bluuebunny/crossref_metadata_2025 huggingface dataset:
948 MULTIMODALITY IMAGING IN CARDIAC MASSES
Authors: Angeli Francesco , Bergamaschi Luca , Stefanizzi Andrea , Armillotta Matteo , Sansonetti Angelo , Amicone Sara , Bodega Francesca , Fedele Damiano , Canton Lisa , Suma Nicole , Tattilo Francesco Pio , Impellizzeri Andrea , Galiè Nazzareno , Rinaldi Andrea , Paolisso Pasquale , Foà Alberto , Pizzi Carmine
Published: December 2022

Background

Cardiac masses (CM) are an extremely heterogeneous clinical scenario, including benign and malignant neoformations. After a first echocardiographic assessment, Cardiac Computed Tomography (CCT) together with Cardiac Magnetic Resonance (CMR) and 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG-PET) represent second-line and third-line imaging techniques to determine the nature of the mass. However, data regarding their diagnostic performance and a standardized imaging algorithm are lacking.

Purpose

To evaluate the different roles of CCT, CMR, and PET in defining the nature of CMs and to propose an evidence-based, stepwise, diagnostic approach.

Materials and methods

Out of 312 patients with suspected mass from January 2000 and August 2022, we enrolled 87 patients who underwent CCT, CMR and 18-FDG-PET within a month from the initial evaluation. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. For each imaging technique, we identified a model with the strongest predictors of malignancy at multivariate analysis and evaluated their ability to discriminate between benign and malignant neoformations. A multiple model with forwarding selection was performed to identify the strongest predictors of malignancy at CCT, CMR and 18-FDG-PET.

Results

CCT model included 4 variables (irregular margins, mass dimension, invasiveness and not-hypodense lesion) with an Area Under the Curve (AUC) of 0.972, 95% Confidence Interval (CI) 0.94-1.0; CMR model included 3 parameters (invasiveness, pericardial effusion and irregular margins, AUC 0.976 with 95% CI 0.95-1.0); PET model included only cardiac maximum Standardized Uptake Value (SUVmax), with an AUC 0.87 (95% IC 0.74-0.971). When implemented with SUVmax, CCT and CMR models showed only a slight improvement in their discrimination ability (AUC 0.975 and 0.986, respectively). No statistical difference was observed between CCT and CMR models regarding their discrimination ability (AUC 0.972 vs 0.976, p=0.26). However, on a multiple model with forwarding selection evaluating CCT, CMR and PET variables, only the 3 MR parameters remained significant predictors of malignancy.

Conclusion

After a first echocardiographic assessment, the application of the CMR model may be the most accurate second-level investigation to discriminate between benign and malignant lesions. When CMR is not available, or the patient has contraindications to CMR, the CCT model performs similarly, and 18-FDG-PET provides a negligible advantage.
572 INTRAMYOCARDIAL CALCIFICATION IN APICAL HYPERTROPHIC CARDIOMYOPATHY ASSESSED USING MULTIMODALITY IMAGING: OUR CASE SERIES
Authors: Radano Ilaria , Mabritto Barbara , Luceri Stefania , Bongioanni Sergio , Maiellaro Francesco , Zappia Luca , Lario Chiara , Macera Annalisa , Cirillo Stefano , Pizzuti Alfredo , Musumeci Giuseppe
Published: December 2022

Introduction

Apical Hypertrophic Cardiomyopathy (ApHCM) characterized by persistent diastolic apical contraction results in dynamic apical small-vessel obstruction with microvascular ischemia. Of note, endomyocardial fibrosis (EMF) and calcification are described only in few patients.

Case presentation

We report 5 cases of ApHCM with apical intramyocardial calcification. They presented characteristic ECG pattern and fibrosis at echocardiogram. All patients presented a preserved ejection fraction (EF), except for one patient with mild reduced EF. Global longitudinal strain was reduced in 3 patients. Diastolic dysfunction was evidenced in 3 patients. Right ventricle involvement was detected in one patient only.On cardiac magnetic resonance, a superficial hypo-intense component, compatible with calcium and a deep layer featured by late gadolinium enhancement (LGE) related to fibrotic tissue, were revealed. LGE was present in all of patients in the apex. One patient presented an apical aneurysm, with high ESC-SCD risk score and ICD implantation.

Conclusion

EMF pathologic hallmarks were the endocardium and myocardium scarring, evolving to dystrophic calcification. In clinical practice, only a minority of ApHCM patients develops EMF and calcifications. Our clinical series is the largest one in literature. Analyzing patients’ history, a microvascular inflammatory trigger was evident in all of them, particularly severe chronic kidney disease, diabetes, high degree obesity, malaria infection, peripheral microangiopathy and form of thalassemia. This series could demonstrate the pathophysiological relation between apical fibrosis, calcification and microvascular ischemia due to hypertrophy and inflammatory conditions coexistence. A broader case series could evaluate any correlation with their long-term outcome and management strategies.
817 IDENTIFICATION OF ECHOCARDIOGRAPHIC FACTORS PREDICTING MACE AT 30 DAYS FROM NON CARDIAC SURGERY IN A PRE-HOSPITALIZATION COURSE
Authors: Rizzi Fabio , Martucciello Arianna , Goffredo Costanza , Grigioni Francesco
Published: December 2022

Background

200 million adults all over the world undergo noncardiac surgery each year, of which more over than 10 million develop MACE within 30 days of surgery. Cardiovascular complications represent the majority of the causes of mortality and morbidity (incidence from 0.5% to 30%), especially myocardial infarct and atrial fibrillation. Ecocardiographic patterns of increasing atrial size and reduction ejection fraction (EF) related to ischemic injury after surgery are related to the construction of a proarrhythmic substrate.

