bluuebunny/crossref_metadata_2025_split huggingface dataset:
555 Torsade-de-pointes electrical storm late after treatment with hydroxychloroquine and azithromycin for COVID-19
Authors: Bricoli Serena , Bonura Rosario , Cacciola Giovanna , Zardini Marco 
Published: December 2021

Abstract
A 78-year-old woman was admitted to our hospital due to multiple brief episodes of transient loss of consciousness. She was recently hospitalized elsewhere for SARS-CoV-2 infection and she had been discharged two days before. During the previous hospitalization she had been treated with hydroxychloroquine 400 mg twice daily on Day 1, followed by Hydroxychloroquine 400 mg daily together with azithromycin 500 mg daily for 7 days, leading to symptomatic resolution and two consecutive negative RT-PCR tests at discharge. Her medical history included dilated cardiomyopathy and in 2017 she underwent CRT-D implantation for primary prevention; over the past 3 years, she did not experience any ICD intervention. Her home therapy included amiodarone, bisoprolol, warfarin, and trazodone. Baseline ECG obtained 6 month before admission is shown in Figure 1, Panel A. On admission, her ECG showed sinus bradycardia with biventricular pacing and significant QT prolongation (i.e. 640 ms, Figure 1 B). On day 2 of hospitalization, she reported multiple brief episodes of transient loss of consciousness. An interrogation of her device revealed 27 torsade-de-pointes episodes in a 48-hour period, treated with 11 shocks. All episodes were preceded by a variable period of bigeminal rhythm due to one or two premature ventricular beats coupled to the prolonged QT segment of the preceding basic beat in a ‘short-long-short’ sequence (Figure 2). The patient experienced a torsade-de-pointes TdP during COVID-19 disease. She had multiple concomitant factors for QT prolongation (TISDALE SCORE 13): mainly, female sex, cardiac disease, inflammation, electrolyte imbalances and multiple QT-prolonging drugs. Amiodarone and bisoprolol were subsequently stopped and potassium and magnesium were supplemented, with rapid resolution of torsade-de-pointes. No more episodes of TdP were detected after two weeks of hospitalization. The remote monitoring assessment of her device did not show any further episodes during subsequent follow-up. To our best knowledge, this is the first ICD-documented report of a TdP electrical storm in a COVID-19 patient, treated with HCQ/AZT, who had multiple concomitant factors for QT prolongation. 555 Figure 1
399 CMR prevalence of subclinical myocardial damage in non-hospitalized COVID-19 patients: are we looking for a needle in a haystack?
Authors: Del Monaco Guido , Bombace Sara , Stankowski Kamil , Lisi Costanza , Mastinu Sara , Monti Lorenzo , Francone Marco 
Published: December 2021

Abstract

Aims
Subclinical myocardial damage is not uncommon in COVID-19 patients, likely reflecting a combination of direct viral toxicity with the activation of an uncontrolled autoimmune response usually developing during the cytokine storm phase. Whilst myocardial involvement in hospitalized patients has been extensively described in literature, no data are currently available for non-hospitalized individuals. Present study aimed to explore prevalence and impact on patients’ management of myocardial damage detected with CMR, in a cohort of consecutive non-hospitalized SARS-CoV-2 infection patients.

Methods and results
We conducted a single centre prospective observational study on 31 consecutive patients with previous COVID-19 who underwent CMR between October 2020 and June 2021 without requiring hospital admission. Myocarditis was defined by CMR according to the revised Lake Louise Criteria (LLC), if at least one criterion was positive: T2-based marker for myocardial oedema and T1-based marker for associated myocardial injury. Our patients’ cohort included 31 individuals with a mean age of 42.5 ± 17.4 years (20 males; 64.5%) with mean follow-up time of 365.8 ± 89 days between first positive PCR and last clinical evaluation. CMR evidence of cardiac involvement was observed in six patients (19.3%)—including two acute (of which one with pericardial inflammation), one subacute and three healed myocarditis. CMR abnormalities were associated with a higher percentage of palpitations (83% vs. 24%, P = 0.013) and chest pain (66% vs. 16%, P = 0.026) during the active phase of COVID-19. In all CMR positive cases, a tailored therapeutic approach was established consisting with the administration of cardioactive therapy with beta-blockers. All cases were uneventful during the follow-up period.

