bluuebunny/crossref_metadata_2025_split huggingface dataset:
P433 LIVER STIFFNESS RELATES TO AN INCREASED RISK FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN PATIENTS WITH NON–ALCOHOLIC FATTY LIVER DISEASE
Authors: Cicco S , Argeri S , Dalbeni A , Lauletta G , Vacca A 
Published: May 2023

Abstract
Obiettivo: l’epatopatia steatosica non alcolica o Nafld, deriva da alterazioni del metabolismo lipidico che comportano un incremento del deposito dei grassi a livello epatico risultando in un danno d’organo. Non ci sono dati chiari circa la connessione tra steatoepatite e malattia cardiaca, tuttavia, molti sono i fattori di rischio sovrapponibili per entrambe le patologie, pertanto, potremmo ritenere plausibile una possibile correlazione tra le due condizioni. Il nostro scopo è stato quello di valutare il rischio di malattia cardiovascolare in un cluster di pazienti affetti da NAFLD. Metodi: Abbiamo coinvolto nel nostro studio 41 pazienti (26 maschi, età media 58,71±13,56) affetti da NAFLD, diagnosticata rispettando i criteri indicati dalle linee guida internazionali e valutata tramite ecografia; abbiamo confrontato i nostri dati con quelli di un gruppo di controllo formato da 88 soggetti, non affetti da NAFLD (55M, età media 57,39±9,91). Abbiamo valutato la rigidità epatica come indicatore di fibrosi, misurandola tramite tecnica “Share Wave ultrasonography”. Per valutare la malattia cardiovascolare abbiamo calcolato per ogni paziente lo score di rischio tramite “ASCVD risk estimator” Risultati: nel gruppo NAFLD è stata riscontrata ipertensione arteriosa nel 58% dei pazienti (n.=24) e diabete mellito nel 34% dei pazienti (n.=14); nessuna differenza significativa, rispetto a questi fattori di rischio, è emersa dal gruppo di controllo. Tuttavia, i pazienti con NAFLD presentavano un aumento della fibrosi epatica (classe metavir 1 [IQR 1–3], p&lt;0,05) ed un aumento del rischio cardiovascolare rispetto al gruppo di controllo (ASCVD–10–yr 17,21 ± 17,99% vs 7,93 ± 7,68, p&lt;0,05). La fibrosi epatica mostrava, inoltre, una diretta correlazione con il rischio cardiovascolare (Spearman r 0,37, p&lt;0,01). La stessa correlazione diretta è stata riscontrata tra ASCVD risk ed il dato relativo alla liver stiffness, misurata in valore assoluto, in kPa (Pearson r 0,39, p&lt;0,05).

Conclusion
i: I nostri dati indicano che la NAFLD possa essere associata ad una ridotta aspettativa di vita, anche per via di una diretta correlazione con l’aumento del rischio di malattia cardiovascolare. Questi dati suggeriscono, quindi di promuovere una valutazione corretta e completa della malattia cardiovascolare nei soggetti affetti da NAFLD allo scopo di ottimizzare la terapia mirata per questi pazienti. Ulteriori studi prospettici sono necessari per confermare i nostri dati.
P436 ASSOCIATION BETWEEN REVERSE–TAKO–TSUBO E NEUROLOGICAL DISORDER
Authors: Alonzo B , Casati M , Montisci R , Cadessu Dessalvi C 
Published: May 2023

