bluuebunny/crossref_metadata_2025_split huggingface dataset:
P290 EXTRACORPOREAL MEMBRANE OXYGENATION SYSTEM AS A BRIDGE TO REPARATIVE SURGERY IN VENTRICULAR SEPTAL DEFECT COMPLICATING ACUTE MYOCARDIAL INFARCTION
Authors: Chivasso P , Miele M , Colombino M , Triggiani D , Cafarelli F , Leone R , Masiello P , Mastrogiovanni G , Iesu S 
Published: May 2023

Abstract

Introduction
Post–infarct ventricular septal defect (VSD) is a life tethering complication of acute myocardial infarction which is associated to high in–hospital mortality (90–95%). The optimal peri–operative management including timing of surgical correction is still debated. There is a large body of evidence demonstrating that surgical repair is also associated to poor post–operative outcomes due to cardiogenic shock and multiorgan failure (MOF). The use of extracorporeal membrane oxygenation (ECMO) system in adult cardiac surgery is not routine, occurring in a minority of critically ill patients, typically postoperatively. Here we present our single centre experience of patients with post–infarct VSD managed preoperatively with ECMO support as a bridge to definitive surgical closure. Materials and methods Between February 2020 to July 2021, 5 patients presented to our unit with diagnosis of post–infarct VSD and were managed with preoperative veno–arterial (V–A) ECMO implantation and enrolled in our study. Clinical parameters (such as mean arterial pressure, central venous pressure, ECG, pulmonary artery pressure), blood tests, trans–thoracic and trans–esophageal echocardiography, chest X–rays have been evaluated both before and after surgery. Primary end–point was all causes in–hospital mortality.

Results
Three (60%) patients were male and mean age was 70,4 (60–78) years. All patients underwent surgical repair. ECMO was positioned between 1 and 9 days prior to surgical correction, giving the chance to reduce the pharmacological inotropic support while still reverting the MOF as demonstrated by the reduction of AST, ALT, bilirubin level, decreased CVP and systemic lactate levels. Two (40%) patients were successfully weaned off from the mechanical support and discharged home in good clinical conditions. Two (40%) patients developed MOF after surgery leading to the exitus.

Conclusions
We postulate that the use of V–A use preoperatively in patients with cardiogenic shock secondary to post–infarct VSD is appropriate and where feasible should be considered. It allows restoration of haemodynamic stability and resolution of MOF. This provides for a delayed surgical repair with a likely higher chance of operative success and reduced mortality.
P305 MULTIVESSEL SUBACUTE STENT THROMBOSIS
Authors: Carpinella G , D‘Andrea D , Furbatto F , Moscato R , Serino F , Mauro C 
Published: May 2023

Abstract
The presence of comorbidities such as psychiatric pathologies negatively influences the prognosis of patients with acute cardiovascular events. A 62–year–old male patient suffering from arterial hypertension, dyslipidemia, ischemic heart disease, treated 3 years earlier with PCI of LAD, Cx e RCA (EF 45%), and schizophrenia, is hospitalized with a diagnosis of NSTEMI. Coronary angiography shows: eccentric stenosis 70% proximal to the pre–existing stent in the middle LAD; Intrastent occlusion of the middle circumflex branch with omocoronary rehabilitation and ulcerated critical plaque in the proximal segment of the right coronary artery with mild intrastent restenosis in the middle. The patient refuses cardiac surgery, so angioplasty with ultra–thin drug–eluting stents is performed. The patient starts DAPT with clopidogrel, choosing a combination formulation to promote compliance, with discharge on the fourth day. Three days after discharge, the patient returns with anterior STEMI, with multivessel intrastent thrombotic closure (LAD, Cx, RCA), so angioplasty with paclitaxel–releasing balloon is performed on LAD and with NC balloons on the right coronary artery; impossibility to obtain total recanalization of the circumflex branch due to the non–transit of guides, even hydrophilic and of different weights. During angioplasty and for the following 12 hours, bolus and infusion of tirofiban is administered due to the high thrombotic burden. The choice of the second antiplatelet agent in this second procedure fell on prasugrel. The patient is discharged on the sixth day and a long conversation is held with his wife regarding the correct management of the home therapy. One year later, the patient a dual–chamber ICD was implanted at another centre, with correct and regular assumption of home therapy. Our case demonstrates an infrequent form of multivessel thrombosis during STEMI. The presence of schizophrenia influences negatively the evolution of the natural history of ischemic cardiopaty. The psychiatric substrate exposes to a greater number of cardiovascular events, given the reduced therapeutic compliance, also as regards the choice of appropriate therapeutic strategies. A joint path between the hospital, local medicine and the family environment would be desirable in order to correctly manage this type of patient.
P311 PULSED INFUSIONS OF LEVOSIMENDAN IN OUTPATIENTS WITH ADVANCED HEART FAILURE
Authors: Falletta C , Gaziano M , Lo Cascio M , Urso O , Floresta A , Scaccianoce M , Cicerone C 
Published: May 2023

