bluuebunny/crossref_metadata_2025 huggingface dataset:
P336 PROCALCITONIN AS PREDICTOR OF IN–HOSPITAL MORTALITY IN A CARDIOGENIC SHOCK POPULATION: A 10–YEARS SINGLE CENTRE RETROSPECTIVE STUDY
Authors: Belfioretti L , Marini M , Francioni M , Battistoni I , Angelini L , Pongetti G , Shkoza M , Matassini M , Paolini E , Piangerelli L , Patani F , Compagnucci P , Perna G
Published: May 2023

Background

Plasmatic procalcitonin (PCT) is an acute–phase inflammatory marker, its value tends to increase during inflammatory conditions such as septic shock, cardiogenic shock (CS) and bacterial infections. Patients with CS complicating acute myocardial infarction (AMI) and signs of systemic inflammatory response syndrome (SIRS) can show increased PCT values but its prognostic role in this setting is still unknown. Purpose: evalute prognostic role of plasmatic PCT in an ischemic CS population.

Methods

All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study. We evaluated PCT and C reactive protein (CRE) values in blood sample only in patients with clinical signs of SIRS or infection. Microbiological examination were also collected to exclude a bacterial infection.

Results

We included 167 patients [males 67%; mean age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 (3,1–8,8) mmol/L. All patients required inotropes while 91,1% required mechanical cardiac support (MCS). The overall in–hospital mortality rate was 46%. The PCT values resulted to be an in–hospital mortality predictor at multivariate analysis (p = 0,018) and we observed a generally lower PCT values in surviving CS patients (Fig 1). At the analysis the optimal maximum PCT cut–off value to predict in–hospital mortality was 5,77 ng/l (SE 0,82; SP 0,72, accuracy 0,78) with an area under the receiver operating characteristic curve of 0.80 (Fig 2). Moreover positivity to microbiological examination such as urine colture, blood colture, bronchoalveolar lavage and maximum CPR values were not associated with in–hospital death at univariable analysis.

Conclusions

in our retrospective study we found that PCT is an in–hospital mortality predictor and values greater than 5,77 ng/ml seem to be a good indicator of patients with poor prognosis in ischemic CS patients. High PCT values could have a role in indentifing CS patients with a intense SIRS or with a septic shock component which is associated with a even higher in–hospital mortality rate. The positivity to microbiological examination and maximum CPR values weren’t death predictors in our sample. Further studies in larger CS population could be advisable to better define prognostic role of PCT and evaluate its role in CICU daily clinical practice.
P338 PERFORMANCE OF THE SIMPLIFIED HEART FAILURE HYDRA SCORE IN PREDICTING ONE–YEAR MORTALITY: COMPARISON WITH HYDRA SCORE
Authors: Scicchitano P , De Palo M , Gesualdo M , Trotta F , Sanasi M , Piscopo A , Pignatelli A , Pinto M , Caldarola P , Massari F
Published: May 2023

Aims

We have recently proposed a new prediction model for risk mortality based on four parameters of congestion to predict mortality in patients with acute or chronic heart failure. This risk model (HYDRA Score, HS) is based on the number of parameters of congestion above significant cut–offs (range 0–4): BNP >441 pg/mL, estimated plasma volume status (ePVS) >5.3 dL/gr, bioimpedance vector analysis (BIVA) >73.8%, and BUN/creatinine ratio (BUN/Cr) >25. As bioimpedance vector analysis is a measure of peripheral congestion but it is not frequently used in clinical practice, we evaluated the performance of the risk model by including the presence of peripheral edema in place of BIVA (HYDRA Semplified Score, HSS).

Methods and results

We analysed data from 436 HF patients. During a one–year follow–up 81 patients died (18.6%). Discrimination for all–cause mortality was compared by Harrell‘s C–statistic. Calibration was assessed by Hosmer–Lemeshow test and global performance by Nagelkerke‘s R2. Correlation between scores was assessed by Spearman rank test. Correlation between the scores was good (rho = 0.91, p<0.001). The two risk models showed similar results in terms of discrimination analyses (HS 0.786 vs HSS 0.760; p=0.09) and global performance (R2 = 0.26 and R2 =0.21). The Hosmer–Lemeshow goodness–of–fit test demonstrated the best calibration of HS risk model (χ2 6.5, P=0.60 for HS model and χ2 7.7, P=0.45 for HSS model).

Conclusions

Simplified HYDRA score seems a good and friendly model risk to predict one–year mortality in patients with heart failure and could be used as alternative to HYDRA score.
P339 LIGHT–CHAIN CARDIAC AMYLOIDOSIS WITH FULMINANT EVOLUTION, A NOT–SO–RARE CONDITION: THE IMPORTANCE OF EARLY DIAGNOSIS
Authors: Liberatore I , Terrinoni F , Occhiuzzi E , Imparato L , Sciarra L , Romano S
Published: May 2023