Methods

The study carried out at the Campus Bio-medico Polyclinic recruits a population of 100 candidates for non-cardiac surgery at intermediate or elevated-risk and with cardiac disease or cardiovascular risk factors. These patients after clinical and 12-lead ECG examination have done echocardiographic study, with evaluation of Global ventricular longitudinal strain, left atrial volume, left ventricular ejection fraction, left ventricular filling volumes and aortic vessel diameters.

Results

Patients underwent a follow-up 30 days after surgery and it was shown that there is a important significance in relation to Global Longitudinal Strain (p = 0.01) in MACE patients and a modest significance in relation to the ejection fraction (p = 0.07) among MACE patients. Patients with atrial fibrillation (p = 0.10) and type 2 diabetes mellitus (p = 0.15) have a mild predisposition to MACE. Maiority of events were 30 day after surgery in patients with elevated risk.

Conclusion

This study underlines the importance of careful preoperative selection and appropriate cardiological postoperative patient evaluation and the value of echocardiographic predictive factors of main perioperative cardiovascular events.
932 CASE REPORT OF MITROAORTIC INTERVALVULAR FIBROUS ANEURYSM IN IMMUNOSUPPRESSED PATIENT
Authors: Serratore Serena , Lombardo Vincenzo , Bellantoni Antonio , Petullà Maria , Zinzi Stefania , Mascaro Giuseppina , Indolfi Ciro , Aquila Iolanda
Published: December 2022

Introduction

infective endocarditis (IE) is a serious infection associated with high mortality and severe complications. Clinical signs of IE include manifestation of local cardiac damage, embolization of septic fragments, seeding of the infection during bacteremia, and tissue injury related to antibody response. Furthermore, immunocompromised patients are considered to be at high risk for developing infective endocarditis. This report describes a case of native valve infective endocarditis complicated by abscess formation in a oncohematological young patient.

Clinical Case

a 23-years-old male with a Hodgkin lymphoma in chemotherapy treatment, was admitted to our hospital for persistent fever, despite taking a long course of antibiotics, confusional mental state and dyspnea. Blood tests revealed anemia, neutrophilia, lymphopenia and elevated inflammatory markers (PCR, PCT, VES). The electrocardiogram showed sinus rhythm at 90 bpm with no evidence of atrio-ventricular block. S. Aureus has been isolated from the blood cultures.

The transthoracic echocardiography (TTE) showed left ventricular dilation, systolic dysfunction, a large pericardial effusion and a hyperechoic mass in the aortic root. An urgent pericardiocentesis was performed. The cytological examination of the drained fluid revealed an exudate fluid with a high proportion of neutrophils.

An urgent total body computed tomography (CT) scan was performed with no evidence of progression of malignancy, signs of pneumonia, signs of septic brain emboli. A rounded mass at aortic valve plane was detected. The mass was further evaluated with additional imaging modalities and then a transesophageal echocardiography (TEE) was performed. The exam showed: aortic posterior root abscess, involvement of left and non-coronary aortic cusps and severe aortic regurgitation.

The patient underwent urgent cardiac surgery: aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement. S. Aureus was also identified in surgically removed tissue.

Twenty days after surgery, chest CT showed no complications and the transthoracic echocardiography showed a well-seated prosthetic tissue valve with a medium gradient of 13 mmHg, and good global left ventricular systolic function and ejection fraction.

Conclusion

infective endocarditis carries a high risk of morbidity and mortality, particularly in the immunocompromised patient. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome.
97 MULTIMODAL EVALUATION OF MYOCARDIAL FIBROSIS IN PATIENTS WITH AORTIC STENOSIS
Authors: Tosto Giuseppe Giovanni , Deste Wanda , Gibiino Fortunata Alessandra , Passaniti Giulia , Tamburino Corrado
Published: December 2022

Introduction

Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac magnetic resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.

Aim

The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early marker of fibrosis. Clinical and laboratory data, particularly BNP, were also analyzed.

Material and Methods

In our study we recruited 33 patients with severe aortic stenosis, comparing echocardiographic values of GLS with those of Late Gadolinium Enhancement (LGE) and T1 mapping of CMR.

Results

70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032) and elevated Pro-BNP values (p = 0.021); for GLS, odds ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033 =) and hypertension (p = 0.025), but not with elevated Pro-BNP values.

Conclusions

In patients with severe aortic stenosis, association between GLS and LGE can help identify earlier those with structural changes caused by the disease, who could benefit from early intervention. It remains to be established, through a longer follow-up, how the presence of these alterations can influence the outcome of patients suffering from aortic stenosis.
874 A NOT-SO-RARE COMPLICATION OF CONNECTIVE TISSUE DISEASE
Authors: Bonadies Davide , Palumbo Rossana , Manna Martina La , Santopietro Mario , Sorvillo Graziano , Visco Valeria , Vigorito Francesco , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Soriente Lucia
Published: December 2022

Pulmonary hypertension is a not-so-rare complication of connective tissue diseases and is usually related with an inauspicious prognosis. We present the case of a 67-years-old woman hospitalized for progressive dyspnea.

