bluuebunny/crossref_metadata_2025_split huggingface dataset:
P441 CARDIO–VASCULAR RISK STRATIFICATION IN T2DIABETES IN ITALY AND USE OF NEW DRUGS (SGLT2I AND GLP1–RA):DATA FROM THE AMD ANNALS:
Authors: Manicardi V , Russo G , Rocca A , Rossi M , Suraci C , Pintaudi B , Di Cianni G , Di Bartolo P 
Published: May 2023

Abstract
The AMD Annals are an initiative of computerized data collection by the Italian diabetes services, to evaluate the quality of the care provided to people with Type 1 and Type 2 Diabetes (T2D), which has been taking place for 15 years now. In 2019 the ESC/EASD Guidelines stratifying Diabetics according to cardio–vascular risk (CV) and the latest national (July 2021) and international Guidelines (LG) put new drugs with high cardio–renal protection at the forefront, such as the SGLT2i and the GLP1–RA: the ANNALS 2021 extracted the data of the year 2019, pre–pandemic, and the collection of the year 2021 is underway. AIM OF THE STUDY was to stratify T2D according to CV risk and to evaluate the prescribing appropriateness of the new drugs according to the Italian guidelines (ISS–AMD–SID).

Design and Methods
The 282 diabetes centers who sent the data are equipped with information systems able to guarantee the standardized extraction of the information necessary for the creation of the AMD Data File. The data analyzed concern socio–demographic, clinical and volume of activity characteristics: 46 indicators based on Revision 8 of June 19, 2019 (AMD Annals website).

Results
The T2D seen in the year 2019 were 531732 (57.3% M and 42.7% F, 67.3% aged &gt; 65 years, and 32.9% aged &gt; 75 years). 6.5% were new diagnoses. All monitoring indicators, with favorable and unfavorable outcome, have improved compared to previous years: 52% of T2D have HbA1c &lt;= 7.0% (53 mmol/mol), 65% have LDL cholesterol &lt; 100 mg/dl, 53.2% have blood pressure values ​​&lt; 140/90 mmHg, 39.5% are obese. 29.1% have GFR &lt; 60 ml/min*1.73 m2 and 6.7% have GFR&lt; 30 ml/min. Use of drugs: further reduction to 16.7% of the use of sulfonylureas and glinides; stable at 32% insulin; new drugs are on the rise (DPPIVi: 22%; GLP1–RA: 15.9%; SGLT2i: 16.6%). Risk stratification according to the ESC/EASD classifies 20.8% of T2DM at high and 78.6% at very high CV risk and only 0.6% are at moderate risk, but only 32.5% of patients are treated with cardio–renal protection drugs.

Conclusions
The 2019 AMD Annals show an overall improvement in the quality of care provided, and a doubling of the use of new drugs, but we are still far from the appropriateness of treatment according to the new Italian guidelines of 2021. We hope that the 2022 Annals campaign, which has just finished, will offer a change of roote
P451 PREDICTIVE VALUE OF INITIAL ASSESSMENT IN IDENTIFYING SYNCOPE TYPE (HYPOTENSIVE/BRADYCARDIA)
Authors: Ferrieri A , Dentico A , Altieri T , Carretta F , D'Agostino C , Carretta D 
Published: May 2023

Abstract

Introduction
Syncope manifests itself according to two main mechanisms: the hypotensive phenotype, in which the prevalent mechanism is represented by the reduction of blood pressure values, and the bradycardia phenotype, in which the reduction in heart rate prevails. The Tilt–Test plays an important role in the diagnosis and study of syncope. The request for tilt–test execution in the last 2 years has progressively increased, also in consideration of the closure of the syncope units present in peripheral hospitals and the covid–19 pandemic. The requests for tilt execution did not always appear to be appropriate or, in any case, the diagnosis emerged already evident at the initial evaluation. The purpose of the study is to evaluate the diagnostic value of the initial evaluation in identifying the type of syncope starting from the bradycardia/hypotensive phenotype, in order to select the patients who need to perform the examination.

Methods
The procedure followed by our center for all patients referring to the syncope unit consists in carrying out an initial evaluation, the clinical evaluation of the patient according to the GIMSI protocol, carrying out the head–up tilt test and carotid sinus massage, and, in certain patients, loop recorder implantation. In this study, the initial evaluations of 58 patients who underwent the tilt test were considered, making an assessment of the phenotype of each, which was subsequently compared with the actual result of the test.

