bluuebunny/crossref_metadata_2025 huggingface dataset:
P224 PRIMITIVE DILATED CARDIOMYOPATHY IN YOUNG MAN NOT ELIGIBLE FOR CARDIAC TRANSPLANTATION: COMBINED USE OF DEFIBRILLATOR, CARDIAC CONTRACTILITY MODULATION (CCM) AND CARILLON
Authors: Verrengia E , Magnano R , D‘Alleva A , Forlani D , Pezzi L , Fulgenzi F , Vitulli P , Paloscia L , Di Marco M
Published: May 2022

Acute heart failure refers to rapid or gradual onset of symptoms and/or signs of chronic heart failure due to precipitating factors. Many patients with heart failure progress into a phase of advanced heart failure, characterized by persistent symptoms despite maximal therapy. Prognosis remains poor, with high 1–year mortality. Prognostic stratification is important to identify the ideal time for referral to an appropriate center capable of providing advanced therapies. We present the case of a 36–year–old black homeless man was admitted to Cardiological intensive care unit for acute heart failure complicated by intermediate–high risk bilateral subsegmentary pulmonary embolism, left endoventricular thrombosis, severe biventricular systolic dysfunction and secondary severe mitral insufficiency. After infusional diuretic and anticoagulant therapy, coronary angiography was performed documenting non–obstructive epicardial coronary arteries. Thereafter the therapy with sacubitril/Valsartan was falled, due to marked hypotension. Due to the high risk of sudden cardiac death, a single–chamber ICD was implanted in primary prevention. He was not eligible for long–term mechanical assistance (VAD) implantation and/or heart transplantation from referral centers, because of the patient‘s precarious psychosocial background. Furthermore, in the fullness of his faculties, the patient refused this possibility for religious reasons. Discharged in fair compensation, after resolution of pulmonary embolism and intracavitary thrombosis, he was again hospitalized for an exacerbation of chronic heart failure. Once labile hemodynamic compensation was reached, a cardiac contractility modulation device (CCM) was positioned, with the aim of improving symptoms. After optimization of therapy, with persistence of severe symptoms despite optimal medical and device therapy, options for intervention on the mitral valve were evaluated before further deterioration of the clinical conditions. Since this is a highly symptomatic patient at high risk for surgery, we opted for a coronary sinus mitral annuloplasty repair with Carillon, performed in the absence of complications. At the follow–up there was a mitral regurgitant volume reduction, improvement symptoms, in the absence of further hospitalizations.
P228 WEARABLE DEFIBRILLATOR IN CLINICAL PRACTICE. MULTIANNUAL MULTI–CENTER EXPERIENCE
Authors: Solarino G , Bartoli C , Talini E , Del Meglio J , Lilli A , Baratto M , Della Tommasina V , Canale M , Arena G , Casolo G
Published: May 2022

Introduction

Heart failure with reduced left ventricular ejection function (LVEF) represents a life–threatening condition for patients (pts). A period of time of 40–90 days, in optimal medical therapy, is indicated to evaluate the recovery of the LVEF and the indication to ICD implantation. In this period, from 1% to 5% of pts can experience sudden death. We evaluated the usefulness of the wearable cardioverter defibrillator (WCD) as a temporary antiarrhythmic therapy in the interval from discharge to the three–month follow–up.

Methods

From December 2015 to December 2021, 174 consecutive pts (141 M (81%); mean age 62 years ± 11.6 years) were discharged with reduced FE < 35% in OMT, with WCD and were re–evaluated within 3 months to establish indication for ICD implantation.

Results

110 pts (63.2%) recovered LVEF at 3 months and left the indication to ICD. 9 pts refused and/or returned the WCD due to poor compliance (5.2%); 52 pts (29.9%) did not recover LVEF and were implanted with ICD. The WCD was worn continuously by the majority of pts with good compliance for 87.4 ± 52.0 days (range 1 ÷ 303 days), for 22.08 hours / day. 23 episodes of AF were correctly recognized; 10 TVNS> 10 sec; 1 episode of VF in 1 patient in which 1 shock was correctly delivered. 1 inappropriate shock was delivered on tachycardic AF. During the WCD wearing period, 3 deaths occurred (1.7%): in 2 pts due to refractory HF (one of these pts had VF correctly recognized and treated by the WCD but degenerated into pulseless activities); 1 death for terminal cancer). The use of WCD has progressively increased over the years (from 4.5 LV / yy in 2015–16 to 45 LV / yy in 2020–21).

Conclusions

The use of WCD has gradually increased in clinical practice for patients who have not yet developed clear indications for ICD implantation. In the majority of them, ventricular dysfunction is transient. Wearable cardioverter defibrillator represents additional security during this period. Continuous monitoring makes it possible to identify supraventricular and ventricular arrhythmias, improving therapeutic appropriateness and in general the patients have excellent compliance with the device. Further studies are needed to substantiate this strategy.
P235 CLINICAL AND INSTRUMENTAL CORRELATES OF LEFT AND RIGHT ATRIAL TWO–DIMENSIONAL STRAIN MEASUREMENTS IN PATIENTS WITH HEART FAILURE
Authors: Diomede N , Terazzi E , Correale M , Di Terlizzi V , Barone R , Manuppelli V , Brunetti N , Iacoviello M
Published: May 2022

Background

The two–dimensional strain obtained through Speckle Tracking Imaging (STI) represents an innovative, rapid and semi–automatic echocardiographic method to study systolic and diastolic function. By analyzing the deformation of cardiac segments, it provides an indirect index of myocardial contractility and relaxation of left and right ventricles, but also of both left and right atria.

