bluuebunny/crossref_metadata_2025 huggingface dataset:
435 Renal denervation in a patient with uncontrolled arterial hypertension secondary to polycystic kidney disease
Authors: Widmann Maddalena , Fezzi Simone , Castaldi Gianluca , Tavella Domenico , Pighi Michele , Ribichini Flavio Luciano
Published: December 2021

Aims

Autosomal dominant polycystic kidney disease (ADPKD) represents the most common inherited cause of chronic kidney disease. Typical manifestations of this condition include secondary hypertension, abdominal pain, haematuria and urinary tract infections. Despite the progressive increase in the use of antihypertensive therapy in patients with ADPKD in the last decades, reaching blood pressure target is often difficult in this setting due to the complex physiopathology of arterial hypertension in ADPKD. Catheter-based renal sympathetic denervation (RDN) represents nowadays a therapeutic strategy to approach resistant hypertension. Based on consistent results of several sham-controlled clinical trials, the evidence of safety and efficacy of this procedure is increasing, also in patients with multiple comorbidities including chronic kidney disease. Patients with ADPKD often develop chronic severe kidney-related pain, caused by distension of the renal capsule due to the expansion of the cysts. RDN was proposed to be an effective therapeutic option able to relieve loin pain.

Methods

A 49-year-old man affected by ADPKD was referred to our centre for resistant uncontrolled arterial hypertension, despite combined therapy with five antihypertensive drugs. He also complained about intense loin pain and 3 years earlier underwent two surgical interventions to remove voluminous renal cysts, that did not relieve chronic pain. His kidney function was moderately decreased at presentation, with progressive decline in the previous years. After a multi-disciplinary discussion with a nephrologist and algologist, the patient was proposed for RDN with the aim of lowering blood pressure and reducing pain. He was treated in July 2018, and after the procedure, was observed a better control of blood pressure but no benefits on pain. Because of the persistence of intractable loin pain, the patient was submitted to a second RDN in December 2018. Also, after this procedure, blood pressure declined remarkably, decreasing his need for antihypertensive medications without a significant worsening of kidney function. Unfortunately, no benefit on chronic pain was observed.

Results

ADPKD is characterized by the progressive bilateral development of focal renal cysts. Cardiovascular complications, mainly related to hypertension, are a major cause of morbidity and mortality for these patients. RDN could be a valid and safe therapeutic option for the treatment of secondary hypertension in this setting.
10 Pharmacodynamic profiles of aspirin versus dual-pathway inhibition with either aspirin or clopidogrel among patients with stable atherosclerotic disease
Authors: Galli Mattia , Franchi Francesco , Rollini Fabiana , Been Latonya , Jaoude Patrick , Rivas Andrea , Zhou Xuan , Jia Sida , Maaliki Naji , Lee Chang , Pineda Andres , Suryadevara Siva , Soffer Daniel , Zenni Martin , Jennings Lisa , Bass Theodore , Angiolillo Dominick J
Published: December 2021

Aims

Inhibition of thrombin-mediated signalling processes using a vascular dose of rivaroxaban in adjunct to single antiplatelet therapy, known as dual-pathway inhibition (DPI), reduces atherothrombotic events in patients with stable atherosclerotic disease. However, there is limited data on the pharmacodynamic (PD) effects of this strategy.

Methods

This investigation was conducted in selected cohorts of patients (n = 40) with stable atherosclerotic disease enrolled from a larger prospective, open-label, parallel-group PD study who were treated with either aspirin, aspirin plus rivaroxaban 2.5 mg/bid or clopidogrel plus rivaroxaban 2.5 mg/bid. Multiple PD assays providing a comprehensive assessment of markers of thrombosis were used. The primary endpoint was the comparison between groups of platelet-mediated global thrombogenicity by light transmittance aggregometry (LTA) following stimuli with collagen-related peptide + adenosine diphosphate + tissue factor (CATF).

Results

There were no differences in the primary endpoint between aspirin vs. aspirin plus rivaroxaban 2.5 mg/bid (P = 0.110), aspirin vs. clopidogrel plus rivaroxaban 2.5 mg/bid (P = 0.611) or aspirin plus rivaroxaban 2.5 mg/bid vs. clopidogrel plus rivaroxaban 2.5 mg/bid (P = 0.315). Rivaroxaban-based treatments significantly reduced markers of thrombin generation (peak thrombin and thrombin velocity index). Clopidogrel-based treatments reduced markers of P2Y12 signalling (LTA ADP 20 max and VerifyNow). Aspirin-based treatments reduced markers of markers of cyclooxygenase-1 activity (LTA collagen).

Conclusions

Compared with aspirin alone, DPI with either aspirin or clopidogrel might provide superior ischaemic protection by targeting pathways alternative to those affected by antiplatelet agents with only a moderate trade-off in bleeding as supported by similar platelet-mediated global thrombogenicity between treatments.
167 Right ventricular involvement in breast cancer patients undergoing chemotherapy
Authors: Ferri Luisa , Bergamini Corinna , Springhetti Paolo , Niro Lorenzo , Cerrito Luca Felice , Schiavone Arianna , Porto Marta Dal , Setti Elisa , Benfari Giovanni , Rossi Andrea , Fiorio Elena , Ribichini Flavio Luciano
Published: December 2021

Aims

Trastuzumab (TZ) and Anthracyclines (AC) are widely used for their key role in breast cancer. However, they may have different side effects on the cardiovascular system. One of the most concerning complications is myocardial dysfunction. Many studies have highlighted the importance of the screening for cardiotoxicity using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Nevertheless, there is little data about the right ventricular (RV) involvement. Aim of this study is to analyse the modification of RV systolic function in this setting.

