bluuebunny/crossref_metadata_2025_split huggingface dataset:
P187 INCREASING ROLE OF REMOTE CONTROL AND OPTIMIZATION IN CARDIAC RESYNCHRONIZATION THERAPY
Authors: Caruso D , Setti S , Lercari F , Canonero D , Brunacci M , Agosti S , Parodi A , Merello M , Costa S , Camerini A 
Published: May 2023

Abstract

Background
Patients (pts) with heart failure and reduced ejection fraction (HFrEF) treated with resynchronization therapy (with or without defibrillator: CRT–D or CRT–P) require echocardiographic or device algorithms optimization for better clinical results. With remote control is further possible improve follow–up of these pts.

Methods
From 01/01/2019 42 pts treated with CRT (33 men and 9 women 30 CRT–D and 12 CRT–P) were split in 3 groups: 14 pts underwent optimization and remote control, 14 underwent optimization without remote control, 14 underwent remote control only with implant parameters.

Results
In the first group ejection fraction (EF) improved from 28 to 43% (p 0.0001)(median age 78.2 years) (y), 3 pts died (2 m and 1 w, for heart failure, neoplastic cause and pneumonia). In the second group (median age 83.3 y) EF improved from 29 to 45% (p 0.0001) 4 pts died (3 m, 1 w, all CRT–D 3 for heart failure and 1 for unknown causes). In the third group (median age 79.2 y) EF improved from 32 to 40% (p 0.012), 2 pts died (1 m and 1 w with heart failure). There weren’t relevant differences for device interventionts in the 3 groups (1 appropriate shock and 1 inappropriate shock for atrial fibrillation in the 1st group, 1 appropriate shock in the 2nd group, 1 appropriate shock in the 3rd group). In the groups with remote control a severe malfunction that needed immediate replacement of CRT and optimal elective replacement timing for 3 device were found.

Conclusions
Biventricular stimolation optimization with echocardiography and with device algorythm should be always utilized after CRT implant. In our work, although the number of pts is little, a better EF is obtained in the groups with optimization compared to the group only in remote control. In the COVID19 era early recognition of arrhytmias and malfunctions of device and of suboptimal biventricular stimolation is possible with remote control and could improve pts clinical conditions, hospitalization and survival. Further data need to evaluate if remote control can improve prognosis of pts with CRT–D and CRT–P.
P197 EFFECTS OF PCSK–9 INHBITORS ON ARTERIAL STRUCTURE AND FUNCTION: PRELIMINARY RESULTS
Authors: Maloberti A , Vatta A , Grasso A , Garofani I , Morelli M , Giani V , Fortuna M , Gualini E , Giannattasio C Prof 
Published: May 2023

Abstract

Background
One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. Purpose: To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid–femoral Pulse Wave Velocity – cf–PWV – and brachial artery Flow Mediated Dilatation – FMD) arterial properties.

Methods
Twenty–two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the Cardiology Rehabilitation of ASST Grande Ospedale Metropolitano Niguarda Hospital (Milan, Italy). Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf–PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months).

Results
In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p&lt;0. 0001) while there was no significant difference in arterial parameters (cf–PWV: from 10.5±3.5 to 9.4±2.3 m/s, p=0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p=0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p=0.854). Similar results were also obtained in the 12 patients who reached one year of follow–up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p&lt;0.0001; cf–PWV from 10.4±3.3 to 10.5±2.9, p=0.874; FMD from 12.0±9.1 to 11.0±5.6%, p=0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p=0.710.

Conclusion
Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf–PWV, FMD and carotid IMT.
P198 PRELIMINARY 30–60 DAY EVALUATION OF INCLISIRAN EFFICACY
Authors: Caporale R , Battista F , Chiappetta D , Alberti S , Leone A , Greco F 
Published: May 2023

Abstract

Background
Inclisiran is a small–interfering RNA that selectively silences the hepatic synthesis of PCSK–9 protein with a two doses per year administration, increasing the availability of LDL receptors. Consequent reduction in circulating LDL levels observed in clinical trials, when associated with statin and ezetimibe therapy, is about 50%, with effect onset 14 days after the first administration.

