bluuebunny/crossref_metadata_2025_split huggingface dataset:
P88 CARDIAC INVOLVEMENT IN FOUR NOVEL NESPRIN–1 GENETIC VARIANTS
Authors: Manai R , Dusi V , Pidello S , Angelini F , Bocchino P , Gallone G , De Lio G , Gobello G , Saglietto A , Castagno D , Anselmino M , Giustetto C , Callegari M , Deaglio S , De Ferrari G , Raineri C 
Published: May 2023

Abstract

Background
Nesprins are proteins encoded by synaptic nuclear envelope (SYNE)–1 and –2 genes, that concur, together with lamin A/C and emerin, to nuclear envelope function. Almost 140 disease–related variants were identified, mostly resulting in central nervous system and skeletal muscle disorders; only a few were associated with cardiomyopathy, mostly with relatively late onset and no specific arrhythmic profile.

Purpose
To describe cardiac involvement in 4 novel SYNE1 variants.

Methods
189 patients underwent genetic analysis in our center (2019–2022) for suspected genetic cardiomyopathy (TruSight Cardio panel, Illumina); 72% had a positive genetic report, including pathogenic/likely pathogenic or variants of undetermined significance (VUS). Among them, 4 (2%) males presented with a sole SYNE1 heterozygous VUS (figure).

Results
None had muscle or neurological involvement. Patients 1 and 2 had negative family history (FH) and underwent pacemaker implantation under 50 years old for high–grade atrioventricular block (AVB). Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) showed a mildly impaired left ventricular ejection fraction (LVEF) without oedema or fibrosis. During 3 and 6 years of follow–up (FU), several non–sustained episodes of fast ventricular tachycardia (VT) and of atrial tachycardia occurred. Patient 3 is a 55–year–old man with negative FH and a left bundle branch block (LBBB) known since the age of 45.In 2021, while playing football, he suffered a cardiac arrest due to ventricular fibrillation treated with two DC shocks; ECG showed first–degree AVB and LBBB; TTE and CMR revealed a mildly impaired LVEF without oedema or fibrosis. A subcutaneous ICD was implanted, which recorded 3 atrial fibrillation episodes in a 1–year FU. Patient 4 is a 49–year–old man, with FH of sudden death (mother’s brothers at 40 and 50 years) and of polycystic kidney, who underwent renal transplant. He had left anterior fascicular block and suffered 2 episodes of sustained monomorphic VT from the right ventricle treated with ablation. TTE and CMR showed mild LV concentric hypertrophy with normal LVEF, segmental abnormalities in right and LV strain, no fibrosis.

Conclusions
SYNE1 genetic variants were found to be associated with a complex cardiac phenotype, including early onset conduction disease, atrial and ventricular arrhythmias, and cardiomyopathy. Further studies are needed to determine the functional significance of the variants.
P91 MYOCARDITIS ASSOCIATED WITH CAMPILOBACTER J. INFECTION IN TWO BROTHERS: A COMMON FATE?
Authors: D’Arco G , De Angelis E , Ragosa N , Aloia A 
Published: May 2023

