bluuebunny/crossref_metadata_2025 huggingface dataset:
386 IMPACT OF REVASCULARIZATION COMPLETENESS ON ONE-YEAR OUTCOMES OF IMPELLA-SUPPORTED PCI IN ACUTE CORONARY SYNDROME: A SINGLE-CENTER EXPERIENCE
Authors: Ruzzarin Alessandro , Pighi Michele , Marin Federico , Zucchelli Federico , Portolan Leonardo , Mainardi Andrea , Mora Francesco Della , Luciano Ribichini Flavio
Published: December 2022

Background

The use of mechanical circulatory support in high-risk percutaneous coronary intervention (HRPCI) has grown over the past decade. We aimed to evaluate the impact of coronary revascularization extent on one-year outcomes of Impella-supported HRPCI in the setting of acute coronary syndrome (ACS).

Methods

We performed a single-center retrospective study including all patients who underwent coronary angiography supported by Impella at our institution. Patients undergoing HRPCI in the setting of ACS with Impella-assistance were identified for the analysis. Revascularization extent was assessed using the British Cardiovascular Intervention Society (BCIS) jeopardy score revascularization index (RI). Patients were classified into two groups according to the completeness of revascularization in high RI (RI>0.75) and low RI (RI<0.75).

The primary study endpoint was survival free from major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke, heart failure hospitalization) at one-year follow-up.

Results

Among fifty patients enrolled in the study, forty ACS patients (mean age 69.2±9 years) were identified for the analysis.

At coronary angiography, 76.3% had multivessel disease, and the mean BCIS-JSPRE-PCI score was 10.2±2.1. After Impella-supported PCI, BCIS-JSPOST-PCI score was 2.1±2.0 (p<0.01) and RI>0.75 was reached in 89.2% of cases (mean RI 0.8±0.2).

In-hospital mortality was 20.5% without a statistical difference between high and low RI (p=0.1).

Within 12 months, time-to-MACCE was statistically higher in patients with high RI as compared to low RI (288.2 vs. 189.8 days, p<0.05) (Figure).

Conclusions

Our single-center experience suggests a more extensive revascularization, aiming for a positive impact on outcomes, when a Impella-protected strategy is performed in the setting of acute coronary syndromes.
918 EARLY RECOGNITION OF SUBCLINICAL ATRIAL FIBRILLATION IN PATIENTS IMPLANTED WITH DIFFERENT DEVICES
Authors: Cardia Giada , Curcio Antonio , Romano Letizia Rosa , Mancuso Cinzia , Fiore Davide , Augusto Florinda Maria , Calvelli Pierangelo , Indolfi Ciro
Published: December 2022

Background

Atrial fibrillation (AF) is the supra-ventricular tachyarrhythmia mostly encountered in the clinical practice.While appearing silent or with a constellation of symptoms, it confers a 5-fold risk of stroke. Early detection is mandatory to establish the diagnosis and recommend anticoagulation. Besides the arrhythmia recognition through several tools, such as Holter ECG and loop recorders, it has been underlined that cardiac implantable electronic devices with an atrial lead can help in recognizing asymptomatic AF periods, also known as atrial high-rate episodes (AHREs).

Materials and Methods

48 patients with AHRE detection at device telemetry checks were enrolled; implanted device were pacemakers (n=31, 64.8%); implantable cardioverter/defibrillators (ICD, n=8, 16.6%); cardiac resynchronization therapy devices with defibrillators (CRT-D, n=9, 18.5%). Male gender was predominant (40 vs. 8), age was > 65years, and mean CHA2DS2VASc was 4.2±2.8. Patients underwent ECG assessment in 6-month intervals (at baseline and during follow-up), MOntreal Cognitive Assessment test, and device interrogation for AHRE of duration >5 minutes and rate >175 beats per minute. Randomization to a direct oral anticoagulant (DOAC) or usual care (aspirin when needed or placebo) was provided in a blind fashion and maintained for the entire study observation until occurrence of overt AF, followed by exclusion from the study.

Results

We found that 13%-16% of patients with device-detected AHRE developed AF over a mean follow-up of 2.5 year (range 4.6±2.0). These cases were given oral anticoagulation since change of indication according to current guidelines. Most important comorbidities were coronary artery disease (n=18 patients, 36.73%); systemic hypertension (n=41, 83.67%); diabetes (n=13, 26.53%); dyslipidemia (n=23, 46.8%); heart failure (n=17, 35.4%). 30 patients were treated with beta-blockers(62.5%). 2 patients died for gastrointestinal bleeding. One patient was excluded for major bleeding after one month from the enrollment. Total AHREs duration was significantly lower in patients with pacemaker (14 hrs) compared to patients with CRT-D (17 hrs) and ICD (20 hrs, p<0.05).

Conclusions

The impact of AHREs was higher in patients affected by cardiac dysfunction and concomitant diseases; none of the patients enrolled in the study developed ischemic stroke; major bleedings were observed in both arms. Further studies are warranted for considering oral anticoagulation based on the sole device interrogation in the context of subclinical atrial fibrillation.
98 ORAL ANTICOAGULANT THERAPY AND RISK OF MACE IN ELDERLY PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: REAL WORLD EVIDENCE DATA.
Authors: Armentaro Giuseppe , Condoleo Valentino , Divino Marcello , Pastura Carlo Alberto , Francica Mattea , Barbara Keti , Monaco Vittoria , Clausi Elvira , Scarcelli Maria Rosangela , Cuda Patrizia , Severini Giandomenico , Marco Mario De , Miceli Sofia , Maio Raffaele , Perticone Maria , Sciacqua Angela
Published: December 2022

Aim

Atrial fibrillation (AF) is the most common cardiac arrhythmia globally and is associated with a five-fold increased risk of stroke compared with patients without AF. Although large clinical trials have demonstrated the noninferiority of NOACs to VKAs in preventing stroke and systemic thromboembolism and their use is recommended by the guidelines, the role of antithrombotic therapies on the risk of major adverse cardiac events (MACE) in a high-risk population, such as the elderly, is still controversial (2). The aim of this work is to evaluate any differences on the occurrence of MACE among NOACs-treated patients versus VKAs in an elderly population with AF and other critical comorbidities.

