bluuebunny/crossref_metadata_2025_split huggingface dataset:
C47 ADAPTATION OF THE PULMONARY CIRCULATION AND OF THE RIGHT HEART IN INTRACARDIAC INVETERATE SHUNTS: UNDER PRESSURE OR LET IT FLOW?
Authors: Pugliesi G , Baratto C , Badano L , Sganzerla P , Perego G , Muscogiuri G , Parati G , Caravita S 
Published: May 2023

Abstract
Congenital heart disease can be associated with pulmonary hypertension (PH) development and heart right remodelling. Nevertheless, the adaptation of the pulmonary circulation and of the right heart can be extremely heterogeneous, so that an accurate diagnostic work up may be advisable when an intracardiac shunt is suspected.

Case Presentation
A 53 years old woman, with no relevant clinical history and asymptomatic, was incidentally found to have clinical, ECG and echocardiographic signs of PH, and was referred to our Center.

Diagnostic and Therapeutic Work Up
Echocardiography showed: normal left ventricle (LV 3D volumes 88/35 ml), mild left atrial dilatation (39 ml/m2); severe right chambers dilatation (RV 3D 347/124 ml, EF 3D 62%, AD 116 ml/m2), moderate tricuspid regurgitation with a regurgitant jet velocity of 2.9 m/s. Right heart catheterization showed normal pulmonary pressures at rest (mPAP 20, PAWP 5 mmHg), extremely high pulmonary blood flow (Qp 29 L/min, calculated with the direct Fick method), with normal pulmonary vascular resistance (PVR 0.5 WU). During the oxymetric run, a step up in hemoglobin saturation between superior vena cava and right atrium (from 74 to 97%) was found, with a Qp/Qs ratio of 5.5. During exercise, Qp reserve was normal, suggesting a normal contractile reserve function of RV despite the extreme dilatation. Additionally, the patient did not develop exercise PH and exercise capacity was normal, based on a measured oxygen consumption (VO2) at peak of 24 ml/kg/min (104% of predicted). Angio–CT of the chest was performed, confirming the presence of a sinus venosus atrial septal defect. The patient was then referred for surgical correction.

Conclusion
Echocardiography signs are useful to direct correctly diagnostic work up. A severe RV dilatation with normal systolic function in an asymptomatic middle age woman should raise the possibility of an intracardiac shunt. Despite a large intracardiac shunt with a high Qp/Qs ratio for decades, PVR was normal, confirming that individual predisposition may play a role in the development of PH in pre–tricuspid shunts. Exercise test showed an optimal RV reserve, suggesting a low cardiac surgery risk.
C49 NO CONTRAST TAVI
Authors: Paparoni F , De Remigis F , Tomassoni G , Marrangoni A , Marrone G , Fragassi G , Lezzi A , Fabiani D 
Published: May 2023

Abstract

Background
Chronic renal failure is a common comorbidity in patients undergoing TAVI. Large amounts of contrast media are generally needed to safely perform TAVI with potential deleterious effects on renal function and long term life quality.

Objectives
Every step of the procedure can be safely replaced by no contrast techniques: ultrasound guided vascular puncture and final check, alignement of 3 guides in Valsalva sinuses to check coplanarity or cusp overlap, coupling of hemodynamics and transthoracic echocardiography to check the results and need of postdilatation, measure of gradient across the arterial puncture to rule out iatrogenic stenosis.

Matherials and Methods
3 patients with severe renal failure (GFR &lt; 30 ml/min/ 1.73 m2) and 1 patient with moderate renal failure and previous double renal transplantation underwent TAVI with protocol without contrast in our center in the last year. All cases were performed with local anesthesia and conscious sedation. 3 cases were performed with balloon expandable bioprosthesis and 1 with self expandable bioprosthesis.

Results
We were able to perform TAVI procedure without contrast in all 4 patients in which the technique was attempted without complications. Hemodynamics was excellent in all cases with no residual gradient or significant leaks. No vascular complication occured. Procedural time was generally 20% longer than average procedure but X rays dose exposure was reduced because less cine acquisitions were needed.

