bluuebunny/crossref_metadata_2025_split huggingface dataset:
P98 A CASE OF “RECURRENT” AORTIC VALVE STENOSIS
Authors: Baroni G , Deola P , Alderighi C , Peluso D , Cucchini U , Chirillo F 
Published: May 2023

Abstract

Clinical Case
A 80–year–old man underwent coronary angiography in 2006 because of stable angina. There was chronic total occlusion of middle left anterior descending artery requiring percutaneous intervention. In 2009 he underwent coronary angiography for recurrent angina: a severe stent restenosis was treated with stenting in stent (DES in BMS). The patient was subsequently asymptomatic till 2018 when he complained of exertional dyspnea and angina. Stent patency and severe aortic valve stenosis (AVA 0.85 cm2) were documented. The patient underwent successful transcatheter aortic valve implantation and discharged with dual antiplatelet therapy (DAPT) (Asa 100 mg and Clopidogrel 75 mg). Clinical and echocardiographic follow–up was unremarkable (mean prosthetic gradient 17 mmHg, DVI=0.45). In July 2021 during a cardiological check the patient complained of bruising: ASA was discontinued. In February 2022 the patient suffered from an exertional angina. A dipyridamole stress–echocardiography failed to demonstrate inducible ischemia, although the patient experienced angina at the peak load step. Transthoracic echocardiogram (TTE) revealed high mean trans–prosthetic aortic gradient (52 mmHg, DVI=0.18). A trans–esophageal echocardiogram (TEE) showed reduced mobility of the thickened left coronary and non–coronary aortic prosthetic leaflets. In the hypothesis of prosthetic valve thrombosis, warfarin (INR range 2–3) was started after stopping clopidogrel. After three months a TTE showed normalized mean trans–prosthetic gradients (17 mmHg, DVI=0.5). When a 6 month–period of anticoagulant therapy was accomplished, warfarin was stopped and DAPT administered again. In September 2022 the patient complained of worsening dyspnea and chest pain on exertion. At TTE mean trans–prosthetic gradients (46 mmHg) was increased. A new TEE showed thickening of non–coronary and right coronary leaflets, suggestive of recurrent valve thrombosis. After stopping DAPT, warfarin was started again with good result (mean prosthetic gradient 12 mmHg, DVI=0.5).

Conclusion
Thrombosis of aortic valve prothesis is an infrequent event usually occurring in early post–implantation period. In our case it occurred four years after implantation following DAPT interruption. The likely initial prosthetic valve degeneration together with a simplification of DAPT may have had a causative role. Since the proved efficacy of warfarin and the limited experience of DOAC in this field, the patient was given warfarin sine die.
P100 RENAL DENERVATION FOR ATRIAL FIBRILLATION IN DRUG–RESISTANT HYPERTENSIVE PATIENTS. AN UPDATED META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Meco M , Belli G , Fouladvand F , Agosteo E 
Published: May 2023

Abstract

Introduction
This meta–analysis of randomized controlled trials (RCT) was permormed to compare clinical outcomes following renal denervation (RDN) in drug–resistant hypertensive patients with atrial fibrillation (AF).

Methods Data collection
We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated AF catheter ablation associated with RDN compared with AF catheter ablation alone, in drug–resistant hypertensive patients. Outcome: The primary outcomes was the rate of AF recurrence throughout the follow–up period. Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented as odds ratios (OR) for dichotomous outcomes (Inverse variance method, random effect model) with 95% confidence interval (CI).

Results
Five full texts met inclusion criteria. A total of 531 patients were included (269 patients randomized to catheter ablation and RDN and 262 patients randomized to catheter ablation alone), with a mean follow–up of 16.8 months. We found a significantly lower number of patients with AF recurrence in the AF catheter ablation with RDN group (83/269), respect to AF catheter ablation alone (125/262) at the end of the follow–up (OR 0.51 (0.35–0.72) p 0.0002) RDN procedure in these trials was was safe with an overall compilcation rate of 6.32%

Conclusions
Combined AF catheter ablation and RDN is beneficial for patients with drug resistant hypertension and AF reducing the risk of AF recurrence.
P119 WHEN THE ELECTROCARDIOGRAM CHANGES YOUR DIAGNOSIS
Authors: Magnano R , Diella N , Pezzi L , Corazzini A , Cappelli C , Ricci F , Genovesi E , Verrengia E , Fulgenzi F , Vitulli P , Forlani D , D‘Alleva A , Gallina S , Di Marco M , Paloscia L 
Published: May 2023

