bluuebunny/crossref_metadata_2025_split huggingface dataset:
P276 LEFT ATRIAL STRAIN RESPONSE TO HEART RATE IN PATIENTS AFFECTED OR NOT BY CHRONIC HEART FAILURE: HEMODYNAMIC CORRELATES
Authors: Corbo M , Di Terlizzi V , Barone R , Goffredo G , Correale M , Pellegrino P , Ieva R , Brunetti N , Iacoviello M 
Published: May 2023

Abstract

Background
and aim of the study. Previous studies evaluated the effects of heart rate (HR) increase on the left ventricular (LV) function, by two–dimensional longitudinal strain, but many authors also assessed the left atrium (LA) function based on speckle tracking imaging (STI). The LA and LV are connected through the mitral annulus and the LA modulates LV filling and performance. The interaction between LA and LV functions during the cardiac cycle (LA–LV coupling) is crucial. We aimed to evaluate the changes in LA strain in response to increases in HR.

Methods
We enrolled 45 patients. 38 were evaluated with LA strain. 31 patients were affected by chronic heart failure (CHF), among whom 18 with implanted cardioverter defibrillator (ICD), 13 with ICD and cardiac resynchronization therapy (ICD–CRT) and 7 without CHF who had a PM implanted. All were in clinically stable conditions for at least 30 days and in conventional medical therapy. Starting from basal values, HR was increased by 10 beats/min programming the implantable devices at higher atrial stimulation frequencies to max 90 beats/min. At each HR, echocardiography was performed and main functional parameters were calculated, including those for LV filling evaluation (i.e. E/e’ ratio). Changes in LA strain measures, i.e. the strain of reservoir (LAr), conduit (LAcd) and contraction (LAct), and in LV global longitudinal strain (LVGLS) were calculated. The ratio between LAr and septal E/e’ was evaluated to estimate LV filling pressures.

Results
No significant variation was found in the measurements of E/e‘s and the LAr/E/e‘s ratio when all patients were analysed. However, there was a significant reduction in LA/E/e‘s in patients who did not show HR–dependent worsening in LV–GLS and a significant increase in the other group (figure 1). These results underline the relationship between LA and LV functions and consequently show the AV uncoupling at higher HR. Interestingly, the worsening of both LA and LV function assessed by strain was more evident at the rate of 90 bpm (figure 2).

Conclusions
The increase of HR was associated with both worsening of LA and LV function assessed by STI. This response is associated with an increase in LV filling pressures. These results offer new data about HR related LA–LV coupling and could be useful for guiding the optimal HR responsiveness of the implanted devices.
P278 A RARE CASE OF RECURRENT SARS–COV–2 MRNA VACCINE–INDUCED PERICARDITIS
Authors: Mistrulli R , Orellana S , Cittadini E , Ricci M , Tini G , Musumeci M , Autore C , Tocci G , Pagannone E 
Published: May 2023

Abstract
42–year–old man, former smoker, with allergic asthma. From February 2022, three weeks after the third dose of SARS–CoV–2 vaccine Spikevax (mRNA–1273), he experienced subcontinuous chest pain, worsened by breathing, sometimes with fever over 38°C, treated at home with ibuprofen and antibiotics without clinical benefit. After one month, blood chemistry tests showed increased inflammatory markers (CRP 76.5 mg/dL, ESR 55 mm/h), with negative troponin I. SARS–CoV–2 Polymerase Chain Reaction test was negative. On suspicion of subacute pericarditis, ibuprofen (600 mg b.i.d.) and colchicine (0.5 mg b.i.d.) were prescribed. After a week, he was admitted to hospital for reappearance of fever, chest pain and a syncopal episode. On ECG, negative T waves in DII, DIII, aVF; on echocardiogram, circumferential pericardial effusion (max 12 mm); indices of inflammation were increased; troponin I, auto–antibody and viral pattern were negative. On cardiac MRI: pericardial effusion (max 20 mm) with a fluid–corpuscular appearance, meso–subepicardial patchy areas of late gadolinum enhancement (LGE) at the antero– and infero–lateral wall of the left ventricle. Prednisone 25 mg/day and colchicine 1 mg/day were prescribed, with initial benefit. Two weeks later (April 2022), when the prednisone dose was reduced by half, chest pain with fever and pericardial effusion reappeared. The patient restarted prednisone at full dose (0.5 mg/Kg/day) in addition to colchicine and it was decided to do a very gradual décalage over the next six months. On follow–up cardiac MRI: thickening and enhancement of the pericardial leaflets with resolution of the fluid–filled effusion and mesomyocardial LGE striae. Further episodes of NSAID–sensitive chest pain were occasionally reported during cortisone dose reductions. In October 2022, at a dose of 2.5 mg/day dose of prednisone, there was another recurrence of pericarditis, with subcontinuous chest pain and marked increase in inflammatory indices. It was therefore decided to prescribe IL–1 inhibitor therapy (Anakinra) 100 mg/day subcutaneously for six months (ongoing follow–up). Pericarditis is a rare complication of SARS–CoV–2 mRNA vaccine, generally with a benign course, responsive to evidence–based therapy for acute pericarditis. This rare case of recurrent corticosteroid–dependent and colchicine–resistant vaccine–induced pericarditis emphasizes the importance of early diagnostic recognition and correct treatment in the acute phase.
P281 CARDIAC RICHTER‘S SYNDROME: A RARE CASE OF CHRONIC LYMPHOCYTIC LEUKAEMIA TRANSFORMATION
Authors: Guarnieri E , Ridolfi L , Castiglione V , Donati V , De Caterina R 
Published: May 2023