Two-dimensional echocardiography showed numerous features related to pulmonary hypertension (PH) with moderate Mitral Regurgitation.

The right cardiac catheterization confirmed mixed PH (pre and post capillary) without chest angio-TC evidence of pulmonary thromboembolism.

Thanks to optimized medical therapy (B-Blocker, ACE-i and diuretics), there was a significant clinical improvement documented at discharge.

After 1 year, due to recurrence of dyspnea, she was admitted to our medical unit.

Her clinical examination showed some of the characteristics of a connective tissue disease.

Compared to previous echocardiography, a moderate to mild reduction of MR was documented.

Chest CT scan revealed interstitial lung disease likely related to patient's underlying pathology. Immunological screening tests detected the presence of antinuclear (ANA) and anti-topoisomerase (ATA) antibodies. Right heart catheterization documented a worsening of PH with only pre-capillary component. On the basis of the above findings, a diagnosis of CREST syndrome complicated with PH was made, and the patient was started on oral combination of macitentan and riociguat. The frequency of this complication in connective tissue disease, the need for screening tests and different treatment approaches of pre and post capillary pulmonary hypertension is discussed.
152 PERFORMANCE OF RISK STRATIFICATION SCORES AND ROLE OF COMORBIDITIES IN OLDER VS YOUNGER PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION
Authors: Stolfo Davide , Barbisan Davide , Ameri Pietro , Lombardi Carlo Mario , Monti Simonetta , Driussi Mauro , Zovatto Isabella Carlotta , Gentile Piero , Howard Luke , Toma Matteo , Pagnesi Matteo , Collini Valentino , Bauleo Carolina , Guglielmi Giulia , Adamo Marianna , D´angelo Luciana , Nalli Chiara , Sciarrone Paolo , Moschella Martina , Zorzi Barbara , Vecchiato Veronica , Milani Martina , Poi Emma Di , Airò Edoardo , Metra Marco , Garascia Andrea , Sinagra Gianfranco , Giudice Francesco Lo
Published: December 2022

Background

Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown.

Methods

Patients with PAH enrolled from 2001 to 2021 were divided in ≥ 65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. FPHN, FPHN non-invasive, COMPERA and REVEAL 2.0 risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated.

Results

Among 383 patients, 152 (40%) were ≥ 65 years old. Older patients had more comorbidities, with the exception of obesity and diabetes (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). At 5-year follow-up, 36% of ≥ 65 years patients vs 10% of <65 years patients died. Except for the COMPERA, risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74) and in younger (C-index 0.72) and older (C-index 0.69) patients. Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients, with the highest accuracy achieved in addition to REVEAL 2.0 (C-index 0.79).

Conclusions

Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients. Comorbidities increased the accuracy of risk scores only in younger patients.
345 INTRAVENOUS CANGRELOR INFUSION IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Benenati Stefano , Gragnano Felice , Capolongo Antonio , De Sio Vincenzo , Scalamera Riccardo , Bertero Edoardo , Musumeci Giuseppe , Annibali Gianmarco , Campagnuolo Salvatore , Galasso Gennaro , Silverio Angelo , Bellino Michele , Centore Mario , Menozzi Alberto , Caretta Giorgio , Rezzaghi Marco , De Luca Leonardo , Antonio Veneziano Francesco , Cirillo Plinio , De Rosa Gennaro , Calabrò Paolo , Porto Italo
Published: December 2022

Aims

To assess the clinical characteristics and compare in-hospital outcomes of elderly and non-elderly patients receiving cangrelor in the peri-percutaneous coronary intervention (PCI) phase.

Methods

Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Elderly patients were defined if age was ≥75 years at the time of PCI. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay. Independent predictors of the primary endpoint were also assessed.

Results

Out of 551 patients undergoing PCI with cangrelor between January 2019 and August 2022, 174 (32%) were elderly. Mean age was 81±5 vs. 61±8 years in elderly vs. non-elderly patients (p<0.001). Female sex (32% vs. 21%, p=0.006), atrial fibrillation (20% vs. 5%, p<0.001), chronic kidney disease (30% vs. 6%, p<0.001) and heart failure (14% vs. 8%, p=0.041) were more frequent in the elderly group, whereas presentation with acute coronary syndrome (ACS) was less frequent (69% vs. 83%, p=0.001). Elderly patients received shorter cangrelor infusion (122±25 vs. 134±43 minutes, p=0.001) and were more frequently administered with clopidogrel after PCI (50% vs. 19%, p<0.001). At 48 hours, elderly patients had higher rates of NACE (13% vs. 6%, p=0.006) and BARC 2, 3 or 5 bleeding (11% vs. 5%, p=0.013), whereas the rates of other 48-hour and in-hospital clinical endpoints did not differ. At multivariable analysis, age ≥75 years (odds ratio [OR] 1.07, 95% CI 1.02-1.12, p=0.004), major anemia (OR 1.10, 95% CI 1.005-1.22, p=0.038), ACS at presentation (OR 1.08, 95% CI 1.03-1.14), femoral access (OR 1.13, 95% CI 1.06-1.22) and cardiogenic shock (OR 1.35, 95% CI 1.21-1.50) independently predicted the occurrence of 48-hour NACE.

