bluuebunny/crossref_metadata_2025 huggingface dataset:
292 QTC CORRECTION IN ATRIAL FIBRILLATION
Authors: De Sarro Rosalba , Vinciguerra Paolo , Licordari Roberto , Ceratti Simona , Perfetti Silvia , Luongo Alfredo , Savio Armando Lo , Cognata Olga La , Poleggi Cristina , Pugliatti Pietro , Crea Pasquale , Luzza Francesco , Dattilo Giuseppe
Published: December 2022

Background

QT interval varies with the heart rate (HR), so a correction in QT calculation is needed (QTc). Atrial fibrillation (AF) is associated with elevated heart rate (HR) and beat-to-beat variation in the length of the QT and RR interval making correction of the QT interval challenging.

Aim

to evaluate which correction formula better correlates with QTc in sinus rhythm after electrical cardioversion (ECV).

Methods

During a 3-month period, we considered patients who underwent 12-lead ECG recording for standard clinical indications and received an AF diagnosis. Exclusion criteria were the following: a QRS duration >120 ms, chronical therapy with QT prolonging drugs, a rate control strategy, a non-electrical cardioversion. The final population was composed by 60 patients. The QT interval was measured in V2 lead as the 10-beat average and corrected using Bazzett's, Framingham, Fridericia and Hodges formulas during the last ECG taken during AF and the first one immediately after ECV. Moreover, QTc mean was calculated as mQTc (average of 10 QTc calculated beat per beat) and as QTcM (QTc calculated from the average of 10 raw QT and RR for each beat).

Results

Population was composed by 26 women (43%) with a mean age was 79 ± 11 years. Good correlations between mQTc and QTcM are present for each formula, even in atrial fibrillation or sinus rhythm. Comparing atrial fibrillation and sinus rhythm a significant change in HR was seen (63,9 ± 14,9 vs 99,5 ± 27,9, p<0,001). Bazett's formula shown a significant change in mean QTc value between the two rhythms (421,5 ± 33,9 vs 446,1 ± 31,9; p< 0,001 for mQTc and 420,9 ± 34,1 vs 441,8 ± 30,9; p = 0.003 for QTcM). On the contrary, QTc assessed by the Framingham, Fridericia, and Hodges formulas was similar to that in AF (Figure).

Conclusion

In ECG during atrial fibrillation, due its high heart rate, Bazzett's formula, although the most used, seems to be the most imprecise in QTc estimation.
968 LYME CARDITIS: COMPLETE AV DISSOCIATION PRESENTING AS DYSPNEA IN THE EMERGENCY DEPARTMENT
Authors: Sciara Pietro , Bandini Marta , Crociani Maria Federica
Published: December 2022

Background

Lyme carditis (LC), an early disseminated manifestation of Lyme disease, has important clinical implications for patients. High-degree atrioventricular block is the most common presentation of LC, and usually resolves with antibiotic therapy.

Clinical case

A 31 years-old man without remote pathological history and cardiovascular risk factors presents for resting dyspnea. In the EKG, findings of paroxysms third-degree atrioventricular block with a junctional escape rhythm were found. No abnormalities found on the transthoracic echocardiogram. After the tick bite reported about 1-2 months earlier, given the suspicion of Lyme carditis, serology for Borrelia Burgdoferi was tested, which was then positive, and empirical antibiotic therapy has been initiated. During the EKG monitoring, paroxysms of second-degree type I atrioventricular block and first-degree AVB were relevated. In few days, we assisted to a complete retrieval of normal atrioventricular conduction. Therefore, a loop recorder was implanted, cardiac resonance was performed and then discharged. About 4 weeks later the patient performed a stress test on the cycloergometer to identify frequency-dependent atrioventricular blocks, which was then negative.

Rationale

The suspicion and the early diagnosis of Lyme carditis is fundamental to identify this unusual transient condition, thus preventing unnecessary PM implantation in otherwise healthy young individuals.
178 ARRHYTHMIC STORM IN ATTR WILD TYPE AMYLOIDOSIS: AN UNUSUAL COMBINATION
Authors: Torselletti Lorenzo , Giulia Stronati , Barbarossa Alessandro , Ciliberti Giuseppe , Coretti Francesca , Belleggia Sara , Coraducci Francesca , Bastianoni Gianmarco , Paolini Federico , Alfieri Michele , Brugiatelli Leonardo , Dello Russo Prof Antonio , Guerra Prof Federico
Published: December 2022

