bluuebunny/crossref_metadata_2025_split huggingface dataset:
P155 CT EVIDENCE OF PARTIAL ISCHEMIC PAPILLARY MUSCLE RUPTURE
Authors: Del Torto A , Dalla Cia A , Ghulam S , Formenti A , Pontone G , Assanelli E 
Published: May 2023

Abstract
A 77–year–old man was referred for coronary CT following an episode of prolonged chest pain that occurred about 30 days earlier, with subsequent onset of dyspnea on moderate exertion. Coronary CT demonstrated right dominance, occlusion of the right coronary artery, as well as severe stenosis of the distal segment of the left anterior descending artery and of the first obtuse marginal branch. CT scan also showed an intraventricular image consistent with partial rupture of the posteromedial papillary muscle (Figure 1). The patient was transferred to the emergency department. An ECG showed signs of inferolateral necrosis. Transthoracic echocardiography confirmed akinesia of the inferior and inferolateral walls and of the basal segment of the inferior septum, with severe mitral valve insufficiency from anterior leaflet prolapse (A3 scallop) from partial rupture of the posteromedial papillary muscle (Figure 2). Transesophageal echocardiography confirmed the diagnosis (Figure 3). The patient was admitted to the CCU and underwent coronarography, which confirmed the severe triple vessel coronary artery disease with occlusion of the right coronary artery, and then urgent mitral valve replacement with bioprosthesis and aortocoronary bypass with saphenous vein grafting to the posterior descending artery. The postoperative course was uneventful. Ischemic papillary muscle rupture is a rare cause of mitral insufficiency. Papillary rupture typically occurs within 5 days of an acute myocardial infarction, and causes mitral insufficiency by prolapse and flail of one or, more rarely, both mitral valve leaflets. The posteromedial papillary muscle is most commonly affected, since the anterolateral papillary muscle has dual supply from the anterior interventricular artery and the circumflex artery. Papillary muscle rupture can be total or partial; however, most cases of partial rupture progress to complete rupture and therefore require urgent surgical treatment. The peculiarity of this case lies in the fact that it is the first case described in the literature of a papillary muscle rupture documented on CT.
P160 WHEN IMPEDANCE TRENDS LIE, REMOTE MONITORING HELPS FOR DIAGNOSIS
Authors: Scicchitano M , Loricchio M , Schirripa V , Iulianella R , Perna S , Castro A , Centurion Aznaran C , Albano B , Rizzo V , Granatelli A 
Published: May 2023

Abstract
An 82–years old female patient with history of hypertension, diagnosis of dilatative cardiomyopathy with normal coronary arteries and permanent atrial fibrillation (AF) was implanted with a dual chamber implantable cardioverter defibrillator (ICD), Guidant Ventak Prizm DR (Boston Scientific,Marlborough,USA) as a secondary prevention of sudden cardiac death in 2002. The ICD was electively replaced in 2005 and in 2010 with a Guidant, Vitality 2 DR (Boston Scientific,Marlborough,USA). In 2016, despite an optimized medical therapy, the patient experienced an episode of palpitation due to an AF with high ventricular response. Considering the difficulties of the heart rate management with the pharmacological therapy the patient underwent to an ablation of AV node. In 2017 we performed a third replacement of the ICD downgrading the system to a single chamber ICD, Fortify Assura VR (Abbott,Sylmar,USA) and providing the patient with a bedside–transmitter Merlin@home (Abbott,Sylmar,USA) The patient, followed for 4 years remotely, did not experience ventricular arrhythmias and the ventricular lead electrical parameters, including pacing and shock impedances, were stable and in the normal range. In March 2021 an alert of the Merlin system triggered an unscheduled transmission that showed several episodes of ventricular oversensing. The episodes revealed that an electrical interference inhibited the ventricular pacing causing episodes of asystole with a maximum duration of three seconds (Fig.1). Unexpectedly electrical parameters such as the pacing and shock impedances showed a stable and normal measurements (Fig .2), while the chest X–rays showed that the ventricular lead was kinked at 90–degrees below the clavicle evidencing a lead fracture (Fig.3). The patient was therefore implanted with a new ventricular lead avoiding inappropriate shocks and further episodes of asystole. The occurrence of a lead failure represents an insidious and potentially harmful event for the device implanted population, especially for ICD or pacemaker–dependent patients. The diagnosis of a lead failure is not easily predictable, and it is usually driven after a clinical event of inappropriate shock or unexplained syncope. Our case highlighted how Remote Monitoring is extremely helpful even more in this case of apparently correct functioning based on electric measurements.
P161 THE ROLE OF CARDIOLOGICAL TELEVISIT FOR THE MANAGEMENT OF PATIENTS WITH POST–ACUTE SEQUELAE OF SARS–COV–2 INFECTION: STUDY DESIGN
Authors: Gatto M , Ferrari I , Biava G , Vergori A , Girardi E , Antinori A 
Published: May 2023

