bluuebunny/crossref_metadata_2025_split huggingface dataset:
P341 ST. THOMAS NO. 2 BLOOD HYPERKALEMIC CARDIOPLEGIA AS A POSSIBLE CAUSE OF ACUTE ENDOTHELIAL INJURY IN SAPHENOUS VEIN GRAFT IN PATIENTS UNDERGOING ON–PUMP CORONARY ARTERY BYPASS GRAFT: SHORT–TERM RESULTS
Authors: Savino L , Giovannico L , D‘errico Ramirez A , Fischetti G , Santeramo V , Parigino D , Silva A , Milano A , Marraudino N , Bottio T 
Published: May 2023

Abstract

Introduction
Coronary artery bypass graft is considered the most frequently performed cardiac surgery and involves the use of different types of grafts: internal mammary artery, saphenous vein, radial artery. The venous graft is often subject to early failure due to various factors such as thrombus formation, intimal hyperplasia or formation of atherosclerotic plaques. Several studies have highlighted various mechanisms that may be responsible for these processes. This study aims to find a statistically significant correlation between the use of hyperkalaemic cardioplegic solutions and endothelial damage. Materials and methods For sample collection, saphenous vein segments were taken from each patient: one was taken when it was isolated to take the graft, and a second sample was taken after administration of St. Thomas no. 2 cardioplegic solution. Both collected specimens were stored in formalin and analyzed by light microscopy following hematoxylin–eosin staining and staining with monoclonal antibodies targeting CD31 and CD34.

Discussion
From the study with hematoxylin and eosin staining, it was observed that in the vein taken before the infusion of cardioplegia, the endothelium was present, continuous, clearly visible and without lesions. In the specimens taken after the infusion of hyperkalaemic cardioplegic solution, it is noted that the endothelium, although present, is more difficult to visualize and is discontinuous to a variable extent from 20 to 60%. This reduction in the percentage of visible continuous endothelium was confirmed by analysis with CD31 and CD34 immunohistochemical stains. Previous studies already confirm that the venous endothelium is affected by a high concentration of potassium, producing acute and chronic lesions. This result would seem to demonstrate how the endothelial tissue is also susceptible to hyperacute damage following short–term exposure to potassium.

Conclusions
The short–term results of this study would seem to confirm the initial hypothesis of a relationship between the use of hyperkalemic cardioplegia and the formation of acute or hyperacute lesions in the saphenous vein graft at the endothelial level. This conclusion could be one of the explanations of the high failure rate of the venous bypass, which in fact has a 10–year occlusion rate of 60/65%.
P342 DEL NIDO VS SERVATOR H CARDIOPLEGIA
Authors: Rosciano A , Paduvakis I , Cerillo A , Stefano P 
Published: May 2023

Abstract

Background and aim
One–shot long–lasting cardioplegia is particularly useful during right minithoracotomy mitral valve surgery (RT–MS), and the Servator H cristalloid solution has been widely used in this setting. However, the Servator H cardioplegia requires the administration of large volumes of fluids and the frequent recourse to ultrafiltration. we compared Servator H versus the Del Nido Cardioplegia, that contains blood and requires smaller volumes, in patients undergoing RT–MS.

Methods
36 consecutive patients undergoing RT–MS (± tricuspid and AF surgery) were randomly assigned to receive Servator H or Del Nido Cardioplegia. There were no differences between the two groups at baseline.

Results
Although there were no differences in terms of mortality and incidence of major complications, the use of Servator H cardioplegia was associated with a significantly increased release of CK–MB (but not of TnI) during the early postoperative period. Moreover, patients receiving Servator H were more likely to require defibrillation or pacing after removal of the aortic cross–clamp (8, 40% vs 2, 12.5%), and experienced a significantly higher rate of postoperative atrial fibrillation (10, 50% vs 4, 25%, p &lt; 0.05).