Purpose of the Study

The aim of this study was to evaluate the clinical and instrumental correlates of the different measures of right and left atrial strain in a group of patients with chronic heart failure (CHF). Method. We enrolled 165 out patients with CHF (63 ± 14 years, 76% male, 39 ± 11% ejection fraction). All patients underwent a cardiological examination, ECG and echocardiogram. The echocardiographic images were analyzed using an innovative software (TomTec, Philips) able to semi–automatically analyze both the ventricular and atrial strain. For each patient, both for the left atrium (LA) and the right atrium (RA), the measures related to all atrial functional phases were calculated: reservoir (r), conduit (cd) and contraction (ct).

Results

At univariate and multivariate logistic regression models, the main determinants of atrial strain measurements were evaluated. As shown in the Table, both for the RA and LA the reservoir and conduit were more closely associated with ventricular systolic function and age. LA contraction was associated only with E/e‘ and heart rate, whereas for the RA one there was no independent statistical association with the parameters studied.

Conclusions

The Strain parameters that evaluate right and left atrial function have an independent association with different clinical and instrumental variables. These results support the hypothesis that the reservoir and conduit measurements express a different physiological and pathophysiological substrate than the contraction measures.
P240 SHORT–TERM EFFECT OF SGLT2I ON ECHOCARDIOGRAPHIC PARAMETERS IN HFREF PATIENTS TREATED WITH ARNI
Authors: Mazzetti S , Cannistraci R , Scifo C , Acone L , Alonge S , Foti M , Tarantini R , Lattuada G , Perseghin G , Mortara A
Published: May 2022

Background

Treatment with Sacubitril / Valsartan (ARNI) in patients with heart failure and reduced ejection fraction (HFrEF) promotes significant improvement of left ventricular remodeling along with positive outcomes in terms of hospitalization for heart failure, quality of life and mortality. In a previous study we demonstrated that ARNI significantly modifies myocardial longitudinal strain (GLS), one of the most reliable markers of myocardial contractility. It is still debated whether this effect remains unchanged regardless of the presence of diabetes and if it can be further increased by SGLT2 inhibitors, which in turn have been shown to reduce hospitalizations for heart failure and cardiovascular mortality.

Purpose

of this ongoing study is to measure, in HFrEF patients with or without T2DM, treated with ARNI and SGLT2i, short–term changes (6 months follow up) of the main echocardiographic parameters, including GLS Methods We enrolled 40 outpatients (32 male, age 65 + 10 years, EF 29,7 + 6,5%) on optimized medical treatment with class I medications, including ARNI at the maximum tolerated dose (starting dose 75 + 15mg, maximum titrated dose 190 + 10mg). Population was then divided into three groups: group 1 (20 pts) without T2DM; group 2 (11 pts) with T2DMI; group 3 (9 pts) with T2DM on SGLT2i treatment (4 with empaglifozin 10 mg, 5 with dapaglifozin 10 mg). No hemodynamic or metabolic complications related with therapy were observed, and no patients needed discontinuation or down–titration of therapy All patient underwent echocardiographic study at baseline and after six–month follow–up.

Conclusions

This ongoing study confirms that, in HFrEF patients, ARNI positively modifies left ventricular contraction and remodeling, and this effect is still verified regardless of the presence of T2DM. The association with SGLT2i, conversely, does not appear to provide further positive benefits on remodeling.
P241 CARDIAC INVOLVEMENT IN CREATINE DEFICIENCY SYNDROME
Authors: Del Franco A , Battini R , Kusmic C , Forini F , L‘ Abbate S , Masotti S , Musetti V , Barison A , Emdin M , Vergaro G
Published: May 2022

Background

Previous reports have demonstrated electrocardiographic and echocardiographic abnormalities consistent with early–stage cardiomyopathy, in patients with creatine transporter deficiency (CRT–D), but cardiac involvement has never been accurately characterized. Our aim was to widen the current knowledge of the cardiac phenotype associated with creatine deficiency in a murine transgenic model and in patients with creatine deficiency syndrome (CDS).

Methods

Wild type (n = 6) and transgenic CRT–/y mice (n = 6) were evaluated in vivo by electrocardiogram (EKG) and echocardiography for six months, and ex vivo by histological and biochemical analyses. Nine patients with CDS (4 with L–arginine:glycine amidinotransferase deficiency – AGAT–D, 5 with CRT–D) underwent blood samples, including cardiac biomarkers, EKG, Holter monitoring, echocardiography and cardiac magnetic resonance (CMR).

Results

Compared to wild–type, CRT–/y mice showed a prolongation of QT interval (p = 0.008) (Fig. 1), as well as a trend of reduction of mitochondrial function (Fig. 2). No differences were dected in the left ventricular systolic function, in terms of ejection fraction and global longitudinal strain, at different times. Aldosterone levels were also not different between the two groups. Three patients with CDS also showed a prolonged QTc interval (median QTc 515 ms), while other 3 had a borderline QTc at Holter monitoring, without tachyarrhythmias. No subject had abnormal systolic and diastolic function. At CMR, an increase of native T1 value was reported in 4 subjects (median 1076 ms), 1 with an increase of extracellular volume matching with the detection of late gadolinium enhancement. Finally, 7 subjects with CDS presented with biohumoral signs of neurohormonal activation (2 with elevated renin, 1 with increased aldosterone and 4 with increased norepinephrine levels). Familiar carriers (3 for AGAT–D and 1 for CRT–D) showed no notable cardiac functional alterations, except for QTc prolongation in 2 AGAT–D carriers.