Abstract

Background
WHO defines Post–Acute Sequelae of SARS–CoV–2 (PASC) as a condition that occurs several weeks after the infection, which persists for at least 8 weeks and cannot be explained by alternative diagnoses. Symptoms of PASC are: palpitations, dyspnoea, chest pain. These symptoms require an initial cardiological investigation, but also a cardiological follow–up that could be carried out with telemedicine. Principal aim: To assess the feasibility of cardiological televisit and its socio–economic impact in patients with PASC. Secondary aims: 1) To describe the clinical, laboratory and instrumental characteristics of patients with PASC and to define the possible role of cardiovascular risk factors in the development of the disease; 2) To correlate the symptoms reported by the patients with any clinical objectivity or instrumental alterations; 3) To assess the patient‘s perception of the use of specialist televisit and its possible economic and social impact.

Methods
Prospective observational study. All patients with previous COVID–19 with suspected PASC will be screened. After the first cardiological face–to–face visit, patients with suspected PASC who require follow–up will be consecutively enrolled and assigned in a 1:1 ratio to the televised study group (GT) and the standard of care (GC) control group. Patients in the GT group will perform the control cardiology examination in televisit, while patients in the GC group will perform the cardiological control according to the current standard of care. The specialist televisit (booking mode, use of freeware platform) will be provided as indicated by the latest regional directives. Exclusion criteria: Failure to sign informed consent; inadequate computer literacy (of the patient or his/her caregiver). Evaluation: Patients in the GT and GC group will take a questionnaire with specific questions on how the specialist check–up will be delivered. Expected results: The use of televisit for the follow–up of patients with PASC, as defined in this protocol, play a key role for the digital transition in our operational context and, above all, for the optimisation of healthcare resources.
P162 ARRHYTHMIC MITRAL VALVE PROLAPSE OCCURRING AS ABORTED SUDDEN CARDIAC DEATH
Authors: Alberio A , Garibaldi S , Mirizzi G , Franchi E , Viacava C , Santoro G , Piacenti M , Rossi A , Assanta N 
Published: May 2023

Abstract
Mitral valve prolapse (MVP) is the common valvular heart disease, with a prevalence about 1–3% in the population. MVP is characterized on echocardiography by an abnormal systolic displacement of mitral valve leaflets into left atrium (LA) ≥ 2 mm above the mitral annulus. We described a clinical case of a 15 years–old boy with a first clinical presentation of out–of–hospital cardiac arrest related to ventricular fibrillation (VF) with a successful resuscitation after 2 DC shocks. Retrospectively, an episode of loss of awareness reported as post–minational. No familiar history of sudden cardiac death (SCD) or MVP was noticed. In the emergency room, the patient was hemodynamically unstable and was sedated and intubated. The surface electrocardiogram (ECG) showed sinus rhythm, QRS with fragmentation, and frequent monomorphic isolated premature ventricular contractions (PVCs) with RBBB/LAFB configuration.Frequent monomorphic PVCs with bigeminy was observed during continuous ECG monitoring, so the patient was treated with magnesium sulphate and metoprolol. The patient was subsequently weaned from ventilation support, presenting good gas exchange and without neurological sequalae. The 24h Holter monitoring showed an average of 53 bpm, extremely rare supraventricular extrasystoles, high incidence of monomorphic PVCs (23% of the total beats) with 4 couplets. Transthoracic echocardiography documented normal size and thickness with systolic function (GLS –21%, mild asynchrony of posterior basal segments), bi–leaflet prolapse associated to mild–moderate mitral regurgitation, and mitral annular disjunction (MAD) of 6.2 mm. The late gadolinium enhancement cardiac magnetic resonance showed bi–leaflet prolapse with mild insufficiency and maximum MAD 9 mm, mild LA dilatation, and slightly dilated both ventricles, without regional wall motion abnormalities; no scar or fibrosis at the late gadolinium enhancement was observed. According to guidelines, the patient received a subcutaneous implantable cardiac defibrillator for the secondary prevention of SCD and maintained under betablockers in order to control the arrhythmic burden. The genetic sampling did not show any pathogenetic mutation potentially related to cardiomyopathies or channelopathies. This case show an arrhythmic MVP complex with probably posterior papillary muscle source. The early PVCs with R/T constituted a possible trigger of VF. The betablocker therapy exhibited a full suppression of extrasystolic burden.
P163 THE ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH HYPOTHERMIA: THE OSBORN WAVE
Authors: Costantino M , Calculli G , Stolfi L , Cortese F 
Published: May 2023

