bluuebunny/crossref_metadata_2025 huggingface dataset:
P146 A CASE OF TYROSINE–KINASE INHIBITOR INDUCED CARDIOTOXICITY
Authors: Bellin A , Cutolo A , Antonucci A , Zucca A , Cavalli G , Themistoclakis S
Published: May 2022

This case is about a 69 years–old woman with no prior cardiovascular disease and a history of rheumatoid arthritis;in 2017 underwent right nephrectomy for renal cancer. A few weeks before admission, due to evidence of secondary bone lesions at a follow–up CT–scan, a single dose of the tyrosine kinase inhibitor (TKI) Nivolumab was administered. On the same evening she suffered from a severe reacutization of arthritic symptoms, that led her Oncologist to suspend treatment with nivolumab, and oral corticosteroid therapy was initiated. The following weeks remained though characterized by intense persistent asthenia, severe arthralgias, profuse diarrhea and a syncopal episode; no chest pain was reported. Given the persistence of symptoms, she went to the Emergency Room. Initial work–up revealed a complete heart block, with a previously unknown right bundle branch block (see Figure 1). At blood tests there was a significant increase of troponin I to 7616 ng/L (Normal<12ng/L), BNP 1113 pg/mL (NR < 100 pg/mL), creatinine 2.34 mg/dL (NR 0.55–1.02mg/dL), CPK 1681 U/L (NR 10–145 U/L) and D–dimer 17780 mcg/L (NR < 600). She was immediately transferred to our Cardiologic Intensive Care Unit, where an echocardiogram showed normally functioning ventricular chambers and no valvulopathies. Due to the ongoing acute kidney injury and the history of right nephrectomy, a coronary angiography was not immediately performed, considering the low probability of ACS (no typical symptoms, no regional wall motion abnormalities).Suspecting nivolumab–induced myocarditis, high–dose glucocorticoids were initiated. After a few days we observed persistence of bradycardia and complete AV block despite isoprenaline infusion, and due to signs of peripheral malperfusion (acute kidney injury, hypotension) a definitive leadless pace–maker Micra was implanted (this choice given the need of immunosuppressive therapy that could predispose her to device infections). After normalization of renal function, we performed a coronary angiography that showed normal coronary arteries. Despite the initial improvement of the clinical conditions, the patient suffered a fatal cardiac arrest due to electromechanical dissociation 3 weeks after admission. This case report is an important example showing the significant mortality of cardiotoxicity induced by tyrosine–kinase inhibitors, a side effect that every Cardiologist must be aware of in order to recognize it and immediately intervene with the appropriate therapy.
P148 CANCER INCIDENCE AND MORTALITY ACCORDING TO PRE–EXISTING HEART FAILURE IN A COMMUNITY–BASED COHORT
Authors: Bertero E , Robusto F , Rulli E , D‘Ettore A , Staszewsky L , Maack C , Lepore V , Latini R , Ameri P
Published: May 2022

Background

Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer–related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community–based cohort.

Methods

By reviewing the health care records of the Puglia region in Italy, we first selected the individuals ≥50–year–old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow–up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Drug–Derived Complexity Index, and follow–up duration. Cancer incidence and mortality were analyzed by Kaplan–Meier method and Cox regression models. Fine and Grey’s regression model was also used to compare cancer–specific mortality while taking into account the competing risk of non–cancer death.

Results

Overall, the mean age of the study population was 76±10 years and the mean follow–up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95%CI, 20.98–21.74) and 12.42 (95%CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95%CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95%CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was <70 years (HR 7.54, 95%CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95%CI 3.44–4.19) and ≥80 years (HR 3.10, 95%CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (subdistribution HR 3.48, 95%CI 3.27–3.72), as well as the interaction with age: <70 years of age: SHR 6.65, 95%CI 5.60–7.94; 70–80 years: SHR 3.14, 95%CI 2.84–3.48; and ≥80 years: SHR 2.81, 95%CI 2.55–3.10. The HF–related risk applied to the majority of cancer types. Interestingly, among HF patients a high consumption of loop diuretic (≥80 mg/d of furosemide equivalents for ≥30 days in the year before the index date) was associated with a higher mortality for cancer (HR 1.35, 95%CI 1.19–1.53 vs. ≤37.5 mg/d).

Conclusions

The analysis of this large community–based sample suggests that HF does portend an increased risk of cancer and cancer–related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes.
P149 AN UNUSUAL CASE OF CARDIAC TAMPONADE AND ST–SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Bongarzoni A , Tumminello G , Tassinario G , Garagiola M , Carrieri F , Allievi L
Published: May 2022