Conclusions
Our data showed a 19.3% prevalence of unexpected/subclinical myocardial involvement in a cohort of 31 consecutive non-hospitalized patients with previous SARS-CoV-2 infection. CMR findings were retrospectively associated with cardiac symptoms during the acute phase and yielded a change in clinical and therapeutic management in all positive cases. A better knowledge of symptomatic course of COVID-19 could help physicians to adequately select individuals in which CMR may show signs of cardiac damage.
148 ECG abnormalities in COVID-19 pneumonia: acute pericarditis, silent cad, or both? A case report
Authors: Franco Erica , Visconti Massimiliano , Taglialatela Vittorio , Panella Silvana , Rovera Chiara , Conti Valentina , Iancu Dana Miruna , Raineri Michele , Corgnati Giuditta , Marangoni Ludovica , Picardi Elisa , Solaro Cristina , Moretti Claudio 
Published: December 2021

Abstract
Aims We report the case of a hypertensive 70 year-old man, who presented to the Emergency Department (ED) with fever, dry cough, malaise, dyspnoea. A nasopharyngeal swab for SARS-CoV-2 test was done, being positive.
Methods and results Chest TC demonstrated ground glass bilateral pneumonia. Laboratory test showed WBC 10680/mmc, CRP 20 mg/l, TnT 0.03 ng/l, NTproBNP 147 ng/l. The liver and kidney function were within normal values. ECG was normal. He was treated with high flow oxygen (cPAP), enoxaparin, dexamethasone, doxycycline. After an initial improvement, dyspnoea got worse in 8th day, with the evidence of a new rise of inflammatory markers (PCR 95 mg/l, IL6 49 pg/ml) and the clinical new onset of cardiac rubbings on medical examination. The ECG revealed a sinus rhythm with T wave inversion everywhere. TnT remained normal. Echocardiography revealed a normal ventricular function, without segmentary alterations, absence of valvular disease. A mild pericardial effusion was evidenced, without signs of tamponade. We treated the patient with tocilizumab, after exclusion of other active infective foci. The clinical response was good, the patient was progressively weaned by oxygen and he was discharged asymptomatic. After 15 days, for ECG alterations persistence, despite no signs of ACS, a Coronary TC was done and a subcritical multivessel coronary artery disease was demonstrated: a subcritical IVA stenosis and a calcific MO.
Conclusions In conclusion we report a successful treatment of COVID pneumonia likely complicated by acute pericarditis, and we observe that in these patients hypoxemia and cytochine storm possibly bring out silent vascular diseases, otherwise neglected.
659 Myocardial infarction and ischaemic stroke in a COVID-19 patient: nothing happens by chance
Authors: Ianniciello Antonio , Attena Emilio , Uccello Ambra , Caso Valentina Maria , Golino Paolo , Russo Vincenzo 
Published: December 2021

Abstract
A 68-years-old man, affected by arterial hypertension in treatment with angiotensin-receptor blocker (cardesartan 32 mg), was admitted to emergency department for fever and dyspnoea. The molecular swab for SARS-CoV-2 was positive. Chest CT showed bilateral interstitial pneumonia with Chung severity score index 15/20. The laboratory examinations showed: PCR 21 mg/dl, IL-6 17 pg/ml, d-dimer 374 ng/ml, lymphopenia, glycaemia 218 mg/dl, total cholesterol 245 mg/dl. At COVID-19 diagnosis he started the following therapy: Azithromycin 500 mg once a day, Methylprednisolone 20 mg twice a day, Remdesivir 200 mg once a day, Enoxaparin 6000 UI twice a day, Insulin Lispro 6/8/8 UI three times a day, High FlowNasal Cannula (FiO2 45%). No lipid-lowering therapy was prescribed. During the hospitalization, the patient experienced a progressive improvement in clinical and laboratory parameters. On the 28th day, there was a sudden worsening of dyspnoea with evidence of ST-elevation in DI, aVL, V2–V6 leads. A primary percutaneous coronary intervention at COVID-19 HUB hospital (2.9 km away) was required. Because of massive demand for emergency vehicles, the patient was admitted to the Chat Lab 3 h and 23 min later. Due to evidence of critical stenosis of the proximal and intermediate left anterior descending artery, a PTCA with stenting was performed. 12 h later, the patient developed left hemiplegia (NIHSS score: 7). The brain CT revealed an acute right frontal ischaemic lesion; no indication to fibrinolysis was given by the consultant neurologist. Our case report describes the rare concomitance of two thrombotic events in a COVID-19 patient with many cardiovascular risk factors, offering the opportunity to underline the need of their appropriate treatment during the hospitalization for SARS-CoV-2 infection. Moreover, a dedicated treatment pathways should be provided for COVID-19 patients in order to ensure the timely and correct application of the protocols suggested by the international guidelines. 659 Figure 1ECG performed at the onset of acute dyspnoea.659 Figure 2Critical stenosis on LAD and subcritical stenosis on first and second obtuse marginal arteries.
429 Incidence and management of adverse events among COVID-19 vaccination receipts with Brugada syndrome. Results from a multicentre-prospective European registry
Authors: Cetera Rosa , Santoro Francesco , Gianfrancesco Domenico , D’Arienzo Girolamo , Bartolomucci Francesco , Pellegrino Pierluigi , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
Patients with Brugada syndrome have an increased risk of life-threatening arrhythmias when experience fever. Therefore, a prompt treatment of non-steroidal anti-inflammatory drugs (NSAI) is suggested in these patients. COVID-19 vaccination can be associated with fever in about 20% of patients. The aim of the study is to evaluate the incidence and management of adverse events within 48 h from COVID-19 vaccination among Brugada patients.