Introduction

Amyloid AL results from misfolding of immunoglobulin light chain (kappa or lambda) secreted by abnormal plasma cells such as in multiple myeloma. It is a rare, multisystemic disease with an estimated annual incidence rate of 6 to 10 cases per million inhabitans in Western countries. The prognosis of this hematologic neoplasm is guided by the extent of cardiac involvement; if untreated, survival rate is less than 6 months; with early initiation of chemotherapy treatment, median survival can range from 4 to 10 years, except for high–risk cases. Case report: 58–year–old patient presented to emergency department in May 2022 with the first syncopal episode and sphincter release. The patient had no cardiovascular risk factors. Echocardiografy showed markedly hypertrophic left ventricle with hyper–reflective walls with a granular–sparkling appearance. Electromyography revealed sensory–motor polyneuropathy, early–stage autonomic neuropathy and bilateral carpal tunnel syndrome. Implantation of a loop recorder was performed to investigate the cause of syncope. In suspected amyloidosis, the patient underwent electrophoresis, which showed no monoclonal peaks, serum and urine kappa and lambda light chains were negative. Bone scintigraphy showed no osteotropic radiopharmaceutical uptake in the heart. Cardiac magnetic resonance imaging (MRI) revealed biventricular hypertrophic phenocopy (concentric hypertrophy) with diffuse edema–like tissue alterations. The patient was asymptomatic. In August 2022, hematologic evaluation revealed a monoclonal band for lambda light chains in repeated immunofixation and bone marrow biopsy showed 9–10% monoclonal lambda plasma cells. The patient was referred to a specialized center for amyloidosis, where a biopsy of peri–umbilical fat was performed to confirm the diagnosis and initiate therapy. In October 2022, due to recurrent syncope, advanced atrioventricular block and extreme bradycardia at loop recorder, a dual–chamber pacemaker was implanted. A few days after discharge, the patient suffered cardiac arrest at home due to electromechanical dissociation and died, only 5 months after the first symptom.

Conclusion

AL amyloidosis is an aggressive hematological neoplasm, with cardiac involvement. Early diagnosis is crucial for timely initiation of therapy, which is the only means available to increase patient survival. It is important to maintain a high level of awareness and diagnostic suspicion for this condition.
P341 ST. THOMAS NO. 2 BLOOD HYPERKALEMIC CARDIOPLEGIA AS A POSSIBLE CAUSE OF ACUTE ENDOTHELIAL INJURY IN SAPHENOUS VEIN GRAFT IN PATIENTS UNDERGOING ON–PUMP CORONARY ARTERY BYPASS GRAFT: SHORT–TERM RESULTS
Authors: Savino L , Giovannico L , D‘errico Ramirez A , Fischetti G , Santeramo V , Parigino D , Silva A , Milano A , Marraudino N , Bottio T
Published: May 2023

Introduction

Coronary artery bypass graft is considered the most frequently performed cardiac surgery and involves the use of different types of grafts: internal mammary artery, saphenous vein, radial artery. The venous graft is often subject to early failure due to various factors such as thrombus formation, intimal hyperplasia or formation of atherosclerotic plaques. Several studies have highlighted various mechanisms that may be responsible for these processes. This study aims to find a statistically significant correlation between the use of hyperkalaemic cardioplegic solutions and endothelial damage. Materials and methods For sample collection, saphenous vein segments were taken from each patient: one was taken when it was isolated to take the graft, and a second sample was taken after administration of St. Thomas no. 2 cardioplegic solution. Both collected specimens were stored in formalin and analyzed by light microscopy following hematoxylin–eosin staining and staining with monoclonal antibodies targeting CD31 and CD34.

Discussion

From the study with hematoxylin and eosin staining, it was observed that in the vein taken before the infusion of cardioplegia, the endothelium was present, continuous, clearly visible and without lesions. In the specimens taken after the infusion of hyperkalaemic cardioplegic solution, it is noted that the endothelium, although present, is more difficult to visualize and is discontinuous to a variable extent from 20 to 60%. This reduction in the percentage of visible continuous endothelium was confirmed by analysis with CD31 and CD34 immunohistochemical stains. Previous studies already confirm that the venous endothelium is affected by a high concentration of potassium, producing acute and chronic lesions. This result would seem to demonstrate how the endothelial tissue is also susceptible to hyperacute damage following short–term exposure to potassium.

Conclusions

The short–term results of this study would seem to confirm the initial hypothesis of a relationship between the use of hyperkalemic cardioplegia and the formation of acute or hyperacute lesions in the saphenous vein graft at the endothelial level. This conclusion could be one of the explanations of the high failure rate of the venous bypass, which in fact has a 10–year occlusion rate of 60/65%.
P342 DEL NIDO VS SERVATOR H CARDIOPLEGIA
Authors: Rosciano A , Paduvakis I , Cerillo A , Stefano P
Published: May 2023

Background and aim

One–shot long–lasting cardioplegia is particularly useful during right minithoracotomy mitral valve surgery (RT–MS), and the Servator H cristalloid solution has been widely used in this setting. However, the Servator H cardioplegia requires the administration of large volumes of fluids and the frequent recourse to ultrafiltration. we compared Servator H versus the Del Nido Cardioplegia, that contains blood and requires smaller volumes, in patients undergoing RT–MS.

Methods

36 consecutive patients undergoing RT–MS (± tricuspid and AF surgery) were randomly assigned to receive Servator H or Del Nido Cardioplegia. There were no differences between the two groups at baseline.

Results

Although there were no differences in terms of mortality and incidence of major complications, the use of Servator H cardioplegia was associated with a significantly increased release of CK–MB (but not of TnI) during the early postoperative period. Moreover, patients receiving Servator H were more likely to require defibrillation or pacing after removal of the aortic cross–clamp (8, 40% vs 2, 12.5%), and experienced a significantly higher rate of postoperative atrial fibrillation (10, 50% vs 4, 25%, p < 0.05).