The case of a 70–year–old woman, a heavy smoker with lung cancer diagnosed in November 2020, is described. The patient underwent 4 cycles of chemotherapy and subsequently a maintenance therapy with atezolizumab. In May 2021, a control CT scan was performed, where multiple cerebral and left adrenal metastases were found. In June 2021, she underwent a cycle of panencephalic radiotherapy. On September 9, 2021, she needed to be admitted to the oncology ward of reference for the appearance, for a few days, of dyspnea due to light exertion and asthenia. In the ward, she was dyspnoic at rest with arterial hypotension (BP 90/60 mmHg). The ECG showed sinus rhythm 110 bpm, anterior STEMI in evolution. The cardiologist performed a bedside echocardiogram which showed abundant pericardial effusion and signs of haemodynamic commitment; akinesia of the apex and middle septum of the left ventricle; LVEF 35%. He was conducted in the angiography room and subjected to pericardiocentesis, guided echo, via the subxiphoid route. 650 ml of blood fluid were removed; on echocardiographic control, a clear reduction of the pericardial effusion was noted. The BP after the procedure went back to 140/80 mmHg and the HR was 100 bpm. Coronary angiography was performed which demonstrated critical stenosis of the mid–segment LAD. After a collegial discussion between the cardiologist and the oncologist which took into account: the presence of haematic pericardial effusion, brain metastatic lesions, a life expectancy <6 months and uncertain date of the heart attack, it was decided not to treat the coronary lesion. A total body CT scan, performed on 13 September, demonstrated widespread and irregular pericardial thickening with nodulations and enhancement due to neoplastic infiltration and the appearance of new metastases in the liver and pancreas. On 14 September, the patient died of respiratory failure. In the literature, only 2 cases are reported with some analogy with the one described.

Conclusion

A rare case of association between haematic pericardial effusion, cardiac tamponade, and myocardial infarction is reported; the priority was to drain the pericardial effusion while the complexity of the case required a collegial assessment between oncologist and cardiologist which led to the decision of not to treat coronary artery lesion on LAD, due to the high risk of bleeding, the short life expectancy and the uncertain date of the heart attack.
P152 R222Q MUTATION OF THE SCN5A GENE IN PEDIATRIC AGE: PHENOTYPE AND RESPONSE TO DRUG THERAPY
Authors: Catucci S , Lombardi M , Vairo U
Published: May 2022

Some studies have shown the association between ventricular and atrial arrhythmias, dilated cardiomyopathy and the R222Q mutation of the SCN5A gene. The mutation causes impaired activation of the sodium channel, the genesis of extrasystoles and the development of dilated cardiomyopathy; both respond better to antiarrhythmic therapy with flecainide and amiodarone than therapy for heart failure. Other studies have shown the efficacy of hydroquinidine.

Purpose of the Study

To observe the clinical characteristics and the response to drug therapy of pediatric subjects carrying the R222Q mutation.

Materials and methods

we observed subjects received at our centre for arrhythmias, carriers of the R222Q variant, subjected to ECG, Echocardiogram, Holter, stress test and follow up.

Results

4 patients were observed, 3 males and 1 female, with ages ranging from 0 to 12 years. The first patient was familiar with dilated cardiomyopathy and rhythm disturbances; he had arrhythmia already in foetal age, he then developed first and second–degree BAV, junctional rhythm and polyform TVNS. Echocardiography and exercise testing were normal. Arrhythmia control was achieved with flecainide. The second patient, with negative familiarity, from the age of 8 is under observation for polyform ventricular ectopic beats, repetitive, unresponsive to propafenone, flecainide, nadolol and sotalol. Echocardiography showed minimal impairment of the contractile function of the left ventricle. Ventricular extrasystoles did not disappear during exertion. At 15, a defibrillator was implanted and hydroquinidine was associated. The third patient presented with foetal tachyarrhythmias; at the age of 6, atrial tachycardia, well–controlled by sotalol, and ventricular ectopic beats were detected. The fourth patient, a cousin of the previous one, developed repetitive ventricular ectopic beats and periods of atrial and junctional rhythm at 12 years; he responded to flecainide.

Conclusions

The R222Q mutation of the SCN5A gene is responsible for arrhythmias already from the pediatric age and is expressed with a variable phenotype. Only one patient with therapy–resistant arrhythmia had contractile dysfunction. Dilated cardiomyopathy could be a consequence of a high arrhythmic burden and occur at a later age if the arrhythmia is not treated. An early and genetic diagnosis is essential.
P174 WELLENS‘ SYNDROME: A TYPICAL CASE
Authors: Dell‘Uomo M , Bier N , Carreras G , Lazzari L , Dominioni I , Nicolì L , Dominici M
Published: May 2022

78–year–old man, hypertensive, diabetic, dyslipidemic, with a recent diagnosis of chronic ischemic encephalopathy and cognitive impairment that severely limited the acquisition of both proximate and remote pathological anamnesis.Transported to the emergency room from 118, contacted by family members, due to pain in the left arm associated with cold sweating and general malaise, symptoms lasting about 4 hours and no longer present upon arrival in the emergency room.On the Echocardiogram performed in ER: akinesia of the apex in its entirety and of the middle anterior wall, not present in a previous examination in April. To laboratory tests: first determination of the high sensitivity troponin within the limits of the norm. On ECG: sinus rhythm at 96 bpm, PR interval 144 ms, left axial deviation, elevation of the ST tract. at J point <1 mm with presence of biphasic T waves in V2–V3. QTc Bazett 409 ms.The patient was then taken to the hemodynamics room and subjected to angioplasty on the proximal anterior descending artery, for critical stenosis of the same. The case is a typical example of Wellens‘ Syndrome.It represents an electrocardiographic manifestation of critical stenosis of the proximal anterior interventricular artery in patients with unstable angina, which is associated with a high risk of developing extensive anterior infarction with a severe prognosis.Originally classified as two separate types, today it is considered as the evolution of type 1 into type 2, manifesting initially with biphasic inversions of the T wave (observed only in 25% of patients with Wellens) and, subsequently, with symmetrical inversions, often deep (> 2 mm) of the T wave, in the anterior precordials.This electrocardiographic aspect is typically present in the absence of pain, while the electrocardiographic trace generally normalizes in presence of pain.After coronary revascularization, most patients show normalization of the electrocardiogram and often of sectoral abnormalities of left ventricular function, suggesting that underlying the electrocardiographic and echocardiographic changes observed in Wellens is a mechanism of myocardial hibernation or stunning.
P182 VALSARTAN LIMITS PULMONARY AND CARDIAC DAMAGE INDUCED BY SARS–COV–2 IN EXPERIMENTAL MODELS BY REDUCING THE EXPRESSION OF ACE2
Authors: Bastaroli F , Mura M , Sammartino J , Ferrari A , Corli M , Guarona C , Percivalle E , Gnecchi M
Published: May 2022