Results
The evaluation parameters chosen were: the presence and type of syncope and prodromes before the test, traumatic and/or driving syncope, blood pressure and baseline heart rate. The patients who at the initial evaluation presented a hypotensive phenotype were 23, those with a bradycardia phenotype 24, while those with a mixed phenotype 11. We then went on to consider the results of the test performed, evaluated on the basis of the VASIS classification. From the data comparison we had a correlation of the phenotype in 72% of the patients, while in 28% it was not possible to predict the phenotype.

Conclusions
Through these data we can therefore see how the initial evaluation allows early identification of the type of syncope in 72% of patients, selecting the patients who actually need the examination to be performed, in the face of an ever–increasing request.
P452 VASOVAGAL SYNCOPE AND COVID–19
Authors: De Laura D , Lavolpe V , Mancini L , Campanella C , Resta M , Sassara M , Buquicchio F , Ligurgo L , Corriero F , Caldarola P 
Published: May 2023

Abstract
Scope. The aim of the study was to evaluate how the Covid–19 state of emergency affected the activity of the Syncope Unit (SU). During the lockdown, the outpatient activities of the SU were suspended(1). Materials. From March 2020 to March 2021, approximately 95 patients booked for the Tilt–up test were medically evaluated by teleconsultation and televiewer. Vasovagal syncope (VVS) (61%), orthostatic hypotension (OH) (5%) was diagnosed. The patients were trained, through television and video tutorials, in the use of counter pressure maneuvers (PCM) and tilt training, while dietary indications were provided and the importance of adequate oral hydration and the need to take, as recommended by the guidelines, 2–3l of water per day. We retrospectively observed the result at the end of the lockdown period: patients with VVS and OH called by the SU no longer needed to perform tilt up tests because they had obtained a significant reduction in syncope in 90% of cases.

Discussion
Reflex syncope is the most frequent, representing 21% of all types of syncope (2). Accurate history and physical examination are necessary for the diagnosis, sometimes a guided path in the SU in the unexplained forms. The indicated therapy is non–pharmacological (increase the salt and water content in the diet, avoid triggers, tilt training)(2) and, especially in young people, has been shown to prevent recurrences(2). Back pressure maneuvers (PCM) are effective in preventing syncope(3); oral hydration increases blood volume and improves symptoms(4).

Conclusions
The Covid–19 state of emergency, through the use of telemedicine tools, has made it possible to reach the diagnosis of reflex syncope through an accurate anamnestic evaluation, has allowed patients to be reassured about the benignity of the events and has motivated patients to implement the recommended non–pharmacological therapies. This has made it possible to reduce the number of tilt tests to be performed when the SU reopens.
P454 ARRHYTHMIC RISK AND REPOLARIZATION ALTERATIONS ON THE ECG UNCOVERED BY AN ISOPRENALINE TEST
Authors: Perniciaro V , Caccavo V , Di Monaco A , Katsouras G , Quadrini F , Romanazzi I , Sgarra L , Troisi F , Mangini F , Grimaldi M 
Published: May 2023

Abstract
A 62–year–old man came to our attention for a syncopal episode that occurred during a competitive race, without prodromes, lasting a few seconds, with total, spontaneous regression and without issues. On ECG sinus bradycardia, HR 46/min and QRS fragmented in V1. During monitoring were documented many polymorphic premature ventricular complex (PVC) and polymorphic nonsustained ventricular tachycardia (NSVT). Coronary angiography showed normal coronary arteries. The Isoprenaline test was performed (intravenous infusion of Isoprenaline 0.2 mg in 100 ml of physiological solution at variable speed until obtaining a HR increase of at least 20% compared to baseline). As HR increased, a clear epsilon wave in V1 became evident. Also documented numerous polymorphic PVC and polymorphic NSVT. Cardiac magnetic resonance (MRI) was performed with documentation of findings suggestive of primary cardiomyopathy with biventricular phenotypic expression with a clear left prevalence. All these elements placed the patient at high arrhythmic risk. An implantable cardiac defibrillator was then performed. The isoprenaline–induced increase in heart rate made the epsilon wave manifest, which is an expression of an extremely delayed depolarization caused by the fibroadipose replacement of portions of the myocardium (as documented by cardiac MRI). It was also possible to exclude a J–wave syndrome in which the alterations are of repolarization and are due to the epi–endocardial electrical gradient which increases and becomes more evident at lower heart rates. The test with isoprenaline has therefore allowed us to distinguish depolarization disorders from repolarization disorders and to direct us towards the former.
P460 HIGH RESOLUTION ATRIOGRAM ANALYSIS AS A PREDICTIVE TOOL OF ATRIAL FIBRILLATION IN STROKE PATIENTS
Authors: Rizzo M , Imperio G , Calcagnini G , Censi F , Urani C , Tanzilli A , Tanzilli G , Miraldi F , Strano S 
Published: May 2023

Abstract
In patients (Pts) with ischemic stroke in addition to acute management, it is essential to prevent new episodes, first identifying the source of the stroke event. The primary objective of the study is to determine whether the parameters of duration, morphology (divided into the three factors optimal model order fitting, number of maximum and minimum and zero–crossing), and variability of the P wave, calculated with appropriate algorithms from high resolution recordings, correlate with the risk of developing atrial fibrillation (AF) in ischemic stroke Pts. As a secondary goal we have analyzed the differences of factors that are currently used in clinical practice for risk stratification.