Abstract
A 71–year–old woman with chronic lymphocytic leukaemia (CLL) presented to our Cardiology clinic complaining of recent–onset chest pain and dysphonia. Physical examination and ECG were normal. A blood test revealed high levels of high–sensitivity troponin T (373 ng/L) and of C–reactive protein (7 mg/dL); blood counts and differential were normal. Transthoracic echocardiography showed a hyperechogenic appearance of the interatrial septum, the interventricular septum and the right ventricular free wall, as well as a mild circumferential pericardial effusion. Cardiac magnetic resonance imaging revealed multiple intracardiac masses involving both ventricles and the interatrial septum, with evidence of oedema and fibrosis. A chest computed tomography showed the presence of multiple cervical, pulmonary, and mediastinal masses, one of which was biopsied through video–thoracoscopy. At the histological examination, the mass mainly consisted of large pleomorphic peripheral CD10–, CD20+/–, CD79a+, PAX5+, BCL2+, BCL6–, c–MYC+ B cells, with high proliferative activity (Ki–67/MIB1+ 80%). A diagnosis of CLL transformation into diffuse large B–cell lymphoma (DLBCL), also known as Richter’s syndrome (RS), was established (Figure). Despite indication for specific haematological chemotherapy, the patient rapidly deteriorated and died few days after the diagnosis. RS is a rare evolution of CLL and of small lymphocytic lymphoma, affecting 2–8% of such patients (transformation &lt;1%/ year), yet is burdened with very poor prognosis (median overall survival 8–16 months). Extra–nodal RS is uncommon, and cardiac involvement has been reported in only 3 cases in the literature (in none with the panel of techniques here used). Despite its rarity, CLL patients with rapidly worsening cardiac symptoms should be suspected of RS transformation involving the heart. The main differential diagnosis of cardiac RS is primary cardiac lymphoma. The characterization of cardiac masses relies on multimodality imaging, but histologic analysis is required to reach a definite diagnosis, which is essential to guide subsequent therapeutic choices.
P286 IMPACT OF PERSONAL PROTECTIVE MASKS ON CARDIORESPIRATORY VARIABLES IN HEALTHY SUBJECTS AND PATIENTS WITH HEART FAILURE: AN INTERIM ANALYSIS
Authors: Mapelli M , Bidoglio J , Salvioni E , Mattavelli I , Gugliandolo P , De Martino F , Vignati C , Campodonico J , Palermo P , Agostoni P 
Published: May 2023

Abstract

Background
protective masks are a powerful mean to contain COVID–19. However, a general feeling that masks alter the normal dynamics of breathing may reduce its application. Patients with heart failure (HF) experience dyspnea even during daily life activities (ADLs). Aim of the study is to evaluate cardiorespiratory parameters during ADLs, cardiopulmonary exercise test (CPET) to highlight differences related to protective masks.

Methods
9 healthy subjects (age 59±11, 2F) and 10 HF patients (age 64±11, 2F, EF &lt;45%) underwent a set of tests twice, wearing a protective surgical mask and without it. We performed the following tests: standard spirometry; CPET; a set of tests recorded by a wearable ergospirometer (Cosmed K5), including ADLs), six–minute walking test (6MWT) and two 4–minute treadmill exercises (TREAD2 and TREAD3 at a speed of 2 km/h and 3 km/h, respectively).

