bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENTRECTINIB–INDUCED ACUTE RIGHT HEART FAILURE IN A PATIENT WITH METASTATIC LUNG ADENOCARCINOMA
Authors: Saaidi S , Bertolini R , Piroli F , Manca F , Cioni E , Tarantini L , Navazio A 
Published: May 2024

Abstract
We report a case report of a 45–year–old woman with a recent diagnosis of stage IV lung adenocarcinoma (PDL1 60%) with brain metastases, who started entrectinib 600 mg orally once daily. Four days after entrectinib initiation, the patient activated the emergency medical services for acute onset of marked fatigue and hypotension. The ECG performed by the emergency unit showed a marked ST–segment elevation in the infero–lateral leads. Therefore, emergent coronary angiography was performed and no evidence of coronary disease was reported. Subsequently, the patient was admitted to the Coronary Care Unit. Clinical evaluation revealed labile hemodynamics, as the patient presented mental confusion, persistent hypotension (BP 90/50 mmHg) and bradycardia (HR 30 bpm). Laboratory testing showed elevated NT–pro BNP, troponin I and transaminases, normal CRP. The electrocardiogram showed persistent diffuse ST–segment elevation. Transthoracic echocardiogram showed severe dilatation and hypokinesia of the right ventricular (GLS VDx –4.5%), with diastolic “D–shape”, normal left ventricular ejection fraction, no significant valvular disease, circumferential pericardial effusion. Clinical, laboratory and instrumental findings suggested a condition of acute right heart failure. We performed urgent computed tomography pulmonary angiography (CTPA) which resulted negative for acute pulmonary embolism. Hence, supportive therapy with dobutamine, norepinephrine and fluid resuscitation was started, with subsequent hemodynamic stabilization. Since no other etiology was demonstrated by the extensive testing, we attributed the acute right ventricular dysfunction to the recent introduction of entrectinib therapy. Therefore, the drug was discontinued. During the hospitalization we observed a rapid normalization of electrocardiogram and right ventricle function by transthoracic echocardiogram, accompanied by a progressive improvement of laboratory parameters. In order to better define right ventricle function and dimension, the patient underwent cardiac magnetic resonance imaging which showed a normal right ventricle ejection fraction (RV EF 52%), the absence of myocardial edema or late gadolinium enhancement and normal volume of the right ventricle. After six days of hospitalization the patient was discharged. Our case report adds to the limited available literature of cardiac toxicity of entrectinib.
CARDIOVASCULAR TOXICITY IN METASTATIC PROSTATE CANCER TREATMENT: BALANCING RISKS, TREATING CONSEQUENCES
Authors: Livrieri A , Massari F , Scicchitano P , De Feo D , Pinto M , Abruzzese S , Tangorra M , Trotta F , Cannito A , Caldarola P , Potenza A 
Published: May 2024

Abstract

Introduction
Enzalutamide inhibits the receptor of androgen hormones. It is administered for treating metastasized prostate cancer. Enzalutamide is known to have a cardiotoxic effect.

Case Report
A 76 year–old man on–treatment for hypertension and overall good health underwent radical prostatectomy and bilateral ileo–obturator lymphadenectomy in 2021 for prostate cancer. In July 2023, infiltrated lymph node and lung/bone metastases were identified. Therefore, oncologist started Enzalutamide administration, i.e. Androgen Deprivation Therapy. Ecocardiography before therapy showed no alterations in cardiac morphology with normal left ventricle ejection fraction (LVEF). Three months after Enzalutamide administration, he experienced worsening dyspnea and peripheral lower extremity edema. He was admitted to the emergency Department of our hospital due to worsening dyspnea at rest, diffuse crackles and increased values in brain natriuretic peptide (BNP, 3203 pg/mL) and troponins. He was transferred to Intensive Care Unit for acute heart failure. Instrumental findings: 2D ECHOCARDIOGRAPHY: LVEF ∼20%, marked global hypocontractility at strain evaluation (GLS –9.3%); LUNG ULTRASOUND: abundant bilateral basal pleural effusion on the right extending to the middle field with atelectasis of the contiguous parenchyma; 24h Holter ECG: frequent supraventricular and ventricular ectopic arrhythmias. He begins non–invasive ventilation (NIV), high–dose diuretics, and Levosimendan. We observed amelioration in symptoms, reduction in pleural effusion, peripheral edema, and BNP levels (from 3203 pg/ml to 468.6 pg/ml). We proceed with weaning from NIV by monitoring respiratory function and performance by means of blood gas analysis. Amelioration in congestion status was evaluated by bioimpedance. After clinical stabilization, coronary angiography was performed which highlighted a bi–vessel obstructive coronary artery disease (long critical stenosis, ∼80%, on the proximal–middle section of the left anterior descending artery, ∼70% at middle section of circumflex and proximal section of first margianl). Therefore, revascularization by PCI plus DES was performed on proximal–middle LAD and on CX–MO1. Patient was discharged soon after in stable condition and underwent outpatient follow–up.