Abstract
A 93–year–old patient came to our observation for general malaise, sensory obnubilation, aphasia and dysphagia. He had arterial hypertension in drug treatment. At the first medical contact, the body temperature was 28 °C. The ECG showed a non–evaluable atrial activity (likely atrial paralysis) with the presence of a junctional rhythm at the frequency of 37 bpm. Blood pressure was around 100/60 mmHg with preserved cardiovascular compensation, in the presence of a moderately depressed cardiac function. Furthermore, the presence of a positive deflection in the terminal part of the QRS complex with elevation of the point J, in the precordial lateral leads V4–V6, and a terminal slowing of the QRS complex in the inferior leads, the so–called ‘wave of Osborn’, were also observed Figure 1. Given the reduction of the sensory, the patient was subjected to brain CT scan with finding of a thin hyperdense layer around the right and left hemispheric convexity suggestive for subdural haematoma. After adequate warming and supportive therapy, a progressive increase in heart rate was observed with restoration of the sinus rhythm and disappearance of the Osborn wave, Figure 2. The Osborn wave is the most specific electrocardiographic sign of hypothermia. It consists of an electrocardiographic deflection which is manifested as a late delta wave or as a small r ’wave following the QRS. It is the manifestation on the surface ECG of the electric gradient between a more prominent spike and dome action potential of epicardial cells than that of endocardial cells, an effect that is believed to be linked to a slowing down of the kinetics of activation of K þ channels Ito compared to calcium channels, associated with low temperature. This wave is not specific for hypothermia but can also occur in other clinical conditions such as subarachnoid haemorrhage, myocardial ischaemia, acidosis, in the presence of hypercalcemia, early repolarization and even in normal subjects. Its amplitude also tends to increase in conjunction with the reduction in body temperature. The bradyarrhythmias and conduction disorders associated with hypothermia cease spontaneously with an increase in body temperature, so the use of beta stimulating drugs and the insertion of transvenous pacemakers, the latter for the mechanical irritation effect on the endocardium, should be considered with caution due to the high risk of inducing ventricular tachyarrhythmias and ventricular fibrillation.
P167 CARDIAC ARREST IN SUSPECTED LONG QT: APPROACH TO ARRHYTHMIC MITRAL VALVE PROLAPSE
Authors: Bevere E , Mastroianno S , Greco A , Brunetti N , Salvatori M , Potenza D , De Luca G , Di Stolfo G 
Published: May 2023

Abstract
Mitral valve prolapse is a common condition. It affects 1–3% of the population. Clinical manifestations range from the absence of symptoms to sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in myocardial posterior caused by valve prolapse. ECG abnormalities indicative of high risk are inverted or biphasic T waves, ST depression, QT prolongation or dispersion, and BEV originating from the left outflow tract or papillary muscles. The echocardiogram allows the identification of mitral prolapse and disjunction of the mitral annulus (MAD), while MRI shows fibrosis. ICD implantation should be considered in high–risk patients with documented ventricular arrhythmias.

Clinical case
A 29–year–old woman with a family history of sudden cardiac death reported a state of absolute well–being until September 2022 when she presented with syncope with referred pulse failure for which she underwent cardiac massage, without defibrillation, by family members. At the arrival of 118 the patient presented bigeminal ventricular extrasystole with superior axis and BBsx type morphology (Fig.1). When she arrived at the hospital, ECG showed long QT (484 ms) associated with hypokalemia (2.8 mmol / l). During hospitalization, the coronary angiography was normal, while the cardiac MRI showed a globular and dilated left ventricle with preserved EF, thickening of the mitral leaflets, prolapse of both leaflets more evident at the level of P2/P3, MAD more evident in P3 with separation maximum end–systolic of 12 mm and absence of edema (Fig. 2). The patient underwent ICD implantation. In the presence of hypertelorism, prognathism, and flat feet, even in the absence of anomalies affecting the aorta and epiaortic vessels, scarring defects or ease to joint sprain, genetic screening was started for channelopathies and collagen diseases.