Abstract
Myocarditis is an inflammatory process of the heart muscle and represents a potential complication of different infectious and non–infectious pathogens. Bacterial infections are more rarely counted than viral ones among the causes of myocarditis and, for example, few cases of myocarditis associated with Campilobacter J. infection are described in the literature. J. Piero, 28 years old, arrives in ED for oppressive chest pain. He does not report any CV risk factors, he had diarrhea in recent days after eating chicken meat. CRP rise and increase in myocardionecrosis enzymes are found in blood chemistry; ECG within limits; echocardiogram: mild left ventricular dysfunction due to hypokinesia of the basal middle segments of the lateral wall (EF 50%). Giulio is hospitalized in the UTIC for suspected myocarditis confirmed in the study with CMR after 1 week according to the Lake Louisse criteria: myocardial edema and early enhancement in the lower basal site of the LV. A few hours later, Piero‘s brother, Giulio, also went to the ED for atypical chest pain and diarrhea; immediately undergoes a cardiological examination with subsequent hospitalization in the cardiology department with a diagnosis of: suspected myocarditis. In fact, even Giulio in the blood chemistry tests shows: increase in PCR and myocardionecrosis enzymes, albeit with an electrocardiogram and an echocardiogram within normal limits. The MRI performed after about one week shows myocardial edema in the lower lateral area of ​​the left side confirming the diagnosis of myocarditis. In both cases, a gastrointestinal film array was performed during hospitalization which highlighted the presence of Campilobacter J. as a pathogen present in the faeces and antibiotic therapy with azithromycin was started for both Piero and Giulio. The CMR of Piero and Giulio, performed in Follow up, shows: subepicardial post–inflammatory scar of the basal inferior lateral wall of the left ventricle withb persistence of a subtle late impregnation of modest entity. The presented clinical case involving two brothers with myocardial involvement after campylobacter J. enteritis supports a hypothesis of "genetic predisposition" at the basis of the myocarditis process. Subsequent clinical evidence and scientific studies are needed to evaluate the genetic background of myocarditis, which is still unknown today.
P95 A RARE CASE OF INFECTIOUS AORTITIS
Authors: Amato F , Mainardi C , Meneghin S , Graziano F , Licchelli L , Famoso G , Cacciavillani L , Pergola V 
Published: May 2023

Abstract
Aortitis is an inflammatory process affecting the arterial wall. There are infectious and non–infectious forms. While the non–infectious forms can be linked to arteritis of the large vessels, the infectious forms are a rare but fearful complication of infective endocarditis. In this case the most affected pathogenic species are gram positive bacteria such as streptococci and enterococci. An 81–year–old patient, hypertensive, with permanent atrial fibrillation, subjected to previous aortic valve replacement (with Intuity 27 mm bioprosthesis for severe stenosis in 2016) and with previous pulmonary embolism in 2021, was admitted to emergency department for oliguria and worsening ankle swelling in December 2022. The haemodynamic parameters at the hospital admission were stable. A transthoracic echocardiography was performed, which highlighted a vegetation of about 2 cm on the aortic bioprosthesis with mild stenosis and negligible intraprosthesis regurgitation. A cerebral and thoraco–abdominal CT angiography showed multiple thromboembolic outcomes involving the splanchnic vessels, kidney and spleen. The patient was then subjected to transesophageal echocardiography which highlighted the presence of vegetation on the bioprosthesis with diameters of 12x12 mm; moreover, aneurysmal dilatation of the aortic root was found with the presence, both anteriorly and posteriorly of the wall, of a thickening of about 1 cm which extended up to the sino–tubular junction. The patient‘s hospitalization was also complicated by intestinal subocclusion without urgent surgical indications.The patient‘s case was discussed collectively and it was decided, in the light of the high risk of intestinal ischemia (linked to the thromboembolic occlusion of the splanchnic vessels) not to subject the patient to cardiac surgery. In a recent publication of a case report with literature review, 12 cases were reported, all treated surgically, of which 2 died. Our patient, unable to undergo surgical therapy, represents the first case treated with medical therapy alone. To date, the patient is still hospitalized, in stable haemodynamic conditions, with a unfavorable long–term prognosis.
P97 AORTIC PSEUDOANEURYSM AS PRESENTATION OF INFECTIVE ENDOCARDITIS FOLLOWING VALVE IN VALVE TAVR: THE IMPORTANCE OF A MULTIMODAL DIAGNOSTIC APPROACH
Authors: Ciampi C , Ossola P , Grieco N , Di Matteo I , Musca F , Giannattasio C , Oliva F 
Published: May 2023

Abstract
Transcatheter aortic valve implantation complicated by infectious endocarditis (TAVI–IE) is an uncommon clinical event with a death rate of 24–46%. Despite several risk factors (young age, sex male, CKD, concurrent PM implantation, residual aortic insufficiency and valve–in–valve implantation) have been reported, the identification of this clinical scenario remains a diagnostic challange due to less sensivity and specificity of echocardiography ascribed to possible imaging artifacts or to a localization of the infectious process that cannot always be evalueted.