Conclusions
Enzalutamide might provoke important cardiotoxic effects. It might induce acute cardiac impairment and/or coronary artery diseases. Further analysis and evaluations should be performed.
SEPTAL COLLATERAL PERFORATION COMPLICATED BY INTRAVENTRICULAR SEPTAL HEMATOMA: RESOLUTION BY COIL EMBOLIZATION
Authors: Minghini A 
Published: May 2024

Abstract
A 76–year–old man with effort angina was admitted to our cardiology department for an elective coronary angiography (CA). Diagnostic CA revealed severely calcified three–vessel coronary artery disease (CAD) with chronic total occlusions (CTO) of the right dominant coronary artery (RCA) and left circumflex artery (LCX), and severe calcific stenosis of the left descending artery (LAD). An urgent percutaneous coronary intervention (PCI) to treat the LAD was carried out because of ECG modifications and chest pain immediately after CA. During the procedure a septal collateral perforation occurred leading to abrupt development of a large intraventricular septal hematoma (IVSH). Urgent embolization of the culprit vessel with coils was performed using block and deliver (BAD) technique. Rapid hematoma expansion involved another proximal septal collateral. A prompt second coil embolization was carried out arresting the growth of the septal hematoma. The patient was discharged in stable condition and complete resolution of IVSH was confirmed by transthoracic echocardiogram two months later. Timely management of the septal perforation and close echocardiographic monitoring resulted in complete hematoma resolution and a satisfactory outcome.
A CASE OF ARRHYTHMIC MITRAL VALVE PROLAPSE
Authors: Rocchi F , Lorenzini B , Sciarra L 
Published: May 2024

Abstract
Mitral valve prolapse (MVP) is a common valvular abnormality and the natural history of MVP is generally benign. However, MVP has been associated with an increased risk for arrhythmic sudden cardiac death (SCD). Moreover, ventricular and supraventricular arrhythmias are common in patients with MVP. Therefore, risk stratification for SCD is particularly challenging in patients diagnosed with MVP. There are several marker that may be associated with heightened risk of SCD including family history of SCD, T–wave inversion in the inferior leads on the 12–lead ECG, ventricular arrhythmias on ambulatory ECG, echocardiographic measures such as several mitral regurgitation, leaflet redundancy, mitral anular disjunction (MAD), left ventricular systolic dysfunction as well as myocardial fibrosis in the left ventricular inferolateral basal region and papillary muscles detected by magnetic resonance imaging. It is important to identify patients at high arrhythmic risk to implement appropriate primary prevention strategy of SCD. We report the asymptomatic patient with MVP and higher risk of SCD.A 48 years–old man was asymptomatic and with no relevant personal and family history. He finded frequent ventricular ectopic beats, with LBBB and DBBB morphology and superior axis at exercise stress test during screening for competitive sport eligibility. The previous transthoracic echocardiogram showed the mitral valve with a myxomatous appearance and prolapse of both leaflets, as well as MAD and preserved biventricular systolic function.The electrocardiogram (ECG) showed sinus rhythm with non–specific ventricular repolarization alterations. Coronary computed tomography angiography excluded coronary disease. The 24–hour Holter ECG revealed very frequent premature ventricular contractions (PVCs), 17% of all beats, polymorphic with LBBB or DBBB morphology and superior axis, in bigeminy and trigeminy, with frequent doublets and triplets. The patient was referred for cardiac magnetic resonance imaging (CMRI), which revealed basal inferior–lateral fibrosis by late gadolinium enhancement, mitral valve prolapse and mitral anular disjunction, with a distance of 15 mm.The patient is diagnosed MPV at high arrhythmic risk. Was initiated medical therapy with beta–blockers, frequent monitoring and abstention from intense–moderate physical activity.
IF YOU WANT TO GO FAST, GO ALONE. IF YOU WANT TO GO FAR, ABLATE AF: A CASE REPORT
Authors: Piscione M , Dajana P , Crispino E , Frau L , Halasz G , Ussi G , Grigioni F , Gabrielli D 
Published: May 2024