Methods
and materials : 63 Pts with stroke ischemic were recruited,8 Pts excluded for finding of other arrhythmias during hospitalization,5 for incomplete data, reducing the sample to 50. In the Pts was recorded EKG track in high resolution with the Cardionica(R) device. We obtained,with special algorithms above mentioned,the parameters of duration, morphology and variability. The population studies as stratified in two groups based to continuous ECG monitoring data: those with AF detected and those without AF (control group).

Results
in the analysis of the P wave we found a significant difference in the parameter "number of zero crossings", that is the number of times the P wave crosses the isoelectric line reversing its polarity, the average of which was 1,60 (0,69) in the group of Pts that then developed AF and 0,97( 0,66) in the control group, with a p–value&lt;0,01. Differences in the other parameters of the P wave didn’t reach statistical significance.

Conclusions
The search for other predictive factors that allows a better stratification of the risk of developing AF is crucial to optimize the prevention of new stroke events. The study showed that the hight resolution parameters of P wave morphology, is significantly associated with increased incidence of AF, therefore the analysis of the P wave is potentially useful in the assessment of the risk of developing AF after a first stroke event. A greater number of Pts and a long–term follow up could definitely confirm the better predictive parameter to stratify the AF probability among the other parameters of the P wave.
P461 ECG MONITORING TO DETECT ATRIAL FIBRILLATION IN PATIENT WITH CRYPTOGENIC ISCHEMIC STROKE
Authors: Bolognesi M , Guidetti D , Rossi L , Biagi A , Immovilli P , Aschieri D 
Published: May 2023

Abstract
Backgroound It’s Known that atrial fibrillation ( AF) is related to 20 % of ischemic stroke, but it is also found in one third of cryptogenetic, lacunar, atherotrombotic stroke. After stroke cardiac test are reccomended . 24 h holter ECG has a diagnostic yield about 1 – 5 % .Nowadays exists diagnostic test for ECG monitoring with a major diagnostic yield, but they are reccomended only in selected stroke patients

Methods
We considered consecutively 256 pazienti hospitalized in Neurology Division with ischemic stroke or transient ischemic attack ( TIA) from February to December 2022 recepient of 24 h or 72 h Holter ECG executed in Cardiology division. We evaluated AF registration, &lt; 30 sec atrial tachicardia ( TA) and cerebral lesions.

Results
Out of 256 patients, with average 77±19 anni years, 149 ( 58%)were males and 105 ( 42%) females with average CHA2DS2VAS 4. AF was detected from 24 – 72 h Holter ECG 24 h – 72 in 11 patients ( 3,9%)with average age 84 years and CHA2DS2VASC 5 . The effective diagnotic yield was 3,1%. Considering cerebral injury imaging of acute stroke iun patients with AF, 3 patient had cortical injury ( one of these with early Hemorragic infarction), 2 con lesioni cortico– subcortical lesions, 2 lacunar lesions e 3 without lesions. We found &lt; 30 seconds atrial tachicardia in 20 patients ( 8%) with average age 80 years e CHA2Ds2VAS 5 Cerebral lesions of these patients were : 5 lacunar lesions, 5 cortical lesion in multiple region, 3 cortico subcortical, 1 corticali, 2 lesions from atherotrombotic etiology, 4 without lesions

Conclusions
In out experience we confirm a 24 – 72 h Holter ECG low diagnostic yield to AF diagnosis more frequent in older patients with high CHA2DSAVSC score. Porolonged ECG monitoring can be considered in parients with cortico subcortical or cortical in multiple territories and with &lt; 30 seconds AT detected at 24 – 72 holter ECG .
P464 ELEVATED SPONTANEOUS INR: THE COMPLEXITY OF REAL LIFE BETWEEN CARDIOLOGY AND HEMATOLOGY
Authors: Prenna E , Maffè S , Paffoni P , Facchini E , Bergamasco L , Careri G , Franchetti Pardo N , Paino A , Ariotti S , Dellavesa P 
Published: May 2023

