bluuebunny/crossref_metadata_2025_split huggingface dataset:
C1 COMPLETE HEART BLOCK AS A RARE MANIFESTATION OF GRANULOMATOSIS WITH POLYANGITIS: A CASE REPORT
Authors: Manai R , Cingolani M , Raineri C , Frea S , Bocchino P , De Ferrari G 
Published: May 2023

Abstract
A 42–year–old male with prior smoking habit presented at our emergency department after atraumatic syncope preceded by severe pain in the left lower limb. One month prior to presentation, due to persistence of nonproductive cough he underwent a chest computed tomography (CT), which showed 2 pulmonary nodules with hypercaptation at PET performed later (figure 1). The 12–lead electrocardiogram showed sinus rhythm with complete atrioventricular block and ventricular escape rhythm at 40 bpm (figura 1). Ecofast revealed a mildly impaired left ventricular systolic function (left ventricular ejection fraction [LVEF] 45%) with basal septal hypokinesis. Laboratory assessment showed leukocytosis (marked neutrophilia and eosinophilia), thrombocytosis anemia, elevated C–reactive protein (193 mg/dl), troponin I (18483 ng/L), NTproBNP (14627 ng/l) and creatinine (2.27 mg/dL) levels. The patient was transported to the catheterization laboratory for temporary pacemaker insertion and coronary angiography, which depicted distal occlusion of the first septal branch (Figure 2A), the first diagonal branch (Figure 2B) and the obtuse marginal branch (Figure 2C). After the procedure due to persistent ischemia of the left lower limb, several unsuccessful procedures to restore limb vascularization by means of locoregional thrombolysis and percutaneous angioplasty were attempted, but a leg amputation above the knee was eventually performed after few days. Neoplastic markers, blood cultures and urine cultures resulted negative, urine sediment examination showed cylinders, leucocytes and microhematuria. A brain/facial bones CT scan was performed, showing left maxillary sinusitis (figure 1). A rheumatologic screening was also performed, showing high titer of cANCA(125 UI/ml) hinting at a systemic vasculitis. The histopathological results of the amputated limb depicted marked necrotizing vasculitis with extensive involvement of small–medium caliber and larger caliber arterial vessels (figure 2). Based on these clinical and laboratory findings, a diagnosis of granulomatosis with polyangiitis (GPA) was made. The patients was treated with ev methylprednisolone and rituximab. After the induction therapy, chest CT scan showed a marked reduction of the size of the pulmonary nodule (Figure 3); renal function progressively improved and physiological atrioventricular conduction being restored
C22 PROGNOSTIC IMPACT OF PERCUTANEOUS CORONARY INTERVENTION IN CHRONIC DIALYSIS PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: FINDINGS FROM THE LOMBARDY HEALTH DATABASE
Authors: Trombara F , Cosentino N , Genovesi S , Bonomi A , Lucci C , Resta M , Milazzo V , Leoni O , Agostoni P , Marenzi G 
Published: May 2023

Abstract

Background
Patients on chronic dialysis are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence from randomized trials, concerns about possible PCI–related side effects, and multimorbidity. Thus, routine use of PCI for treatment of dialysis patients with AMI remains an unresolved issue.

Methods
We analyzed data of patients on chronic dialysis hospitalized with AMI (both ST–elevation myocardial infarction [STEMI] and non–ST–elevation myocardial infarction [NSTEMI]) from 2003 to 2018, by using the administrative Lombardy Health Database (Italy). Patients were grouped according to whether they were treated or not with PCI during hospitalization. The primary outcome was in–hospital mortality while 1–year mortality was the secondary endpoint.

Results
During the study period, 265,048 patients were hospitalized with AMI in Lombardy. Of them, 3,206 (1.2%) were on chronic dialysis (age 71±11; 72% males). Among dialysis patients, 44% were treated with PCI, while 54% underwent PCI among non–dialysis patients (P&lt;0.0001). Dialysis was an independent predictor of conservative treatment with medical therapy only (OR 0.75 [95% CI 0.70–0.81]). In–hospital mortality in the dialysis cohort was 15%. It was significantly lower in patients treated with PCI than in those not treated with PCI (11% vs. 19%; P&lt;0.0001). One–year mortality was 47% and it was lower in PCI–treated patients (33% vs. 52%; P&lt;0.0001). The adjusted risk of the study endpoints was significantly lower in dialysis patients treated with PCI: OR 0.62 (95% CI 0.50–0.76) for in–hospital mortality; HR 0.63 (95% CI 0.56–0.71) for 1–year mortality. Similar results were found in STEMI and NSTEMI patients considered separately.