Conclusion
Our data show that the Del Nido cardioplegia could offer improved myocardial protection during minimally invasive mitral valve surgery, resulting in reduced need for post–cardioplegia defibrillation and of postoperative atrial fibrillation. This is consistent with the results of similar, recent research. Further studies on larger populations are needed to consolidate these data.
P347 SHORT–TERM EFFECTIVENESS OF TAFAMIDIS THERAPY IN PATIENTS WITH TRANSTYRETIN CARDIAC AMYLOIDOSIS: EVALUATION OF CLINICAL–INSTRUMENTAL AND BIOHUMORAL PARAMETERS
Authors: Ciaramella P , Ajmone F , Maggio E , Costantino J , Manguso G , Ballatore F , Magnocavallo M , Alfarano M , Vizza C , Chimenti C 
Published: May 2023

Abstract

Background
In the ATTRACT trial, Tafamidis has been shown to be effective in patients with transthyretin amyloidosis (ATTR) by improving quality of life and survival at 30–month follow–up. However, it‘s not clear which are the clinical–instrumental and bio–humoral parameters that change first and after how long time from the begging of treatment.

Methods
In our cardiomyopathy tertially referral center from January 2022 to October 2022, 47 patients with ATTR (73% males, 27% females, mean age 75±16 years) were admitted for the evaluation of the possible TTR treatment. Of these,30 received treatment with Tafamidis and 10 (M, mean age 77±11 years, 9ATTRwt, 1vATTR) completed a six months follow–up and constituted our patient population. The following parameters werecollected at baseline and after six–months follow–up: 6 minute walking test, Kansas score, NYHA class, NT–pro BNP,echocardiographic ejection fraction, 12 lead ECG with assessment of amplitude of QRS voltages, heart rhythm, presence of Q waves of pseudo necrosis, number of ventricular/supraventricular ectopic beats, presence of atrioventricular (AV) blocks, sinus blocks, hemiblocks, bundle branch blocks, QTc length, type and dose of additional medications.

Results
No patient changed the antiarrhythmic therapy during the six months follow–up, and no ventricular arrhythmias nor sinoatrial blocks were recorded. Two patients had pacemaker (PM) before the beginning of thetherapy and no PM was implanted during the follow–up. There was no significant difference in QRS voltage amplitude (p=0.157), atrial fibrillation (p=0.785), Q waves of pseudonecrosis (p= 1.000), ectopic beats (p= 1.000), AV blocks (p= 1.000), hemiblocks (p= 1.000), bundle branch blocks (p= 1.000), QTc (p= 0.813), ejection fraction (p= 0.317), NYHA class (p= 0.564), NTproBNP (p=0.273). Statistically significant differences were found in the Kansas score (p=0.042) and in the 6 minute walking test (p= 0.018).

Conclusions
Tafamidis is able to improve quality of life andfunctional capacity in ATTR patients early in the course of the treatment. The stability of the other parameters, that tend to fast worsen in the natural course of the disease, demonstrates the ability of Tafamidis to halt and possibly revert amyloidosis.
P354 REMOVAL OF CARDIAC AL–AMYLOID LEADS TO CARDIOMYOCYTE POSITIVE REMODELING AND RESTRICTIVE PATTERN REVERSAL
Authors: Maggio E , Ballatore F , Ajmone F , Manguso G , Verardo R , Ciaramella P , Vernile A , Alfarano M , Vizza C , Chimenti C 
Published: May 2023

Abstract

Background
Properly treated AL cardiac amyloidosis can have a long survival. However, the mechanism involved in arresting or reversing cardiomyopathy, such as toxic suppression of the light chain or removal of the amyloid substance, is still unclear. We describe the case of a patient with AL amyloidosis treated with chemotherapy in whom serial endomyocardial biopsies were performed at diagnosis and after 17 years.

Clinical case
A 71–year–old lady onset with a hypertrophic phenotype cardiomyopathy (maximum thickness LV 18.2 mm, diastolic dysfunction with E/A ratio 2.45. preserved contractility (EF 55%) and NYHA class 3) received a diagnosis in 2004 of AL amyloidosis and underwent several cycles of chemotherapy. At clinical onset, cardiac amyloidosis was documented by endomyocardial biopsy. After 17 years, in 2021, the patient was hospitalized for palpitations and chest pain and documented intermittent phases of atrial fibrillation. The patient was reevaluated with immunoelectrophoresis, echocardiogram, cardiac magnetic resonance, coronary angiography, and left ventricular endomyocardial biopsy. Serum monoclonal chain AL–K was reduced from initial 233 mg/L to 18.2 mg/L, vn&lt;19.4 mg/L. The echocardiogram showed reduction of the heart walls with reduction of the thickness to 14 mm, with regression of the restrictive pattern (E/A ratio from 2.45 to 0.5). Serum NT–proBNP decreased from 3188 pg/mL to 480 pg/mL (n.v.&lt;334 pg/mL). Cardiac MRI revealed normal myocardial wall thickness, with preserved systolic function, in the absence of the typical late gadolinium enhancement pattern. Histology and electron microscopy showed no more hypo/atrophic cardiomyocytes and the interstitium was almost completely devoid of amyloid fibrils, which were distant from the cardiac cell allowing an improvement in oxygenation and trophism.