Conclusions

Advanced age is a distinctive risk feature among patients receiving intravenous cangrelor in the peri-PCI phase. Elderly patients had higher rates of adverse events at 48 hours, with advanced age (≥75 years) being an independent predictor of NACE.
158 AIR POLLUTION AND CORONARY VASOMOTOR DISORDERS IN PATIENTS WITH MYOCARDIAL ISCHEMIA AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE
Authors: Camilli Massimiliano , Russo Michele , Rinaldi Riccardo , Iannaccone Giulia , Lavecchia Giulia , Vergallo Rocco , Trani Carlo , Niccoli Giampaolo , Crea Filippo , Antonio Montone Rocco
Published: December 2022

Background

Coronary vasomotor abnormalities are important causes of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). However, the role of air pollution in determining coronary vasomotor disorders has never been investigated.

Objectives

We aimed to evaluate the association between long-term exposure to particulate matter 2.5 (PM2.5) and 10 (PM10), and coronary vasomotor disorders in NOCAD patients.

Methods

Patients with myocardial ischemia and NOCAD undergoing coronary angiography and intracoronary provocation test with acetylcholine (ACh) were prospectively studied. Both patients with chronic myocardial ischemia (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) were enrolled. Based on each case's home address, exposure to PM2.5 and PM10 was assessed.

Results

We included 287 patients (median age 62.0 years [52.0-70.0], 149 [51.9%] males): 161 (56.1%) INOCA and 126 (43.9%) MINOCA. One hundred seventy-six patients (61.3%) had positive provocation test. Exposure to PM2.5 and PM10 was higher in patients with a positive provocation test (p<0.001). At multivariate logistic regression analysis, PM2.5 and PM10 were independent predictors of a positive provocation test (p=0.001 and p=0.029, respectively). Interestingly, among these patients, PM2.5 and PM10 were both independent predictors of MINOCA (p<0.001 and p=0.001, respectively) as clinical presentation, while PM2.5 was independently associated with the occurrence of epicardial spasm as opposed to microvascular spasm (p=0.001).

Conclusions

Higher exposure to PM2.5 and PM10 in patients with myocardial ischemia and NOCAD is associated with coronary vasomotor abnormalities. In particular, PM2.5 is an independent risk factor for the occurrence of epicardial spasm and MINOCA as clinical presentation.
778 IN-STENT USE OF INTRAVASCULAR LITHOTRIPSY IN THE TREATMENT OF STENT UNDEREXPANSION: A SYSTEMATIC REVIEW AND METAREGRESSION
Authors: Caminiti Rodolfo , Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Della Rocca Domenico Giovanni , Cerrato Enrico , Saporito Francesco , Andò Giuseppe , Carerj Scipione , Di Bella Gianluca , Micari Antonio , Vizzari Giampiero
Published: December 2022

Introduction

Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologist. Stent Underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis. To date, SU with heavily CCP can be addressed by means of scoring/cutting balloons, very-high/high pressure non-compliant balloons, off-label rotational/orbital atherectomy and intravascular lithotripsy (IVL).

Objective

In this meta-analysis we investigate the success rate of IVL for the treatment of SU due to CCP.

Methods

Studies and case-based experiences reporting on the use of IVL strategy for treatment of SU were included. The primary outcome was IVL strategy success, defined as adequate expansion of the underexpanded stent. Metanalysis was performed for the main focuses to calculate proportions of procedural success rates with corresponding 95% confidence intervals (CI). Random effects models weighted by inverse variance were used because of clinical heterogeneity.

Results

Our study included 13 studies with 354 patients. Mean age was 71.3 years (95% CI: 64.9-73.1) and 77% (95% CI: 71.2-82.4%) were male. The mean follow-up time was 2.6 months (95% CI: 1–15.3). Strategy success was seen in 88.7% (95% CI: 82.3–95.1) of patients. The mean Minimal Stent Area (MSA) was reported in 6 studies, pre-IVL value was 3.4 mm2 (95% CI: 3–3.8) and post-IVL value was 6.9 mm2 (95% CI: 6.5–7.4). The mean diameter stenosis (%) was reported in 7 studies, pre-IVL value was 69.4% (95% CI: 60.7–78.2) and post-IVL value was 14.6% (95% CI: 11.1–18). The rate of intraprocedural complications was 1.6% (95% CI: 0.3-2.9).

Conclusions

The “stent-through” IVL plaque modification technique is a safe tool to treat SU due to CCP, with high success rate and very low incidence of complications.
265 PROGNOSTIC ROLE OF VITAMIN D DEFICIENCY IN STEMI PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Verdoia Monica , Gioscia Rocco , Rolla Roberta , Rognoni Andrea , De Luca Giuseppe
Published: December 2022

Background and Aims

The pandemic proportion of vitamin D deficiency has raised particular concerns on its association with mortality and cardiovascular disease (CVD). However, the independent and causative role of hypovitaminosis D in CVD is still debated. Few data have been reported, so far, among STEMI patients undergoing primary percutaneous coronary intervention (pPCI), that was therefore the aim of the present study.

