bluuebunny/crossref_metadata_2025_split huggingface dataset:
P49 THE IMPACT OF MITRAL VALVE SURGERY ON VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH BARLOW’S DISEASE: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY
Authors: Ascione G , Azzola Guicciardi N , Boccellino A , Lapenna E , Palmisano A , Della Bella P , Esposito A , Agricola E , Alfieri O , Castiglioni A , Maisano F , Vergara P , De Bonis M 
Published: May 2023

Abstract

Background
Barlow’s disease is associated with malignant ventricular arrhythmias (VA) and sudden cardiac death. No definitive data are available on baseline arrhythmic burden and evolution of VA in pts undergoing mitral surgery for concomitant severe mitral regurgitation (MR), therefore we started a prospective, single–center study with these two aims. Materials &

Methods
From February 2021 to May 2022, 88 consecutive pts with severe MR and Barlow’s disease were admitted to our Institution for surgical treatment of MR and were prospectively enrolled in this study. All pts underwent 24–hour Holter monitoring before surgery. A subgroup of them (16 pts, 18.2%) also had either cardiac MRI or CT scan, to detect myocardial fibrosis. Sixty–three mitral repair pts completed 3 months echocardiographic and Holter follow–up. Significant arrhythmic burden was defined as &gt;= 1% premature ventricular beats (PVB)/24 h or at least one episode of non sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT) or ventricular fibrillation (VF). Preoperative, intra and postoperative variables were compared between arrhythmogenic (AR) and non–arrhythmogenic (NAR) pts.

Results
At baseline (88 patients): • 29 patients (33%) had significant arrhythmic burden (median 2000 PVB/24h) and 59 did not (67%, median 24 PVB/24h) • AR pts tended to be more often females with history of palpitations. Changes in VA were assessed in 63 mitral repair pts who completed 3 months follow–up. Among them, those with significant arrhythmic burden at baseline (20 pts) did not show significant VA at follow–up in 55 % of cases, while pts without relevant VA at baseline remained free from them in 81.4% of cases and worsened in 18.6% (8 pts).

Conclusions
In our experience, 1/3 of Barlow’s pts with severe MR, referred for mitral surgery, showed a significant arrhythmic burden.These pts more frequently experienced palpitations and were affected by polymorphic PVB, but no other differences were found in clinical or echocardiographic characteristics (including MAD prevalence) between AR and NAR subjects. Almost half of pts with arrhythmic burden at baseline were free from significant VA after mitral repair. However, a minority (18.6%) of subjects without arrhythmic burden at baseline experienced a significant PVB burden at follow–up. Our prospective study will continue to enroll pts to investigate in a larger sample with longer follow–up the role of MV repair on VA.
P58 SCREENING FOR SUBCLINICAL ATRIAL FIBRILLATION AFTER EMBOLIC STROKE OF UNDETERMINED SOURCE: A SINGLE CENTRE EXPERIENCE
Authors: Gaziano M , Mannino M , Migano A , Gasparro A , Bonocore M , Cicerone C , Lo Coco D , Terruso V 
Published: May 2023

Abstract

Introduction
Embolic stroke of undetermined source (ESUS) describes a stroke for which no cause has been found, which implicates embolism as a cause of stroke. There are several mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation (AF), hypercoagulable state or undiagnosed malignancy. As ESUS is associated with a significant stroke recurrence, a clear risk prediction and management is of utmost importance to improve prognosis. In ESUS, the options for further investigation include long–term cardiac monitoring, transesophageal echocardiography, investigation for occult malignancy or arterial hypercoagulability. Implantable cardiac monitors offer the capability to maximize the chances to detect AF and should be considered after non–invasive monitoring in patients with previous stroke at higher probability of having AF. Current guidelines do not suggest a specified approach (ie, blood, echocardiographic, ECG or brain imaging biomarkers) to screen AF in ESUS patients.

Methods
We enrolled consecutive patients with ESUS admitted to our Stroke Unit from January 2021 to October 2022.

Results
In the study period, 509 patients with acute ischemic stroke were admitted in our Stroke Unit. ESUS was diagnosed in 10.6% of patients (54/509). Only 12 of these patients underwent loop recorder implantation (mean age 76.5 y, 75% male), according to clinician judgment. AF was detected in 16.6% of these patients (2/12).

