bluuebunny/crossref_metadata_2025_split huggingface dataset:
P344 OCCURRENCE OF PERMANENT PACE–MAKER IMPLANTATION DURING HOSPITALIZATION AFTER INTUITY RAPID DEPLOYMENT AORTC BIOPROSTHESIS IMPLANTATION: A RETROSPECTIVE SINGLE CENTER STUDY
Authors: Cortese F , Costantino M , Stolfi L , Stabile E , Luzi G 
Published: May 2023

Abstract
Between March 2017 and June 2020, 97 consecutive patients underwent aortic valve replacement (AVR) with the Edwards Intuity and its evolution Intuity Elite rapid deployment bioproshesis were enrolled at the Cardio Surgery Department at the “San Carlo” Hospital in Potenza. A total of nine patients were excluded: 3 patients for incomplete data, 3 patients because they already had a pacemaker at the time of admission, and other 3 patients because they underwent combined aortic and mitral valve surgery. The remaining 88 patients were evaluated. Among these, 62 (70%) underwent insolated AVR and the remaining 26 (30%) combined procedure with myocardial revascularization, performed through mini–sternotomy or full sternotomy respectively. Population was divided into two groups according to the date of surgery: before (N: 66, 75%), group A, and after (N: 22,25%), group B, September 2019, when we modified prosthesis implantation technique in order to reduce the incidence of permanent pacemaker implantation (PPI), with a particular attention in annular decalcification compared to standard technique near to the interventricular septum, in order to prevent hard calcium block compression on conduction system. Subjects underwent serial ECGs at baseline, after the intervention and every 24 hours until hospital discharge, moreover they had continuous monitoring till discharge. ECG Holter monitoring were prescribed during the first year after discharge if any alteration at basal ECG were observed. The policy for PPI followed the current guidelines. All the ECGs and the Holter monitoring were analyzed by two independent physicians blinded to each other’s. At the end of our study, we observed 4 PPI in the group A, 3 cases for complete AV block (third degree AV block) and one case for tachy–brady syndrome about four months after the AVR, no PPI were observed in the group B. In conclusion the new technique of aortic valve decalcification during INTUITY rapid deployment bioprosthesis implantation, introduced in our institution in September 2019, provided to be safe and effective in reducing the occurrence of cardiac conduction disorders and consequently of PPI compared to standard technique.
P348 COMBINATION THERAPY IN A PATIENT WITH TTRV AMYLOIDOSIS
Authors: Bellini F , Di Gesaro G , Di Stefano V , Nardi E , Cefalù A , Noto D 
Published: May 2023

Abstract
73 year old male. He has a brother with an unspecified heart disease, three children, all in good health. Former smoker, arterial hypertension, bilateral carpal tunnel syndrome for several years. Therapy used: zofenopril 7.5 mg 1 cp/day. In August 2019 hospitalization for acute heart failure. Echocardiogram showed severe concentric left ventricular hypertrophy with a granular sparkling myocardial appearance, moderately reduced EF, moderate mitral regurgitation, restrictive transmitral pattern, and pulmonary hypertension (PAPS 60 mmHg). ICV with increased dimensions and not collapsible. Moderate circum–cardiac pericardial effusion. During this hospitalization, therapy with an ACE inhibitor, beta blocker and MRI was started with clear clinical benefit. He also started anticoagulant therapy for evidence of atrial fibrillation. At discharge, NYHA class II. Myocardial scintigraphy with bone tracer was positive for the presence of grade 2 myocardial uptake according to the Perugini score. Blood chemistry tests were performed to exclude the AL form and finally the genetic test showed the presence of a mutation on the transthyretin Val122Ile gene (mutation associated with a variant of amyloidosis with a predominantly cardiological phenotype). Then, heart failure therapy was optimized and disease modifying therapy was started with Tafamidis 61 mg/day. Over time there was a reduction in left ventricular function, so sacubitril/valsartan was started; this drug was not tolerated due to hypotensive episodes. The NYHA class has however always remained stable (class II). During the follow–up in September 2022 he had a new hospitalization for heart failure during which the therapy was optimized with the insertion of the SGLT–2 inhibitor, which was well tolerated. During this hospitalization, symptoms related to the neurological involvement of the pathology emerged: severe weight loss and paresthesias in the four limbs for which it was decided to associate therapy with patisiran IV. To date, the approved therapy for amyloid cardiomyopathy is tafamidis but, in consideration of the neurological symptoms and the results obtained from patisiran in patients with the variant form, it was decided to associate the two therapies, taking care to also optimize therapy for heart failure.
P349 EARLY DIAGNOSIS OF HEREDITARY CARDIAC AMYLOIDOSIS(ATTRV) IN A CARRIER: WHEN IS ENDOMYOCARDIAL BIOPSY INDICATED?
Authors: Chimenti C , Alfarano M , Ballatore F , Sciarra R , Verardo R , Frustaci A 
Published: May 2023