Conclusion

Prolonged QT interval is observed in a murine model of CRT–D deficiency and in patients with CDS, in absence of an arrhythmic burden. No alterations in cardiac function were detected in the two setting, except for an increase of native T1 in patients with CDS suggesting an interstitial and replacement fibrosis.
P249 365 DAYS OF NOT ONLY COVID–19. DATA COHORT FROM THE HEART FAILURE OUTPATIENT’S AMBULATORY UNITE –IVREA HOSPITAL
Authors: Troiano F , Fornengo C , Almohani A , Grosso Marra W
Published: May 2022

The years 2020 and 2021 will always be remembered as the years of the SARS–Cov–2 pandemic, affecting and utilizing much of the world’s economic and humanitarian resources, especially in the health sector. At the start of 2020, Ivrea Hospital opened a new heart failure ambulatory unit. This unit was quickly set side to face the emerging health emergency of SARS–Cov–2. It was only in September 2020, with the reorganization of the hospital services, that the new unit could once again be used for outpatient visits. For this reason, this paper only covers the analysis of patients in our service from September 2020 to September 2021. During this time, 143 patients with heart failure have been evaluated as outpatients, most of whom were men (114 men, 29 females), with an average age of 70 years. The main reason for admission was ischemic cardiomyopathy (54%), although in 28% of cases the etiology was instead defined as idiopathic, on the basis of the diagnostic investigation performed. All patients had heart failure phenotype with reduced ejection fraction according to the latest ESC guidelines, with an average value of left ventricular ejection fraction of 38%. 24% of the patients received therapy with Sacubitril/Valsartan either introduced or optimized during outpatient’s follow–up. The remaining 44% of the patients (64) had sudden cardiac death prevention devices (ICD) implanted, 43% of whom had cardiac resynchronisation (Biventricular ICD– CRT–D). During the follow–up period, 10 patients died, of whom, one patient due to complications of Sars–Cov2 interstitial pneumonia, one patient due to early complications after LVAD implantation and the remaining patient due to progression of their heart failure condition, in which LVAD/transplantation was previously excluded. One patient underwent a successful heart transplant. The data presented reflect the reality of a medium sized center in the province of Turin and is aligned with what is reported by the scientific literature.
P257 THE IMPORTANCE OF ADMINISTERING A PHYSICAL EXERCISE PROGRAM WITH A NUTRITIONAL INFORMATION SHEET TO PATIENTS SUFFERING FROM CONGESTIVE HEART FAILURE INCLUDED IN A FOLLOW–UP PROGRAM WITHIN A DEDICATED CLINIC
Authors: De Masi De Luca G , Stefanelli S , Longo S , Barba F , Mauro R , Marzo S , Papadia P , Accogli M
Published: May 2022

Background

With this work we wanted to draw attention on the importance of administering a physical exercise path sheet and nutritional information sheet to patients with congestive heart failure (HF) in a FUP path. Materials and methods 164 patients were included in the FUP course dedicated to the HF at the dedicated outpatient clinic of the “Card.G. Panico” hospital in Tricase (Lecce, IT) in collaboration with the “Cardiomed Center” in Maglie (Lecce, IT). During the evaluation of insertion in the FBD, patients were divided according to the risk of events: low, medium and high. To improve adherence, both the patient and his caregiver obtained adequate and detailed information about the importance of the project and its aims. Patients with greater clinical stability, at medium and low risk (102) were divided into two groups. The FUP path was ideal for both, but only in the first (58 Group A) had a sheet with a personalized physical exercise path (PEP) and a sheet with nutritional information (SNI), identifying it as a real additional pharmacological therapy. The aim of the work was to highlight how an education and invitation to carry out physical exercise and an adequate nutritional path can bring benefit by evaluating medium–short term parameters that are weight, Borg scale, BNP, clinical alerts.

Results

The following differences were observed in the group of patients followed in the follow–up of Group A to whom the PEP and SNI sheets were administered compared to group B. – Alert in group A: 10 (7 diuretic therapy correction for OS, 1 access to the ER, 2 coomorbidity corrections) — Alert in group B: 18 (9 correction of diuretic therapy, 4 accesses to the ER, 1 hospitalization, 4 coomorbidity correction) P < 0.05 — BNP group A Δ –122 / group B Δ –188 P n.s. — Borg scale (0/10) Group A Δ + 1.9 / Group B Δ –0.2 P < 0.05 – Weight (kg) Group A –9% / Group B + 1% P < 0.05

Conclusions

Our experience in the clinic dedicated to heart failure has demonstrated the improtance and usefulness of administering a personalized physical exercise sheet to an adequate nutritional path, highlighting the improvement of various parameters such as weight, the perception of effort and the reduction of clinical alerts in the medium–short term.
P301 FULMINANT COVID–19 RELATED MYOCARDITIS: A CASE REPORT
Authors: Parato V , Germana G , Pierantozzi S , Principi T
Published: May 2022