Background

SARS–CoV–2 primarily affects the respiratory system, but cardiac complications also occur very often. The entry of SARS–CoV–2 into host cells is mediated by the interaction between the viral glycoprotein Spike (S) and the host angiotensin–converting enzyme 2 (ACE2) protein. The use of ACE inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) might influence both ACE2 expression and viral infection, but our knowledge about these possible interactions is limited. Aim. To evaluate the effects of ACEIs and ARBs during active viraemia.

Methods

We tested the effects of exposure to the ACEI Lisinopril (100nM and 500nM) and the ARB Valsartan (10µM and 50µM) on three different cell types: green monkey–derived epithelial cells (VERO E6) which are used to replicate SARS–CoV–2, cardiomyocytes derived from hiPSC (iPSC–CMs) as heart model and a lung epithelial cancer cell line (16HBE) as pulmonary model. The SARS–CoV–2 wild strain was inoculated on cell lines for 1 hour. Cell viability was measured 72 hours after infection. The supernatants of the infected cells were collected and titrated by the micro–neutralization assay on VERO E6 cells to verify the presence of the virus. Levels of ACE2 mRNA and protein content on cell lysates were quantified after each treatment by RT–qPCR and western blot, respectively.

Results

ACEI and ARB at both concentrations do not affect the viability of the 3 cell lines. Vice versa, viral infection significantly decreases the viability of VERO E6 (–60%, p < 0.0001) and iPSC–CMs (–44%, p < 0.001), while 16HBE cells do not show a cytopathic effect after infection. Viral titration shows that SARS–CoV–2 replicated in cell lines and was actively released into supernatants. Valsartan 50µM decreased virus release in the three cell lines and increased the viability of VERO E6 (+69%, p < 0.01) and iPSC–CMs (+20.5%, p < 0.05) after the infection. Valsartan 50µM also decreases both mRNA (–65% in VERO E6, p < 0.001; –50% in iPSC–CMs, p < 0.05; –60.5% in 16HBE, p < 0.01) and protein levels of ACE2 in all 3 cell lines.

Conclusion

The data suggest that ACEIs and ARBs do not worsen the SARS–CoV–2 infection and that Valsartan, by reducing the levels of ACE2 expression, might result protective.
P185 META–ANALYSIS OF PLACEBO–CONTROLLED TRIALS OF LEVOSIMENDAN IN ACUTE MYOCARDIAL INFARCTION
Authors: Tumminello G , Cereda A , Laricchia A , Carlà M , Conconi B , Barbieri L , Lucreziotti S , Carugo S
Published: May 2022

Introduction

Despite the potential beneficial effects in the acute phase of myocardial infarction, the use of Levosimendan in recent guidelines is currently limited to patients with heart failure and a severe reduction in cardiac output not responding to standard therapy. In spite of everything, the haemodynamic effects of the drug that reduces afterload, the beneficial pleiotropic effects on myocardial stunning and the improvement of microcirculatory indices make Levosimendan still an interesting therapeutic prospect in AMI.

Purpose of the Study

The study aimed to analyse the available data of the use of Levosimendan in the acute setting of myocardial infarction Materials and Methods This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and was conducted and presented according to best practice recommendations, including the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) reporting guidelines. Seven selected studies were included in the meta–analysis. Meta–Analysis Levosimendan treatment was associated with a reduction in one year mortality and adverse event rates, without inconsistency. A trend of the increase of cardiac index and reduction of wedge pressure was evident, with an inconsistent effect on blood pressure and heart rate. No evidence of small study effects was found upon the inspection of funnel plots or regression tests. Finally, possibly given the limited number of included studies, metaregression analysis did not identify any major effect modifier.

Discussion

A clearly significant mortality reduction in the acute phase and long–term mortality induced by Levosimendan in AMI is evident. In the acute ischemic field, the haemodynamic properties of Levosimendan may explain part of the benefits. Levosimendan, over an inotropic effect, has a positive effect on ventriculo–arterial coupling, peripheral vasodilation consequently increasing tissue perfusion, anti–stunning effects and anti–inflammatory effects.