Abstract
Sarcomeric hypertrophic cardiomyopathy is among the most common genetic cardiovascular diseases.Clinical,electrocardiographic and echocardiographic evaluation plays a crucial role in the diagnosis and initial framing of the hypertrophic phenotype. A 51–year–old Caucasian man with multiple myeloma,previous autologous transplant,undergoing chemotherapy for disease recurrence,without cardiovascular risk factors or family history of MCV or MCI came to our outpatient clinic for a follow–up visit.At another center,cardiac amyloidosis was diagnosed due to the echocardiogram finding of concentric left ventricular hypertrophy. Patient asymptomatic for angor,NYHAI dyspnea,heart palpitation,syncope,presented with rhythmic cardiac action,2/6 systolic murmur at centrum and tip,no central or peripheral stasis.On ecg sinus bradycardia at fc57 bpm,PR202 msec,high QRS V4–V6 voltages with negative T waves in infero–lateral site,suggestive for left ventricular hypertrophy. On echocardiogram:concentric left ventricular hypertrophy with posterolateral papillary hypertrophy,preserved contractile function,FE 62%,grade I diastolic dysfunction,no signs of elevated filling pressures,left atrium and right ventricle in normal range;tripartite aortic valve in absence of gradients,prolapse of the LAM(A1–A2)with mild grade insufficiency,mild tricuspid insufficiency. At cardiac MRI:non–dilated left ventricle with concentric hypertrophy,maximum thickness 16mm at basal SIV level,apical inferior wall,15mm anterior wall,anterolateral media,apex systolic obliteration 14mm,FE 64%.Right ventricle and atria in normal.T2–STIR sequences tenuous hyperintensity at infero–lateral media wall,inferior apical wall and lateral,increased T2 mapping in relation to myocardial edema. Subendocardial LGE of middle infero–lateral,apical lateral and postero–medial papillary wall,slight increase in native T1 mapping,ECV 27%,picture of sarcomeric hypertrophic heart disease.Holter ecg showed no arrhythmias;at HCM score low risk,no indication for ICD implantation. The patient was undergoing genetic screening test for HCM.The presence of left ventricular hypertrophy may mimic different forms of hypertrophic cardiomyopathy,leading to misdiagnosis or delayed diagnosis.Differential diagnosis,ecg and specific use of imaging tests are of paramount importance.
P126 RADIOTHERAPY AND THE HEART: IN SEARCH OF ARIANNA‘S THREAD
Authors: Irma B , Federico A , Raffaella M , Camilli M , Canale M , Russo G , Turazza F , De Felice F , Matera S , Cartoni D 
Published: May 2023

Abstract

Background
Radiation therapy (RT) is widely diffused in the treatment of cancer; but it could lead to various negative consequences on the cardiovascular system, even several years after treatment end. They include also valvular heart diseases, arrythmias, coronary artery diseases, heart failure, pericardial diseases, systemic and pulmonary artery diseases. We report an interesting case about RT cardiotoxicity different manifestation occurred in the same patient. Case report: 79 years old patient, history of previous testicular seminoma when he was 54 years old (1997), treated through surgery and RT with betatron (total body cobalt). In 2008 aortic valve replacement with mechanical prothesis; in 2017 first hospitalization for heart failure during atrial fibrillation. In subsequent years, recurring episodes of atrial fibrillation (2 unsuccessful attempts at electrical cardioversion), and heart failure exacerbations with mild reduced ejection fraction, treated through medical therapy improvement. At follow–up echocardiogram (03/19) finding of ejection fraction mild reduced (45%), right sections increased in volumes, tricuspid valve moderate regurgitation. In January 2022, at the last cardiac check–up, he reported worsening dyspnoeic symptoms, and occasional episodes of retrosternal pain in last months. It was performed Coro–TC observing a 60% stenosis at distal tract of right coronary; in addition, patient underwent a transoesophageal echocardiogram which documented further reduction in left ventricle ejection fraction, and worsening tricuspid regurgitation to a severe degree, with anulus dilatation and partial failure of leaflets coaptation, which appeared fibro–elastic; inferior vena cava ectasia, Paps 40–45 mmHg circa. Holter–ECG showed atrial fibrillation for all 24 hours, plus 2000 BEV. The case was discussed in Heart Team, and an indication was placed for Triclip intervention.