The case

A 58–year–old man presented to ED because of fever, non–productive cough and worsening dyspnea. The patient’s medical history was unremarkable. On examination there was a hypoxic respiratory failure and the clinical picture rapidly evolved towards a cardiogenic shock characterized by altered mental status and cool extremities. Vital parameters: peripheral blood pressure was of 60/30 mmHg, pulse rate of 126 bpm, respiratory rate of 30 breaths/min, temperature of 38 °C. Two episodes of ventricular fibrillation were resolved by electrical shocks. The nasopharyngeal swab tested positive for COVID–19 on real–time reverse transcriptase–polymerase chain reaction assay. Arterial blood gas analysis showed a severe metabolic acidosis with hyperlactacidaemia (pH 7.26, excess basis–22 mEq/L, lactates 10 mmol/dL) and hypoxaemia. Situation evolved towards an end–organ hypoperfusion associated with multisystem organ failure (MOF). High resolution chest CT demonstrated bilateral ground glass opacities consisting of COVID–19 related interstitial pneumonia. 12–leads ECG demonstrated sinus rhythm with diffuse concave ST–segment elevation. T–T echocardiogram showed: 1) severely thickened LV walls; 2) decreased LV systolic function; 3) segmental wall motion abnormalities consisting of akinesis of the LV distal segments with relatively preserved function at the base; 4) LVEF) of 25%; 5) pericardial effusion. Thickened LV walls meant myocardial inflammatory infiltration/edema and the final diagnosis was FULMINANT COVID–19 related MYOCARDITIS. Patient underwent oro–tracheal intubation+invasive ventilation. An intra–aortic balloon pump (IABP) was placed on top of adrenaline (0.07μg/kg/min), and noradrenaline (0.1μg/kg/min) was added for worsening hypotension (systolic blood pressure: 80/67/60 mmHg). Additional therapy consisted of intravenous high dose diuretics, methyprednisolone, tucilizumab, immunoglobulin, ceftriaxone, remdesivir. After 3 weeks, patient recovered a good respiratory and haemodinamic status, LV wall thicknesses decreased and EF increased to normal values. The final outcome was favorable.

Discussion

The prevalence of fulminant myocarditis among COVID–19 patients is unclear. This simultaneous presentation of fulminant myocarditis and COVID–19 pneumonia favors an alternative pathogenetic pathway with possible acute replication and direct dissemination of the virus through the blood or the lymphatic system from the respiratory tract to the myocardium.
P316 TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: A SINGLE CENTER EXPERIENCE
Authors: Gallone G , Bongiovanni F , Bruno F , Scudeler L , Landra F , Andreis A , Casoni R , Fava A , Pidello S , Raineri C , Usmiani T , Alunni G , Conrotto F , D‘ascenzo F , De Ferrari G
Published: May 2022

Background

Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR–CA) remains difficult in this subset.

Methods

Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR–CA based on clinical assessment underwent 99mTc–DPD cardiac scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR–CA in AS, was retrospectively calculated to rule–out ATTR–CA in the remaining patients. Patients were categorized as follow: “ATTR–CA +”: patients with confirmed ATTR–CA at 99mTc–DPD cardiac scintigraphy; “ATTR–CA –”: patients with negative 99mTc–DPD cardiac scintigraphy or a negative RAISE score; c) “ATTR–CA indeterminate”: patients not undergoing ATTR–CA assessment with a positive RAISE score. The characteristics and outcomes of ATTR–CA + and ATTR–CA – patients were compared.

Results

Of 107 included patients, ATTR–CA suspicion was posed in 13 patients and confirmed in 6. Patients were categorized as follow: 6 (5.6%) ATTR–CA +, 79 (73.8%) ATTR–CA –, 22 (20.6%) ATTR–CA indeterminate. Excluding ATTR–CA indeterminate patients, the prevalence of ATTR–CA was 7.1%. As compared to ATTR–CA – patients, ATTR–CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, bifascicular block was more common. No difference in procedural outcomes and 1–year mortality was observed between groups.

Conclusions

Among severe AS patients, ATTR–CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. The procedural and mid–term outcomes following TAVR seems unaffected by ATTR–CA status.
P334 RARE CASE OF PAPILLIFEROUS FIBROELASTOMA ON AORTIC VALVE
Authors: Magnano R , D’Alleva A , Di Marco M , Forlani D , Pezzi L , Vitulli P , Fulgenzi F , Verrengia E , Corazzini A , Paloscia L
Published: May 2022