Methods
This initial experience refers to three male patients with post–infarction ischemic heart disease who underwent revascularization (two with PCI, one with BPAC) one to three years previously, treated with ezetimibe 10 mg OD and high–dose atorvastatin (two with 80 mg OD, one with 40 mg OD). LDL levels were higher than recommended in patients at very high cardiovascular risk by European Society of Cardiology guidelines (mean 90 mg/dL, range 87–95). Patients were informed of the available data on Inclisiran and consented to the terms of use. Subcutaneous administration was performed by a physician in a hospital outpatient setting. Lipid values were checked on the 30th day.

Results
Two patients continued oral therapy and got a 58% reduction in values (mean 39 mg/dL, range 22–55). One patient, despite informed of the need to continue oral treatment, spontaneously stopped statin and ezetimibe treatment, obtaining a 30–day increase in LDL of 50% (131 vs 87 mg/dL). At the next control, 30 days after the resumption of oral therapy, the value was 44 mg/dL, with a reduction of 49% compared to baseline. No adverse events were recorded.

Conclusions
Data at 30–60 days on three patients treated with Inclisiran show that its addition to statin and ezetimibe treatment resulted in an average reduction in LDL cholesterol of 56% allowing the achievement of the target in 100% of cases. The favorable interaction between Inclisiran, statin and ezetimibe represents an effective strategy in patients at very high cardiovascular risk. The case of suspension of oral treatment seems to suggest a marked interaction of Inclisiran effect with statin therapy. Administration by a healthcare professional represents an opportunity for better follow–up management, allowing monitoring of therapeutic adherence and re–evaluation of concomitant therapies.
P204 CARDIAC INVOLVEMENT IN NEUTRAL LIPID STORAGE DISEASE (NLSD): A CASE REPORT
Authors: Marino G , Di Fusco S , Colivicchi F 
Published: May 2023

Abstract

Introduction
Neutral Lipid Storage Diseases (NLSDs) are rare diseases with autosomal recessive transmission characterized by a defect in the metabolism of triglycerides that accumulate in many tissues. Vacuoles containing lipids in white blood cells (Jordans anomaly) are considered a diagnostic marker. In particular, NLSD–M (NLSD–myopathy) is caused by mutations in the PNPLA2 gene (Patatin Like Phospholipase Domain Containing 2, chromosome 11p15.5) that codes for an enzyme involved in the first phase of triglyceride hydrolysis in adipose tissue. In this patient the mutation of the PNPLA2 gene is c.542delCA, truncating the protein with loss of the hydrophobic domain. This mutation is associated with more severe infiltrative and arrhythmic cardiac involvement than those known in the literature.

Case Report
52–year–old man with NLSD–M. The first symptoms of the disease appeared when he turned 35: weakness and atrophy of axial and proximal muscles, increased CK, scoliosis, fatty liver, electromyographic changes, arterial hypertension, dyslipidemia, renal failure and hypertransaminasemia. At 49, ECG revealed sinus rhythm, absence of ventricular repolarization abnormalities and echocardiogram revealed wall hypertrophy with a trabecular appearance of the left ventricle, sigmoid interventricular septum, preserved EF (58%), moderate diastolic dysfunction, left atrial enlargement, absence of significant valvulopathies. Cardiac MRI revealed lipid infiltration. An ICD was implanted for sustained ventricular tachycardia. At 50, atrial fibrillation was detected. EF was 53% and there was a small partially organized circumferential pericardial effusion. The last medical check, performed at 52 during hospitalization for atrial fibrillation with high ventricular response associated with hypokalemia and hypomagnesaemia, revealed ST–T alterations on ECG and a further reduction of EF to 46% on echocardiogram.