Methods

A consecutive cohort of patients admitted for STEMI treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Hypovitaminosis D was defined for 25(OH)D < 10 ng/ml. The primary study endpoint was net adverse cardiovascular events (a composite of death, recurrent MI and target vessel revascularization) at the longest available follow-up. Secondary endpoints were overall mortality, major bleedings or the individual components of the primary endpoint.

Results

We included 136 patients divided according to tertiles values of 25(OH)D (< 12.98 ng/ml, n=44; 12.98-22.1 ng/ml, n=41; ≥ 22.1 ng/ml, n=51). The prevalence of renal failure (p=0.047) and coronary calcifications inversely related with vitamin D. Lower vitamin D levels were associated with “no reflow” (10.3% vs 6.7% vs 0%, p=0.04), with increased use of adenosine. At a mean follow-up of 305± 217 days (mean + SD), the primary endpoint (NACE) was slightly increased in patients with lower vitamin D values (adjusted HR [95% CI] = 3.07 [0.85-11.1], p = 0.09). Similar results were observed for ischemic events (MACE: adjusted HR [95% CI] = 2.78 [0.68-11.48], p = 0.16). However, when considering separately patients with severe hypovitaminosis D (<10 ng/ml), we found a significant increase in the risk of NACE and MACE (adjusted HR [95% CI] = 5.17 [1.42-18.8], p = 0.01 and HR = 4.75 [1.14-19.7], p = 0.03, respectively).

Conclusion

The present study shows that among patients with STEMI undergoing pPCI, extremely low levels of vitamin D are independently associated with impaired outcomes. Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.
478 VENTRICULAR AND ATRIAL REMODELING AFTER EDGE-TO-EDGE TRANS-CATHETER MITRAL VALVE REPAIR: A PILOT STUDY
Authors: Albini Alessandro , Passiatore Matteo , Leo Giulio , Imberti Jacopo Francesco , Valenti Anna Chiara , Coppi Francesca , Sgura Fabio Alfredo , Boriani Giuseppe
Published: December 2022

Background

Percutaneous mitral valve repair (PMVR) is an established therapy for mitral regurgitation (MR) in patients at high risk for surgical treatment. The aim of this study was to determine the impact of PMVR on left and right ventricular (LV, RV) and left and right atrial (LA, RA) remodelling according to the mechanism of MR and history of atrial fibrillation (AF).

Methods and results

Twenty-four patients (mean age 78.54 years ± 7.64 SD; 62.5% males) undergoing PMVR at our centre were prospectively enrolled. All the patients underwent echocardiography 1.6 ± 0.9 months before the procedure and after 5.7 ± 3.5 months; functional MR accounted for 54% of cases. Compared to baseline, a statistically significant improvement in LV end-diastolic diameter (LVEDD), LV indexed mass (ILVM), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), indexed LA volume (iLAV) and morpho-functional RV parameters was recorded. LVEDD and LVEDV improved in primary MR cohort whereas in secondary MR a significant reduction in LVEDV and LVESV with a nonsignificant improvement in ejection fraction were found. (Table 1) LA positive remodelling was found in organic MR with a trend toward ameliorated function; in functional MR, with more dilated and dysfunctional LA, no significant improvement was found. (Table 1) Furthermore, a significant reduction of LA volumetry was detected only in patients without history of AF (AF baseline 51.4 mL/m2 IQR 45.6-62.5 mL/m2 f-u 48.9 mL/m2 IQR 42.9-59.2 mL/m2; p=0.101; no AF baseline 43.5 mL/m2 IQR 34.2-60.5 mL/m2 f-u 42.0 mL/m2 IQR 32.0-46.2 mL/m2; p=0.012). As regards right sections, the most relevant positive remodeling was obtained in patients with functional MR with a baseline poorer RV function and more severe RA and RV dilation. (Table 1)

Conclusion

At mid-term follow-up after PMVR, a positive cardiac remodeling is detected in atrial and ventricular chambers also involving the right sections. To deliver a tailored intervention, MR mechanism and history of AF should be considered in view of the impact on remodeling process.
532 SEX-RELATED DIFFERENCES IN THROMBUS BURDEN IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Manzi Maria Virginia , Buccheri Sergio , Jolly Sanjit S , Zijlstra Felix , Frobert Ole , Lagerqvist Bo , Mahmoud Karim D , Dzavik Vladimir , Barbato Emanuele , Sarno Giovanna , James Stefan
Published: December 2022

Background

Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated.

Objectives

The aim of this study was to assess the sex-related differences in TB and its clinical implication in patients with STEMI.

Methods

We analyzed individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year.

Results

Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death; 1.52; 95% CI: 1.10-2.12; P=0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, this risk for 1-year CV death was higher only in women with HTB (HR 1.23, 95% CI: 1.18-1.28; P<0.001) who also had an increased risk for all-cause death and ST than men.