Cardiac amyloidosis (CA) is characterized by extracellular protein fibril deposition in the myocardium leading to restrictive heart failure. Both atrial and ventricular arrhythmias are common in CA. Study have shown up to one half of patients with CA die suddenly. However, the most common cause of sudden death has been historically through to be secondary electromechanical dissociation rather than a lethal ventricular arrhythmia. We present the case of a 84 years old man, with a history of hypertension, dyslipidaemia, and prior smoking. In June 2020 the patient was admitted to the emergency room of our hospital due to an episode of hemodynamically unstable sustained ventricular tachycardia (SVT). The patient underwent electrical cardioversion with restoration of sinus rhythm. An echocardiogram that showed a slightly reduced ejection fraction (FE = 45%), severe concentric hypertrophy, grade 3 diastolic dysfunction with high pressures in the left ventricular (LV) cavity, and a reduced GLS (-13.8%) with a typical apical-sparing aspect. A cardiac magnetic resonance (Fig.1). was performed showing a diffuse area of LGE with a subepicardial pattern involving left ventricular and atrial segments, compatible with myocardial storage disease. In order to complete the diagnostic workout, we performed a bone scintigraphy (Fig.2). (Positive for CA, with Perugini score grade 2), a genetic test (negative for hATTR-CA mutations) and free light chain in serum (negative for AL-CA). The patient was discharged at home after ICD implantation in secondary prevention and prescribed appropriate heart failure therapy. In May 2022 the patient was readmitted in emergency room for dyspnea during an arrhythmic storm characterized by several SVTs and ICD interventions, and atrial fibrillation (FA). After stabilization of clinical parameters, the patient was hospitalized in our ward. We optimized medical therapy with metaprololo 100 mg 1 cp BID, cordarone 600 mg ev and mexiletina 200 mg cp BID. During the hospitalization we succeeded in reducing SVT burden. However, ventricular PVCs and slow SVT remained. For this reason, we decided to perform an electrophysiological study (EPS) followed by catheter ablation. The EPS found two low voltage areas (Fig.3). The first were found under the aortic valve; the second was an area of dense scar and fragmented potentials along the basal-posterior wall. After ablation of the first area we succeeded in removing clinical PVCs. During the ablation of the second area the procedure was complicated by ventricular fibrillation that required advanced life support and many electrical shocks. The patient was discharged at home in absence of further episodes of SVTs with optimized therapy At a three moths follow up no arrhythmic events were recorded.
950 THE ROLE OF THE BETA ANGLE IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED BRUGADA SYNDROME: A METANALYSIS
Authors: Vetta Giampaolo , Magnocavallo Michele , Polselli Marco , Parlavecchio Antonio , Caminiti Rodolfo , Maria Cauti Filippo , Lo Savio Armando , Vetta Francesco , Rossi Pietro , Crea Pasquale , Natale Andrea , Bianchi Stefano , Della Rocca Domenico Giovanni
Published: December 2022

Background

The diagnostic value of the β-angle in the diagnosis of patients with Brugada Syndrome (BrS) is still unclear.

Objective

to evaluate the diagnostic accuracy of the β-angle and establish its best cut-off value.

Methods

We searched databases for studies evaluating sensitivity and specificity of the β-angle in patients with suspected BrS undergoing Sodium Channel Blocker Provocation Test (SCBPT). The pooled sensitivity and specificity were calculated, and the Summary Receiver Operating Characteristic curve was constructed. The effect size was estimated using a random-effect model as Odds Ratio.

Results

we included 4 studies enrolling 1471 patients (Positive SCBPT: 382 patients; Negative SCBPT: 1089 patients). Patients with positive SCBPT had a higher mean β-angle value than those with negative SCBPT (39.25° vs 22.52°; p<0.0001). The best diagnostic accuracy was observed at the IV Intercostal space (Ic) (AUC: 0.82; 95% CI: 0.78-0.85) compared to IIIic (AUC:0.77; 95% CI: 0.74–0.81) and IIic (AUC: 0.68; 95% CI: 0.64–0.72), Figure 1. The risk of positive SCBPT was significantly increased in patients with a β-angle≥58° than those with a β-angle≥23° (OR:16.33 vs 3.39; p=0.0004).

Conclusion

A β-angle ≥58° represents the best diagnostic predictor for patients with suspected BrS.
1074 AXILLARY VEIN PUNCTURE VERSUS CEPHALIC VEIN CUTDOWN FOR CARDIAC IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A METANALYSIS
Authors: Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Caminiti Rodolfo , Lo Savio Armando , Pistelli Lorenzo , Vetta Francesco , Dattilo Giuseppe , Della Rocca Domenico Giovanni , Crea Pasquale
Published: December 2022

Introduction

Transvenous lead implantation for pacemaker implantation is commonly performed by the cephalic vein cutdown (CVC), subclavian (SVP), or axillary vein puncture (AVP)(1). However, the CVC or AVP should be considered as first choice, according to the last guidelines, due to high rate of lead complications and pneumothorax of SVP.

Objective

To compare efficacy and safety of AVP compared with CVC for CIED implantation by a meta-analysis.

Methods

We systematically searched Medline, Embase and Cochrane electronic databases up to September 5th, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary outcome was acute procedural success. The secondary outcomes were pneumothorax, lead failure, pocket hematoma/bleeding, device infection, total procedure time, venous access time and fluoroscopy time. The effect size was estimated using a random-effect model as Risk Ratio (RR) and relative 95% Confidence Interval (CI).

Results

A total of 8 studies were included enrolling 1926 patients with 3532 leads and average age of 72.3±14.8 years. AVP compared to CVC showed a significant increase in the procedural success (95.7% vs 76.1%; RR: 1.24; 95% CI: 1.09-1.40; p=0.001), (Figure 1). Total procedural time (Mean Difference [MD]: -8.25 min; 95%CI: -10.23- -6.27; p<0.0001) and Venous access time (MD: -6.24 min; 95%CI: -7.01- -5.47; p<0.0001) were significantly shorter with AVP compared with CVC. No differences were found between AVP and CVC for pneumothorax (RR: 0.72; 95% CI: 0.13 - 4.0; p=0.71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p=0.26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15- 2.23; p=0.43), device infection (RR: 0.95; 95% CI: 0.14- 6.60; p=0.96) and fluoroscopy time (MD: -0.24 min; 95%CI: -0.75- 0.28; p=0.36).