Clinical case
Sixty day after TAVI valve–in–valve procedure, during a rehabilitation recovery, an 80 years old female patient presented intermitted fever with an elevation of flogosis index. In suspicion of urinary tract infection, antibiotic therapy with ciprofloxacin has been started and at the same time the patient has been transferred to our center. At the admission time a blood colture resulted positive for Staphylococcus epidermidis. A complete echocardiogram(TTE+TEE) has been performed and showed an aortic bioprothesis with normal morphology, position and shape and normal gradient at continuos doppler analysis(17/30 mmHg). The distal part of the ascending aorta has not been evalueted due to a masking phenomenon caused by prostetich cage artifact. Considering the high probability of infective endocarditis, a chest CT was performed and showed a 22x11x18mm pseudoaneurism in the extreme distal point of the cranial part of the prosthesis. Therefore, the patient underwent to an emergency cardiac surgery with replacement of the ascending aorta with a prosthetic graft and the aortic valve with a new bioprothesis. The diagnosis of infected pseudoaneurysm was confirmed by the hystologic examination and after 22 days since the intervention, the patient was transferred to the sending rehabilitation center with an indication to continue Daptomicin therapy, started during the recovery, for 6 weeks. Even with non–suggestive ecocardiographic evidence, the presence of positive blood colture test in patients with endocarditis risk factors, need a multimodal imaging approach to diagnosis (for instance, CT or PET) in order to provide prompt and appropriate therapy.
P106 AN INTRIGUING CASE OF INOCA IN THE CATH–LAB
Authors: Cosenza M , Cesari A , Vella C , Ghizzoni G , Ferri L , Russo F , Biondi F , Colombi R , Agricola E , Slavich M , Montorfano M 
Published: May 2023

Abstract
A 63–year–old woman presented to our Center for a longstanding history of typically radiating oppressive chest pain, with both resting and exertional episodes,mostly occurring early in the morning and exacerbated by cold.Two years before for a treadmill test positive for electrocardiographic (EKG) criteria of exercise–induced ischemia, she underwent coronary angiography which was found negative for epicardial obstructive coronary artery disease.Given the suspicion of coronary microvascular disease,empirical antianginal therapy with Ranolazine was started at that time,with transient improvement of symptoms. She presented to our Center for a 6 month history of recurrence of symptoms. Her antianginal therapy with Ranolazine was up titrated to 750 mg BID and Verapamil (40 mg TID) was added to her usual therapy given the suspicion of coronary vasospasm as additional component in the pathogenesis of her symptoms,as suggested by the anamnestic recall.Moreover a 24–hour–Holter monitoring was performed with subsequent finding of several episodes of horizontal ST–segment depression(up to 3 mm),mainly on awakening,in the absence of significant arrhythmias.The patient underwent coronary angiography for the assessment of coronary physiology. On angiography, the absence of epicardial obstructive coronary artery disease was confirmed, with the finding of extensive coronary fistulas originating from the left coronary system and communicating with the left ventricular cavity.After induction of maximal hyperemia, the clinical suspicion of coronary microvascular disease was confirmed (CFR 1.9).In addition, reduced coronary flow reserve in the left anterior descending (LAD) territory compatible with both microvascular dysfunction and coronary steal was documented (RFR 0.91;baseline FFR:0.94,after systemic adenosine:0.79).Given the clinical suspicion, vasoreactivity test with intracoronary acetylcholine (2–20–100–200 mcg) was also performed,which was positive for epicardial spasm at mid–distal LAD and concomitant onset of chest pain and ischemic EKG changes(diffuse ST–segment depression) with prompt regression after intracoronary nitrate administration.Taken together,clinical and instrumental findings suggested the diagnosis of mixed angina by combination of three mechanisms:microvascular disease,epicardial spasm and coronary steal due to extensive coronary artery fistulas.The patient was discharged with Ranolazine and Diltiazem at maximum tolerated dose with clinical benefit.
P108 FIVE YEARS RESULTS OF BIORESORBABLE VASCULAR SCAFFOLDS VERSUS CONVENTIONAL DRUG–ELUTING STENTS. A META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Meco M , Guido B , Fouladvand F , Agosteo E 
Published: May 2023

Abstract

Background
Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug–eluting stents (DES) by dissolving once they have restored lasting patency.