Conclusions
Remission of monoclonal gammopathy is associated with a removal of cardiac amyloid deposits and with a regression of cardiac hypertrophy and restrictive pattern. Histologically, the degradation of amyloid fibrils determines a better trophism of cardiomyocytes.
P355 PATIENT–REPORTED OUTCOME MEASURES IN WILD–TYPE AND VARIANT CARDIAC TRANSTHYRETIN AMYLOIDOSIS: THE ITALY (IMPACT OF TRANSTHYRETIN AMYLOIDOSIS ON LIFE QUALITY) STUDY
Authors: Aimo A , Teresi L , Argirò A , Serenelli M , Carnevale Baraglia A , Picerni A , Ricordari R , Ponti L , Di Bella G , Cappelli F , Perfetto F , Merlini G , Vergaro G , Castiglione V , Fabiani I , Niccolai M , Severino S , Passino C , Emdin M 
Published: May 2023

Abstract

Background
Transthyretin amyloidosis (ATTR) is due to TTR tissue accumulation. Both patients without mutations in the TTR gene (wild–type ATTR, ATTRwt) and those with such mutations (variant ATTR, ATTRv) may develop cardiac amyloidosis (CA). ATTR–CA has a deep impact on the quality of life. The ITALY study aimed 1) to create the first patient–reported outcome measures (PROMs) for ATTRv– and ATTRwt–CA, 2) to assess the feasibility of their administration, 3) to investigate the relationship between score values, clinical and laboratory findings, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Short Form Health Survey 36 (SF–36) scores.

Methods
Five Italian referral centers were involved (Pisa, Pavia, Ferrara, Florence, Messina). Item selection involved expert clinicians and 2 groups of 10 patients. The questionnaires were administered to consecutive patients evaluated at baseline and 6 months.

Results
Two 30–items questionnaires were created. Each item has 5 answers graded from 4 (best option) to 0 (worst option). The score ranged from 100 (best condition) to 0 (worst condition). As of November 2022, 82 patients (65 ATTRwt–CA, 17 ATTRv–CA) have completed the follow–up. At baseline, 30% of patients needed help to fill the questionnaire, and 20% at 6 months; 65% completed the questionnaire at baseline and 63% at 6 months. At baseline, median score values were 64 (interquartile range [IR] 54–74) in ATTRwt–CA and 59 (IR 51–71) in ATTRv–CA. ITALY score were correlated with global KCCQ and SF–36 scores at baseline and 6 months (r values from 0.7 to 0.8 in ATTRwt–CA and from 0.5 to 0.7 in ATTRv–CA). In patients with ATTRwt–CA, all KCCQ and SF–36 domains were univariate predictors of ITALY score values at baseline. All the KCCQ and SF–36 domains were independently predictive of ITALY score values in models including age, NYHA class, 6MWT, NT–proBNP; these results were confirmed at 6 months. In ATTRv–CA, All the KCCQ and SF–36 domains were independently predictive of ITALY score values in models including LV ejection fraction, at baseline and at 6 months.

Conclusions
The ITALY questionnaires are the first specific PROMs for ATTRwt– and ATTRv–CA. They have been created by experts in CA and patients and validated in a multicenter Italian cohort with 2 assessments over 6 months. Questionnaire completion is usually feasible. ITALY scores display close relationships with non–ATTR–specific measures of quality of life (KCCQ and SF–36).
P357 DOES CARDIAC AMYLOIDOSIS EVER HIDE A SEVERE AORTIC STENOSIS A CASE REPORT
Authors: Piscione M , Polito D , Castaldo G , Bianco S , Crispino S , Nafisio V , Mallus M , Grigioni F , Parti F 
Published: May 2023