Conclusions
The approach to the patient with cardiac arrest and typical facies must be based on a systemic overview of the patient, whose phenotypic characteristics may suggest involvement of connective tissue diseases. In the future, the cardiologist must develop adequate knowledge to fully collect the information that the patient provides not only during instrumental examinations but also during an adequate clinical objective examination and facies, possibly supported by artificial intelligence.
P168 FOLLOW–UP IN A PATIENT WITH LYMPHOMA UNDERGOING CHEMOTHERAPY TREATMENT
Authors: Mautone F , Casavecchia G , Pesolo M , Gravina M , Brunetti N 
Published: May 2023

Abstract
We present the case of a 55–year–old hypertensive patient, with no other cardiovascular risk factors and no noteworthy cardiovascular history. Suffering from lymphoma, derived from grade I/II peripheral B lymphocytes, diagnosed in January 2018, underwent chemotherapy according to the R–CHOP scheme and continued until September 2021 with immunotherapy (Rituximab). The follow–up cardiological evaluation in September 2022 refers to dyspnoea for moderate exertion and some episodes of stinging chest pain, of short duration, not associated with neurovegetative symptoms. The Echocardiogram documented a left ventricular global systolic function at the lower limits of the norm evaluated with Eco3D (FE 53%). GLS –17.6%. ECG normal. A Coro–Tc was recommended and scheduled which documented the presence on the middle part of the anterior descending artery of partially calcified atheromatous plaque which extends for about 5 mm and which determines the reduction of the area by 67% and of the diameter of 70% therefore the patient underwent a coronary angiography with angioplasty with implantation of a medicated stent on IVA. This case demonstrates how important it is to perform a careful follow–up in cancer patients and how properly used imaging methods can help us in diagnosis and treatment.
P176 GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF RESPONSE TO CARDIAC CONTRACTILITY MODULATION IN PATIENTS WITH HEART FAILURE: A CASE SERIES
Authors: Matteucci A , Pignalberi C , Pandozi C , Magris B , Meo A , Schiaffini G , Di Fusco S , Cianfrocca C , Aquilani S , Colivicchi F 
Published: May 2023

Abstract

Background
Cardiac contractility modulation (CCM) in heart failure (HF) patients with reduced ejection fraction (HFrEF) is an innovative therapy which may contribute to increased exercise capacity and quality of life and reduced hospitalizations. With speckle–tracking echocardiography and global longitudinal strain (GLS), changes in myocardial function can be detected with greater sensitivity than conventional approaches for measuring diastolic and systolic function, including left ventricular ejection fraction. We aim to analyze the usefulness of GLS in detecting improvement in systolic function and response to CCM treatment.

Methods
We studied 5 patients with CCM referred to our outpatient cardiology clinic. All patients underwent complete echocardiography with evaluation of GLS and ejection fraction. Follow–ups were performed at 1, 3, and 6 months.

Results
All patients were men (mean age 65.3±15.7 yrs). Mean baseline ejection fraction was 37.1±9.3%, mean GLS was 7.7±3.1%, and patients had mild–to–moderate left ventricular enlargement (mean indexed telediastolic volumes 101.4±8.7 ml/m2). Follow–up performed at the first month showed values similar to baseline values. Between the third and sixth months, a non–significant improvement in ejection fraction and GLS was recorded (EF 40.75±9.6% p=0.51; GLS 8.9±4.2 p=0.62). Indexed telediastolic volumes were reduced (101.4±9.3 ml/m2 vs 89.5±7.4 ml/m2 p=0.05).