Abstract
Reverse–Tako–tsubo (r–TTC) is a rare variant of Tako–tsubo syndrome (TTC). TTC is characterized by transient and reversible left ventricular systolic dysfunction, for which an emotional or physical stressful trigger can usually be identified. Clinically, it mimics an acute myocardial infarction, with elevation of myocardial cytonecrosis enzymes and no obstractive coronary artery stenosis. On imaging, r–TTC is characterized by hypokinesia of the mid–basal regions associated with hyperkinesia of the apical region that resolves spontaneously. Case report: 78–year–old female affected by cerebral atrophy, leukoencephalopathy, cognitive impairment, behavior disorders. Reported episode of loss of consciousness lasting several minutes, associated with spontaneously resolving tremors and left hemisome hyposthenia. When she arrived in the emergency room, the haematological tests found high troponin values. On CT brain without contrast, no evidence of alterations of the encephalic tissues referable to acute lesions, but it showed of diffuse supratentorial leukoaraiosis and widening of the cerebrospinal fluid spaces on an atrophic basis. The neurological evaluation excludes the presence of a seizure. The electrocardiogram showed diffuse negative T waves and QTc 636 ms. The coronary angiography didn’t show significant coronary arteries stenosis and the ventriculography showed normal ventricular dimensions with total akinesia of the mid segments and normokinesia of the apical region with an ejection fraction of 50%. With these findings a diagnosis of mid left ventricular Tako–tsubo (r–TTC) was made. Transthoracic color Doppler echocardiography confirmed the alterations of the left ventricular kinetics observed by ventriculography.

Conclusions
compared to CTT, r–TTC is associated with a lower decline in global systolic function and, as reported in the literature, there is a greater connection to neurological insults as triggering factors, such as episodes of aneurysmal subarachnoid hemorrhage, brain surgery, ischemic stroke seizures and traumatic brain injury. The underlying mechanisms are still unknown, a crucial role in catecholamine–induced cardiotoxicity, coronary microvascular dysfunction or coronary vasospasm and/or estrogen deficiency is hypothesized.
P443 ACUTE ACALCULOUS CHOLECYSTITIS AND CARDIOVASCULAR DISEASE, WHICH CAME FIRST?
Authors: Fiore D , De Rosa S 
Published: May 2023

Abstract

Background
The existence of a close association between disease of the biliary tract and heart‘s disease is known from the mists of time. Acute acalculous cholecystitis (AAC) is a challenging diagnosis. The atypical clinical onset associated to a paucity and similarity of symptoms and to laboratory data mimicking cardiovascular disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC is often associated with gangrene, perforation and empyema as well as considerable morbidity and mortality(up 50%). Early diagnosis is crucial to increase survivability. Even today, there is still a lot of confusion regarding the relationship and consequently the clinical management AAC and CVD. Aim The aim of this review was to provide evidence regarding epidemiology, pathophysiology, clinical presentation and treatment of the complex association between AAC and CVD.

Methods
we searched for publications addressing Acalculous cholecystitis and cardiovascular disease, consulting Medline and Scopus databases. Any retrospective or prospective study design or systematic review focusing on the aforementioned topic was accepted. This study was conducted in accordance with the PRISMA and AMSTAR Guidelines. Our search rendered 1422 hits (995 from Medline and 427 from Scopus). After progressive screening, 268 full texts were assessed for eligibility and 135 studies were included in qualitative synthesis.

Results
According to the literature, 11 cases of AAC were reported after cardiopulmonary bypass surgery. Similarly, in 6 of 7 patients following aortic reconstruction. Small vessel occlusion has shown to be the predominant phenomenon in AAC. Histological analysis suggest involvement of ischaemia and reperfusion mediated injury. The most common ECG alterations noted in AAC are changes in T waves in significant leads, slurring and notching of the QRS complex and elevation or depression of the S–T segment, hypothesizing a vagally reflex mechanism, due to the distention of the common bile duct, with a reduced coronary blood flow. Finally it was reported a resolution of ECG changes due to AAC after cholecystectomy or antibiotic treatment within a few days.