Conclusion

Our data show that the Del Nido cardioplegia could offer improved myocardial protection during minimally invasive mitral valve surgery, resulting in reduced need for post–cardioplegia defibrillation and of postoperative atrial fibrillation. This is consistent with the results of similar, recent research. Further studies on larger populations are needed to consolidate these data.
P347 SHORT–TERM EFFECTIVENESS OF TAFAMIDIS THERAPY IN PATIENTS WITH TRANSTYRETIN CARDIAC AMYLOIDOSIS: EVALUATION OF CLINICAL–INSTRUMENTAL AND BIOHUMORAL PARAMETERS
Authors: Ciaramella P , Ajmone F , Maggio E , Costantino J , Manguso G , Ballatore F , Magnocavallo M , Alfarano M , Vizza C , Chimenti C
Published: May 2023

Background

In the ATTRACT trial, Tafamidis has been shown to be effective in patients with transthyretin amyloidosis (ATTR) by improving quality of life and survival at 30–month follow–up. However, it‘s not clear which are the clinical–instrumental and bio–humoral parameters that change first and after how long time from the begging of treatment.

Methods

In our cardiomyopathy tertially referral center from January 2022 to October 2022, 47 patients with ATTR (73% males, 27% females, mean age 75±16 years) were admitted for the evaluation of the possible TTR treatment. Of these,30 received treatment with Tafamidis and 10 (M, mean age 77±11 years, 9ATTRwt, 1vATTR) completed a six months follow–up and constituted our patient population. The following parameters werecollected at baseline and after six–months follow–up: 6 minute walking test, Kansas score, NYHA class, NT–pro BNP,echocardiographic ejection fraction, 12 lead ECG with assessment of amplitude of QRS voltages, heart rhythm, presence of Q waves of pseudo necrosis, number of ventricular/supraventricular ectopic beats, presence of atrioventricular (AV) blocks, sinus blocks, hemiblocks, bundle branch blocks, QTc length, type and dose of additional medications.

Results

No patient changed the antiarrhythmic therapy during the six months follow–up, and no ventricular arrhythmias nor sinoatrial blocks were recorded. Two patients had pacemaker (PM) before the beginning of thetherapy and no PM was implanted during the follow–up. There was no significant difference in QRS voltage amplitude (p=0.157), atrial fibrillation (p=0.785), Q waves of pseudonecrosis (p= 1.000), ectopic beats (p= 1.000), AV blocks (p= 1.000), hemiblocks (p= 1.000), bundle branch blocks (p= 1.000), QTc (p= 0.813), ejection fraction (p= 0.317), NYHA class (p= 0.564), NTproBNP (p=0.273). Statistically significant differences were found in the Kansas score (p=0.042) and in the 6 minute walking test (p= 0.018).

Conclusions

Tafamidis is able to improve quality of life andfunctional capacity in ATTR patients early in the course of the treatment. The stability of the other parameters, that tend to fast worsen in the natural course of the disease, demonstrates the ability of Tafamidis to halt and possibly revert amyloidosis.
P354 REMOVAL OF CARDIAC AL–AMYLOID LEADS TO CARDIOMYOCYTE POSITIVE REMODELING AND RESTRICTIVE PATTERN REVERSAL
Authors: Maggio E , Ballatore F , Ajmone F , Manguso G , Verardo R , Ciaramella P , Vernile A , Alfarano M , Vizza C , Chimenti C
Published: May 2023

Background

Properly treated AL cardiac amyloidosis can have a long survival. However, the mechanism involved in arresting or reversing cardiomyopathy, such as toxic suppression of the light chain or removal of the amyloid substance, is still unclear. We describe the case of a patient with AL amyloidosis treated with chemotherapy in whom serial endomyocardial biopsies were performed at diagnosis and after 17 years.

Clinical case

A 71–year–old lady onset with a hypertrophic phenotype cardiomyopathy (maximum thickness LV 18.2 mm, diastolic dysfunction with E/A ratio 2.45. preserved contractility (EF 55%) and NYHA class 3) received a diagnosis in 2004 of AL amyloidosis and underwent several cycles of chemotherapy. At clinical onset, cardiac amyloidosis was documented by endomyocardial biopsy. After 17 years, in 2021, the patient was hospitalized for palpitations and chest pain and documented intermittent phases of atrial fibrillation. The patient was reevaluated with immunoelectrophoresis, echocardiogram, cardiac magnetic resonance, coronary angiography, and left ventricular endomyocardial biopsy. Serum monoclonal chain AL–K was reduced from initial 233 mg/L to 18.2 mg/L, vn<19.4 mg/L. The echocardiogram showed reduction of the heart walls with reduction of the thickness to 14 mm, with regression of the restrictive pattern (E/A ratio from 2.45 to 0.5). Serum NT–proBNP decreased from 3188 pg/mL to 480 pg/mL (n.v.<334 pg/mL). Cardiac MRI revealed normal myocardial wall thickness, with preserved systolic function, in the absence of the typical late gadolinium enhancement pattern. Histology and electron microscopy showed no more hypo/atrophic cardiomyocytes and the interstitium was almost completely devoid of amyloid fibrils, which were distant from the cardiac cell allowing an improvement in oxygenation and trophism.