Objectives
Compare the safety and efficacy after five years, of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease in randomized controlled trials (RCT).

Methods
Data collection: We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated log–term results (at least 60 months) of BVS versus DES in patients underwent percutaneous coronary intervention. Outcome: The primary outcomes were target lesion failure (TLF), stent thrombosis, myocardial infarction, all–causes mortality, and cardiac mortality Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented odds ratios (OR) for dichotomous outcomes (Generic Inverse Variance random effect model) with 95% confidence interval (CI).

Results
Five full texts met inclusion criteria. A total of 4994 patients were included (2927 patients randomized to BVS and 2067 patients randomized to DES), Target lesion failure: At five years of follow–up, the number of TLFs was significantly higher in patients randomized to BVS (OR 1.23 (1.04–1.45) p=0.02). Stent thrombosis: at 5 years the number of stent thrombosis is significantly higher in patients randomized to BVS (OR 3.06 (1.93–4.87) p&lt;0.0001) Myocardial infarction: also in this case the number of myocardial infarctions is significantly higher in patients with BVS (OR 1.40 (1.13–1.73) p=0.002) All–cause mortality: there were no differences between the two groups (OR 0.89 (0.71–1.12) p=0.33) Cardiac mortality: no difference between the two groups (OR 0.81 (0.58–1.13) p=0.21.

Conclusions
Summary evidence from the included RCTs showed that DES are much safer and more effective than BVS in long term follow up.
P109 INTRAVENOUS CANGRELOR INFUSION IN PATIENTS UNDERGOING COMPLEX VERSUS NON–COMPLEX PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Scalamera R , Benenati S , Gragnano F , 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 compare the clinical characteristics and in–hospital outcomes of patients undergoing complex vs. non–complex percutaneous coronary intervention (PCI) with peri–procedural use of cangrelor.

Methods
Consecutive patients treated with cangrelor in 6 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high–bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Complex PCI was defined as any of the following: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length &gt;60 mm, or chronic total occlusion. 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
Among 551 patients enrolled in the ICARUS registry and undergoing PCI between January 2019 and August 2022, a total of 534 (97%) patients had complete information on PCI complexity, of whom 173 (32%) underwent complex PCI and 361 (68%) underwent non–complex PCI. In general, patients with complex PCI had similar clinical features compared with non–complex PCI patients, including comparable prevalence of high bleeding risk (HBR) status according to the ARC–HBR definition (35% vs. 30%, p=0.253), but complex PCI patients presented more often with cardiogenic shock (9% vs. 2%, p&lt;0.001). PCI with ≥3 stents implanted was the most frequent criterion of procedural complexity (62%). The incidence of the primary endpoint of 48–hour NACE (10% vs. 7%, p=0.264) and other clinical endpoints occurring at 48 hours or during hospitalization did not differ between complex and non–complex PCI patients.

Conclusions
Among patients receiving peri–procedural cangrelor, about 30% of cases underwent complex interventions. Notwithstanding higher procedural complexity, short–term clinical outcomes were similar between complex and non–complex PCI patients.
P112 CLINICAL OUTCOMES OF LEFT ATRIAL APPENDAGE OCCLUSION WITH CONSCIOUS SEDATION WITHOUT ANESTHESIOLOGIST ON SITE: RESULTS FROM A MULTICENTER RETROSPECTIVE STUDY
Authors: Bianco M , Visalli A , Tomassini F , Giacobbe F , Rolfo C , Cerrato E , Franzè A , Zanda G , Pavani M , Piedimonte G , Biolè C , Destefanis P , Palacio Restrepo S , Celentani D , Luciano A , Tizzani E , Chinaglia A , Varbella F 
Published: May 2023

Abstract

Background
Left atrial appendage (LAA) occlusion is an important therapeutic option to prevent cardioembolic stroke in patients with atrial fibrillation (AF) with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) under general anesthesia (GA). In this retrospective study we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without anesthesiologist on site.

