonality. 7 phases were defined for the collection of vital signs (from the arrival in the waiting room to the stay in the "recovery room"). The results were compared with a homogeneous group of patients undergoing the same procedures.

Results

During phase 3 (insertion of the introducer), the mean systolic blood pressure was lower in the music therapy group than in the control group (139.9+–23.9 vs 145+–25.5 mmHg; p=0.529). During phase 2 (entering the room), mean oxygen saturation was higher in the music therapy group than in the control group (96 1.5% vs 95.4 1.8%; p=0.212). In all phases, the mean heart rate was lower in the music therapy group than in the control group (70.7+–10.8 vs 75+–18.1 bpm; p=0.33). The lowest mean systolic blood pressure and heart rate were recorded while listening to the Adagio and with 2/4 tempo tracks (mean systolic blood pressure 143,3+–26,9 mmHg; mean heart rate 69,7+–9,3 bpm).

Conclusions

This study was the first one to focus on changes in vital signs during music therapy in patients undergoing interventional cardiology procedures. Patients receiving music therapy showed a reduction in heart rate in all phases, a reduction in systolic blood pressure in phase 3, and an improvement in oxygen saturation in phase 2 compared with the control group. This approach may reduce the need for drug sedation and its side effects. The results are preliminary and require further analysis with a larger sample size.
P45 MINITHORACOTOMY APPROACH FOR MITRAL VALVE REDO SURGERY
Authors: Fiorentino M , Mikus E , Tripodi A , Zucchetta F , Calvi S , Sangiorgi D , Tenti E , Savini C
Published: May 2023

Objective

Redo cardiac surgery through median sternotomy still represents a challenging procedure due to the high risk of graft injuries, the presence of dense adhesions and complex valve exposure. The use of a minithoracotomy approach may reduce the surgical complexity. We report our experience performing redo mitral valve surgery through a right–sided mini–thoracotomy.

Methods

From march 2010 to May 2022, 58 patients (Median age 68 years (IQR 56–76) and 41.4% females) underwent redo mitral valve surgery through right anterior thoracotomy at our institution. Median EuroSCORE II was 3.83 (IQR 2.54–7.28).

Results

The median time from the original operation to redo surgery was 6.1 (1.0–10.3) years. First surgery was mitral repair in 60% of patients, mitral valve replacement in 15%, Coronary Artery Bypass Grafting in 12% and Aortic valve Replacement in nearly 9% of our population. Four patients (6.9%) were affected by active endocarditis at the time of surgery. Median cardiopulmonary bypass and cross–clamp times were 120 (IQR 80–148) minutes and 81 (IQR 59.5–114) minutes, respectively. No conversion to full sternotomy was necessary. Twenty–eight patients (48.3%) required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 6 patients (10.3%) and 7 patient (12.1%) required Pace–maker implantation due to third degree AV block. Moreover, we observed 1 rethoracotomy for bleeding (1.7%). One patient (1.7%) required re–intubation, dialysis and Extracorporeal Life Support, for a septic shock that finally caused exitus. Median ventilation time was 7 hours (IQR 4–13). Median ICU and in–hospital length of stay were 2 (IQR 2–3) days and 10 (IQR 8–15) days respectively. In–hospital and 30–days mortality was 1.7%.

Conclusions

In our experience, a minimally invasive approach through right thoracotomy for redo mitral valve procedures is safe and feasible, with acceptable CPB and Cross–clamp times and good in–hospital outcomes. Therefore, it can be an attractive option for patients with previous cardiac surgery, above all for patients with patent grafts. Further studies are needed with a bigger population and a comparison to full sternotomy results.
P47 MITRAL VALVE RE–REPAIR THROUGH A RIGHT MINITHORACOTOMY
Authors: Mikus E , Calvi S , Fiorentino M , Sangiorgi D , Pin M , Tripodi A , Brega C , Tenti E , Savini C
Published: May 2023

Objective

Recurrent mitral valve regurgitation after prior repair is usually treated with re–repair or replacement through a median sternotomy. We report our small initial experience with mitral valve re–repair through a repeated minimally invasive approach.

Methods

From July 2018 to November 2021, 10 patients (median age 52 years IQR 49–68; male 90%) underwent isolated mitral valve re–repair with a right mini–thoracotomy approach with peripheral arterial and venous cannulation. Median Euroscore II was 2.05 (IQR 2.03–2.54).

