bluuebunny/crossref_metadata_2025_split huggingface dataset:
P39 MANAGEMENT OF A CASE OF LAST REMAINING PATENT VESSEL
Authors: Legnazzi M , Azzarelli S , Tomasello S , Di Giorgio A , Di Simone E , Scardaci F , Argentino V , Amico F 
Published: May 2023

Abstract
A 72–year–old hypertensive, dyslipidemic and smoker (20 cig/day) gentleman was admitted to the emergency department for pulmonary edema. Past medical history included COPD, anterior MI treated with PCI and stenting of proximal LAD 5 years back, recent TIA. He was admitted to cardiac intensive care unit and treated with CPAP, IV furosemide and norepinephrine. Echocardiogram showed severe ventricular dysfunction (LVEF 20%) and severe functional mitral regurgitation; lab tests pointed out mild troponin elevation (50 ng/L) and high levels of BNP (1300 pg/mL). After stabilization, he underwent coronary angiography: in–stent CTO of LAD, critical stenosis of distal LM and ostio–proximal LCX (last remaining patent vessel, LRPV); hypoplastic RCA. At the end of angiography, new episode of pulmonary edema that required treatment with inotropes, CPAP and diuretics. Considering hemodynamic instability and high surgical risk (combined STS 37%), the Heart Team decided to proceed to PCI with mechanical circulatory support with Impella CP. From left radial access we achieved advancement of JR4 guiding catheter with guide extension in right common iliac artery. We performed angiography and then put a coronary guidewire in superficial femoral artery to facilitate right femoral access (angio–guided). From this femoral access we implanted Impella CP device. From left radial access we performed PCI: cannulation with JL 3 guiding catheter, wiring with Sion Blue ES guidewire, pre–dilatation with NC balloons until 3.0 mm diameter, stenting of LM–LCX with 1 DES 4.0/32 mm, post–dilatation with NC balloons (4.5 and 5.0 mm diameter). Good angiographic result; IVUS examination revealed good expansion and apposition of stent. Femoral access was closed with 2 Perclose Proglide. Patient was then monitored in cardiac intensive care unit, with clinical improvement and without complications. 10 days after PCI the patient, asymptomatic, was discharged. The echocardiogram displayed betterment of contractile function (LVEF 28%) and of mitral regurgitation (now moderate). At 4–month follow–up visit, patient is paucisymptomatic (NYHA class II), without angina episodes, with good quality of life in guideline–directed optimal medical therapy. Critical disease of LRPV is a severe condition, with unpredictable evolution and poor prognosis. PCI of LRPV in HFrEF patients is an high–risk PCI scenario in which mechanical circulatory support with Impella can prove to be essential.
P40 LIGHTS AND SHADOWS OF THE MICROCOAXIAL PUMP DEVICE IN A UNIQUE SETTING: CARDIOGENIC SHOCK DUE TO ACUTE MYOCARDIAL INFARCTION IN PATIENT WITH UNKNOWN HYPERTROPHIC CARDIOMYOPATHY
Authors: Demola P , Bosi D , Romagnoli F , Manca F , Azzarone M , Pignatelli G , Musto D' Amore S , Copelli S , Navazio A , Guiducci V 
Published: May 2023