Conclusion

Our meta-analysis proved that AVP improves procedural success and reduces total procedural time and venous access time compared to CVC.

Figure 1 – Forest plots comparing Acute Procedural Success between Axillary Vein Puncture Versus Cephalic Vein Cutdown.
1120 DIAGNOSTIC ACCURACY OF SMART GADGETS/WEREABLE DEVICES IN ATRIAL FIBRILLATION DETECTION: A METANALYSIS
Authors: Vetta Giampaolo , Magnocavallo Michele , Parlavecchio Antonio , Gianni Carola , Polselli Marco , Vuono Francesco De , Pannone Luigi , Mohanty Sanghamitra , Cauti Fillippo Maria , Caminiti Rodolfo , Miraglia Vincenzo , Monaco Cinzia , Chierchia Gian Battista , Rossi Pietro , Biase Luigi Di , Bianchi Stefano , De Asmundis Carlo , Natale Andrea , Della Rocca Domenico Giovanni
Published: December 2022

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis.

Hypothesis

We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices.

Methods

We systematically searched Medline, Embase and Cochrane electronic databases up to April 15th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities.

Results

A total of 79 studies were included enrolling 36903 patients, 66.3% male with average age of 68.3±8 years. In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(95% CI: 94–96%), the specificity 96%(95% CI: 96–97%). Wrist-worn wearables had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 92–97%), the specificity 97%(95% CI: 96–98%)(Figure 1A). Smartphone applications had AUC of 0.98 (95% CI: 0.96-0.99), the sensitivity 96%(9% CI: 94–97%), the specificity 96%(95% CI: 93–98%)(Figure 1B). External devices had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 93–97%), the specificity 96%(95% CI: 95–97%)(Figure 1C). Single-lead ECG had AUC of 0.99 (95% CI: 0.98- 1.00), the sensitivity 95%(9% CI: 92–96%), the specificity 96%(95% CI: 95–97%). PPG had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 96%(9% CI: 95–97%), the specificity 97%(95% CI: 95–98%).

Conclusions

Smartphone application, wrist-worn devices and external devices with PPG and single-lead ECG have excellent diagnostic accuracy in atrial fibrillation diagnosis.

Figure 1. Summary Receiver Operating Characteristic curves and Areas Under The Curve of Wrist-worn wearables (A), Smartphone applications (B) and External devices (C).
164 HIGH HDL CHOLESTEROL INCREASES CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS
Authors: Manzi Maria Virginia , Trimarco Valentina , Izzo Raffaele , Morisco Carmine , Mone Pasquale , Falco Angela , Pacella Daniela , Gallo Paola , Lembo Maria , Santulli Gaetano , Trimarco Bruno
Published: December 2022

Background

Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension.

Methods

To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy.

Results

We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes (Figure 1). Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients.

Conclusions

Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.
567 BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT: THE MEASUREMENT OF OVERALL ECHOGENICITY (GSM) OF CAROTID INTIMA MEDIA COMPLEX SHOWS A POSITIVE CORRELATION WITH ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS
Authors: Natale Francesco , Loffredo Francesco , Molinari Riccardo , Covino Simona , Alfieri Roberta , Altobelli Ippolita , Cimmino Giovanni
Published: December 2022

Beyond the Intima Media Thickness assessment: the measurement of overall echogenicity (GSM) of Carotid Intima Media Complex shows a positive correlation with Arterial Stiffness of hypertensive patients.

According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk.

Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima-media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color-Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM > 30 showed a significantly increased arterial stiffness and LVMI (P < 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, < 0.001), and duration of hypertension (r = 0.31, < 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.
730 P2Y12 INHIBITORS MONOTHERAPY IN PATIENTS UNDERGOING COMPLEX VS NON-COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Oliva Angelo , Castiello Domenico Simone , Franzone Anna , Condorelli Gianluigi , Colombo Antonio , Esposito Giovanni , Stefanini Giulio , Piccolo Raffaele
Published: December 2022

Background

Monotherapy with P2Y12 inhibitors (P2Y12i) is emerging as alternative strategy to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). However, early withdrawal of aspirin as part of P2Y12i monotherapy regimens may pose concerns in high-risk patients, such as those undergoing complex PCI. Thus, we aimed to evaluate the efficacy and safety of P2Y12i monotherapy compared with standard DAPT according to PCI complexity.

Methods

We performed a meta-analysis of randomized trials using random effects models to combine hazard ratios (HRs) with 95% confidence intervals (CIs). No restrictions were applied to the type of P2Y12 receptor inhibitor or to the definition of complex PCI. Within-trial interactions were pooled to estimate heterogeneity between complex and noncomplex PCI strata. The study protocol was registered in the PROSPERO (CRD42021291027).

Results

After screening of 7,502 unique citations, we included in the analysis 5 randomized clinical trial enrolling 31,627 patients, of whom 8,328 (26.3%) underwent complex PCI (Table 1) Risk estimates for efficacy and safety outcomes associated with P2Y12i monotherapy and standard DAPT across studies included in the analysis, stratified by complex and noncomplex PCI, are reported in Figure 1. P2Y12i monotherapy compared with standard DAPT was associated with a similar risk of all-cause death, stent thrombosis, and stroke, with no evidence for interaction between complex and noncomplex PCI. We found heterogeneity in the treatment effect of P2Y12i monotherapy vs. standard DAPT with respect to myocardial infarction (P-interaction=0.027). Compared with standard DAPT, P2Y12i monotherapy decreased the risk of myocardial infarction in complex PCI (HR 0.77, 95%CI 0.60-0.99, P=0.042), but not in noncomplex PCI patients (HR 1.09, 95%CI 0.90-1.30, P=0.382). The risk of major bleeding was significantly reduced by P2Y12i monotherapy with a consistent treatment effect (P-interaction=0.699) in both complex and noncomplex PCI strata.