Conclusions
TAVI with no use of contrast media is feasible and safe by extensive use of vascular ultrasound, hemodynamics, transthoracic echocardiography and multiple guides to depict coronary sinuses and assure correct prothesis implantation.
C52 GENDER DIFFERENCES IN AMPLITUDE SPECTRAL AREA (AMSA) OF VENTRICULAR FIBRILLATION IN PATIENTS WITH OUT–OF–HOSPITAL CARDIAC ARREST
Authors: Vicini Scajola L , Quilico F , Gentile F , Compagnoni S , Baldi E , Aramendi E , Isasi I , Lopiano C , Primi R , Bendotti S , Currao A , Contri E , Palo A , Savastano S 
Published: May 2023

Abstract

Introduction
Ventricular fibrillation (VF) Amplitude Spectral Area (AMSA) is a well–established predictor of successful defibrillation and return of spontaneous circulation (ROSC). Attending to the limited evidence on the topic, gender seems to affect AMSA, and higher values have been reported in females. The aim of this work was to investigate the effect of gender in AMSA values for patients suffering out–of–hospital cardiac arrest (OHCA).

Methods
We enrolled 4619 consecutive OHCA patients from January 2015 to December 2020 in the LombardiaCare Registry. We considered only those subjects with attempted cardio–pulmonary resuscitation (697 patients) and at least one shock delivered. A total of 250 patients were considered (40 F/ 210 M) with 830 shocks (100 F/ 730 M). AMSA values were computed for the ventricular fibrillation in the 2–s pre–shock interval of the ECG recorded by the Corpuls3 defibrillator (Corpuls, Kaufering, Germany).

Results
Female patients were older than male [median(IQR) 70.5 (62–72) vs 67 (55–75) years, p=0.01], with cardiac arrest more frequently at home (84% vs 76%, p=0.003), fewer shocks [2 (1–4) vs 4 (2–7), p=0.004] and higher percentage of success (53% vs 40%, p= 0.009). On the contrary, cardiac arrest duration [ 58.7 (31–69) vs 57.6 (41.4–77.3) min, p=0.366] and the rate of ROSC (32% vs 33%, p=0.88) were similar in both groups. Higher AMSA values were found in female patients [10.3 Hz–mV (6.6–13.5) vs 7.9 Hz–mV (5.2–12.1), p= 0.0007]. At a multivariable analysis, after correction for witnessed status, bystanders CPR, amiodarone administration, age and call–to shock time, male sex was found to be independently associated with the probability of having low values of AMSA, below the median value of 8.3 Hz–mV [OR 2.15 (95%CI1.35–3.43), p=0.001]. Despite gender stratification ROC curve analysis confirmed AMSA as a predictor of shock success [AUC–F: 0.75 (95%CI 0.65–0.83), p&lt;0.001; AUC–M: 0.78 (95%CI 0.74–0.81)] and ROSC [AUC–F: 0.69 (95%CI 0.59–0.68), p=0.008; AUCM: 0.84 (95%CI 0.81–0.87)].

Conclusion
Female sex is related to higher AMSA values. As AMSA reflects the energetical status and the ATP levels in the myocardial cells during cardiac arrest, this difference may be due to lower incidence and lower severity of cardiac ischemic disease in women. AMSA remains a valid predictor of both shock success and ROSC for female and male patients. Further investigations are needed to support and comprehend these conclusions.
C57 ASSOCIATION OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY AND STRESS–ECHOCARDIOGRAPHY WITH LONG–TERM CARDIAC OUTCOME: A COMPARISON STUDY
Authors: Tuttolomondo D , Gaibazzi N 
Published: May 2023

Abstract

Aims
The study aims to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress–echocardiography (SE) are best associated with long–term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests.

Methods
We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis &gt;50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was assessed using Fine and Gray competing risk models.

Results
During a median follow–up of 10 years, 38 (9.6%) patients experienced a non–fatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, p&lt;0.001) and a lower CFVR (HR 0.034, p&lt;0.001) on SE, CACS (HR 1.004, p&lt;0.001) and the number of &gt;50% stenosed coronary vessels (HR 1.975, p&lt;0.001) on CTA were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both p&lt;0.001) with cardiac outcome.

Conclusion
Our data suggest that only CFVR on SE and CACS on CTA are independently and strongly associated with long–term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.
C58 A NEW MAGNETIC RESONANCE IMAGING TECHNIQUE TO ASSESS PROGNOSIS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND LOW–INTERMEDIATE 5–YEAR RISK OF SUDDEN DEATH
Authors: Bracco A , Sinagra G , Carerj S , Todiere G , Grigoratos C , Di Bella G , Aquaro G 
Published: May 2023

Abstract

Background
Late gadolinium enhancement (LGE) is an important prognostic marker in hypertrophic cardiomyopathy and an extent &gt;15% it is associated with high risk of sudden cardiac death. We proposed a novel method, the LGE–dispersion mapping, to assess heterogeneity of scar, and evaluated its prognostic role in patients with hypertrophic cardiomyopathy.