Abstract

Background
Several non–randomized studies and small registries showed the efficacy of pulsed levosimendan infusion in relief of symptoms and preventing hospitalization in patients with advanced heart failure excluded by age or comorbidity from heart transplant program Aim of the study to describe the experience of pulsed levosimendan infusion in patient with advanced heart failure followed by the Division of Cardiology at "Villa Sofia" Hospital in Palermo Materials and methods we collected data of patient with adavced heart failure (NYHA III–IV) with reduced ejection fraction, who underwent pulsed levosimendan infusione at Division of Cardiology at "Villa Sofia" Hospital. Reduction of NYHA class, body weight and Nt–pBNP were examined as outcome indicators

Results
Between July 2021 an December 2022, fifhteen levosimendan infusion were made in five patient with advanced heart failure. Levodimendan was adminestered for a 24–hours infusion, as therapeutic day–hospital regimen. in the population of analysis, the following mean parameters were recorded at admission: NYHA class 3.2, furosemide dose 390mg, Nt–pBNP 10710pg/ml, body weight 72.8Kg, glomerualr filtration rate (GFR MDRD) 44ml/min. At discharge, the following mean parameters were recorded: NYHA class 2.1, Nt–pBNP 9225pg/ml, body weight 70.7Kg. One patient dead of sudden cardiac death during follow–up, one patient refused to continue treatment, the remaining three patient are still on treatment.

Conclusions
In our center experience, pulsed levosimendan infusion in patient with advanced heart failure determined an improvement of clinical and instrumental signs of congestion. Patients treated reported a subjective improvement of symptoms and of quality of life, also as a consequence of the reduction of the hospitalizations for heart failure. Although data ara scarce, they can be considered representative of a pilot experience of an integrated modality of assistance for patient with advanced heart failure, in which the sinergy between cardiology ward, a strict follow–up at the heart failure outpatient clinic are essential to obtain a good outcome in patient with such high complexity and frailty.
P313 AN UNUSUAL CASE OF SEVERE LEFT VENTRICULAR DYSFUNCTION: MILANESE ‘BREAKING BAD‘
Authors: Guareschi A , Pasero G , Galasso M , Calcagnino M , Gherbesi E , Palazzini M , Settepani F , Vicenzi M , Garascia A , Carugo S 
Published: May 2023