Materials and Methods

420 caucasian patients with non-valvular AF, aged ≥65 years were enrolled, 136 in treatment with VKAs and 284 with NOACs, with mean age 76.7±5.7. A clinical-instrumental and laboratory evaluation was performed for a follow-up of 93.9 months. Statistical analysis was performed with Wicoxon's test, Student's t-test, log rank test, univariate and multivariate Cox regression model in order to calculate the hazard ratio (HR) for independent predictors associated with the incidence of MACE.

Results

The two groups were overlappings for sex, smoking, T2DM. NOACs group had a higher prevalence of: HF (110 vs 32, p=0.002), COPD (127 vs 39 p = 0.001), arterial hypertension (266 vs 112, p = 0.0003) and they were older than VKAs group (78.4±4.7 vs 73.2±5.9 years; p<0.0001). In the whole general population at baseline, the following values ​​were detected: estimated glomerular filtration rate (eGFR) 64.6 ± 18.2 ml/min/1.73 m2, Systolic blood pressure (BP)132.5±11.6 mmHg, diastolic BP 76.6±9.5 mmHg, BMI 29.4±4.8 Kg/m2. In patients treated with NOACs, MACEs observed were 44 (2.4 events /100 patient-years), while in the group treated with VKAs were 76 (7.2 events/100 patient-years) (p <0.0001). A multivariate analysis model showed that an enhancement of 1g/dl of albuminemia value (HR 0.565, p=0.033), taking a therapy with β-blockers (HR 0.621, p=0.013), ACE inhibitors or ARBs (HR 0.695, p=0.024) were protective factors for the onset of MACE, while VKAs therapy (HR 2.596, p<0.0001) and HF (HR 1.471, p<0.0001) increased the risk of MACE in patients with AF.

Conclusions

The data of present study confirm a better safety profile of NOACs compared to VKAs on the occurrence of MACE in an elderly population with critical comorbidities, even though patients treated with NOACs were older and had a greater burden of comorbidities that negatively affect the risk of MACE such as: arterial hypertension, COPD and heart failure.
7 EXPLOITABILITY AND DISTRIBUTION OF SLEEP APNEA AND ATRIAL FIBRILLATION BURDEN DURING LONG TERM FOLLOW-UP IN UNSELECTED DUAL-CHAMBER PACEMAKER PATIENTS
Authors: Mascioli Giosuè , Aimè Ezio , Contardi Danilo
Published: December 2022

Background

Sleep Apnea (SA) and Atrial Fibrillation (AF) are common comorbidities in paced patients (pts). Modern pacemakers (PMs) are capable of storing continuous long-term reliable daily information about: 1) AF burden (AFB); 2) severity of SA, defined by a respiratory disturbances index (RDI) measured by a minute ventilation sensor-based algorithm.

Aim of the study

This retrospective study aimed to assess exploitability and distributions of daily AFB and RDI over long-term follow-up (FU) in unselected dual-chamber (DC) paced pts implanted with PMs equipped with a dedicated SA monitoring (SAM) algorithm and followed-up in their Institutions. Pts affected by permanent AF were excluded from the study.

Methods

Data from long-term FU have been collected after implant, together with pts clinical baseline characteristics. Between Aug 2013 and Oct 2018, n=210 pts were implanted with Reply 200/Kora 100 PMs (MicroPort CRM, Saluggia-VC, Italy), equipped with the SAM algorithm. At each FU visit all the daily AFB and RDI data were retrieved from the PM memory. Days of FU have been considered exploitable (Expl-FU) when both the daily AFB and RDI information were available.

Results

Data from n=864 visits are available for analysis. Pts characteristics: male 56.2%, mean age 76.4±11.1 yrs, BMI 25.6±4.4 Kg/m2; implant indication: sinus node disease 40.5%, AV block 46.2%; 37.1% of pts had a history of paroxysmal AF. The overall FU / Expl-FU durations were 1.94±1.23 / 1.48±1.14 years (23.7% of days were lost due to various technical reasons). The PMs classified RDI as valid in 92.3%±19.5% of nights (85.7% of pts showed >90% of valid nights, Figure 1). Severe or moderate SA was suspected in 43.8% and 59.5% of pts, respectively. An AFB≥25% / 50% was observed in 9.5% / 5.7% of pts (Figure 2).

Conclusions

In this retrospective study, SA and AF have been shown to highly affect unselected DC paced pts. PM devices proved to be really helpful in consistently and reliably measure both SA (RDI successfully identified in 92.3%±19.5% of nights) and AF (9.5% of pts with AFB≥25%). This is relevant to allow clinicians to implement early preventive actions to improve clinical prognosis.
1094 MULTIVESSEL CORONARY ARTERY SPASM TRIGGERED BY GANGLIONATED PLEXI STIMULATION DURING ATRIAL FIBRILLATION RADIOFREQUENCY CATHETER ABLATYION: A CASE REPORT
Authors: Innocentiis Carlo De , Astore Pasquale , Buonpane Angela , Giannantonio Maria , Ienco Vincenzo , Laborante Renzo , Fumarulo Isabella , Santamaria Matteo
Published: December 2022

Background

Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Atrial fibrillation could be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment.