Cardiac tumors are rare neoplastic processes that can arise from any tissue in the heart. They are divided into primitive (benign or malignant) and metastatic (always malignant). The prevalence of cardiac tumors ranges from 0.002% to 0.28%, of which most are benign. Papillary fibroelastoma is the third most common heart cancer and the most frequent heart valve cancer. We describe the case of a 50–year–old ex–smoker patient with a recent history of recurrent right popliteal – tibial femoral thrombectomy and subsequent percutaneous angioplasty. He arrived in the emergency room for ischemic ulcers and fistulization of the right lower limb, for which he was admitted to the Vascular Surgery Department. The patient came to our observation for appearance during the hospitalization of episodes of chest pain at rest with irradiation to the left upper limb and spontaneous regression. The physical examination, blood pressure, blood chemistry tests, chest X–ray and ECG were normal. Transthoracic and transesophageal echocardiography showed a left ventricle with good contractile function, a tricuspid aortic valve with cusp movement preserved with an oval mass, hypoechoic, with well–defined margins, adhering to the ventricular surface of the right coronary cusp, conditioning insufficiency of mild degree. This image was suggestive for papillary fibroelastoma. In addition, in anticipation of cardiac surgery, a coronary CT was performed which confirmed the presence of an oval, hypodense mass and the absence of significant coronary lesions. The absence of fever, increased inflammation and leukocytosis indices made it possible to exclude an endocarditic origin of the lesion, just as the echocardiographic and radiological characteristics eliminated the suspicion of thrombosis. The patient underwent cardiac surgery via longitudinal median sternotomy, in normothermic extracorporeal circulation (CEC). The mass was then excised, preserving the native aortic valve. Postoperative follow–up with transesophageal echocardiography showed no signs of aortic insufficiency. The postoperative course was uneventful. The histological examination of the lesion confirmed the diagnosis of papillary fibroelastoma. At the follow–up after about 3 years the patient was asymptomatic and without echocardiographic signs of local recurrence.
P342 REAL–WORLD ANALYSIS ON THE ECONOMIC VALUE OF REACHING LIPID TARGET IN ITALY
Authors: Degli Esposti L , Borghi C , Galvani M , Giacomini E , Manotti P , Marra A , Passaro A , Perrone V , Pieraccini F , Sangiorgi D , Navazio A
Published: May 2022

The study aimed to evaluate the healthcare direct costs for Italian National Health System of patients treated with lipid–lowering drugs that do not achieve the low–density lipoprotein (LDL)–cholesterol target compared to those reaching their targets, and to analyze costs according to the distance from LDL target by using real–world data.

An observational analysis was performed on administrative and laboratory data from selected Italian Healthcare Departments. Patients were included if they presented at least one laboratory LDL test between 2012 and 2019 and if they were prescribed lipid–lowering drugs during 6 months prior the last LDL detection (index date). Mean annual direct costs were evaluated in the 12 months before index date in terms of all drugs prescribed, all–cause hospitalizations and all outpatient services. Distance to LDL target was calculated as difference between the index LDL level and LDL target. Total mean annual healthcare direct cost for patients that did not reach LDL target was higher compared to total cost of patients achieving LDL target (€3,678 vs €2,906). Costs were mainly driven by hospitalization (€1,330) followed by drugs expenditure (€1,012) and outpatient services (€563). Mean total annual healthcare costs increased with the distance from LDL target, specifically from €3,004 for patients with 10% distance from LDL target up to €4,823 for those 50% or more distance from LDL target. This trend was particularly evident for the cost item related to hospitalization, that went from €1,486 to €2,819 moving from 10% to ≥ 50 distance from LDL target. Results from this real–world study highlighted the higher economic burden for patients that do not reach the therapeutic LDL target, that tend to rise along with increasing distance from the LDL target. Overall, our findings could suggest that reducing the distance from LDL target could have a positive impact also on the economic outcomes for these patients.
P347 NURSING SENSITIVE OUTCOME (NSO) IN CARDIOVASCULAR CARE: NEW PERSPECTIVES TO IMPROVE QUALITY OF CARE AND PERSONALIZED ASSISTANCE
Authors: Boccini V , Giannini A , Martinelli C , Banti S , Baratta S
Published: May 2022

Over the years, attention of literature on the relation between the caring process and the patient’s outcomes has increased. In healthcare Organization, collection and recording of data about Nursing Sensitive Outcomes (NSO) allow a reflection on the impact of some nursing interventions in the clinical practice. The goals is to improve the quality and safety of nursing care and of continuing nursing training too. The cardiac and / or cardiac surgery patient is complex. For this reason, Nurse has a central role in the Healthcare Team to ensure prevention, assessment and treatment along the clinical pathway.

Objective

Mapping a set of NSOs, through shared clinical indicators. These specific indicators refer to several macro–areas: multidimensional assessment, pain management, wound care, vascular access management and assessment, drug therapies management. The indicators are measured in all of setting involved in cardiac patient care. METHODS Monocentric, observational, retrospective study. The data are extracted from the Computerized Nursing Record on the total hospitalizations in the 2020 and 2021 and will be analyzed. RESULTS Some data about the total accesses to the ward, in 2020: Barthel scale evaluated within 6 hours of admission in 90% of cases, Braden in 91% and Retos in 92%. Specifically, in patients > = 65 years of age, Retos filled in 90% of cases. Mews score evaluated at least once in 24h in 95% of cases and if mews score > = 3 vital signs are revalued in 93% of patients. STU correctly completed by physicians in 95.2% of patients.

Conclusions

The preliminary results of this study are strategic in order to initiate a monitoring phase about the nursing process, organizational models and skills over time. It allows a reflection on the quality and safety of care and to enhance nursing skills. However, in the future, we will hope to carry out a survey aimed at nurses, to explore, with an intra–professional perspective, which outcomes are the most perceived as sensitive to nursing care in the cardiovascular field and to better describe the competences related to NSOs. The association between the results of the questionnaire and the indicators monitoring, will strategic in order to build future specific nursing training.
P357 THE MANAGEMENT OF CHOLESTEROL LEVEL CONTROL WITH LIPID–LOWERING DRUGS IN ITALIAN CLINICAL PRACTICE: FINDINGS FROM THE STREAM (SUPPORTING WITH THE REAL–WORLD EVIDENCE THE ASSESSMENT OF MEDICINES AND HEALTH TECHNOLOGIES) STUDY
Authors: Degli Esposti L , Borghi C , Galvani M , Giacomini E , Manotti P , Marra A , Passaro A , Perrone V , Pieraccini F , Sangiorgi D , Navazio A
Published: May 2022

The study aimed to evaluate the proportion of patients not reaching their low–density lipoprotein (LDL)–cholesterol target according to their risk profile in real–world settings of Italian clinical practice.