Results

The median time from the original operation to redo surgery was 4.7 (3.5–8.1) years. Median cardiopulmonary bypass and cross–clamp times were 128 (IQR 109–134) and 99.5 (IQR 81–112) minutes, respectively. Failure of previous mitral valve repair was mainly due to Gore–Tex chordal rupture (3 patients), annular detachment (3 patients), native chordal rupture (2 patients), and posterior leaflet prolapse (2 patients). Concerning the surgical terchnique, a complete mitral valve ring Corcym Memo 3D or 4D was used in 8 patients while additional repair techniques were needed 5 patients (PTFE neochords implantation, cleft or commissure closure). No conversion to full sternotomy and no reoperation for bleeding was necessary. Median ICU and hospital stay were 2.0 (IQR 2.0–2.0) and 7.5 (7.0–9.0) days respectively. Median follow up time was 3.5 (2.8–3.9) years. Neither deaths nor major postoperative complications occurred in the follow–up period.

Conclusions

In our experience, mitral valve re–repair can be an attractive option for patients with failure of previous mitral valve surgery and can be safely performed through a minimally invasive approach with good outcomes. Main advantages seem to be the avoidance of extensive surgical dissection, optimal valve exposure, and low risk of surgical complications.
P49 THE IMPACT OF MITRAL VALVE SURGERY ON VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH BARLOW’S DISEASE: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY
Authors: Ascione G , Azzola Guicciardi N , Boccellino A , Lapenna E , Palmisano A , Della Bella P , Esposito A , Agricola E , Alfieri O , Castiglioni A , Maisano F , Vergara P , De Bonis M
Published: May 2023

Background

Barlow’s disease is associated with malignant ventricular arrhythmias (VA) and sudden cardiac death. No definitive data are available on baseline arrhythmic burden and evolution of VA in pts undergoing mitral surgery for concomitant severe mitral regurgitation (MR), therefore we started a prospective, single–center study with these two aims. Materials &

Methods

From February 2021 to May 2022, 88 consecutive pts with severe MR and Barlow’s disease were admitted to our Institution for surgical treatment of MR and were prospectively enrolled in this study. All pts underwent 24–hour Holter monitoring before surgery. A subgroup of them (16 pts, 18.2%) also had either cardiac MRI or CT scan, to detect myocardial fibrosis. Sixty–three mitral repair pts completed 3 months echocardiographic and Holter follow–up. Significant arrhythmic burden was defined as >= 1% premature ventricular beats (PVB)/24 h or at least one episode of non sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT) or ventricular fibrillation (VF). Preoperative, intra and postoperative variables were compared between arrhythmogenic (AR) and non–arrhythmogenic (NAR) pts.

Results

At baseline (88 patients): • 29 patients (33%) had significant arrhythmic burden (median 2000 PVB/24h) and 59 did not (67%, median 24 PVB/24h) • AR pts tended to be more often females with history of palpitations. Changes in VA were assessed in 63 mitral repair pts who completed 3 months follow–up. Among them, those with significant arrhythmic burden at baseline (20 pts) did not show significant VA at follow–up in 55 % of cases, while pts without relevant VA at baseline remained free from them in 81.4% of cases and worsened in 18.6% (8 pts).

Conclusions

In our experience, 1/3 of Barlow’s pts with severe MR, referred for mitral surgery, showed a significant arrhythmic burden.These pts more frequently experienced palpitations and were affected by polymorphic PVB, but no other differences were found in clinical or echocardiographic characteristics (including MAD prevalence) between AR and NAR subjects. Almost half of pts with arrhythmic burden at baseline were free from significant VA after mitral repair. However, a minority (18.6%) of subjects without arrhythmic burden at baseline experienced a significant PVB burden at follow–up. Our prospective study will continue to enroll pts to investigate in a larger sample with longer follow–up the role of MV repair on VA.
P58 SCREENING FOR SUBCLINICAL ATRIAL FIBRILLATION AFTER EMBOLIC STROKE OF UNDETERMINED SOURCE: A SINGLE CENTRE EXPERIENCE
Authors: Gaziano M , Mannino M , Migano A , Gasparro A , Bonocore M , Cicerone C , Lo Coco D , Terruso V
Published: May 2023

Introduction

Embolic stroke of undetermined source (ESUS) describes a stroke for which no cause has been found, which implicates embolism as a cause of stroke. There are several mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation (AF), hypercoagulable state or undiagnosed malignancy. As ESUS is associated with a significant stroke recurrence, a clear risk prediction and management is of utmost importance to improve prognosis. In ESUS, the options for further investigation include long–term cardiac monitoring, transesophageal echocardiography, investigation for occult malignancy or arterial hypercoagulability. Implantable cardiac monitors offer the capability to maximize the chances to detect AF and should be considered after non–invasive monitoring in patients with previous stroke at higher probability of having AF. Current guidelines do not suggest a specified approach (ie, blood, echocardiographic, ECG or brain imaging biomarkers) to screen AF in ESUS patients.

Methods

We enrolled consecutive patients with ESUS admitted to our Stroke Unit from January 2021 to October 2022.