Conclusions
There is currently no medical treatment. A dietary supplement with medium–chain fatty acids (CNT–02) can be used to slow down the accumulation of lipids. The search for specific mutation is important to stratify cardiac risk.
P206 DO WE NEED LOWER CUT–OFFS OF LEFT VENTRICULAR WALL THICKNESS TO SUSPECT CARDIAC TRANSTHYRETIN AMYLOIDOSIS IN WOMEN?
Authors: Aimo A , Tomasoni D , Porcari A , Adamo M , Bonfioli G , Lombardi C , Nardi M , Varrà G , Saro R , Rossi M , Merlo M , Castiglione V , Vergaro G , Passino C , Metra M , Sinagra G , Emdin M 
Published: May 2023

Abstract

Background
Echocardiographic reference values for interventricular septal (IVS) thickness (upper reference limit [URL] 11.2 mm in women vs. 12.4 mm in men), and posterior wall (PW) thickness (URL 11.5 mm vs. 12.3 mm, respectively) exist. According to a European Society of Cardiology position statement, cardiac amyloidosis (CA) should be suspected when left ventricular (LV) wall thickness is ≥12 mm and at least one red flag is present. Given the normal difference between men and women, a same cut–off might cause a diagnostic delay in women.

Methods
Consecutive patients diagnosed with amyloid transthyretin (ATTR)–CA at 3 centers were evaluated.

Results
The cohort included 302 patients (Pisa, n=215; Brescia, n=58; Trieste, n=29). Women (n=49, 16%) were older than men (median age 83 years [interquartile range 80–85] vs. 80 years [76–84], p=0.009), but their survival free from all–cause death (p=0.380) or heart failure (HF) hospitalization (p=0.381) did not differ significantly. N–terminal pro–B–type natriuretic peptide values (p=0.897), the proportion of patients with variant ATTR (p=0.369), the prevalence of hypertension (p=0.659), diabetes (p=0.629), or New York Heart Association class III–IV (p=0.613) were not different. LV ejection fraction was 53% (43–60%) in women vs. 50% (43–65%) in men (p=0.066), and tricuspid annular plane systolic excursion was 16 mm (13–20) in women vs. 16 mm (14–19) in men (p=0.674). Even relative wall thickness (RWT) did not differ significantly (0.61 [0.49–0.98] in women vs. 0.69 [0.57–0.87] in men; p=0.448). Conversely, women had lower IVS (15 mm [14–18] vs. 17 mm [15–20]) and PW thickness (13 mm [12–16] vs. 15 mm [13–17]). These differences disappeared when IVS and PW thicknesses were indexed for height (as m), height2,7, or body surface area: IVS, p=0.150, 0.212, 0.325, respectively; PW, p=0.309, 0.107, 0.743, respectively.

Conclusions
At the time of diagnosis, women with ATTR–CA are older, but their biventricular function, the pattern of LV remodeling, and final outcome did not differ significantly from men, suggesting a similar disease stage. Even indexed IVS or PW thicknesses are similar, while non–indexed measures may point to a less advanced disease and then be misleading. Indexed measures or sex–specific cut–offs (e.g., 11 mm in women vs. 12 mm in men) to suspect CA might be considered.
P211 BLEEDING AND THROMBOSIS: A MULTIDISCIPLINARY SLALOM
Authors: Vecchio C , Nassiacos D 
Published: May 2023