Conclusions

Remission of monoclonal gammopathy is associated with a removal of cardiac amyloid deposits and with a regression of cardiac hypertrophy and restrictive pattern. Histologically, the degradation of amyloid fibrils determines a better trophism of cardiomyocytes.
P355 PATIENT–REPORTED OUTCOME MEASURES IN WILD–TYPE AND VARIANT CARDIAC TRANSTHYRETIN AMYLOIDOSIS: THE ITALY (IMPACT OF TRANSTHYRETIN AMYLOIDOSIS ON LIFE QUALITY) STUDY
Authors: Aimo A , Teresi L , Argirò A , Serenelli M , Carnevale Baraglia A , Picerni A , Ricordari R , Ponti L , Di Bella G , Cappelli F , Perfetto F , Merlini G , Vergaro G , Castiglione V , Fabiani I , Niccolai M , Severino S , Passino C , Emdin M
Published: May 2023

Background

Transthyretin amyloidosis (ATTR) is due to TTR tissue accumulation. Both patients without mutations in the TTR gene (wild–type ATTR, ATTRwt) and those with such mutations (variant ATTR, ATTRv) may develop cardiac amyloidosis (CA). ATTR–CA has a deep impact on the quality of life. The ITALY study aimed 1) to create the first patient–reported outcome measures (PROMs) for ATTRv– and ATTRwt–CA, 2) to assess the feasibility of their administration, 3) to investigate the relationship between score values, clinical and laboratory findings, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Short Form Health Survey 36 (SF–36) scores.

Methods

Five Italian referral centers were involved (Pisa, Pavia, Ferrara, Florence, Messina). Item selection involved expert clinicians and 2 groups of 10 patients. The questionnaires were administered to consecutive patients evaluated at baseline and 6 months.

Results

Two 30–items questionnaires were created. Each item has 5 answers graded from 4 (best option) to 0 (worst option). The score ranged from 100 (best condition) to 0 (worst condition). As of November 2022, 82 patients (65 ATTRwt–CA, 17 ATTRv–CA) have completed the follow–up. At baseline, 30% of patients needed help to fill the questionnaire, and 20% at 6 months; 65% completed the questionnaire at baseline and 63% at 6 months. At baseline, median score values were 64 (interquartile range [IR] 54–74) in ATTRwt–CA and 59 (IR 51–71) in ATTRv–CA. ITALY score were correlated with global KCCQ and SF–36 scores at baseline and 6 months (r values from 0.7 to 0.8 in ATTRwt–CA and from 0.5 to 0.7 in ATTRv–CA). In patients with ATTRwt–CA, all KCCQ and SF–36 domains were univariate predictors of ITALY score values at baseline. All the KCCQ and SF–36 domains were independently predictive of ITALY score values in models including age, NYHA class, 6MWT, NT–proBNP; these results were confirmed at 6 months. In ATTRv–CA, All the KCCQ and SF–36 domains were independently predictive of ITALY score values in models including LV ejection fraction, at baseline and at 6 months.

Conclusions

The ITALY questionnaires are the first specific PROMs for ATTRwt– and ATTRv–CA. They have been created by experts in CA and patients and validated in a multicenter Italian cohort with 2 assessments over 6 months. Questionnaire completion is usually feasible. ITALY scores display close relationships with non–ATTR–specific measures of quality of life (KCCQ and SF–36).
P357 DOES CARDIAC AMYLOIDOSIS EVER HIDE A SEVERE AORTIC STENOSIS A CASE REPORT
Authors: Piscione M , Polito D , Castaldo G , Bianco S , Crispino S , Nafisio V , Mallus M , Grigioni F , Parti F
Published: May 2023

Case presentation: A 89-year-old man, with an history of paroxysmal atrial fibrillation and chronic renal disease, was admitted to our ER for acute decompensated heart failure. He reported dyspnea on minimal exertion and worsening peripheral edema. He had a history of heart failure and a severe aortic stenosis first diagnosed in 2020 with an echocardiogram demonstrating a left ventricular ejection fraction (LVEF) of 30% and a low-flow low-gradient aortic stenosis (AVA=0,6 cmq, mean pressure gradient=21 mmHg). Besides, in 2019, he underwent a 99m Tc MDP scintigraphy for a prostatic nodule which showed important myocardial uptake of the bone tracer highly suggestive of cardiac amyloidosis. Urinary light chain assessment and determination of immunoglobulin light chain levels were negative for AL amyloidosis. The electrocardiogram showed: sinus rhythm, low voltage in the frontal leads and complete left bundle branch block with secondary repolarization abnormalities. The patient underwent transthoracic echocardiography for staging the severity of the aortic valve stenosis, which revealed borderline results: the aortic valve area was 0.5 cmq with a transaortic mean pressure gradient of 20 mmHg (EF 25%, with GLS of −5%). Low-dose dobutamine stress echocardiography was performed. At rest conditions, there was global hypokinesia with an ejection fraction of 24%. Aortic valve mean pressure was 19 mmHg referring to a calculated aortic valve opening area of 0,78 cmq. Under peak dobutamine stress (30 mcg/kg/min), LVEF increased to 36%. On the basis of these diagnostic findings, aortic stenosis was classified as pseudo-severe due to systolic dysfunction of the left ventricle with preserved contractile reserve. Besides, aortic calcium score of 574 confirmed that the aortic stenosis was non severe.