Results

In the study period, 509 patients with acute ischemic stroke were admitted in our Stroke Unit. ESUS was diagnosed in 10.6% of patients (54/509). Only 12 of these patients underwent loop recorder implantation (mean age 76.5 y, 75% male), according to clinician judgment. AF was detected in 16.6% of these patients (2/12).

Conclusions

AF is one of the causes of ESUS; a recognition of AF in these patients is important, because its treatment can modify the risk of recurrence. A tailored diagnostic pathway, including clinical and echocardiographic parameters, is advisable to improve the recognition of this arrhythmia in ESUS patients.
P60 THE ELECTROPHYSIOLOGICAL DIAGNOSIS OF THE CRYPTOGENETIC STROKE
Authors: Altieri T , Dentico A , Ferrieri A , Carretta F , D'Agostino C , Carretta D
Published: May 2023

Introduction

In the neurological field, one of the pathologies not yet fully clarified from an etiopathogenetic point of view is cryptogenic stroke. This definition applies to all those forms of stroke in which clinical–instrumental investigations have not been able to define the "primum movens". In the literature, a significant percentage of cryptogenic stroke is the result of Paroxysmal Atrial Fibrillation (FAP). Currently the recognition of asymptomatic and rapidly evolving forms of AF can be investigated with the use of implantable electrocardiographic recorders (Loop Recorder or ILR) which increase the recognition rate of AF compared to standard investigations. The Loop Recorders, monitoring the electrical activity of the heart, are automatically activated and record the event. This data, thanks to a transmission system, as well as being stored in the memory of the recorder and therefore being interrogated, is sent to a central server which in turn transmits it to the control room which stores the patient and the events remotely.

Objectives

To diagnose the cause of the cryptogenic Stroke through the implantation of the ILR with long–term monitoring, up to 36 months.

Methods

All patients admitted to the Stroke Unit with cryptogenic stroke were evaluated with the ESUS SCORE. Patients who tested positive at the administration of the score underwent Loop Recorder (ILR) implantation for prolonged cardiac monitoring in the clinical suspicion of FAP as the cause of cryptogenic stroke. The results of such monitoring were documented along with the duration of hospital cardiac monitoring.

Results

A total of 210 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) were identified. Of the strokes, 22 (10.4%) were classified as cryptogenic. These patients underwent a Loop Recorder implant and were monitored for 12 months. 6 out of 22 patients (27.2%) were affected by atrial fibrillation and were treated with warfarin.

Conclusion

Continuous Loop Recorder monitoring changed the drug treatment of 27.2% of cryptogenic stroke patients due to intermittent AF detection despite no AF detection by electrocardiography and in–hospital telemetry monitoring.
P63 THE EQUIVOCAL AND DANGEROUS CLASSIFICATION OF STABLE CHEST PAIN
Authors: Cosmi D , Tarquini B , Mariottoni B , Cosmi F
Published: May 2023

Background

The classification of suspected anginal stable chest pain into typical, atypical, and non anginal is equivocal and may lead to patient perceptions and physician decisions that do not match the importance of the clinical picture. The study compares the clinical and ischemic burden with that of the cardiovascular risk.

Methods

Over 15 years, 3588 outpatients, >35 years old (mean 64±9, female 55%) were evaluated for stable chest pain. 290 patients with findings indicative of ischemic heart disease, heart failure, cardiomyopathy, valvular disease were excluded. In the others we applied the classification of typical, atypical and nonanginal pain (Table 1). All were evaluated for the presence of HEART score risk factors (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non–anginal pain according to the doctor‘s judgment performed functional tests to search for ischemia.

Results

In Table 2 we find the results of the classification of chest pain and the positivity of the functional test. In Table 3 we have the major events at follow–up stratified according to the initial assessment of chest pain. Table 4 stratifies events according to risk factors and age. Prognosis and event rate differ significantly only when stratified by risk factors and age. Approximately 1% presented a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. 9% of heavy smokers aged <65 years had a major event and are the highest risk group with a peak of 12.5% ​​in those with atypical pain.

Conclusions

The traditional classification of stable chest pain is dangerous and misleading, both for the identification of ischemia and prognosis, which appears to be linked to the burden of cardiovascular risk and above all to cigarette smoking in patients aged <65 years, rather than the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search for high–risk coronary lesions improves the prognosis with an added value with respect to the treatment of lifestyles and risk factors.
P71 SGLT2I IN THE REAL WORLD: DATA FROM THE PONTE (BRIDGE) HF PROJECT (PDTA FOR INTEGRATED TERRITORY HOSPITAL FOLLOW–UP OF PATIENTS WITH HEART FAILURE)
Authors: De Gennaro L , Iacoviello M , Grande D , Bulzis G , Cataneo L , Citarelli G , Correale M , De Masi G , Donadeo V , Di Stolfo G , Ferraretti A , Galgano G , Gioia I , Leone M , Malerba L , Marazia S , Minielli V , Petruzzi P , Potenza A , Rizzo C , Ruggiero M , Brunetti N , Caldarola P
Published: May 2023