Conclusions
Our real–world data showed that in patients with AMI on chronic dialysis, PCI use is associated with a significant in–hospital and 1–year survival benefit. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET)
C29 ANAEMIA AND CONGESTION IN HEART FAILURE: CORRELATIONS AND PROGNOSTIC ROLE
Authors: Scicchitano P , Potenza A , Basile M , Sasanelli P , Massari A , Landriscina R , Cannito A , Abruzzese S , Tangorra M , Caldarola P , Massari F 
Published: May 2023

Abstract

Background
The relationship between anaemia and congestion in HF and its prognostic role are controversial. The aim of this study was to evaluate the relationship between anaemia and biomarkers of central/peripheral congestion in HF and the impact on mortality.

Methods
We retrospectively evaluated 434 acute/chronic HF (AHF/CHF) patients. Anaemia was defined as haemoglobin (Hb) levels &lt; 12 g/dL in women and &lt; 13 g/dL in men. We evaluated brain natriuretic peptide (BNP, central congestion biomarker) and Hydration Index (HI %, bioimpedance vector analysis, peripheral congestion biomarker). The endpoint was all–cause mortality.

Results
Anaemia occurred in 59% of patients with AHF and in 35% with CHF (p&lt;0.001) and showed significant correlation with NYHA functional class and renal function. BNP and HI were significantly higher in patients with than in those without anaemia. Independent predictors of anaemia included BNP, estimated creatinine clearance (eCrCL), and HI. During a median follow–up of 463 days, all–cause mortality rate was 21% which was significantly higher in patients with than in those without anaemia (30% vs 14%, p&lt;0.001; HR 2.6). At multivariate Cox regression analysis BNP, eCrCL, and HI confirmed as independent predictors for mortality (HR 1.0002, HR 0.97, and HR 1.05, respectively), while anaemia did not confirm its predictive value.

Conclusions
Anaemia correlates HF status, functional class, renal function and biomarkers of central/peripheral congestion. Indeed, anaemia was not an independent predictor for mortality. Therefore, anaemia in HF seems rather a marker of disease severity in patients with high congestion burden than a predictor of death.
C31 NEXT GENERATION MYOCARDITIS
Authors: Mistrulli R , Cartoni D , Andreoli F , Lestuzzi C , Paccone A , Gallucci G , Fiscella D , Petrolati S , Bisceglia I 
Published: May 2023

Abstract
A 75–year–old overweight man, affected by hypertension, diabetes mellitus and atrial fibrillation since 2020. After 3 unsuccessful attempts of electrical cardioversion it was opted for a strategy of rate control with beta blocker and anticoagulant therapy with Rivaroxaban 20 mg. Following episodes of rectal bleeding; adenocarcinoma of the colon was diagnosed. The patient underwent hemicolectomy and started therapy with Pembrolizumab. The anticoagulant was replaced with Edoxaban 60 mg. In August 2022, he was admitted to the emergency department for severe signs and symptoms of heart failure. On ECG, atrial fibrillation with a heart rate of 90 bpm and non–specific changes in ventricular repolarization. The echocardiogram showed a severe reduction of the ejection fraction (FE 30%), which was not present at previous controls. On blood tests, troponins were negative and BNP increased. The patient underwent coronarography which was negative for significant lesions, and heart failure therapy was prescribed. Three months later the patient came to our cardio–oncology outpatient clinic; we repeated the echocardiogram which showed a recovery of the ejection fraction to 45% and planned a cardiac MRI. Cardiac MRI (CMR) showed global left ventricular hypokinesia (FE 42%) and late subepicardial gadoline enhancement in the basal segment of the inferior wall and transmural in the basal segment of the lateral wall without signs of oedema. Report described as compatible with myocarditis. The case was discussed collegially with radiologists and oncologists, and it was decided to discontinue immunotherapy (ICI). Myocarditis is the most common cardiovascular adverse events of ICI therapy, although it has a very low incidence. Generally, myocarditis related to ICI therapy has a high mortality rate and requires discontinuation of ICI. In addition, CMR may have a lower sensitivity in this setting. There is also a possibility of developing left ventricular dysfunction without associated myocarditis in the absence of increase in cardiac troponin and active myocardial inflammation at CMR. Although our case has been defined as myocarditis, it presents some unclear aspects due in part to the early non–diagnosis as a complication of ICI therapy. Although cancer patients taking ICI has expanded considerably in recent years, the evidence on cardiovascular complications is scarce and unknown to the clinical cardiologist.
C56 ACCURACY OF TWO–DIMENSIONAL SPECKLE TRACKING PARAMETERS REFLECTING LEFT ATRIAL FUNCTION IN PREDICTING OUTCOME AMONG OUTPATIENTS AFFECTED BY HEART FAILURE
Authors: Diomede N , Diomede D , Terazzi E , Granatiero M , Romano M , Goffredo G , Di Terlizzi V , Correale M , Ieva R , Brunetti N , Iacoviello M 
Published: May 2023