Abstract

Background
Hereditary transthyretin amyloidosis (ATTRv) is a rare, adult–onset, autosomal dominant genetic disorder caused by mutations in the TTR gene. The growing availability of effective therapies determining a greater benefit the earlier they start, highlights the importance of identifying cardiac involvement even in the absence of left ventricular hypertrophy.

Clinical Case
A 58–year–old man came to our observation for exertional dyspnea and received a diagnosis of hereditary transthyretin amyloidosis (Val142Leu). Family screening led to the identification of the 56–year–old brother who was carrier of the same mutation. This patient was symptomatic for palpitations. Blood tests, including cardiac Troponin and NTproBNP, were normal. The ECG showed sinus rhythm, with normal atrioventricular and intraventricular conduction but frequent premature ventricular contractions. Transthoracic echocardiogram was normal, including strain rate evaluation. In order to identify early cardiac involvement, the patient underwent cardiac magnetic resonance imaging and biphosphonate scintigraphy that were negative for cardiac involvement. Neurological examination showed initial bilateral carpal tunnel syndrome. Due to the presence of premature ventricular contractions, the patient underwent to an endomyocardial biopsy which unpredictably showed a slight focal positivity to Congo Red staining, and immunohistochemistry confirmed a slight focal positivity for transthyretin. Therefore, the patient started therapy with Tafamidis. At 12–month follow up cardiac scintigraphy was still negative as well as ventricular thickness resulted within normal limits.

Conclusion
This case shows that in ATTR mutation carriers, an initial cardiac involvement can be present even in the absence of left ventricular hypertrophy and positive bisphosphonate scintigraphy. In the presence of clinical symptoms and/or suspicious signs of disease, such as arrhythmias, an endomyocardial biopsy may be indicated in order to start disease modifying therapy earlier.
P350 LOOKING FOR RED FLAGS
Authors: Bianco S , Piscione M , Castaldo G , Polito D , Crispino S , Nafisio V , Grigioni F , Ussia G , Prati F , Gatto L 
Published: May 2023