Case summary

We report a case of severe multivessel coronary artery spasm triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent atrial fibrillation, promptly resolved after intracoronary nitrate administration.

Discussion

Although rare, coronary artery spasm is a serious complication of atrial fibrillation catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
791 CAN ALARMINS BECOME A THERAPEUTIC TARGET FOR A PATIENTS WITH ATRIAL FIBRILLATION?
Authors: Orlando Luana , De Fazio Marianna Gigliotti , Terranova Dario , Montemurro Vincenzo , Imbalzano Egidio
Published: December 2022

The link between alarmins and atrial fibrillation is clear and well known in the literature. We performed a non-systematic review about role of alarmins in pathophysiological mechanism of AF, hypothesizing their role in potential novel therapeutic targets for arrhythmia.

Several studies have shown a key role of HMGB1 in AF physiopathology. We have seen an almost direct correlation between HMGB1 and oxidative stress in the inflammatory process of AF. Wu et al. observed that HMGB1 is higher in patients with permanent AF, because they experienced a continuous inflammatory tissue damaging impulse. It was shown a prothrombotic and procoagulative role of HMGB1, increased in patients with AF and atrial thrombosis.

Scherschel et al. showed higher concentration of S100β protein in AF patients undergoing catheter ablation. Neuronal injury by intrinsic cardiac autonomic nervous system (ICSN) upon catheter treatment released damage-associated molecular pattern proteins (DAMPs) as S100β protein. In vitro studies dealing with murine intracardiac neuros showed that S100β decreased potential action and increased neuronal cells growth.

Many studies demonstrate HSP70 protective role when intracellular, at high concentrations in patients who do not develop arrhythmia after cardiac injury, such as bypass, and low concentrations preoperatively in patients who later develop arrhythmia. At the serum level, on the other hand, it becomes an important marker of cellular damage and oxidative stress, also related to increased IL-2 AND IL-4.

Conclusions

These results could be considered for new therapeutic strategies, as inhibition of oxidative stress, novel therapeutic targets of anticoagulant drugs and considering alarmins as predictive or prognostic biomarkers of disease.
19 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AFTER TRANSVENOUS LEAD EXTRACTION: SAFETY, EFFICACY AND OUTCOME
Authors: Pittorru Raimondo , Giacomin Enrico , Migliore Federico , Falzone Pasquale , Bernardo Dall´aglio Pietro , De Lazzari Manuel , Vianello Riccardo , Iliceto Sabino
Published: December 2022

Background

Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy and outcome of S-ICD implantation after TLE of TV-ICD.

Methods

The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD.

Results and Conclusions

Indications for TLE were: infection (63.4%) and lead malfunction (36.4%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n=4;11.1%), pulse generator pocket erosion with no evidence of infection (n=2;5.5%) and ineffective therapy (n=1;2.7%).No pocket or systemic device-related infection, lead/hardware dysfunction were reported.Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF).There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥2 (HR 5.05;95% CI 1.00–26.38;p=0.04), hypertension (HR 22.72;95% CI 1.05–26.31;p=0.02), diabetes (HR 10.64;95% CI 2.05-55.60; p=0.001) and ischemic heart disease (HR 5.92;95% CI 1.17–30.30;p= 0.01).

Our study provides evidences on the use of S-ICD as an ideal alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidity.
678 WIDE COMPLEX TACHYCARDIA IN A PATIENT TREATED WITH PERMANENT HIS BUNDLE PACING: A CASE REPORT
Authors: Rizzello Davide , FrancescaNotarangelo Maria , Bearzot Luca , Crocamo Antonio , Gonzi Gianluca , Dinatale Alessandro , Grassi Francesca , Niccoli Giampaolo , Ardissino Diego
Published: December 2022

Introduction

Differential diagnosis of wide complex tachycardias based only on ECG analysis remains a challenging exercise. But, when intracardiac tracings are available (i.e., pacemaker EGM), electrophysiologists may consider several tricks to make a correct diagnosis.

Case Presentation

A 73-years-old sporty male was admitted to our hospital for palpitations and dizziness.

ECG monitoring revealed AF, typical atrial flutter and asystolic pauses following spontaneous cardioversion of atrial arrhythmias. We diagnosed sick sinus syndrome and implanted a dual-chamber pacemaker with an atrial lead in the right appendage and a stylet-directed active fixation lead in the His region, obtaining non-selective narrow paced QRS.

The day after PM implantation, during a new episode of AF, two runs of regular wide-complex tachycardia (LBBB morphology, cycle length of 270 ms) occurred (Fig 1A, B). LBBB morphology, patient's history, and AF favored aberrancy, but couldn't exclude VT or preexcitation (by atrio-fascicular AP).

Our diagnostic strategy consisted in adding atrial and His intracardiac electrograms registered by pacemaker to analysis of ECG traces.

The device interrogation showed AV dissociation at the time of the wide complex tachyarrhythmia and a negative HV interval (Fig. 2A). These findings ruled out aberrant ventricular conduction and bundle branch reentrant tachycardia, because both these arrhythmias are characterized by HV ≥ HV in sinus rhythm. We performed incremental atrial pacing maneuver, during SR, obtaining decremental AH conduction with constant HV interval (60 ms), excluding atrio-fascicular, nodo-fascicular and nodo-ventricular AP.