Abstract

Background
The two–dimensional speckle tracking analysis (2D–ST) is a new useful tool in order to evaluate both atrial and ventricular function. Aim of the study. To evaluate the accuracy of the 2D–ST measures reflecting atrial and ventricular function in predicting the outcome among outpatients affected by chronic heart failure (CHF).

Methods
We enrolled 212 outpatients (age 64±13 years, 77% males, mean left ventricular ejection fraction, LVEF, 38±11%, NYHA class 2.4±0.5) affected by CHF in conventional therapy (sacubitril/valsartan or ACE–inhibitors or Angiotensin II receptor blockers in 85%, beta–blockers in 94%, mineralcorticoid receptor antagonists in 74%, diuretics in 72%, SGLT2 inhibitors in 20%). All patients underwent a medical visit, an ECG and an echocardiographic examination. The following 2D–ST parameters reflecting atrial and ventricular function were analyzed: global longitudinal left ventricular strain (LV–GLS, mean –11.4±3.9%), global longitudinal right ventricular strain (RV–GLS, mean –15.2±5.2%), free wall right ventricular longitudinal strain (RV–fwLS, mean –20.2±5.8%); left atrial reservoir (LAr, mean 19±10.8%), conduit (LAcd, mean –10.–8±6.8) and contraction (LAct, mean –8.1±8.2). Moreover, 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, mean 13.9±6.4) and between E and the mean of e’s and e’l (E/em, mean 11.1±5.4) were also calculated. Finally, the ratio between LAr and E/es (LAr/Ees, mean 1.98±1.65) and E/em (LAr/Eem, mean 2.51±1.95) were computed. During follow–up the progression of heart failure, defined as heart failure hospitalization or cardiovascular death, were evaluated.

Results
During a mean follow–up of 13±6, 32 patients experienced death (13) and/or hospitalization (25) for heart failure worsening. The table shows the relationship among echocardiographic variables and outcome At Cox univariate regression analysis and the relative C–index. LAR/Ees showed the greater accuracy (C–index) in predicting heart failure progression.

Conclusions
2D–ST is an echocardiographic approach able to more accurately assess both left ventricular and atrial function. In our series, among the 2D–ST parameters, the ratio between LAr and E/es is characterized by the greater accuracy in predicting heart failure progression.
C65 TRANSTYRETIN CARDIAC AMYLOIDOSIS IN THE ELDERLY PATIENT: ALWAYS A WILD TYPE?
Authors: Costantino J , Ajmone F , Ballatore F , Manguso G , Maggio E , Ciaramella P , Alfarano M , Vizza C , Chimenti C 
Published: May 2023

Abstract

Background
Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome.

Methods and results
In our centre, from January to October 2022, 20 patients older than 75 years received a diagnosis of cardiac ATTR (73% male, 27% female, mean age 83±5). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.070± 0.074 ng/mL) and NT–proBNP (1533±1204 pg/ml), with the absence of a monoclonal component in the blood and urine, and myocardial bisphosphonate scintigraphy positive grade 2/3. All patients showed absence of peripheral neuropathy with the presence of carpal tunnel syndrome in 9 cases. Before starting therapy with Tafamidis all patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 3 elderly male patients (15%) the genetic test resulted positive with 3 different mutations of pathogenetic significance (Val50Met; Ile88Leu; Val142Ile). First–degree relatives (10 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 4 (1 male and 3 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. All of these tests were normal and they were included in an annual follow–up protocol at the to identify an early manifestation of the disease.