Abstract

We report a case of a 70–years–old woman who was admitted at the Emergency Department of our hospital with chest discomfort, palpitations and dyspnoea at rest. Her cardiovascular risk factors were: arterial systemic hypertension and atrial fibrillation. She had been diagnosed with Fabry disease about twenty years before and she had undergone bilateral septal myectomy to alleviate left ventricular outflow tract obstruction. She had been previously implanted with a pacemaker and her last left ventricular ejection fraction was of 50%. The patient had associated symptoms and signs, including monolateral mild hearing loss, neuropathic pain in treatment with corticosteroids and verticillate cornea. At the entrance in CICU, the EKG showed: atrial fibrillation at 160 bpm, left ventricular hypertrophy by t voltage criteria with secondary repolarization abnormalities. PA=90/45 mmHg, SpO2=85% in room air. The transthoracic echocardiogram demonstrated a reduced left ventricular ejection fraction (EF=35%) with increased filling pressure. A chest tomography showed multiple heterogeneous parenchymal consolidations, suggestive of active bronchopneumonic foci, which were treated with antibiotics. A transesophageal echocardiogram demonstrated Windsock–like appearance of the auricle, with the detection of stratified thrombus and microcalcification. The rhythm was unsuccessfully controlled with Esmolole c.i., Verapamil c.i. and Metoprolole with bolus injection and intravenous administration. It was started Noradrenaline and Furosemide infusion. Because of low pressure values and high inflammatory markers, low dose of Dobutamine was initiated but the patient developed ventricular fibrillation which was successfully shocked. After that, she was urgently transferred in Intensive Care Unit. After three days, she returned to CICU with Landiolol c.i.. and inotropes. She was gradually weaned off inotropes and the inflammatory markers got improved but the heart rate was not under control. After the test with Adenosine, it was decided to ablate the atrioventricular node with relief of signs and symptoms.

Conclusions
Fabry disease is a X–linked recessive lysosomal storage disorder. In our case, it is demonstrated that the increase in the heart rate allows to maintain the cardiac output so it is considered a measure of compensation of hypotension and septic vasodilation. However, once the pneumonia is resolved, it is possible to ablate and pace since medical therapy is not effective.
AN ISOLATED ACUTE RIGHT VENTRICULAR INFARCTION
Authors: Cortese F , Costantino M , Clemente M , Stolfi L , Di Marino S , Luzi G 
Published: May 2024

Abstract
Isolated right ventricular infarction occurs only in about 3% of the overall myocardial ischemic episodes. Clinical presentation is often insidious and variable case by case. The correct diagnosis is therefore crucial for a proper management, and a good prognosis in the short and long term. A 72–year–old patient suffering from arterial hypertension went to the emergency room of our hospital for malaise and asthenia for about 12 hours that have increased in 3–4 hours before the arrival. He was sweating, tachypneic with normal value of the oxygen saturation to the finger (SpO2:96%), with arterial hypotension (pressure values = 85/50 mmHg), turgor of the jugular veins in the absence of peripheral edema. Cardiac examination revealed no pathological noises and lung examination revealed clear lung fields. Electrocardiogram showed sinus tachycardia at a rate of 118 bpm, second degree atrioventricular (AV) block 2:1 type and an AV conduction delay with a first–degree AV block (P–Q interval: 320–330 msec). A pulmonary P wave was present and the QRS complex showed predominant R waves in V2–V3 with slight repolarization abnormalities (figure, panel A). An ST–elevation in right precordial leads, V3R and V4R was evident. (figure, panel B). Echocardiographic evaluation showed a hypertrophic left ventricle with normal volume and function, with marked enlarged right sections (figure, panels C–H). Moreover, we can observe the flattening of the interventricular septum with a D shaped left ventricle. Septal flattening occurred only in diastole, expression of RV volume overload (figure, panels F–H). After taking 180 mg of ticagrelor administrated orally and 150 mg of aspirin intravenously, the patient was immediately transferred to the catheterization laboratory for emergency coronary angiography. Coronary angiography highlighting an ostial thrombotic obstruction of a co–dominant right coronary artery (RCA) in the absence of significant stenosis of the left coronary circulation (figure, panels I–M). Primary percutaneous coronary intervention of RCA was performed with STENT implantation with a good postoperative result. (figure, panels L). During the hospital stay, the patient showed a good clinical status without any CV events, with progressively normalization of electrocardiographic abnormalities and persistent sinus rhythm. He was discharged after ten days.
NAPHAZOLINE ABUSE: A RARE CASE OF MINOCA
Authors: Galasso M 
Published: May 2024