Conclusion
AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases and major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA could be related to a misdiagnosed AAC.
P465 NON–VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN PATIENTS WITH THALASSEMIA
Authors: Capanni A , Clò S , Sirugo P , Guardigli G , Bertini M , Orazio G , Malagù M 
Published: May 2023

Abstract
Apixaban, dabigatran, edoxaban and rivaroxaban (NOACs) are drugs widely used and recommended for the prevention of thromboembolic events in patients with atrial fibrillation (AF) or atrial flutter and to prevent or treat pulmonary embolism (PE) and deep vein thrombosis (DVT). However, very little is reported in literature regarding their use in patients with β–thalassemia, among which high incidence of AF is reported and where the balance between thromboembolic and bleeding risk is of paramount importance. In this study 18 patients with transfusion–dependent β–thalassemia were enrolled. Patients were treated with NOACs for throboembolic prevention due to history of AF or atrial flutter. Mean follow–up duration was 21 ± 15 months for each patient and no thromboembolic events were reported. Three patients had non–major bleeding events without oral anticoagulation interruption. Two patients reported dyspepsia during treatment with dabigatran and were shifted to a different NOAC with resolution of symptom. These data suggest efficacy and safety of NOACs for the prevention of thromboembolic events in patients affected by β–thalassemia.
P471 CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS WITH HEART FAILURE IN THERAPY WITH SGLT2I RELATED TO THE HEART FAILURE OUTPATIENT
Authors: Benvenuto M , Iacoviello M , Gronda E 
Published: May 2023

Abstract
Sodium–glucose co–transporter type 2 inhibitors are the new class of drugs that have been shown to reduce heart failure hospitalizations and cardiovascular deaths in patients with HFrEF with a class of recommendation IB for the treatment of patients with HFrEF in the most recent international guidelines. The objective of this observational study was to analyze the main clinical characteristics, therapeutic associations and any adverse events highlighted in outpatients in which SGLT2i therapy was added. Data from 42 patients on SGLT2i therapy (98.2% dapagliflozin) were analysed. 71% of patients were male, with a mean age of 70.5 years. Approximately 52% of cases had an ischemic heart failure aetiology, 54% had arterial hypertension, and 27% had type 2 diabetes mellitus. Of these, 76% had HFrEF, 14% had HFmrEF and the remaining 9% from HFpEF. At the time of the visit, 11.9% of patients had a serum creatinine value &gt; 1.3 mg/dL. Thirty–one percent of patients were NYHA Class III. The analysis of concomitant drug therapies with the use of SGLT2i showed that 76% of patients were on therapy with a renin angiotensin system inhibitor (62% ACEI/ARBs and 14% ARNI), 71% were on MRA and 91% % beta blockers. 82% of patients were on concomitant diuretic therapy with furosemide. ARNI therapy was suspended due to hypotension in 5% of cases (2 patients). No patient had significant renal deterioration requiring discontinuation of SGLT2i.

Conclusions
From the observed data emerged that the addition of SGLT2i to the optimized therapy is safe and well tolerated. None of the patients had to discontinue this drug and there were no adverse events. The association between SGLT2i and ARNI was also well tolerated and, in accordance with the documented efficacy in the main clinical trials, should be privileged as soon as possible.
P473 SURVEY ON THE USE OF SGLT2I THERAPY: CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS WITH HEART FAILURE IN A GROUP OF CENTERS IN PUGLIA, MOLISE AND ABRUZZO. ANMCO CARDIO RENO METABOLIC AREA
Authors: Benvenuto M , Valenti C , Shehaj E , Panzarella G , Gronda E , Iacoviello M 
Published: May 2023