Methods

One hundred and five women affected by HER-2 positive breast cancer treated with TZ referring to our echo-lab were enrolled in our single centre prospective study. Three patients were excluded due to an early TZ suspension not related to cardiovascular complications, thus 102 patients (97.1%) were eligible for analyses. Eighty-six of these (84.3%) were treated also with AC. All patients underwent consecutive transthoracic echocardiography (TTE) before starting TZ and then every 3 months up to 12 months. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software. A complete clinical evaluation was also performed at each Follow-up. LV systolic dysfunction was defined as an absolute reduction of LVEF >10% from baseline to LVEF < 53% or a relative reduction of GLS >15% from baseline and an absolute reduction of LVEF >10% from baseline. RV systolic dysfunction was defined as TAPSE <17 mm, pulsed doppler S wave <9.5 cm/s and/or RV free wall strain <20%.

Results

LV systolic dysfunction occurred in 11 patients (10.8%). TAPSE and pulsed doppler S wave remained within the normal limits in all patients at Follow-up. On the contrary, RV free wall strain was reduced in 11 patients (10.8%), none of whom reported symptoms or signs of right-sided heart failure; 5 of these (45.5%) also presented LV dysfunction. LV and RV systolic dysfunction occurred mainly at the same time.

Conclusions

Cancer treatment also appears to impact on right chamber myocardium. RV free wall strain analysis seems more reliable in detecting RV systolic dysfunction rather than clinical examination or common echocardiographic parameters, such as TAPSE or pulsed doppler S wave, in the setting of patients with breast cancer treated with chemotherapy. However, further studies are needed to investigate its prognostic role.
7 DOACs: a new skyline in cancer-associated thrombosis resistant to heparin. A clinical case of seminoma in BEP chemotherapy protocol solved with edoxaban
Authors: Fioretti Agnese Maria , Leopizzi Tiziana , Sarcinella Gianvito , Giotta Francesco , Lorusso Vito , Oliva Stefano
Published: December 2021

Aims

TEV is a common cancer complication with 20% incidence. LMWH is the standard therapy for efficacy, safety and ease of use. However, some scenarios are deeply challenging for intercurrent prothrombotic anticancer drugs.

Methods

A 35-year-old man reported dysphagia, EGDS: oesophagus ulcers, thyroid echography: thoracic mass compressing proximal borders. Vascular ultrasound: thrombosis of left internal giugular, subclavian, axillary and brachial veins; he began enoxaparin 6000 IU ×2/die (65 kg). CT-scan: solid anterior–superior mediastinum vascularized mass (16 × 13 cm) incorporating great thoracic vessels with 20 cm cranio-caudal longitudinal extension with trachea dislocation. PET-CT: massive superior-anterior mediastinum pathological 18F-FDG accumulation suggestive for malignancy. Lung perfusion scan: absence of left lung perfusion. Angio-CT: showed compression of pulmonary artery trunk and of branches. He presented marked asthenia, sweating and presyncope. D-dimer: 6026 µg/L, NT-proBNP: 1417 pg/mL. Mediastinum biopsy exhibited seminoma (ki67+: 65%), he started BEP Protocol (etoposide, cisplatin, bleomycin). TTE: periaortic cuff from mediastinum mass which ab extrinseco compressed pulmonary artery trunk and branches with occlusion of left one, right chambers dilatation, sovra-epatic veins and inferior vena cava (21 mm) ectasia, decreased inspiratory collapse, pulmonary hypertension (SPAP: 52 mmHg), EF: 55%. After 2 months of enoxaparin, vein ultrasound: persistent DVT and positive CUS. So, we replaced enoxaparin with edoxaban 60 mg/die. After 2 months of edoxaban, overall regression of vein thrombosis with minimal residual thrombosis of left internal giugular vein; D-dimer: 1554 µg/L.

Results

After 2 months of BEP Protocol, CT-scan: decrease mediastinum mass (6 × 12 cm) dimensions.

Conclusions

Cancer associated thrombosis is a frequent complication, worsening mortality, morbidity and decision-making. Cancer stage and drugs favour development of severe thrombosis, not solvable with LMWH, the cornerstone of anticoagulant therapy in cancer-related thrombosis. DOACs appear as a new and successful therapeutical option, especially in the most challenging cases of highly thrombotic profile after ‘heparin failure’.
785 Sodium–glucose cotransporter 2 inhibitors in real-life patients at high cardiovascular risk
Authors: Cesaro Arturo , Fimiani Fabio , Gragnano Felice , Moscarella Elisabetta , Signore Giovanni , Maratea Anna Chiara , Rotolo Francesco Paolo , Vergara Andrea , Schiavo Alessandra , Calabrò Paolo
Published: December 2021

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), were recently approved in the USA and the EU for the treatment of adults with symptomatic heart failure with reduced ejection fraction (HFrEF). These drugs currently play a prominent role in the treatment algorithm for HFrEF [ejection fraction ≤40%], and international guidelines considered they as first-line drugs. However, data on the use of SGLT2i in real-world practice lack. We aim at providing data on SGLT2i in high cardiovascular risk patients in the real-world setting.