Methods
We collected all the LAA occlusion procedures performed from October 2018 to May 2022. All the included patients underwent the procedure for OAC intolerance mainly due to bleeding with irreversible causes. All the procedures were performed with Watchman or Amulet LAA occluders under TOE and fluoroscopy guidance by two expert interventional cardiologists without anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl.

Results
One hundred and fifteen patients (age 76.4 ± 7.6 year) with non–valvular AF (median CHA2DS2Vasc 4.4 ± 1.4) were included in the study. CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl (mean dose 52.8 ± 19.6 mcg) in case of poor tolerance of the procedure despite midazolam. Acute procedural success rate was of 99.2%. One patient suffered a cardiac tamponade, urgent necessity of cardiac surgery and died 5 days after procedure. Two patients (2.6%) had anemia with need for transfusion after interventions. A patient (0.8%) suffered from oropharynx hematoma due to TOE. One case (0,8%) of vascular access site pseudoaneurysm occurred. One case (0.8%) of device thrombosis at 3 months TOE follow–up was reported. One procedure (0.8%) result in large leak device (³5 mm), confirmed at TOE follow–up performed at 3 months follow–up. No thromboembolic complications were reported. One hundred and fourteen (99.2%) patients stopped dual antiplatelet therapy within 12 months. In a follow–up of 10 ± 9 months one case of stroke (0.8%) and one case (0.8%) of transient ischemic attack (TIA) occurred.

Conclusion
LAA occlusion performed under CS and without the presence of anesthesiologist in cath–lab appear to be safe and effective. It can be an attractive alternative to (GA) because of lower medical staff needed and organizational effort required. In our retrospective study the success rate and the incidence of adverse events appear to be comparable with those of previous studies on the topic of LAA occlusion
P116 INTRACARDIAC ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE CLOSURE WITH WATCHMANN FLX DEVICE. A SINGLE–CENTER STUDY
Authors: Varotto L , Sembenini C , Dotto A , Bonanno C , Caprioglio F 
Published: May 2023

Abstract

Introduction
Intracardiac echocardiography (ICE–Abbot ViewFlex) is used increasingly as an alternative to transoesophageal echocardiography (TEE) to guide left atrial appendage closure (LAAC). ICE allows LAAC to be carried out under local anesthesia and can be performed by the interventional cardiologist, as sole operator. Previous works on ICE–guided LAAC are registry studies with self–reported data. We aimed to investigate the efficacy and safety of ICE–guided LAAC with the novel Watchman FLX device (Boston Scientific, Marlborough, Massachusetts) in a single–center study.

Methods
This is a rigorous study of patients undergoing LAAC with the Watchmann FLX device. Procedures were guided by ICE from left atrium with local anesthesia. Atrial fibrillation (AF) patients with CHA2DS2VASc score ≥2 and a clinical indication for LAAC were eligible for the study. Procedural preplanning with either cardiac CT or TEE within 7 days prior to LAAC was mandatory, to exclude the presence of LAA thrombus. ICE was used to guide the transseptal puncture and intraprocedurally was carried out with a single transseptal access directly from the left atrium to guide the procedure and device implantation. The primary outcome was the rate of significant peri–device leaks (&gt;5 mm) at 45–days TEE. Safety outcome was a composite of periprocedural complications.

Results
Twenty–four patients were enrolled over 2 years. Mean age was 75±8 years, CHA2DS2VASc score 4.0±1.3 and HASBLED score 3.4±0.9. The incidence of the primary outcome of significant peri–device leak (&gt;5 mm) was 0,04%; all patients had effective LAAC at 45–days. All patients had a Watchman FLX implanted and technical success was 100%. The number of devices per case was 1.0±0.2. ICE successfully guided assessment of device release criteria, including mean device compression of 21%, which was within the recommended 10–30% range. No subject required conversion to TEE. The only procedural complications were 3 access site bleeds. There were no episodes of stroke, transient ischemic attack, systemic embolization, pericardial effusion, device embolization or device–related thrombus during the procedure or 45–days follow–up.

Conclusions
ICE can be used to successfully guide LAAC with Watchman LFX with excellent procedural success, a high rate of effective LAAC and minimal peri–procedural complications. The efficacy and safety results are comparable to those reported for TEE–guided Watchmann FLX implantation.