Abstract
Case report: a 81 years old man with systemic hypertension, dyslipidemia, past smoking habit, was admitted to the ER of our hospital with acute decompensated heart failure. Since July he complained of worsening of dyspnea and paroxysmal nocturnal dyspnea. His blood pressure was of 155/80 mmHg, the HR was of 78 bpm in atrial fibrillation. He reported past myocardial infarction at the age of 32, thenceforth he underwent periodic cardiac check–up. From 2013 he had developed atrial fibrillation. He had suspended Amiodarone because of dysthyroidism, rate control was obtained with Bisoprolol. In 2015, he underwent coronary angiography for a positive scintigraphy showed absence of lesions. During the same hospitalization there was evidence of nocturnal bradycardia (35 bpm). In 2016, a cardiac MR showed subendocardial and intramyocardial fibrosis at mid–basal wall resembling post ischemic events. He underwent past carpal tunnel syndrome surgery. During the actual hospitalization, the EKG showed atrial fibrillation (78 bpm), complete left bundle branch block (both already known). Serum and urinary light–chain assessment and determination of immunoglobulin light chains levels were negative for AL amyloidosis. The echocardiogram documented: hypertrophy of the interventricular septum, mildly reduced LV systolic function (EF=43%). Invasive coronary angiography showed absence of lesions. CMR showed: left ventricular size at the upper limit of normal with hypertrophy of the interventricular septum and the anterior wall, diffused left transmural LGE, focal fibroadipose infiltration of lower basal SIV. During the hospitalization multiple episodes of non sustained ventricular tachycardia occurred, so that a CRT–D device was implanted in secondary prevention. There was a strong suspicion of cardiac amyloidosis so that definitive diagnosis was obtained by the use of 99m Tc scintigraphy coupled with haematologic tests (already done, resulted negative). Scintigraphy showed myocardial uptake of the radiotracer greater than the bone (Grade 3 Perugini score).

Conclusion
cardiac amyloidosis is a restrictive cardiomyopathy. Early diagnosis is really important, firstly, because new treatments, such as a TTR stabilizer, have transformed this once incurable disease to a treatable condition. Secondly, diagnostic tools now allow earlier and more accurate non–invasive diagnosis. It is crucial to put the attention on red flags which have to be found to rise the clinical suspicion.
P352 EXPLORATORY ANALYSES FROM APOLLO–B, A PHASE 3 STUDY OF PATISIRAN IN PATIENTS WITH ATTR AMYLOIDOSIS WITH CARDIOMYOPATHY
Authors: Cappelli F , Kale P , Maurer M , Fontana M , Grogan M , Fernandes F , Palacek T , Taylor M , Hung R , González–duarte A , Puolsen S , Donal E , Perfetto F , Tsujita K , Yu W , Sarswat N , White M , Yureneva E , Jay P , Vest J , Gillmore J 
Published: May 2023

Abstract

Introduction
Transthyretin–mediated (ATTR) amyloidosis is a progressive and fatal disease. Patients with hereditary or wild–type ATTR amyloidosis frequently develop cardiomyopathy (CM). Patisiran, an IV RNAi therapeutic that inhibits synthesis of wt and variant TTR, is approved for the treatment of hATTR amyloidosis with polyneuropathy.

Methods
In APOLLO–B, patients were 18–85 yrs old with evidence of cardiac amyloidosis by echocardiography, ATTR amyloid deposition on tissue biopsy or fulfilling nonbiopsy diagnostic criteria for ATTR amyloidosis with CM, and had prior hospitalization for heart failure (HF) due to ATTR amyloidosis or clinical evidence of HF. Patients were randomized 1:1 to patisiran IV 0.3 mg/kg or placebo Q3W for 12 months. The primary endpoint was change from baseline in 6–MWT at Month 12 (M12) with patisiran vs placebo. Exploratory parameters at M12 included changes in cardiac biomarkers, echocardiography and Tc scintigraphy.

Results
APOLLO–B enrolled 360 patients (patisiran, n=181; placebo, n=179): median age, 76.0 yrs; male, 89%; wtATTR, 80%; on tafamidis at baseline, 25%. Patisiran showed a significant benefit compared with placebo in 6–MWT (median [95% CI] change from baseline: patisiran, –8.15 [–16.42, 1.50]; placebo, –21.35 [–34.05, –7.52]; HL estimate of median difference: 14.69 [0.69, 28.69]; p=0.0162). Patisiran demonstrated favorable trends in change from baseline of NT–proBNP (mean fold change ratio [95% CI]: 0.80 [0.73, 0.89]; p=1.825×10–5) and troponin I (mean fold change ratio [95% CI]: 0.87 [0.80, 0.95]; p=0.0011) at M12 vs placebo. Patisiran also demonstrated a trend towards benefit in change from baseline of most evaluated echocardiographic parameters at M12 vs placebo. Patisiran–treated patients evaluable for scintigraphy (n=37) experienced a reduction (37.8%) or no change (62.2%) in Perugini grade at M12 compared with baseline. Among placebo patients (n=28) at M12, none experienced a reduction from baseline in Perugini grade, and 1 (3.6%) increased in grade. Patisiran demonstrated an acceptable safety profile; AEs were mostly mild or moderate in severity, and there were no cardiac safety concerns.