Conclusions

Patients undergoing complex PCI may derive more benefit and less harm from P2Y12i monotherapy after early aspirin withdrawal compared with standard DAPT, resulting in decreased risks of myocardial infarction and bleeding.
711 CROSS-SECTIONAL ANALYSIS OF CARDIOVASCULAR CAUSES OF COMMON PRESENTING SYMPTOMS IN PATIENTS WITH ACTIVE CANCER: THE EXPERIENCE FROM A TERTIARY ONCOLOGICAL CENTRE IN MODENA.
Authors: Maisano Anna , Valenti Annachiara , Alessandro Albini , Cherubini Benedetta , Mantovani Marta , Leo Giulio , Trapanese Paola , Rampini Francesca , Bertuglia Filippo Federico , Minnocci Melania , Boriani Giuseppe
Published: December 2022

Background and aim of the study

There is a rising interest in cardio-oncology as an holistic approach to oncological patients with established cardiovascular comorbidities or at increased cardiovascular risk. Symptoms of potential cardiovascular significance are a common cause of cardiologic consultation in patients with active cancer. Moving from this perspective, we analyzed the proportion of cardiovascular conditions underpinning potentially cardiologic presenting symptoms in a cohort of patients with active malignancy referred to the Emergency Department (ER) of a tertiary oncological centre.

Methods and Results

The study included 250 consecutive patients (median age 69 years [IQR 59.7-77.4], 50% female) presenting to the oncologic ER from September 1st 2021 to May 31st 2022. The most common presenting symptoms were fever (26.9%), gastrointestinal symptoms (24.9%), dyspnea (10.4%), hypotension and hypertension (1.6%), syncope (1.2%) and other (11.2%). We considered as symptoms of potential cardiologic significance the following: dyspnea, lipothymia and syncope, palpitations, fever, chest pain, hypotension and hypertension. We found that 101 of 250 patients (40%) presented with symptoms of potential cardiologic significance. Out of them, 14 patients (13.9%) had confirmed cardiologic diseases: pulmonary embolism (21.4%), heart failure (21.4%), pericardial effusion (21.4%), reflex syncope (14.2%), pericarditis (14.2%) and new onset atrial fibrillation (7.1%). As reported in the table, no significant difference was reported in terms of risk profile or history of cardiac diseases when comparing patients with and without cardiovascular cause of presenting symptoms (CV cause vs non-CV cause).

Conclusions

Cardiovascular conditions are not common causes of ER presentation among oncologic patients with active cancer. Nevertheless, when a cardiologic condition is diagnosed, it could be potentially life-threatening. The cardiovascular risk profile and the history of cardiac disease is not a good discriminator to identify a cardiac cause of presenting symptoms in this specific setting.

Table. Characteristics of patients with potentially cardiologic presenting symptoms.
13 CANCER-ASSOCIATED THROMBOSIS AND THROMBOCYTOSIS: THE EDOXABAN SOLUTION.
Authors: Fioretti Agnese Maria , Leopizzi Tiziana , Giotta Francesco , Luzzi Giovanni , Oliva Stefano
Published: December 2022

Introduction

TEV is the second highest cause of death in malignancy with 20% incidence. Platelets is a leading mediator of thrombosis as well as of tumor development. Indeed, thrombocytosis is a predictive biomarker of thrombosis risk and contributes to CAT burden. However, the management of thrombocytopenia in patients with CAT is well investigated, whereas evidence is poor on the management of patients with concomitant occurrence of thrombocytosis and CAT.

Case report

A 67 y-o woman, in primary thromboprophylaxis with 100 mg/die aspirin for myeloproliferative syndrome (PC: 771 x103/µl), was treated with left mastectomy for infiltrating ductal carcinoma (G3 pT1cN1a Mx Ki67:25%) and adjuvant chemotherapy with anthracyclines and anastrozole. Due to bone metastases, zoledronic acid, fulvestrant and palbociclib were administrated. For liver metastases, she was treated with exemestane, paclitaxel and bevacizumab and for disease progression, started capecitabine and cyclophosphamide, still ongoing. She experienced left jugular vein thrombosis (Fig 1-2) treated with edoxaban 60 mg/die with an almost total DVT regression after 2 months. The multidisciplinary team (oncologist, cardiologist, hematologist) decided to interrupt aspirin, proceeding antithrombotic therapy with edoxaban full dose. Concomitant cytoreductive therapy with hydroxyurea was started concomitantly with edoxaban. PC was reduced (522 x103/µl). After 1-month follow-up duplex ultrasound still documented mild persistence of the DVT (Fig 3-4), the patient was compliant and the anticancer regimens (addressed to both the solid cancer and the hematologic disease) were still administrated without any adverse effects.

