bluuebunny/crossref_metadata_2025_split huggingface dataset:
P69 SHORT–TERM EFFECT OF DAPAGLIFLOZIN ON LEFT VENTRICULAR LONGITUDINAL FUNCTION IN PATIENTS WITH HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION
Authors: De Masi De Luca G , Longo S , Barba F , Papadia P , Accogli M , Palamà Z , Romano S , Sciarra L 
Published: May 2023

Abstract

Background
It is known that sodium–glucose cotransporter 2 (SGLT2) inhibitors have been shown to confer important clinical benefits in patients with congestive heart failure (HF). Several evidences show SGLT2 influence the longitudinal systolic function of the left ventricle after medium and long term follow–up (FUP) in patients with HF. The aim of this study is to demonstrate how dapagliflozin can modify the global longitudinal strain (GLS) in a population of patients with systolic congestive heart failure (HFrEF) evaluating possible correlations with the basal functional capacity.

Methods
Clinical and echocardiographic data were retrospectively analyzed in 60 HFrEF patients treated with dapagliflozin, within a dedicated outpatient HF clinic. Pre–treatment data were correlated with to clinical and instrumental FUP date that was generally performed after two months of treatment. The clinical and instrumental data consisted of the NYHA functional class, the left ventricular ejection fraction (LVEF) and the GLS.

Results
There was no significant change between baseline and FUP date on LVEF (25.2 ± 9.9% vs 25.6 ± 9.6% p.s.), while GLS showed significant improvement (13.1 ± 3.7% vs 14.3 ± 3.1% p &lt; 0.03). GLS improvement in HFrEF patients with more impaired functional class (NYHA III/IV) was more significant from 10.9 ± 3.4% to 13.1 ± 2.2% (p &lt; 0.01), compared to that in HFeEF patients with less compromised functional class (NYHA I–II) from 13.6 ± 2.4% to 14.1 ± 2.1% (p 0.07).

Conclusions
Dapagliflozin was associated with short term improvement in longitudinal left ventricular myocardial function in patients with chronic congestive systolic heart failure. This improvement is more evident in patients who start from a more impaired functional capacity than in clinically more stable patients.
P130 FINGER ISCHEMIA IN A YOUNG LADY: EXPECT THE UNEXPECTED FROM A PAPILLARY FIBRO–ELASTOMA
Authors: Pernigo M , Dinatolo E , Cirillo M , Mhagna Z , Cozza F , Berti M , Cuccia C , Troise G 
Published: May 2023

Abstract
Case presentation: In December 2022, A 32–y old women presented to the emergency department of our institution for pain and acrocyanosis of the 3rd and 4th finger of the right hand, compared abruptly 10 hours before. Physical examination was otherwise normal, she was apyretic. Her previous medical history was unremarkable, she did not take any medication and was a light smoker. Blood samples including blood count, platelets, coagulation tests, liver and kidney function, and inflammatory markers were normal. An echocardiogram was prescribed to rule out significant cardiovascular disease. The exam showed: normal left and right ventricular dimensions and systolic function, and absence of significant valvular disease. A highly mobile, iso–echoic mass was noted inside the left ventricle, with a major diameter of 8 mm; it was attached to the antero–lateral papillary muscle, not involving the mitral valve leaflets, and it had a frond–like appearance. Findings were consistent with a fibroelastoma (PFE; figure 1, 2). Doppler examination excluded pathology of ascending aorta, right subclavian artery, and demonstrated patency of arteries of the right arm and right hand. The case was compatible with peripheral embolization from the cardiac mass. A cardiac CT scan confirmed the echo findings and ruled out significant coronary disease. The patient underwent cardiac surgery two days later. With median sternotomy and cardiopulmonary bypass, the left ventricle was reached through aortotomy. A multilobular yellowish mass was seen attached to the antero–lateral papillary muscle, and was completely resected (figure 3); chordae tendineae were preserved. Macroscopic examination (figure 3) and histological findings confirmed the diagnosis of PFE. Post operative course was unremarkable.