Abstract
GG is a 75 kg and 75 years old smoker man with metabolic syndrome, potus, OSAS and LBBB. In 1/2022 the echo imaging showed EF 35%, high dissincrony and PVCs so a myocardial SPECT had been recommended but not carried out by the patient. In 6/2022 new exertional dyspnea, orthopnea and peripheral oedema lead the patient to the Emergency Department: the ECG indicated new onset AF 75 bpm, at laboratory tests creatinine 1.8 mg/dL and NTproBNP 6200 pg/ml and echocardiography confirmed hypokinetic cardiopathy with EF 35%, mild–moderate mitral and tricuspidal regurgitation with pulmonary hypertension and vascular congestion. Admitted for heart failure and new onset AF, diuretic and levosimendan ev, MRA, BB and LMWH started with benefit. At the end of inotropic therapy, ARNI, SGLT2 and inhaled cortisone began. Myocardial SPECT proved moderate fixed inferior wall hypoperfusion. Hospitalization was complicated by ecchymoses and hematomas of abdomen superficial soft tissues during LMWH and proximal saphenous vein and III middle left thigh thrombophlebitis, so apixaban 5mg BID and elastic stockings started with resolution. The onset of paresthesias, pain and left leg progressive hyposthenia led to diagnosis of a partial hematoma of the ilio–psoas muscle resulting in a complete left femoral nerve lesion and severe obturator nerve and left lumbosacral trunk suffering plus further right iliac and rectus abdominis muscles hematomas. Discontinued apixaban, after 72 hours the hematoma was surgically removed without complications and fast recovery thanks to FKT. 9 days later left leg DVT recurrence was observed: in absence of absolute contraindications to anticoagulant therapy and blood count stability, without evident new bleedings, heparin infusion was set with maintenance of the aPTT values at the lower therapeutic range limits. One week later radiological imaging demonstrated reduction of left retroperitoneal hematoma so dabigatran 150 mg BID was initiated. Control echo showed EF 42%, mild MR and TR. Regular the subsequent rehabilitation course: the patient was discharged with dabigatran 110 mg twice daily to limit long–term bleeding risk. The thrombotic/bleeding risks require a complex therapeutic modulation in a multidisciplinary teamwork.
P221 ASSOCIATION BETWEEN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND A SEVERE DILATED CARDIOMYOPATHY: A CASE REPORT
Authors: Cavallone E , Feneziani A , Franco E , Rovera C , Moretti C 
Published: May 2023

Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 and PKD2 genes, encoding polycystin 1 and 2. We report the case of a 51–year–old woman with arterial hypertension and stage V chronic kidney disease from polycystic kidney disease, without a significant family health history. She was admitted to our Cardiology Ward for worsening dyspnea, dependent oedemas and a 3/6 systolic heart murmur detected. Blood tests showed mild anemia and hyperkalemia, severe renal failure (creatinine 6 mg/dl) and normal both liver and thyroid function. The ECG showed sinus rhythm with normal atrioventricular conduction, low voltage in precordial leads and non–specific repolarization disturbances. Hemodialysis and intravenous decongestion therapy were started. A transthoracic two–dimensional echocardiography was performed and a dilated left ventricle with severe global systolic dysfunction (EF 25%) was documented, with severe secondary mitral regurgitation (MR) with a central jet (EROA 0,5 cm2). A possible bicuspid aortic valve was suggested with moderate aortic regurgitation. CT scans showed small pleural and pericardial effusions, polycystosis affecting both kidneys and liver. Coronary CT showed a subcritical interventricular artery stenosis and confirmed a bicuspid aortic valve. Magnetic resonance angiography was negative for intracranial aneurysms. Finally, genetic testing revealed a heterozygous pathogenic mutation of PKD1 gene (c.9622del G p.Ala3208Hisfs*108 exone 28). Maximum tolerated heart failure therapy was prescribed after discharge, resulting in symptoms reduction but only mild echocardiographic improvement (EF 30% with severe MR). An edge–to–edge transcatheter mitral valve repair was proposed. In literature we learn that PKD1 mutations are linked to various cardiomyopathies: hypertrophic, dilated, left ventricular non compaction. We report the association of ADPKD with a complex dilated cardiomyopathy with severe secondary MR, an aortic congenital defect and an associated subcritical coronary artery stenosis. Further investigations are needed to study the genetic aspect of the ADPKD when associated with different cardiac anomalies.
P225 CICU–COVID: SMALL NUMBERS BUT BIG DIFFERENCES
Authors: Piemonte F , Carraturo A , Damiano S , De Angelis A , Forte R , Leccia A , Lirato C , Molaro M , Penna G , Petitto M , Piemonte M , Puzio E 
Published: May 2023