This observational analysis was based on administrative and laboratory databases from a pool of Italian Entities covering around 10% of Italian population. All patients included had at least one laboratory LDL test between 2012 and 2019. Presence of lipid–lowering drugs was analyzed in the 6 months before index date (last LDL test detected), during which time adherence to these therapies was measured as proportion of days covered (PDC). Risk profile was assessed based on ESC guidelines.1 Among patients with LDL tests that received lipid–lowering drugs, 49.7% were deemed as very high–risk (VHR), 38.3% at high risk (HR), 12% with other risks (OR). Overall, 80% of patients did not reach their LDL–cholesterol target: 87.2% in the HR–cohort, 82.9% in the VHR–cohort (LDL level target 70 mg/dl and 55 mg/dl, respectively) and 49.6% in OR–cohort (LDL level target 116 mg/dl). Statin and ezetimibe combination was observed only in 6.5% of HR and OR and 10.3% of VHR patients, while patients were mainly in monotherapy with statins (87.5 VHR, 91.2% HR, 90.6% OR). Furthermore, patients adherent to treatment (PDC≥80%) accounted for the 52% of VHR–cohort, 47.2% of HR–cohort and 39.1% of OR–cohort. Our findings highlight the need to optimize the management of cholesterol control, especially among patients at risk. Despite the high proportion of patients not reaching LDL target, sub–optimal levels of adherence and a low use of combination regimens were observed, thus suggesting LDL–control could be supported by increasing adherence and/or the use of combination therapies and, if the target is not yet achieved, by the utilization of more recent therapies.

European Heart Journal (2020) 41, 111–188
P364 IMPORTANCE OF URIC ACID THRESHOLD IN ITS CORRELATION WITH METABOLIC SYNDROME
Authors: Maloberti A , Garofani I , Fumagalli S , Ciampi C , Ossola P , Carbonaro M , Monticelli M , Tavecchia G , Bombelli M , Giannattasio C
Published: May 2022

Background

The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut–off: 1) ≥6 mg/dL for women and ≥7 for men (classic cut–off); 2) >5.6 mg/dL for both sexes (recently proposed by the URRAH Project).

Methods

We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP–ATP–III criteria were used for diagnosis of MS.

Results

MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut–off and 35.9% according to URRAH study’s cut–off. Hyperuricemia and MS coexist in 9.7% (traditional cut–off) and 17.3% (URRAH’s threshold) of the population. Hyperuricemia was more frequent in MS than in non–MS subjects (29 vs 7.6%, p–value<0.0001 for cut–off 6/7 mg/dL and 51.6 vs 28.0%, p–value<0.0001 for cut–off 5.6 mg/dL). Linear regression models showed that SUA is related to MS diagnosis (β = 1.597, p–value<0.0001). At logistic analysis Hyperuricemia was strongly related to MS when defined by the HURRAH‘s cut–off (OR = 0.303, p–value<0.0001). The same relation is weak, although significan, when Hyperuricemia was defined by the classic cut–off (OR = 0.182, p–value<0.0001).

Conclusions

Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut–off of 5.6 mg/dL.
P380 THE REEL‘S SYNDROME : A RARE COMPLICATION AFTER PACEMAKER IMPLANTATION
Authors: Fais L , Floris R , Orrù F , Sirigu F , Marini R , Melis P , Mancosu M , Racis M , Delogu G
Published: May 2022

We report the case of a 83–year–old male who underwent single chamber pacemaker implantation in another center for bradyarrhythmia (atrial fibrillation) symptomatic for syncope. A ventricular lead was implanted in the apical septum, the post–procedural posterior–anterior chest radiograph showed correct placement of the leads and generator. Approximately 4 months after the implant, the patient came to our observation for repeated electric pulsations in his left shoulder. The patient was affected by mild dementia and was asymptomatic except for the presenting symptomatology, in particular he denied a history of syncope. The ECG showed arrhythmia due to atrial fibrillation, ventricular undersensing, and lack of ventricular capture (Figure 1). The chest X–ray showed the complete dislodgement of the ventricular lead tip apparently into the vein secondary to the rotation of the pulse generator on its transverse axis with consecutive coiling of the lead (Fig. 2). These findings were consistent with Reel syndrome The patient was admitted to undergo a lead repositioning attempt in consideration of the recent first implant. During the surgery, however, it was shown that the lead was completely displaced from the venous system, near the pectoral muscle. This extreme dislocation of the lead has been related to the electric pulsations felt by the patient. We proceeded with a new re–implantation of the lead and removal of the previous one. The lead was firmly tied to the pectoral muscle with 2 silk points with slight traction control of optimal fixation. Reel‘s syndrome is a variant of the better known Twiddler syndrome, characterized by the coiling of catheters along the transverse axis of the pacemaker. It is often a complication due to the manipulation of the generator by the patient, unlike Twiddler syndrome it occurs early and the leads remain intact. This syndrome is one of the most serious complications of pacemaker or defibrillator implants, it can be potentially fatal due to lack of therapy in the case of defibrillators, or asystole in pacemaker–dependent patients.
P385 SYNCOPAL VENTRICULAR TACHYCARDIA IN HEALTHY HEART: AN UNUSUAL ORIGIN!
Authors: Astegiano M , Pasquero M , Ruffini S , Franco E , Iancu D , Moretti C
Published: May 2022