Conclusion

In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for stent thrombosis, CV and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.
485 PROGNOSTIC IMPACT OF TREATMENTS EVOLUTION IN STEMI: INSIGHTS FROM A PRIMARY PCI REGISTRY
Authors: Boldrin Claudia , Fabris Enrico , Gregorio Caterina , Pezzato Andrea , Gagno Giulia , Vitrella Giancarlo , Rakar Serena , Perkan Andrea , Sinagra Gianfranco
Published: December 2022

Objective

We aimed to evaluate in a real world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis, comparing different decades of treatment.

Methods

Consecutive STEMI patients undergoing pPCI at University Hospital of Trieste, Italy, were enrolled in a pPCI registry. Outcomes were evaluated during two successive periods: the first cohort (old treatments cohort) included STEMI patients treated between January 2007 and December 2012, and the second cohort (new treatments cohort), included STEMI patients treated between January 2013 and December 2020. Cox regression models were performed to predict the risk of the study primary endpoint (PE) a composite of all cause death, reinfarction and re-PCI at 5 years. The secondary endpoint was all cause of mortality at 5 years. Moreover, we evaluated the incidence of stent thrombosis at 12 months.

Results

A total of 2425 STEMI patients, 947 in the old treatments cohort and 1478 in the new treatments cohort were analysed. The mean age of the population was 66 ± 12.5 years, most were males (74.3%), 20.2% were diabetics, and 12% presented in Killip class III-IV. At 5-years of follow-up the new treatments cohort compared to the old treatments cohort presented a lower rate of primary outcome (18.5% vs 23.1%, p=0.006) and mortality (15.5% vs 19.9%, p=0.006). At Cox regression model adjusted for baseline differences between the two cohorts, patients in the new treatments cohort had lower risk of PE (HR 0.717, 95% CI 0.567–0.907, p=0.006) and mortality (HR 0.662, 95% CI 0.509–0.860, p=0.002). When considering both clinical and procedural variables, complete revascularization (HR 0.459, 95% CI 0.265–0.796, p=0.006) and the administration of prasugrel or ticagrelor (HR 0.721, 95% CI 0.524–0.992, p=0.013) were independent predictors of PE as well as of 5 years mortality. The new treatments cohort compared to the old treatments cohort had more frequent use of radial approach (83.1% vs 24.4%, p<0.001) and had lower ischaemia time (3.05 vs 3.45 hours, p>0.001), however they were not associated with PE. Patients receiving prasugrel or ticagrelor or drug eluting stent (DES) were at lower risk of stent thrombosis at 12 months (HR 0.502, 95% CI 0.280–0.900, p=0.021).

Conclusions

In a real-word STEMI population the prognosis of patients is improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization. The application of new evidence-based therapies in clinical practise is fundamental to improve patient prognosis because the benefits demonstrated by clinical trials have translated into a benefit in the real-world population.
239 VASOSPASTIC ANGINA: A CASE OF COMPLETE FUNCTIONAL ASSESSMENT
Authors: Pricoco Francesco , Scala Antonella , Pompei Graziella , Campo Gianluca , Tebaldi Matteo , Biscaglia Simone
Published: December 2022

Introduction

Vasospastic angina is defined as a focal or diffuse spasm of the arterial wall of an epicardial coronary artery due to muscle cells hyperreactivity caused by an increased calcium sensitivity. Clinical presentation typically consists in chronic story of rest and/or effort typical chest pain, episodes of ST elevated or not ST elevated myocardial infarction, arrhythmias or cardiac arrest; an increased vagal tone, drugs, allergic reactions or the exposure to extreme cold also can trigger vasospasm.

Clinical case

73 years old dyslipidemic woman; in past medical history thyroidectomy and radiotherapy for carcinoma and right quadrantectomy with radiotherapy and hormonal therapy for breast cancer. In 2017 admission to cath-lab for non-ST elevation myocardial infarction (NSTEMI) with the evidence of mild left coronary artery disease without critical obstructive stenosis (MINOCA). For the persisting of effort angina and dyspnea (NYHA and CCS II-III), started Diltiazem therapy (60 mg x3) with clinical benefit. In 2020, due to the onset of new episodes of angina, started Ranolazine therapy. In June 2022, for the worsening of clinical symptoms, was evaluated with a Coronary CT, that showed a 65% stenosis at right coronary-acute marginal bifurcation and mild disease on left coronary artery, and then was admitted for an elective coronary angiography, with no evidence of epicardial artery critical stenosis. At the functional evaluation FFR, CFR and IMR (>0.80, 2.5 and 18) demonstrated normal coronary flow reserve and good microcirculation function. For the suspicion of vasospastic angina, acetylcholine test was performed with the evidence of mid-distal left anterior descending artery total occlusion, angina onset and ECG changes, promptly regressed with nitrates administration (Figure 1). Patient was discharged with the optimization of medical therapy with Diltiazem 120 mg x3, with clinical benefit.