Abstract
Case presentation: A 89-year-old man, with an history of paroxysmal atrial fibrillation and chronic renal disease, was admitted to our ER for acute decompensated heart failure. He reported dyspnea on minimal exertion and worsening peripheral edema. He had a history of heart failure and a severe aortic stenosis first diagnosed in 2020 with an echocardiogram demonstrating a left ventricular ejection fraction (LVEF) of 30% and a low-flow low-gradient aortic stenosis (AVA=0,6 cmq, mean pressure gradient=21 mmHg). Besides, in 2019, he underwent a 99m Tc MDP scintigraphy for a prostatic nodule which showed important myocardial uptake of the bone tracer highly suggestive of cardiac amyloidosis. Urinary light chain assessment and determination of immunoglobulin light chain levels were negative for AL amyloidosis. The electrocardiogram showed: sinus rhythm, low voltage in the frontal leads and complete left bundle branch block with secondary repolarization abnormalities. The patient underwent transthoracic echocardiography for staging the severity of the aortic valve stenosis, which revealed borderline results: the aortic valve area was 0.5 cmq with a transaortic mean pressure gradient of 20 mmHg (EF 25%, with GLS of −5%). Low-dose dobutamine stress echocardiography was performed. At rest conditions, there was global hypokinesia with an ejection fraction of 24%. Aortic valve mean pressure was 19 mmHg referring to a calculated aortic valve opening area of 0,78 cmq. Under peak dobutamine stress (30 mcg/kg/min), LVEF increased to 36%. On the basis of these diagnostic findings, aortic stenosis was classified as pseudo-severe due to systolic dysfunction of the left ventricle with preserved contractile reserve. Besides, aortic calcium score of 574 confirmed that the aortic stenosis was non severe.

Conclusions
This case results exemplary of the fact that amyloidosis does not always hide a severe stenosis. Actually the echo with dobutamine indicates a non-valvular reason for heart-failure and no indication for valve replacement.The discharge suggestions consists of clinical/ echo follow ups and TTR stabilizers. Anyway, Tafamidis is not recommended because of the age and the patient short life expectancy. The implantation of CCM which, during the action potential platea delivers non-excitatory electrical currents and enhances systolic function in patients with heart failure, is proposed to obtain an improvement of symptoms.
P359 A POSSIBLE ROLE OF A NOVEL NUTRACEUTICAL COMPOUND FOR IBS IN TRIGLYCERIDES–LOWERING EFFECT
Authors: Natale F , Loffredo F , Molinari R , Alfieri R , Covino S , Mollo N , Limatola M , De Luca L , Pezzullo E , Cimmino G 
Published: May 2023

Abstract
In the last few years, growing evidence indicate that gut miocrobiome is linked to irritable bowel syndrome (IBS) and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have been also recorded. Triobiotix is a nutraceutical consisting of: maltodextrin; mineralized extract of Lithothamnion; Bioecolians® gluco–oligosaccharides; ferment mix; short–chain fructo–oligosaccharides powder. We analyzed the database of 40 Italian General Practitioners (GPs). A total of 587 patients with IBS and on Triobiotix were identified. Of these, in only 535 patients, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia. Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the TO evaluation. Triglycerides levels were also significantly decreased (186.37+66.4 vs. 176.13+67.9; p &lt; 0.05). Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL–C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low–moderate dyslipidaemia.
P361 SMALL INTERFERING RNA: REAL–LIFE DATA WITH A NEW FRONTIER IN HYPOLIPIDEMIC THERAPY
Authors: Bertani G , Mugnolo A , Venturi G , Bacchion F , Morando G , Zamboni A 
Published: May 2023