His bundle activity was identified just after the ventricular activation, producing a relatively short VH interval, suggesting the presence of a retrograde activation of the His bundle, therefore it was possible to hypothesize that the site of origin of the ventricular arrhythmia was within/or very close to RBB (Fig 2B, C). Just in few beats His bundle deflection was missing, probably because of recovery of functional LBBB (Fig 2D).

Discussion

Our final diagnosis was RBB VT. Patient was treated with Verapamil 80 mg t.i.d., with no further recurrence. This case highlights the diagnostic value of device interrogation in patients with permanent His bundle pacing, for the evaluation of wide complex tachycardias.
955 SUBCUTANEOUS VERSUS TRANSVENOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATORS IN CHILDREN AND YOUNG ADULTS: A METANALYSIS
Authors: Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Valente Debora , Caminiti Rodolfo , Polselli Marco , Vetta Francesco , Cirone Donatello , Cauti Fillippo Maria , Crea Pasquale , Rossi Pietro , Chierchia Gian Battista , Bianchi Stefano , De Asmundis Carlo , Natale Andrea , Della Rocca Domenico Giovanni
Published: December 2022

Introduction

The Implantable Cardioverter Defibrillator (ICD) has been demonstrated to successfully prevent sudden cardiac death in children and young adults. A wide range of device-related complications/malfunctions have been described, which depend on the intrinsic design of the defibrillation system [Transvenous (TV-ICD) vs Subcutaneous (S-ICD)].

Objective

To compare the device-related complications and inappropriate shocks with TV-ICD vs S-ICD.

Methods

Electronic databases were queried for studies focusing on the prevention of SCD in children and young adults with TV-ICD or S-ICD. The effect size was estimated using a random-effect model as Odds Ratio (OR) and relative 95% Confidence Interval (CI). The primary endpoint was a composite of any device-related complications and inappropriate shocks.

Results

We identified a total of 5 studied including 236 patients (Group S-ICD: 76 patients; Group TV-ICD: 160 patients) with a mean follow-up time of 54.2 ± 24.9 months.

S-ICD implantation contributed to a significant reduction in the risk of the primary endpoint of any device-related complications and inappropriate shock (OR:0.18; 95% CI: 0.05 - 0.73; p=0.02)(Figure 1).

S-ICD was also associated with a significantly lower incidence of inappropriate shocks (OR:0.28; 95% CI: 0.11 - 0.74; p=0.01) and lead-related complications (OR:0.18; 95% IC: 0.05 - 0.66; p=0.01). Otherwise, a trend towards a higher risk of pocket complications (OR:5.91; 95% CI: 0.98 - 35.63; p=0.05) was recorded in patients with S-ICD.

Conclusion

Children and young adults undergoing S-ICD implantation may have a lower risk of a composite of device-related complications and inappropriate shocks, compared to TV-ICD patients.
444 PULSE WAVE VELOCITY TO GLOBAL WORK EFFICIENCY RATIO IN HYPERTENSION: A NEW WAY TO EXPLORE VENTRICULAR-ARTERIAL COUPLING
Authors: Trimarchi Giancarlo , Lofrumento Francesca , Mandraffino Giuseppe , Cusmà-piccione Maurizio , Spanò Federico , Certo Giuseppe , Manganaro Roberta , Carerj Scipione , Di Bella Gianluca , Zito Concetta
Published: December 2022

Introduction

Ventricular–arterial coupling (VAC) is considered as the cornerstone of the functional interaction between ventricles and the arterial system. VAC is commonly assessed as arterial elastance (Ea) to ventricular end-systolic elastance (Ees) ratio and it has independent prognostic value in hypertension, so it may be used to refine risk stratification and monitor therapeutic interventions in hypertensive patients. Therefore, VAC may be better characterized by the measurement of each component of this ratio through novel and more sensitive markers of myocardial function (e.g. global longitudinal strain and myocardial work parameters) and arterial function (e.g. pulse wave velocity). In this context, we aim to investigate whether new coupling indices may be able to identify left ventricular (LV) performance changes induced by blood pressure (BP) overload earlier than conventional ones.

Methods

50 young individuals were prospectively enrolled, distinguishing between newly diagnosed untreated hypertensives (n= 25; 40±8 years) and controls (n=25; 39±9 years), matched for age and gender. All patients underwent at the same time carotid-femoral pulse wave velocity (PWV) measurement through an applanation tonometer (SphygmoCor® XCEL) and a transthoracic echocardiogram to calculate Ea/Ees ratio, assessed as end-systolic volume to stroke volume ratio (ESV/SV), global longitudinal strain (GLS) and myocardial work efficiency (GWE). Two new indices of VAC were derived: PWV/GLS, previously validated and PWV/GWE, still unknown.

Results

Ea/Ees ratio was lower in hypertensives (0,48±0,17) than in controls (0,57±0,14) but without any signiﬁcant difference (p=0.18), whereas PWV/GLS was signiﬁcantly higher in hypertensives than in controls (0,45±0,19 vs 0,35 ± 0,09 m/sec%; p= 0,02). PWV/GLS ratio correlated to Ea/Ees (r= 0,52; p < 0,01), diastolic dysfunction degree (r=-0,59; p<0,001), age (r=-0,64; p<0,001), systolic BP (r=-0,41; p=0,002), diastolic BP (r=-0,39; p=0,005) and mean arterial pressure (MAP) (r=-0,40; p=0,004). PWV/GWE was higher in hypertensives than in controls (0,10± 0,02 vs 0,08±0,01 m/sec%; p=0,001) and it was associated with Ea/Ees (r=- 0,55; p = 0,006), age (r= 0,59; p<0,001), diastolic dysfunction degree (r=0,55;p< 0,001), systolic BP (r=0,8; p< 0,001), diastolic BP (r=0,5;p< 0,001) and MAP (r=0,52; p<0,001).