Conclusions

Our data support the idea that Levosimendan may already have a role in the treatment of acute ischemic heart disease. Further studies, specifically designed to investigate the early role in the treatment of ischemic heart failure are needed.
P230 CARDIOGENIC SHOCK NETWORK: FROM PRIMARY PERCUTANEOUS CORONARY INTERVENTION TO VENTRICULAR ASSIST DEVICE IMPLANTATION
Authors: Sorini Dini C , Maccherini M , Bernazzali S , Natali B , Codecasa R , Antenore A , Bellandi F , Valente S
Published: May 2022

We report the clinical case of a 75 year–old man, previous smoker with mild lower extremity arterial disease, that presented a sudden and intensive chest pain. The emergency medical system documented an anterior STEMI quickly complicated by out–of–hospital cardiac arrest from a shockable rhythm, treated with DC–shock with rapid ROSC and recovery of consciousness. The patient was transported to the local hospital where coronary angiography showed extensive intraluminal thrombosis of ostial Cx and ostial LAD treated with thrombus aspiration and balloon angioplasty. During the procedure the patient was supported with inotropic agents, mechanical ventilation and IABP for a cardiogenic shock. After few hours he was transferred to level II hospital, equipped with all mechanical circulatory supports (MCS) and on–site cardiac surgery, where he was assisted with vaso–inotropic drugs, Impella CP and continuous renal replacement (CRRT). After 3 days for a refractory cardiogenic shock (stage D) the patient was referred and then transferred to our hospital, a level III hospital with cardiac transplantation program, for hemodynamic stabilization and eventual long term ventricular assist device (VAD). After 5 days the patient was weaned by Impella support, then weaned by mechanical ventilation, renal replacement therapy, without any neurological damage. The echocardiography showed a severe left ventricular dysfunction (EF 20%) with severe mitral regurgitation with good right ventricle function, confirmed also by strain assessment. In the following weeks were reported repeated episodes of pulmonary congestion treated with high doses of diuretics, NIV and nitroprusside infusion and episodes of low cardiac output treated with inotropes for prolonged periods. Mitraclip implantation was technically feasible but Heart Team decided to implantation an LVAD due to numerous episodes of low cardiac output and reduced cardiac index values. Screening for VAD showed no contraindications, therefore after 72 days from acute event LVAD was implanted with positive outcome.

Conclusion

the presence of a local network for cardiogenic shock allowed to optimize the clinical pathway of this patient and to manage in an integrated way the complex treatment of cardiogenic shock.
P263 ROLE OF VITAL SIGNS AND INDICES OF SHOCK DERIVED FROM THEM IN THE SUSPICION OF MASSIVE PULMONARY EMBOLISM IN ELDERLY: THE ER AS A WINDOW ON REAL LIFE
Authors: Savioli G , Brattoli M , Fumoso F , Lapia F , Mugellini A , Martignoni A , Ceresa I , Muzzi A , Novelli V , Preda L , Lava M , Manzoni F , Bressan M
Published: May 2022

Purpose

Assess which vital parameters or shock parameters, in the real life of an Emergency Department, correlate with the presence of massive pulmonary embolism to see which ones can be of help to early suspect it.

Methods

Single–center retrospective observational study, on all geriatric patients (> 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Anni), and for the presentation of the risk of mortality at 30 days (sPESI). We then had all chest CTs retested by an experienced radiologist. We assess the correlation of vital parameters and shock indexes with the presence of massive pulmonary embolism. We took into consideration: the shock index (SI), the modified shock index (MSI) and the age–shock index (AGE_SI).

Results

We enrolled 247 patients, with a mean age of 83 years and prevalence of female (F = 63%). Of these, 85 (34.4 %) presented with massive pulmonary embolism. There is no correlation between blood pressure, systolic and diastolic values, respiratory rate with the presence of massive pulmonary embolism (p > 0.05). However, there is a strong statistical correlation between heart rate values and the presence of massive pulmonary embolism (p < 0.0001). The shock index correlates with the presence of massive pulmonary embolism with good statistical strength (p < 0.001); the modified shock index correlates with the with even greater statistical strength (P = 0.0005). The age–shock index correlates with the presence of pulmonary embolism with excellent statistical strength (p < 0.0001).

Conclusions

The study suggests that the alteration of shock indices, in particular of the AGE–shock index, correlate with the condition of massive pulmonary embolism. Taking into consideration these parameters, of very low cost, available from triage and obtainable in a few minutes at the medical examination, easily performed in the various Italian situations, can help to raise the suspicion of massive pulmonary embolism early and direct the patient more quickly towards the correct procedure therapeutic diagnostic.
P265 RED ZONE: 22 MILES OF FIRE. ANALYSIS OF THE TIMING AND PROCESSES OF ELDERLY PATIENTS WITH ACUTE PULMONARY EMBOLISM IN THE EMERGENCY ROOM. THE REAL–LIFE EXPERIENCE OF 5 YEARS IN THE EMERGENCY ROOM
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Muzzi A , Novara E , Fumoso F , Lapia F , Brattoli M , Bressan M
Published: May 2022

Purpose

to describe the role of the emergency room in the diagnostic–therapeutic process of acute pulmonary embolism.

Methods

single–center retrospective observational study, on all geriatric patients (> 75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes.

Results

We enrolled 247 patients, all requiring hospitalization for acute pulmonary embolism. The average age of 83 with female prevalence (63%). Median wait times for medical examination were 42 minutes. The average waiting times, however, for the large number of low priority codes (40% between 5 and 4 codes), was more than 6 hours. All patients required a chest CT with contrast, 44% first did a chest x–ray and 2% an ultrasound. All patients underwent ECG and blood tests. The time spent in the Emergency Department (LOS) was on average 18 hours. 58% of patients were managed in areas of low or medium intensity, 42% were sent to OBI for therapeutic diagnostic completion or necessary monitoring. OBI patients were on average 504 minutes. 56% face the phenomenon of boarding. 34% showed massive EP, 32% showed organ damage. 41% were considered to be at high risk of short–term mortality according to European guidelines, 8% required intensive care and in–hospital mortality was 7.7%. Under triage is 31%.