We have retrospectively evaluated high cardiovascular risk patients treated with SGLT2i according to Italian national regulation, and collected 1-year outcomes. The primary objective of the study is to generate real-world data about clinical characteristics, major adverse cardiovascular events (MACE), hospitalizations for heart failure, and adverse event in patients receiving canagliflozin, empagliflozin, dapagliflozin, ertugliflozin from our cohort. Ninety-three patients with diabetes treated with SGLT2i were retrospectively enrolled. At 1-year follow-up, the rate of hospitalization was 10.7%, the MACE events occurred in 6.4% of patients; of these, 4.3% had a myocardial infarction, and 2.1% had a stroke/TIA, the rate of urinary tract infections was 5.3% while no major adverse event occurred.

In conclusion, in a real-world study including patients with high and very high cardiovascular risk, SGLT2i showed to be safe, with no major adverse events occurring at follow-up.
21 Direct oral anticoagulants vs. vitamin K antagonists in the treatment of left ventricular thrombosis: a systematic review and meta-analysis
Authors: Condello Francesco , Maurina Matteo , Chiarito Mauro , Sturla Matteo , Terzi Riccardo , Fazzari Fabio , Sanz-Sanchez Jorge , Cannata Francesco , Condorelli Gianluigi , Stefanini Giulio
Published: December 2021

Aims

Evidence about the use of direct oral anticoagulants (DOACs) in patients with left ventricular thrombosis (LVT) are emerging. The aim of our study was to provide a comprehensive synthesis of the available evidence concerning the clinical effects of DOACs vs. vitamin K antagonists (VKAs) in LVT treatment.

Methods

Systematic search of studies evaluating DOACs vs. VKAs use in patients with LVT was performed on 11 May 2021. Data were pooled by meta-analysis using a random-effects model. Odds ratios (OR) with relative 95% confidence intervals (CI) were used as measures of effect estimates. The primary efficacy and safety endpoint were ischaemic stroke and any bleeding, respectively. Secondary endpoints were LVT resolution, systemic embolism, major bleeding, haemorrhagic stroke, and all cause death.

Results

Twenty studies were included in the meta-analysis: 1391 patients were treated with DOACs and 1534 with VKAs. A significant reduction in the risk of ischaemic stroke [OR 0.67, 95% CI 0.45–0.98, P = 0.048, number needed to treat to benefit (NNTB) 22 (95% CI 15–43)] and any bleeding [OR 0.64, 95% CI 0.46–0.89, P = 0.009, NNTB 26 (95% CI 16–80)] was observed with DOACs compared to VKAs. No statistically significant difference was observed among the two treatment arms for the secondary endpoints.

Conclusion

Compared to VKAs, DOACs are associated with a reduced risk of ischaemic stroke and bleeding. In light of these findings, and the practical advantages of DOACs, additional large scale randomized controlled trials are needed to confirm the benefits of DOACs in patients with LVT.
398 Right ventricular cardiogenic shock induced by propafenone intoxication: a case report
Authors: Maurina Matteo , Bertoldi Letizia , Briani Martina , Chiarito Mauro , Reimers Bernhard , Corrada Elena
Published: December 2021

Aims

Propafenone is a Class 1C antiarrhythmic drug recommended in the treatment of supraventricular or ventricular tachycardia and paroxysmal atrial fibrillation (AF). Most common cardiological features associated with propafenone intoxication include heart failure and conduction disturbances while other clinical findings range from nausea and vomiting to seizures and coma.

Methods

We report a case of atypical presentation of propafenone intoxication occurred in 88-year-old woman who presented at Emergency Department with severe ECG abnormalities and prevalent acute right ventricular with massive tricuspidalic regurgitation and cardiogenic shock. The patient underwent urgent coronary angiography that revealed a stable 90% coronary plaque that was treated with a single stent and then brought to Intensive Care Unit where she was successfully treated with inotropic and mechanical circulatory support (intra-aortic balloon pump, IABP).

Results

The patient progressively achieved hemodynamic stability with complete ECG normalization and biventricular function recovery.

Conclusions

Our case further expands the vast spectrum of presentations of Class 1c antiarrhythmic drugs overdose. In an emergency setting it is difficult to rule out other causes of cardiogenic shock but propafenone toxicity needs to be suspected in every case of hemodynamic instability in patients in chronical treatment. Patients in chronical treatment with propafenone who have kidney or liver dysfunction might be at higher risk of drug accumulation: in such cases, the real utility of propafenone must be evaluated before therapy initiation.
136 Blood vortices analysis in children with Wolff–Parkinson–White syndrome
Authors: Borrelli Nunzia , Di Salvo Giovanni , Ciriello Giovanni Domenico , Grimaldi Nicola , Barracano Rosaria , Fusco Flavia , Merola Assunta , Correra Anna , Colonna Diego , Romeo Emanuele , Palma Michela , Scognamiglio Giancarlo , Russo Maria Giovanna , Sarubbi Berardo
Published: December 2021

Aims

Wolff–Parkinson–White syndrome (WPW) is a clinical condition characterized by pre-excitation on electrocardiogram (ECG) and symptoms of arrhythmias. It has been described that premature ventricular activation induces septal wall motion abnormalities and ventricular dyssynchrony, causing detrimental effects on cardiac performance. The new speckle-tracking-based technique, blood speckle imaging (BSI), has been previously used to evaluate blood flow characteristics in normal and dysfunctional hearts in patients with normal atrio-ventricular (AV) conduction. We aimed to study the features of left ventricle blood vortices in patients with WPW and short AV conduction by using BSI.