Discussion
PFEs are benign tumors most commonly involving aortic valve, followed by mitral valve; atypical origins including mitral subvalvular apparatus, as in our case, has seldom been described. Most cases of PFE are asymptomatic, limited in dimensions and discovered incidentally. Interestingly, Raynaud phenomenon was at first suspected as cause of acrocyanosis in our patient, but it was inconsistent with biochemical findings, so that an echocardiogram was prescribed. Echo and CT aspects of the mass were typical for PFE, and it appeared at high embolic risk being pedunculated and highly mobile. Given the peripheral ischemic event occurred, prompt surgical resection was performed successfully.
P135 A CASE OF RIGHT CORONARY ARTERY ANEURYSM COMPLICATED BY ENDOVASCULAR THROMBOSIS
Authors: Benedetti G , Colarusso L , Marchi F , Pizzino F , Chiappino S , Sorbo S , Al Jabri A , Ravani M , Berti S , Paradossi U 
Published: May 2023

Abstract
Coronary artery aneurysm is a rare disorder with prevalence in male population. The most commonly involved vessel is the right coronary artery followed by the anterior descending artery. The most frequent etiologies are coronary atherosclerosis and Kawasaki disease. The treatment of coronary aneurysms with significant stenosis is often surgical, with implantation of covered stents in case of saccular aneurysms. In coronary artery aneurysms without significant stenosis, medical therapy is often the most suitable choice. Case report We present a case of a 68–year–old man with history of hypertension and dyslipidemia, who arrived to our ED with inferior STEMI. Left coronary angiography showed a 75% stenosis of the distal anterior descending artery and subocclusion of the first left marginal artery. Right coronary angiography revealed a severely ectatic vessel (7–8 mm diameter) with intraluminal thrombosis and markedly slowed flow (TIMI 1). Considering the regression of symptoms and ECG alterations, intracoronary bolus of Tirofiban was performed followed by i.v. infusion of 24 hours in association with DAPT. Blood tests did not detect any relevant alterations of coagulation profile but only an heterozygous mutation for MTHFR with slightly altered homocysteine values. Six days later, a second coronary angiography was performed which confirmed the persistence of thrombotic formation into the right coronary artery that was treated with rheolytic thromboaspiration and TIMI 2 final flow. In consideration of the angiographic findings, it was decided not to implant coronary stents. After multidisciplinary team discussion it was decided to associate DAPT with oral anticoagulant therapy (Warfarin 5 mg, INR 2–3) The patient was discharged with indication to continue the triple antithrombotic therapy for 6 months followed by double antithrombotic therapy with ASA and Warfarin.

Conclusions
Coronary aneurysms in the context of ACS are rare findings, often caused by endovascular thrombosis. Thrombolytic therapy, rheolytic thromboaspiration and anticoagulation therapy are valid tools for the successful treatment of such cases.
P151 UTILITY OF MULTIMODALITY IMAGING IN A CASE OF MULTIPLE AORTIC POST–ENDOCARDITIS PSEUDOANEURYSMS
Authors: Bianchi N , Frascaro F , Merani A , Maio D , Guardigli G , Campo G , Pavasini R 
Published: May 2023

Abstract

Introduction
First–line therapy for infective endocarditis is antibiotic treatment to avoid the occurrence of complications such as septic embolization, septic shock (1), pseudoaneurysm or abscess formation (1). A pseudoaneurysm is a cavity that communicates with the vascular lumen and develops as a result of necrosis of the infected tissue (1). Case report: An 81–year–old man with past medical history of aortic valve replacement with bioprosthesis for severe stenosis and re–intervention for infective Enterococcus faecalis endocarditis was admitted to hospital for hyperpyrexia. PET–CT scan was performed. An aortic bioprosthesis hypercaptation suggestive of endocarditis recurrence was found. Blood cultures were positive for Staphylococcus epidermidis. Transesophageal echocardiography was initially negative for vegetations. Therefore, it was decided for a conservative approach with antibiotic therapy. About 2 months later the patient presented in our emergency department with atypical chest pain. At a transthoracic echocardiogram was reported an eccentric paravalvular regurgitation jet on bioprosthesis in atypical position and thickening of the periaortic tissue (Fig 1A). A contrast enhanced cardio–synchronized CT scan was performed confirming the presence of three paravalvular aortic pseudoaneurysms, the largest of 16x8 mm and located on the posterolateral portion of the valvular ring near to the left atrial wall (Fig 1B). Finally, a transesophageal echocardiogram was repeated finding a fistula from the posterior pseudoaneurysm to the left ventricular outflow tract (Fig 1C). The patient underwent re–intervention of aortic valve and ascending aorta replacement.