Torsade de pointes is a particular type of ventricular tachycardia, characterized by QRS complexes that vary progressively in amplitude and morphology, giving the impression of oscillating around the isoelectric line. Causes include long QT syndrome (congenital or drug–induced) or severe hypomagnesemia. We report the case of a 57–year–old woman, a smoker, with a history of weight loss in the last 6 months, hospitalized in Medicine for marked asthenia and an episode of fleeting loss of consciousness, from sitting. She was asymptomatic for chest pain. The physical examination showed a pathological thinness, with BMI 15 kg/m2, rhythmic cardiac activity, no murmurs, no signs of decompensation, flat abdomen, not enlarged liver. Pale, dry skin was observed. On ECG: sinus rhythm, HR 70 bpm, QTc slightly increased 0.47 sec, flat T wave in lateral. Blood exams evidenced: hypokalemia, hypomagnesemia, rise of the amylase. On the MRI abdomen we found large inhomogeneous areas on the head and body of the pancreas, referable to the picture of focal pancreatitis. For syncopal episode during hospitalization in Medicine, she was transferred in Cardiology, where, during electrocardiographic monitoring, paroxysmal ventricular tachycardias torsade de pointes–like, symptomatic, self–resolved was registered. We diagnosed an acute pancreatitis with typical radiological characteristics of an autoimmune form, determining severe electrolyte imbalance and consequent symptomatic paroxysmal ventricular tachycardias. Oral magnesium supplement and corticosteroid therapy allowed the resolution of the arrhythmic problem, monitored over time through the implantation of a loop recorder.
P390 ADIPOSITY AND VASCULAR AGEING: WHICH PARAMETER BETTER CORRELATES?
Authors: Guareschi A , Vicenzi M , Calcagnino M , Carugo S , Scuteri A
Published: May 2022

The increase in stiffness of large arteries is one of the mechanisms that could play a role in the association between obesity and increased risk of cardiovascular (CV) events. Carotid–femoral pulse wave velocity (cfPWV), known as an independent CV risk factor, represents a validated measure of large arteries stiffness and a good proxy of arterial ageing. We aimed at evaluating which body composition parameters better correlated with cfPWV and whether this correlation differed between men and women. cfPWV was measured in all subjects with Sphigmocor by sequentially recording electrocardiogram–gated carotid and femoral artery waveforms; body composition was measured by bioimpedance analysis and waist circumference (W). Furthermore, each subject was characterized by sex, age, height, weight, body mass index (BMI), brachial blood pressure (BP) and heart rate. A linear correlation was used to define the relationship between cfPWV and parameters. Univariate and multivariate analysis were performed in male and female subgroups separately to select the main determinants of arterial stiffness, considering the following parameters: age, mean BP (mBP), BMI, W, fat mass (FM) and skeletal muscle mass (SMM). We enrolled 69 subjects (37 men, 32 women) with average age 34.5 years (min 19–max 76). cfPWV was significantly correlated with age (r = 0.65, p<.0001), and mBP (r = 0.38, p<.01). Among the body composition parameters, W, BMI and FM percentage were significantly correlated with cfPWV (respectively: r = 0.48, r = 0.42, r = 0.41; p<.0001). Multivariable regression analysis in men revealed that age and mBP were significant determinants of cfPWV (respectively: b = 0.042, p = 0.002; b = 0.051, p = 0.004). Conversely, multivariate analysis in women showed that age, FM and SMM are retained as main determinants of increased cfPWV (respectively: b = 0.079; p < 0.0001; b = 0.217, p = 0.012; b = 0.125, p = 0.011). Irrespectively of gender, age is the main determinant of arterial stiffness. Our results demonstrated that the relationship between adiposity and arterial stiffness is verified only in female subjects. This suggests that this relationship is influenced by complex and not fully known mechanisms. Moreover, technical factors (algorithm and indirect methods to assess body composition) contribute to uncertainty regarding which parameter exploring adiposity is more accurate in stratifying CV risk.

The present study recalls attention on possible gender–specific determinants of arterial ageing.
P417 ASSESSMENT OF RESIDUAL CARDIOVASCULAR RISK AFTER STENTING: THE ROLE OF IMAGING
Authors: Micillo M , Cocco M , Cossu A , De Raffele M , Boccadoro A , Campo G , Guardigli G , Tonet E
Published: May 2022

Background

Reduction of residual risk after myocardial infarction (MI) represents the main goal in secondary prevention. Imaging may provide additional evidence beyond the monitoring of risk factors.