Methods and results

Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest WPW (WPW group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A complete echocardiographic evaluation with 2D, color Doppler, and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristics were analysed during the filling phase of the left ventricle. We focused on the anterior vortex generated by the mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. For each child in the WPW group, Arruda criteria were used to esteem accessory pathway localization from a 12-lead surface ECG. All patients in the WPW group manifested the accessory pathway in the septal region. All patients in the CTR group presented one major anterior vortex along the septal wall during the filling phase (Figure A), while in the WPW group, 10 patients out of 13 (P = 0.009) lacked this main anterior vortex, showing instead fragmented vortices (Figure B). Interestingly, the main differences in blood vortices pattern were showed in the last part of filling phase, when blood flow could be affected by premature activation of the septal wall. There were no differences in terms of left ventricle function (WPWg 59.8 ± 4.02% vs. CTRg 59.0 ± 2.5%, P = 0.6) and global longitudinal strain (WPWg −18.6 ± 1.0% vs. CTRg −19.6 ± 3.1%, P = 0.5) between the two groups. 136 Figure A and B 

Conclusions

In our preliminary study, patients with WPW showed a fragmented pattern of diastolic blood vortices that adapted to septal dyssynchrony. We speculate this fragmentation may contribute to impair the performance of the left ventricle.
276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work
Authors: Ciriello Giovanni Domenico , Borrelli Nunzia , Di Salvo Giovanni , Sabatino Jolanda , Bucciarelli Valentina , Avesani Martina , Grimaldi Nicola , Barracano Rosaria , Fusco Flavia , Merola Assunta , Correra Anna , Romeo Emanuele , Colonna Diego , Palma Michela , Scognamiglio Giancarlo , Russo Maria Giovanna , Sarubbi Berardo
Published: December 2021

Aims

Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome.

Methods and results

Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls.

Conclusions

WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.
535 Right ventricular dysfunction is independent predictor of in-hospital mortality in patients with low flow low gradient aortic stenosis
Authors: Peluso Angela Pamela , Ferruzzi Germano Junior , Attisano Tiziana , Migliarino Serena , Vigorito Francesco , Bellino Michele , Iuliano Giuseppe , Silverio Angelo , Cristiano Mario , Provenza Gennaro , Baldi Cesare , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Citro Rodolfo
Published: December 2021

Aims

Aim of the study is to assess the prevalence and in-hospital death in patients with low flow low gradient aortic stenosis (LFLG-AS) and right ventricular dysfunction (RVD) hospitalized for heart failure in a single referral centre.

Methods and results

Complete demographic, clinical characteristics, and imaging data were collected. Patients with LFLG AS hospitalized for heart failure were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient < 40 mmHg, and stroke volume index <36 ml/m2. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) < 16 mm at baseline in apical four chamber view according to current guidelines. Patients were divided into two subgroups according to the presence or absence of RVD. In hospitals all cause death has been considered as the primary outcome. A total of 130 patients [78 ± 10 yy; 67 (51%) male] with new diagnosis of LF-LG AS were included in the study. The most frequent comorbidities were hypertension (88.5%; n = 114), dyslipidaemia (74%; n = 96), and diabetes (38%; n = 49). Concomitant coronary artery disease and history of stroke were reported in 19% (n = 24) and 9% (n = 11), respectively. Society of thoracic surgeons score in overall population was 12.6 ± 4.5. Regarding echocardiographic evaluation, the mean transaortic gradient was 25.81 ± 7.42 mmHg and the mean iAVA was 0.42 ± 0.10 cm/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. LFLG AS with a preserved LV EF was detected in 69 patients (53%) and the LFLG AS with a low LV EF was detected in 61 patients (47%). 26 patients (20%) underwent surgical valve replacement, 14 patients (11%) had aortic percutaneous valvuloplasty and 31 patients (24%) underwent TAVI. The remaining patients (45%, n = 59) were maintained under optimized medical therapy. In-hospital death occurred in 16 patients. When compared patients with RVD with those without a higher prevalence of atrial fibrillation/flutter (n = 21, 36%; P = 0.042) and in hospital death was observed (n = 8; 28%; n = 8, 8%; P = 0.026). In the overall population at multivariate regression analysis only RVD was a significant independent predictor of all-cause in-hospital death (P = 0.028; OR: 3.44; CI: 1.146–10.334).