Conclusions

Innovative indices of ventricular-arterial coupling could be more sensitive to investigate the impact of hypertension on LV performance.
747 HIGH PLATELET REACTIVITY AFTER DAPT IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ATRIAL FIBRILLATION
Authors: Sammartino Aniello , Toso Anna , Di Mario Carlo , Bellandi Francesco
Published: December 2022

Background

The incidence of atrial fibrillation (AF) in patients who undergo percutaneous coronary intervention (PCI) is not negligible, especially in the elderly. Both oral anticoagulation (OAC) and dual anti-platelet therapy (DAPT) are recommended by main guidelines, therefore is essential to balance the prevention of ischemic events with the risk of bleeding. Evidences from literature suggest that incidence of anti-platelet therapy resistance is higher in elderly patients. There is a paucity of data about the response to antiplatelet therapy in patients with AF. The purpose of this study is to analyze platelet reactivity during DAPT (aspirin + clopidogrel) in elderly patients hospitalized for acute coronary syndrome (ACS), stratifying them by the presence or absence of AF.

Methods

We analyzed data of patients admitted to our center for ACS. All patients were ≥ 75 years old and treated with DAPT (Aspirin 100 mg daily and Clopidogrel 75 mg daily). At discharge they were tested with a point-of-care antiplatelet-function test (VerifyNow assay) to assess the platelet response to aspirin in aspirin-reaction units (ARU) and to clopidogrel in P2Y12-reaction units (PRU). Low response to aspirin was defined as ARU ≥550; low response to clopidogrel was defined as PRU ≥208; high response was defined as PRU values ≤ 85.

Results

Among the 216 patients included in the registry we selected 154 of these [median age 81 (IQR 77-87) years; 45% female] who were submitted to the platelet function tested before discharge. Patients were divided into two groups: AF (43 pts); non-AF (111 pts). The table shows the platelet reactivity values by two groups.

Conclusions

In this series of elderly patients with ACS, AF was associated with higher residual platelet reactivity with both clopidogrel and aspirin. AF patients were significantly less responsive to clopidogrel than non-AF, while among non-AF patients there were significantly more high responders. No difference was found for aspirin low responders between AF and non-AF group. This evidence could assume clinical significance in the choice of antiplatelet drugs to be combined with chronic anticoagulant therapy for AF.
857 DEVELOPMENT AND VALIDATION OF A DIAGNOSTIC ECHOCARDIOGRAPHIC MASS (DEM) SCORE IN THE COMPLEX APPROACH TO CARDIAC MASSES
Authors: Bodega Francesca , Angeli Francesco , Paolisso Pasquale , Bergamaschi Luca , Armillotta Matteo , Sansonetti Angelo , Stefanizzi Andrea , Amicone Sara , Suma Nicole , Canton Lisa , Fedele Damiano , Impellizzeri Andrea , Tattilo Francesco Pio , Rinaldi Andrea , Foa´ Alberto , Galie´ Nazzareno , Pizzi Carmine
Published: December 2022

Background

Cardiac masses (CM) are an extremely heterogeneous clinical entity, including benign and malignant neoformations. 2D Echocardiography is, nowadays, the first-line approach to define nature and management of CM.

Purpose

The purpose of our study was to identify the echocardiographic predictors of malignancy and create a multiparametric score to further increase the diagnostic yield and accurately suggest the nature of CM.

Materials and methods

249 consecutive patients undergoing a complete echocardiographic assessment for suspected cardiac mass in our center were enrolled from January 2004 to December 2020. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic regression was performed to evaluate the ability of echocardiography to discriminate benign versus malignant masses.

Results

A scoring system was developed in a derivation cohort of 178 (70%) and validated in 71 (30%) patients. A weighted score [Diagnostic Echocardiographic Mass (DEM) Score] ranging from 0 to 9 was obtained from 6 variables: infiltration, polylobate mass, moderate-severe pericardial effusion, inhomogeneity, sessile and non-left localization. The AUC for the score was 0.965 (95% CI 0.938-0.993). In a logistic regression analysis using the DEM score as a predictor, the likelihood of malignancy increased more than 4 times for a 1-unit increase of the score (OR=4.468; 95% CI 2.733-7.304). The prognostic validity of the score was confirmed by its ability to predict survival during follow-up (median time of 31 months).

Conclusions

The application of a multiparametric echocardiographic score in the approach to CM accurately predicts mass malignancy, thereby reducing the need for second-level investigations, and minimizing the diagnostic delay in such a complex clinical scenario.
200 BERBERINE ASSOCIATED TO DAPAGLIFLOZIN SYNERGISTICALLY REDUCES CARDIAC CELL APOPTOSIS DURING EXPOSURE TO TRASTUZUMAB THROUGH INDUCTION OF PAMPK AND RECUTION OF NLRP3, IL6 AND LEUKOTRIENES LEVELS
Authors: Quagliariello Vincenzo , Paccone Andrea , Saviano Claudia , Maurea Fabrizio , Buccolo Simona , Bonelli Annamaria , Conforti Gabriele , Caronna Antonietta , Maurea Nicola
Published: December 2022

Background

Trastuzumab has improved the prognosis in patients with HER2-positive breast cancer, but it can induce left ventricular dysfunction with reduced ejection fraction or HF during treatment. Dapagliflozin is a SGLT2i with cardio-renal benefits. In the DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure) trial, the sodium-glucose cotransporter 2 inhibitor dapagliflozin decreased the risk of worsening HF events and cardiovascular death in patients with HF and reduced ejection fraction. Berberine is a nutraceutical compound characterized by multiple metabolic effects in patients with/without cardiovascular diseases. Recent preclinical systematic review indicated that Berberine significantly reduces myocardial infarct size and the incidence of ventricular arrhythmia, improves cardiac function, ameliorates myocardial apoptosis.