Conclusions
Exploratory analyses after 12 months provide further evidence for the potential benefit of patisiran treatment on cardiac biomarkers and manifestations of cardiac amyloid involvement in patients with ATTR amyloidosis. The long–term impact of patisiran will be assessed in the ongoing APOLLO–B open–label extension.
P360 INFLAMMATION AND LIPID METABOLISM IN YOUNG PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Meringolo F , Panattoni G , Proietti G , Jacomelli I , Lanzillo C , Calò L 
Published: May 2023

Abstract

Background
Inflammation and lipid metabolism play a central role in pathogenesis of atherosclerosis. High sensitivity C–reactive protein (hsCRP), Lipoprotein(a) [Lp(a)] and other inflammation markers are well–established markers of cardiovascular (CV) diseases and are associated with adverse CV outcome after acute coronary syndrome (ACS).

Methods
The study enrolled patients ≤ 55 years of age referred to Cardiology Department of Policlinico Casilino with ACS. In order to evaluate inflammation and lipid metabolism in young patients presenting with ACS, we design an acronym to describe biochemical tests measured: ACS–Lip. Biochemical tests include: A – Apolipoprotein A (ApoA), A – Apolipoprotein B (ApoB), C – hsCRP, C – Cystatin C, S – Suppression of tumourigenicity 2 (ST2). Lip – low–density lipoprotein cholesterol (LDL), high–density lipoprotein (HDL) cholesterol and triglycerides (TG), – Lp(a), Interleukin 6 (IL–6), plasma glucose, glycosylated hemoglobin Type A1c (HbA1c) levels were also determined.

Results
A total of 20 patients (85% males, mean age 45.5 ± 7.7 years old) were enrolled from July 2020 to March 2022. Hs–CRP was ≥3 mg/L in 100 % of patients. Mean LDL cholesterol level at admission was 117 ± 56 mg/dL, while mean HDL cholesterol was 38 ± 11 mg/dL. Mean Lp(a) level was 42.9 ± 36.1 mg/dL. Elevated Lp(a)&gt;30 mg/dL was documented in 55% of patients. Lp(a) level distribution in the study population is reported in Figure 1. Additional parameters are reported in Table 1.

Conclusion
In our experience, elevated levels of Lp(a) and of markers inflammation display a detailed profile of patients presenting with ACS at a relatively young age, identifying patients with high risk of recurrence of cardiovascular events. This result focus on the potential use in clinical practice of efficacious Lp(a)–lowering drugs and on the role on inflammatory mediators both as indicator and therapeutic target.
P362 SHORT TERM EFFECTIVENESS OF A NOVEL NUTRACEUTICAL FOR THE MANAGEMENT OF HYPERCHOLESTEROLEMIA IN PATIENTS WITH LOW TO MODERATE CARDIOVASCULAR RISK: A MULTICENTER PRIMARY CARE OBSERVATIONAL
Authors: Natale F , Loffredo F , Molinari R , Covino S , Limatola M , De Luca L , Mollo N , Pezzullo E , Alfieri R , Cimmino G 
Published: May 2023

Abstract
Purpose: Increasing evidence reinforces the benefits of reduction of low–density lipoprotein (LDL–C) levels on cardiovascular outcomes. Different targets are suggested based on cardiovascular risk (CVR). According to the current European guidelines, a goal of LDL–C≤ 115mg/dL is desirable for patients with low–moderate CVR. However, a high percentage of these patients are far from this target. Nutraceuticals are “food supplements” that may help to achieve this goal in this population. In this retrospective analysis, we evaluate the effects of dietary supplementation with a novel monacolin/berberine/bergamot nutraceutical formulation on plasma lipid levels of subjects with low–moderate hypercholesterolemia who are not treated with conventional drug or other dietary supplements.