Methods and results
Eighty patients were enrolled from a prospective registry involving four European hospitals with a dedicated inherited disease ambulatory. Cardiological follow-up was performed within one month from vaccination. Mean age was 47 ± 17 years, 80% (num = 63) were male. Prevalence of Brugada types 1, 2, and 3 was as follows: 25% type 1, 39% type 2, and 24% type 3. Twenty-six percent of patients had an implantable cardioverter defibrillator (ICD). Within in 48 h from vaccination, 35% (num = 28) of patients experienced joint paint, 19% (num = 15) fever and 4% (num = 3) chest pain. In 8 out of 15 fever episodes body temperature was ≥38 degrees and treated with NSAI drugs. No patients had syncope or fatigue episodes and no arrhythmic episodes were recorded in patients with ICD.
Conclusions About 20% of patients experienced fever after Covid-19 vaccination but no patient experienced life-threatening arrhythmias. Careful evaluation of body temperature and administration of NSAI in case of temperature higher than 38 is suggested.
764 Prevalence and clinical implications of cardiac involvement in individuals with paucisymptomatic SARS-CoV-2 infection
Authors: Trancuccio Alessandro , Mazzanti Andrea , Kukavica Deni , Arnò Carlo , Sturla Matteo , Marino Maira , Bloise Raffaela , Napolitano Carlo , Monti Lorenzo , Priori Silvia G. 
Published: December 2021

Abstract

Aims
Myocardial involvement has been reported in SARS-CoV-2 infection, especially in hospitalized patients during the acute phase of the disease. However, the exact prevalence and the clinical implications of cardiac involvement in young individuals with paucisymptomatic SARS-CoV-2 infection are debated.

Methods and results
We gathered data on 100 young patients with previous paucisymptomatic SARS-CoV-2 infection, not undergoing hospitalization and without previous diagnosis of structural heart disease, who underwent cardiological evaluation in our clinic at IRCCS ICS Maugeri (Pavia, Italy). Results were validated in an external cohort of 28 patients who underwent cardiac magnetic resonance (MRI) at Humanitas Research Hospital (Rozzano, Italy). The study population included 100 patients with previous paucisymptomatic SARS-CoV-2 infection: 60 (60%) males; median age 36 years (IQR: 22–50 years); median time after SARS-CoV-2 infection 181 days (IQR: 76–218 days). At the cardiological evaluation, 31/100 (31%) of patients referred cardiological symptoms, including dyspnoea, palpitations, chest pain or syncope. Overall, 26/100 (26%) patients showed on or more of the following instrumental alterations at first level assessment: 4/100 (4%) increase of TnI; 7/100 (7%) electrocardiographic abnormalities, 12/100 (12%) ventricular arrhythmias, and 11/100 (11%) echocardiographic abnormalities. Of 32 patients who underwent cardiac MRI, myocardial involvement was detected in 6/32 (19%) patients (Figure 1), similarly to what was observed in the validation cohort [54% males; median age 47 years (IQR: 26–55 years); myocardial involvement at MRI 4/28, 14%]. Furthermore, the proportion of patients with myocardial involvement was significantly higher in patients with first-level cardiac alterations (6/18, 28%) as compared with patients without cardiac alterations at first-level examination (0/14, 0%, P = 0.024). When analysing possible predictors for the occurrence of cardiac involvement at the MRI, documentation of ventricular arrhythmias at Holter ECG or exercise test was associated with an 87-fold higher probability of cardiac involvement at the MRI (OR: 87.3; 95% CI: 4.0–1914.3; P &lt; 0.001).