Abstract
Cardiogenic shock remains the leading cause of death in patients with acute myocardial infarction (AMICS). The IntraAortic Balloon Pump (IABP) has been the device of first choice for these patients for years, but it has not shown a mortality benefit over optimal medical therapy. The Impella (AbioMed, Danvers, Massachusetts) is an alternative circulatory support system that produces cardiac output appropriate for the needs of the patient. A 59–year–old mailman suddenly lost consciousness during his work. Basic life support was administered, and ROSC was achieved after a single effective defibrillator discharge. When the ambulance arrived, the patient presented conscious but complained of oppressive chest pain, with soreness in his left arm and head. EKG showed an ST elevation in aVR and aVL and a right bandle branch block (Fig 1). Aspirin, Heparin, and opioids were administered. During the transport, hemodynamic parameters appeared to deteriorate towards cardiogenic shock. Coronary angiography showed a total occlusion of the left main. Cangrelor was started promptly. Hemodynamic conditions dictated the application of a mechanical circulatory support device (MCSD), so IABP was applied. Primary angioplasty was performed with restoration of TIMI 3 flow. A 3.50 x 23 mm everolimus–eluting stent was implanted with a good result. Norepinephrine was ineffective in achieving satisfactory hemodynamic status with systemic arterial pressure below 50 mmHg. After volemic restoration, neither IABP nor the vasopressor could interrupt the spiral of cardiogenic shock. A coaxial pump, i.e. the Impella CP, was applied via left arterial femoral access. Despite the precise placement of this device, the parameters suggested a poor suction capacity from the pump–inlet into the left ventricle (LV) to systemic circulation in aorta. Meanwhile, echocardiogram revealed an unknown and severe hypertrophic cardiomyopathy that did not allow a proper functioning of the Impella CP device (Fig. 2). When a temporary pacemaker was applied due to reperfusion bradycardia, there were a better LV diastolic filling and Impella functioning due to right pacing. The patient was transferred to the intensive care unit, Impella was removed after 3 days, he was extubated within two weeks, no brain damage was reported but he is still hospitalised after a concomitant urinary infection, with predictable low ejection fraction (around 30%). We‘ll see: luckily, slow improvement, it is still an improvement!
P41 INCIDENCE AND PREDICTORS OF PERIPROCEDURAL MYOCARDIAL INFARCTION IN PATIENTS UNDERGOING COMPLEX VS NON–COMPLEX PERCUTANEOUS CORONARY INTERVENTION
Authors: Leone A , Piccolo R , Avvedimento M , Simonetti F , Angellotti D , Verde N , Manzi L , Franzone A , Napolitano G , Esposito G 
Published: May 2023

Abstract

Background
Percutaneous Coronary Intervention (PCI) is the most used treatment strategy for patients with coronary artery disease (CAD) undergoing revascularization. Periprocedural Myocardial Infarction (PMI) still represents a frequent complication after PCI. Complex PCI procedures carry a higher risk of adverse events. Despite several studies assessed the incidence of PMI, no data exist about the rate of PMI according to different definitions in patients undergoing complex PCI. Aims. This study aims to evaluate the incidence of PMI in patients with chronic coronary syndrome (CCS) undergoing PCI according to the complexity of the procedure and different definitions of PMI. Independent predictors of PMI according to the 4th Universal definition of myocardial infarction (UDMI) were also investigated.

Methods
1010 patients treated with PCI from 2017 to 2021 at Federico II University Hospital, Naples, Italy were enrolled. PMI was adjudicated by full trained cardiologists. Primary outcome of interest was PMI according to the 4thUDMI. Secondary outcomes of interest were PMI rates according to different definitions available in literature and myocardial injury according to 4th UDMI and Academic Research Consortium –2 (ARC–2).

Results
Of the 1010 patients, 226 underwent Complex PCI (22.4%). The incidence of the primary outcome was significantly higher in complex PCI group compared with non–complex PCI (26.5% vs 14.5%, p&lt;0.001). After multivariate adjustment, complex PCI (OR 1.54, 95% CI: 1.04–2.27 p= 0.031), presence of calcified lesions (OR 2.05, 95% CI: 1.38–3.03 p&lt;0.001) and multivessel disease (OR 2.94, 95% CI: 1.76–4.89 p&lt;0.001) were found to be independently associated with PMI.

Conclusions
Patients undergoing complex PCI have an increased risk of PMI. Multivessel disease, calcified lesions and complex PCI represent independent predictors of PMI.
P46 TRANSAXILLARY MITRAL VALVE SURGERY IS ASSOCIATED WITH EARLY RECOVERY AND SHORTER ICU AND HOSPITAL STAY
Authors: Malvindi P , Berretta P , Wilbring M , Bifulco O , De Angelis V , Cefarelli M , Zingaro C , Kappert U , Di Eusanio M 
Published: May 2023

Abstract

Background and Aim
Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection and valve exposure in minimally invasive mitral valve surgery (MIMVS). Aim of this study is to compare the early outcomes of patients operated through a right trans–axillary (TAxA) approach with those achieved in conventional full sternotomy (FS) operations.

Methods
Prospectively collected data of patients who underwent mitral valve surgery between 2017 and 2022 at two academic centres were reviewed. Among them, 454 patients underwent MIMVS through TAxA access and 667 patients through FS (associated aortic and CABG procedures, infective endocarditis and urgent operations were excluded). A propensity match analysis was performed using seventeen preoperative and intraoperative variables.

