bluuebunny/crossref_metadata_2025_split huggingface dataset:
P264 THE RELATIONSHIP BETWEEN MEAN DAILY HEART RATE AND THE INCIDENCE OF CARDIAC ARRHYTHMIAS IN PATIENTS WITH WEARABLE CARDIAC DEFIBRILLATOR
Authors: Matteucci A , Pignalberi C , Pandozi C , Magris B , Meo A , Schiaffini G , Russo M , Galeazzi M , Mocini D , Aquilani S , Colivicchi F 
Published: May 2023

Abstract

Background
The wearable defibrillator (WCD) is a useful device to prevent sudden cardiac death (SCD) due to fatal arrhythmias in patients in which an implantable cardioverter defibrillator (ICD) is not currently indicated. Measurement of mean daily heart rate and related variability (HRV) has proved to be useful in identifying patients at increased arrhythmic risk of SCD and in patients with chronic heart failure (CHF), although the specificity and predictive accuracy of fatal arrhythmic events is still relatively limited. We analyzed the mean HR of patients with WCD to determine their impact on the incidence of fatal and non–fatal arrhythmic events.

Methods
We enrolled 7 patients with WCD and optimal medical therapy by monitoring daily HR and variability over a 30– 90 day follow–up. Monitoring was performed remotely, analyzing both trends acquired by the devices, daily ECG recordings, and telephone surveillance.

Results
Men constituted 71.4% of the population, with a mean age of 69.1±10.3 yrs, and an ejection fraction of 30.7%±8.7. The devices were worn for 36±24 days, with a daily adherence of 23.8±0.23 hrs. The trend in mean HR showed a progressive, although non–significant reduction (77.5±10.2 bpm vs 66.5±11.9 bpm p=0.08). No fatal arrhythmic events were recorded during monitoring. Two non–fatal arrhythmic events were recorded from patient discharge.

Conclusions
Mean daily HR is a predictor of cardiac death, independent of other risk factors in patients with cardiovascular disease. Although the small sample size doesn‘t provide a convincing correlation, it is conceivable that reducing mean HR may contribute to a decrease in fatal cardiac arrhythmias. Further studies are needed to confirm these insights.
P266 SUBCUTANEOUS DEFIBRILLATOR USE LIMITATION IN PATIENT AFFECT BY ARRHITMOGENIC CARDIOMYOPATHY IN REAL WORLD
Authors: Agus E , Casula M , De Toni C , Scalone A , Schintu B , Setzu A , Tola G , Corda M 
Published: May 2023

Abstract

Introduction
The prevention of sudden cardiac death (SCD) through the implantation of a defibrillator (ICD) represents one of the fundamental milestones in the management of arrhythmogenic cardiomyopathy (ACM). Individual characteristics of the patient and of the disease can help in the selection of the device [transvenous (TV) or subcutaneous (S–ICD) defibrillator]. The objective of this study is to evaluate the major factors limiting S–ICD implantation in a real–world ACM patient population.

Methods
This multicenter retrospective observational study enrolled consecutive patients undergoing ICD implantation in primary or secondary prevention for ACM at the participating centers. The population was subdivided according to the execution of the preimplant S–ICD screening test and its result. Baseline clinical and instrumental data were analyzed to identify predictors of passing the screening test.

Results
21 ACM patients (67% men) who underwent 24 S–ICD or TV–ICD implant procedures were enrolled. 70.8% of patients (N=17) were screened for S–ICD. Screening was not performed in 4 patients (17%): in one case due to an indication for resynchronization therapy and in three patients because they were implanted in the pre–S–ICD era. Screening failed in 53% of cases. The cause of the failures were the low voltages of the QRS (100% of the failures) and a poor stability of the trace in the different positions tested for significant variation of the QRS/T ratio (37.5% of the failures). No significant difference was noted between the clinical and instrumental characteristics of the two subgroups (Table 1), although the patients who passed the screening showed a trend towards a greater QRS amplitude in DI (0.52±0.29 vs 0.28±0.17 mV – P= 0.07) and to present a positive QRS in DI (100% vs 50%; P=0.08 – Table 2).