Methods
One hundred eighty–three patients with hypertrophic cardiomyopathy and a low– or intermediate 5–year risk of sudden cardiac death underwent cardiac magnetic resonance imaging. A parametric map was generated from each LGE image. A score from 0 to 8 was assigned at every pixel of these maps, indicating the number of the surrounding pixels having different quality (nonenhancement, mild–enhancement, or hyperenhancement) from the central pixel. The Global Dispersion Score (GDS) was calculated as the average score of all the pixels of the images.

Results
During a median follow–up time of 6 (25th–75th, 4–10) years, 22 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter–defibrillator therapy, resuscitated cardiac arrest, and sustained ventricular tachycardia). Kaplan–Meier analysis showed that patients with GDS&gt;0.86 had worse prognosis than those with lower GDS (P&lt;0.0001). GDS&gt;0.86 was the only independent predictor of cardiac events (hazard ratio, 9.9 [95% CI, 2.9–34.6], P=0.0003). When compared with LGE extent &gt;15%, GDS improved the classification of risk in these patients (net reclassification improvement, 0.39 [95% CI, 0.11–0.72], P&lt;0.019).

Conclusions
LGE–dispersion mapping is a marker of scar heterogeneity and provides a better risk stratification than LGE presence and its extent in patients with hypertrophic cardiomyopathy and a low intermediate 5–year risk of sudden cardiac death.
C59 CLINICAL AND ECHOCARDIOGRAPHIC FOLLOW–UP IN PATIENTS WITH SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS: SINGLE CENTER ANALYSIS IN ELEVEN–YEARS EXPERIENCE
Authors: Concistrè G , Margaryan R , Bianchi G , Chiaramonti F , Kallushi E , Gasbarri T , Murzi M , Varone E , Simeoni S , Leone A , Pierandrea F , Solinas M 
Published: May 2023

Abstract

Aims
We describe long–term clinical and echocardiographic follow–up in the largest single center cohort of patients underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis.

Methods
Between March 2011 and September 2022, 1237 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 78 ± 4 years and mean EuroSCORE II was 6.9 ± 2.8%. Concomitant procedures were performed in 272 patients (22%).

Results
Thirty–day mortality was 1.37% (17/1237). 890 of 951 (93.5%) isolated AVR underwent minimally invasive surgery with a ministernotomy (n = 221) or right minithoracotomy (n = 669) approach. Cardiopulmonary bypass and aortic cross–clamp times were 80.6 ± 21.5 and 50.1 ± 10.5 minutes for isolated AVR and 145.8 ± 33.6 and 95.8 ± 20.7 minutes for combined procedures. At mean follow–up of 55.09 ± 6.7 months (range: 1–138.5 months), survival was 95.4% and mean transvalvular pressure gradient was 13.3 ± 4.2 mmHg. LV mass decreased from 153.5 g/m2 to 114.6 g/m2 (p&lt; 0.001) and moderate paravalvular leakage occurred in 3 patients without hemolysis not requiring any treatment. Freedom from reoperation was 97.4%. Nine patients required surgical reintervention and 21 patients transcatheter valve–in–valve procedure for structural prosthesis degeneration at mean of 6.3 years after first operation (range: 2–10 years).

Conclusion
AVR with Perceval bioprosthesis is associated with good clinical results and excellent hemodynamic performance in our eleven–years experience. Structural degeneration rate of Perceval is comparable with others bioprosthetic aortic valve. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.
C61 RAREFACTION OF MYOCARDIAL LYMPHATIC VESSELS IN PATIENTS WITH CARDIAC AMYLOIDOSIS
Authors: Aimo A , Martinelli G , Bonino L , Musetti V , Castiglione V , Emdin M , Vergaro G , Pucci A 
Published: May 2023

Abstract

Introduction
In cardiac amyloidosis (CA), amyloid fibers accumulate in the extracellular spaces of the heart, causing a compression and obliteration of lymphatic vessels, and possibly their disappearance. As lympathic drainage removes proteins from the interstitial spaces, including amyloid precursors, an impairment of lympathic vessels could exacerbate amyloid accumulation, triggering a vicious circle.

Methods
Lymphatic vessels were visualized by immunohistochemistry using a monoclonal antibody against podoplanin (D2–40, a marker of lymphatic endothelial cells) and the immunopreroxidase technique. We investigated 3 groups of cases: 1) as a reference standard, endomyocardial specimens from the left ventricular (LV) endomyocardium of 10 heart valve donors, deceased for trauma and/or cerebral hemorrhage, with no evidence of cardiac disease on gross and microscopic examination; 2) 15 consecutive LV endomyocardial biopsies (EMBs) from patients with CA, where cardiac amyloid was detected and typed by Congo red staining, immunohistochemistry and proteomics, and 3) 13 surgical endomyocardial biopsies from patients with septal LV hypertrophy, undergoing aortic valve surgery and with CA excluded by histology.