Conclusions

The population that arrives in ED due to pulmonary embolism presents an overall clinical picture with a high degree and high care and therapeutic complexity. Need for numerous investigations and second level imaging. They often require complex therapies and multi–parameter monitoring during stabilization and observation. Therefore, the time spent in the emergency room is long. The workload to treat these patients is high and requires excellent multi–professional and multidisciplinary integration, especially between the various professional figures in urgency, the laboratory and radiology.
P303 A CASE OF MYOPERICARDITIS AFTER II DOSE COVID 19 MRNA VACCINE IN YOUNG MALE
Authors: Bolognesi M , Iconomu E , Armentano C , Turchio P , Petrini M , Moderato L , Michieletti E , Aschieri D
Published: May 2022

COVID 19 disease caused devasting health consequences from March 2020. The development of effective vaccines against SARs COV 2 is an important weapon to defeat this virus. However rare cases of vaccines complications have been reported including myopericarditis above all in young males that we have to follow strictly and to begin right therapy as soon as possible. Data regarding specific therapy about mypericarditis after COVid 19 vaccine are scanty. We report a case of 16 years old male with no health problems, admitted in emergency department with chest pain relieved by sitting posistion and persistent fever rised 24 h after receiving his second dose of mRNA COVID 19 vaccineA 12 lead ECG showed normal sinusal rhythm without ST changes. On admission the complete blood cells count was normal, PCR was high: 5,92 mg/dl and troponin I at high sensivity was elevated: 9249 ml/L. The patient was hospitalized in our cardiology department with suspected myopericarditis. Ecocardiography TT showed normal left ventricular ejection fraction and no pericardial effusion. We began immediately non steroidal anti inflammatory therapy at high dose (ibuprofen 600 mg x 3/die and colchicine 1 mg/die) with conseguently reduction of chest painfuls symptoms. We also began ACEi therapy. On the advice of of the infectious disease specialist we added in the 5 th day methilprednisolone 25 mg/die in consideration of an excessive acute inflammatory response and we observed a clinical improvement with an indices of inflammation reduction. Cardiac magnetic resonance (CMR) performed after 3 day in T2 weighted images showed intramyocardial and subepicardial hyperintensity localized to the mid and apical lateral, basal infero lateral, distal anterior segment, as myocardial edema. Furthermore after Injection of contrast: subepicardial late gadolinium enhancement in the same segment. Minimum (4 mm) pericardial effusion. The clinical setting was attributable as symptoms, elevated troponin above upper limit of normal, in absence of other identifiable cause of symptoms and findings, to confirmed case of acute myocarditis after vaccine in according to the “CDC case definitions”. Myocarditis after mRNA COVID 19 vaccination affect above all young males with mild and multifocal forms with risks and benefits in favour of vaccines. However we need to identify them for an early therapy. In these setting of myocarditis an early use of corticosteroids can be provided.
P309 A CASE OF POST COVID VACCINE MYCARDITIS
Authors: Gentile G , Busti A , De Carlini C , Meles E , Maggiolini S , Bruni F
Published: May 2022

Background

Myocarditis is an inflammatory disease of the heart muscle commonly caused by viral infections. Vaccines can also cause myocarditis although the occurrence of this side effect is very rare. In the course of the Sars Cov 2 pandemic, there have been myocarditis both related to the virus and related to the anti–virus vaccine (especially related to RNA vaccines).

We present a case of myocarditis from Comirnaty. 23 year old sportsman. In anamnesis only frequent tonsillitis in school age leading him to tonsillectomy at 18 years old. June 2021 1st dose Pfizer vaccine. Next day in ER for fever, headache, nausea, dizziness, abdominal pain. Brain CT: neg; Blood tests: slight increase in Gb 14,200 (109 / L) (neutrophils 88%) which drop the next day to 9,000 and a slight increase in CRP which from 0.19 mg / dl (nv < 0.5) reaches the value of 1.5. Of note a slight increase in CPKs stable in the two samples (CPK 602 U / l –> 652); August 2021 2nd dose of Pfizer vaccine. From 6th to 12th day post vaccine intense headache. Chest pain on the 13th day. In ER ECG with diffuse elevated ST. Trop I 12888 (vn < 50); Echocardium: normal. Trop I peak 45795 ng / l; Bisoprolol 1.25 mg started for a 6–beat TVNS. CardiacMRI: FE 67%, T2–weighted sequences: anterior and lateral intramural hyperintensity, sequences after contrast medium: large areas of late intramural enhacement in the apical and middle anterior wall and in the lateral wall, suggestive for myocarditis. In discharge recommended suspension of competitive physical activity. 3 months later inspection: pz in excellent condition. Echocardium: normal. CardiacMRI: reduction of ventricular volumes (EDV Vsx 187 ml –> 136) (EDV Vdx 227 ml –> 195) areas of intramural fibrosis reduced at the level of the lateral wall.