Abstract
Nasal vasoconstrictors are some of the most widely used over–the–counter drugs, considered by many consumers as relatively safe with few significant side effects. At recommended dosage, the drug produces local vasoconstriction in nasal mucous membranes. However, the use of such drugs has been linked to cardiovascular adverse effects, including hypertension, arrhythmias, prolongation of the QT interval, and angina pectoris. The various cardiovascular adverse effects may occur with both oral and nasal administration and after a single dose or prolonged treatment, without dose–effect and independently of vascular status and age. While the effects of ephedrine and pseudoephedrine have been widely studied, the effects of naphazoline are less well known. We describe the case of a previously healthy man who experienced a MINOCA (myocardial infarction with non–obstructive coronary arteries) after abuse of recommended dose of Naphazoline. To our knowledge, this is the first time that a strict temporal relation between the occurrence of MINOCA and topical naphazoline abuse is being described.
A COMPLEX POST CARDIAC–ARREST SYNDROME: FROM UNCERTAIN NEUROLOGICAL OUTCOME TO HEMORRHAGIC COMPLICATION
Authors: Vitale E , Sorini Dini C , Cesareo F , Righini F , Ceschia N , Valente S 
Published: May 2024

Abstract
A 49–years–old woman with type II diabetes mellitus, hypothyroidism and Churg–Strauss syndrome experienced chest pain with loss of consciousness. Emergency service was called and CPR promptly started. Cardiac arrest with shockable rhythm was documented, DC–shock performed with sign of anterior STEMI after ROSC, then refractory cardiac arrest appeared. The patient was centralized in our hospital and VA–ECMO was positioned through a percutaneous femoral access in cath–lab. Coronary angiography showed acute occlusion of the mid–proximal LAD and subocclusive stenosis of the dominant Cx for which PCI with DES was performed, then intra–aortic balloon pump (IABP) was implanted. At ICCU admission the patient was supported by ECMO and IABP with MAP 65 mmHg and lactates 3.5 mmol/L. Echocardiography and chest X–ray showed severe biventricular dysfunction and pulmonary overload (Fig 1). She was ventilated via ECMO circuit and mechanical ventilation setting protective TV values of 6 ml/kg. Diuresis was good with low dose of furosemide, lactates progressively decreased. Temperature control was set within 36°C with the cooling system of the ECMO circuit. Cardioaspirin, ticagrelor and bivalirudin were administered. At early neurological stratification EEG documented absence of epileptiform anomalies, responsiveness to painful stimuli, SSPE showed normal and symmetrical morphology, NSE at 48 h was 59 ng/mL, she opened eyes and performed simple orders. Levosimendan was administered with partial recovery of the right ventricular dysfunction leading to ECMO removal on 5th day. Due to poor consciousness recovery despite sedation reduction, percutaneous tracheostomy was performed on 8th day, IABP removed and the following day all vasopressors suspended. Neurological improvement allowed transition to spontaneous breathing and weaning from mechanical ventilation; on 19th day tracheostomy was removed. Massive enterorrhagia appeared after ECMO removal (figure 2). The colonoscopy showed ischemic pancolitis, therefore ticagrelor was suspended. On 18th day clopidogrel was reintroduced based on hemoglobin stability and endoscopic improvement. She was discharged from the cardiology department after a total length of stay of thirty days, with normal neurological status, no motor deficits, recovery of left and right ventricular function, stable hemoglobin levels.
CONCOMITANT ACUTE CORONARY SYNDROME AND PEPTIC ULCER PERFORATION. A DRAMATIC LIFE–THREATING COMBINATION STILL UNRESOLVED
Authors: Schettino M , Bezante G , Porto I 
Published: May 2024