Abstract
A 39–year–old Filipino man was admitted for dyspnea and lower limb edema for about a month, in combination with stable cardiac enzymes movement (TnT 128&gt;78&gt;115 ng/dl), fluctuating unspecific inflammatory profile and hepatic impairment. Trans–thoracic echocardiography confirmed heart failure (HF) in a setting of eccentric left ventricular hypertrophy, diffuse hypokinesia and severe global functionreduction. Despite the absence of typical chest pain, the presence of cardiovascular (CV) risk factors (DMT2, smoking, dyslipidemia), previous alcoholism and the finding of widespread ventricular repolarization ECG changes seemed to suggest an ischemic or multifactorialorigin of the HF. After the finding of a critical trivascular coronary artery disease on coronarography and a pulmonary nodule on chest CT, the cardiac magnetic resonance (CMR) confirmed the diagnosis of severe dilated HF with evidence of a diffuse wall signal hyperintensity in STIR sequences and a intramyocardial and subepicardial patchy LGE pattern of non–ischemic meaning. The possible ischemic etiology was thus overlaid with an inflammatory disease, leading to assume sarcoidosis or myocarditis be the cause of HF. The main screening tests (ACE and immunologic–infectious profile) were negative a a PET/CT scan confirmed a diffuse cardiac inflammation with no focal hypercaptant lesions. Therefore, sarcoidosis was ruled out, and an endomyocardial biopsy (BEM) was performed, and resulted, however, inconclusive. Following, an unexpected finding revealed through a more scrupulous anamnesis: a long–time abuse of a methamphetamine (MDMA) prevalent in the Filipino community called Shaboo. This type of MDMA is accompanied by multiple CV system impacts, including MDMA–associated cardiomyopathy (MACM), a clinical picture compatible with the findings obtained by CMR and BEM performed. After discussion in Heart Team and therapeutic optimization, the patient was candidate for coronary artery bypass. Thus, with the correct diagnostic definition and treatment of HF triggers, an improvement in clinical and left ventricularfunction was marked (EF 45%). Monitoring will allow evaluation of the evolution of the changes found at CMR and will document eventually reversibility of MACM after protracted abstention from MDMA abuse.
P319 MID VENTRICULAR TAKOTSUBO SYNDROME IN A PATIENT WITH COVID 19 PNEUMONIA: A CASE REPORT
Authors: D’ Elia R , Pompa A , Ciccarelli M , Vecchione C , Galasso G 
Published: May 2023

Abstract

Background
Takotsubo Syndrome (TTS) is an acute and transient myocardial disfunction associated with chest pain, electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction but without significant coronary artery disease. Physical or emotional stress play a central role in the pathogenesisof this cardiomyopathy. Several variants have been described including the classic type, reverse Takotsubo, midventricular type and focal type. Mid ventricular Takotsubo is characterized by circumferential mid–ventricular hypokinesia with hypercontractility of base and apex. This atypical variant is one of the most rare form that occurs in 15% of patients with Takotsubo syndrome. We report a Takotsubo case with mid–ventricular pattern in a postmenopausal woman with COVID–19 interstitial pneumonia.

Clinical case
A 56–year–old female patient was admitted to our intensive cardiac care unit for acute chest pain and dyspnea. In clinical history hypertension, dyslipidemia, anemia and schizophrenia were documented. COVID–19 molecular test was positive. CT scan showed multiple ground–glass opacities bilaterally. Hemodynamic parameters were normal but ECG showed ST–segment elevation and T waves inversion in the lateral precordial leads. Troponin–I was elevated and peaked at 1704 ng/mL. A transthoracic echocardiogram showed ballooning of the midventricular segments with hyperkinesis of the basal and apical segment. Coronary angiography showed normal coronaries. The patient was treated with beta–blockers and intravenous fluid infusion. After 10 days in hospital, echocardiography showed normalization of regional contractility and improvement of ejection fraction. The patient was discharged in good condition.

Conclusions
Recent studies have reported an increase in TTS incidence during the COVID–19 pandemic. SARS-CoV-2 infection induces physical and psychological stress in patients, which may lead to an increase in the risk of TTS development. The pathophysiology of COVID-19-induced TTS still remains unclear. The mortalityrate of TTS is higher (36.5%) in COVID–19 patients.
P335 TEMPORAL TRENDS (2003–2018) OF IN–HOSPITAL AND 30–DAY MORTALITY IN PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE IN LOMBARDY
Authors: Trombara F , Marenzi G , Cosentino N , Leoni O , Poggio P , De Metrio M , Rubino M , Bonomi A , Oliva F , Agostoni P 
Published: May 2023

Abstract

Introduction
Limited and controversial temporal trend of in–hospital mortality of patients hospitalized with acute heart failure (AHF) have been reported. We evaluated whether, in AHF hospitalized patients, the rate of in–hospital and 30–day mortality, and 30–day re–hospitalization for AHF changed in the last 15 years.