Conclusions

This case results exemplary of the fact that amyloidosis does not always hide a severe stenosis. Actually the echo with dobutamine indicates a non-valvular reason for heart-failure and no indication for valve replacement.The discharge suggestions consists of clinical/ echo follow ups and TTR stabilizers. Anyway, Tafamidis is not recommended because of the age and the patient short life expectancy. The implantation of CCM which, during the action potential platea delivers non-excitatory electrical currents and enhances systolic function in patients with heart failure, is proposed to obtain an improvement of symptoms.
P359 A POSSIBLE ROLE OF A NOVEL NUTRACEUTICAL COMPOUND FOR IBS IN TRIGLYCERIDES–LOWERING EFFECT
Authors: Natale F , Loffredo F , Molinari R , Alfieri R , Covino S , Mollo N , Limatola M , De Luca L , Pezzullo E , Cimmino G
Published: May 2023

In the last few years, growing evidence indicate that gut miocrobiome is linked to irritable bowel syndrome (IBS) and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have been also recorded. Triobiotix is a nutraceutical consisting of: maltodextrin; mineralized extract of Lithothamnion; Bioecolians® gluco–oligosaccharides; ferment mix; short–chain fructo–oligosaccharides powder. We analyzed the database of 40 Italian General Practitioners (GPs). A total of 587 patients with IBS and on Triobiotix were identified. Of these, in only 535 patients, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia. Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the TO evaluation. Triglycerides levels were also significantly decreased (186.37+66.4 vs. 176.13+67.9; p < 0.05). Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL–C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low–moderate dyslipidaemia.
P361 SMALL INTERFERING RNA: REAL–LIFE DATA WITH A NEW FRONTIER IN HYPOLIPIDEMIC THERAPY
Authors: Bertani G , Mugnolo A , Venturi G , Bacchion F , Morando G , Zamboni A
Published: May 2023

Inclisiran (Leqvio® 284 mg) is a new small interfering RNA that acts on the mRNA coding for the gene PCSK9. Inclisiran is indicated in adults with primary hypercholesterolemia (heterozygous familial and non–familial) or mixed dyslipidemia as an adjunct to diet alone or in combination with a statin or other lipid–lowering therapies in patients unable to reach LDL–cholesterol goals with the maximum tolerated dose of a statin, or alone or in combination with other lipid–lowering therapies in patients who are statin–intolerant/contraindicated. The drug is administered subcutaneously and should be performed by a healthcare professional. After the initial dose, a second dose is given at 3 months followed by every 6 months. Real–life data with inclisiran is very limited. Herein, we present real–life data on 6 patients with a mean age of 71 years who started therapy with inclisiran in September 2022 (Fig. 1). Three patients were receiving combined lipid–lowering therapy with a statin and exetimibe, 2 were on ezetimibe alone because they were statin–intolerant, 1 patient was not receiving any therapy because intolerant. All patients had high to very high cardiovascular risk according to current ESC guidelines, and the lipid target was not met on optimized oral lipid–lowering therapy. Following initiation of inclisiran, lipids were assessed at 1 week, and at 1, 2, and 3 months. Changes in serum levels of LDL–cholesterol are shown in Figure 2. Reduction in LDL–cholesterol was seen as early as week 1. The mean percentage reduction in LDL–cholesterol at 1 month was 50% in patients not receiving statin therapy and 40% in those receiving a statin. The greatest reduction in LDL–cholesterol was seen in patients receiving combined therapy with a statin and ezetimibe. There was a clear reduction in LDL–cholesterol regardless of the type of statin and dosage. All patients receiving combined therapy with a statin reached their lipid target within 1 week after the start of treatment. No adverse effects were observed in any patient. From these preliminary observations, in a real–life setting therapy with inclisiran therapy appears to be safe and effective in lowering LDL–cholesterol in patients with high cardiovascular risk, especially when given in combination with a statin.
P376 HIGH RISK PULMONARY EMBOLISM COMPLICATED BY CARDIOGENIC SHOCK
Authors: Sanguineti M
Published: May 2023

The case concerns a 62–year–old woman with no significant cardiovascular history. In October 2022 the patient had an acute diverticulitis hesitated in ostomy placement (Hartmann surgery). Post surgery was complicated by linezolid–resistant Staphylococcus aureus sepsis. During the hospitalization an incidental low risk pulmonary embolism was detected by CTPA. The patient was discharged with thrombohaembolic prophylaxis (subcutaneous LMWH) to be continued for one month. The day after the end of the prophylaxis (November 24th ) she came to the emergency room because of chest pain, dyspnoea, diaphoresis. Hypotension, tachycardia, metabolic alkalosis and increased serum lactate levels were present. CTPA revealed thrombi in both left and right pulmonary arteries, including main bifurcation branches. Compressive ultrasonography in left popliteal vein resulted positive. Due to recent surgery, although not entirely contraindicated, the patient was judged unfit for systemic thrombolysis and percutaneous catheter–directed treatment with Penumbra Indigo system was performed, with suboptimal result. The woman was therefore moved to intensive care unit due to worsening clinical conditions, and the following day a further percutaneous procedure was performed. During the days CTPA and laboratory data detected a great improvement, and reduction of inotropes, diuretic and high flow oxygen therapy was possible. Meanwhile there was a gain of function in right ventricular contractility, with final TAPSE value of 15, and S’ 8 cm/s. Oral anticoagulation with loading dose and rehabilitation therapy were started . The patient was discharged on November 9th in good health.
P379 A BIG MASS AROUND THE HEART: SHOULD I BE WORRIED?
Authors: Feneziani A , Cavallone E , Franco E , Moretti C
Published: May 2023

