bluuebunny/crossref_metadata_2025_split huggingface dataset:
P166 LEFT VENTRICULAR SUMMIT PVC–INDUCED CARDIOMYOPATHY: A CASE REPORT
Authors: Di Fraia F , Canciello M , Izzo G , Calvanese R 
Published: May 2023

Abstract
A 76 y.o. patient referred to our attention for syncopal and presyncopal episodes. His ECG showed several premature ventricular contractions (PVC) with the morphology of a right bundle branch block (RBBB)– positive concordance in precordial leads and transtion in V3 lead– and an inferior axis. Echocardiographic finding was a moderate reduced ejection fraction. Furthermore coronarography did not identify critical stenosis, excluding an ischemic etiology. Cardiac MRI was performed, confirming the reduce ejection fraction and excluding LGE. Because of high burden of 25000 PVCs on 24 h ECG registration and progressive deterioration of ejection fraction, despite antiarrhythmic drugs, catheter ablation was considered. An high density multielectrode mapping catheter was used and an initial right ventricular mapping was perfomed, recording local electrograms but without identification of a clear earliest site of activation. Therefore a retrograde transaortic left ventricular mapping was performed. Earliest site of activation was not significant (about 15 milliseconds), as well as percentage of correlation during pace–mapping. Epicardial mapping through coronary sinus into the anterior interventricular vein (AIV) showed a significant earliest activation site (greater than 30 ms) and a negative unipolar signal (QS) was detected. Pacing in this region highlighted a significant percentage of correlation with native PVC (92%), then catheter ablation was attempted. A first short duration application of radiofrequency was erogated on the endocardial side in front of the projection of the catheter in the AIV, because of possible risks of procedure, obtaining a temporary PVC suppression. Subsequently, after execution of a coronary angiogram proving a distance of the ablator in AIV and IVA/Cx vessels greater than &gt; 1 cm, an endovenous approach was attempted with application of radiofrequency into the AIV, obtaing complete PVC suppression. At a 6 months follow–up ejection fraction improved (FE 50%) and PVC were not detected.

Discussion
Epicardial approach throught coronary sinus is an effective strategy to map and ablate arrhythmias of left ventricular summit. In addiction this stretegy allows a less invasive epicardial approach than other procedures, requiring a cardiosurgery standby.
P179 RISCONTRO ACCIDENTALE DI UN RARO CASO DI COR TRIATRIUM DESTRO ASSOCIATO A DIFETTO INTER–ATRIALE IN UN PAZIENTE ADULTO
Authors: Talarico M , Colangelo M , Cassadonte F , Ciconte V 
Published: May 2023

Abstract

Background
Il cor triatrium destro (CTD), anomalia congenita in cui l’atrio sinistro è settato da una membrana in due parti, è un rilievo estremamente raro: in centri ad alti volumi la prevalenza è inferiore allo 0.01% (1). Il cor triatriatum destro è spesso associato ad alter anomalie congenite quali anomalie della valvola polmonare, il ventricolo destro ipoplasico, l’anomalia di Ebstein, i difetti del setto inter–atriale (DIA) (2,3). Quando la settazione è incompleta può essere asintomatico e riscontrato accidentalmente all’esame ecocardiografico (4). Descrizione del caso: A dicembre 2022 un uomo di 55 anni, affetto da fibrillazione atriale parossistica e sintomatico per cardiopalmo e dispnea (EHRA II),si ricoverava per ablazione dell’aritmia. Non venivano rilevati segni di scompenso cardiaco e gli esami del sangue erano normali. All’esame obiettivo si auscultava un soffio sistolico continuo. All’esame ecocardiografico (TTE) si evidenziava un DIA ed una membrana che divideva in modo incompleto l’atrio destro in due parti. Si sospettava un CTD o una valvola di Eustachio prominente. All’ecocardiogramma trans esofageo 3D (TEE) si mostrava una membrana non ostruttiva che divideva l’atrio destro in una camera superiore ed una camera inferiore, compatibile con CTD (Figura 1 e 3). Si confermava la lieve dilatazione dell’atrio destro ed il DIA ostium secundum (Figura 2 e 3) con un flusso eccentrico di 0.7 cm2 di area, shunt sinistro – destro non significativo (Qp/Qs 0.9). Non si indicava la chiusura ma follow–up clinico ed ecocardiografico poichè la funzione e le dimensioni del ventricolo destro e le pressioni polmonari erano normali. Per il riscontro di una formazione trombotica nell’auricola sinistra, ridotte velocità di svuotamento e smock–effect, si indicava una strategia e l‘ablazione veniva posticipata.