Conclusions

To date vasospastic angina remains underdiagnosed. Functional evaluation of coronary arteries plays a fundamental role in the diagnostic algorithm of the disease and should always be investigated in case of patients with typical symptoms and the absence of critical epicardial stenosis. Further investigations are required to better explain pathogenesis and to identify affected patients in shorter times to ensure early optimized medical therapy.
1145 BAIL-OUT INTRAVASCULAR CORONARY LITHOTRIPSY FOR THE TREATMENT OF STENT IN-STENT UNDER EXPANSION
Authors: Riverso Vincenzo , Sorrentino Sabato , Mongiardo Annalisa , Polimeni Alberto , Spaccarotella Carmen , Calvelli Pierangelo , Esposito Giovanni , Indolfi Ciro
Published: December 2022

Background

in-stent restenosis remains a significant clinical problem for which optimal treatment is under debate. Intravascular lithotripsy (IVL) is mostly used for safe and effective treatment of de novo coronary calcifications, while the use of this technology to support bailout procedures, including stent under-expansion, is still off-label. One of the advantages of lithotripsy is the possible use after stent deployment.

Case presentation

a 66-year-old male patient was admitted to our Institution due to a medically refractory angina and a coronary computed tomography (CCT) detecting three vessel disease with multiple critical stenosis. The patient had multiple comorbidities including history of hypertension, dyslipidemia, type 2 diabetes and multiple myocardial rivascularization. In 2003 he underwent coronary artery by-pass (CABG) with left internal mammal artery (LIMA) to left anterior descending (LAD) artery and free saphenous vein graft (VG) to the ramus intermedius (RI). In 2009 the patient underwent percutaneous coronary intervention (PCI) of the right coronary artery (RCA) with the implantation of a stent at the central segment, and a second stent at the crux cordis. For recurrent in-stent restenosis of the stent previously implanted at the central segment the patient was treated in 2013 with percutaneous balloon angioplasty (POBA) and in 2017 with the implantation of another drug eluting stent (Resolute Onyx, Medtronic, Santa Rosa, California) overlapping the proximal part of the scaffold.

Coronary angiography revealed, a severe coronary artery disease with 80% stenosis of distal left main. The LAD was occluded at the middle segment and the ramus presented 99% stenosis at the proximal segment. The RCA had a diffuse severe in-stent restenosis involving the Resolute Onyx stent. Therefore, the operator decided to treat the restenosis with a direct stenting (Xience, Abbott Vascular Santa Clara, USA), but he was unaware of the fact that there was already an Onyx stent that was barely visible. After implantation, an inadequate expansion of the stents was observed (Figura 1A-B), which persisted despite post-dilation with non-compliant balloon (NCB) at high-pressure (Figure 1C). Given the persistence of stents under-expansion, it was decided to perform bail-out intravascular lithotripsy (IVL) therapy with a Shockwave balloon catheter (Figure 2A). The stent was then post-dilated with a NCB (Figure 2B). The final angiographic image and intravascular ultrasound (IVUS) showed an optimal stent expansion (Figure 3).

Conclusion

intravascular lithotripsy could be used to treat undilatable stent-in-stent restenosis. Of interest, the case presented demonstrated, for the first time, the possible use of IVL in 2-stent layers, with an optima final stent expansion.
823 MIGRAINE IN PFO PATIENTS: CHARACTERIZATION OF A PLATELET-ASSOCIATED PATHOPHYSIOLOGICAL MECHANISM BEFORE AND AFTER PFO CLOSURE: THE LEARNER STUDY
Authors: Trabattoni Daniela , Brambilla Marta , Teruzzi Giovanni , Canzano Paola , Muratori Manuela , Tedesco Calogero , Becchetti Alessia , Montorsi Piero , Camera Marina
Published: December 2022

Background

A strong relationship links migraine with aura (MHA) and patent foramen ovale (PFO). Increased platelet aggregation and oxidative stress were documented in migraineurs. To date, no mechanisms connecting MHA to PFO have been demonstrated.

Objectives

To perform a comprehensive analysis of platelet activation, inflammation, and oxidative stress status in 78 aspirin-treated MHA-patients before (T0) and 6-months after (T1) PFO closure (LEARNER Study-NCT03521193-clinicaltrials.gov). The primary endpoint was migraine regression rate in relation to these parameters.

Methods

P-selectinpos-, activated-glycoprotein IIbIIIa (aGPIIbIIIa)pos-, Tissue Factor (TF)pos-, reactive oxygen species (ROS)pos-platelets, platelet-leukocyte aggregates (PLA) and microvesicles (MVs) were evaluated by flow cytometry; thrombin generation (TG) by Calibrated Automated Thrombogram (CAT) assay; oxidative stress status by mass spectrometry; serotonin and cytokines by ELISA. 12 aspirin-treated-healthy subjects (HS) were enrolled for comparison.

Results

Migraine resolution occurred in 69.7%, a significant reduction in 27%, while no effect was observed in 2 patients (3.2%). Only ROSpos-platelets, and TFpos-platelets and -MVs were significantly higher at T0, sustaining a TG capacity that was associated with an altered blood GSSG/GSH (Oxidized/Reduced Glutathione). This phenotype reverted to HS levels at T1. MHA-PFO plasma, added to HS blood, mirrored the in vivo platelet activation and N-acetylcysteine blunted it. GSSG in vitro reproduced the in vivo condition. Aspirin had little effect on the platelet prothrombotic phenotype which was effectively inhibited by a P2Y12-antagonist.