Lipomas account for about 10% of all cardiac tumors and symptoms are often secondary to the compression of cardiac chambers and the consequent hemodynamic impact. We report the case of a 76–year–old woman with no cardiological history, undergoing oncological follow–up for breast cancer underwent a left radical mastectomy in 2014, not followed by radiotherapy or chemotherapy, who came to our attention due to the identification at the total–body CT scan of a mediastinal mass. A voluminous intrapericardial formation was detected, with a maximum size of 5.4 x 8.6 cm, characterized by adipose attenuation values at baseline. On examination, the patient was asymptomatic and eupneic, in good hemodynamic compensation, in functional class NYHA I. The ECG showed sinus rhythm with regular atrioventricular and intraventricular conduction without significant alterations in repolarization. On the echocardiogram, the left ventricle appeared of normal size and thickness without alterations in the global and segmental systolic function, EF 65%; the right ventricle was regular in size and contractility; a voluminous pericardial mass of about 8 x 4.5 cm was observed in the inferior, posterior and lateral site, homogeneous, not vascularized, not compressing the cardiac cavities and not determining hemodynamic impact. The patient was then submitted to cardiac MRI which confirmed the suspicion of intrapericardial lipoma. Considering the absence of symptoms, the benign nature of the lesion and the absence of compression on the cardiac structures, we decided not to remove the mass and to continue clinical and radiological follow–up, thus monitoring size and symptoms.
P384 APPROPRIATENESS OF PRESCRIBING DIRECT ORAL ANTICOAGULANTS IN THE REAL WORLD: THE ANMCO NATIONAL AUDIT INITIATIVES APPRO–FA EVO PROJECT
Authors: Di Fusco S , Spinelli A , Caldarola P , De Luca L , Riccio C , Gabrielli D , Oliva F , Colivicchi F
Published: May 2023

Although direct oral anticoagulants (DOACs) have been in use for more than 10 years, their use in clinical practice does not always comply with established indications, especially in terms of dosage. With the National APPRO– FA EVO Audit Initiatives, data were collected on the use of DOACs in Italian hospital heart centres. In the present study, we analyse DOAC use based on the indications reported in the summary of product characteristics.

Methods

Aggregated data on patients discharged with a diagnosis of non–valvular atrial fibrillation (FANV) over a 2–week observation period were collected through a digital platform. Extrapolated variables included age, sex, diagnosis at discharge, presence of comorbidities, renal function (creatinine clearance, ClCr), and prescribed antithrombotic therapy.

Results

A total of 48 heart centres contributed to data collection. During the observation period, the total number of discharged patients was 1933. Among patients with a discharge diagnosis of FANV (569), 338 (59.4%) were male, 228 (40%) were >80 years old, and 228 (40%) had a ClCr between 15 and 50 ml/min). Patients with a diagnosis of FANV undergoing coronary angioplasty during hospitalization were 103 (18.1%), 112 (19.7%) with a diagnosis of acute coronary syndrome, and 232 (40.6%) of heart failure (Figure 1). There were 300 (52.7%) male patients with CHA2–DS2–VASc score ≥2 and 219 (38.5%) female patients with CHA2–DS2–VASc score ≥ 3. Among patients with FANV discharged on oral anticoagulant therapy (96,3%), 89.6% were on DOAC. The most frequently used DOAC was apixaban (35.5%), followed by rivaroxaban (25.2%), edoxaban (20.6%) and dabigatran (18.8%) (Figures 2 and 3). The use of reduced dosage met the reduction criteria in 90.2% of cases for apixaban, 90.9% for rivaroxaban, and 86.7% for edoxaban. Among patients treated with dabigatran, there was a higher prescription of the reduced dose than the full dose (10.2% vs 8.6%).

Conclusions

In accordance with international guidelines, DOACs are the anticoagulants of choice in most patients with FANV. Although the dosage used in clinical practice was found to be appropriate in about 90% of prescriptions, there is non–negligible room for the improvement of prescribing DOAC appropriateness.
P391 THE DIAGNOSTIC CHALLENGE BETWEEN CHRONIC PULMONARY EMBOLISM AND PULMONARY ARTERY SARCOMA: A CASE REPORT
Authors: Franco E , Iancu D , Cavallone E , Feneziani A , Pasquero M , Ruffini S , Astegiano M , D'Armini A , Moretti C
Published: May 2023

We report the case of a 63–year–old obese and hypertensive woman, admitted in hospital with worsening dyspnea for 2 weeks and syncope. A suspected chronic thromboembolism was diagnosed nine months before for a similar clinical picture; hematologic screening excluded thrombophilia and NOACs were prescribed. Two–dimensional transthoracic echocardiography showed enlargement of right chambers, the interventricular septum shifted to the left ventricle, showing “D” sign. Color Doppler flow imaging showed moderate regurgitation in tricuspid valve, with indirect pulmonary pressure estimation 90 mmHg. Left ventricle was normal for dimensions and function. ECG evidenced sinus tachycardia and no specific ST–T alterations. Blood exams evidenced anemia (Hb 9 mg/dl), negative neoplastic markers and absence of occult blood in feces, mildly elevated inflammatory markers, T–Troponin and D–dimer. Naso–pharyngeal swab for SARSCoV2 infection was negative. Chest computed tomography with contrast revealed a large filling defect within bilateral main pulmonary arteries. No lymph nodes or pulmonary pneumonia were detected. Lower extremity venous ultrasound was positive for right popliteal deep vein thrombosis. The global clinical picture suggested an acute pulmonary embolism recurrence, with a severe right ventricle impairment and a concomitant deep vein thrombosis. Some factors were not completely clear: chronic anemia, only mildly increased D–dimer, no specific increase of inflammatory markers. The patient was referred to Cardiac Surgery Unit of IRCCS Foundation Policlinico San Matteo in Pavia, for pulmonary endarterectomy. Unexpectedly the surgical finding was a bilateral pulmonary artery sarcoma, confirmed by histological exam. We thus clarified some uncertain clinical aspects, explainable in the context of a severe neoplastic picture. There were no immediate complications, and a chemotherapy was initiated after a period of cardio–pulmonary rehabilitation. Pulmonary artery intimal sarcoma is a very rare disease, its prevalence is about 0.001–0.003%, it can originate from the left and right pulmonary arteries and intimal layer of pulmonary arteries, forming a tumor growing in the nodular cavity or spreading along the intimal surface. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome.
P392 POST–THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPLEX CASE
Authors: De Laura D , Lavolpe V , Rutigliano D , Cavallari D , Basso P , Palumbo V , Musci S , Ruggero M , Tota F , Sublimi Saponetti L , Locuratolo N , Caldarola P
Published: May 2023

Introduction

Patients with post–thromboembolic pulmonary hypertension (CTEPH) achieve functional recovery after pulmonary endarterectomy (PEA). 40% of them are inoperable (1,2).