Conclusions
In this case–report, the use of multimodality imaging allowed adequate diagnosis of fistulizing paravalvular aortic pseudoaneurysms and proper subsequent surgical planning. The results of this case report suggest that following infective endocarditis presence of paravalvular aortic regurgitation with eccentric jet should be investigated with second–level diagnostic examinations for better anatomic resolution, such as cardio–synchronized CT and transesophageal echocardiogram. Bibliography: 1. Okada K et al. doi: 10.1007/s11748–012–0152–x
P200 A POSITIVE CORRELATION BETWEEN THE OVERALL ECHOGENICITY OF CAROTID INTIMA MEDIA COMPLEX AND ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS: BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT
Authors: Natale F , Loffredo F , Molinari R , Alfieri R , Covino S , De Luca L , Limatola M , Mollo N , Pezzullo E , Cimmino G 
Published: May 2023

Abstract
According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness (AS) still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk. Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima–media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color–Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM &gt; 30 showed a significantly increased arterial stiffness and LVMI (P &lt; 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, P&lt; 0.001), and duration of hypertension (r = 0.31, P &lt; 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.
P218 WILD TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS (WTATTR) AND HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF): CAN ANGIOTENSIN RECEPTOR/NEPRILYSIN INHIBITORS (ARNI) BE A THERAPEUTIC OPTION?
Authors: Fowler B , Vincenzi A , Vullo E , Fagnani A , Lettino M 
Published: May 2023

Abstract

Background
wtATTR is associated with high mortality rate, median survival from diagnosis is 43 months and mortality reaches 50% at 4 years. Most patients (pts) present with heart failure and preserved ejection fraction (HFpEF), fewer with HFrEF. Tafamidis is the only modifying–disease agent available in Italy and therapeutic strategy is based on diuretic titration. Beta blockers and therapies for neurohormonal antagonism have raised concerns about their efficacy and safety. The role of ARNI has not been explored. We report our experience of the use of ARNI in pts with wtATTR not eligible to Tafamidis due to advanced NYHA classes.

Cases
4 male pts (median age 81 y.o.) received diagnosis of wtATTR between 2018 and 2019 when Tafamidis was not available. Median left ventricular ejection fraction (mLVEF) at the time was 51%. 2 years later they presented with acute HFrEF (Tab1–T0), NYHA classes III–IV with median systolic blood pressure 105 mmHg. Average N–terminal pro natriuretic peptide (NTproBNP) levels were 13888pg/ml and median estimated glomerular filtration rate (eGFR) was 36 mil/min/1,72m2. mLVEF was 23%. Once congestion was relieved pts started Sacubitril/Valsartan (S/V) with titration of dose. At 6 months follow–up (FU) (Tab1–T1) pts were downgraded to NYHA class II and no symptomatic hypotension was reported. Average NTproBNP levels were reduced to 7.800pg/l, only mild worsening of renal function was reported (median eGFR 31mil/minx1.73m2). Absolute increase of mLVEF (46%) was shown on echocardiography. At 12 months FU (Tab 1–T2) pts were clinically stable in NYHA class II, NTproBNP median values had mildly increased to 9700pg/ml and average eGRF was stable (30mil/minx1.73m2). Echocardiogram highlighted minimal reduction of mLVEF compared to previous result (41%). During FU only 1 of the pts required hospitalization for intravenous diuretic therapy and S/V was temporarily suspended.

Conclusion
The efficacy of S/V in HFrEF is well known. Our brief study proves that ARNI can be tolerated in frail pts affected by wtATTR with no other therapeutic options, guaranteeing a long hospitalization–free period with improvement in quality of life. The result may be purely due to the natriuretic effect of ARNI in patients so strictly reliant on volemic state. More complicated effects may be mediated by neprilisin on amyloid protein; further studies are warranted to establish the role of ARNI in wtATTR.
P231 CORONARY VASOSPASM REFRACTORY TO MEDICAL THERAPY AND COMPLICATED BY ASYSTOLE, HOW TO MANAGE IT?
Authors: Facchini E , Maffè S , Paffoni P , Prenna E , Bergamasco L , Franchetti Pardo N , Ariotti S , Careri G , Paino A , Dellavesa P 
Published: May 2023