Results
There was no difference in preoperative characteristics in matched populations. The rate of mitral valve repair was similar in both groups. Patients in TAxA group had a higher rate of repair using artificial chordae. Operative times were shorter in FS group but in patients operated in minimally invasive approach there was a trend towards decreasing CPB and cross–clamp time over the study period. Hospital mortality in TAxA group was 0.25%, postoperative cerebral stroke rate was 0.7%. TAxA mitral surgery was associated with shorter intubation time (p&lt;0.001) and ICU stay (p&lt;0.001). After a median hospital stay of 8 days, 30% of patients who had TAxA surgery were discharged home vs. 5% in the FS group (p&lt;0.001).

Conclusions
TAxA approach is safe and effective. Compared to FS, it allows shorter mechanical ventilation, ICU and postoperative hospital stay with a higher rate of patients able to be discharged home without any further period of cardiopulmonary rehabilitation.
P52 DIGEORGE SYNDROME: HYPOCALCEMIC PARALYSIS AND INTERVENTRICULAR DEFECT
Authors: Greco A , Mastroianno S , Bevere E , Massaro R , Potenza D , Salvatori M , Brunetti N , Di Stolfo G 
Published: May 2023

Abstract

Introduction
DiGeorge syndrome (DGS), known as "22q11.2 deletion syndrome" (22q11DS) (MIM#192430#188400), is caused by microdeletion of the long arm of chromosome 22 resulting in impaired development of the pharyngeal pouch. It is the most frequent chromosomal microdeletion syndrome with an estimated prevalence of 1 in 3 in 6,000 live births and approximately 1 in 1,000 fetuses. 22q11DS is the second leading chromosomal cause of congenital heart malformations, after trisomy 21. Patients with DGS may have developmental abnormalities of the craniofacial structures, parathyroid glands, thymus, and cardiac outflow tract. Doctors have been screening infants with conotruncal heart abnormalities for DGS since the late 1990s, before which the diagnosis was only clinical.

Clinical case
A 48–year–old woman came to our attention for recurrent episodes of tetanus paresis, the worst in her youth, associated with a systolic murmur. Her face was characterized by hypertelorism, thin lips, micrognathia, and low–set ears associated with short stature. Blood chemistry tests showed hypocalcemia during the tetanic crisis, exacerbated also during blood pressure measurement (Trosseau‘s sign with obstetrician‘s hand). The electrocardiogram showed sinus rhythm, high QRS voltages and the presence of U wave in some precordial leads (Fig. 1). The echocardiographic examination showed a globular left ventricle with evidence of a subaortic interventricular defect (Fig.2). The patient was sent for genetic evaluation with subsequent evidence of 22q11.2 microdeletion (Di George syndrome) and placed on oral calcium treatment and cardiac surgery evaluation for possible correction of the congenital defect. At the same time, psychological support was guaranteed for adequate coping with the diagnosed disease.

Conclusions
The presence of multiple stigmata in the same patient, such as typical facies, congenital heart defects and hypocalcemia, must raise the suspicion of syndromic involvement of the patient and consequent genetic evaluation oriented towards diagnosis and adequate counseling.
P64 PERSISTENT ST–ELEVATION WITH HIGH MYOCARDIONECROSIS MARKERS: A CASE OF MYOCARDIAL CONTUSION
Authors: Galasso M , Stucchi M 
Published: May 2023

Abstract
Myocardial contusion (MC) is a note rare and potentially fatal complication of blunt chest trauma (BCT). The spectrum of manifestations of post–traumatic cardiac injury varies widely: from clinically silent injuries to severe reductions in cardiac function, myocardial hematomas, heart ruptures, and life–threatening arrhythmias1. There is no unique definition for this entity, and the diagnostic criteria proposed by different authors vary widely. Some authors define MC as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence on imaging of pathologic findings2. Consequently, the true incidence of MC remains unknown, varying in reports between 8% and 71%3. We describe a case of cardiac contusion secondary to a low–energy trauma manifested as persistent ST elevation and pathologic elevation of myocardiocytosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the correct diagnostic pathway, it is essential to integrate first–level pathologic examinations (ECG and laboratory diagnostics) with cardiac magnetic Resonance Imaging (MRI) to define the presence of cardiac contusion and its extent, especially if the echocardiographic data are unconclusive.
P65 A STRANGE CASE OF ACUTE CORONARY SYNDROME WITH VESSEL SQUEEZING AND INTRAMURAL HEMATOMA
Authors: Dominici T , Schiavoni M , Bernardo V , Dato I , De Luca A , Moretti A , Percoco F , Pontiroli C , Tung M , Evangelista F , Kol A 
Published: May 2023