Conclusions
The use of the S–ICD in patients with ACM could be limited by some intrinsic characteristics of the disease. In a real–world cohort of patients affected by ACM, the presence of low QRS voltages on the surface ECG and positional morphology variations allowed S–ICD use in half of the patient candidates.
P267 ASSOCIATION BETWEEN EARLY MODIFICATION OF LEFT ATRIAL VOLUME AND RIGHT VENTRICULAR FUNCTION AFTER TRANSCATHETER EDGE–TO–EDGE REPAIR FOR MITRAL REGURGITATION
Authors: Bonelli A , Guasti S , De Sanctis G , Spanò F , Santambrogio G , De Chiara B , Belli O , Musca F , Casadei F , Garascia A , Oreglia J , Bruschi G , Oliva F , Giannattasio C , Moreo A 
Published: May 2023

Abstract

Background
Transcatheter edge–to–edge repair (TEER) for severe mitral regurgitation (MR) is a therapeutic option in patients at high surgical risk. Post procedural reverse remodeling of the left ventricle, the left atrium (LA) and the right ventricle (RV) was shown to be associated with reduced symptoms and mortality.

Methods
In this retrospective study we have assessed consecutive patients with functional severe MR from February 2015 to July 2022. LA and RV structure and function have been evaluated before the procedure and at the discharge and they were correlated with symptoms.

Results
In the present study, 52 patients (69% males, mean age 65.2±10.2 years and mean left ventricular ejection fraction 28.8±5.7%) were included. No differences about baseline clinical and echocardiographic characteristics were reported in the group of patients who had LA volume reduction (n=31) and those who did not (n=21). In the overall population we have detected a significant increase of tricuspid annular plane systolic excursion (TAPSE), S‘ wave at Tissue Doppler and the ratio between TAPSE and systolic pulmonary artery pressure (SPAP), together with a significant reduction of SPAP (respectively, p=0.034, p=0.003, p&lt;0.001 and p&lt;0.001). Compared to patients who did not have LA volume reduction, the other group showed a significant increase of TAPSE/SPAP (from 0.40±0.17 to 0.52±0.21 mm/mmHg, p=0.002) and S’ wave (from 8.7±1.6 to 9.4±1.7 cm/s, p=0.005) and a reduction of SPAP (from 50.3±14.3 to 38.9±11.5 mmHg, p&lt;0.001). LA volume modification from baseline to the discharge was associated with the modifications of SPAP (B coefficient 0.55, 95% confidence interval 0.09, 1.02, p=0.022) and TAPSE/SPAP (B coefficient –4.06, 95% confidence interval –7.78, –0.33, p=0.033), even at the multivariable analysis (respectively, B coefficient 0.61, 95% confidence interval 0.07, 1.14, p = 0.027 e B coefficient –4.82, 95% confidence interval –9.43, –0.23, p=0.040). Lastly, NYHA class improved in the group of patients who had LA volume reduction (p=0.011).

Conclusion
In this retrospective study an association between early modification of LA volume and RV functional parameters has been described. After TEER, RV function improved, particularly in the group of patients who had LA volume reduction. The latter have shown an improvement of symptoms at the discharge.
P268 CORONARY FLOW VELOCITY RESERVE REDUCTION IS ASSOCIATED WITH CARDIOVASCULAR, CANCER, AND NON–CANCER, NON–CARDIOVASCULAR MORTALITY
Authors: Tuttolomondo D , Gaibazzi N 
Published: May 2023

Abstract

Background
Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high–dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non–CV conditions. We aimed to assess whether CFVR is associated with all–cause death, but more specifically with CV, cancer, and non–CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables.

Methods
One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow–up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality.

Results
A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR &lt; 2 was significantly associated with each category of cause–specific mortality. A CFVR &lt; 2 or ≥2 separated a group of patients with 8–year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality.