Abstract
Pharmacological treatment of heart failure with reduced ejection fraction has undergone considerable development in recent years. Type 2 sodium–glucose co–transporter inhibitors represent the most recent class of drugs that has been shown to reduce hospital admissions for heart failure and deaths from cardiovascular causes and have immediately entered in the most recent international guidelines for the treatment of HFrEF patients. The objective of this survey, which involved various cardiologists from Puglia, Molise and Abruzzo, was to analyze the clinical characteristics and therapeutic associations of patients in whom SGLT2i therapy was prescribed. Into the REINFORCE project, each of the cardiologists participating in the survey was asked to provide anonymised data of patients who were initiated on SGLT2i therapy. Each cardiologist provided information on the main clinical and therapeutic characteristics of the patients. Data relating to 788 patients on SGLT2i therapy (98.8% dapagliflozin) were analysed. 71% of patients were male, with a mean age of 69.5 years. Approximately 53.5% of the cases had an ischemic heart failure aetiology, 73% had arterial hypertension and 40.6% had type 2 diabetes mellitus. Of these, 83.9% had HFrEF, the 12.3% from HFmrEF and 3.9% from HFpEF. 38.8% of patients had presented an episode of hospitalization for heart failure (in the previous 6 months). At the time of the visit, 23.2% of patients had a serum creatinine value &gt;1.3 mg/dL. 47% of patients were in NYHA Class I–II, while 53% had an advanced class (NYHA III). The analysis of concomitant drug therapies using SGLT2i showed that: 93.4% of the patients were on therapy with a renin angiotensin system inhibitor (40.5% ACEI/ARBs and 52.8% ARNI), 65.9% were on MRA and 91.5% beta blockers. 86.1% of patients were on concomitant diuretic therapy with furosemide.

Conclusions
Data from the REINFORCE study provide real–world data to help understand the characteristics of heart failure patients prescribed SGLT2i therapy. The data show safety and tolerability of the therapies provided also in the ARNI–SGLT2i association which, associated with efficacy documented in the trials, would suggest to favor this association as soon as possible.
P477 PIRCHE (PREDICTED INDIRECTLY RECOGNIZABLE HLA EPITOPES) ALGORITHM AS A POSSIBLE PREDICTOR OF AMR (ANTIBODY MEDIATED REJECTION) FOLLOWING HEART TRANSPLANT, FROM LAB EXPERIENCE TO CLINICAL PRACTICE: A CASE REPORT
Authors: Fischetti G , Giovannico L , D‘errico Ramirez A , Parigino D , Santeramo V , Margiotta M , Mininni D , Di Bari N , Bottio T , Milano A 
Published: May 2023

Abstract
PIRCHE–II is an algorithm used to estimate the risk for developing alloreactivity towards HLA mismatches. A 35–year–old man with idiopathic dilated cardiomyopathy with several previous hospitalizations for heart failure is admitted to our unit for a new episode in August 2021. After evaluation, the patient was placed on the waiting list for transplant. The following month the patient underwent heart transplant. The donor had a compatible CDC crossmatch and was negative for anti–HLA antibodies. After 46 days, the patient was discharged at home in stable conditions after 2 negative endomyocardial biopsies (EMB): ISHLT’04 0. In January 2021, the patient was newly admitted for dyspnea and oliguria. Imaging revealed bilateral severe pleural effusion, biventricular cardiac disfunction; EMB showed acute rejection (ISHLT’04 3R). Panel–reactive antibody (PRA) screening found 93 % of class I PRA, 3 % of class II PRA with IgM and IgG donor–specific antibodies (DSA), C1q–positive. After 2 months, the patient was placed again on the transplant waitlist for a persistent severe biventricular disfunction, massive tricuspid regurgitation and diffuse myocardial fibrosis; class I PRA was decreasing (41 % in March 2022, 31 % in April 2022). Unfortunately, the patient died of infection before re–transplantation. After the event, which was recognized as AMR caused by class I DSA, a form rarely described in literature, we employed the PIRCHE (Predicted Indirectly Recognizable HLA Epitopes) algorithm to predict indirect donor–recipient alloreactivity: PIRCHE–II was 54. Is a high PIRCHE–II score a reliable predictor of AMR following heart transplant? More data and deeper understanding is surely needed. A correct after–transplant serologic monitoring is definitely needed to search for de–novo DSA.
P483 IMPACT OF AN ENDOCARDITIS TEAM ON PROGNOSIS: PRELIMINARY RESULTS
Authors: Di Domenico A , Carigi S , Amati S , Di Giannuario G , Di Cesare A , Farneti L , Sarti A , Tripodi A , Moscatelli G , Kety L , Vandi G , Mele E , Biagetti C , Santarelli A 
Published: May 2023