Abstract
Direct acting oral anticoagulants (DOACs) have guaranteed safety and convenience of use in anticoagulated patients. DOACs only require monitoring of hepato–renal function. But how to handle a patient with persistently elevated INR (International Normalized Ratio) in the absence of anticoagulant therapy? We present the case of a 77 years old woman with hypertension and hypothyroidism. The patient was admitted to our division for high frequency atrial fibrillation with initial heart failure. The patient gradually improved with rate control therapy (metoprolol and digoxin) and a few diuretic therapy. The echocardiogram didn’t showed anything significant. Laboratory tests showed a persistently elevated INR, even after she achieved clinical stability. Liver funcion tests and abdomen echography were normal. Patient’s CHA2DS2–VASc risk score was 3 with indication to anticoagulant therapy. We opted for rate control therapy because, in the absence of a diagnosis, there was uncertainty as to start or not anticoagulation therapy, with the doubt whether the persistently high INR corresponded to real anticoagulation. We didn‘t want to expose the patient to bleeding risks by initiating a DOAC. Blood tests showed mild to moderate factor X deficiency with prolonged dRVVT (diluited Russel Viper Venom time) but normal aPTT (activated partial thromboplastin time). Factor X (FX) deficiency is a rare hereditary bleeding disorder characterized by decreased antigen and/or activity of FX leading to mild to severe bleeding symptoms. Severe congenital form manifests itself early while heterozygous patients are often asymptomatic. Indeed, no previous literature data are reported about use of DOACs in this kind of patient. In mild to moderate FX deficiency there are no known contraindications for the use of anticoagulant therapy. According to the hematologist we started low–dose dabigatran, the only DOAC that acts by directly inhibiting thrombin. Regular 6 months follow–up. In conclusion this case was particularly challenging because of the lack of indications about how to manage these patients. The complexity of patients in real–life goes beyond the guidelines, which must therefore be adapted to the individual case
P466 PREDICTORS OF RECURRENT CEREBRAL ISCHEMIA AFTER PATENT FORAMEN OVALE CLOSURE: A SINGLE CENTER EXPERIENCE WITH A LONG–TERM FOLLOW–UP
Authors: Gurgoglione F , Cattabiani M , Vignali L , Solinas E , Dizdari C , Benatti G , Tadonio I , Barocelli F , Tuttolomondo D , Nicolini F , Ardissino D , Niccoli G 
Published: May 2023

Abstract

Aims
Transcatheter patent foramen ovale (PFO) closure has been shown to lower recurrent stroke in patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) with an indication for closure. However, the incidence of recurrent stroke is not negligible and underlying pathogenic mechanisms remain largely unknown. We sought to evaluate the prevalence of recurrent CS/TIA and to assess its predictors after transcatheter PFO closure.

Methods
We enrolled consecutive patients who underwent PFO closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2006 and 2021. For each subject, CS/TIA index event was diagnosed after exclusion of alternative etiologies, PFO features were characterized by transesophageal echocardiography (TEE), the Risk of Paradoxical Embolism (ROPE) score was retrospectively assessed and the presence of migraine was investigated. Clinical follow–up was scheduled with outpatient visits at 3 – 12 months and yearly thereafter device implantation; the primary outcome was the recurrence of any ischemic neurological event.

Results
We enrolled a total of 169 patients with mean Risk of Paradoxical Embolism (ROPE) score at hospital admission of 6.4 ± 1.5. The primary indication for PFO closure was previous CS (94 [55.6%] subjects), followed by TIA (75 [44.4%]). Among patients with complete outcome data (n= 154), after a median follow–up of 112 months, recurrent cerebral ischemia occurred in 13 [8.4%], with an annualized rate of 0.92/100 patients. The presence of obesity [OR 5.268, p = 0.018], ROPE score &lt; 7 [OR 5.991, p = 0.035] and migraine [OR = 5.932 p = 0.012] were independent positive predictors of recurrent stroke/TIA after PFO closure.