Abstract
Vasospastic angina is a form of angina caused by coronary artery spasm. This usually determines rest chest pain and electrocardiogram changes. In some patients severe ventricular tachyarrhythmias or bradyarrhythmias may develop during myocardial ischemia. Vasospastic angina attacks can be prevented by calcium antagonists and nitrates but artery spasm may be refractory to optimal medical therapy. A 66–year–old woman, affected by Hailey–Hailey disease was brought to the emergency department for hemorrhagic shock after anti–conservative purposes. She underwent emergency surgery for haemostasis of the neck lesion, reinsertion of the subhyoid muscles and right parotidectomy. After surgery an electrocardiogram (ECG) showed inferior and posterior ST–segment elevation, total atrioventricular block (AVB) and torsades de pointes (FIG 1), then evolved in asystole and cardiac arrest . ROSC occurred in 4 minutes. Temporary pacemaker (PM) was placed. Coronary angiography showed right coronary artery and left anteriori descending artery vasospasm, slightly reduced after nitroglycein infusion (FIG 2). Transdermal nitrates and calcium channel blocker were started. Hospitalization has been prolonged due to infectious/psychiatric problems, with necessity of percutaneous endoscopic gastrostomy and tracheostomy, A new episode of vasospastic angina developed during hospitalization with recurrence of total AVB and torsades de pointes. Temporary PM was placed but after 24 hours perforated the right ventricle free wall. Echocardiogram showed small circumferential pericardial effusion. The patient underwent transvenous removal of the right ventricular catheter and two lead DDD PM was implanted. She was discharged with nitrate and calcium channel blocker therapy. No recurrence of angina was documented at 6–months follow–up. The management of this clinical case was complex because it was a form of vasospastic angina complicated by 2 cardiac arrests, unresponsive to medical therapy and with temporary PM that perforated the right ventricle. We therefore opted for a definitive PM implant for protection. Few case report describes definitive PM implantation in fatal bradyarrhythmias during vasospastic angina. To date, the best treatment of coronary vasospasm refractory to medical therapy is debated, pecutaneous revascularization and sympathectomy are considered, treatment methods that we will consider at follow–up in case of (probable) anginal recurrences.
P239 BASELINE HIGH RENAL RESISTANCE INDEX IS ASSOCIATED WITH WORSENING OF RENAL FUNCTION IN PATIENTS UNDERGOING CARDIAC SURGERY
Authors: Goffredo G , Barone R , Di Terlizzi V , Squiccimarro E , Margari V , Di Biase M , Brunetti N , Iacoviello M , Paparella D 
Published: May 2023

Abstract
Renal resistance index (RRI) is a parameter which is easily evaluable by the echo Doppler technique and which has been demonstrated to predict worsening of renal function (WRF) in patients affected by chronic heart failure as well as among those undergoing coronary angiography. The aim of this study was designed to evaluate the role of the RRI in predicting WRF after cardiac surgery.

Methods
Thirty–one patients were enrolled. Their clinical characteristics are shown in Table 1. All patients underwent cardiac surgery. Before surgery, RRI was evaluated according to Peurcelot’s formula by renal interlobular arteries pulsed Doppler. WRF was defined as an increase in serum creatinine of &gt; 0.3 mg/dl associated with a change &gt; 25% or the need of renal replacement therapy due to severe acute kidney injury.

Results
Among the patients in 12 WRF occurred, in 10 a worsening of creatinine serum levels and in 2 a severe AKI requiring RRT were observed. As shown in Table 1, RRI and the presence of peripheral artery disease were the only parameters which were significantly different among patients with and without WRF, whereas no difference in GFR values was observed. Baseline RRI showed a significant AUC of 0.74 (95% CI, 0.55–0.93) whereas baseline GFR of 0.52 (95% CI, 0.28–0.75) was not significant.

Conclusions
Among patients with WRF after cardiac surgery an increased RRI but not a different baseline GFR is observed. This parameter could allow a more accurate stratification of the risk of cardiorenal syndrome worsening among patients candidated to cardiac surgery.
P280 TEAMWORK IS SUCCESSFUL (1): FAVOUREABLE RE–CHALLENGE OF DOUBLE ANTI–HER2 TREATMENT IN SEVERE MYOCARDIAL DYSFUNCTION IN PATIENT WITH ADVANCED BREAST CANCER AND OCCULT TYPE II DIABETES
Authors: Valenti C , Moretti G , Copelli S , Di Cicilia R , Manca F , Cioni E , Gasparini E , Pinto C , Navazio A , Tarantini L 
Published: May 2023