Purpose

To investigate on the potential cardioprotective properties of Berberine associated to SGLT2i Dapagliflozin against HER-2 blocking agent-induced cardiotoxicity

Methods

Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of trastuzumab (200 nM) alone or co-incubated with Berberine (200 mM) or Dapagliflozin (50 nM) or both in combination for 48 h. After the incubation period, we performed the following tests: cell viability, apoptosis, expression of NLRP3 inflammasome, methylglyoxal and leukotrienes-B4. Expression of pAMPK was analyzed through western blot. Moreover, quantification of IL-6 was performed through ELISA method.

Results

Berberine and Dapagliflozin increased significantly the cell viability of cardiomyocytes exposed to Trastuzumab. When combined, Berberine and Dapagliflozin increased synergistically cell viability of cardiac cells (p<0.001 vs Trastuzumab). Cell apoptosis was reduced of 32.5, 41.8 and 72.7% for berberine, dapagliflozin and both combined (vs trastuzumab group). Methylglyoxal,a marker of AGEs, was strongly reduced compared to untreated cells. Western blot analysis clearly demonstrate that pAMPK was induced by berberine and Dapagliflozin, improving mitochondrial metabolism. No significant changes in Leukotriene B4 expression were seen. Intracellular levels of IL-6 were reduced of 46.3, 62.7 and 86.3% for berberine, dapagliflozin and both combined (vs trastuzumab group).

Conclusion

Berberine and Dapagliflozin exerts significant cardioprotective effects in cardiac cells exposed to the HER2-bloking agent Trastuzumab. Berberine and Dapagliflozin in combination induces an anti-inflammatory phenotype to myocardial cells through the reduction of biomarkers involved in heart failure and apoptosis.
766 NON-INVASIVE ASSESSMENT OF RIGHT VENTRICLE TO ARTERIAL COUPLING FOR PROGNOSIS STRATIFICATION OF FIBROTIC INTERSTITIAL LUNG DISEASE
Authors: Buongiorno Federica , Buonauro Agostino , Canora Angelo , Canonico Mario Enrico , Esposito Roberta , Sanduzzi Alessandro , Bocchino Marialuisa , Esposito Giovanni , Santoro Ciro
Published: December 2022

Background

The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance non-invasively estimable by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD).

Methods

Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF), (M=37; mean age 67±7 yrs) were studied with standard and speckle tracking echocardiography and compared to 30 age-matched healthy volunteers. Mean patients follow-up was of 70±4 months.

Results

Fibrotic-ILD patients had a larger right ventricle (RV) and a worst diastolic function as RV-global longitudinal strain (GLS) was significantly lower along with higher systolic pulmonary artery pressure (sPAP) estimates in comparison with controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV-GLS/sPAP were significantly reduced in f-ILDs patients (p<0.0001). Patients with a RV-GLS/sPAP below the median value had a shorter survival (61 vs. 74 months, p=0.01), this parameter being an independent predictor of worse outcome.

Conclusion

Low estimates of RV-GLS/sPAP are predictive of worse outcome in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis repercussions.
1129 IMAGING STRESS TEST OR CORONARY COMPUTED TOMOGRAPHY PRIOR TO NON-CARDIAC SURGERY? A SEVEN YEARS SINGLE CENTRE EXPERIENCE
Authors: Fazzari Fabio , Cannata Francesco , Chiarito Mauro , Gitto Mauro , Terzi Riccardo , Didedda Emanuele , Lisi Costanza , Condorelli Gianluigi , Stefanini Giulio , Chiti Arturo , Bragato Renato , Francone Marco
Published: December 2022

Introduction

Recent published ESC guidelines on non-cardiac surgery suggest the use of imaging stress test in patients with poor functional capacity and high likelihood of coronary artery disease or high clinical risk (class I, level B), while the use of coronary computed tomography has lower evidence (class IIa, level B). Witch test has the best performance in the clinical contest of pre-operative risk assessment is a matter of debate.

Aim

The aim of our single centre, retrospective study was to compare the prognostic role of the three main cardiac imaging modalities (CCT: Cardiac computed tomography, sCMR: stress cardiac magnetic resonance, SPECT MPI:single photon emission computed tomography myocardial perfusion imaging) in relation to 30 days post-surgery cardiac events (composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema, life threatening cardiac arrythmias).

Method

Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Recorded data included demographic characteristics, clinical risk factors, results from laboratory tests, results from cardiac imaging tests, pharmacological therapy, type of intervention, cardiac complication within 30 days after surgery.

Results

Eight-hundred eighty-three patients were included (287 sCMR, 382 SPECT-MPI, 214 CCT). Rate of 30-days myocardial infarction was not significantly different between different modalities (CMR 1.1%, SPECT 1.3%; CT 0.5%; CMR vs SPECT p 0.998; sCMR vs CT p 0.639; SPECT vs CT 0.427); while planned invasive coronary angiography (ICA) was more common in CT group (CT 34%, CMR 16%, SPECT 10%, p<0,001). Absence of ischemia on stress test and absence of relevant coronary artery disease on CT are associate to lower cardiac events at follow-up (0.67%).