Conclusions

RVD can be detected in more than one quarter of patient with new diagnosis of LFLG AS and is an independent predictor of all-cause in-hospital death. Quantification of right ventricular systolic function in these complex population give important information in identifying patients and higher risk requiring more aggressive therapy.
395 Diagnostic role of native T1 mapping compared to conventional magnetic resonance techniques in cardiac diseases: a real-life study
Authors: Licordari Roberto , Grigoratos Chrysanthos , Todiere Giancarlo , Barison Andrea , Di Bella Gianluca , Aquaro Giovanni Donato
Published: December 2021

Aims

T1 mapping is a validated technique in cardiac magnetic resonance (CMR), however in real-life clinical practice its effectiveness to diagnose myocardial disease is still unclear. To compare native T1 mapping to conventional late gadolinium enhancement (LGE) and T2-STIR techniques for the evaluation of a cohort of consecutive patients undergoing CMR for the suspicion of myocardial disease.

Methods and results

CMR was performed in 323 patients, 206 males (64%), mean age 54 ± 8 years, and in 27 age- and sex-matched healthy controls. LGE, T2-STIR, and pre- and post-contrast T1 mapping were acquired as suggested by the SCMR position paper. The CMR findings of global and regional T1 mapping were compared to the respective results of LGE and T2-STIR techniques. The main baseline indications for CMR were: suspicion of ARVC in 20%; non-ischaemic DCM in 19%; HCM in 16%; chest pain without obstructive coronary artery in 14% of patients (suspicion of MINOCA, Tako-tsubo or myocarditis); other indications (amyloidosis, scleroderma, previous myocardial infarction, pericarditis, LV non-compaction) in the remaining of cases. At T2-STIR images myocardial hyperintensity suggesting oedema was found in 41 patients (27%). LGE images were positive in 206 patients (64%). Native T1 mapping was abnormal in 171 (49%). In 206 patients (64%) a matching between LGE and native T1 was found (both positive in 132 and negative in 74). T1 was also abnormal in 32 out of 41 (78%) with oedema at T2-STIR. Overall, LGE and/or T2-STIR were abnormal in 209 patients, whereas native T1 in 154(52%). Conventional techniques and T1 mapping were concordant in 208 patients (64%). Conventional techniques were abnormal in 76 (24%) of patients with negative T1 mapping. Finally, in 39 patients T1 mapping was positive despite negative conventional techniques (12%). Among these latter 39 patients, only in 18 T2-STIR were acquired based on clinical decision. Then, the percentage of cases where T1 mapping could have an additive role would range between 6% and 12%. T1 mapping was particularly able in conditions with diffuse myocardial damage as cardiac amyloidosis, scleroderma and fabry disease (additive role in 42%). On contrast, T1 mapping was less effective in cardiac disease with regional distribution of myocardial damage as myocardial infarction, HCM, myocarditis (additive role in 1%).

Conclusions

T1 mapping may give additive information in 6–12% of patient but is less effective cardiac disease presenting with regional or segmental distribution of myocardial damage. Results of the present study suggest that conventional LGE/T2-STIR and T1 mapping are complementary techniques and should be used together in every CMR examination.
672 Isolated pulmonic valve endocarditis. AN unusual case with giant vegetations detected by transthoracic echocardiography
Authors: Parato Vito Maurizio , Di Geso Luca , Parato Andrea Giovanni , Pelliccioni Simona
Published: December 2021

Aims

Isolated pulmonic valve infective endocarditis (PV-IE) is a rare form of endocarditis.

Methods and results

The authors report a case of giant vegetations detected by transthoracic echocardiography on pulmonic valve in a 33 year-old patient, with drug abuse history (Figure 1). Patient underwent surgical intervention by pulmonary valved bioconduit implantation. After operation a pulmonary embolism episode was treated by a direct oral anticoagulant. The final outcome was favourable. We report a short review of this rare pathology.

Conclusions

The difficulty in diagnosing PV-IE is due to inability to properly visualize the pulmonic valve by echocardiography. In this case, with such large vegetations, transthoracic echocardiography (TTE) allowed a correct diagnosis and an effective surgical planning, confirming its importance as diagnostic tool.
746 Assessment of intracardiac fluid-dynamics of patients with aortic stenosis
Authors: Sabatino Jolanda , Leo Isabella , Strangio Antonio , La Bella Sabrina , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Canino Giovanni , Spaccarotella Carmen , Di Salvo Giovanni , De Rosa Salvatore , Indolfi Ciro
Published: December 2021

Aims

Recent technological developments enabled visualization of intracardiac flow patterns. This study aims to evaluate intracardiac flow dynamics of patients with aortic stenosis (AS).

Methods and results

Sixty-one patients with severe AS and 38 healthy sex- and BSA-matched controls (CTRL) were prospectively included. Standard echocardiographic assessment was performed in all patients. Fluid dynamics were evaluated using the HyperDoppler software to measure vortex area (VA), vortex length (VL), and vortex depth (VD). The assessment of VA, VL, and VD was feasible and reliable, as the inter-rater variability (ICCs) were very good for VA (0.878, P = 0.033), VL (0.960, P = 0.004), and VD (0.905, P = 0.021). Mean VA, VL, and VD (P = 0.033, P = 0.026, and P > 0.001, respectively) were significantly larger in AS patients compared with CTRL. A significant difference in the delta values of VA and VL, reflecting their change from before to after TAVI, was observed in patients with and without significant paravalvular leak.