Conclusions
The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.
P270 THE IMPORTANCE OF INTEGRATED IMAGING IN THE DIFFICULT DIFFERENTIAL DIAGNOSIS OF A LEFT INTRACARDIAC MASS IN YOUNG ADULT
Authors: Guasti S , Musca F , Bonelli A , De Sanctis G , Intravaia R , Casadei F , Occhi L , Spano‘ F , Belli O , De Chiara B , Santambrogio G , Pedrotti P , Quattrocchi G , Giannattasio C , Moreo A 
Published: May 2023

Abstract
The patient is a 34–year–old man who comes to the emergency room with mild hemoptysis, asthenia, low–grade fever, night sweats and weight loss. Cardiac auscultation reveals a diastolic murmur at the cardiac apex. Transthoracic and transesophageal echocardiograms are performed and show an isoechoic thickening encompassing the posterior leaflet, cranially involving the atrial septum and the lateral wall up to the inlet of the left atrial appendage and inferiorly involveing the subvalvular apparatus with diffuse thickening and chordal fusion. Functionally it determines a moderate mitral stenosis with an average gradient of 10 mmHg and a valve area of ​​1.1 cm2 and a mild–moderate regurgitation with an anteriorly directed eccentric jet. At this point we needed to make the differential diagnosis considering as possible etiologies infective endocardic vegetation, thrombosis, primary and secondary neoplasms, aseptic vegetation and inflammatory or rheumatic valvulitis. We therefore begin our diagnostic work–up by performing a scintigraphy with labeled leukocytes, which does not show the presence of hyperuptake areas referable to infective endocarditis, and a PET scan which shows, in addition to the increased uptake at the cardiac level, an area of ​​greater concentration of the metabolic tracer in the gastric area (between the body and the fundus). Given the confirmation of metabolically active tissue, the patient performed cardiac magnetic resonance with contrast medium which confirmed the presence of pathological tissue with inhomogeneous late post–contrast enhancement. After collegial discussion, due to the high risk of biopsy of the mitral lesion, which was poorly separable from the cardiac structures, given the other localization of the disease at the gastric level, it was decided to perform an EGDS with relief of an ulcerated lesion on the gastric fundus which is subjected to biopsy and histological typing. We then arrive at the diagnosis of “undifferentiated pleomorphic sarcoma”. Sarcoma is the most frequent histological type of primary malignant cardiac tumors. The clinic is characterized by constitutional symptoms, obstruction of the valve inflow or outflow tract, thromboembolism, and arrhythmias. It has a poor prognosis: 6–12 months from diagnosis. In conclusion, we reiterate the importance of integrated imaging to arrive at the final diagnosis, each method with a specific objective.
P271 CASEOUS CALCIFICATION OF THE MITRAL ANNULUS: ROLE OF 3D ECHOCARDIOGRAPHY
Authors: Fede G , Abate G , Belluardo P , Guccione N , Scollo V , Sulsenti G , Ficili S 
Published: May 2023

Abstract
The caseous calcification of the mitral annulus (CCMA) is a rare degenerative condition of the mitral valve (0.067% prevalence in the general population) that generally affects older women with hypertension, chronic kidney disease and dyslipidemia. Usually CCMA is asymptomatic and it is associated with mild to moderate mitral regurgitation and it can cause severe mitral valve dysfunction that requires surgical treatment. CASE 1: A 84–year–old woman, with arterial hypertension, was evaluated in our clinic to perform a transthoracic echocardiogram (TTE) for a previous finding of heart murmur. TTE reveled at the level of the posterior mitral annulus a hyperechoic roundish formation with a central eco–shiny area with a maximum diameter of 20x20 mm. A tridimensional trans–esophageal echocardiography (3D TEE) allowed a better characterization of the mass showing well–defined contours, adhered to the posterior mitral annulus, systolic dislocation of the anterior mitral leaflet, with slight mitral regurgitation. Considering the morphological characteristics of the mass we concluded for a presumptive diagnosis of CMAC. We recommended regular follow–up to the patient. After 6 and 12 months the mass did not change in size and echostructure. CASE 2: An 88–year–old woman with chronic kidney disease, high blood pressure and chronic ischemic heart disease was admitted to our ward for acute heart failure. TTE showed a large an echodense mass (43 × 19 mm) involving the posterior mitral annulus, with a central echo–lucent area. A 3D TEE was performed with better mass characterization: involvement of the entire posterior mitral ring, reduced movement of the posterior mitral flap, anterior mitral flap with normal morphology and normal mobility. In consideration of the echocardiographic characteristics we concluded for the presence of CMAC. We discharged the patient with indication for a regular clinical and echocardiographic follow–up.