Conclusions

CAT is a frequent and major complication of malignancy, worsening mortality, morbidity and decision-making. Platelets play a central role in promoting the hypercoagulable melieu of cancer as well as the metastases growth. Notably, thrombocytosis occurrence further increases the thrombogenic burden in malignancy; nevertheless, its concomitant development together with CAT is understudied. In the reported case, a solid tumor, together with hematologic cancer and DVT, concurred to a difficult management of a patient admitted to our multidisciplinary team. The use of a DOAC, edoxaban, at full dose, without concomitant therapy with aspirin, was an effective, safe and manageable antithrombotic treatment option, allowing the continuation of anticancer agents with no interruptions or delays. The knowledge of tumor-specific pathways may help to personalize strategies for CAT prevention.

Fig 1-2

Fig 3-4
201 CTLA-4 AND PD-1 BLOCKING AGENTS INCREASES SYSTEMIC SDF-1, CARDIAC DAMPS FIBRONECTIN EDA, S-100 CALGRANULIN, GALECTINE-3 AND NLRP-3/MYD-88 CHEMOKINE PATHWAYS
Authors: Quagliariello Vincenzo , Passariello Margherita , Mauro Annabella Di , Cipullo Ciro , Paccone Andrea , Barbieri Antonio , Palma Giuseppe , Luciano Antonio , Buccolo Simona , Bisceglia Irma , Canale Maria , Galluccu Giuseppina , Saviano Claudia , Maurea Carlo , Lorenzo Claudia De
Published: December 2022

Background

Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases.In this study, pro-inflammatory and pro-fibrotic effects of short-term ICIs therapy in preclinical models were analyzed.

Methods

Firstly, in a human in vitro model, human cardiomyocytes co-cultured with hPBMC were exposed to ICIs (with CTLA-4 or PD-1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through colorimetric and enzymatic assays. C57/Bl6 mice were treated with CTLA-4 or PD-1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF-kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs (S100- Calgranulin, Fibronectin and Galectine-3), MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF-1, IL-1β and IL-6 were analyzed before, during and after ICIs therapy.

Results

Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF-kB expression shows that short-term anti-CTLA-4 or anti-PD-1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin-3, pro-collagen 1-α and MMP-9 were increased after treatment with all ICIs. Both anti-CTLA-4 or anti-PD-1 treatments increased the expression of DAMPs, NLRP3 inflammasome and MyD88 and induced both in vitro and in vivo the secretion of IL-1β, TNF-α and IL-6. Systemic levels of SDF-1, IL-1β and IL-6 were increased during and after treatment with ICIs.

Conclusions

Short therapy with PD-1 and CTLA-4 blocking agents increases vascular expression of NF-kB, systemic SDF-1, IL-1β, IL-6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro-inflammatory cytokine storm was induced in myocardial tissues and in cultured cardiac cells after ICIs therapy. The overall picture of the study suggests new putative biomarkers of ICIs-mediated systemic and myocardial damages potentially useful in clinical cardioncology.
267 EFFECTS OF PIRFENIDONE ON SCAR SIZE AND VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION: A PRECLINICAL STUDY
Authors: Aimo Alberto , Burchielli Silvia , Aquaro Giovanni Donato , Barison Andrea , Musetti Veronica , Masotti Silvia , Pucci Angela , Modena Martina , Passino Claudio , Emdin Michele
Published: December 2022

Background

An intense fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Pirfenidone is a drug currently approved for the treatment of idiopathic pulmonary fibrosis, and reduces LV fibrosis in patients with heart failure and preserved ejection fraction. We aimed to characterize the different profiles or protein expression in the infarct zone in rats receiving or not receiving pirfenidone on top of standard therapy for MI.

Methods

Male Wistar rats were randomized to: sham procedure (group 1; n=13), reperfused MI induced by surgical ligation of the left anterior descending artery (LAD) for 45 minutes (group 2; n=17), reperfused MI plus standard therapy (aspirin, angiotensin-converting enzyme inhibitor, beta-blocker, and also mineralocorticoid receptor antagonist [MRA]) (group 3; n=17), reperfused MI plus pirfenidone alone (group 4; n=17), reperfused MI plus standard therapy and pirfenidone (group 5; n=17). Rats surviving LAD ligation and reperfusion underwent cardiac magnetic resonance (CMR) after 72 hours and 30 days from MI, and were sacrificed the day after the second CMR exam. The primary endpoint was the change in late gadolinium enhancement (LGE) mass as a percentage of LV mass.

Results

Forty-six rats survived until the second CMR. Percent changes in LV end-diastolic and end-systolic volume (p=0.370 and 0.423, respectively), ejection fraction (p=0.236) and mass (p=0.815) did not differ significantly between rats on pirfenidone plus standard therapy compared with those receiving standard therapy alone. The decrease in LGE mass was significantly greater in rats on pirfenidone plus standard therapy vs. those on standard therapy alone: -22.0% (interquartile range, -37.1 to -5.7, range -51.1 to +37.5) vs. +1.9% (-7.7 to +12.5, range -19.8 to +56.5), p=0.029.

Conclusions

Pirfenidone had additive effects to standard therapy for MI (including an MRA) in reducing LV fibrosis in a rat model of reperfused MI, while it did not further improve LV function, volumes or mass.
611 PLASMA EXOSOMES REFLECT MYOCARDIAL INJURY DETECTED BY CARDIAC MAGNETIC RESONANCE IN STEMI PATIENTS
Authors: Baggiano Andrea , Zarà Marta , Banfi Cristina , Campodonico Jeness , Tedesco Calogero , Amadio Patrizia , Gili Sebastiano , Dona Gianluca De , Sandrini Leonardo , Maragna Riccardo , Marenzi Giancarlo , Pontone Gianluca , Barbieri Silvia Stella
Published: December 2022

Background

CMR is the gold standard technique to detect microvascular obstruction (MVO) and myocardial salvage index (MSI) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Exosomes are lipid vesicles released by all cells that reflect the metabolic status of the releasing cells, thus representing potential biomarkers of disease.

