bluuebunny/crossref_metadata_2025_split huggingface dataset:
P401 A CASE OF CORTICO–DEPENDENT AND COLCHICINE–RESISTANT RECURRENT IDIOPATHIC PERICARDITIS: THE ROLE OF ANAKINRA
Authors: Gentile G , Gidiucci R , Gorgoglione M , Meles E , De Carlini C , Bruni F , Bucalo R , Maggiolini S 
Published: May 2023

Abstract
68–year–old female. Arterial hypertension. Diabetes. Hyperthyroidism. History of Polyserositis: 2019 massive right pleural effusion subjected to 2 thoracentesis a few days apart. Also finding of ascitic effusion. Negative etiological investigations On 3/2022 Admission to Cardiology for dyspnea and finding of pericardial effusion. CRP 10.55. On CT chest and abdomen significant pericardial effusion, mild bilateral pleural and peritoneal effusion with liver congestion. Pericardiocentesis was performed due to the absence of improvement in the pericardial effusion and persistence of sinus tachycardia despite therapy (ASA 750 mg x 3 + colchicine). Procedure complicated by Tako Tsubo syndrome. Intra–hospitalization recurrence of pericardial effusion despite NSAID therapy. Prednisone 25 mg per day was associated to therapy on board with improvement of pericardial effusion (maximum of 8 mm). At discharge WBC: 10.8, CRP: 2 (NV &lt; 0.5 mg/dl) 04/26/22 CRP 0.73. Pericardial effusion Resolution. Cortisone tapering continued. 5/24/2022 Dyspnea and tachycardia with recurrence of significant pericardial effusion. Diagnosis of recurrent cortico–dependent and colchicine–resistant idiopathic pericarditis. New Hospitalization. Reverted to prednisone 25 mg (previous effective dose) with no effusion reduction. Anakinra introduction. At discharge: WBC 9500, CRP 0.6. Echo: maximum pericardial effusion of 20 mm. 6/10 Boosted for 3 days prednisone (50 mg/day), reduced ASA to 250 mg x 3 6/17 WBC 11.2; PCR 0.63. echo: pericardial effusion persistence max about 2.5 cm. No signs of cardiac tamponade. Boosting prednisone for a few days is ineffective. 6/24 stop ASA 6/20 stable. Start corticosteroid tapering. 7/20 asymptomatic, stable effusion. CRP 0.87. taperig prednisone again, stop colchicine. 8/18/22 Eco: slight effusion reduction. Stable CRP. Slight weight gain and slight increase in blood pressure probably caused by cortisone intake. –&gt; prednisone reduction. 9/18 stop prednisone 10/18/2022 WBC 8.12 CRP 0.23; +2kg since last visit in August. Perimalleolar succulence. Eco: Stable effusion 2cm max. furosemide 25 mg 1 cp is added in the morning. 06/12/2022 WBC 7.5; CRP 0.52 Eco: stable effusion. Anakinra is reduced to 6 administrations per week.

Conclusions
Anakinra proved to be valid in stabilizing the pericardial effusion allowing to suspend corticosteroids, colchicine and ASA.
P408 PREVALENCE CHARACTERISTICS AND OUTCOMES OF COVID 19 ASSOCIATED ACUTE MYOCARDITIS
Authors: Palazzini M , Ammirati E , Lupi L , Giannattasio C , Soriano F , Pedrotti P , Briguglia D , Mapelli M , Campodonico J , Agostoni P , Leonardi S , Turco A , Guida S , Peretto G , Sala S , Camici P , Marzo F , Grosu A , Senni M , Turrini F , Bramerio M , Marini M , Matassini M , Rizzo S , Basso C , De Gaspari M , Hendren N , Schmidt M , Bochaton T , Piriou N , Ubarri A , Van De Heyning C , Ariza Sole A , Cannatà A , Salamanca J , Lehtonen J , Huang F , Adler E , Metra M 
Published: May 2023

Abstract

Background
Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID–19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in–hospital management, and outcomes for patients with COVID–19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.

Methods
A total of 112 patients with suspected AM from 56963 hospitalized patients with COVID–19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID–19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID–19–associated AM.

Results
AM prevalence among hospitalized patients with COVID–19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty–one cases (57.4%) occurred in the absence of COVID–19–associated pneumonia. Twenty– one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in–hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P&lt;0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%).