Results
In donor hearts (n=10), lymphatic vessels were mostly distributed in the subendocardial and subepicardial layers, with some intra–myocardial lymphatic vessels near larger blood vessels. We then examined 15 patients with CA (amyloid transthyretin [ATTR]–CA, n=10; amyloid light–chain [AL]–CA, n=5; 50% men, median age 75 years [interquartile range 71–78]), and 13 patients with CA excluded (55% men, median age 68 years [59–71]). The density of lymphatic vessels in patients with CA was 0.52 vessels/mm2 (0–3.32), vs. 10.90 vessels/mm2 (3.10–26.25) in those without CA (p=0.001). No significant differences were found in LV mass index (p=0.170) or LV ejection fraction (p=0.262). Three patients with ATTR–CA and 2 patients with AL–CA showed no lymphatic vessels on EMB. The density of lymphatic vessels did not differ significantly in patients with ATTR– or AL–CA.

Conclusions
Patients with CA have significantly decreased endo–myocardial lymphatic vessels as compared to patients without CA, despite no significant difference in the degree of LV wall thickening or LV ejection fraction. These results support the hypothesis that the lymphatic drainage is deranged in patients with CA, possibly promoting further amyloid deposition.
C71 EFFICACY AND SAFETY OF PERCUTANEOUS LEFT STELLATE GANGLION BLOCK IN PATIENTS WITH REFRACTORY ELECTRICAL STORM
Authors: Compagnoni S , Gentile F , Baldi E , Sanzo A , Rordorf R , Savastano S 
Published: May 2023

Abstract

Background
Neuromodulation by percutaneous stellate ganglion block (PSGB) with local anaesthetic has proved its antiarrhythmic effect suitable for an emergency setting.

Purpose
To assess the efficacy and safety of PSGB performed with an anterior anatomical approach in patients with refractory electrical storm refractory.

Methods
Patients with electrical storm at the Policlinico S.Matteo of Pavia were enrolled from November 2017 to January 2022. Left PSGB (PLSGB) was performed after failure of at least one intravenous antiarrhythmic drug. Its repetition or a continuous infusion of the local anaesthetic were considered in selected cases. Clinical data, characteristics of the block and complications were collected. The efficacy was evaluated by comparing the number of arrhythmias treated with ATP or DC–shocks by external or internal defibrillator 1 hour before the block with 1 hour after the block. Per–patient efficacy was assessed by comparing the number of ATP/shocks in the 12 hours before the first procedure with that in the 12 hours after the last one.

Results
37 patients were enrolled: 76% male, mean age 65 years; 11 with dilated cardiomyopathy, 18 with chronic ischemic heart disease, 11 with STEMI, 3 with NSTEMI, 1 with ARVC and 1 with drug intoxication. A total of 62 PLSGBs were performed: 19 for VT, 26 for VF and 17 for both VT and VF episodes; 15 on intubated patients, 4 in extracorporeal circulation, 7 in cardiogenic/septic shock, 28 on patients on single antiplatelet therapy, 11 on dual antiplatelet therapy, 33 on anticoagulant therapy. PLSGBs were performed during intravenous infusion of antiarrhythmics (amiodarone in 30, lidocaine in 37 procedures). The local anaesthetic used was lidocaine in 27/62 PLSGB, bupivacaine in 6/62 and both in 29/62. The per–procedure analysis showed a significant reduction of the number of ATP/shocks in the hour after PLSGB compared with the hour before [0 (0–0) vs 5 (1–8) p&lt;0.001]. Similarly, in the per–patient analysis, the number of ATP/shocks significantly decreased in the 12 hours after the PLSGB compared with that in the 12 hours before [0 (0–1.3) vs 7 (4.8–12.5) p&lt;0.001]. No complications occurred.

Conclusions
This is the case series with the highest number of PLSGB for antiarrhythmic purposes in literature and it confirms its efficacy and safety in refractory electrical storm. The exiguity of the equipment required makes the anatomical approach suitable to be easily performed by cardiologists.
C75 INTRAVENOUS CANGRELOR INFUSION IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SUBANALYSIS OF THE ICARUS REGISTRY
Authors: Scalamera R , Benenati S , Gragnano F , Schettino M , Bertero E , Capolongo A , De Sio V , Musumeci G , Annibali G , Campagnuolo S , Galasso G , Silverio A , Bellino M , Centore M , Menozzi A , Caretta G , Rezzaghi M , De Luca L , Veneziano F , De Nardo D , Cirillo P , De Rosa G , Calabrò P , Porto I 
Published: May 2023

Abstract

Aims
To assess the clinical characteristics and compare in–hospital outcomes of elderly and non–elderly patients receiving cangrelor in the peri–percutaneous coronary intervention (PCI) phase.