Clinical case

66–year–old man admitted in 2012 to our ward for dyspnea on exertion and high echocardiographic probability of pulmonary hypertension (PI). Medical history: smoking; thalassemia trait; COPD; splenectomy at 13; diagnosis of chronic myeloproliferative syndrome. BP: 120/70 mmHg. NYHA class III. Blood tests: Hb: 9.4 g/dl; MCV: 70; HCT: 30%; PLT: 511; WBC: 14.84 (Mo 13%).NT–pro BNP:933. Autoantibodies and tests –HIV: negative. EGA in AAPaO2: 53 mmHg, PaCO2: 32 mmHg, SO2: 87%. PFR: FEV1: 68% FVC:74%, FEV1/FVC:72.DLCO:75%.6MWT:450m,Borg:0/3;Baseline SO2: 86%,final SO2 74%. On ECG: sinus r. at 64 beats/min. Echocardiogram: left sections within limits; right ventricle:DTD:30mm; RV/LV< 1; right atrial area: 19cm2, PAPs: 70+5 mmHg (Vel: 4.1 m/s), AcT: 90 msec. TAPSE: 16mm. Performs pulmonary CT scan with contrast medium: negative for pulmonary embolism; some 1 cm bubbles of emphysema in the subpleural area of the right middle lobe; right heart catheterization: PAD: 13mm; PAPM: 50mm; IC: 4.1l /min/m2; RVPtot:11WU;RVP:art:5.2WU;WP:11mmHg.Haematological diagnosis of thalassemia intermedia and exclusion of myeloproliferative syndrome/P lung scintigraphy is positive for multiple bilateral perfusion defects. The possibility of PEA for peripheral lesions at the referral Centre, therapy with warfarin (TAO), riociguat and bronchodilators was started., discontinued therapy with TAO. Finding of recurrence of pulmonary micro embolism on scintigraphy. At the end of the intravitreal treatments with resumption of TAO, at control catheterization evidence of PAD:5mm PAPm19mmHg;WP:9mmHg;IC: 3.4l/min/m2; RVPart:2.9 WU;NYHA:II.

Discussion

Not all CTEPH from thalassemia intermedia can perform PEA (3). Hypercoagulability is an important pathogenetic mechanism in the genesis of PH (4) and comorbidities have a significant role in the prognosis and response to medical therapy. COPD is the comorbidity that favors hypercoagulability, worsens pulmonary ventilation and gaseous exchanges (5).

Conclusions

In thalassemia intermedia with inoperable CTEPH, hypercoagulability is the condition that most influences the prognosis and efficacy of vasodilator therapy.
P396 FIBRINOUS PERICARDITIS AND STILL’S DISEASE IN ADULTHOOD: A RARE AND INSIDIOUS COMBINATION
Authors: Paffoni P , Maffè S , Facchini E , Prenna E , Bergamasco L , Careri G , Paino A , Franchetti Pardo N , Ariotti S , Dellavesa P
Published: May 2023

In 9/2022 we admitted a 69–year–old man with history of hypertension, in therapy with bisoprolol and edoxaban after recent diagnosis of persistent atrial fibrillation, with a minor pericardial effusion at the echocardiogram. He had dyspnea, fever, and atrial fibrillation with elevated cardiac frequency. The echocardiogram showed increased pericardial effusion, circumferential, about 2 cm, with important fibrinous organization, without signs of cardiac tamponade (fig1). Hemocultures and urocultures were repeatedly negative, with significant increase in flogosis parameters. Therapy with high–dose acetylsalicylic acid was started first and then Ibruprofene + colchicine with poor clinical response and persistence of symptoms and effusion. The presence of elevated fever, arthralgias, transient skin rush to the trunk and flogosis indices (CRP 17 mg/dl, ESR 97mm, WBC 11000/ul with 80% neutrophil, ferritin 2200 ng/ml), with negativity of antinucleus antibodies and rheumatoid factor, allowed to place diagnosis of adult Still’s disease (AOSD). High–dose steroid therapy (prednisone 1mg/kg) was initiated with fever regression, progressive normalization of inflammatory indices and spontaneous restoration of sinus rhythm. The 7–day echocardiogram showed almost complete resolution of pericardial fibrinous effusion (fig 2). At 2 months patient remained asymptomatic, no more pericardial effusion, no signs of flogosis. Differential diagnosis of pericarditis is often complex, and therapeutic attitude and prognosis are variable according to etiology. AOSD has a prevalence of about 1/100,000, affects mainly young adults, very late onset cases are rare. Transient, small, salmon–pink, not itchy rashes, usually concurrent with fever, can drive diagnosis, along with major and minor criteria of Yamaguchi. Often patients have serositic involvement with pleuritis or pericarditis, with tamponade needing drainage. Such forms respond well only to steroid treatment. However, cases of fibrinous pericarditis as marked as the one described have not been described; the so important fibrinous component would made an eventual pericardiocentesis difficult. Although infrequent, it is a differential diagnosis that the cardiologist must consider in cases of refractory pericarditis and pericardial effusion.
P402 PROSTHETIC MECHANICAL VALVE THROMBOSIS: THE EXPERIENCE OF SALAM CENTRE FOR CARDIAC SURGERY (EMERGENCY NGO)
Authors: Masini F , Lentini S , Portella G , Raafat Shadig D , Abdelwahab Abdalla S , Erba N , Giovanella E
Published: May 2023