Conclusion
In our study, recurrent cerebral events after PFO closure were not negligible, with an annualized rate of 0.92/100 patients, consistent with prior research. Multiple heterogeneous predictors were identified: the presence of obesity, ROPE score &lt; 7 and migraine were independent positive predictors of recurrent stroke/TIA after PFO closure
P474 A PIVOTAL ROLE OF THE MULTIDISCIPLINARY TEAM IN THE BRIDGING THE PATIENT TO HEART TRANSPLANTATION
Authors: Domanskaya E , Enea G 
Published: May 2023

Abstract
The complexity of care of the patients affected by advanced heart failure (AHF) requires a dedicated team led by cardiologists and consists of nurses, physical therapists, patient care coordinator, nurse educator, dietician, anesthesiologists, and perfusionists. Multidisciplinary team “ has been shown to reduce the risk of hospitalization, death, and health care costs in randomized controlled trials”1. AHF is characterized by the progressive worsening of the clinical conditions of the patient unresponsive to the optimal medical therapy. Therefore, the short–term mechanical circulatory supports as Intraaortic Balloon Pump (IABP) may represent a valid strategy for optimizing and bridging the patient affected by AHF to the heart transplant2. A 52 years old lady with the diagnosis of the AHF and associated cachexia and sarcopenia has admitted in emergency. Despite of the high dose of inotrope severe hypotension required a IABP support to provide an adequate organs perfusion. Left ventricular assist device therapy has been rule out: the patient originated from the other country lives alone so no caregiver may be designed and trained to provide a support during the period following the LVAD’s implantation. For over than 130 days the patient well tolerates a treatment with inotrope at low dosage under continuously IABP support without a complications. Dedicated nurse in collaboration with the physical therapist provide a self mobilization of the patient with ambulatory IABP that is favorable to strengthen the level of her autonomy during the pre–transplant period. The out of bed position was performed by patient every day maintaining an acceptable level of muscle trophism to make the cardiac transplant program attainable. The patient was ambulating during almost every day sessions of the physical therapy covering the distance about 260 meters. A comfort environment, a quality of sleeping and an unchanged sleep–wake cycle are factors that enhance the patient’s experience. After more than five months of hospitalization, the patient receives her new heart. Heart–failure associated cachexia and sarcopenia, one of the most critical issues in the patients with AHF were regressed as a result of intensive physical activity and regular mobility of the patient. Synergic effort and expertise of each member of the multidisciplinary team has been a significant impact to successfully bridges critically ill lady to her complete recovery after the heart transplantation.
P475 RECURRENT CORONARY ARTERY VASOSPASM COMPLICATED BY CARDIAC ARRESTS IN HEART TRANSPLANT RECIPIENT: AN UNUSUAL ENEMY
Authors: Tedeschi A , Palazzini M , Gentile P , Conti N , Ianni U , Perna E , D'Angelo L , Masciocco G , Foti G , Ammirati E , Verde A , Garascia A 
Published: May 2023

Abstract
Even if coronary vasospasm (CV) is considered a rare phenomenon in heart transplant (HT) recipients, during routine coronary angiography asymptomatic CV may be observed. We report the case of a 30–year–old male who underwent HT in 2007 for dilatative cardiomyopathy. He was maintained on tacrolimus and mycophenolate mofetil and had no significant rejection or coronary allograft vasculopathy (CAV) demonstration. In December 2020 patient presented with cardiac arrest preceded by angina. Coronary angiography demonstrated diffuse spasm of the right coronary artery (RCA) with resolution after intracoronary nitrate administration. An endomyocardial biopsy (EBM) revealed no signs of cellular rejection whilst cardiac magnetic resonance showed signs of acute rejection (Fig.1). Moreover, two major histocompatibility complex (MHC) Class 2 donor–specific antibodies (DSAs) were positive with a high title. Treatment for antibody–mediated rejection (AMR) was initiated with steroids and plasmapheresis, followed by immunoglobulin infusion. Cardiac defibrillator was implanted before discharge. In August 2021, patient experienced a second cardiac arrest. Left heart catheterization found diffuse CV and after nitrates administration, proximal critical stenosis of RCA was pointed out and treated with stent insertion (Fig. 2–3). EMB and DSAs assessment were both negative. The patient was discharged after medical therapy optimization for CV prevention including the switch from mycophenolate to everolimus. After two more episodes of ACS with angiography finding of CV we decided to empirically treat the patient with weekly photopheresis sessions. Despite aggressive AMR management, a third ACC occurred in March 2022. The patient was finally reintroduced to the HT waiting list. Most CV episodes run without any symptoms due to the denervated heart post–transplant so probably re–innervation occurred in our patient. Calcium channel blockers, nitrates, and beta–blockers failed in CV prevention, suggesting ineffectiveness in HT recipients because of a different pathogenetic mechanism when compared to healthy subjects. Furthermore, documentation of coronary disease progression after the second ACC supports the hypothesis that CV could be the first manifestation of CAV. An intriguing hypothesis would be the presence of pathological vasoreactivity in the donor‘s heart, ascribable to an “inherited” endothelial dysfunction that could last be exacerbated by multiple factors, including AMR.