Methods
We examined administrative data from Lombardy (∼10.000.000 inhabitants), Italy. We analyzed data of all adults hospitalized for AHF from 2003 to 2018 in Lombardy. Patients were stratified according to hospitalization period: 2003–2006; 2007–2010; 2011–2014; 2015–2018. The primary study endpoint was the comparison among periods of in–hospital mortality, while secondary endpoints were 30–day mortality and re–hospitalization for AHF temporal trends.

Results
During the study period, 414,164 patients were hospitalized with a primary diagnosis of AHF. The in–hospital and 30–day mortality in the entire cohort showed a progressive increase over time (from 6.7% to 8.5% and from 12.4% to 14.5%, respectively). Thirty–day re–hospitalization for AHF was 2% showing a progressive decrease across years. However, patient’ complexity, as inferable from number of comorbidities, increased in most recently hospitalized patients. After matching for age, gender, and admission ward, the study population included 78,884 patients in each study period. In the matched population, after further adjustment for major comorbidities, the risk of in–hospital and 30–day mortality and of the 30–day risk of AHF re–hospitalization progressively decreased from one period to the following one by 1% (95% confidence interval [CI] 0%–2%), 2% (1%–3%) and 10% (8%–12%), respectively.

Conclusions
In our study, the greater patients’ complexity largely accounted for the continuing rise in early mortality observed in patients hospitalized with AHF. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET).
P336 PROCALCITONIN AS PREDICTOR OF IN–HOSPITAL MORTALITY IN A CARDIOGENIC SHOCK POPULATION: A 10–YEARS SINGLE CENTRE RETROSPECTIVE STUDY
Authors: Belfioretti L , Marini M , Francioni M , Battistoni I , Angelini L , Pongetti G , Shkoza M , Matassini M , Paolini E , Piangerelli L , Patani F , Compagnucci P , Perna G 
Published: May 2023

Abstract

Background
Plasmatic procalcitonin (PCT) is an acute–phase inflammatory marker, its value tends to increase during inflammatory conditions such as septic shock, cardiogenic shock (CS) and bacterial infections. Patients with CS complicating acute myocardial infarction (AMI) and signs of systemic inflammatory response syndrome (SIRS) can show increased PCT values but its prognostic role in this setting is still unknown. Purpose: evalute prognostic role of plasmatic PCT in an ischemic CS population.

Methods
All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study. We evaluated PCT and C reactive protein (CRE) values in blood sample only in patients with clinical signs of SIRS or infection. Microbiological examination were also collected to exclude a bacterial infection.

Results
We included 167 patients [males 67%; mean age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 (3,1–8,8) mmol/L. All patients required inotropes while 91,1% required mechanical cardiac support (MCS). The overall in–hospital mortality rate was 46%. The PCT values resulted to be an in–hospital mortality predictor at multivariate analysis (p = 0,018) and we observed a generally lower PCT values in surviving CS patients (Fig 1). At the analysis the optimal maximum PCT cut–off value to predict in–hospital mortality was 5,77 ng/l (SE 0,82; SP 0,72, accuracy 0,78) with an area under the receiver operating characteristic curve of 0.80 (Fig 2). Moreover positivity to microbiological examination such as urine colture, blood colture, bronchoalveolar lavage and maximum CPR values were not associated with in–hospital death at univariable analysis.

Conclusions
in our retrospective study we found that PCT is an in–hospital mortality predictor and values greater than 5,77 ng/ml seem to be a good indicator of patients with poor prognosis in ischemic CS patients. High PCT values could have a role in indentifing CS patients with a intense SIRS or with a septic shock component which is associated with a even higher in–hospital mortality rate. The positivity to microbiological examination and maximum CPR values weren’t death predictors in our sample. Further studies in larger CS population could be advisable to better define prognostic role of PCT and evaluate its role in CICU daily clinical practice.
P338 PERFORMANCE OF THE SIMPLIFIED HEART FAILURE HYDRA SCORE IN PREDICTING ONE–YEAR MORTALITY: COMPARISON WITH HYDRA SCORE
Authors: Scicchitano P , De Palo M , Gesualdo M , Trotta F , Sanasi M , Piscopo A , Pignatelli A , Pinto M , Caldarola P , Massari F 
Published: May 2023

Abstract

Aims
We have recently proposed a new prediction model for risk mortality based on four parameters of congestion to predict mortality in patients with acute or chronic heart failure. This risk model (HYDRA Score, HS) is based on the number of parameters of congestion above significant cut–offs (range 0–4): BNP &gt;441 pg/mL, estimated plasma volume status (ePVS) &gt;5.3 dL/gr, bioimpedance vector analysis (BIVA) &gt;73.8%, and BUN/creatinine ratio (BUN/Cr) &gt;25. As bioimpedance vector analysis is a measure of peripheral congestion but it is not frequently used in clinical practice, we evaluated the performance of the risk model by including the presence of peripheral edema in place of BIVA (HYDRA Semplified Score, HSS).