Results
Spirometry showed a reduction of forced expiratory volume in 1s (3.29±0.75 L vs 2.65±0.57 L as for healthy subjects, p= 0.002; 2.45±0.6 L vs 1.97±0.54 L as for HF patients, p= 0.002) and forced vital capacity (4.14±0.92 L vs 3.39±0.83 L as for healthy subjects, p= 0.004; 2.93±0.76 L vs 2.59±0.73 L as for HF patients, p= 0.01) in both the groups from no mask to mask. Both healthy and HF patients showed: a trend of reduction of peak oxygen pulse (p&lt;0.005 in healthy) and peak oxygen consumption (VO2); a decrease of tidal volume (Vt) at peak exercise (peak Vt: 2.283±0.449 L vs 1.864±0.359 L in healthy, p= 0.022; 1.6±0.41 L vs 1.448±0.431 L in HF, p= 0.02), with no significative variations of resting and peak ventilation (VE). HF patients experienced a statistically significative decrease of VO2 at the anaerobic threshold (AT) (794±227 vs 682±151 mL · min–1, p=0.01). Task–related VO2 was significantly reduced from no mask to mask in ALDs and 6MWT in the healthy, whereas HF patients experienced a significative reduction more physically demanding tasks. Both healthy and HF subjects showed an increase in the basal and task–related ratio of VE vs carbon dioxide production (VE/VCO2) in the two protocol conditions.

Conclusions
Surgical masks influences cardiorespiratory variables in healthy and HF patients at rest and during both mild and maximal physical activity. The physiological impact of the mask is far from being clinically relevant The use of masks seems to be safe both in the general population and in HF patients. These data should be confirmed in a larger group of patients.
P293 MULTI–DIMENSIONAL EVALUATION IN PATIENTS WITH AORTIC STENOSIS CANDIDATE FOR CARDIAC SURGERY
Authors: Bonanni F , Caciolli S , Berteotti M , Grasso Granchietti A , Cenni N , Tozzetti V , Marchi E , Bandini M , Servoli C , Grandi G , Del Pace S , Gabriele M , Stefano P 
Published: May 2023

Abstract
In patients with severe aortic stenosis, the presence of left ventricular systolic dysfunction is one of the main predictors of adverse events after valve replacement surgery. However, more and more patients are being referred for surgery early and have preserved systolic function at the time of surgery. Within this category, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling after cardiac surgery. Our study aims to identify the variation of Global longitudinal strain (GLS) in patients undergoing aortic valve replacement and any differences compared to classes of diastolic dysfunction.

Methods
From June 2020 to June 2022 we analyzed patients with severe aortic stenosis with an indication for cardiac surgery treatment admitted to the cardiac surgery department of our AOU. All patients underwent an echocardiogram immediately before surgery and in the early postoperative period (mean 7 days). In all cases, the GLS of the left ventricle was calculated and patients were divided into four classes according to the degree of diastolic dysfunction (0–III) according to the most recent international guidelines. The data were analyzed with SPSS 28 software. Analysis of variance was performed with a t–test and ANOVA test.

Results
In the final analysis, 63 patients were included, with a mean age of 70.5±8.2%, of whom 28 were women (44.4%) and 35 were men (55.6%). In 12 patients (19%) ischaemic heart disease with an indication for coronary revascularization was also present. The mean preoperative ejection fraction was 59±9.5%. The mean GLS values before surgery were 15.26±4.3% vs. early postoperative 12.52±2.6%, p&lt;0.0001. GLS values were comparable within the various classes of diastolic dysfunction and preoperative examination (0 14.54±3.6%; I 16.04± 4.1%; II 15.27±4.7%; III 9.27%, p=0.39) and postoperative (0 12.28± 3.2%; 12.81±1.7%; II 12.53±2.9%; III 9.97%, p=0.73).

Conclusions
In our case series, patients with severe aortic stenosis undergoing aortic valve replacement with or without myocardial revascularization show a significant early reduction in GLS regardless of the degree of diastolic dysfunction. An extension of follow–up is needed to assess any differences in the intervention‘s benefit in different diastolic dysfunction subgroups.
P302 SIMULTANEOUS CORRECTION OF SEVERE LOW–FLOW LOW–GRADIENT AORTIC STENOSIS AND ABDOMINAL AORTIC ANEURYSM BY TAVI + EVAR
Authors: Scherillo G , Acerbo V , De Michele G , Raucci G , Signore G , Rotolo F , Scialla F , Panico D , Alfieri A , Martelli E , Riccio C , Cesaro A , Calabrò P 
Published: May 2023