Objectives

To evaluate the correlation between exosome profile and myocardial infarction characteristics as detected by CMR in patients after STEMI.

Methods

exosomes were isolated from plasma of 42 patients by different commercial kits, their concentration and size distribution determined by Nanoparticle Tracking Analysis, exosomal surface epitopes by the MACSPlex Exosome Kit and GPIIb-IIIa expression by ELISA kit. Data obtained were correlated with parameters of myocardial damage (STEMI location, culprit lesion, time to revascularization, MVO and MSI).

Results

Levels of circulating plasma exosomes were higher in patients with anterior STEMI (p = 0.0002) and when the culprit lesion was located in LAD (p = 0.045). In addition, a high number of exosomes was measured in the subset of patients who underwent a late revascularization (> 3 h from onset of symptoms; p = 0.038). Patients with MVO and low MSI (< 0.5) have smaller exosome (p = 0.0015 and p = 0.014, respectively). By analysing the expression of 37 surface protein markers, the strongest signals are platelet specific markers (CD41b and CD42a) followed by endothelial and immune cells markers. Interestingly, a lower expression of platelet marker GPIIb-IIIa was detected in both patients with MVO and anterior STEMI (p = 0.039 and p = 0.0038, respectively). Univariate analysis demonstrated that exosome size and GPIIb-IIIa were independent predictors of MVO/MSI and ROC analysis demonstrated that dimension and GPIIb-IIIa can identify patients with MVO/MSI (AUC 0.75 and 0.71, respectively).

Conclusions

The plasma exosome profile well reflects CMR-assessed myocardial injury after STEMI. In particular, the exosome dimension and the expression of platelet marker GPIIb-IIIa are independently associated with MVO. Future studies with larger populations are required to confirm the role of platelet-derived exosomes in risk stratification after STEMI.
797 ENDOTHELIAL FUNCTION AND RIGHT VENTRICLE DIMENSION AND FUNCTION IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: Croella Francesca , Tricarico Lucia , Alfieri Simona , Altomare Alberto , Mansueto Natalia , Correale Michele , Corrado Addolorata , Pugliese Rosanna , Romano Matteo , Noviello Giulia , Iacoviello Massimo , Cantatore Francesco Paolo , Brunetti Natale Daniele , Biase Matteo Di
Published: December 2022

Background

Systemic sclerosis (SSc) is a connective tissue disease characterized by the fibrosis of skin and internal organs, frequent immunity abnormalities and alterations in microvasculature. Among SSc complications, Pulmonary Hypertension (PH) is a frequent and severe one.

Many echocardiographic parameters are used to assess pulmonary pressure and Right Ventricle (RV) dimension and function in these patients, from classical echocardiographic indexes to the most recent Speckle-Tracking Echocardiography (STE), while flow-mediated vasodilation (FMD) is the most common method to assess vascular reactivity.

Aim of the study

To evaluate any possible relations between endothelial function and RV dimension and function in patients with SSc.

Method

48 sclerodermic patients underwent to echocardiographic examination and FMD, searching for relations between RV dimension and function and endothelial function indexes. For the RV we considered: 1) the eccentricity index (EI), 2) the fractional area change (FAC), 3) the ratio TAPSE/PAPs, 4) the RV basal diameter, 5) the RV free-wall strain and 6) the tricuspid regurgitation velocity; for the endothelium we evaluated the absolute difference between the radial artery diameters before and after 5 minutes of ischemia. We used a t-Student test (t-test) for unpaired samples with similar variances to verify the hypothesis that patients with altered RV parameters show a lower value in the absolute difference between radial diameters.

Results

Only EI and endothelial function showed a significant relation. In fact, with a level of confidence of the 95% we can say that patients with an EI>=1,1 report a minor increase in radial artery diameter than patients with EI<1,1.

Conclusions

In patients affected by SSc, the endothelial function is related to eccentricity index. Multicenter studies are needed in order to confirm the results of our study
354 THE ADDED VALUE OF MYOCARDIAL WORK IN EARLY DETECTION OF SYSTOLIC DYSFUNCTION IN CARDIAC AMYLOIDOSIS
Authors: Gaetano Fabrizio De , Losi Valentina , Consoli Alessio , Tamburino Corrado , Monte Ines Paola
Published: December 2022

Aim

The involvement of the heart represents the main determinant of mortality and morbidity for patients with systemic amyloidosis (SA). In cardiac amyloidosis (CA), numbered among the clearest examples of restrictive cardiomyopathies, EF (ejection fraction) often keeps itself preserved (≥ 50%) but this doesn't mean LV (left ventricle) systolic function couldn't be impaired, even in the early stages of disease. In this survey we searched for echocardiographic signs of early systolic impairment in CA: among them we adopted the analysis of myocardial work (MW), an emerging less load-dependent tool for the evaluation of cardiac performance.