Discussion

Post vaccine myocarditis cases are rare but more frequent than reported in pivotal studies. The incidence varies according to the different registers. There seems to be an increase in incidence compared to the general population but not compared to the population affected by Sars Cov2. As confirmed by our case, this pathology is more frequent in young men and appears mainly after the 2nd dose. The pathogenetic mechanism of this reaction is still uncertain. The short–term prognosis of the disease is generally benign even if a longer follow–up is necessary in order to observe the evolution of the clinical status over time
P351 “HOLDING AREA AND SHORT STAY HOSPITAL: A NEW MODEL OF ORGANIZATION
Authors: Verde M , Taberini L , Macali L , Stolfi A , Matera S , Gabrielli D , Petrolati S
Published: May 2022

In A.O. San Camillo–Forlanini, dedicated “Holding Areas” (HA) are active. They enable a rapid allocation of patients (pts), avoiding their long stay in the Emergency Department (ER) and therefore reducing the overcrowding. Moreover they allow the optimization of diagnosis and care, thanks to the direct management of specialists and reduce improper hospitalizations. Our HA is committed to receive (except on weekends) 3 pts/day destined to hospitalization in Cardiology. Here the patients are re–examined and quickly undergo to further specific tests, aiming at identifying those who can be addressed to alternative paths (Day Hospital/Day Service) and those who need to be hospitalized. For the latter, the HA allows to select the most appropriate diagnostic/therapeutic path according to the model of the intensity of care: critical area (ICU); ordinary hospitalization; short stay (SHS). In 2020 (with a total of 206 of Cardiology HA opening days, net of the lockdown and summer closure periods) 402 patients from the ER were admitted to cardiology HA. Among those, 20% (81 pts) was assigned to the SHS (availability of 2 beds/day, except for weekends) while another 4.3% (17 pts) was allocated to outpatient care. 52% of SHS pts had ischemic pathology (NSTE–ACS at low risk, CCS – Chronic Coronary Syndrome – with positive stress test, doubtful chest pain with multiple risk factors), 33% arrhythmic pathology (66% tachyarrhythmias, 34% bradyarrhythmias) and 12.6% heart failure (Killip class I–III). The HA reduced the average hospital stay (AHS): for SCA–NSTE, for example, from 5.1 days to 3.6 and the waiting time for diagnostic procedures (for example, for coronary angiography from 1.8 to 0.3 days). The opening of the SHS has further reduced the duration of the AHS: 1.5 nights for the CCS (the need for revascularization was not indicated in 68% of cases); 1 night for tachyarrhythmias (electrical cardioversion in 89% of cases); 3.75 nights for bradyarrhythmias (PMK implantation in 55% of patients). The overall average stay in SHS was very brief (2.5 nights) allowing a rapid turnover even with more difficult procedures. While criticalities persist (limited availability of SHS beds, “short” week opening), the results obtained confirm the need for dedicated and specialized HA in order to reduce improper hospitalizations, trim hospitalization times and broaden the appropriateness of care.
P393 MULTIMODALITY IMAGING IN ACROMEGALIC CARDIOMIOPATHY: A CASE REPORT
Authors: Boccadoro A , Pompei G , Pavasini R , Passarini G , Micillo M , Campo G , Guardigli G , Tonet E
Published: May 2022

Background

Acromegaly is a disease caused by an excessive production of GH. Cardiac involvement, called acromegalic cardiomyopathy, is present in 90% of cases.

Clinical Presentation

A 56–year–old woman with acromegaly from pituitary adenoma, hypertension and obesity undewent angioCT showing thoracic aortic aneurysm (Figure 1). She was referred to a cardiological visit to evaluate the possible presence of acromegalic heart disease. The EKG showed signs of left ventricular hypertrophy (LVH) and so transthoracic echocardiogram (TTE) was prescribed: it showed slightly dilated, very hypertrophic left ventricle with ejection fraction of about 50% and signs of diastolic dysfunction. The exam also highlighted moderate to severe aortic valve regurgitation (Figure 2). In order to better characterize the cardiomyopathy a Cardiac magnetic resonance with contrast media (CMR) was performed: cine images confirmed severe left ventricular hypertrophy associated with mild dilatation, global biventricular hypertrophy and hypokinesia. After contrast media administration, a diffuse mild–enhancement pattern was found, a possible expression of diffuse interstitial fibrosis (Figure 3). In consideration of the dilatation of the ascending aorta and the contextual valve insufficiency, the patient was referred for cardiac surgery outpatient visit.

Discussion

The most frequent manifestations of acromegalic cardiomyopathy are bi–ventricular hypertrophy, the presence of diastolic and systolic dysfunction and the presence of valve regurgitation. Concentric hypertrophy is due to the increase in cardiomyocytes secondary to the GH stimulus and it is often bi–ventricular. Another characteristic finding is diffuse interstitial fibrosis with consequent systo–diastolic dysfunction and heart rhythm abnormalities. Aortic valve anomalies are linked to matrix abnormalities and myxoid degeneration.