Background

The DAPA–HF and the EMPEROR reduced trials showed that sodium–glucose cotransporter type 2 inhibitors (SGLT2i) dapagliflozin and empagliflozin, on best medical therapy, resulted in a reduced incidence of the combined primary outcome cardiovascular death and worsening heart failure (–26%) and a preventive effect on renal function decline. Based on this evidence, the 2021 ESC guidelines have included SGLT2i in class I recommendations in combination with angiotensin and neprilysin receptor inhibitors (ARNI) or ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB), beta–blockers (BB), and mineral corticoid receptor antagonists (MRA). However, the effect of adding SGLT2i in real–life patients is just partly known. The aim of the study was therefore to evaluate the impact of SGLT2i in a real world population of patients with heart failure and reduced left ventricular ejection fraction (HFrEF).

Methods

220 consecutive patients with HFrEF, treated with SGLT2i and with 6 months of follow–up already enrolled in the PONTE (BRIDGE) HF project (PDTA FOR THE INTEGRATED FOLLOW–UP IN THE HOSPITAL TERRITORY OF THE PATIENT WITH HEART FAILURE), a care model implemented in Puglia region (Italy) based on hospital–territory integration aimed at the optimized management of patient with HF after hospitalization, were considered for the study. Demographic, clinical, laboratory and instrumental characteristics and changes in NYHA class, creatinine, NT proBNP, loop diuretic dose, LVEF after initiation of therapy with SGLT2i were evaluated.

Results

The 220 enrolled patients (mean age of 62 years, 72% hypertensive, 38% diabetic, 67% with ischemic heart disease, 50% with ICD/CRT, 44% with atrial fibrillation, 5.6% in NYHA class I, 61% class II, 33% class III, mean LVEF 30±11%) were in treatment with BB in 93% of cases, with MRA in 94%, with ACE/ARB in 24% and with ARNI in 80%. At 6–month follow–up of, a reduction of patients in NYHA class III from 33 to 20%, an increase in patients in NYHA class II from 61 to 70%, and in NYHA class I from 5.6 to 10% were observed; the LVEF (30 vs 37.2%) and creatinine values (1.3 vs 1.5) increased significantly, while loop diuretic doses decreased (35 vs 97.5).

Conclusions

Data from patients treated with SGLT2i from real world seem to confirm the efficacy of this class of drugs already in a short term follow–up, with a positive effect on NYHA class, LVEF, and renal function.
P72 A CASE OF DRAMATIC HEART CHAMBERS REVERSE REMODELING AND DISEASE REGRESSION IN A PATIENT WITH HEART FAILURE AND END–STAGE RENAL FAILURE TREATED WITH SACUBITRIL/VALSARTAN AND SGLT2I: THE IMPORTANCE OF PUSHING THE BOUNDARIES
Authors: Mapelli M , Mantegazza V , Ferrari C , Cimino R , Maragna R , Pontone G , Palermo P , Amelotti N , Matteo S , Pepi M , Agostoni P
Published: May 2023

Background

Heart failure (HF) therapy has been disrupted by the introduction of 2 new prognostic–relevant drugs: Sacubitril/Valsartan and SGLT2i. However, the amount of evidence for guideline–directed HF therapies in the context of chronic kidney disease (CKD) is relatively modest, especially in advanced stages (e.g., on haemodialysis). Aim of this report is to describe the feasibility and the efficacy of HF medical therapy in a patient with naive HFrEF and CKD on haemodialysis. Case report: A woman in her 40’s, with no cardiovascular history, affected by polycystic kidney disease end end–stage CKD placed on hemodialysis for the previous 9 months, underwent a echocardiography (TTE) in 09/2021, as part of investigations for kidney transplantation. The TTE showed a picture consistent with dilated cardiomyopathy with reduced EF, severe left atrium (LA) dilation and moderate–to–severe mitral regurgitation (MR). Thus, the patient was temporarily suspended from the transplant list. She was on chronic diuretic therapy with high dose of furosemide (250mg b.i.d.), with a residual diuresis of 400–500 mL per day. An elective coronary angiography showed normal coronary arteries. A Cardiac Magnetic Resonance (CMR) confirmed the diagnosis of DCM with severe dilation of the left ventricle (LV), reduced EF and severe MR. A cardiopulmonary exercise test (CPET) showed mild functional limitation with no pulmonary vascular limitation. After a multidisciplinary evaluation involving HF specialists and nephrologists, the recommended quadruple HF therapy was started and gradually up–titrated during the following 10 months. Neither the hemodialysis protocol nor the diuretic therapy was changed throughout this period. No adverse events were observed (e.g., increased sessions or dialysis schedule, hyperkalemia, hypotension). During this timeframe, the patients was asymptomatic and a progressive and sustained decrease in N–terminal pro B–type natriuretic peptide (NT–proBNP) from 26356 to 1556 ng/ml was observed. We documented a significant amelioration in CPET and other laboratory parameters (sST2), as well as a consistent reverse remodeling of the left heart chambers and a significant reduction in MR grade.