Patients and Methods
526 adult patients with hypercholesterolemia were retrospectively selected from the database of participant family practitioners according to prespecified criteria. All selected patients had a baseline and 30–day value of total cholesterol (TC), LDL–C, high–density lipoprotein cholesterol, triglycerides, C–reactive protein, and transaminases and have started a dietary supplementation with this novel nutraceutical. Similarly, 104 subjects with comparable clinical features but not treated with any supplements were also selected.

Results
At 30–day, the administration of nutraceuticals was associated with a significant reduction of LDL–C (124 ± 14 vs. 100 ± 13 mg/dL, Δ 24.5mg, p–value &lt;0.0001) and TC levels (210 ± 56 vs. 187 ± 60, p–value &lt; 0.0001), in the absence of a significant change of transaminase levels. No side effects were reported in the database during the observation period.

Conclusion
This novel nutraceutical is an effective dietary supplement to achieve a significant and early LDL–C reduction.
P367 LONG–TERM BENIGN EVOLUTION OF SARS–COV 2 VACCINE RELATE MYOPERICARDITIS
Authors: Ballatore F , Costantino J , Alfarano M , Ajmone F , Manguso G , Maggio E , Ciaramella P , Vizza C , Chimenti C 
Published: May 2023

Abstract

Background
Myopericarditis following vaccination for Sars–CoV2 disease (COVID–19) is a described entity, but its long–term evolution is not yet clear.

Methods
Patients diagnosed with myopericarditis after COVID–19 mRNA vaccine represented our population. Clinical evaluation, laboratory tests, noninvasive tests, echocardiography, and cardiac magnetic resonance (CMR) were performed at baseline, six months, and twelve months.

Results
Between January and August 2021, we identified 7 patients with myopericarditis after vaccination with Sars–CoV 2 mRNA. The mean age of the patients was 29 years (IQR: 25.5–53.5 years). and all patients were male. The median time from vaccine administration to symptom onset was 5 days (IQR: 4–7 days); five patients received BNT162b2, two mRNA–1273, and only one patient developed symptoms after the first vaccine dose. The most common symptoms at presentation were chest pain (100%) and fatigue (71.4%). Left ventricular ejection fraction (LVEF) remained preserved in 6 of them while it was found to be slightly reduced in one (median LVEF: 61.3% [IQR: 60–62.9%]). Late Gadolinium enhancement (LGE) was detected by CMR in 42.9% of cases. Treatment was conservative for all patients except one in whom pericardiocentesis was required due to massive pericardial effusion. At the 6–month follow–up all patients were asymptomatic with normal troponin levels, electrocardiographic and echocardiographic parameters and CMR, data which confirmed the complete resolution of the inflammatory state. At the twelve–month follow–up, the CMR confirmed the resolution of the inflammatory picture. Two patients received the booster dose of COVID–19 vaccine without evidence of myopericardial involvement.

Conclusions
COVID19 mRNA vaccination–associated myopericarditis is more frequent in young males and is usually characterized by a benign evolution.
P369 AUTOIMMUNE LYMPHOCYTIC MYOCARDITIS: ONE SIZE DOES NOT FIT ALL
Authors: Panza A , Giordani A , Naso P , Schiavon B , Leoni L , Baritussio A , Rizzo S , Basso C , Masiero G , Tarantini G , Perazzolo Marra M , Cecchetto A , Iliceto S , Marcolongo R , Caforio A 
Published: May 2023