Methods

We chose a cohort of patients (n=20; mean age 69±13 years) with AL or ATTR CA and we compared them with a control group (n=18; mean age 62±17 years) without evident cardiac damage. We examined their systolic and diastolic function and we calculated multilayer strain and all the contributors of MW from speckle tracking echocardiography.

Results

We found a statistically relevant difference in cardiac mass (138±35 versus 83±23 g/m2) and in signs of both systolic and diastolic function (LAVi, TR Vmax, E/e’) worsening between patients with CA and the control group. In CA average EF was 52±11% while the reduction in Global Longitudinal Strain (GLS) was significant, regardless of the considered wall layer and the stage of diastolic impairment. For our patients ejection fraction to strain ratio (EFSR, 4,41±1,38 vs 3,04±0,55), a simple way to quantify apical sparing, better underlined the dissociation between EF and strain than apex to base ratio. In CA we identified a dramatic decrease in Global Work Index (954±278 vs 2089±354 mmHg%) and Global Constructive Work (1103±323 vs 2376±390 mmHg%), with no significant difference between AL and ATTR amyloidosis.

Conclusions

The infiltration by amyloid and the consequent increase in cardiac mass lead to an early and often severe weakening of the intrinsic contractility of the heart in both AL and ATTR amyloidosis, even when ejection fraction is normal or slightly reduced. Therefore, we suggest the analysis of MW starting from the first echocardiographic evaluation in patients with known SA or multiple myeloma.
1044 CHARACTERISTIC AND OUTCOME IN PATIENTS WITH LOW FLOW, LOW GRADIENT AORTIC STENOSIS
Authors: Ferruzzi Germano Junior , Cristiano Mario , Peluso Angela Pamela , Migliarino Serena , Bellino Michele , Iuliano Giuseppe , Silverio Angelo , Attisano Tiziana , Baldi Cesare , Vigorito Francesco , Giordano Arturo , Vecchione Carmine , Ciccarelli Michele , Galasso Gennaro , Citro Rodolfo
Published: December 2022

Aim

The aim of this study was to assess the prevalence and outcome in patients with severe low flow, low gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve intervention (TAVI).

Methods

Patients with LFLG AS undergoing TAVI from 2013 to 2022 were prospectively collected.

Clinical, imaging data and procedural parameters were collected. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. Overall population was classified in due subgroups: classical LFLG AS if left ventricular ejection fraction (LVEF) was <50%, and paradoxical in patients with preserved LVEF. The major comorbidities and primary outcome defined as a composite of all-cause mortality and rehospitalization for worsening heart failure (HF) up to 1 year in the different subtypes of severe LFLG AS undergoing TAVI were evaluated.

Results

The study included 268 patients [81±6 years; 142 (53%) females]; of these, 155 patients (58%) had paradoxical LFLG AS and 113 patients (42%) had LFLG AS with low LVEF. Regarding echocardiography parameters, in the overall population the mean transaortic gradient was 31±6 mmHg, the mean iAVA 0.38±0.08 cm/m2, and the median LVEF 50% (IQR 38-55).

Compared with paradoxical LFLG AS, the patients with classical form were characterized by a lower percentage of women (43% vs. 60% p 0.07), worse renal function (46% vs. 30%, p 0.012), and a significantly higher number of cardiovascular disease as coronary artery disease (52% vs. 29%, p <0.001) and atrial fibrillation (37% vs. 23%, p 0.018), resulting in higher Society of Thoracic Surgeons scores [7,34% (IQR: 4.96 to 13,25) versus 5,36% (IQR: 3,22 to 11); p value 0.037]. Higher percentage of patients of New York Heart Association functional class III or IV (61% vs. 27%; p 0.037) was observed in classical LFLG AS.

At one-year follow-up, the composite outcome was reported in 49 patients (18%), 21 patients (13%) had paradoxical LFLG AS and 28 patients (24%) had classical form.

Kaplan-Meier survival free from the composite outcome was significantly lower in patients with classical LFLG AS compared to those paradoxical LFLG AS (Log-Rank 0,022, Figure 1).

Conclusion

LFLG AS is a complex population with significant incidence of adverse event at one years. Patients with classical LFLG AS have higher number of risk factor and cardiovascular disease and lower survival compared paradoxical form.

Figure 1
468 EFFECT OF AGE ON GLOBAL KINETIC ENERGY DISSIPATION WITHIN THE LEFT VENTRICLE. AN ECHOCARDIOGRAPHIC STUDY.
Authors: Martini Marika , Fiorencis Andrea , Pergola Valeria , Grandi Silvia , D´andrea Emilio , Cozza Elena , Iliceto Sabino , Mele Donato
Published: December 2022

Background

The echocardiographic evaluation of the left ventricular function is traditionally based on parameters of cardiac mechanics and analysis of transvalvular blood flow, but recently the study of intracardiac fluid dynamics has been proposed as an integrative approach to the assessment of cardiac function. More precisely, dissipation of the kinetic energy of blood moving within the left ventricle (global kinetic energy dissipation, gKED) during the entire cardiac cycle (systole and diastole) can now be evaluated in a very practical way using the new non-contrast, color Doppler based HyperDoppler technique. Although feasibility of this technique and reproducibility of gKED have been demonstrated, the effect of age and its consequences have not been clarified.

Objectives

The purpose of this study was to evaluate: 1) the effect of age on gKED measures; and 2) whether this impacts on the ability of gKED to differentiate physiological and pathological hemodynamic models, expected to have different loss of kinetic energy within the left ventricle.