Conclusions

We described a case of significant left heart chambers reverse remodeling and disease regression in a patient with end–stage CKD presenting with HFrEF treated with off–label optimized HF medical therapy. Further studies on hemodialyzed HF patients will be needed.
P80 EFFICACY OF DAPAGLIFLOZIN IN EARLY IMPROVEMENT OF QUALITY OF LIFE IN OUTPATIENT WITH CHRONIC HEART FAILURE
Authors: Di Tano G , Quinzani F , Fiini M , Pedrinazzi C , Magatelli M
Published: May 2023

Sodium glucose cotransporter–2 inhibitors reduce mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). As a consequence, they are recommended by the European guidelines as mandatory pillar for HFrEF treatment with a strong recommendation (IA). In order to confirm the quality of life improvement shown in prespecified analysis of randomised controlled trial, we administered the Kansas City Cardiomyopathy Questionnaire (KCCQ–12) to 21 patients treated with Dapagliflozin 10mg in an outpatient setting of four Heart Failure Unit of Val Padana Hospitals. Among 21 HFrEF patients included in the analysis 11 have had coronary artery disease, 12 had hypertensive or dilatative cardiomyopathy etiology. The average age of our population was 73 yrs (54–89), 67% were male and 33% female, every patient were in NYHA II class and average BNP was 315 pg/mL. All the patients received Dapagliflozin for the entire observation period without any discontinuation for adverse event or intolerance. Every patient received KCCQ–12 questionnaire twice: at Time 0 when the first dose of Dapagliflozin was administered and after 3 months (Time 1) to verify the variation of the score. During the follow–up different therapy or dose regimen change has not occurred, as baseline therapies were already optimized. Only one patient changed furosemide dosage, reduce it from 75 to 50 mg/die without significant changes in body weight. After 3 months from the first administration of Dapagliflozin the KCCQ–12 summary score has increased by 10,27 points (from baseline avg value to 57,89 – 22% increase (Figure 1). Each of the single components of the score (physical limitation, symptoms frequency, QOL single score, social limitation) had increase in a consistent way from baseline values (Figure 2) In conclusion our data from an outpatient setting of real–world chronic HF population confirm the results of secondary analysis of the Trials and show that adding Dapagliflozin to the standard of care therapy leads to an early improvement in quality of life and physical limitations as quantified by KCCQ–12 questionnaire results. Furthomore, the KCCQ–12 seems to be a reliable and a useful health status instrument to evaluate the performance of HF outpatients, especially to test the benefits of new therapies.
P90 CAMPYLOBACTER JEJUNI–ASSOCIATED MYOCARDITIS: A RARE BACTERIAL TRIGGER OF ACUTE MYOCARDITIS
Authors: Ruffino E , Coppini L , Ferraro I , Giordana F , Coletta G , Desalvo P , Baralis I , Talenti A , Rossini R
Published: May 2023

Introduction

Acute myocarditis is an important cause of chest pain in the young, with potential acute arrhythmic and hemodynamic complications and possible evolution into chronic inflammatory cardiomyopathy. Even though multiple triggers can be recognized, bacterial infections are rarely associated with myocarditis in immunocompetent patients.

Case report

A 22–year–old Caucasian woman presented to the Emergency Department with stabbing chest pain exacerbated by breathing, for several hours, without fever. She experienced diarrhea and gastroenteric symptoms for 4 days. One year prior she experienced identical pain during an acute myocarditis episode, with no clear trigger. The patient’s father too suffered from myocarditis a few months earlier. She underwent routine blood tests with evidence of elevated troponin HS (peak 8000 ng/L) and PCR (82mg/L). ECG showed sinus rhythm and anterolateral concave ST elevation of a maximum of 2 mm. Echocardiography showed normal bi–ventricular dimensions, thickness, regional motion, and absence of pericardial effusion. MRI exhibited inferolateral subepicardial edema and late gadolinium enhancement (LGE). The previous MRI performed 6 months after the resolution of the previous myocarditis did not show any LGE or edema. We began empirical anti–inflammatory therapy with swift benefit. Due to the persistence of gastroenteric symptoms, fecal film array and coproculture were performed and resulted positive for Campylobacter Jejuni, treated with Azithromycin 500 mg/day for 3 days. Finally, considering the recurrent event and the family history of myocarditis in the father, a genetic test was planned to exclude a “hot phase” in the context of arrhythmogenic cardiomyopathy.