Conclusions
AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID–19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID–19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
P411 THE ROLE OF CARDIAC MAGNETIC RESONANCE FOR ARRHYTHMIC RISK STRATIFICATION IN A PATIENT WITH MYOCARDITIS
Authors: Fede G , Belluardo P , Guccione N , Abate G , Scollo V , Sulsenti G , Ficili S 
Published: May 2023

Abstract
Myocarditis is an inflammatory disease of cardiac muscle with a variable clinical presentation, ranging from asymptomatic cases to different degrees of left ventricular systolic dysfunction up to heart failure and dilated heart disease. Ventricular arrhythmias (VA) can occur in patients with myocarditis and implantable cardioverter defibrillator (ICD) may be indicated in patients with life–threatening VA who are not in the acute phase of myocarditis and who are receiving optimal medical therapy. Reduced left ventricular ejection fraction (LVEF) below 35%, which is used as the main criterion for stratifying the risk of sudden cardiac death (SCD), has low sensitivity and low specificity for arrhythmic risk stratification in patients with myocarditis. Myocardial scar is the main determinant for VA in these patients. Cardiac magnetic resonance imaging (CMR), using late gadolinium enhancement(LGE), has an excellent ability to determinate the extension and characterization of myocardial scar, indeed CMR can potentially improve SCD risk stratification and indication for ICD implantation in patients with myocarditis. We present a case of a 36 years–old male presenting to the Emergency Department with a monomorphic sustained ventricular tachycardia in whom MRI revealed myocardial–pericardial recurrent inflammatory involvement and worsening disease progression. ICD was implanted in consideration of the high risk of life–threatening arrhythmias.
P413 A CASE OF PERIPARTUM DILATED CARDIOMYOPATHY WITH SEVERE BIVENTRICULAR DYSFUNCTION
Authors: Pezzi L , Magnano R , Verrengia E , D‘Alleva A , Forlani D , Vitulli P , Fulgenzi F , Genovesi E , Di Marco M , Paloscia L 
Published: May 2023

Abstract
Woman, 38 aa, without cardiovascular risk factors with the exception of the tobagic habit; In anamnesis recent Caesarean cut about six months ago for a placenta with the central, complicated by hemorrhagic shock and consequent virgonecontomy. It came to our observation sent by the emergency room, where it had gone by on the onset of about 20 days of heart disease, nightlife dyspnea and fattening dyspnea, associated with the recent appearance of marked edemas declining in the lower limbs bilaterally. At the entrance to the ward, the patient presented himself vigilant, apipperic and tachipnoic. The feedback of turgor of the jugular and of extended edemas extended up to the upper third of the leg bilaterally was also reported. The ECG evidenced a sinus tachycardia and signs of left ventricular overload. The hematochimic tests, including myocardionecrosi markers, were in the norm, with the exception of the pro–bnp which was increased with a value of 5263 pg/ml (cutoff &lt;125 pg/ml). A trastracic echocardiogram was carried out which highlighted a dilated left ventricle with normal parietal thicknesses, global hypocinesia and severely depressed systolic function (FE 28%), a biatrial dilation with dilated and hypocinetic right sections (15mm tapse), to the Doppler color, an insufficiency Mutral valve of moderate and tricuspidal grade of severe grade with an estimated paps of 55 mmhg and a lower cava dilated cava and poorly collapsed with the inspirium. For further diagnostic deepening, a cardiac MRI was performed which confirmed the framework of two–hundred dilation with severe reduction of systolic function (LVEF 25%; RVEF 20%) and showed a post–control myocardial strengthening of the lateral pericardium with extension to be paid by the Subpicardio homosede. A high dosage diuretic therapy and anti–scompense therapy with progressive improvement of the hemodynamic picture was then set. The patient was discharged at home in protected discharge after positioning of wearable defibrillator; It was then checked after 30 days from discharge with a recovery feedback almost complete with the contractile function and followed later over time with periodic follow–ups.
P416 A RARE CASE OF CHEST PAIN
Authors: Sarubbi M , Pittorino L , Capasso R 
Published: May 2023

Abstract
81–year–old woman, affected by arterial hypertension, paroxysmal atrial fibrillation treated with DOACs. She came to our emergency service for oppressive chest pain emerging after two weeks from the implantation of a dual–chamber pacemaker. The EKG showed 1 mm ST segment elevation in leads DII and aVL. Global and segmental function were normal, mild pericardial effusion along right chambers was reported on the echocardiogram. This case was managed as a STE–ACS and then the patient was given dual antiplatelet therapy and unfractioned heparin and taken to the cath lab. The coronary angiography didn’t show any significant stenosis. She was admitted to CCU, where pericardial effusion was noticed to be significantly increased. A CT scan revealed the ventricular pacemaker lead projecting into the pericardial sac with a 13 mm hemorrhagic pericardial effusion. Antithrombotic therapy was stopped and colchicine was started. The patient refused to undergo a trans–venous lead extraction. She was asymptomatic and hemodinamically stable at the time of discharge and was given a follow up program. This case shows a subacute complication of pacemaker implantation, in which antithrombotic agents administration made the real diagnosis to be shown after the increase of pericardial effusion. Ventricular lead perforation is a rare condition (0.1–0.8%). Some risk factors can be old age, female sex, anticoagulants, DMARDs and NSAIDs, the ventricular lead being positioned along the right ventricular free wall. Symptoms and signs depend on lead position. Diagnosis can be made by echocardiography, chest X–ray, CT scan. The best treatment for this patients is debated. In hemodinamically unstable patients an emergency treatment is recommended, while it is unclear which therapeutic option should be offered in the other cases. Lead perforation can be managed with transvenous or surgical lead extraction or a conservative treatment with a watchful waiting strategy can be performed. Acute, subacute and symptomatic perforations could better benefit from invasive strategies, otherwise chronic and asymptomatic cases could be followed up during time without invasive treatment.
P417 THE REBUS OF POCKET INFECTION
Authors: Dentico A , Ferrieri A , Altieri T , Carretta F , D‘Agostino C , Carretta D 
Published: May 2023