Discussion
Nowadays great achievements of anticancer therapies improved patients’ survival, consequently increased the number of anticancer therapies complications; therefore, an accurate cardiac screening for early diagnosis and effective treatment of CV adverse effects is necessary. Several distinct factors contribute to determine the onset cardiotoxicity insurgence, such as the type of cancer, its anatomical localization; radiation techniques applied, total and fractional radiation doses; patient’s age and his comorbidity and risk factors for cardiovascular diseases.
P188 OUTCOMES OF TRANSVENOUS LEAD EXTRACTION IN OCTOGENARIANS USING BIDIRECTIONAL ROTATIONAL MECHANICAL SHEATHS
Authors: Migliore F , Pittorru R , Dell‘Aglio P , De Lazzari M , Iliceto S , Bertaglia E , Gerosa G , Tarzia V , Carretta D 
Published: May 2023

Abstract

Background
Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, date on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited.The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid–term outcome after TLE.

Methods
The study population comprised 83 patients [78% male; mean age 85±3 years; (range 80–94 years)] with 181 target leads.All the leads (mean implant duration 112±77 months [range 12–377) were extracted exclusively using the Evolution RL sheaths (Cook Medical,Bloomington,IN,USA).

Results
The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3% respectively. Failure of lead extraction was seen in 1.7% of leads.The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty–day mortality after TLE was 6%. During a mean time follow–up of 22±21 months, 24 patients (29%) died. No procedure–related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35;95%CI 1.87–10.13;P=0.001), LVEF ≤35% (HR 7.89;95%CI 3.20–19.48;P&lt;0.001), and TLE for systemic infection (HR 4.24;95%CI 1.69–10.66;P=0.002).

Conclusions
At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in octogenarian with long lead dwell time Patient’s age should not influence the decision to extract or not the leads, although the 30–day and mid–term mortality are significant, especially in the present of specific comorbidities.
P194 DESTRUCTIVE AORTIC VALVE ENDOCARDITIS WITH INVOLVEMENT OF THE MITRO–AORTIC CURTAIN: A SUCCESSFUL “UFO” PROCEDURE
Authors: Testa S , Ottaviani A , Bendetti C , Gallina S , Renda G , Ricci F 
Published: May 2023

Abstract
Infective endocarditis is a relatively rare disease with an estimated mean incidence of 3.6–7.0 cases per 100,000 subject–years. Aortic bicuspid disease, the most frequent congenital anomaly, is one of the main risk factors. Heart failure, uncontrolled infection (fistulas, abscesses, persistently positive blood cultures) and systemic embolization are among the most feared complications of endocarditis: these cases constitute an indication for emergency/urgent cardiac surgery. An example of extremely demolitive surgery is the Commando or "UFO" procedure, which consists in the double replacement of the aortic valve and the mitral valve with reconstruction of the mitro–aortic junction. The clinical case concerns a 36–year–old man who went to the emergency room for high fever with shivering. Having been found positive blood cultures for MSSA and having emerged mitro–aortic vegetation by echocardiogram, a diagnosis of infective endocarditis was made. During hospitalization, multi–organ cardioembolic phenomena (e.g. splenic, cerebral) with hemorrhagic cerebral infarction occurred: therefore, in accordance with current guidelines, a conservative treatment was temporarily opted for. However, in the following days the deterioration of the clinical–haemodynamic picture was such as to require emergency cardiac surgery. The patient was thus subjected to Commando or UFO procedure with reconstruction of the mitral–aortic junction. Severe bi–ventricular dysfunction was found for the first time at post–operative echocardiographic control, with the need for mechanical support to the circulation (AV ECMO, Impella). The remainder of the hospitalization was characterized by a progressive recovery of ventricular function (LVEF 16% to 44%), therefore patient was discharged in discrete hemodynamic compensation, despite the multiorgan sequelae (hepatic, neurological, renal).
P207 DIAGNOSTIC PATHWAY OF CARDIAC AMYLOIDOSIS. INSIGHTS FROM CUNEO HOSPITAL
Authors: Coppini L , Coletta G , Rossini R 
Published: May 2023

Abstract

Introduction
In the last fifteen years, thanks to the refinement of non–invasive diagnostic techniques, there has been a clear increase in the diagnosis of amyloidosis. From this need arises the establishment of a specific out–patients department in order to guarantee the best path of diagnosis and treatment.