Conclusions

this case can be considered an example of acromegalic heart disease. Multimodality imaging plays a key role in the early diagnosis of cardiac involvement and therefore it allows an early start of therapeutic strategy. Additionally, it is useful for the risk stratification of acromegalic patient.
P394 FROM A PET THE FIRST AND UNEXPECTED DIAGNOSTIC ORIENTATION
Authors: Capoferri A , Sanvito R , Aiolfi E , Cinelli F , Pavone A , Canziani F , Rondi M
Published: May 2022

Introduction

Nuclear medicine plays an important role in the diagnosis and treatment of numerous pathologies. In the cardiology field it can be used to obtain a lot of information about ischemic heart disease, infiltrative heart disease and inflammatory and infectious diseases such as endocarditis. The greatest impact in the field of these latter pathologies was obtained using F–fluorodeoxyglucose (FDG) in the study of patients with implantable electronic devices and replaced valves or valve prostheses. In this regard, I report the case of a patient with results of valve tube implantation in which a PET performed to investigate an inflammatory pathology has allowed to make a diagnosis of endocarditis.

Discussion

The case concerns a 66–year–old man subjected to intervention of Bentall for type A aortic dissection (in 2015); chronic aortic dissection remains (Stanford B). Diabetic with chronic renal failure and COPD. Recovered in medicine for low back pain, dysuria and episodes of chills without pyrexia. High inflammatory indices but with urine culture and negative blood cultures performed on isolated febrile peak. CT scan of the chest negative for phlogistic localizations and for intense rachialgia in the suspicion of spondylodiscitis is subjected to total body PET that shows accumulation of radio compound in the first tract of the ascending aorta with greater anterior focality: hyper fixation is associated at the level of the lower limiter of L4 and L5. With these results therefore posed the suspicion of endocarditis for which started to perform transthoracic echocardiogram that did not identify certain pathological elements and transesophageal elements that instead showed suggestive images for endocarditic vegetation in aortic mechanical prosthesis (intravalvular mobile filiform appearance) and on the atrial side of the tricuspid valve (“soft” appearance of large dimensions). It is not associated with valvular dysfunction. After the echocardiographic finding, therapy with daptomycin in addition to piperacillin/tazobactam is initiated and the patient transferred to the infectious diseases department.

Conclusions

Bacterial endocarditis in particular in patients undergoing cardiac surgery or wearing implantable devices is often characterized by unusual clinical presentation as in this case, so it is not excessive to resort to second–level imaging such as transesophageal echocardiography and nuclear cardiology diagnostics.
P405 ALDOSTERONE AND INTERLEUKIN–6: IS IT A NEW ASSOCIATION IN COVID–19?
Authors: Campana P , Ranieri A , Basile C , Forzano I , Perillo E , Ciaramella L , Follero P , Tagliamonte G , Sibilio G
Published: May 2022

Introduction

Several pieces of evidence have confirmed the interleukin–6 (IL–6) activity in the cytokine storm induced by COVID–19 pneumonia. Furthermore, the correlation between serum IL–6 levels and plasma aldosterone has been widely ascertained in patients with primary aldosteronism (PA). Hence, the highest levels of aldosterone may increase IL–6 in COVID–19 patients with PA.

Case Presentation

We reported the clinical case of a 47–year–old woman with severe COVID–19 pneumonia complicated by Guillain–Barré Syndrome (GBS). At admission, the patient presented severe interstitial pneumonia complicated by hypoxemia and respiratory failure, which required mechanical ventilation. Blood tests revealed very high levels of IL–6 (serum IL–6: 402 pg / mL) and its soluble receptor (soluble IL–6 receptor> 1900 pg / mL). In addition, the patient was diagnosed with PA after accidental evidence of right adrenal adenoma, resistant arterial hypertension, severe hypokalemia, and elevated serum levels of aldosterone with a high aldosterone/renin ratio. Therefore, infusion therapy with spironolactone was administered with a rapid improvement of the clinical condition. Later she was diagnosed with acute motor and sensory axonal neuropathy and with the indication of motor rehabilitation.

Conclusions

The higher aldosterone levels in PA could be associated with more severe forms of COVID–19, stimulating the production of IL–6 and its pro–inflammatory effects. Hence, the association between IL–6 and aldosterone may have a synergistic effect in the development of more severe complications such as GBS. The highest aldosterone levels and activity could be also identified in patients with COVID–19 pneumonia and secondary aldosteronism. More studies are needed to evaluate spironolactone therapy in COVID–19.
Familial clustering of unexplained heart failure - A Danish nationwide cohort study
Authors: Glinge C , Rossetti S , Bruun Oestergaard L , Stampe NK , Ravn Jacobsen M , Koeber L , Engstroem T , Torp-Pedersen C , Gislason G , Jabbari R , Tfelt-Hansen J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the European Union’s COST programme under acronym PARQ, registered under grant agreement No CA19137.

Background

Although family history of heart failure (HF) is associated with increased risk of HF, the extent to which a family history contributes to the risk of HF needs further investigation.

Purpose

To determine whether a family history of unexplained HF in first-degree relatives (children or sibling) increases the rate of unexplained HF.

Methods

Using Danish nationwide registry data (1978-2017), we identified patients (probands) diagnosed with first unexplained HF (HF without any known comorbidities) in Denmark, and their first-degree relatives. All first-degree relatives were followed from the HF date of the proband and until an event of unexplained HF, exclusion diagnosis, death, emigration, or study end, whichever occurred first. Using the general population as a reference, we calculated adjusted standardized incidence ratios (SIR) of unexplained HF in the three groups of relatives using Poisson regression models.