Abstract

Introduction
Guidelines define pocket infection as an infection limited exclusively to the generator pocket. This is clinically associated with local signs of inflammation. Often, however, the infection also involves leads which constitute an entrance door for cardiac and systemic infection. The pocket infection is a big puzzle for deciding the type of approach to adopt, conservative or aggressive? Our study aims to identify the significant predictive criteria to develop a score that identifies patients most at risk of endocarditis and sepsis.

Materials and Methods
66 patients undergoing extraction for pocket infection were enrolled. Before extraction, all patients underwent instrumental and laboratory investigations to search for vegetation or culture positivity.

Results
Of the 66 patients, 61 presented vegetations and/or positive culture of the leads. The statistical analysis made it possible to assign a score to each sign and/or symptom (see table) with the creation of a score with a maximum cut–off of 5. The 61 positive patients had a score greater than/equal to 5. The score structured in this way demonstrated a predictive value of 92.4%, resulting positive in 61 out of 66 patients.

Conclusion
In patients with pocket infection, the identification of a highly predictive score of endocarditis or sepsis on leads allows the clinician to easily identify patients at higher risk to be rapidly referred to tertiary centers for the most suitable treatment of the clinical situation without having to carry out particular tests, often difficult to perform (PET/CT), and allows the electrophysiologist, who will have to carry out the extraction procedure, to have a precise indication in class I. The study we have started is a preliminary study which has the limit of the number of patients enrolled. We intend to increase the number of patients thanks to collaboration with other centers that carry out extractions. However, this study, based on the data obtained so far, could be a guide for the management of patients with pocket infection who often create embarrassment in decision–making on the therapy to be adopted, even due to the lack of clarity of the guidelines.
P422 CARDIOTOXICITY ASSOCIATED WITH IMMUNE CHECKPOINT INHIBITORS: A CLINICAL CASE
Authors: Frascaro F , Pavasini R , Marchini F , Bianchi N , Zanarelli L , Sanguettoli F , Meossi S , Guardigli G 
Published: May 2023

Abstract
We reported a case of 46–year–old women without cardiovascular risk factors, with a diagnosis of relapsed metastatic melanoma undergoing treatment with immune check–point inhibitors (ICI), ipilimumab and nivolumab. A transthoracic echocardiogram was performed before starting the treatment that showing normal indices of biventricular function and a normal value of global longitudinal strain (GLS). After the third immunotherapy cycle, she presented to the hospital for diplopia and blurred vision; in the suspicion of ICI–related toxicity, muscle–specific enzymes and troponin I high sensitivity (TnI hs) were assayed and were found elevated (TnI hs 712 ng/L). Brain natriuretic peptide (BNP), electrocardiogram (ECG) and echocardiogram were within the limits. Given the positivity of cardiac markers in an asymptomatic patient, it was concluded for grade I ICI–related toxicity. Immunotherapy was discontinued and the patient was admitted to the cardiology intensive care unit. She underwent telemetry monitoring and a cardiac magnetic resonance (CMR) were performed showing a thin stria of sub–epicardial oedema along anterior wall without late gadolinium enhancement or altered kinetics. During hospitalization, patient was treated with methylprednisolone 1g i.v. for the first days with benefit and she was discharged with oral prednisolone, reducing the dose by 10 mg/week under clinical, ECG and TnI surveillance. I.v. immunoglobulins were started due to myopathy involvement. The tapering of corticosteroids after 15 days caused a flare–up of troponin levels, which resolved after increasing the steroid dosage. After a thorough discussion between experts, it was decided to resume ICI treatment. Myocarditis is a severe complication of ICI that occurs in 0.27–1.14% of patients and develops early. Surveillance should be done by biomarker assay, as major cardiac events occur in up to 40% of patients with normal ejection fraction. The clinical diagnosis includes the cTn elevation with 1 major criterion (CMR positive for Lake Louis criteria) or 2 minor criteria. The treatment strategy consists of interruption of ICI therapy, immunosuppressive agents and cardiac monitoring. Current guidelines recommend permanently ending ICI therapy when patients develop grade 3 or 4 toxicities; conversely, it may be considered again in case of grade 1 (asymptomatic biomarker elevation) or 2 (biomarker elevation and mild symptoms) toxicity.
P423 RELAPSE OF ACUTE MYELOID LEUKEMIA WITH CARDIAC INFILTRATION: A CASE REPORT
Authors: Caldarella Y , Carrer A , Possamai M , Betta D , Favero L , Cernetti C , Iliceto S , Gasparetto N 
Published: May 2023