Conclusions
AF is one of the causes of ESUS; a recognition of AF in these patients is important, because its treatment can modify the risk of recurrence. A tailored diagnostic pathway, including clinical and echocardiographic parameters, is advisable to improve the recognition of this arrhythmia in ESUS patients.
P60 THE ELECTROPHYSIOLOGICAL DIAGNOSIS OF THE CRYPTOGENETIC STROKE
Authors: Altieri T , Dentico A , Ferrieri A , Carretta F , D'Agostino C , Carretta D 
Published: May 2023

Abstract

Introduction
In the neurological field, one of the pathologies not yet fully clarified from an etiopathogenetic point of view is cryptogenic stroke. This definition applies to all those forms of stroke in which clinical–instrumental investigations have not been able to define the "primum movens". In the literature, a significant percentage of cryptogenic stroke is the result of Paroxysmal Atrial Fibrillation (FAP). Currently the recognition of asymptomatic and rapidly evolving forms of AF can be investigated with the use of implantable electrocardiographic recorders (Loop Recorder or ILR) which increase the recognition rate of AF compared to standard investigations. The Loop Recorders, monitoring the electrical activity of the heart, are automatically activated and record the event. This data, thanks to a transmission system, as well as being stored in the memory of the recorder and therefore being interrogated, is sent to a central server which in turn transmits it to the control room which stores the patient and the events remotely.

Objectives
To diagnose the cause of the cryptogenic Stroke through the implantation of the ILR with long–term monitoring, up to 36 months.

Methods
All patients admitted to the Stroke Unit with cryptogenic stroke were evaluated with the ESUS SCORE. Patients who tested positive at the administration of the score underwent Loop Recorder (ILR) implantation for prolonged cardiac monitoring in the clinical suspicion of FAP as the cause of cryptogenic stroke. The results of such monitoring were documented along with the duration of hospital cardiac monitoring.

Results
A total of 210 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) were identified. Of the strokes, 22 (10.4%) were classified as cryptogenic. These patients underwent a Loop Recorder implant and were monitored for 12 months. 6 out of 22 patients (27.2%) were affected by atrial fibrillation and were treated with warfarin.

Conclusion
Continuous Loop Recorder monitoring changed the drug treatment of 27.2% of cryptogenic stroke patients due to intermittent AF detection despite no AF detection by electrocardiography and in–hospital telemetry monitoring.
P63 THE EQUIVOCAL AND DANGEROUS CLASSIFICATION OF STABLE CHEST PAIN
Authors: Cosmi D , Tarquini B , Mariottoni B , Cosmi F 
Published: May 2023

Abstract

Background
The classification of suspected anginal stable chest pain into typical, atypical, and non anginal is equivocal and may lead to patient perceptions and physician decisions that do not match the importance of the clinical picture. The study compares the clinical and ischemic burden with that of the cardiovascular risk.

Methods
Over 15 years, 3588 outpatients, &gt;35 years old (mean 64±9, female 55%) were evaluated for stable chest pain. 290 patients with findings indicative of ischemic heart disease, heart failure, cardiomyopathy, valvular disease were excluded. In the others we applied the classification of typical, atypical and nonanginal pain (Table 1). All were evaluated for the presence of HEART score risk factors (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non–anginal pain according to the doctor‘s judgment performed functional tests to search for ischemia.

Results
In Table 2 we find the results of the classification of chest pain and the positivity of the functional test. In Table 3 we have the major events at follow–up stratified according to the initial assessment of chest pain. Table 4 stratifies events according to risk factors and age. Prognosis and event rate differ significantly only when stratified by risk factors and age. Approximately 1% presented a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. 9% of heavy smokers aged &lt;65 years had a major event and are the highest risk group with a peak of 12.5% ​​in those with atypical pain.