Abstract
Infective endocarditis (IE) is a life–threatening microbial infection with high mortality rate (6–50% in–hospital and 19–82% at 5–years)1.Guidelines for management of infective endocarditis underline the importance of multidisciplinary approach with an Endocarditis Team (ET) for the complexity of disease and for prognosis which depends on patients’ characteristics, microorganisms involved and local or systemic complications.ET includes specialists that define multimodality imaging approach to confirm diagnosis and to exclude local or systemic complications, discuss timing of antibiotic therapy, indication and timing of surgical treatments and follow–up. This study was a retrospective analysis based on a population of 86 patients from Infermi Hospital, Rimini, who received a diagnosis of IE from 2019 to 2021 thanks to a multidisciplinary approach. Among 86 patients, 76 (88,4%) had early–diagnosed IE and 10 (11,3%) had late–diagnosed IE.Early–diagnoses IE was defined when diagnoses occurred within 30 days from first symptoms.The aim of this study was to assess the impact of ET on timeliness of diagnosis and prognosis.Comparing the two groups, in the early–diagnosed IE we found higher rate of risk factors for endocarditis and systemic embolisation (27,6% vs. 20%), with Staphylococcus and Streptococcus as the most frequent causative pathogens (43,4% and 31,5%).More frequently the late–diagnosed IE group had mechanical prosthetic valves (20% vs 7,8%) with a higher rate of cardiac surgery (80% vs 35,5%), cardiac valves complications such as abscesses, perforations and pseudo–aneurysms (20% vs 18,4%) and a higher rate of intra–hospital mortality (40% vs 18,4%). Streptococcus and Enterococcus were most involved in the late–diagnosed group.Several trials demonstrated that presence of ET reduces 1–year mortality from 18.5% to 8.2% 2 and in–hospital mortality from 28% to 13% 3. Our preliminary study confirms the importance of ET application to improve early diagnosis (88.4%) and to reduce mortality. Bibliography:1.Kouijzer et al., Native valve, prosthetic valve, and cardiac device–related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies(2022). 2.Botelho–Nevers et al. Dramatic reduction in infective endocarditis–related mortality with a management–based approach(2009). 3.Chirillo,F.et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis(2013).
P486 ALIROCUMAB EFFECTIVENESS AND RAPIDITY IN ACHIEVING AND MAINTAINING TARGET LDL CHOLESTEROL VALUES IN PATIENTS AT VERY HIGH CARDIOVASCULAR RISK, ALSO ASSESSING ITS EFFECTS ON TRIGLYCERIDE AND HDL CHOLESTEROL VALUES
Authors: Cavarra M , Salerno E , Chiaranda‘ M , Chiaranda‘ G , Tamburino C 
Published: May 2023

Abstract

Introduction
Still too few patients (pts)after an acute cardiocerebrovascular(CeVD) event reach LDL–C values recommended by guidelines even in therapy with statins and Ezetimibe(Eze),thus maintaining a high risk of new cardiovascular(CV)episodesPurpose: To evaluate in a long follow–up the effectiveness and the rapidity of Alirocumab(Ali)in the attainment and maintenance of LD–C target values in pts at very high risk in therapy with only Eze because they are intolerant to statins

Methods
Our case studies consist of 72 pts of which 80% are male(58)and 20% female(14),with an average age of 61.9 y,90.2% of pts were hypertensive,34.7% diabetic and 15.2% with peripheral arteriopathy;5.5% had chronic kidney disease (CKD stage III) In the case history the 65.2% had an ACS and the 34.7% had CeVD.84.7% were in therapy only with Eze while 15.3% in association with PUFA N–3. The average value of LDL–C was 169.2 mg/dl. The follow up was 24 months (mths) with clinical checks and value of LDL–C at 3,6,12 and 24. The dosage of Ali varied from 150 to 75 mg in relation to the value of basal LDL–C to achieve a rapid reduction of at least 50%.Triglyceride (Tg) and HDL–C values were also evaluated