Abstract
We report the case of a 72–year–old man with arterial hypertension, dyslipidemia, type 2 diabetes mellitus, and severe chronic obstructive pulmonary disease. The patient had a previous stroke with occlusion of both internal carotid arteries about 7 years ago. He presented to the emergency department with dyspnea on exertion (NYHA class III), and the echocardiogram revealed a dilated left ventricle with severe reduction of global systolic function (EF 35%), severe low–flow low–gradient aortic stenosis (AVA on VTI 0.526 cmq/mq, SVi 29.7 ml/mq, Gmax 25.6 mmHg, Gmed 16 mmHg), and abdominal aortic aneurysm. Subsequently, he underwent an angio–CT scan that showed an almost completely thrombosed abdominal aortic aneurysm with a maximum diameter of 65 mm and a longitudinal extension of about 11 cm. The patient also underwent coronary angiography, which showed diffuse calcified atherosclerosis, and he was recommended for medical therapy. After a joint Heart Team consultation with cardio–anesthesiologists, cardiac surgeons, and vascular surgeons, it was decided to perform transfemoral transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) in the same procedure (EUROSCORE II &gt; 4%). The patient underwent TAVI followed by EVAR of the aorto–bisiliac arteries through a main access site in the left femoral artery guided by ultrasound, a secondary access site in the right femoral artery for placement of a pigtail catheter on the aortic plane, and a venous access site in the right femoral vein for placement of a temporary pacing catheter at the apex of the right ventricle. First, an Edwards Sapien 3 Ultra 26mm valve was implanted, and then the 14Fr sheath in the left femoral artery was exchanged for an 18Fr sheath for the EVAR, which was placed in the aorto–bisiliac region. Hemostasis was achieved using the Manta system on the left femoral artery and two Proglide devices on the right femoral artery. The procedure was completed without complications, and the patient was discharged 10 days later, asymptomatic and in stable clinical condition, with a recommendation for dual antiplatelet therapy with aspirin and clopidogrel. At the 6–week follow–up, the patient remained asymptomatic with an EF of 40%.

Conclusion
In selected cases, the simultaneous correction of severe low–flow low–gradient aortic stenosis using TAVI and abdominal aortic aneurysm using EVAR can be considered after appropriate discussion and consultation within the Heart Team."
P322 LEFT VENTRICULAR NON COMPACTION: WHATEVER WORKS(?)
Authors: Rosati A , Benvenuto M , Ruggieri B , Lavorgna A , Fabiani D 
Published: May 2023

Abstract
A 36–year–old boy arrived in the emergency room for asthenia, dyspnoea and heart palpitations for several months. In PS he found atrial flutter with high ventricular penetrance complicated by severe left ventricular dysfunction (EF25%). He was therefore hospitalized in the UTIC. The blood tests also documented hepatic suffering and alteration of the coagulation indices. A new echocardium showed marked myocardial trabeculation of the left ventricle, with an appearance referable to non–compact myocardium. Clinical stability was achieved with diuretic therapy, CVE, inotropic support with a course of Levosimendan, and progressive titration of HFrEF–optimized medical therapy. Based on the clinical suspicion, the patient underwent cardiac magnetic resonance, which confirmed the echocardiographic findings, thus documenting a severe impairment of biventricular function, with LVEF of 26% and RVEF of 25%, a moderate increase in LV volumes, with an increase in the thickness of the myocardial trabeculae at the level of the lateral and inferior mid–cavitary segments and at the level of the apical segments, with a maximum trabecular thickness/ myocardial wall thickness of about 2.5, possibly related to non–compact myocardium. Following discharge, the patient underwent periodic check–up and after three months of optimized medical therapy an indication was given for PM–ICD implantation in primary prevention for persistence of EF &lt;35%. Non–compact myocardium is a rare cardiomyopathy characterized by intrauterine arrest of the myocardial compaction process with consequent residual myocardial hypertrabeculae. Clinical manifestations range from heart failure, systemic embolisms, ventricular arrhythmias, and sudden death. The diagnosis is based on two instrumental pillars, echocardiography and magnetic resonance. The absence of well–defined diagnostic criteria is linked to a fundamental aspect of the pathology: although it is recognized as a nosological entity in its own right, the marked ventricular hypertrabeculature can be found both in the paraphysiological field and in other cardiomyopathies, such as hypertrophic and dilated cardiomyopathy. In a practical context, it is important to manage the patient clinically to increase his quality of life, hoping that the genetically compromised myocardium works enough while we try not to get lost in the diagnostic and confusing maze of this pathology.
P330 MANAGEMENT OF HYPERKALEMIA IN A PATIENT WITH HFREF
Authors: Salucci C , Orso F , Verga F , D‘Errico G , Perini E , Cagnoni C , Poletti E , Vatri M , Corti G , Di Bari M , Ungar A , Baldasseroni S 
Published: May 2023