Abstract

Introduction
Cardiovascular diseases (CVD) and Cancer (C), the most important causes of mortality worldwide. share many risk factors and common pathophysiological processes such as chronic inflammation and unfavorable cardio–metabolic profile. Progress in oncological treatments improved the survival of oncological patients (Pt) but have increased the likelihood of short– and long–term CV cardiovascular complications. The multidisciplinary collaboration between cardiologist and onco–hematologists is the task of Cardioncology, an emerging new sub–specialization of clinical cardiology that often make available personalized treatment with a favorable outcome also in clinically complex patients. Here we present a case of severe acute heart failure in a woman with advanced breast C (BC).

Clinical Case
2021 April: 55–year–old woman with G3 BC, (ER 0%PgR 0%,Ki6770%HER2+) (T4N3M1), (chest wall and liver) on well tolerated treatment with Docetaxel X 6 and continuous double antiHER2 block (Trastuzumab + Pertuzumab) X 4 and steroids as ancillary therapy. After about 6 months of therapy a lower airways infection occurred and acute congestive heart failure (HF) with severe left ventricular systolic dysfunction (LVEF 25%) ensued requiring hospitalization in the ICU, where newly detected type II diabetes was diagnosed. Appropriate HF therapy with insulin and anticoagulant was established and congestive clinical state resolved. On outpatient basis B–Blocker and anti–RAAS therapy was titrated switching to empagliflozin. About 7 months after discharge, we registered the full recovery up to a normalization of systolic function (LVEF 55%) and the disappearance of the intraventricular thrombus. For progression of C, pt underwent chemotherapy with Capecitabine at metronomic and in October 2022 after cardio–oncological collegial discussion, anti–HER2 therapy resumed. Paz started Trastuzumab–Emtansine, well tolerated with substantial stability of the clinical picture (NYHA I–II) and instrumental and echocardiographic evaluation (LVEF 65%).

Conclusions
This clinical case reaffirms that close collaboration between cardiologist and oncologist is fundamental for the successful management of complex patients and surveillance must also extend during (and after) treatment. It also demonstrates that an early diagnosis and an "evidence–based" cardiological therapy can allow the recovery of the cardio–toxic effect of anti–HER2 drugs and may allow to resume the therapy successfully.
P297 INTRAVENOUS CANGRELOR INFUSION IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: PRELIMINARY RESULTS OF THE ICARUS REGISTRY
Authors: Benenati S , Gragnano F , Scalamera R , Schettino M , Bertero E , Capolongo A , De Sio V , Musumeci G , Annibali G , Campagnuolo S , Galasso G , Silverio A , Bellino M , Centore M , Menozzi A , Caretta G , Rezzaghi M , De Luca L , Veneziano F , De Nardo D , Cirillo P , De Rosa G , Calabrò P , Porto I 
Published: May 2023

Abstract

Aims
To investigate the prevalence of high bleeding risk (HBR) criteria and compare clinical outcomes between HBR and non–HBR patients receiving cangrelor in the peri–percutaneous coronary intervention (PCI) phase.

Methods
Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high–bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. HBR status was assessed according to the Academic Research Consortium (ARC–HBR) definition. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay.

Results
We enrolled 551 patients undergoing PCI with cangrelor between January 2019 and August 2022. HBR definition was met in 33% of cases. HBR patients were older (76±10 vs. 63±10 years, p&lt;0.001), more frequently affected by peripheral arterial disease (16% vs. 8%, p=0.010), atrial fibrillation (24% vs. 2%, p&lt;0.001), chronic kidney disease (35% vs. 3%, p&lt;0.001), active cancer (7% vs. 0%, p&lt;0.001) and heart failure (17% vs. 7%, p&lt;0.001). At 48 hours, HBR patients had a significantly higher rate of NACE (13% vs. 6%, p=0.004), and BARC 2, 3 or 5 bleeding (12% vs. 4%, p=0.001). In the HBR group, the frequency of the primary endpoint increased proportionally to the HBR score. There was no significant difference with respect to other 48–hour and in–hospital endpoints.

Conclusions
Among consecutive patients treated with cangrelor in the peri–PCI phase, about 30% fulfilled the ARC–HBR definition. In the HBR subpopulation, the incidence of 48–hour adverse events was higher than in the non–HBR subgroup, primarily driven by a higher rate of clinically relevant and major bleeding.