Discussion

Up to 80% of acute myocarditis has an infectious trigger. The recent 2020 consensus advises against routine serology unless specific pathogens are suspected. In the literature, Campylobacter Jejuni is reported as a trigger of various inflammatory diseases, including acute myocarditis. We suggest investigating the presence of this bacterium in stool in case of active gastroenteric symptoms and adding targeted antibiotic therapy in case of active bacterial infection. Previous case reports excluded viral in myocarditis patients positive for Campylobacter. This may support C. Jejuni’s causal role and not as an innocent bystander.
P92 PERIMYOCARDITIS AS FIRST MANIFESTATION OF DYSTHYROIDISM: AN UNUSUAL CASE
Authors: Gualini E , Occhi L , Maida G , Dalino P , Pedrotti P , Gallone G , Gentile P , Casadei F , Giannattasio C
Published: May 2023

Thyroid and cardiovascular system are inextricably related and cardiovascular complications can occur in both subclinical and overt thyroid dysfunction. We report the case of a 42–year–old woman presenting with chest pain. She had a positive SARS–CoV–2 swab in June and she was hospitalised in suspicion of COVID–related pneumonia and pericarditis in July: treatment with ibuprofen and colchicine was started and patient was discharged. On July 26th, the patient came back to emergency department due to worsening chest pain and myalgias after therapy decalage. She had face edema and hoarse voice. 12–leads EKG was normal; echocardiography showed 8 mm pericardial effusion and normal ejection fraction. Blood testing revealed no inflammatory signs, a mild increase of Troponin (peak value 19.1 ng/L, n.v. 0–14) and a high value of CPK (peak value 2299 U/L, 464 U/L at time of discharge, n.v. 30–150). Moreover, she had a biohumoral profile of Hashimoto thyroiditis: severe hypothyroidism with increase in TSH levels (538 microU/ml peak value, 322 microU/ml at time of discharge, n.v. 0.27–4.2) and positivity to thyroid autoantibodies. The patient underwent a cardiac magnetic resonance imaging that was suggestive for acute perimyocarditis with biventricular diffuse myocardial edema, preserved biventricular function and mild–to–moderate pericardial effusion. Low dose L–T4 therapy was started together with liothyronine that was stopped after few days, once acceptable FT3 concentrations were obtained. At echocardiography control after 8 days, we registered a significant reduction of pericardial effusion (2 mm). Myocarditis is an inflammatory disease of the myocardium and it is predominantly mediated by viral infection. A rare cause of myocarditis is represented by dysthyroidism. In our case, the severe hypothyroidism seems to be the cause of myocardial and pericardial edema. The failure in diagnosis of this endocrinological disorder can determine a delay in specific therapy with possible serious cardiovascular manifestations. So, it would be reasonable to check the thyroid status of all patients presenting with myopericarditis, in the absence of another clearly identifiable aetiology. The role of to the prior SARS–CoV–2 infection in not certain in our case, but the quick recovery after specific endocrinological therapy suggests the low probability of perimyocarditis as SARS–CoV2 related manifestation.
P113 TRANSCATHETER CORRECTION OF RESIDUAL INFERIOR SINUS VENOSUS DEFECT AFTER SURGICAL CLOSURE
Authors: Granata G , Corciu A , Oliveri F , Bollati M , Bedogni F , Mazzarotto P
Published: May 2023

A 21–year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV–ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event. The contrast transcranial Doppler (CTD) was positive for right–to–left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left–to–right shunt and severe RLS after Valsalva’s Manovre (>20 bubbles) (fig.A–B). No clear intra–cardiac source of embolization was detected on workup. After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior–posterior rim towards the IVC (<5 mm). A Figulla Flex II ASD Occluder with the smallest waist of 4 mm was implanted with no evidence of residual intraprocedural shunt; no intraprocedural complications were observed (fig.C). The 1 month follow–up CTD was negative for RLS.

Conclusions

Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior–inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case–by–case basis. Reference 1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure. Cardiovascular Intervention and Therapeutics (2021) 36:256–259 2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002
P114 NO CONTRAST APPROACH FOR TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH SEVERE RENAL DISFUNCTION
Authors: Pignatelli G , Travaglio N , Cavalla F , Elicio A , Carrozzo A , Pantaleo P
Published: May 2023

Introduction

Transcatheter aortic valve implantation (TAVI) is nowadays the preferred procedure for patients with symptomatic aortic stenosis (AS) older than 75 years or not suitable for surgery. On the other hand, acute kidney injury (AKI) is one of the strongest predictors of mortality after TAVI The purpose of our study has been to evaluate the impact of a no–contrast approach for TAVI in patients with severe renal disfunction.