Abstract
We describe the case of a 42–year–old man who presented to the emergency department suffering from asthenia, dyspnea and tachycardia. The patient had been diagnosed, two years earlier, with acute myeloid leukemia (AML), treated with two lines of chemotherapy and allogeneic bone marrow transplantation from a family donor. Atrial fibrillation with rapid ventricular response was documented at the ECG. The echocardiogram showed moderate left ventricular dysfunction in the presence of dishomogeneous thickening of left and right ventricular wall and a severe circumferential pericardial effusion causing cardiac tamponade, with the need of urgent pericardiocentesis. AML relapse was documented at the laboratory tests. The suspected cardiac involvement was investigated with cardiac MRI which documented thickening and diffuse late gadolinium enhancement at the level of the left and right ventricular wall, the interatrial septum and the atria walls. The pericardium and the epicardial fat were also thickened and endowed with contrast enhancement. A lymphocyte assay was performed on pericardial fluid and showed the presence of a blast population (approximately 27% of white blood cells) with variable expression of myeloid antigens. The clinical, radiological and finally immunophenotypic picture therefore concluded with relapse of acute myeloid leukemia with myocardial and pericardial infiltration. Acute myeloid leukemia usually presents with symptoms related to bone marrow failure. Clinically significant cardiac involvement is rare but should be considered when cardiorespiratory symptoms occur. Cardiac manifestations include coronary artery disease, heart failure, conduction disturbances, myocarditis, pericarditis, and pericardial effusion. Understanding the underlying pathophysiology and recognizing potential cardiac manifestations could help in the early diagnosis, evaluation, and treatment of these patients. Echocardiography or cardiac MRI could reveal morphological, structural and signal abnormalities of the cardiac structures and therefore should raise the suspicion of a possible myocardial infiltration by leukemia cells, both in patients with a positive history of leukemia and in those in whom cardiac involvement could represent the first manifestation of a hematological pathology.
P426 IMPLEMENTATION OF MODULAR NURSING IN THE CARDIOLOGY CONTEXT: EXPERIENCE AND RESULTS IN THE CONEGLIANO HOSPITAL
Authors: Mazzariol E , Canzian M , Cesaro M , Tonegutti M , Bottega M , Migotto S , Coppe A , Mantovan R , Salemi M 
Published: May 2023

Abstract

Introduction
In response to regional requirements and the ever–increasing complexity of the needs of the patients, the UOC Health Professions of the ULSS 2 Marca Trevigiana Company, in collaboration with the team of the Cardiology UOC of the Conegliano Hospital decided, in the year 2022, to start a Field Training project (FSC) oriented towards the implementation of Modular Nursing (MN) in the specific context.

Methods
The project involved all the staff of the Cardiology, Hemodynamics, and Intensive Care Unit, with the contribution of the Coordinator and the support of the Health Professions Unit. 4 working groups were therefore formed, relating to the User Path in the care setting, Nursing Handover, Management of care–organizational resources and Indicators of the quality of care. Furthermore, we surveyed to collect the perception of the care staff concerning Relationship Time, Clinical Risk, Safety of Professional Action, and Continuity of Care.

Results
During the process, each working group presented the results of the work developed, which were: the description of the admission and discharge paths, the structuring of a Handover model based on the SBAR method, the definition of standard Care Plans for care cases, the analysis of the data deriving from the collection of defined indicators and the perception of the care staff pre–post implementation of the Care Model. The first data that emerged shows a 26% decrease in phlebitides observed in patients and an average reduction of 4 minutes in the Handover process. Furthermore, the survey conducted shows how nurses, with the introduction of the NM, perceive they have more time for the relationship with patients and family members (42.6%), a reduction (65%) of interruptions in the management of drug therapy, and an improvement in the quality of information given and received during the handover (95.6%) between shifts.

Discussion
The data collected demonstrates how the implementation of the MN has had positive effects not only on the organizational well–being and the working methods of the assistance staff but has also contributed to better management of assistance needs. Moreover, in this first phase, the increase in the Safety of Care provided emerges, thus, the continuity of care even after discharge.