Methods and results
We analysed data from 436 HF patients. During a one–year follow–up 81 patients died (18.6%). Discrimination for all–cause mortality was compared by Harrell‘s C–statistic. Calibration was assessed by Hosmer–Lemeshow test and global performance by Nagelkerke‘s R2. Correlation between scores was assessed by Spearman rank test. Correlation between the scores was good (rho = 0.91, p&lt;0.001). The two risk models showed similar results in terms of discrimination analyses (HS 0.786 vs HSS 0.760; p=0.09) and global performance (R2 = 0.26 and R2 =0.21). The Hosmer–Lemeshow goodness–of–fit test demonstrated the best calibration of HS risk model (χ2 6.5, P=0.60 for HS model and χ2 7.7, P=0.45 for HSS model).

Conclusions
Simplified HYDRA score seems a good and friendly model risk to predict one–year mortality in patients with heart failure and could be used as alternative to HYDRA score.
P339 LIGHT–CHAIN CARDIAC AMYLOIDOSIS WITH FULMINANT EVOLUTION, A NOT–SO–RARE CONDITION: THE IMPORTANCE OF EARLY DIAGNOSIS
Authors: Liberatore I , Terrinoni F , Occhiuzzi E , Imparato L , Sciarra L , Romano S 
Published: May 2023

Abstract

Introduction
Amyloid AL results from misfolding of immunoglobulin light chain (kappa or lambda) secreted by abnormal plasma cells such as in multiple myeloma. It is a rare, multisystemic disease with an estimated annual incidence rate of 6 to 10 cases per million inhabitans in Western countries. The prognosis of this hematologic neoplasm is guided by the extent of cardiac involvement; if untreated, survival rate is less than 6 months; with early initiation of chemotherapy treatment, median survival can range from 4 to 10 years, except for high–risk cases. Case report: 58–year–old patient presented to emergency department in May 2022 with the first syncopal episode and sphincter release. The patient had no cardiovascular risk factors. Echocardiografy showed markedly hypertrophic left ventricle with hyper–reflective walls with a granular–sparkling appearance. Electromyography revealed sensory–motor polyneuropathy, early–stage autonomic neuropathy and bilateral carpal tunnel syndrome. Implantation of a loop recorder was performed to investigate the cause of syncope. In suspected amyloidosis, the patient underwent electrophoresis, which showed no monoclonal peaks, serum and urine kappa and lambda light chains were negative. Bone scintigraphy showed no osteotropic radiopharmaceutical uptake in the heart. Cardiac magnetic resonance imaging (MRI) revealed biventricular hypertrophic phenocopy (concentric hypertrophy) with diffuse edema–like tissue alterations. The patient was asymptomatic. In August 2022, hematologic evaluation revealed a monoclonal band for lambda light chains in repeated immunofixation and bone marrow biopsy showed 9–10% monoclonal lambda plasma cells. The patient was referred to a specialized center for amyloidosis, where a biopsy of peri–umbilical fat was performed to confirm the diagnosis and initiate therapy. In October 2022, due to recurrent syncope, advanced atrioventricular block and extreme bradycardia at loop recorder, a dual–chamber pacemaker was implanted. A few days after discharge, the patient suffered cardiac arrest at home due to electromechanical dissociation and died, only 5 months after the first symptom.

Conclusion
AL amyloidosis is an aggressive hematological neoplasm, with cardiac involvement. Early diagnosis is crucial for timely initiation of therapy, which is the only means available to increase patient survival. It is important to maintain a high level of awareness and diagnostic suspicion for this condition.