Conclusions
CCM therapy seems to be useful in achieving volumetric remodeling in patients with HFrEF. GLS assessment may be useful in detecting improvement in systolic function. Further studies with larger samples and longer follow–up are needed to confirm these results.
P181 COMPARISON OF ECGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY
Authors: Cavarra M , Chiaranda‘ M , Salerno E , Chiaranda‘ G , Tamburino C 
Published: May 2023

Abstract
The diagnosis of Left ventricular hypertrophy (LVH) in the hypertensive patient is important for the prognosis and therapeutic implications that must be more aggressive in hypertensive with organ damage. On the other hand, echocardiography laboratories (Echo) are overwhelmed by an excessive indiscriminate demand for exams in hypertension. Purpose of Work: In a large population of subjects with high blood pressure we tested some ecgraphic standard criteria for LVH Materials and methods: 12859 ecgs with preoperative cardiological examination have been performed in a cardiological surgery consecutively in the last 3 years. From this population was selected a series of 7615 subjects who had carried out an echocardiogram in the last year ( Echo). Average age 66 23 aa, 61% women and 39% males. The sensitivity ( Se) and specificity (Sp) of several LVH ecgraphic criteria were evaluated in this population: Romhilt–Estes score; Sokolow–Lyon; Cornell, Perugia. Echo reference parameters for LVH were left ventricular mass (LVM) and/or diastolic thickness of interventricular septum (IVS) and posterior wall (PW) of the LV reported in the echo taking into account the reference values for LVH of the last LLGG of the European Society of echocardiography.

Results
The prevalence of IVS on the ecg for the scores studied was respectively 5.9%, 11.9%, 12.8%, 18.5%. The IVS echo prevalence ranged from 27.8% for LVM &gt; 125 g/m2 to 57.1% for LVM &gt; 51g/m2. Using this last parameter or the thickness of the IVS or PW of the LV the Se and Sp of the various scores / criteria were respectively: 6.9% and 95.9% for Romhilt–Estes; 10.9% and 90.8% for Sokolow–Lyon; 15.9% and 92.1% for Cornell; 23.6% and 84.8% for Perugia. Combining the positivity of at least one of three score/ecgraphic criteria ( Romhilt–Estes, Cornell, Perugia) the SE increased to 35.4% with a slight reduction of the SP of 86.5%.

Conclusions
The ecg Se for LVH is low with a good Sp; combining multiple scores/ecgraphic criteria of LVH, Se increases without a significant reduction of Sp. The ecg could be used to address the execution of the Echo with a better appropriateness and therefore use of resources .
P184 TRANSESOPHAGEAL ELECTROPHYSIOLOGICAL STUDY FOR FOLLOW UP OF NEONATAL PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
Authors: Catucci S , Lombardi M , Maiorano A , Massari E , Meliota G , Pirolo T , Vairo U 
Published: May 2023

Abstract

Introduction
Paroxysmal supraventricular tachycardia (TPS) is the most common form of arrhythmia in neonatal age. The transesophageal electrophysiological study allows us to demonstrate the possible persistence of arrhythmia after the first year of age. Aim of the study: To evaluate the reliability of transesophageal electrophysiological study in the follow–up of these patients. Materials and methods: We retrospectively observed 8 patients who came to our observation in neonatal age for TPS. All patients underwent echocardiogram and Holter and were discharged to effective drug therapy for rhythm control (with one or two drugs). Afterwards, they carried out follow–up with Holter in drug therapy every 3 months. Within one year of age, antiarrhythmic therapy was discontinued and a transesophageal electrophysiological study was performed, including atrial stimulation at increasing frequencies and programmed atrial stimulation with single, double and triple extrastimulus. In case of TPS inducibility, therapy was resumed and the study was repeated after one year in wash out.

Results
We observed 8 patients who came for TPS in neonatal age. 7 of these had a structurally normal heart; one patient had aortic coarctation corrected with aortoplasty. After one year of therapy, 4 patients (50%), half of whom were in dual therapy (flecainide associated with beta–blocker and/or amiodarone) were non– inducible; these patients, who were permanently discontinued, no longer presented arrhythmic episodes in the follow–up. The remaining 4 resumed therapy (double in half of the cases) for another year and then repeated the study in wash out: one patient continued to present arrhythmias (patient with correct aortic coarctation); the other 3 were non–inducible. In the subsequent follow–up, 3 of these patients only one showed a recurrence of arrhythmia.

Conclusions
The transesophageal electrophysiological study is a simple, minimally invasive and reliable method to identify subjects at risk of TPS recurrence. The persistence of arrhythmia in our study is independent of the pharmacological treatment carried out in mono or dual therapy. We also observed that in case of positivity after one year of therapy, the study can be repeated later allowing therapy to be interrupted at a later time.