Conclusions
our experience shows that 15% of patients older than 75 years and diagnosed with cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage can occur.
C85 COFFEE CONSUMPTION RELATES TO A REDUCTION OF VASCULAR AND HEART DAMAGE IN WELL–CONTROLLED HYPERTENSIVES
Authors: Marozzi M , Di Trani M , Vacca A , Zotti F , Rignani F , Gramigna D , Amodio G , Santoro G , De Benedittis L , Schirosi G , Brosolo G , Catena C , Ranieri G , Sechi L , Nazzaro P , Cicco S 
Published: May 2023

Abstract

Aim
Nutritional interventions might prevent hypertension–related organ damage but are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated heart and vascular damage in well–controlled hypertensives according to coffee consumption.

Methods
We evaluated 316 primary hypertensives (150F, 166M, aged 62.22±10.76) evaluated for target organ damage. The number of coffee cups per day was asked during the visit.

Results
The median coffee consumption was 2 cups per day and patients were subdivided into tertiles: Group 1, 0–1 cups 112 patients (57F, 55M; 64.21±10.91 y.), Group 2, 2 cups, 101 patients (53F; 48 M; 61.95±10.10 y.), Group 3, &gt;2 cups, 103 patients (40F; 63M; 60.32±10.95 y.). No differences were seen in BMI, systolic and diastolic BP. Group 1 had a higher left ventricular mass than the other two groups (p= 0.0008 and p=0.019 respectively) while no difference there was between group 2 and 3. Similarly, Group 1 had a significant reduction in E/e’ ratio (p=0.042 and p=0.019, respectively). No significance was found between Group 2 and 3 for left ventricular mass and diastolic function. Group 3 had an increased intima–media thickness (p=0.004 and p=0.005 vs Group 1 and 2, respectively). Prevalence of carotid stenosis was lower in Group 3 (p=0.011 and p=0.039, respectively) and was comparable in Group 1 and 2.

Conclusion
Coffee consumption at least of 2 cups/day may have a role in prevention of heart remodelling and diastolic dysfunction.
C90 THE ROLE OF PREPARTICIPATION SCREENING IN DETECTING SILENT CORONARY ARTERY DISEASE IN MASTER ATHLETES: A WAY TO PREVENT EXERCISE–RELATED ADVERSE CARDIOVASCULAR EVENTS
Authors: Scarfò G , Rizza A , Bollino A , Besola L , Colli A , Franzoni F 
Published: May 2023

Abstract
Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre–existing lesions. However, long–term exercise is frequently associated with adverse cardiovascular events in 35–year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death. The purpose of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes. Between 2018 and 2019, 420 35–year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular risk factors or previous cardiovascular diseases. After a physical examination, all subjects were submitted to spirometry and ECG stress test. The ECG stress test demonstrated signs of myocardial ischemia (ST depression &gt; 1 mm) in 41 subjects; 3 athletes showed a frequency–dependent left bundle–branch block; 24 subjects had exercise–induced premature ventricular complexes during the ECG stress test. These subjects underwent further evaluations (Tc–99 myocardial perfusion SPECT and coronary angio–CT) to detect the presence of perfusion defects or coronary abnormalities: 26 athletes had an important coronary atherosclerosis with significant stenosis in one or more vessels and later subjected to Percutaneous transluminal coronary angioplasty (PTCA) or to coronary artery bypass grafting (CABG). 5 athletes presented a coronary myocardial bridge and 1 subject was demonstrated to have an anomalous origin of the left coronary. Preparticipation screening in 35–year–older athletes was able to detect the presence of obstructive coronary artery disease (CAD) in the 38% of suspected cases and anomalous origin or intramural coronary course in 8,8% of cases that showed electric abnormalities during the stress test. Despite recent conflicting opinions about the scientific value of the preparticipation screening in young athletes, the present study demonstrated that it was fundamental to early detect silent conditions that could predispose master athletes to adverse cardiovascular events.
P50 ODD CONNECTIONS
Authors: Bellin A , Cutolo A , Vio R , Ronco F , Themistoclakis S 
Published: May 2023