Conclusions

The newly developed quantitative indices of flow dynamics, namely VA, VL, and VD, were significantly increased in the LV of patients with severe AS compared to controls and their measurement was feasible and reliable in a clinical setting.
324 Unilateral pulmonary artery agenesis with controlateral embolism: a double vascular trouble
Authors: Pierri Alessandro , De Luca Antonio , Restivo Luca , Bologna Alessandro , Poletti Angela , Belgrano Manuel Gianvalerio , Sinagra Gianfranco
Published: December 2021

Methods and results

A 60-year-old male patient underwent coronary angiography (CA) for a non-ST segment elevation myocardial infarction (NSTEMI). CA revealed significant multivessel disease. Both internal mammary arteries (AMI) were patent, with right IMA markedly larger than the left IMA. The exam revealed also an abnormal branch arising from the proximal right coronary artery extending backwards, likely to the right lung. Pre-operative chest radiograph demonstrated asymmetry of the two hemithoraces with slight elevation of the right hemidiaphragm, small ipsilateral lung, and mediastinal shift towards the right. The patient underwent urgent CABG surgery. Myocardial revascularization was successfully performed using both AMI and one saphenous vein segment. The postoperative course was complicated by respiratory failure requiring prolonged mechanical ventilation. A chest computed tomography angiography was performed, revealing complete absence of the right pulmonary artery and a left lower lobe segmental pulmonary embolism. Furthermore, blood in the hypoplastic right lung was supplied by multiple collaterals arising from RCA and right IMA. Intravenous heparin was started with clinical improvement. Two weeks later, a lung scintigraphy was performed, ruling out perfusion defects. The patient was discharged home on oral anticoagulation with warfarin.

Conclusions

Unilateral pulmonary artery agenesis (UPAA) is an uncommon congenital anomaly of the great vessels. Despite the absence of the pulmonary artery, blood supply of ipsilateral lung is provided by systemic collaterals originating from bronchial, intercostal, internal mammary, and sub-diaphragmatic arteries. More rarely, these collaterals may arise from the coronary arteries with different implications, ranging from asymptomatic condition to myocardial ischaemia and infarction. In our case, the condition was previously asymptomatic. The occurrence of pulmonary embolism contributed to worsen the ventilation–perfusion mismatch, explaining the respiratory failure during the postoperative period.
770 Small heart and single coronary artery in a young patient with chronic fatigue syndrome: a case report
Authors: Poleggi Cristina , Perfetti Silvia , Restelli Davide , Perna Alessia , Donato Rocco , Di Bella Gianluca
Published: December 2021

Aims

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by fatigue and unexplained aspecifical symptoms. Patients with CFS/ME frequently have reduced stroke volume with an inverse relation between cardiac output and post-exertional malaise severity. We describe a rare case of a young man affected by CFS/ME, small heart, and anomalous anatomy of left main coronary artery (LMCA).

Methods and results

A 19-year-old Caucasian male referred to our clinic complaining weakness, lack of concentration, and sleepiness. He suffered by CFS/ME, D hypovitaminosis, inflammatory bowel disease, and exocrine pancreas insufficiency. Blood tests revealed no pathological findings. Faecal exams documented intestinal dysbiosis and low pancreatic elastase. He was treated with oxygen-ozone rectal insufflations and probiotics. Physical examination was unremarkable. Electrocardiogram showed normal sinus rhythm. Echocardiogram revealed reduced diameters of the left ventricle (LV), normal aortic root dimensions and, in a five-chamber apical view, a binary structure that seemed to cross the aorta perpendicularly. Cardiac magnetic resonance (CMR) found reduced LV stroke volume (34 ml/m2) and end-diastolic volume (57 ml/m2) together with reduced end-diastolic wall mass (51 g/m2). Right ventricle volumes were reduced too. In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro-aortic course. Mechanism of CFS/ME remains unknown, although various factors have been implicated, including immune activation, chronic viral infection, and emotional disorders. A considerable number of patients affected by CFS has an anatomically small heart. Small heart syndrome, in fact, may contribute to the onset of CFS/ME. Previous studies hypothesized that clinical manifestations of CMS/ME were caused by reduced venous return, cardiac output, and heart mass, together with decreased arterial oxygen saturation. Single coronary artery is an uncommon congenital anatomic abnormality identified by a single coronary ostium giving rise to all arteries supplying the heart. Thus, we reported a rare case of a very young man affected by chronic fatigue syndrome and small heart, investigated not only with echocardiogram but also with CMR, not often used in this clinical setting. More, we found an anomalous origin of LMCA. From literature, it’s not reported any cases of a patient including these three rare conditions (CFS/ME, small heart, and single coronary artery).

Conclusions

This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association between cardiac congenital anomalies and CFS/ME.

770 Figure
422 Atrioventricular blocks in children: clinical aspects and special features in a cohort of Italian patients
Authors: Ridolfi Lorenzo , Bronzetti Gabriele , Donti Andrea , Lanari Marcello , Gargiulo Gaetano Domenico
Published: December 2021

Aims

The natural history of atrioventricular blocks (AVBs) in children is not completely clarified, with particular regard for isolated, acquired, and non-immune disorders. Moreover, there is still concern on when—and not on if—a pacemaker (PM) implantation is indicated. In this retrospective study, we investigated diagnostic and therapeutic approach to AVBs in children and we described complications occurred in PM recipients.