Abstract
A 53–year–old woman presented herself at our center for the appearance of oppressive chest pain radiating to the upper limbs associated with cold sweat, which arose in resting conditions. The patient had as cardiovascular risk factors tobacco habits and an important family history of cardiovascular diseases (father died of AMI at a young age) and had entered menopause for some months. The ECG showed signs of anterior transmural ischemia (Figure 1a) with corresponding echocardiographic kinetic abnormalities of the cardiac apex (EF 40%). The patient underwent an emergency coronary angiography documenting an intramyocardial bridge with evident systolic squeezing of the vessel in the proximal–middle section of the anterior descending artery and normal appearance of the remaining coronary tree (Figure 2). She was subjected to infusion of intracoronary nitrates with improvement of the instrumental picture and on that occasion it was opted for medical therapy alone with double antiplatelet therapy and low–dose calcium antagonist. On the second day after the diagnostic procedure, there was a recurrence of anginal symptoms with evidence on the ECG of anterolaterally reversed T waves (figure 1b). The patient underwent a new coronary angiography, IVUS–guided, with documentation of probable intramural hematoma in the absence of non–flow–limiting dissection image with an area of 7 mm² (Figure 3). During the subsequent hospitalization, the patient remained asymptomatic with stable ECG tracing, but telemetry revealed ventricular tachyarrhythmias for which beta–blocker therapy was optimized with improvement of the arrhythmic burden. The pre–discharge echocardiogram showed improvement of cardiac kinesis with resumption of systolic function (EF 48%). The patient was discharged stable and asymptomatic with follow–up at our dedicated ischemic heart disease clinic. This case report is an example of an infrequent cause of acute coronary syndrome, of non–atherosclerotic origin, to be considered in clinical practice.
P66 PROGNOSTIC IMPACT OF PERCUTANEOUS CORONARY INTERVENTION IN ACUTE MYOCARDIAL INFARCTION PATIENTS OLDER THAN 75 YEARS. REAL–WORLD FINDINGS FROM THE LOMBARDY REGION
Authors: Della Rocca M , Trombara F , Cosentino N , Bonomi A , Leoni O , Marana I , Moltrasio M , Cava F , Agostoni P , Savonitto S , Marenzi G 
Published: May 2023

Abstract

Background
Older patients, generally defined as individuals age &gt;75 years, are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI) compared to younger patients. This is due to the paucity of evidence derived from randomized trials, concerns about possible PCI–related side effects, and multimorbidity. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003–2018, by using the administrative Lombardy Health Database.

Methods
We analyzed data of all patients &gt;75 years hospitalized with AMI (both STEMI and NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during index hospitalization. The primary outcome was in–hospital mortality. One–year mortality and 1–year re–hospitalization for acute heart failure (AHF) or AMI were considered as secondary endpoints.

Results
During the study period, 116,063 patients (mean age 83±6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty–seven percent of them (n=42,912) were treated with PCI. The in–hospital mortality rate in the entire cohort was 12%. It was significantly lower in patients treated with PCI than in those not treated with PCI (6% vs. 15%; P&lt;0.0001). In the overall population, 1–year mortality was 32% and 1–year re–hospitalization for AHF/AMI was 19%. Both these endpoints were less frequent in PCI–treated patients (16% vs. 41% and 15% vs. 21%, respectively; P&lt;0.0001). The adjusted risk of the study endpoints was significantly lower in patients treated with PCI: OR 0.37 (95% CI 0.36–0.39) for in–hospital mortality; HR 0.37 (95% CI 0.36–0.38) for 1–year mortality; HR 0.74 (95% CI 0.71–0.77) for 1–year re–hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately.