Clinical Case

In June 2019 a 29–year old man, Pakistani ethnicity, former smoker with family history of cardiovascular disease experienced a myocardial infarction without ST–segment elevation. Coronary angiography revealed a severe disease of circumflex branch (LCx) and of second obtuse marginal branch (OM2) treated with drug eluting stent (DES) implantation. A strong medical therapy was planned including dual antiplatelet therapy, high–potency statin and ACE inhibitor. The year after, a new coronary angio was performed because of effort angina: intrastent restenosis of LCx–OM2 was highlighted and treated with balloon, associated with a critical disease of right coronary artery (RCA), treated with DES. In the following months, the patient experienced three hospitalization for unstable angina related to critical intra–stent restenosis of LCx and intermediate stenosis of left anterior descendent (LAD). In order to better understand the subtle mechanism of patient’s symptoms, an invasive assessment of microvascular disease was performed, showing microvascular dysfunction (IMR 30; CFR 2.2; RRR 2.7). Additionally, coronary angio images raised the suspicion of positive remodeling on mid tract of RCA and LCx, expression of a progressive and high risk atherosclerosis (Figure 1). A close follow up was planned: a coronary computed tomography angiography (CCTA) 4 months after the last angio was performed aiming the assessment of atherosclerosis progression. CT images showed patency of the previously placed stents. A severe amount of positive plaque remodeling of RCA and LCx was documented: it was characterized by hypodense eccentric plaque (<30 HU) with some little calcific spot near to the lipid core. These features underlined the presence of high–risk coronary plaque (Figure 2, Figure 3). Taking into account clinical history, instrumental and laboratory data, the patient was a candidate for therapy with PCSK9 inhibitors, which previously demonstrated an effect on reduction of plaque’s lipid core.

Conclusions

CT coronary represents an excellent method for the assessment of residual risk in ischemic patients thanks to its ability to detect not only stenotic plaques, but also high–risk features of atherosclerosis, thus allowing therapeutic optimization.
P423 REACTION TIME IS CARE TIME: HOW TO ENSURE TO QUALITY AND SAFETY IN HEALTH CARE
Authors: Boccini V , Giannini A , Tongiani F , Ricci T , Banti S , Baratta S
Published: May 2022

Background

Caring cardiac and / or cardiac surgery patient requires specific and specialized skills. Interprofessional collaboration is needed along integrated care pathway. To improve innovation and quality of care services are important the multidisciplinary teamwork, customized patient interventions, continuing nursing training and the use of validated clinical tools shared between Healthcare Team. Nurses have a central role in terms of prevention: Patient monitoring system and multidimensional assessment allow to care and to identify ward patients who are in danger of clinical deterioration. That is important to ensure an appropriate management at an early stage.

Clinical Case

On admission the patient is bright and alert and does not appear to be in distress. His vital signs are normal (MEWS 0). The patient is on therapy with Tirofiban and Furosemide in drips The diagnosis at admission is sub–occlusion of the Common Trunk of the Coronary Artery. After a few hours, the patient report retrosternal heartburn and dyspnoea with spontaneous regression. There aren’t any significant alterations of clinical signs during the symptomatic phase (MEWS 0). However, the nurse decides to continue to monitor the person more frequently compared to the timing of MEWS Protocol. In a short time the nurse finds a progressive clinical instability of the patient, confirmed by an increase in MEWS score.

Treatment

The patient monitoring system and the nursing process of Problem Solving and Decision Making allow to identify patient clinical deterioration at an early stage. For this reason, physicians and the critical care Team discuss about the management plan to guarantee of an appropriate care is provided. They decide to transfer the patient to the Intensive Care Unite, already intubated and ventilated.

Conclusions

The reaction time is important to ensure quality and appropriateness of care, to minimize possible complications and to generate a positive impact on health outcomes, especially in the treatment of time–dependent disease. The experience is also important to promote the development of nurses’ critical–thinking skills, competence and the ability to associate the use of clinical tools to the overall assessment of the person (medical history, clinical pathway and manifestations of the disease).
P427 LATE TREATMENT OF A CASE OF PULMONARY ARTERY HYPOPLASIA
Authors: Parodi A , Trocchio G , Camerini A , De Caro E , Lupi G
Published: May 2022

Here we want to present the case of a woman who came to our observation for the onset of dyspnea due to exertion. It is a subject followed from a young age for a congenital malformation of the urinary tract. At that time the presence of stenosis of the branches of the pulmonary artery associated with an interventricular septal defect was accidentally diagnosed; however the blood pressure values in the pulmonary artery were within the limits, so no interventional therapy was undertaken. In the following years the patient developed systemic arterial hypertension associated with renal failure for which medical therapy was started and an annual follow–up was scheduled. Over the years various echocardiographic checks were repeated without ever finding high pressures in the pulmonary artery. At the last check, performed precisely for the onset of dyspnea from exertion, the estimated systolic pressure in the pulmonary artery was equal to 100 associated with a dilation of the right ventricle with hypertrophy, hepatomegaly was also present in the absence, however, of signs of peripheral congestion. The catheterization of the right heart confirmed the presence of severe precapillary pulmonary hypertension and the CT scan with three–dimensional reconstruction highlighted the almost total agenesis of the left lung branch thus revealing the presence of a pulmonary hypertension of the fourth group, also supported by the negativity of the other tests proposed in the diagnostic work of the ESC Guidelines. In agreement with a national reference center for the treatment of pulmonary hypertension, we started Bosentan therapy with increasing dosage up to the target dose and long–term oxygen therapy. After four months of follow–up, the patient shows an improvement in functional capacity and the haemodynamic data remain stable. To our knowledge there are only the experiences of single centers regarding the treatment of forms of pulmonary hypertension due to anatomical malformations of the pulmonary circulation and for this reason medical therapy is not standardized. This subset of patients represents a challenge for the clinician as hypertension can be secondary both to the lack of part of the vascular bed and to reactive hyperplasia of the endothelium of the remaining circulation due to parietal stress due to pressure overload.