Abstract
Acute myocardial infarction with ST–segment elevation (STEMI) and ulcer peptic perforation are two different conditions that could manifest at the same time. We reported a 79–year–old Caucasian man with hypertension, dyslipidemia and CAD (previous stenting on RCA and LAD) with chest pain, vomiting and tarry stool, with normal vital signs. ECG: ST–segment elevation in inferior leads. Hemoglobin: 7.4 g/dl. TnI: negative. The Chest X–ray was normal. The coronary angiography showed a multivessel disease with a sub–occlusion of RCA, a restenosis borderline of LAD and a critical stenosis of OM. Multiple dilatations on culprit lesion with balloon were performed. There was a regression of the ST–segment elevation in the inferior leads, so the interventional cardiologist decided not to stent the vessel. After PCI, clopidogrel loading dose 600 mg was prescribed and two blood transfusions were administered. The echocardiography showed a mildly reduced ejection fraction with abnormalities of inferior, posterior and lateral walls. Subsequently, the patient was stable, asymptomatic with normal vital signs but, progressively, the blood pressure dropped, and the patient became tachypnoic. The echocardiogram showed micro–bubbles moving in all the left and right cardiac chambers. Chest X–ray showed subdiaphragmatic free air and CT demonstrated free intraperitoneal air and air inside the systemic and portal venous circulation, suggesting a perforated viscus. The patient was transferred directly to the operating room in unstable hemodynamic condition, and there for the first time he complained abdominal pain. During surgery the perforation was found in the first segment of the posterior region of duodenal tract and, because of unstable clinical conditions, a conservative treatment was made with a Petzer sound’s application and a plastic of the perforation with stitches and omentoplasty. The patient passed away three days later because of sepsis. The concomitant presence of STEMI and peptic ulcer perforation is rare, but possible event. In our case it might have been reasonable not to give the DAPT or to halve the loading dose, but this has not been supported by clinical studies. There are no clear guidelines or algorithms to choose what to treat first, and up to now the patient’s management depends on the clinical presentation and the algorithms used in clinical practice are those defined by the 112 staff together with the Emergency Department teams.
ECHOCARDIOGRAPHIC PREDICTORS OF RESIDUAL MR ≥ 2+ AND CLINICAL OUTCOMES ONE YEAR AFTER MITRACLIP IMPLANTATION
Authors: Costantino M , Stolfi L , D‘Addeo G , Cortese F , Fiorilli R 
Published: May 2024

Abstract

Introduction
The extent of residual mitral regurgitation (MR) (1+ vs ≥ 2+) has a notable impact on the outcome of MitraClip (MC) repair of significant functional MR.

Aim
The aim of the study was to analyze the one–year results in our series of patients with functional MR treated with MC.

Materials and Methods
Between 2020 and 2022, 58 consecutive patients underwent percutaneous mitral valve repair with MC technology. All patients had moderate–severe MR on a functional basis.

Results
At one year 10 patients died (mortality 17.2%). The remaining 48 patients had complete follow–up for up to one year and were included in the statistical analysis: The incidence of new hospitalizations was 8.3%; The incidence of grade 1+ and ≥ 2+ MR was 54.1% (26) and 45.9% (22), respectively; In patients with MR ≥ 2+ the clinical and instrumental outcomes were worse than in patients with MR 1+; Posterior leaflet height and extent of immediate postprocedural MR were independent predictors of MR ≥ 2+. In multivariable analysis, preprocedural posterior leaflet height (PLH) (OR 0.16, p = 0.02) and immediate postprocedural MR degree (IPOMR) (OR 12.4, p = 0.03) were predictive; preprocedural Ejection Fraction (EF) was almost significant (OR 0.87, p = 0.08) (Figure 1).

Conclusions
Percutaneous repair with MC of moderate/severe functional MR has favorable one–year outcomes in terms of mortality and rehospitalizations. The best results are obtained in cases with residual MR 1+. Echocardiographic parameters are independent predictors of residual MR ≥ 2+.