Conclusions
The traditional classification of stable chest pain is dangerous and misleading, both for the identification of ischemia and prognosis, which appears to be linked to the burden of cardiovascular risk and above all to cigarette smoking in patients aged &lt;65 years, rather than the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search for high–risk coronary lesions improves the prognosis with an added value with respect to the treatment of lifestyles and risk factors.
P71 SGLT2I IN THE REAL WORLD: DATA FROM THE PONTE (BRIDGE) HF PROJECT (PDTA FOR INTEGRATED TERRITORY HOSPITAL FOLLOW–UP OF PATIENTS WITH HEART FAILURE)
Authors: De Gennaro L , Iacoviello M , Grande D , Bulzis G , Cataneo L , Citarelli G , Correale M , De Masi G , Donadeo V , Di Stolfo G , Ferraretti A , Galgano G , Gioia I , Leone M , Malerba L , Marazia S , Minielli V , Petruzzi P , Potenza A , Rizzo C , Ruggiero M , Brunetti N , Caldarola P 
Published: May 2023

Abstract

Background
The DAPA–HF and the EMPEROR reduced trials showed that sodium–glucose cotransporter type 2 inhibitors (SGLT2i) dapagliflozin and empagliflozin, on best medical therapy, resulted in a reduced incidence of the combined primary outcome cardiovascular death and worsening heart failure (–26%) and a preventive effect on renal function decline. Based on this evidence, the 2021 ESC guidelines have included SGLT2i in class I recommendations in combination with angiotensin and neprilysin receptor inhibitors (ARNI) or ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB), beta–blockers (BB), and mineral corticoid receptor antagonists (MRA). However, the effect of adding SGLT2i in real–life patients is just partly known. The aim of the study was therefore to evaluate the impact of SGLT2i in a real world population of patients with heart failure and reduced left ventricular ejection fraction (HFrEF).

Methods
220 consecutive patients with HFrEF, treated with SGLT2i and with 6 months of follow–up already enrolled in the PONTE (BRIDGE) HF project (PDTA FOR THE INTEGRATED FOLLOW–UP IN THE HOSPITAL TERRITORY OF THE PATIENT WITH HEART FAILURE), a care model implemented in Puglia region (Italy) based on hospital–territory integration aimed at the optimized management of patient with HF after hospitalization, were considered for the study. Demographic, clinical, laboratory and instrumental characteristics and changes in NYHA class, creatinine, NT proBNP, loop diuretic dose, LVEF after initiation of therapy with SGLT2i were evaluated.

Results
The 220 enrolled patients (mean age of 62 years, 72% hypertensive, 38% diabetic, 67% with ischemic heart disease, 50% with ICD/CRT, 44% with atrial fibrillation, 5.6% in NYHA class I, 61% class II, 33% class III, mean LVEF 30±11%) were in treatment with BB in 93% of cases, with MRA in 94%, with ACE/ARB in 24% and with ARNI in 80%. At 6–month follow–up of, a reduction of patients in NYHA class III from 33 to 20%, an increase in patients in NYHA class II from 61 to 70%, and in NYHA class I from 5.6 to 10% were observed; the LVEF (30 vs 37.2%) and creatinine values (1.3 vs 1.5) increased significantly, while loop diuretic doses decreased (35 vs 97.5).

Conclusions
Data from patients treated with SGLT2i from real world seem to confirm the efficacy of this class of drugs already in a short term follow–up, with a positive effect on NYHA class, LVEF, and renal function.
P72 A CASE OF DRAMATIC HEART CHAMBERS REVERSE REMODELING AND DISEASE REGRESSION IN A PATIENT WITH HEART FAILURE AND END–STAGE RENAL FAILURE TREATED WITH SACUBITRIL/VALSARTAN AND SGLT2I: THE IMPORTANCE OF PUSHING THE BOUNDARIES
Authors: Mapelli M , Mantegazza V , Ferrari C , Cimino R , Maragna R , Pontone G , Palermo P , Amelotti N , Matteo S , Pepi M , Agostoni P 
Published: May 2023