Abstract
Hyperkalimia (HK) is a condition that occurs very frequently in patients with heart failure (HF). HK often limits and discourages the implementation and optimization of RAASI therapy in patients with HFrEF. The introduction of the new K–binders drugs has made it possible to overcome this obstacle by allowing optimization of therapy even in patients with persistent hyperkalemia. Mr. AB aged 83 years cognitively intact and autonomous ( Katz‘s BADL and Lawton‘s IADL preserved; MMSE 29/30). February 2022 accessed DEA for aggravating exertional dyspnea; at that time echocardiogram finding reduced left ventricular systolic function, FE 35%. March 2022 performed elective coronarography: coronary tree free of critical lesions, confirmed on echocardiogram reduced FE. Post indication to undertake Sacubitril/Valsartan, beta blocker and SGLT2i therapy. For moderate CKD (eGFR 33 ml/min) with tendency to hyperkalemia not initiated MRA. April 2022 the patient was taken to our Heart Failure Outpatient Clinic–UTIG– AOU Careggi. June 2022 considered improvement in renal function and Kaliemia in optimized range GDMTs therapy with Potassium Canreonate 25 mg/day. At control EEs in July 2022 found hyperKalemia with K values 5.5 mEq/L but stability of renal function. Reduced therefore the dosage of Potassium Canreonate (25 mg every other day) with indication to repeat blood tests soon. September 2022 despite reduction in MRA dosage further increase in Kaliemia values to 5.8 mEq/L. Suspended Potassium Canreonate and started Sodium Zirconium Cyclosilicate therapy initially at loading dosage of 10 g three times daily for two days then continued with maintenance dosage of 5 g. At follow–up performed the following week K 4.5 mEq/L. Re–introduced Potassium Canreonate 25 mg/day with initial tight control of potassium values that remained stably at optimal values. Hyperkalemia is an obstacle in titrating HFrEF, especially in elderly patients with CKD. However, we have new drugs available that may allow the implementation of guideline–recommended treatments by controlling potassium values.
P337 THREE–DIMENSIONAL RIGHT VENTRICULAR ARTERIAL COUPLING IN HEART FAILURE: PROGNOSTIC COMPARISON WITH TRADITIONAL METHODS
Authors: Sforna S , Biagioli P , Mengoni A , Zuchi C , Lupi A , Grassano D , Scapicchi C , Gobbi F , Maltempi M , Scarpignato A , Tritto I , Carluccio E 
Published: May 2023

Abstract

Background
Right ventricular (RV) contractile function and pulmonary artery (PA) pressures influence outcomes in patients with heart failure (HF). Analysis of RV–arterial coupling (RVAC) from pressure–volume loops is not routinely performed. Several non–invasive RVAC methods by echocardiography have been described in patients with HF. The aim of this study was to compare the prognostic impact of these RVAC methods in HF patients.

Methods
One–hundred–sixty patients with chronic HF underwent standard, speckle–tracking (STE) and three–dimensional (3DE) echocardiography. RVAC was assessed by calculating: a) tricuspid annular plane systolic excursion (TAPSE) to noninvasively measured PA systolic pressure ratio (TAPSE/PASP), b) RV free wall longitudinal strain (RVFWLS) by STE to PASP ratio; and c) by 3DE, by measuring PA effective elastance (Ea), RV maximal end–systolic elastance (Emax), and RVAC (PA Ea/RV Emax) using simplified formulas including mean pulmonary artery pressure (mPAP), stroke volume and end–systolic volume. The primary endpoint was a composite of all–cause mortality and/or HF hospitalization.

Results
During a median follow–up time of 17.9 months, 35 events occurred. At univariable analysis, TAPSE/PASP ratio &lt; 0.43 (HR: 4.36 [95%CI: 2.18–8.65, P&lt;0.0001]), RVFWLS/PASP ratio &lt; 0.50 (HR 8.07 [95%CI: 3.12–20.82, P&lt;0.0001]), and 3D–RVAC &gt; 1.13 (HR: 4.34 [95%CI: 1.80–10.46, P&lt;0.0001]) were all significantly associated with outcome. After adjusting for MAGGIC risk score and natriuretic peptides levels at multivariable analysis, TAPSE/PASP ratio was no longer predictive of adverse outcome.

Conclusions
Non–invasively assessed RV–arterial coupling by 3D echocardiography and RV free wall longitudinal strain appears to be a more powerful predictor of outcome in heart failure than traditional index.