Abstract
Fulminant myocarditis (MF) is an acute onset, rapidly progressive and potentially fatal inflammatory cardiomyopathy which could manifests with cardiogenic shock and incessant arrhythmias. There is often a need for aminic or mechanical support to the circulation in the acute phase, waiting to obtain a histological diagnosis as quickly as possible to establish a specific therapy. Mortality in the acute phases is high, with a worse prognosis than in other forms of presentation of myocarditis, even in the long term. We report the case of a 45–year–old Asian woman suffering from autoimmune hypothyroidism, who had been reporting atypical chest pain for about 3 days, associated with fever, asthenia, and vomiting. On admission, the patient was in cardiogenic shock; an echocardiogram revealed biventricular dysfunction. Pulmonary embolism and acute coronary syndrome were excluded. Blood tests showed a significant troponin rise, neutrophilic leukocytosis, and hypertransaminasemia. Anti heart antibodies (AHA) were negative. Amine support with dobutamine and norepinephrine was then started. The first EKG showed an advanced atrioventricular block with a ventricular escape with the need for emergency temporary PM placement. Right heart catheterization showed pressures in the pulmonary circulation at the upper limits with average resistance and reduced cardiac index. An endomyocardial biopsy (EMB) was performed, subsequently complicated by cardiac tamponade due to lead displacement, treated with urgent pericardiocentesis. At the end of the procedure, the appearance of incoming episodes of complete BAV was highlighted, for which ICD implantation was performed. The biopsy showed virus–negative diffuse acute lymphocytic myocarditis. Cortisone therapy was therefore started, with immediate benefit, until the aminic support was suspended. A follow–up echocardiogram showed a complete recovery of normal biventricular function. In MF, early diagnosis, and the possibility of establishing specific therapy are crucial to reduce mortality. EMB is the only method that allows you to make an etiological diagnosis and exclude a possible infectious genesis. The patient‘s prognosis, in fact, in addition to supportive therapy, depends on the possibility of establishing a targeted treatment as soon as possible, which in virus–negative autoimmune forms consists of an immunosuppressive therapy modulated on the patient‘s histological type and clinic.
P370 INCIDENCE AND MAIN CLINICAL CHARACTERISTICS OF MYOCARDITIS IN PIACENZA PROVINCE IN THE LAST FIVE YEARS
Authors: De Santis N , Bricoli S , Caraffini A , Canu E , Del Giudice F , Ferdenzi E , Bolognesi M , Pisati M , Ferraro S , Pelizzoni V , Aschieri D 
Published: May 2023

Abstract
Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of etiologies, myocardial involvement and clinical presentations ranging from chest pain to extreme conditions such as cardiogenic shock or death. The variability in presentation reflects the variability in histological disease severity, etiology, and disease stage at presentation. The diagnosis may be suspected by clinical and noninvasive features and is confirmed by endomyocardial biopsy by established histologic, immunologic, and immunohistochemical criteria. CMR imaging is a valid diagnostic support which can detect important myocarditis features from evidence of inflammatory hyperemia and edema to myocardial scar. Due to its clinical presentation and the absence of a safe sensitive non–invasive diagnostic tool, the frequency of this condition and its specific etiology is often difficult to identify, and because of this, the cause is frequently unknown. Anyway among the infectious etiologies, viruses are the presumed to be the most frequent pathogens. We analyzed the main clinical features of patients who were hospitalized for myocarditis in our province in the past five years. Since 2018, 53 patients received a diagnosis of myocarditis. Mean age was 38, 40 (75%) of them were males. The vast majority of patients underwent CMR as a part of diagnostic work–up and we found lateral wall as the most frequently involved. Almost half of the patients showed oedema as a sign of acute inflammation and 35% had more than one segment affected. Mean ejection fraction was 60%. 22 of them were discharged as having as “idiopathic”, 18 had a viral cause (of which 2 were clearly COVID–related) with gastroenteritis being the most common clinical presentation. Of note, only one case was associated with COVID–19 vaccination. Figure 1 shows different distribution of the cases per year. Of note, we did not observe an increased incidence in the last 3 years and mean age was similar in the years analysed possibly reflecting a limited effect of COVID and COVID–vaccination related incidence in our population.