Abstract

Background
Heart failure (HF) therapy has been disrupted by the introduction of 2 new prognostic–relevant drugs: Sacubitril/Valsartan and SGLT2i. However, the amount of evidence for guideline–directed HF therapies in the context of chronic kidney disease (CKD) is relatively modest, especially in advanced stages (e.g., on haemodialysis). Aim of this report is to describe the feasibility and the efficacy of HF medical therapy in a patient with naive HFrEF and CKD on haemodialysis. Case report: A woman in her 40’s, with no cardiovascular history, affected by polycystic kidney disease end end–stage CKD placed on hemodialysis for the previous 9 months, underwent a echocardiography (TTE) in 09/2021, as part of investigations for kidney transplantation. The TTE showed a picture consistent with dilated cardiomyopathy with reduced EF, severe left atrium (LA) dilation and moderate–to–severe mitral regurgitation (MR). Thus, the patient was temporarily suspended from the transplant list. She was on chronic diuretic therapy with high dose of furosemide (250mg b.i.d.), with a residual diuresis of 400–500 mL per day. An elective coronary angiography showed normal coronary arteries. A Cardiac Magnetic Resonance (CMR) confirmed the diagnosis of DCM with severe dilation of the left ventricle (LV), reduced EF and severe MR. A cardiopulmonary exercise test (CPET) showed mild functional limitation with no pulmonary vascular limitation. After a multidisciplinary evaluation involving HF specialists and nephrologists, the recommended quadruple HF therapy was started and gradually up–titrated during the following 10 months. Neither the hemodialysis protocol nor the diuretic therapy was changed throughout this period. No adverse events were observed (e.g., increased sessions or dialysis schedule, hyperkalemia, hypotension). During this timeframe, the patients was asymptomatic and a progressive and sustained decrease in N–terminal pro B–type natriuretic peptide (NT–proBNP) from 26356 to 1556 ng/ml was observed. We documented a significant amelioration in CPET and other laboratory parameters (sST2), as well as a consistent reverse remodeling of the left heart chambers and a significant reduction in MR grade.

Conclusions
We described a case of significant left heart chambers reverse remodeling and disease regression in a patient with end–stage CKD presenting with HFrEF treated with off–label optimized HF medical therapy. Further studies on hemodialyzed HF patients will be needed.
P80 EFFICACY OF DAPAGLIFLOZIN IN EARLY IMPROVEMENT OF QUALITY OF LIFE IN OUTPATIENT WITH CHRONIC HEART FAILURE
Authors: Di Tano G , Quinzani F , Fiini M , Pedrinazzi C , Magatelli M 
Published: May 2023

Abstract
Sodium glucose cotransporter–2 inhibitors reduce mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). As a consequence, they are recommended by the European guidelines as mandatory pillar for HFrEF treatment with a strong recommendation (IA). In order to confirm the quality of life improvement shown in prespecified analysis of randomised controlled trial, we administered the Kansas City Cardiomyopathy Questionnaire (KCCQ–12) to 21 patients treated with Dapagliflozin 10mg in an outpatient setting of four Heart Failure Unit of Val Padana Hospitals. Among 21 HFrEF patients included in the analysis 11 have had coronary artery disease, 12 had hypertensive or dilatative cardiomyopathy etiology. The average age of our population was 73 yrs (54–89), 67% were male and 33% female, every patient were in NYHA II class and average BNP was 315 pg/mL. All the patients received Dapagliflozin for the entire observation period without any discontinuation for adverse event or intolerance. Every patient received KCCQ–12 questionnaire twice: at Time 0 when the first dose of Dapagliflozin was administered and after 3 months (Time 1) to verify the variation of the score. During the follow–up different therapy or dose regimen change has not occurred, as baseline therapies were already optimized. Only one patient changed furosemide dosage, reduce it from 75 to 50 mg/die without significant changes in body weight. After 3 months from the first administration of Dapagliflozin the KCCQ–12 summary score has increased by 10,27 points (from baseline avg value to 57,89 – 22% increase (Figure 1). Each of the single components of the score (physical limitation, symptoms frequency, QOL single score, social limitation) had increase in a consistent way from baseline values (Figure 2) In conclusion our data from an outpatient setting of real–world chronic HF population confirm the results of secondary analysis of the Trials and show that adding Dapagliflozin to the standard of care therapy leads to an early improvement in quality of life and physical limitations as quantified by KCCQ–12 questionnaire results. Furthomore, the KCCQ–12 seems to be a reliable and a useful health status instrument to evaluate the performance of HF outpatients, especially to test the benefits of new therapies.
P90 CAMPYLOBACTER JEJUNI–ASSOCIATED MYOCARDITIS: A RARE BACTERIAL TRIGGER OF ACUTE MYOCARDITIS
Authors: Ruffino E , Coppini L , Ferraro I , Giordana F , Coletta G , Desalvo P , Baralis I , Talenti A , Rossini R 
Published: May 2023

Abstract

Introduction
Acute myocarditis is an important cause of chest pain in the young, with potential acute arrhythmic and hemodynamic complications and possible evolution into chronic inflammatory cardiomyopathy. Even though multiple triggers can be recognized, bacterial infections are rarely associated with myocarditis in immunocompetent patients.