Abstract
Inclisiran (Leqvio® 284 mg) is a new small interfering RNA that acts on the mRNA coding for the gene PCSK9. Inclisiran is indicated in adults with primary hypercholesterolemia (heterozygous familial and non–familial) or mixed dyslipidemia as an adjunct to diet alone or in combination with a statin or other lipid–lowering therapies in patients unable to reach LDL–cholesterol goals with the maximum tolerated dose of a statin, or alone or in combination with other lipid–lowering therapies in patients who are statin–intolerant/contraindicated. The drug is administered subcutaneously and should be performed by a healthcare professional. After the initial dose, a second dose is given at 3 months followed by every 6 months. Real–life data with inclisiran is very limited. Herein, we present real–life data on 6 patients with a mean age of 71 years who started therapy with inclisiran in September 2022 (Fig. 1). Three patients were receiving combined lipid–lowering therapy with a statin and exetimibe, 2 were on ezetimibe alone because they were statin–intolerant, 1 patient was not receiving any therapy because intolerant. All patients had high to very high cardiovascular risk according to current ESC guidelines, and the lipid target was not met on optimized oral lipid–lowering therapy. Following initiation of inclisiran, lipids were assessed at 1 week, and at 1, 2, and 3 months. Changes in serum levels of LDL–cholesterol are shown in Figure 2. Reduction in LDL–cholesterol was seen as early as week 1. The mean percentage reduction in LDL–cholesterol at 1 month was 50% in patients not receiving statin therapy and 40% in those receiving a statin. The greatest reduction in LDL–cholesterol was seen in patients receiving combined therapy with a statin and ezetimibe. There was a clear reduction in LDL–cholesterol regardless of the type of statin and dosage. All patients receiving combined therapy with a statin reached their lipid target within 1 week after the start of treatment. No adverse effects were observed in any patient. From these preliminary observations, in a real–life setting therapy with inclisiran therapy appears to be safe and effective in lowering LDL–cholesterol in patients with high cardiovascular risk, especially when given in combination with a statin.
P376 HIGH RISK PULMONARY EMBOLISM COMPLICATED BY CARDIOGENIC SHOCK
Authors: Sanguineti M 
Published: May 2023

Abstract
The case concerns a 62–year–old woman with no significant cardiovascular history. In October 2022 the patient had an acute diverticulitis hesitated in ostomy placement (Hartmann surgery). Post surgery was complicated by linezolid–resistant Staphylococcus aureus sepsis. During the hospitalization an incidental low risk pulmonary embolism was detected by CTPA. The patient was discharged with thrombohaembolic prophylaxis (subcutaneous LMWH) to be continued for one month. The day after the end of the prophylaxis (November 24th ) she came to the emergency room because of chest pain, dyspnoea, diaphoresis. Hypotension, tachycardia, metabolic alkalosis and increased serum lactate levels were present. CTPA revealed thrombi in both left and right pulmonary arteries, including main bifurcation branches. Compressive ultrasonography in left popliteal vein resulted positive. Due to recent surgery, although not entirely contraindicated, the patient was judged unfit for systemic thrombolysis and percutaneous catheter–directed treatment with Penumbra Indigo system was performed, with suboptimal result. The woman was therefore moved to intensive care unit due to worsening clinical conditions, and the following day a further percutaneous procedure was performed. During the days CTPA and laboratory data detected a great improvement, and reduction of inotropes, diuretic and high flow oxygen therapy was possible. Meanwhile there was a gain of function in right ventricular contractility, with final TAPSE value of 15, and S’ 8 cm/s. Oral anticoagulation with loading dose and rehabilitation therapy were started . The patient was discharged on November 9th in good health.
P379 A BIG MASS AROUND THE HEART: SHOULD I BE WORRIED?
Authors: Feneziani A , Cavallone E , Franco E , Moretti C 
Published: May 2023

Abstract
Lipomas account for about 10% of all cardiac tumors and symptoms are often secondary to the compression of cardiac chambers and the consequent hemodynamic impact. We report the case of a 76–year–old woman with no cardiological history, undergoing oncological follow–up for breast cancer underwent a left radical mastectomy in 2014, not followed by radiotherapy or chemotherapy, who came to our attention due to the identification at the total–body CT scan of a mediastinal mass. A voluminous intrapericardial formation was detected, with a maximum size of 5.4 x 8.6 cm, characterized by adipose attenuation values at baseline. On examination, the patient was asymptomatic and eupneic, in good hemodynamic compensation, in functional class NYHA I. The ECG showed sinus rhythm with regular atrioventricular and intraventricular conduction without significant alterations in repolarization. On the echocardiogram, the left ventricle appeared of normal size and thickness without alterations in the global and segmental systolic function, EF 65%; the right ventricle was regular in size and contractility; a voluminous pericardial mass of about 8 x 4.5 cm was observed in the inferior, posterior and lateral site, homogeneous, not vascularized, not compressing the cardiac cavities and not determining hemodynamic impact. The patient was then submitted to cardiac MRI which confirmed the suspicion of intrapericardial lipoma. Considering the absence of symptoms, the benign nature of the lesion and the absence of compression on the cardiac structures, we decided not to remove the mass and to continue clinical and radiological follow–up, thus monitoring size and symptoms.