Conclusions

The use of imaging stress test and coronary CT are both associated to low incidence of cardiac events and should be recommended in risk assessment before non-cardiac surgery, in the appropriate clinical context.
679 PROGNOSTIC IMPACT OF ECHOCARDIOGRAPHIC DERIVED PRECAPILLARY WEDGE PRESSURE AND PULMONARY VASCULAR RESISTANCES IN PATIENTS WITH HEART FAILURE
Authors: Giannoni Alberto , Gentile Francesco , Buoncristiani Francesco , Chubuchny Vlad , Sciarrone Paolo , Panichella Giorgia , Bazan Lorenzo , Gasparini Simone , Fabiani Iacopo , Taddei Claudia , Poggianti Elisa , Petersen Christina , Pasanisi Emilio , Passino Claudio , Emdin Michele
Published: December 2022

Background

A reliable echocardiographic algorithm for the estimation of precapillary wedge pressure (PCWP) and pulmonary vascular resistances (PVR) has been recently validated by our group in a large cohort of patients undergoing right heart catheterization (RHC). Those metrics may add relevant clinical and prognostic information in patients with heart failure (HF).

Objective

To assess the clinical/prognostic significance of echocardiographic derived PCWP and PVR in a large cohort of chronic HF patients on modern treatments.

Methods

Outpatients with chronic HF with either reduced (≤40%) or mildly reduced LVEF (41-49%) underwent a thorough clinical multiparametric assessment and were followed-up for a composite endpoint of cardiac death, appropriate ICD shock, or first HF hospitalization.

Results

Out of 1,483 patients prospectively enrolled (70±12 years, 73% males, 42% ischemic etiology, LVEF 35±8%, 74% HFrEF), PCWP (16.4±5.8 mmHg) was elevated (>15 mmHg) in 53% of cases, while PVR (1.7±0.7) was elevated (>2 WU) in 25% of cases. Of the latter group, most (83%) had also elevated PCWP. Patients with increased PCWP were older, had a higher heart rate and lower cardiac output, showed a higher degree of left and right chamber remodeling, had a higher neurohormonal activation, worse renal function, worse functional capacity and ventilatory efficiency on effort, particularly when also PVR were elevated (all p<0.001). The optimal prognostic cut-point was identified for both PCWP (16.2 mmHg) and PVR (2 WU) by log-rank maximal likelihood ratio. Over a median follow-up of 27 (12-43) months, both measures significantly stratified patients for the risk of the primary endpoint at Kaplan-Meier analysis (Log Rank 99.5, p<0.001 for PCWP; Log Rank 18.4, p<0.001 for PVR). While both increased PCWP and PVR were associated with a higher risk of events in the HFrEF subgroup (both p<0.001), only increased PCWP significantly stratified the outcome in HFmrEF patients (Figure). At multivariable Cox regression analysis (adjusted for age, sex, ischemic HF etiology, glomerular filtrate, LVEF, and NT-proBNP), increased PCWP (hazard ratio, HR 1.67 [95%CI 1.28-2.18], p<0.001) but not PVR (HR 1.25 [95%CI 0.98-1.60], p=0.07) remained an independent predictor of the primary outcome.

Conclusion

The estimation of PCWP and PVR by echocardiography add relevant clinical and prognostic information and may help in the decision making in patients with HF.
256 LEFT ATRIAL STRAIN ANALISIS IMPROVES NON-INVASIVE ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES IN TAKOTSUBO SYNDROME
Authors: Iannaccone Giulia , Graziani Francesca , Del Buono Marco Giuseppe , Camilli Massimiliano , Lillo Rosa , Vecchia Giulia La , Caffè Andrea , Pedicino Daniela , Sanna Tommaso , Trani Carlo , Lombardo Antonella , Lanza Gaetano Antonio , Montone Rocco A , Crea Filippo
Published: December 2022

Background

Takotsubo syndrome (TTS) is associated with a non-negligible risk of in-hospital complications. Elevated left ventricular filling pressures (LVFP) showed to predict adverse outcomes in this population. Recently, LA reservoir and LA pump strain, demonstrated a close correlation with increased LVFP in unselected patients. The aim of our study is to assess the ability of LA strain analysis to improve non-invasive estimation of LVFP and to predict IH complications in TTS patients.

Methods

We prospectively enrolled patients with confirmed TTS diagnosis. LVEDP was assessed invasively at the time of catheterization. Transthoracic echocardiography was performed within 48 hours from hospital admission. In-hospital complications were collected, including occurrence of acute heart failure, death from any cause and life-threatening arrhythmias.

Results

A total of 62 patients were analysed (72.2±10.1 years, female 80%). In-hospital complications occurred in 25 (40.3%). Patients who experienced IH complications had higher LVEDP and lower LVEF, LA reservoir strain and LA pump strain values compared to patients without IH complications (all p<0.001). However, at multivariate analysis, only LVEF and LVEDP were independent predictors of worse IH outcomes (p<0.001 and p=0.004, respectively). We observed that in our population the optimal LVEDP cut-off value to predict adverse in-hospital outcome was 24.5 mmHg (sensitivity 80%, specificity 63%). LA reservoir and pump strain resulted to be better predictors of LVEDP >24.5 mmHg in comparison with E/e’, LAVi and tricuspid regurgitation (TR) peak velocity. Moreover, the incorporation of LA strain values in a multivariable model including E/e’ ratio, LAVi and TR peak velocity to predict a LVEDP>24.5 mmHg led to a significant incremental predictive value (p=0.002).