Results
At 3 mths the reduction of LDL–C was 52.24%, recording in 34,7% of cases a greater reduction of 65%; at 6 mths of 51.18%; at 12 mths of 51.36% and at 24 mths of 52.47%. The 37 pts who had started with 150 mg, had a very high average LDL–C base 183.0 mg/dl, and showed a reduction of C–LDL to 3 mths of 59.04%, to 6 mths of 58.45%, to 12 mths of 65.05%, to 24 mths of 55.76%. The target value of C–LDL recommended by the ESC guidelines was reached for 42.10% at 3 mths; for 52.63% at 6; for 63.15% at 12 and for 73.68% at 24. 5.5% of pts with a CKD showed a 73.68% reduction in LDL–C values to 3 mths, 65.22% to 6, 57.49% to 12 and 53.95% to 24. The follow–up to the Tg study showed a reduction of 3.55% to 3 mths, an increase of 8.75% to 6, a reduction of 1.65% to 12 and 7.95% to 24. HDL–C values showed an increase of 4.55% at 3 mths, 3.69% at 6, 10.97% at 12 and 7.82% at 24

Conclusions
Our case studies have confirmed the effectiveness of Ali in reducing LDL–C values in pts at very high CV risk and the rapidity in reaching the target value set by guidelines for the management of CV risk. Our study also confirmed the effectiveness of Ali in increasing the values of HDL–C, in accordance with the guidelines ESC 2019 while it was not possible to confirm the reduction of Tg values.
P490 MANAGEMENT OF SEVERE HYPERCHOLESTEROLEMIA IN ITALY: EVIDENCE FROM SANTORINI STUDY
Authors: Arca M , Solini A , Calabrò P , Gambacurta R , Catapano A 
Published: May 2023

Abstract
The management of severe hypercholesterolemia (sHC) (LDL–C &gt;160 mg/dL) represents a clinical challenge in routine practice, mainly in the setting of high cardiovascular (CV) risk. The aim of the present analysis was to assess the characteristics and management at baseline examination of patients with sHC enrolled in the Italian cohort of SANTORINI study. The SANTORINI study (NCT04271280) is a multinational, observational, prospective study evaluating the use of lipid–lowering therapies (LLTs) in 9044 adult patients with high– and very–high CV risk enrolled from 14 European countries between March 2020 and February 2021, with a 12–month follow–up period per patient. The Italian cohort comprised 1977 patients, 229 (11.6%) of whom were classified with sHC. Their mean age was 59.4 years, 56% were male, BMI was 27.2 kg/m2 and mean LDL–C levels were 196.7 mg/dL. In 7% of cases sHC was reported to be associated with a clinical diagnosis of familial hypercholesterolemia. By investigators, 150 (65.5%) patients were classified at very–high and 79 (34.5%) at high CV risk, mainly (74.2%) based upon ESC/EAS European guidelines criteria. Atherosclerotic cardiovascular disease was actually present in 68.4% of patients, while 40.6% were on primary prevention. Despite sHC was associated with high CV risk, 64.6% of patients had no documented LLTs at baseline, 15.3% was receiving lipid–lowering monotherapy including 9.2% on statins (6.1 % moderate and 2.6% high–intensity), 1.7% were on ezetimibe, 1.6% on PCSK9i and 0.5% on other oral LLTs, and 20.1% was receiving combination therapy (10.9% were on statin + ezetimibe, 4.8% on PCSK9i + oral LLT, and 4.4% other oral combination therapy). Based on present findings, it is therefore concluded that, although the clinicians mostly follow current guidelines to determine CV risk in hypercholesterolemia, there is a low utilisation of LLTs, especially combination therapies, in the subgroup of patients with sHC at high and very–high CV risk. This means that further measures are needed to improve the therapeutic management of these patients in order to minimise the risk of adverse cardiovascular events.