Conclusions
Our real–world data showed that in patients with AMI &gt;75 years of age, PCI use is associated with a significantly lower in–hospital mortality and up to 1 year. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET)
P83 EFFICACY AND SAFETY OF LEVOSIMENDAN IN AN ISCHEMIC CARDIOGENIC SHOCK POPULATION: A 10–YEARS SINGLE CENTRE RETROSPECTIVE STUDY
Authors: Belfioretti L , Marini M , Francioni M , Battistoni I , Angelini L , Pongetti G , Shkoza M , Matassini M , Piangerelli L , Corinaldesi C , Patani F , Pupita G , Compagnucci P , Perna G 
Published: May 2023

Abstract

Background
Levosimendan is a Ca2+–sensitizer with inodilator action able to improve cardiac contractility without increse oxygen demand. In AHF setting clinical trial and registries showed an improvement in systemic haemodynamics without a decrease in in–hospital mortality. Purpose: evaluate safety and efficacy of Levosimendan in an ischemic CS population.

Methods
All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study. 39 patients received Levosimendan alone or in combination with other inotropic drugs. All patients had an invasive monitoring of arterial pressure and continuous ECG–monitoring. Patients with severe renal failure were excluded. An echocardiogram was performed before drug infusion and 3 days after. We collected data from haemodynamics and from ECG monitoring looking for arrhythmic events.

Results
We enrolled 167 patients with CS after AMI, 39 patients received Levosimendan and 10 of them required association with low–dosage noradrenaline. 32 received Levosimendan at dosage of 0,1 mcg/kg/min. The drug was started on average 4 days after hospitalization. Statistical analysis showed a significant change in left ventricular EF assessed by echocardiogram from 25% to 31% (P = 0.018, fig 1). We observed also an improvement of symptoms with an overall relief of dyspnea and fatigue clinically evaluated. The ECG monitoring showed ventricular arrhythmias (VA) in 11 patients (NSVT, SVT, VF) but the most frequent arrhythmia after Levosimendan was atrial fibrillation (AF) which was significantly associated with in–hospital mortality (OR = 1,82, p = 0,002), whereas VA did not. Moreover patients with new onset AF after Levosimendan showed a lower clinical and instrumental response to the drug. No significant changes in electrolytes (sodium and potassium) have been documented during arrhythmic events.

Conclusion
Levosimendan is useful in CS after AMI setting because has demonstrated to improve systemic hemodynamics parameters and symptomatology. Overall Levosimendan is safe with a low rate of ventricular arrhythmias that, in our sample, are not associated with in–hospital mortality. Moreover we observed also a significant increase in AF that was associated with in–hospital mortality, but further studies in larger populations could be advisable to describe the real incidence of AF after Levosimendan infusion and its prognostic role in CS patients.
P87 GENETIC CARDIOMYOPATHIES: THE FIRST YEAR OF THE FONDAZIONE IRCCS CÀ GRANDA OSPEDALE MAGGIORE POLICLINICO OF MILAN DEDICATED CLINICAL SERVICE
Authors: Faggiano A , Calcagnino M , Paganini S , Ruscica M , Carugo S 
Published: May 2023

Abstract

Objectives
Cardiac genetic counselling and testing for inherited cardiomyopathies have become essential aspects of cardiovascular care. A genetic diagnosis in a family can offer an invaluable tool for cascade genetic testing of at–risk relatives. A careful clinical and individualized approach to genetic cardiomyopathies is now needed to guarantee the best care possible. We report the results of our first–year genetic cardiomyopathies single–centre experience.

Methods
From September 2021, 69 genetic tests have been carried out at Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan by the staff of a new specific clinical service dedicated to genetic cardiomyopathies.

Results
The present study collects the data of 69 patients who underwent genetic testing and clinical follow up at our centre in suspicion of underlying genetic etiology of disease. Next generation sequencing was adopted to conduct genetic testing either by a customized panel of 54 specific genes for cardiomyopathies or by a clinical exome (180 genes). Time required for reporting and patient communication were 8 and 12 weeks, respectively. Female sex was 36%, mean age was of 53.2 ± 21.3 years. The main indications for genetic testing were dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Figure 1. 41% of DCM and 50% of HCM patients tested positive for a pathogenic or likely pathogenetic mutation. Cascade genetic tests conducted on at–risk relatives were 21 (30%). Among these subjects, 38% resulted positive at genetic screening and 57% were in turn positive at phenotypic screening. The genes hit by pathogenic or likely pathogenetic mutations are illustrated in Figure 2.

Conclusion
The first year of a specific clinical service dedicated to genetic cardiomyopathies made it possible to identify a substantial number of patients and at–risk relatives affected by pathogenic or likely pathogenetic genetic mutations.