Conclusion

In patients with TTS, lower LA reservoir and pump strain values correlate with increased LVEDP and improve non-invasive estimation of LVFP. LA strain analysis may be an easy tool to individuate subjects at higher risk of in-hospital complications.
897 PEAK RIGHT ATRIAL LONGITUDINAL STRAIN: A NEW PARAMETER IN PREDICTING VENOUS CONGESTION
Authors: Niro Lorenzo , Iseppi Manuela , Fanti Diego , Maffeis Caterina , Bergamini Corinna , Rossi Andrea , Tafciu Elvin , Benfari Giovanni , Luciano Ribichini Flavio
Published: December 2022

Background

tricuspid regurgitation (TR) of either organic or functional etiology can lead to systemic venous congestion particularly in its more severe forms. Little is known about the role of the right atrium (RA) which acts as an intermediate player between TR and systemic veins.

Purpose

to assess the influence of right atrial size and function on venous congestion in TR patients.

Methods

101 stable patients with at least mild to moderate TR were enrolled at the time of echocardiography (age 74±13 years, 37% male). Systemic congestion was assessed by inferior vena cava (IVC) diameter and right atrial pressure (RAP) estimated according to inferior vena cava diameter and collapsibility. TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RA and right ventricular (RV) function were assessed respectively by peak atrial longitudinal strain (PALS) and free wall longitudinal strain (FWLS) while indexed RA volume (RAVi) by Simpson's disk summation method.

Results

TR was quantified mild or moderate in 52 patients and more than moderate in 49 patients (mean EROA 37±31 mm2; mean RVol 34±23 ml). Mean indexed RA volume was 58±31 ml/m2; mean RA strain was 18±11% and mean RV strain (free wall) was -21 ± 7%. Mean IVC diameter was 20±6 mm; estimated RAP was ≤5 mmHg in 32 patients, 6-10 mmHg in 26, 11-15 mmHg in 26 and greater than 15 mmHg in 17 patients. In univariate analysis both IVC diameter and RAP correlated significantly with EROA, RVol, RAVi and RA strain (p<0.0001 for all); only RAP correlated with RV strain. In linear multivariate analysis only RAVi and RA strain were independent predictors of IVC diameter (p=0.01 and <0.0001, respectively), and only RVol and RA strain were independent predictors of RAP (p=0.001 and 0.002, respectively). We found a RA strain cut-off of -15% to have a sensitivity of 82% and specificity of 70% to identify a RAP greater than 15 mmHg (area under the curve-AUC 0.842).

Conclusions

RA size and function together with the TR-related volume overload were independent predictors of venous congestion. Among these variables, only RA strain predicted both parameters of venous congestion.
1082 LEFT VENTRICULAR FUNCTION ESTIMATION: WHEN VOLUMES MEASUREMENT IS NOT FEASIBLE
Authors: Pazzi Sara , Maffignoli Laura Bariselli , Bertani Gabriele , Bergamini Corinna , Pegoretti Monica , Siviero Valentina , Giorgio Daniela , Maffeis Caterina , Tafciu Elvin , Benfari Giovanni , Rossi Andrea , Luciano Ribichini Flavio
Published: December 2022

Background

Contrast echocardiography is mainly performed for the assessment of global left ventricular (LV) function, left ventricular ejection fraction (LVEF) and stroke volume (SV) thanks to improved visualization of endocardial LV borders. Neverless in some patients estimation of ventricular volumes could be difficult also with contrast and assessment of LVEF can be really hard. The aim of the study was to find alternative methods for LV function evaluation independent from volume assessment.

Methods

Patients who underwent a contrast echocardiography between October 2015 and September 2022 were enrolled in the study. A complete transthoracic echocardiography was performed and Sonovue contrast was then injected. End-diastolic and end-systolic LV volume in apex 4 and 2 chamber views, were measured prior and after injecting contrast. Left ventricular outflow tract diameter (LVOTd) was measured and LVOT velocity time integral was traced in order to calculate LVOT VTI Stroke Volume (product of LVOT cross sectional area to the LVOT VTI). LVOT VTI SV obtained during traditional echocardiography was then compared to LV SV calculated as the difference between end-diastolic and end-systolic volume traced after contrast. After intravenous bolus injection of Sonovue pulmonary transit time (PTT) was recorded as contrast agent's transit time from right to left ventricle in apex 4 chamber view (seconds). PTT was then compared to measures of LV function: LVEF with and without Sonovue and LV SV with contrast.

Results

149 patients were enrolled in the study, 86 had history of CAD, 31 presented dilatative cardiomyopathy, 5 hypertrophic cardiomyopathy (HMC), 113 had arterial hypertension, and 37 diabetes. Medium BMI was 28. The main indications for contrast echocardiography were measurement of EF and exclusion of thrombi in LV apex. LVOT VTI SV was calculated in 126 patients. In the same patients LVEF Stroke Volume was calculated. A strong correlation (P value < 0.0001) between LVOT VTI SV and LV SV was found (Figure 1). PPT was calculated in 74 patient and in the same patients LVEF with and without contrast (Figure 2) and LV SV were calculated. A strong correlation (P-value <0.048, p-value<0.006 and p-value < 0.046 respectively) was found.

Conclusion

This study demonstrates that, besides extremely poor acoustic windows, bedside echocardiography, with and without contrast, can be used to estimate LV function using volume-independent methods like PTT and LVOT VTI SV.