Abstract
A 40 yo man was admitted to the ER due to typical oppressive chest pain at rest; he had no previous medical history and he denied any cardiovascular risk factor, including family history of cardiac disease. He was actually a sportsman, practicing martial arts. The basal ECG showed sinus rhythm, and an early repolarization pattern with no pathological features. Physical examination revealed a continuous cardiac murmur (2/6) along the sternal border and no other pathological signs. Three consecutive HsTnI determinations resulted negative. He was evaluated by the cardiologist, and a bedside echocardiogram resulted unremarkable. Due to the typical characteristics of the symptoms, an exercise ECG was performed, and the results were suspicious for inducible ischemia at high workloads. He was then admitted to our Cardiology ward, where he underwent a coronary angiography that showed a really surprising and unexpected anatomy: numerous coronary fistulas arising from various tracts (mid–LAD, intermediate coronary artery, conal branch of RCA, and distal Cx). A CT coronary angiogram was then performed, showing some ectasic vascular malformations between different coronary arteries, between coronaries and the pulmonary artery, and also a vascular anomaly connecting a bronchial artery with the right pulmonary artery. We subsequently performed a full body CT angiogram and a cerebral MR angiography, that excluded the presence of extrathoracic arteriovenous malformations. This case shows an extremely rare coronary congenital anomaly (accounting for 0.08–0.4% of all congenital heart disease), that generally goes underdetected in the first decades of life of these subjects. In this case, the typical anginal symptoms (probably due to coronary “steal” mechanism) arose suspicion that lead to the, albeit least expected, odd diagnosis. The treatment of symptomatic coronary fistulas is percutaneous/surgical closure. The patient was referred to our Tertiary Centre GUCH department, where a multidisciplinary discussion will decide the best therapeutic strategy.
P53 DOUBLE OUTLET RIGHT VENTRICLE IN PATIENT WITH XP11.23 DUPLICATION AND SYNDROMIC PHENOTYPE: BROADENING OF THE CLINICAL SPECTRUM
Authors: Morreale P , Amato S , Mannino P , Sanfilippo M , Comparato C , Scardino G 
Published: May 2023

Abstract
DORV accounts for 2–3% of congenital heart disease (prevalence of 1/10,000). It is a cono–truncal anomaly with variable clinic. In 25–42.5% of cases there are chromosomal anomalies such as trisomy 13, 18, 22q11 microdeletion and possible associated anomalies such as facial and skeletal dysmorphisms, brain anomalies and renal agenesis. duplication Xp11.22–p11.23 was described in 2009 by Giorda and is characterized by intellectual disabilities, speech delay, epilepsy, and EEG abnormalities. We report the case of a patient with dupXp11.23 and major anomalies not reported in the literature. C.B. born from 1st pregnancy at 32+4 w, by cesarean section for fetal bradycardia and polyamnios; At first trimester screening, finding of large ventricular defect and high risk for trisomy 18 and 13. Non–resolving fetal DNA and normal 46XY karyotype. At birth weighing 1750 g, APGAR 1‘:3, 5‘:7,10‘: 8, he was intubated and transferred to intensive care. On physical examination: prominent frontal bumps, facial asymmetry with right hypoplasia, anterior plagiocephaly, microphthalmia, low–set left ear, large both pinnae, macroglossia, hypospadias. He underwent surgery for duodenal atresia and Meckel‘s diverticulum. In the following days poor clinical conditions, poor growth and manifestations of heart decompensation. On auscultation II tone of increased intensity, meso–pulmonary systolic murmur, hepatomegaly. The electrocardiogram showed normal sinus rhythm and signs of left ventricular hypertrophy. On echocardiogram Situs solitus –D loop Levocardia. Patent foramen ovale with middle left–right shunt, dilated left atrium, globular left ventricle, preserved systolic function. Poorly aligned arterial outflows emerging from the right ventricle. Large subpulmonary interventricular defect. Hyperflow flowmetry. Aortic arch dilated in the proximal tract. He therefore started therapy with furosemide. Subsequent monitoring showed poor growth for which cardiac surgery was indicated. This case report contributes to broadening the clinical spectrum of duplication syndrome Xp11.22–p11.23.