Conclusions
The 3D TTE provides adequate morphostructural information that allows in most cases to characterize the CCAM. When the transthoracic approach is difficult due to poor acoustic windows, 3D TEE can be used. Only in rare cases it is necessary to use second–level diagnostic tests such as CT and Cardiac Magnetic Resonance Imaging.
P283 PULMONARY, CARDIAC AND NEUROLOGIC FOLLOW–UP AFTER SEVERE COVID–19 PNEUMONIA
Authors: Franco E , Oberto L , Gagliardi L , Barra M , Ruffini S , Cavallone E , Moretti C 
Published: May 2023

Abstract

Background
Since December 2019 COVID–19 has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID–19 after recovery from the acute disease are still under study. Purpose: The aim of this study was to investigate pulmonary impairments, neurologic disorders and the prevalence of right ventricle dysfunctions in patients with severe COVID–19 pneumonia, almost six months after discharge from hospital. Material and methods: Hospitalized COVID–19 patients with severe pneumonia, requiring mechanical ventilation were included in the study and evaluated at about 6 months after hospital discharge. Pulmonary function tests, echocardiography, EMG were performed to all patients, and a sitting psychotherapy was proposed.

Results
A total of 56 patients (median age 64 years) with severe COVID–19 pneumonia were included in the study. The disease was complicated by pulmonary embolism in 5 patients, by cerebral stroke in 1 patient, by bacterial infections in 4 patients, by pericarditis in 1 patient, by Guillain Barrè syndrome in 2 patients. At almost 6 months after hospital discharge, 17 patients (30%) had dyspnea NYHA II, 1 was in NYHA III (1.8%), and 4 (7%) suffered from symptoms of fatigue. Pulmonary function tests did not reveal any significant limitation (FVC: 96.9% {78–101}; FEV1: 99% {72–103}; FEV1/FVC 81.3% {76–85}; except for slightly reduced DLCO (61% {69–95}). Only 3 (5%) patients developed a severe DLCO alteration, among them only one patient had acute pulmonary embolism. There were no echocardiographic impairments, in particular right chambers were normal in size and function (median TAPSE=23 mm, median S1 = 12 cm/sec) and there were no cases of pericardial effusion. From the neurological point of view, in addition to the 2 patients who have developed a Guillain Barré syndrome, the patients recovered from COVID–19 who have left the Resuscitation of our Hospital have manifested after–effects of Critical Illness Myopathy and Neuropathy (CRIMYNE), a form of neuromuscular pathology considered in all respects an "organ failure" linked to the stay in intensive care caused by inflammatory mediators.

Conclusions
Hospitalized patients with severe COVID–19 pneumonia, requiring mechanical ventilation, are unlikely to develop pulmonary long–term impairments or cardiac dysfunction after discharge, but frequently suffer from symptoms of fatigue and persisting dyspnea on effort, due to CRIMYNE syndrome.
P287 RELATIONSHIP OF HYPOVITAMINOSIS D WITH HEART FAILURE DEVELOPMENT, HEART TRANSPLANTATION NECESSITY AND MORTALITY AMONG INDIVIDUALS WITH DILATED CARDIOMYOPATHY
Authors: Aleksova A , Fluca A , D‘Errico S , Munaretto L , Zhou X , Sinagra G , Janjusevic M 
Published: May 2023

Abstract

Background
Non–ischemic dilated cardiomyopathy (DCM) is a progressive heart disease often affecting young individuals leading to heart failure (HF) development, heart transplantation (HT) and adverse outcome. We aimed to evaluate the prevalence of hypovitaminosis D among Italian patients with DCM and its prognostic value during follow–up.

Methods
Plasma vitamin D levels were measured in 204 patients with DCM enlisted from The Trieste Registry of Cardiomyopathies. The endpoints during follow–up were defined as the incidence of major ventricular arrhythmias (MVAs), HT, hospitalization for HF and all–cause mortality.