Conclusions
Around 15–20% of patients with paucisymptomatic SARS-CoV-2 infection exhibit cardiac involvement documented at the cardiac MRI after a mean of 6 months from the onset of the disease. The presence of instrumental alterations detected with first level diagnostic tests, and in particular the documentation of ventricular arrhythmias at the 24 h-Holter ECG or at the exercise stress test, is a powerful predictor of myocardial involvement.
220 Electrocardiographic findings and mortality in COVID-19 patients hospitalized in different clinical settings
Authors: Mele Marco , Tricarico Lucia , Vitale Enrica , Favia Andrea , Croella Francesca , Alfieri Simona , Corbo Maria Delia , Mango Federica , Casavecchia Grazia , Brunetti Natale Daniele 
Published: December 2021

Abstract

Aims
12-lead electrocardiogram (ECG) still represents the first line approach for cardiovascular assessment even in patients with COVID-19. We therefore sought to describe and compare ECG findings in three different hospital settings: intensive care unit (ICU) (invasive ventilatory support), respiratory care unit (RCU) (non-invasive ventilatory support) and Covid-19 dedicated internal medicine unit (IMU) (oxygen supplement with or without high flow).

Methods and results
We retrospectively analysed the 12-lead ECGs of 1124 consecutive patients hospitalized for respiratory distress and COVID-19 in a single III level hospital. Age, gender, main clinical data and in-hospital survival were recorded. 548 patients were hospitalized in IMU, 361 in RCU, 215 in ICU. Arrhythmias in general were less frequently found in RCU (16% vs. 26%, P &lt; 0.001). Deaths occurred more frequently in ICU patients (43% vs. 20–21%, P &lt; 0.001). After pooling predictors of mortality (age, intensity of care setting, heart rate, ST-elevation, QTc prolongation, Q-waves, right bundle branch block, and atrial fibrillation), the risk of in-hospital death can be estimated by using a derived score. Three zones of mortality risk can be thus identified: &lt;5%, score &lt;5 points; 5–50% score 5–10, and &gt;50%, score &gt;10 points. The accuracy of the score assessed at ROC curve analysis was 0.791.

Conclusions
ECG differences at admission con be found in COVID-19 patients according to different clinical settings and intensity of care. A simplified score derived from few clinical and ECG variables may predict in-hospital mortality with a good accuracy.
112 Safety and biochemical efficacy of sodium–glucose cotransporter 2 inhibitors based on cardiovascular risk profile and volume status in a real-world diabetic population
Authors: Gitto Mauro , Kotinas Alexios , Terzi Riccardo , Oliva Angelo , Zagoreo Jorgele , Reimers Bernhard , Stefanini Giulio G , Mirani Marco , Favacchio Giuseppe , Condorelli Gianluigi , Panico Cristina 
Published: December 2021

Abstract

Aims
Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have become a first-line cardiovascular medication. However, their potential side effects still limit a widespread use in real-world clinical practice. Further, there is uncertainty about the mechanisms mediating SGLT2i-associated cardiovascular benefit.

Methods
We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral centre. Patients who completed at least 1 year of treatment were included in the data analysis. Changes in glycated haemoglobin, weight and haematocrit were evaluated and compared across two cardiovascular risk categories, defined through the inclusion criteria of three large randomized clinical trials. Additionally, a modified clinical score (mH2FPEF) was applied to detect the probability of heart failure with preserved ejection fraction (HFpEF).

Results
Of the 459 patients screened from 2015 to 2020, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%) and 55 were lost to follow-up (12.0%). The most common causes of drug discontinuation were genital or urinary tract infections (9.4%) and poor glycaemic control (5%). At 1 year, a significant reduction in glycated haemoglobin concentration (−0.6 ± 1.4%, P &lt; 0.001) and body weight (2.4 ± 4.6 Kg, P &lt; 0.001) was observed and was comparable between patients at high vs. low cardiovascular risk. Haematocrit increase at 1 year (2.3 ± 3.3%, P &lt; 0.001) was more marked in patients with high cardiovascular risk and low baseline haematocrit. Among patients with no established heart failure (N = 295), 156 (52.9%) had &gt;50% probability of HFpEF (mH2FPEF ≥3).