Methods
Since 2018 we have begun to suspect cardiac amyloidosis in hospitalized patients with heart failure with preserved ejection fraction and clinical and/or instrumental red flags: left ventricular hypertrophy unexplained by other causes, biatrial enlargement, minimal pericardial effusion, history of carpal tunnel, low voltages in peripheral leads, elevated values ​​of cardiac biomarkers. In these patients we excluded AL amyloidosis by searching for monoclonal components and at the same time we performed a myocardial scintigraphy with diphosphonates. In the case of positive scintigraphy, patients are taken care of at our cardiology rare disease outpatient clinic. We believe that this collaboration is essential for the correct management of the patient with amyloidosis, especially in an area like ours where there is a high prevalence of a mutation, val30met, with prevailing initial neurological involvement.

Results
From 2019, 156 patients underwent bone scintigraphy with diphosphonates. The average age is 78 years. 87 scintigraphies were positive (Perugini 2–3), 47 patients were diagnosed with TTRwt amyloidosis, 3 with TTRv amyloidosis, 38 are awaiting genetic testing. 34% underwent organ biopsy (of which 10 patients underwent salivary gland biopsy, 3 patients underwent periumbilical fat biopsy and 1 patient underwent BEM at another center. 25% underwent cardiac MRI. 7 patients underwent started in Tafamidis.

Conclusions
Amyloidosis is a frequently underdiagnosed disease. An early diagnosis is crucial to undertake, in cases that allow it, a specific therapy: chemotherapy in the case of AL amyloidosis or disease–modifying drugs in the case of TTR. The experience of our center has shown us how a multidisciplinary approach and a specific diagnostic path are crucial to achieve an early diagnosis in order to establish therapeutic paths that can modify natural history of the disease.
P210 PLATELET REACTIVITY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME AND ATRIAL FIBRILLATION
Authors: Sammartino A , Toso A , Leoncini M , Grippo G , Nieri M , Musilli N , Maioli M , Bellandi F 
Published: May 2023

Abstract

Background
Previous studies showed that incidence of antiplatelet therapy resistance is higher in elderly patients. There is a paucity of data about the response to antiplatelet therapy in patients with atrial fibrillation (AF). The purpose of this study is to analyze platelet reactivity during dual antiplatelet therapy (DAPT) in elderly patients (≥ 75 years) with acute coronary syndrome (ACS), stratifying them by the presence or absence of AF.

Methods
From the PRATO–ACS registry we selected 160 patients (81±5 years; 45% female) treated with DAPT (Aspirin 100 mg daily and Clopidogrel 75 mg daily). At discharge they were tested with the VerifyNow assay to measure platelet reactivity in aspirin (aspirin–reaction unit – ARU) and in clopidogrel (P2Y12–reaction unit – PRU). Low response to aspirin was defined as ARU ≥550; low response to clopidogrel was defined as PRU ≥ 208; high response was defined as PRU values ≤ 85.

Results
The ARU and PRU values for patients divided according to the presence of AF are shown in the Figure 1.

Conclusions
In this series of elderly ACS patients, AF was associated with higher residual platelet reactivity under both clopidogrel and aspirin. AF patients were significantly more clopidogrel low responders than non–AF, while non–AF patients were significantly more high responders. No difference was found for aspirin low responders between AF and no AF patients.
P216 DAPAGLIFLOZIN USE IN HFREF PATIENTS: A SINGLE CENTRE COMPARISON BETWEEN REAL–LIFE AND DAPA–HF DATA
Authors: Mapelli M , Capovilla T , Mattavelli I , Salvioni E , Marongiu A , Maranzano G , Paganin C , Vignati C , Palermo P , Sinagra G , Agostoni P 
Published: May 2023

Abstract

Background
Practice guidelines recommend Sodium–glucose co–transporter–2 inhibitors (SGLT2–i) for patients with heart failure with reduced ejection fraction (HFrEF). Our study aimed to describe our population of patients with indications for Dapagliflozin, to compare it with the DAPA–HF trial population and assess the possible prognostic evolution.

Methods
We retrospectively analysed clinical data of the first 100 HFrEF patients treated with Dapagliflozin at our heart failure clinic (Centro Cardiologico Monzino) from September 2021.