Results
The median concentration of vitamin D in our cohort was 20.7 (15.53–29.3) ng/ml) and the majority of enrolled individuals were vitamin D deficient (54.4%). Vitamin D levels positively correlated with left ventricular ejection fraction (LVEF) (R=0.216, p=0.002) and patients with LVEF &gt; 35 have significantly higher plasma vitamin D concentration compared to patients with LVEF &lt;= 35 (respectively, 22.7 (17.35 – 30.5) ng/ml vs 19.2 (13.0 – 26.35) ng/ml, p=0.009). During a median follow–up of 58.47 (38.05 – 74.97) months, 7.8% of patients died, 3.9% had HT, 12.3% of individuals were hospitalized for HF, and 12.7% suffered from MVAs. Deceased individuals, patients requiring HT and hospitalized for HF during follow–up were observed to have significantly lower plasma vitamin D values compared to living and event–free individuals at the end of follow–up (respectively, 18.65 (9.49 – 20.7) ng/ml vs 21.3 (15.75 – 29.58) ng/ml, p=0.046, 14.35 (7.03 – 17.85 ng/ml vs 20.9 (15.9 – 29.48) ng/ml, p=0.021, 15.5 (9.56 – 21.35) ng/ml vs 21.7 (16.2 – 29.5) ng/ml, p= 0.012). In addition, patients suffering from MVAs had lower vitamin D values compared to individuals without events, although not significant (18.8 (14.48 – 24.48) ng/ml 21.56 (15.6 – 29.53) ng/ml, p=0.219). Unfortunately, Kaplan–Meier analysis and multivariate Cox regression analysis did not show an association and prognostic feature of vitamin D levels with events as expected probably due to the limited number of samples.

Conclusions
Hypovitaminosis D is common in patients with DCM. Given that lower levels of vitamin D are noted among patients with MVA, HT, HF hospitalization and poor outcome, future studies with a larger cohort are needed to confirm its predictive value. Vitamin D supplementation should be highly recommended as part of preventive therapies in patients with DCM.
P294 BIOPROSTHETIC AORTIC VALVE REPLACEMENT IN PATIENTS AT INCREASED RISK OF EARLY STRUCTURAL VALVE DEGENERATION
Authors: Paduvakis I , Cerillo A , Petrini F , Manca A 
Published: May 2023

Abstract

Background
Biological prostheses are increasingly been used in young patients to avoid anticoagulation. The Edwards Inspiris aortic bioprosthesis is extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the hemodynamic performance and clinical outcome of the Inspiris bioprosthesis in patients aged 56 ± 10.7 years.

Methods and Results
Between may 2018 and December 2022, 342 patients aged 56 ± 10.7 years underwent AVR with the Edwards Inspiris bioprosthesis at our institution. 37 of them (10.8%) were younger than 40, and 98 (28.6%) had a BMI &gt;30 kgm2. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 157 (45.9%) patients. There were 56 redo patients (16.4%). 7 patients died (2%). Major complications included bleeding (32), respiratory failure (20) and BAV requiring PMK (4). The mean follow up was 23 ± 15.2 months (range 2–55). Late valve–related events included endocarditis (5) requiring reoperation. There were no thromboembolic events, valve thrombosis or SVD cases. At follow up, all except four patients reported a significant improvement of their symptomatic status (98.8% were in NYHA II) and quality of life.

Conclusion
Our study demonstrates excellent early haemodynamics and promising results at up to four years in a cohort of very young patients. Further studies with longer follow–up are needed.
P301 TAVI IN PATIENT SUFFERING FROM NIEMANN – PICK DISEASE (ACID SPHINGOMYELINASE DEFICIENCY) WITH CONCOMITANT SITUS INVERSUS AND DEXTROCARDIA
Authors: De Feo D , D’Anzi A , Caragnano V , Pestrichella V , Scialpi A , Laronga G , Lafranceschina C , Tiecco F , Scicchitano P , Ciccone M , Iliceto S 
Published: May 2023

Abstract
Abstract Acid sphingomyelinase deficiency (ASMD) – also known as Niemann–Pick (NP) disease – is a rare, autosomal recessive disorder which is characterized by deficiency of the lysosomal enzyme acid sphingomyelinase (ASM), thus resulting in excessive storage of lipids in organs (i.e. spleen, liver, lung, bone marrow, lymph nodes, and vascular system). Literature provided few cases of moderate–to–severe valvular heart disease due to ASMD, mostly in adulthood. We reported the case of a patient with B–subtype NP disease which was diagnosed during his adulthood. NP disease was associated to situs inversus. Specifically, a severe, symptomatic aortic stenosis was also identified and the need for surgical or percutaneous intervention was deemed. The heart team chose Trans Aortic Valvular Implantation (TAVI) which was successfully performed with no further complications at follow–up.