Conclusion

This study suggests a pathophysiological mechanism linking PFO, or its right-to-left shunt, with MHA. MHA-PFO patients show a platelet-associated prothrombotic phenotype, sustained by altered oxidative stress status. This phenotype, not fully controlled by aspirin but by P2Y12-antagonism, could play a primary role in producing the prodromal symptoms of migraine, and it is reverted after PFO closure together with a complete migraine remission
1108 PERI-PROCEDURAL COMPLICATIONS AND LONG-TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTRE REGISTRY
Authors: Magnocavallo Michele , Della Rocca Domenico Giovanni , Van Niekerk Christoffel J , Gilhofer Thomas , Ha Grace , D´ambrosio Gabriele , Galvin Jennifer , Urbanek Lukas , Schmidt Boris , Christoph Geller J , Lakkireddy Dhanunaja , Di Biase Luigi , Price Matthew , Mansour Moussa , Saw Jacqueline , Horton Rodney P , Gibson Douglas , Natale Andrea
Published: December 2022

Background

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thromboembolic events. CKD concomitantly contributes to several pathophysiological changes predisposing towards a pro-haemorrhagic state.

Objective

To evaluate the impact of kidney function on peri-procedural complications and clinical outcomes in AF patients undergoing left atrial appendage occlusion (LAAO) with a Watchman device.

Methods

2124 consecutive AF patients undergoing Watchman implantation at 8 different centers were categorized into CKD stage 1+2 (n=1089), CKD stage 3 (n=796), CKD stage 4 (n=170), CKD stage 5 (n=69) based on the estimated glomerular filtration rate at baseline. The primary efficacy endpoint included a composite of cardiovascular (CV) mortality, stroke, transient ischemic attack, peripheral thromboembolism (TE), and major bleeding.

Results

A non-significant higher incidence of major peri-procedural adverse events (1.7% vs. 2.3% vs. 4.1% vs. 4.3%) was observed with worsening baseline kidney function (p=0.14). The mean follow-up period was 13 ± 7 months [2226 patient-years (PY)]. In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank p-value= 0.04), CKD stage 4 (log-rank p-value= 0.01), and CKD stage 5 (log-rank p-value= 0.001). A non-significant increase in event rates for stroke/TIA and clinically relevant bleeding was observed among the four groups. LAAO led to a TE risk reduction of 72%, 66%, 62%, and 41% in each group. The relative risk reduction in the incidence of major bleeding was 58%, 44%, 51%, and 52%, respectively.

Conclusion

Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative risk reduction in the incidence of TE and major bleeding was consistent across CKD groups, irrespective of the very different risk profiles at baseline.
988 UNCLEAR SUDDEN DEATH IN THE YOUNG: DIFFERENT DISTRIBUTION AMONG THE ITALIAN REGIONS
Authors: Mastroianno Sandra , Lucia Bevere Ester Maria , Greco Antonio , Potenza Domenico , Massaro Raimondo , Salvatori Mauro , Di Stolfo Giuseppe
Published: December 2022

Introduction

Sudden death (SD) in the young due to cardiovascular diseases remains a focus of the public health system. It occurs unexpectedly in apparently healthy people. In addition, several of the diseases that cause sudden death in the young can be diagnosed and treated prior to the first lethal event; on the other hands, a post mortem approach, by the means of clinical autopsy and molecular autopsy, may clarify the underling disease to better develop futher prevention by a familial approach. The attention on this issue has greatly sensitized doctors and public opinion.

Aim

The aim of the manuscript was to evaluate the frequency of sudden deaths in Italy in the decade 2008-2017.

Methods and Data sources

The searches were carried out by consulting the database of the National Institute of Statistics (ISTAT). We counted in the ISTAT database all the deceased under the age of 40 due to unclear causes in the decade 2008-2017.

Results

We counted 7159 young patients with DS, unevenly distributed throughout the Italian territory. In detail, 10% (1373) were in the North-West, 14% (988) in the North-East, 13% (934) in the Center, 44% (3178) in the South and 10% (686) in the islands.

The analysis showed how the unclear SD in Italy have decreased over time. Southern Italy had the highest number (357) of SD at the start of the observation which slightly dropped to 272 in 2017. Despite this significant reduction, the South remains the place where the largest number of unclear SD are counted. Most likely, the initial studies conducted in the Veneto region sensitized doctors to SD in young people and athletes, leading a wider screening through cardiological examination and electrocardiogram for prevention; furthermore a widespread recurrence to clinical autopsy, to reach a clear diagnosis, allows the awareness that other cases could occur in the same family. Grief coping approach and cultural competency may explain the regional difference. The new methods available to genetics, such as next generation sequency (NGS), have allowed an increase in diagnoses even in the deceased and have identified possible pathogenic genes in family members.

Conclusions

Sudden death in young people represents an important challenge, considering the number of events that occur in our country and the different distribution in the Italian regions.

Medical community need to better address this issue, by implementing both prevention and post-mortem analysis, to reduce the sudden death burden, especially in southern region.

Thiene G. Sudden cardiac death in the young: a genetic destiny? Clin Med (Lond). 2018 Apr 1;18(Suppl 2):s17-s23. Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med. 2021 Mar;135(2):483-495.Webster G, Carberry T, Berger S. Screening for prevention of sudden death in the young: what is new? Curr Opin Cardiol. 2020 Jan;35(1):80-86.