Results

We identified 57,845 first-degree relatives to individuals previously diagnosed with unexplained HF. Having a family history was associated with a significantly increased unexplained HF rate of 2.08 (95% CI 1.82-2.38) (Figure 1). The estimate was higher among siblings (SIR 4.82 [95% CI 3.17-7.32]). Noteworthy, the rate of HF increased for all first-degree relatives when the proband was diagnosed with HF in a young age (≤50 years, SIR of 3.60 [95% CI 2.37-5.47]) and having >1 proband (SIR of 2.73 [95% CI 1.14-6.56]). The highest estimate of HF was observed if the proband was ≤40 years at diagnosis (6.12 [95% CI 3.39-11.05]) (Figure 2).

Conclusion

A family history of unexplained HF was associated with a two-fold increased rate of unexplained HF among first-degree relatives. If the proband age was ≤40 years, the risk was six-folded. These findings suggest that screening families of unexplained HF with onset below 50 years is indicated.
Genetics of idiopathic ventricular fibrillation
Authors: Pannone L , Gauthey A , Sorgente A , Monaco C , Bisignani A , Overeinder I , Bala G , Almorad A , Stroker E , Pappaert G , Sieira J , Brugada P , La Meir M , Chierchia GB , De Asmundis C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Idiopathic ventricular fibrillation (IVF) accounts for up to 44% of sudden cardiac deaths (SCD); the diagnostic yield of genetic testing in probands is reported as low as 3%.

Purpose

The aim of this study is to describe the results of genetic testing in IVF from a high-volume center.

Methods

All consecutive patients with IVF and genetic testing were retrospectively analyzed. IVF was diagnosed, following HRS/EHRA guidelines, by means of excluding other causes through clinical, imaging and genetic data. Genetic analysis was performed in all patients with SeqCap v3 for Brugada syndrome and with next generation sequencing HiSeq1500 for other inherited primary arrhythmia syndromes. Genetic variants were classified following ACMG as pathogenic (P)/likely pathogenic (LP) or variants of unknown significance (VUS).

Results

Fourteen patients with IVF were included (Table); an ICD was implanted in all patients. A genetic variant was found in 9 patients (64.3%), 5 patients with a P/LP variant (35.7%) and 4 patients (28.6%) with a VUS variant. Genes mutated with a P/LP variant included: RYR2 in 3 patients and TTN in 2 patients. Genes mutated with a VUS included: MYPN in one patient, SCN4A in one patient, DES in one patient and CACNA1C in one patient. At a mean follow-up of 76 months 5 patients (35.7%) experienced an ICD shock [2 patients (40%) with P/LP variant vs 3 patients (33%) of VUS/no variants, p=NS).

Conclusion

Genetic testing can be useful in IVF; prognosis is modest with a high rate of ICD shock at long-term follow up.
A novel weighted hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias: a multicenter study
Authors: Falasconi G , Penela D , Carreno JM , Soto-Iglesias D , Jauregui B , Viveros D , Bellido A , Scherer C , Benito B , Marti J , Sabate X , Matiello M , Acosta J , Fernandez-Armenta J , Berruezo A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

To correctly predict the outflow tract ventricular arrhythmia (OTVA) site of origin (SOO) before the ablation is still a procedural major step, having important implications for correct patient counseling, ablation planning, and periprocedural complication evaluation. Although multiple ECG criteria have been proposed for predicting OTVA SOO, their accuracy and usefulness are still limited as recently (1).

Purpose

The present study sought to prospectively evaluate the accuracy of a previously published Hybrid Score (HS) for prediction of OTVAs with LVOT origin. Besides, multiple ECG measurements of patients with V3 precordial transition (V3PT) OTVA were analyzed to identify potential variables useful to improve the accuracy of the HS (2).

Methods

Consecutive patients (n=105) referred for OTVA ablation were prospectively enrolled from three referral centers. Vascular access and first-mapped ventricle were decided based on the previously published HS, which includes ECG (R/S precordial transition) and clinical information (age, hypertension, and gender). Surface ECGs during the OTVA were analyzed by two independent electrophysiologists to compare the discriminative performance of HS and previous published ECG-alone criteria, to assess their inter-observer variability and to identify potential variables useful to improve the proposed model.

Results

Of the 105 VAs, 70.5% had an RVOT origin and 29.5% an LVOT origin. HS achieved a correct prediction in 90% patients. This rate dropped to 75% in the subgroup of patients with V3PT OTVA. The correct prediction rate of the other ECG-alone criteria in the whole population ranged from 74 to 82% and from 41 to 76% in V3PT patients, and their Cohen’s Kappa coefficient for inter-observer variability assessment ranged from 0.63 to 0.81. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3PT patients. When this parameter was incorporated in the novel Weighted Hybrid Score (WHS) (Figure 1), it correctly classified 99 (94.2%) patients (90% sensitivity, 96% specificity, AUC: 0.97). The WHS discriminatory capacity was maintained in V3PT subgroup, (87% sensitivity, 91% specificity AUC: 0.95). WHS showed a Cohen’s kappa coefficient of 0,82. Finally, WHS was validated in an additional population of 97 patients with OTVAs referred for catheter ablation from three additional external centers; in this testing sample the WHS correctly predicted the SOO in 90% patients and proved to have 89% sensitivity and 90% specificity (AUC: 0.94) for a score ≥2 to predict a LVOT origin.

Conclusions

The novel simple-to-use WHS proved to accurately anticipate the PVC’s SOO and can be introduced in clinical practice for choosing the first chamber to map.