Methods and results

We analysed 73 patients with a diagnosis of AVB who were submitted to a regular follow-up between 2015 and 2020 at the Paediatric Cardiology and Cardiac Surgery Unit of an Italian referral centre. Forty-four patients (60%) were diagnosed with a complete AVB and after a mean follow-up of 8.2 ± 6.8 years, 35 patients (79.5%) had received a permanent PM. AVB was asymptomatic in 52 children (71.2%) and a congenital heart disease was present in 13 cases (17.8%). Anti-SSA/B autoantibodies were detected in eight patients (11%) with complete block and their prognostic role was substantially redefined. The mean interval between diagnosis and implantation and the complication rate in PM recipients were similar to data available on literature, regardless of the age at diagnosis.

Conclusions

From a diagnostic point of view, we identified several differences between partial and complete AVBs. As regards the timing of pacing therapy, the moment of implantation should be accurately chosen but should not depend only on the age at diagnosis or the presence of maternal autoantibodies, since the incidence of device-related complications was independent from those features.
720 Angiography-derived index of microvascular resistance (IMR-angio) in Takotsubo syndrome
Authors: Castaldi Gianluca , Fezzi Simone , Widmann Maddalena , Mammone Concetta , Rizzetto Francesca , Lia Micaela , Prati Daniele , Pighi Michele , Pesarini Gabriele , Tavella Domenico , Scarsini Roberto , Ribichini Flavio
Published: December 2021

Aims

Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an ‘adrenergic storm’ upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify coronary microvascular disfunction in patients with TTS using the recently developed angiography-derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation.

Methods and results

41 consecutive TTS patients were retrospectively analysed. Three different formulas for compute non-hyperemic IMRangio (NH-IMRangio) derived by 3D-Quantitative Coronary Angiography (3D-QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was deﬁned as an IMRangio ≥25. Moreover, correlation between NH-IMRangio and clinical presentation and a comparation between the three formulas were provided. Median age was 76 years, 85.7% were women and mean LVEF at first echocardiogram was 41.2%. All patients presented CMD with NH-IMRangio ≥25 in at least one territory. Mean NH-IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either Oxford-NH-IMRangio (52.7 ± 18.6 vs. 35.3 ± 13.6 vs. 41.4 ± 15.1, P-value < 0.001), Madrid-NH-IMRangio (47.2 ± 17.3 vs. 31.8 ± 12.2 vs. 37.3 ± 13.7, P-value <0.001) or Ferrara-NH-IMRangio (52.7 ± 19 vs. 36.1 ± 14.1 vs. 41.8 ± 16.1, P-value < 0.001). Furthermore, the mean values of NH-IMRangio were not significantly different using the different equations (OXFvsMAD P-value = 0.1930; OXFvsFER P-value = 0.9609; MADvsFER P-value = 0.2144). NH-IMRangio in LAD territory was significantly higher in pts presenting with LVEF impairment (≤40%) than pts with preserved ventricular global function (mean NH-IMRangio LAD 59.3 ± 18.1 vs. 46.3 ± 16, P-value = 0.030). NH-IMRangio assessed in LAD territory showed a trend towards linear association with LVEF (Figure 1). 720 Figure

Conclusions

CMD, assessed with NH-IMRangio, is a common finding in TTS and it is associated with LVEF dysfunction and LVEF recovery. The validated formulas for NH-IMRangio computation have a superimposable diagnostic performance and accuracy.
397 Long-term follow-up after balloon expandable covered stents implantation for management of TAVI-related vascular access complications
Authors: Maurina Matteo , Regazzoli Damiano , Condello Francesco , Mangieri Antonio , Stefanini Giulio Giuseppe , Bongiovanni Dario , Leone Pier Pasquale , Baggio Sara , Gasparini Gabriele , Pagnotta Paolo , Colombo Antonio , Reimers Bernhard
Published: December 2021

Aims

Despite increasing experience and device innovation with transcatheter aortic valve implantation (TAVI), vascular complications are still a major problem and endovascular management is generally the first option. When stent implantation is required, self expandable (SE) stents are generally preferred over balloon expandable (BE) stents as they are more elastic and less compressible. However, BE stents support higher radial outward force, adhere to the vase lumen with greater precision and are less expensive. As no large registry reported data about stents BE alone in this setting, we report our experience with BE stents implantation to manage a vascular complication after TAVI. We believe that our work could be useful and possibly serves as a starting point for future research.

Methods and results

We retrospectively collected baseline, procedural and follow-up data about 78 patients who were implanted with a BE stent to manage a vascular complication after TAVI. At a median clinical follow-up of 410 days (IQR: 66–1016 days), no percutaneous or surgical interventions were reported after discharge. No cases of symptomatic leg-ischaemia were reported and only one patient was symptomatic for claudication. Doppler follow-up (available for 25 patients; 32%) showed no cases of stent fracture or displacement.