Methods
Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high–bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Elderly patients were defined if age was ≥75 years at the time of PCI. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay. Independent predictors of the primary endpoint were also assessed.

Results
Out of 551 patients undergoing PCI with cangrelor between January 2019 and August 2022, 174 (32%) were elderly. Mean age was 81±5 vs. 61±8 years in elderly vs. non–elderly patients (p&lt;0.001). Female sex (32% vs. 21%, p=0.006), atrial fibrillation (20% vs. 5%, p&lt;0.001), chronic kidney disease (30% vs. 6%, p&lt;0.001) and heart failure (14% vs. 8%, p=0.041) were more frequent in the elderly group, whereas presentation with acute coronary syndrome (ACS) was less frequent (69% vs. 83%, p=0.001). Elderly patients received shorter cangrelor infusion (122±25 vs. 134±43 minutes, p=0.001) and were more frequently administered with clopidogrel after PCI (50% vs. 19%, p&lt;0.001). At 48 hours, elderly patients had higher rates of NACE (13% vs. 6%, p=0.006) and BARC 2, 3 or 5 bleeding (11% vs. 5%, p=0.013), whereas the rates of other 48–hour and in–hospital clinical endpoints did not differ. At multivariable analysis, age ≥75 years (odds ratio [OR] 1.07, 95% CI 1.02–1.12, p=0.004), major anemia (OR 1.10, 95% CI 1.005–1.22, p=0.038), ACS at presentation (OR 1.08, 95% CI 1.03–1.14), femoral access (OR 1.13, 95% CI 1.06–1.22) and cardiogenic shock (OR 1.35, 95% CI 1.21–1.50) independently predicted the occurrence of 48–hour NACE.

Conclusions
Advanced age is a distinctive risk feature among patients receiving intravenous cangrelor in the peri–PCI phase. Elderly patients had higher rates of adverse events at 48 hours, with advanced age (≥75 years) being an independent predictor of NACE.
C83 BEHIND MYOCARDITIS DIAGNOSIS
Authors: Andreoli F , Tolone S , Cifarelli A , Pennacchi M , Cesario V , Pulignano G , Tinti M , Gabrielli D 
Published: May 2023

Abstract

Background
Myocarditis is an inflammatory disease of myocardium, with a wide range of clinical presentation. Myocarditis may mimic acute coronary syndrome (ACS), but it is also possible an overlap between these two different syndromes, as we considered the close relationship between wide inflammatory systemic condition and coronary atherosclerotic plaque instability Case report: We report the case of 29 years old man admitted to emergency department for burning chest pain changed with breathing and in different positions of the body, associated to dyspnea on mild–moderate exertion. Symptoms had begun to arise a week earlier, with flu–like symptoms, and got worse in the last 48 hours. In his clinical history the patient reports: previous myocarditis, dyslipidemia, hyperhomocysteinemia, overweight, family history of cardiovascular disease and a previous COVID infection. Blood tests found a rise of Troponin I HS. Electrocardiogram showed diphasic T wave in antero–lateral leads. An echocardiogram showed left ventricle with normal cavitary dimensions and preserved global systolic function, apical segment of interventricular septum and inferior wall hypokinetic; minimal pericardial detachment with leaflet hyperecogenicity. The patient was admitted to Cardiology ward, and he was given a medical therapy with colchicina 0.5 mg 1 cp x 2/die and AcetylSalicilic Acid 1000 mg x 3 /die. Cardiac Magnetic Resonance showed epi–mesocardial LGE in inferior and lateral distal segments, compatible with myocarditis. CT coronary angiography exhibited a calcified plaque determining partial caliber reduction in anterior descending coronary proximal segment, the coronary in its apical portion appeared ectatic, hypodense and poorly dulled likely for steno–occlusion. Therefore, it was performed a coronary angiography that revealed an anterior descending coronary artery occluded at the apical tract, the OCT showed plaque erosion with thrombotic apposition at the mid–proximal tract of the vessel. Finally, considered results of instrumental exams, a second antiplatelet agent, a hypolipidemic drug were added

Discussion
According to the cardiac MRI findings and the coronary angiography, it was hypothesized a picture of acute coronary syndrome triggered by erosion of the unstable coronary plaque, induced by the massive myocardial inflammation related to the myocarditis. The relationship between acute infections and myocardial infarction has been already established in COVID–19 patients