Results
Table 1 shows patient characteristics in our study (n = 100) and in the DAPA–HF trial (n = 2373). Our patients had a mean age of 69±11 years, mean left ventricular ejection fraction of 31,1±8,0%, New York Heart Association class II (78%), class III (21%) and class IV (1%). 64% of our patients performed cardiopulmonary exercise test (CPET), with mean peak VO2/kg of 14,3±4,5 ml/min/kg and mean VE/VCO2 slope of 39,1±10,5. In our study, compared to the DAPA–HF trial population, there were fewer diabetic patients (14,1% vs 41,8%, p &lt; 0,001), a larger number of patients with implanted cardioverter defibrillator (ICD) (59,6% vs 26,2%, p &lt; 0,001) and cardiac resynchronization therapy (CRT) (22,2% vs 8,0%, p &lt; 0,001). Furthermore, our population had a higher percentage of patients already on optimised therapy with Sacubitril/Valsartan (86,9% vs 10,5%, p &lt; 0,001) and mineralocorticoid receptor antagonists (82,8% vs 71,5%, p &lt; 0,001), along with beta–blockers (97,9% vs 96%, p = 0,434).

Conclusions
Our patients were slightly older and frailer than those in the pivotal DAPA–HF trial and probably at a more advanced stage of the disease as suggested by the higher prevalence of ICD/CRT and Sacubitril/Valsartan. Based on these results, it may be that the expected prognostic benefit of adding Dapagliflozin to their therapy, in terms of absolute risk, will be lower than in the DAPA–HF trial. Future studies and a longer follow–up are needed to compare death and hospitalisation rates.
P273 THE RATIO BETWEEN LEFT ATRIAL RESERVOIR AND SEPTAL E/E’: A NEW PARAMETER REFLECTING ATRIO–VENTRICULAR FUNCTION WHICH IS ASSOCIATED WITH A WORSE OUTCOME AMONG HEART FAILURE OUTPATIENTS
Authors: Diomede D , Nicolangelo D , Erica T , Michele G , Pugliese R , Alcidi G , Ioannoni S , Barone R , Correale M , Ieva R , Brunetti N , Iacoviello M 
Published: May 2023

Abstract

Background
Two–dimensional speckle tracking (2D–ST) analysis allows to evaluate both atrial and ventricular function. Recently, it has been demonstrated that the ratio between left atrial reservoir (LAr) assessed by 2D–ST and the E/e’ ratio could allow a more accurate estimation of left ventricular filling pressure. Aim of the study. To evaluate if the ratio between LAr and E/e’ is also associated with heart failure progression among chronic heart failure (CHF) outpatients.

Methods
All patients enrolled underwent a medical visit, an ECG and an echocardiographic examination. LAr was assessed by 2D–ST. The early diastolic peak at pulsed Doppler (E) and at the level of septal (e’s) and lateral (e’l) mitral annulus by Tissue Doppler Imaging (TDI) were also evaluated. Then the ratio between E and e’s (E/es) and between E and the mean of e’s and e’l (E/em) were also calculated. Finally, the ratio between LAr and E/es (LAr/Ees) and E/em (LAr/Eem) were computed. During follow–up the progression of heart failure, defined as heart failure hospitalization or death, were evaluated.

Results
Among 256 patients, LAr/Eem and LA/Ees were available in 191 patients (age 64±13 years,80 % males, mean LVEF 39±11%, NYHA class 2.3±0.5). All patients were in conventional medical therapy (sacubitril/valsartan or ACE–inhibitors or Angiotensin II receptor blockers in 85%, beta–blockers in 94%, mineralcorticoid receptor antagonists in 73%, diuretics in 81%, SGLT2 inhibitors in 21%). During a mean follow–up of 13±7 months, 25 patients experienced death (9) and/or hospitalization (21) for heart failure worsening. At univariate Cox univariate regression analysis, both LAr/Eem (HR 0.61; 95%CI: 0.43–0.87; p:0.006) and LAr/Ees (HR 0.43; 95%CI: 0.25–0.71; p:0.001) were associated with the events. However, LAr/Ees showed a greater accuracy than LAr/Eem (C–index 0.76 vs. 0.73) and remained significantly associated with the events at multivariate analysis after correction for age, LVEF, NYHA class and estimated glomerular filtration rate (HR: 0.55; 95%CI: 0.33–0.92; p:0.22). Figure shows Kaplan–Meier curves according with the median value of LAr/Eem (panel A) and LAr/Ees (panel B).

Conclusions
The ratio between LAr and E/es is a new echocardiographic parameter able to reflect both left ventricular filling pressure and worse prognosis among patients affected by CHF. Further studies should evaluate its incremental value in stratifying patients’ prognosis.