Methods

41 consecutive patients were enrolled from April 2021 to June 2022 in our Center. Mean age was 83 ± 5 yo, 43% were women. Mean glomerular filtration rate 29 ± 4.2 ml/min; The Society of Thoracic Surgeons mortality score (STS Score) was 16.1 ± 4.5. All procedures were performed without use of contrast dye. All patients underwent angio computed tomography (CT) and Coronary angiography with a minimal use of contrast dye at least two months before the procedure. Echo scan was perfomed to evaluate the femoral and carotid arteries anatomy Outcomes and events were evaluated according to the Valvular Academic Research Consortium 2 criteria (VARC–2). Baseline and postopertative creatinine were collected for each patient and glomerular filtration rate was calculated using CKD–EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Acute kidney injury was defined using KDIGO definitions as an increase in serum creatinine (Scr) by ≥ 0.3 mg/dl (26.5 mol/l) within 48 hours; or increase in SCr to ≥ 1.5 times base–line or urine volume < 0.5 ml/kg/h for 6 hours. TAVI procedure was performed under general anesthesia. Intraprocedural transesophageal echocardiogram was used for annulus valve sizing and to monitor proper positioning of self–expanding bioprosthesis.

Results

No patients died during hospital stay. A permanent pacemaker before discharge was required in 2 cases. No patients developed acute kidney injury at 48 h or at discharge. At 3 and 6 months of follow up, two patients died, one for cerebral event and one for sudden death; mean glomerular filtration rate and creatinine values were similar to pre–discharge values.

Conclusions

Our data show that a zero–contrast TAVI approach in patients with advanced chronic kidney disease is feasible and should always be considered for these subset of patients
P121 MITRAL VALVE STENOSIS ASSOCIATED WITH LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION: A TERRIBLE COMBINATION WITH A DIFFICULT TREATMENT
Authors: Deola P , Carasi M , Zadro M , Iavernaro A , Lentini P , Onorato E , Chirillo F
Published: May 2023

Case n. 1 A 77 year–old woman with obstructive hypertrophic cardiomyopathy who had undergone alcohol septal ablation with a reduction in dynamic left ventricular outflow tract (LVOT) gradient from 95 to 65 mmHg was hospitalized for pulmonary oedema. Echocardiography and cardiac catheterization confirmed the presence of obstructive hypertrophic cardiomyopathy with a dynamic gradient of 65 mmHg, and identified a severe calcific mitral stenosis (3D planimetric area= 0,9 cm2). There was severe postcapillary pulmonary hypertension (pulmonary artery mean pressure of 60 mmHg and pulmonary capillary wedge pressure of 26 mmHg). The patient underwent a combined surgical intervention of mitral valve replacement (Epic 27 mm bioprosthesis) and surgical septal myectomy via a mini–thoracotomic approach. After the intervention there were dehiscence and infection of the thoracotomy and right inguinal surgical wounds, septic shock, hyporexia (with marked cachexia), emotional instability and delirium. After 21 days of hospitalization in the ICU, the patient was transferred to a medical department and died seven days later. Case n. 2 A 82 year–old woman with severe mitral stenosis associated with marked left ventricular hypertrophy and LVOT obstruction was admitted for heart failure and worsening renal function. Her comorbidities included diabetic neuropathy and stage 4 chronic kidney disease. Cardiac catheterization excluded significant coronary artery disease; mitral valve area was 1 cm2, and LVOT gradient was 75 mmHg. Pulmonary artery mean pressure was 32 mmHg, pulmonary capillary wedge pressure was 25 mmHg, and right atrial mean pressure was 8 mmHg. She was deemed a high–risk surgical candidate. The patient therefore was treated initially with peritoneal dialysis. However she demonstrated persisting pulmonary congestion. An atrial septostomy inserting a 8–mm Atrial Flow Regulator was subsequently performed, with an immediate reduction of capillary wedge pressure to 18 mmHg. In the following 18 months the patient had no more hospitalizations for heart failure.