Conclusions

Our experience showed good acute and long-term results of BE covered stent implantation to manage a vascular complication after TAVI. It is possible that a greater radial outward force is a good choice in terms of hemostasis without necessarily being associated with stent deformation/fracture resulting in restenosis or further interventions. While present data may not be generalized, they may be useful to critically re-evaluate (and eventually reduce) the need of SE stents when treating femoral arteries bleedings.
442 Thrombocytopenia following transcatheter aortic valve implantation in portico and Evolute recipients
Authors: Totaro Antonio , Sacra Cosimo , Missiroli Bindo , Massetti Massimo , Testa Gianluca
Published: December 2021

Aims

Thrombocytopenia (TP) following transcatheter aortic valve implantation (TAVI) is a common phenomenon and is associated with mortality and complications. The underlying mechanisms are still unclear. Few data exist on differential risk of thrombocytopenia between different types of transcatheter valves.

Methods and results

This retrospective study aimed to evaluate the different behaviour of platelet count in Portico or Evolut recipients. Patients underwent TAVI between Feb 2017 to Aug 2021 at Gemelli Molise Hospital were enrolled and were divided in two groups: Portico (n = 90) and Evolut recipients (n = 64). Blood samples and platelets count were collected at admission (T1), implantation day (T2), second post TAVI day (T3), third post TAVI day (T4) and at discharge (T5). Drop platelets count (DPC) was calculated in this way: 100% × (baseline platelet count–nadir platelet count)/(baseline platelet count). CT and echo data were collected. The overall analysis consisted of a total of 154 patients who underwent TAVI. Among these patients, 90 patients (58%) were implanted with Portico valve, and 64 patients (42%) with an Evolut valve. We observed no differences among baseline characteristic between two groups. Interestingly, patients implanted with Portico valve, showed a high degree of thrombocytopenia at time T3, T4 and T5 (respectively, 122 ± 42 vs. 143 ± 43, P 0.004; 111 ± 39 vs. 137 ± 43, P 0.000; 136 ± 56 vs. 173 ± 69, P 0.001). DPC was greater in Portico valve (44 ± 16 vs. 31 ± 15, P = 0.000). No differences were found among inflammation variables (neutrophil lymphocyte ratio, CRP), implantation depth, degree of calcification evaluated with CT (FACTS score) and PVL. Balloon post dilatation (BPD) was performed in 33% of Portico recipients vs. 18% of Evolut recipients (P 0.044). No correlations were found between DPC and BPD in Portico patients (r = 0.035, P = 0.744) and Evolut recipients (r = 0.074, P = 0.569).

Conclusions

Our study suggests a more thrombocytopenia in Portico recipients, irrespective inflammation, valve calcification, perivalvular leak, implantation factors. Larger studies are needed to confirm these data.
637 Real-world experience with the new watchman FLX device: data from two high volume sicilian centres. The FLX-iest registry
Authors: Vizzari Giampiero , Mazzone Paolo , Sardone Andrea , Laterra Giulia , Frazzetto Marco , Sacchetta Giorgio , Micari Antonio , Tamburino Corrado , Contarini Marco , Carmelo Grasso
Published: December 2021

Aims

Left Atrial Appendage closure (LAAC) represents a standard therapy for patients with Atrial Fibrillation and contraindication to oral anticoagulation (OAC). The ‘Watchman FLX’ presented innovative features: higher conformability to LAA shapes, reduced length of the device, closed ‘atraumatic’ distal end with ‘flex-ball’ shape during deployment, flattened covered external surface. We report the early ‘real-world’ experience with the innovative Watchman-FLX device, in two centres at high-procedural volume with consolidated LAAC experience.

Methods and results

From May 2019 to January 2021, we enrolled 200 consecutive patients treated with Watchman FLX in a non-randomized double-centre registry. We collected procedural data and followed up the patients for mid-term clinical outcomes. Mean age was 77 ± 7.18 years (67.5% male). Patients presented hypertension in 93% of cases, CKD in 57.5% (mean creatinine level 2 ± 1.1), Diabetes mellitus in 41.5%, Coronary artery disease and Heart failure in 55%. 29% had previous stroke and 56.5 bleeding events. Mean CHA2DS2-VASc was 5 ± 1.40 and HAS-BLED 4 ± 1.01. LAAC indication was: 39.5% of cases symptomatic Haemorrhage, 39% need for Triple antithrombotic therapy, 32% gastro-intestinal bleeding; 18% of patients presented OAC intolerance. TEE guidance was feasible in 186 cases (93%), of which 96 (48%) in general anesthesia and 90 (45%) in conscious sedation (MID-DEX) protocol. 14 ICE cases (7%) were performed in local anesthesia. FLX device repositioning after first attempt was required in 40 cases (20%) without any complication. Device size change, after first choice was needed in eight cases (4%). In one exceptional case simultaneous implant of two Watchman FLX devices was performed in a bi-lobed LAA. Peri-device leak was found in two cases (1%), one solved by changing FLX size (31 to 35 mm). Final procedural success was 99.5%; one unsuccessful case due to LAA reverse chicken-wing with very short depth; no device embolization. Six complications were related to access-site (3%), two cases of combined LAAC-Mitraclip procedure; two major bleedings occurred and one in-hospital death due to hemorrhagic shock (HAS-BLED = 6). At mean follow-up of 272 ± 172.76 days, only 2% of (non-device-related) stroke and 0.6% fatal bleeding resulted.

Conclusions

Our registry in a high-risk population treated with the innovative Watchman FLX device, showed high technical procedural success with easy implant and repositioning, no embolization, good LAA sealing and low rate of ischaemic/bleeding complications. 637 Figure