Abstract
For about 2 months (from 13 January to 15 March 2022) our CICU–Cardiology department (spoke for the AMI network) of the "San Giovanni di Dio" Hospital of Frattamaggiore (Naples) has assumed the role of CICU–COVID for Local Health Authority Napoli 2 Nord. We analyzed data regarding patients hospitalized in our department from January to August, selected on the basis of the presence of SARS–COV2 infection at admission, and we noted some substantial differences between the two populations, despite in the small sample examined. Patients hospitalized with Covid were, on average, of older age (73 vs 66.3 years old) and their hospitalization was on average longer (9 days vs 6.5), with differences both in the percentage of patients hospitalized for acute myocardial infarction (46.4 % in non–Covid patients vs 34% in Covid patients) and in the type of myocardial infarction: in fact, among the Covid patients who arrived at the ward with a heart attack diagnosis, STEMIs were more numerous (53.3% vs 15.7 of the non–Covid patients) . This may be due to the fact that in the period in which we have acted as Covid–CICU we have also accepted patients with STEMI who otherwise would have been hospitalized in the CICU HUB. Furthermore, the Covid patients were mostly affected by other chronic pathologies: in particular diabetes (40.8% of Covid patients and 18.4% of non–covid patients) and heart failure (54.5% in Covid patients vs 38, 9% in non–Covid). Finally, we examined the data regarding intra–hospital and 6–month mortality, and here too we found substantial differences: 16 of the 44 patients hospitalized with covid (36% of the total) died within 6 months of admission (18.1% in hospital ), while among non–covid patients 6–month mortality was 7% and intra–hospital mortality was 2%. In detail, the difference in mortality between the two groups of patients with myocardial infarction was even more marked, being the 6–month mortality 33.3% in Covid patients and 2.2% in non–Covid. Again, the group of Covid patients who died was affected by diabetes in a much higher percentage than the non–covid (56% vs 28.6%) These data come from a very small sample but nevertheless indicate that the simultaneous infection with SARS–COV2 dramatically worsens the prognosis of patients who normally refer to the CICU–Cardiology departments, and that some associated pathologies affect the prognosis even more significantly than others.
P229 ROLE OF GENDER IN MINOCA PATIENTS
Authors: Tattilo F , Sansonetti A , Amicone S , Bergamaschi L , Armillotta M , Angeli F , Andrea S , Impellizzeri A , Canton L , Suma N , Bodega F , Fedele D , Paolisso P , Rinaldi A , Foà A , Casella G , Galié N , Pizzi C 
Published: May 2023

Abstract

Background
Myocardial Infarction (MI) with Non–Obstructive Coronary Arteries (MINOCA) accounts above 6 % of patients presenting with acute MI (AMI) and it’s known to be more prevalent in females. Differences in terms of clinical features and prognosis in MINOCA patients according to gender have been poorly understood. Purpose: To evaluate clinical and prognostic differences between male and female patients with MINOCA.

Methods
We included all consecutive patients with AMI undergoing coronary angiography between 2016 and 2020 in our multicentric Registry. We considered as MINOCA all patients fulfilling the European Society of Cardiology diagnostic criteria. We analyzed the baseline clinical characteristics of MINOCA patients by dividing the population according to gender. We performed a multivariate logistic regression analysis including all AMI patients to determine independent predictors of MINOCA at admission. We considered the composite endpoint (MACE) of death, re AMI, stroke and heart failure at follow–up (FU, mean of 36 ± 14.8 months). Outcomes were evaluated also using Kaplan–Meier survival curves.

Results
Among 289 patients affected by MINOCA, 191 were female (66%). Males were more frequently smokers (56.1% vs 33.9 %, p=0.001) while females were older (68.9± 13.1 vs 58.4±14.5 years, p=0.0001), more affected by hypertension (69.3% vs 55.1%, p=0.017) and dyslipidemia (65.6% vs 49%, p=0.005), more frequently on beta–blockers (39% vs 20%, p=0.002) and statins (33% vs 19%, p=0.015) and had a lower degree of coronary stenosis (9.1% vs 15.5%, p=0.019) than males. During follow–up, females had more MACE (33% vs 19.3%, p=0.015), also shown at Kaplan Meier curves (χ2 = 5.997, p=0.014). Finally, multivariate analysis revealed that age is an independent predictor of MINOCA (HR 1.04, CI 1.01–2.07, p=0.006), rather than sex, diabetes, and hypertension.

Conclusions
In our MINOCA population, females had a higher incidence of MACE than males: this could reflect the different pathogenesis of myocardial damage in our subgroups. Statins and estrogens have a well–known protective role towards the progression of atherosclerosis, but they have less impact on other causes of MINOCA more frequent in females.