Conclusion

The association between mitral stenosis and LVOT obstruction is associated with elevated capillary wedge pressure and frequent episodes of heart failure. Surgical intervention remains the first therapeutical option. Nevertheless, in older patients, the association between atrial septostomy and peritoneal dialysis may represent a valuable solution, with a lower operative risk.
P125 LEFT ATRIAL AND VENTRICULAR STRAIN, AND 3D–ECHOCARDIOGRAPHY FOR SUBCLINICAL CHEMOTHERAPY–RELATED CARDIAC DYSFUNCTION IDENTIFICATION IN PATIENTS WITH BREAST CANCER
Authors: Magnesa M , Casavecchia G , Pesolo M , Mautone F , Barone R , Masella A , Brunetti N
Published: May 2023

Cardio–oncology is a recent rapid–developing multidisciplinary approach created by oncologists in accordance with cardiologists with the objective to minimize the adverse cardiovascular effects of contemporary cancer therapy and to maximize the benefits that can be obtained from it. Pre–treatment cancer therapy–related cardiovascular toxicity (CTR–CVT) risk assessment can be performed using HFA–ICOS risk assessment tools, in addition to a careful clinical history analysis, physical examination, ECG, biomarkers, and echocardiography. In our study, the analysis of standard and advanced echocardiographic parameters (left atrial strain or LAS, left ventricular global longitudinal strain or GLS, and 3D echocardiography) were performed at baseline, at three, six, and 12 months timepoints. A number of 53 female patients with breast cancer, scheduled to receive chemotherapy, was enrolled. All patients had basal 3D LVEF values ≥ 50% and a basal GLS > –18,5%. Statistically significant reductions (p<0,001) in 3D LVEF at three, six, and 12 months compared to baseline were found, and in all cases 3D LVEF levels were within the reference values (3D LVEF ≥ 50%). GLS and atrial strain parameters (LASr and LASct) were significantly reduced compared to the baseline at 3 months (GLS p<0.01; LASr p<0,001; LASct p<0,001), 6 months (GLS p<0.05; LASr p<0,001; LASct p<0,001) and 12 months (GLS p<0.01; LASr p<0,05; LASct p<0,01). Moreover, 10 patients out of 53 (18,87%) had asymptomatic cardiotoxicity (expressed by >15% of GLS reduction compared to baseline) after 12 months, and 17 out of 53 patients (32,08%) had atrial dysfunction (expressed by >15% of LASr reduction compared to baseline) after three months. Although atrial dysfunction was not statistically significant in predicting asymptomatic cardiotoxicity (p=0.12), patients with atrial dysfunction at three months have a 3,7 times greater risk of developing asymptomatic cardiotoxicity at 12 months. With our analysis, we found that HFA–ICOS risk score could be considered a predictor of cardiotoxicity at 12 months (p<001). Further studies will be conducted, in order to expand the population and to confirm our results.
P127 ASSESSMENT OF LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN A POPULATION AFFECTED BY CANCER AND IN THERAPY WITH POTENTIALLY CARDIOTOXIC CHEMOTHERAPY
Authors: Spinelli A , Cianfrocca C , Di Fusco S , Di Michele S , Aquilani S , Colivicchi F
Published: May 2023

Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. The aim of this observational study is to analyse some echocardiographic (echo) features of patients affected by cancer evaluated in our laboratory.

Methods

We studied patients who came to our laboratory for echo assessment of potential chemotherapeutic cardiotoxicity in October and November 2022. We performed complete echocardiograms (Philips Epiq 7) with a focus on systolic (left ventricular ejection fraction, LVEF and GLS) and diastolic function.

Results

Over the study period, 112 cancer patients underwent echo. Twenty–six patients waiting to start radio/chemotherapy were excluded from analysis. Twenty patients were excluded due to poor quality of echo images. The majority of patients were female (92%, mean age 61.9 years). The predominant type of cancer was breast cancer (78%), followed by prostate cancer (4%), ovarian cancer (2%), and lymphoma (2%). No patients had signs or symptoms of heart failure. Twenty–three patients had a history of hypertension, 3 had diabetes mellitus, and 1 had coronary artery disease (Table 1). We separately evaluated patients according to cancer treatment. Twenty–four patients (28%) had been treated with anthracycline (AT), 3 patients (3%) had been treated with AT in combination with trastuzumab, 9 patients (10%) had been treated with trastuzumab monotherapy, 25 patients (29%) had been treated with left chest radiotherapy (RT) and were currently undergoing hormone therapy (HT), and 25 patients (29%) had been treated with other chemotherapy (CT), specifically tyrosine kinase inhibitors, anti VEGF–drugs, taxanes, and antimetabolites. No moderate or severe dysfunction was found in the study population, however 52 patients (60%) had mild diastolic dysfunction. The mean EF value was 63% and the mean GLS value was 17.4% (Table 2). Ten patients had reduced GLS values (< 16%) with normal EF. Of these patients, 2 had been treated with AT, 3 with trastuzumab, 2 with HT, and 3 with other CT (Table 3).

Conclusions

According to the literature, GLS assessment during/after cardiotoxic CT could help identify subclinical left ventricular dysfunction. Our data, derived from a short observation period, show mild reduction in GLS in asymptomatic patients treated with different CT, thus suggesting a potential benefit of closer follow–up of these pts.