Case report
A 22–year–old Caucasian woman presented to the Emergency Department with stabbing chest pain exacerbated by breathing, for several hours, without fever. She experienced diarrhea and gastroenteric symptoms for 4 days. One year prior she experienced identical pain during an acute myocarditis episode, with no clear trigger. The patient’s father too suffered from myocarditis a few months earlier. She underwent routine blood tests with evidence of elevated troponin HS (peak 8000 ng/L) and PCR (82mg/L). ECG showed sinus rhythm and anterolateral concave ST elevation of a maximum of 2 mm. Echocardiography showed normal bi–ventricular dimensions, thickness, regional motion, and absence of pericardial effusion. MRI exhibited inferolateral subepicardial edema and late gadolinium enhancement (LGE). The previous MRI performed 6 months after the resolution of the previous myocarditis did not show any LGE or edema. We began empirical anti–inflammatory therapy with swift benefit. Due to the persistence of gastroenteric symptoms, fecal film array and coproculture were performed and resulted positive for Campylobacter Jejuni, treated with Azithromycin 500 mg/day for 3 days. Finally, considering the recurrent event and the family history of myocarditis in the father, a genetic test was planned to exclude a “hot phase” in the context of arrhythmogenic cardiomyopathy.

Discussion
Up to 80% of acute myocarditis has an infectious trigger. The recent 2020 consensus advises against routine serology unless specific pathogens are suspected. In the literature, Campylobacter Jejuni is reported as a trigger of various inflammatory diseases, including acute myocarditis. We suggest investigating the presence of this bacterium in stool in case of active gastroenteric symptoms and adding targeted antibiotic therapy in case of active bacterial infection. Previous case reports excluded viral in myocarditis patients positive for Campylobacter. This may support C. Jejuni’s causal role and not as an innocent bystander.
P92 PERIMYOCARDITIS AS FIRST MANIFESTATION OF DYSTHYROIDISM: AN UNUSUAL CASE
Authors: Gualini E , Occhi L , Maida G , Dalino P , Pedrotti P , Gallone G , Gentile P , Casadei F , Giannattasio C 
Published: May 2023

Abstract
Thyroid and cardiovascular system are inextricably related and cardiovascular complications can occur in both subclinical and overt thyroid dysfunction. We report the case of a 42–year–old woman presenting with chest pain. She had a positive SARS–CoV–2 swab in June and she was hospitalised in suspicion of COVID–related pneumonia and pericarditis in July: treatment with ibuprofen and colchicine was started and patient was discharged. On July 26th, the patient came back to emergency department due to worsening chest pain and myalgias after therapy decalage. She had face edema and hoarse voice. 12–leads EKG was normal; echocardiography showed 8 mm pericardial effusion and normal ejection fraction. Blood testing revealed no inflammatory signs, a mild increase of Troponin (peak value 19.1 ng/L, n.v. 0–14) and a high value of CPK (peak value 2299 U/L, 464 U/L at time of discharge, n.v. 30–150). Moreover, she had a biohumoral profile of Hashimoto thyroiditis: severe hypothyroidism with increase in TSH levels (538 microU/ml peak value, 322 microU/ml at time of discharge, n.v. 0.27–4.2) and positivity to thyroid autoantibodies. The patient underwent a cardiac magnetic resonance imaging that was suggestive for acute perimyocarditis with biventricular diffuse myocardial edema, preserved biventricular function and mild–to–moderate pericardial effusion. Low dose L–T4 therapy was started together with liothyronine that was stopped after few days, once acceptable FT3 concentrations were obtained. At echocardiography control after 8 days, we registered a significant reduction of pericardial effusion (2 mm). Myocarditis is an inflammatory disease of the myocardium and it is predominantly mediated by viral infection. A rare cause of myocarditis is represented by dysthyroidism. In our case, the severe hypothyroidism seems to be the cause of myocardial and pericardial edema. The failure in diagnosis of this endocrinological disorder can determine a delay in specific therapy with possible serious cardiovascular manifestations. So, it would be reasonable to check the thyroid status of all patients presenting with myopericarditis, in the absence of another clearly identifiable aetiology. The role of to the prior SARS–CoV–2 infection in not certain in our case, but the quick recovery after specific endocrinological therapy suggests the low probability of perimyocarditis as SARS–CoV2 related manifestation.