Methods

Two groups of individuals were considered for this study: 50 normal subjects (physiological model) and 50 patients with chronic heart failure in stable clinical and hemodynamic condition, with no signs of clinical and echocardiographic increase of left ventricular filling pressure (pathological model). Normal subjects were divided into 3 age groups: 17-32 years (group I), 33-48 years (group II) and 49-64 years (group III). All participants underwent both standard and HyperDoppler echocardiography using a Esaote MyLab X8 echo scanner.

Results

In normal subjects, gKED decreased with age (group I 0.8, group II 0.59, and group III 0.27; P=0.001). In particular, this reduction was statistically significant between group III (age >=49) and the other 2 age groups. At the multivariate analysis, gKED was associated with both age and peak of transmitral E-wave, while there was no association with left ventricular ejection fraction. Patients with heart failure showed lower gKED values (0.715 vs. 0.18, P<0.001). HF patients with age <49 years had a markdly different gKED compared with normals of the same age, while the difference in gKED between normals and HF patients with age >= 49 years was much less pronounced, although significant (P<0.003). HF patients were characterized by reduced left ventricular ejection fraction in addition to reduced peak E-wave and this may explain the low gKED values observed in these patients.

Conclusions

Our preliminary observations show that gKED depends on age but maintains the ability to differentiate two physiological and pathological hemodynamic and functional models. These results should be taken into account when applying the HyperDoppler technique in clinical practice for evaluation of gKED.
398 CARDIAC MAGNETIC RESONANCE PHENOTYPE AND GENOTYPE IN LEFT-SIDED CARDIOMYOPATHIES: CHARACTERIZATION AND CLINICAL OUTCOMES
Authors: Castrichini Matteo , De Luca Antonio , Paldino Alessia , Cittar Marco , Dal Ferro Matteo , Angelis Giulia De , Barbati Giulia , Medo Kristen , Groves Daniel , Quaife Robert , Eldemire Ramone , Gigli Marta , Stolfo Davide , Graw Sharon , Addison Jeffrey , Taylor Matthew Rg , Mestroni Luisa , Merlo Marco , Sinagra Gianfranco
Published: December 2022

Background

The combined prognostic role of cardiac magnetic resonance (CMR) and genotype in cardiomyopathies has not been fully investigated. The aim of this study was to identify specific genotype-CMR phenotype correlations in a well-characterized cohort of patients with a spectrum of left-sided cardiomyopathies spanning from arrhythmogenic (ACM) to dilated cardiomyopathy (DCM), and analyze patients’ outcome.

Methods and Results

One-hundred and seventy-four patients with DCM (127) and left sided ACM (47), who underwent a comprehensive evaluation including genetic testing and CMR imaging, were enrolled in this study. The phenotype was classified as DCM or ACM according to current consensus criteria. The primary outcome was a composite of sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA). DCM patients showed more frequently pathogenic or likely pathogenic (P/LP) variants of non-arrhythmic genes (34% vs. 7%, p < 0.001), whereas ACM patients reported more frequently P/LP variants of arrhythmic genes (47% vs. 8%, p < 0.001) and non-ischemic free-wall LGE (30% vs. 10%, p = 0.002). After a median follow-up of 92 months (interquartile range 46 - 168), 39 patients (22%) reached the combined endpoint. Carrying a P/LP variant of arrhythmic genes (hazard ratio (HR) 2.2, 95% confidence interval (CI) 1.1 - 4.4, p = 0.024) along with presence of LGE (HR 4.5, 95% CI 1.99 - 11.5, p < 0.001) were independently associated with the study endpoint.

Conclusion

In cohort of well-characterized left sided cardiomyopathies patients spanning from ACM to DCM, a P/LP variant of arrhythmic genes along with presence of LGE were independent predictors of SCD/MVA.
64 PULMONARY ARTERY INTIMAL SARCOMA: A CASE REPORT
Authors: Passaniti Giulia , Deste Wanda , Cannizzaro Maria Teresa , Tosto Giuseppe , Tamburino Corrado
Published: December 2022

We present the case of a 56-years old man, with a history of smoking and chronic hypertension. From September 2021, he began experiencing shortness of breath, with marked limitation of ordinary physical activity. He underwent a cardiologic evaluation: an echocardiogram was performed, finding no alterations in the wall motions, but founding an increased atrioventricular gradient in the right heart and an augmented systolic pulmonary arterial pressure. Also, the acceleration time in the pulmonary artery was increased. Patient's physician prescribed him laboratory exams that resulted within normal ranges, with no increased levels of D-dimer and Chest X-ray in which it resulted to be a nodule, in the lower lobe of the left lung, that was biopsied in our center.

We evaluated the patient with CT scan, CT angiography, PET-scan and cardiac MRI and discovered that the increased pressure in the pulmonary artery was due to a non-better specified tumor, which was then completely resected.

After one month, the final diagnosis came back: poorly differentiated pleomorphic sarcoma, with high mitotic index and large areas of necrosis, characterized mainly by spindle cells and cells with epithelioid morphology; furthermore, there was a formation of vascular spaces surrounded by pleomorphic cells and areas of lower density cells with myxoid stroma and hemangiopericytoma-like aspects. Considering several factors such as anamnesis, localization of the tumor, growth from the tunica intima of the pulmonary artery and immunophenotypic expression, the tumor was diagnosed as a pulmonary arterial intimal sarcoma.