Mechanical heart valve (MHV) replacement in patients with rheumatic valve disease is common in Africa. MHV requires long–life anticoagulation (OAT) and managing this can be difficult. Prosthetic valve thrombosis (VT) is a pathological entity characterized by thrombus formation on the prosthetic structures, with subsequent prosthesis dysfunction. Salam Centre for Cardiac Surgery was built in Khartoum Sudan by Emergency NGO. Since April 2007 high–quality and free–of–charge medical and cardio–surgical treatment has been offered to patients. More than 10000 cardiac surgery, 80% of which for MHV replacement, were performed. The aim of the work is to analyze the characteristics of patients with VT, the risk factors and clinical follow–up. From Aug 1, 2018 to Nov 30, 2022, 287 VT involving 237 patients were collected.The incidence is 1.36% p/y. The most relevant risk factor was the interruption of anticoagulant therapy and irregular INR control (N. 142; 49,5%). In 101 cases (35,2%) a clinical factor (infection, pregnancy, eosinophilia, heart failure) was the main cause of VT. The diagnosis, suspected with the Transthoracic Echo and confirmed with fluoroscopy, was done at the OPD visit (32,4%) in asymptomatic or at triage for symptomatic patients (67,6%). 236 patients were admitted to Salam Centre.The treatments of choice were thrombolysis, performed with 2 different protocols, fast and low dose–slow infusion (Alteplase 25 mg./6 hrs), followed by Triple Therapy (TT) (Warfarin, LMWH and Aspirin) (N.189–65,8%), TT alone (N.44– 15,3%) or Warfarin and Aspirin (N.54–18,8%). 210 events (73,2%) ended with unblocked valve,24 events ended with the death of the patient (8,3%); low dose/slow infusion regimen had less deaths. Thrombolysis was more effective (unblockage 79,9%). Warfarin and Aspirin and not admission to Salam Centre were linked to less unblokage and high mortality rate.

Conclusions

The incorrect conduct of OAT represents the most relevant risk factor for VT.Many are the underlying causes, from economic and social factors to insufficient patient awareness. MOH intervention to offer free of charge INR check, but also patient education must be improved. VT is caused also by intercurrent clinical events such as pregnancy, infection. Eosinophilia represents a chapter that deserves a detailed study.Patients with history of VT must be followed by a dedicated clinic that aims to increase patient loyalty in order to intercept risk factors as early as possible.
P406 LAUBRY–PEZZI SYNDROME: EVERYTHING IS NOT AS IT SEEMS
Authors: Polito M , Cannavaro G , D'Auria F , Bottiglieri P , Vassallo M , Ianniello G , Longobardi A , Ferrara F , Coscioni E , Malinconico M
Published: May 2023

Introduction

Laubry–Pezzi syndrome is a congenital heart disease characterized by the prolapse of an aortic valve cusp into a subjacent ventricular septal defect (VSD), mostly supracristal, leading to severe aortic regurgitation (AR). It has been reported nearly always in childhood, the Venturi effect is the predominant factor and onset symptoms may be variable.

Case Report

A 61–years–old male was admitted to our intensive case unit for chest pain radiated to interscapular region and exertional dyspnea. Hemodynamic parameters were normal. At ECG sinus rytm with heart rate 92 bpm and non–specific repolarization abnomalities were reported. Hs troponin I was 276 ng/L, myoglobin 30.2 ng/mL and BNP 325 pg/mL. Transthoracic echocardiography showed a dilated left ventricle (LV EDV 107 mL/m2) with normal ejection fraction (55%), severe AR without aortic root dilation and a suspicious shunt left to right at level of interventricular septum. Therefore, transesophageal echocardiography was performed and confirmed severe AR by probable bicuspid valve and right cusp prolapse, in absence of calcifications and/or vegetations by endocarditis, restrictive perimembranous VSD (maximum diameter 0.6 cm) and ostium secundum ASD with shunt L–R. Right chambers were not dilated and non invasive systolic pulmonary artery pressure was 43 mmHg. Coronary angiography was performed and showed a significant stenosis of distal left anterior descending (LAD) artery and of proximal circumflex artery. Right heart catetherization excluded significant high values of pulmonary pressures (mPAP=18 mmHg), of pulmonary capillary wedge pressure (9 mmHg), with a mild increase of pulmonary vascular resistances (1.16 HRU; nv < 96). Coronary artery bypass grafting (left internal mammary artery on LAD and Y–graft radial artery on obtuse marginal artery), aortic valve replacement with bioprothesis (Inspiris Resilia 23 mm), ASD closure by direct suture and VSD closure with pericardial patch were performed. No post–surgical complications were reported. Interestingly, during the replacement of aortic valve, it resulted tricuspid, confirming the suspicion of Laubry Pezzi syndrome.

Conclusions

our case was object of great debate because restrictive VSD and severe AR were not previously known, were diagnosed in middle age and until then paucisymptomatic. Laubry–Pezzi syndrome is a very rare disease that may explain controversial cases of severe AR.