Conclusions
In a real-world population of diabetic patients, SGLT2i were well-tolerated at 1 year and led to improved glycaemic control and weight loss. Haematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating the potentially beneficial role of euvolemic restoration. More than half of these diabetic patients had a high likelihood of unrecognized HFpEF.
683 Cor in memoria posterorum: role of familial screening in sudden death syndrome
Authors: Chiti Chiara , Parisi Vanda , Graziosi Maddalena , Biagini Elena 
Published: December 2021

Abstract
A 14-year-old boy suddenly died during a school lesson. His familial history was negative for sudden cardiac death and no comorbidities were reported. As part of Emilia Romagna regional network for sudden cardiac death, the heart was examined at our Cardiovascular Pathology Unit. The molecular autopsy revealed extensive lymphocytic macrophage left ventricle myocarditis (infero-lateral and anterior wall) in various evolutive stages. Genetic testing with next-generation sequencing was performed on DNA isolated from explanted heart samples (178 candidate genes for channelopathies and cardiomyopathies were analysed) and it showed a frameshift pathological mutation in the filamine C gene (FLNC c.8034delC p. Cys2679fsTer6) which induces protein premature termination. In order to screen family members, we evaluated the father, 53-year-old, asymptomatic and with an unremarkable cardiology history. The ECG showed sinus rhythm, HR 60 b.p.m., normal atrioventricular conduction, QRS fragmentation and negative T waves in the inferior leads. The echocardiogram revealed left ventricle mild dilation (79 mL/m2) with global hypokinesia (EF 45%), while right ventricle was normal for size and kinetics. A cardiac MRI confirmed left ventricular dilation and hypokinesia with diffuse LGE with circumferential mesocardial distribution mainly in the middle-baseline site, which reflected structural damage (fibrosis). The 24-h Holter ECG did not record arrhythmias. The genetic test was then performed and the same FLNC frameshift mutation was identified. We thus suspected familial arrhythmogenic cardiomyopathy involving left ventricle with pathological filamine C mutation and an ICD was recommended. Other family members had no pathological findings. Filamine C mutations are associated with many type of cardiomyopathy. A possible association between some mutated variants and certain subtypes of cardiomyopathy has been highlighted. In particular, the frameshift variant is associated with an increased arrhythmic risk, particularly when dilated forms are considered. Recent studies have identified a correlation with arrhythmogenic cardiomyopathy, although the role of these mutated variants has not yet been fully defined. This clinical case underlines the importance of multidisciplinary approach in cases of sudden cardiac death, consisting of autopsy, genetic and clinical evaluation, in order to identify any forms of familial cardiomyopathy and activate a systematic screening in family members with important prognostic and therapeutic implications. Data about our regional structural network for sudden cardiac death will also be shown.
14 Telomerase and myocardin co-expressing mesenchymal cells increase survival and induce cardiac and vascular markers in cardiac stromal cells undergoing simulated ischemia/reperfusion
Authors: Madonna Rosalinda , Guarnieri Simone , Kovacshazi Csenger , Gorbe Aniko , Giricz Zoltan , Geng Yong-Jian , Mariggiò Maria Addolorata , Ferdinandy Peter , De Caterina Raffaele 
Published: December 2021

Abstract

Aims
Cardiac stromal cells (CSCs) contain a pool of cells with supportive and paracrine functions. Various types of mesenchymal stromal cells (MSCs) can influence CSCs in the cardiac niche through their paracrine activity. Ischemia/reperfusion (I/R) leads to cell death and reduction of the paracrine activity of CSCs. The forced coexpression of telomerase reverse transcriptase (TERT) and myocardin (MYOCD), known to potentiate anti-apoptotic, pro-survival and pro-angiogenic activities of MSCs isolated from the adipose tissue (AT-MSCs), may increase CSC survival, favouring their paracrine activities. To investigate the hypothesis that CSCs feature improved resistance to simulated I/R (SI/R) and increased commitment toward the cardiovascular lineage when preconditioned with conditioned media (CM) or extracellular vesicles (EV) released from AT-MSCs overexpressing TERT and MYOCD (T/M AT-MSCs).

Methods
Murine CSCs were isolated with the cardiosphere (CSps) isolation technique.

Results
T/M AT-MSCs and their secretome improved spontaneous intracellular calcium changes and ryanodine receptor expression in aged CSps. The cytoprotective effect of AT-MSCs was tested in CSCs subjected to SI/R. SI/R induced cell death as compared to normoxia (28 ± 4 vs. 10 ± 3%, P = 0.02). Pre-treatment with CM (15 ± 2, P = 0.02) or with the EV-enriched fraction (10 ± 1%, P = 0.02) obtained from mock-transduced AT-MSCs in normoxia reduced cell death after SI/R. The effect was more pronounced with CM (7 ± 1%, P = 0.01) or the EV-enriched fraction (2 ± 1%, P = 0.01) obtained from T/M AT-MSCs subjected to SI/R. In parallel, we observed lower expression of the apoptosis marker cleaved caspase-3 and higher expression of cardiac and vascular markers eNOS, sarcomeric α-actinin and cardiac actin.

Conclusions
The T/M AT-MSCs secretome exerts a cytoprotective effect and promotes development of CSCs undergoing SI/R towards a cardiovascular phenotype.