Conclusion
i: Il presente caso clinic sottolinea la possibile coesistenza di CTD ed altre anomalie cardiache congenite, inclusi i DIA, come riscontrato nel nostro paziente. Mentre molti casi di CTD richiedono correzione chirurgica nell’infanzia, nell’adulto il CTD è spesso asintomatico e diagnosticato accidentalmente perché non coinvolti né le camere sinistre né l’arteria polmonare. Il presente caso clinico contribuisce ad aumentare la conoscenza di questa anomalia estremamente rara, inclusa la possibile associazione con uno stato pro–trombotico e con le aritmie sopra–ventricolari.
P189 WHEN A PACEMAKER CAN BE HARMFUL IN A PATIENT WITH COMPLETE AV BLOCK
Authors: Maffè S , Paffoni P , Bergamasco L , Prenna E , Facchini E , Franchetti Pardo N , Careri G , Ariotti S , Paino A , Dellavesa P 
Published: May 2023

Abstract
The occurrence of complete AV block in patients with aortic valve stenosis is a frequent event and the implantation of a dual–chamber pacemaker is the therapy of choice for these cases. We present the case of an 84–year–old hypertensive diabetic patient hospitalized with heart failure during a severe anemia caused by bleeding duodenal ulcer (Hb &lt; 7g/dl). The patient was treated with blood transfusions, proton pump inhibitors, and endoscopic ulcer treatment with clinical stabilization. However, he presented a third–degree AV block, with a narrow QRS escape rhythm of about 45 bpm. The echocardiogram showed a calcified aortic valve with severe stenosis (transvalvular flow 4m/s, valvular area 0.9 cm2) ( fig1–2), with moderate mitral regurgitation and preserved systolic function (EF 60%). He was therefore subjected to a dual–chamber pacemaker implant. In the hours following the procedure, with heart rate increased to 90 bpm and correct AV synchronism, the patient presented an episode of acute pulmonary edema, treated with diuretics, oxygen and nitrogliceryn. with initial clinical improvement but subsequent new instabilization. The echocardiogram showed worsening of systolic function with septal dyssynergia secondary to electrostimulation and a severe mitral regurgitation (fig 3). The clinical status definitively stabilized only after changing the pacemaker programming to VVI 40 bpm (sentinel mode). The patient repeatedly refused the indications for aortic valve replacement surgery, and was therefore discharged with medical supportive care, third–degree AV block at electrocardiogram and a dual–chamber pacemaker programmed in sentinel VVI to obtain a minimal ventricular pacing. After 24–month follow–up, the patient remains in good clinical conditions, he was never hospitalized again, the third–degree AV block persists with PM stimulation percentages of 5%. This clinical case shows how electrostimulation and increased heart rate, in the presence of aortic outflow obstruction and significant mitral valve disease, can cause very insidious acute left ventricular systolic dysfunction, while restoring correct AV synchrony.
P192 POSTINFARCTION VENTRICULAR SEPTAL DEFECT: MANAGEMENT AND A NEW SURGICAL OPTION FOR CLOSURE
Authors: Torre M , Baldi C , Bottiglieri P , Vassallo M , Attisano T , Vigorito F , Bonadies D , Coscioni E 
Published: May 2023

Abstract
Postinfarction ventricular septal defect is a rare mechanical complication of myocardial infarction, with difficult management, debated closure timing and high mortality rates. Standard repair techniques – infarcectomy and infarct exclusion through a left ventriculotomy – are surgically challenging and have high risk of operative mortality and frequently suboptimal results. We report the case of a 66–year–old patient with a 1.4 cm septal rupture developed after a sub–acute STEMI. At the admission, he had chest pain and moderate dyspnoea, EKG showed inferior STEMI with increased myocardial necrosis markers. Echocardiography showed a preserved ejection fraction, akinesia of the inferior, posterolateral walls and of the posterobasal septum, with septal rupture at this level and 1.5 Qp/Qs ratio. A total occlusion of proximal right main coronary artery was found at coronary angiography. After the heart team meeting, we performed a new modified closure, in urgent setting, using two hand–made composite patches (Fig. 1) parachuted through a transversal aortotomy and a right atriotomy, without left ventriculotomy (Fig. 2). In the 7th postoperative day a second septal rupture was detected at the echocardiographic control. After two weeks follow–up in optimized medical therapy, we decided to complete the closure of the later developed septal rupture percutaneously using an Amplatzer device. Six months after the event, the patient is still asymptomatic and echocardiography documents a 50% ejection fraction, with trivial residual left–to–right shunt and normal valve function. Computed tomography scans confirmed optimal surgical result. Timing, management and surgical strategy are still on debate. Our technique is effective, simple, reproducible and provides good result (Fig. 3) and can be perfectly integrated in a hybrid approach.
P193 A MYXOMA IN THE LEFT ATRIUM ADHERENT TO THE INTERATRIAL SEPTUM
Authors: Cortese F , Costantino M , Matera A , Stabile E , Luzi G 
Published: May 2023

Abstract
A 73–year–old woman came to our observation to perform a routine echocardiographic examination. The patient had arterial hypertension, dyslipidemia, hypothyroidism, and paroxysmal atrial fibrillation. She underwent a bilateral mastectomy for breast cancer about 5 years ago, and she was undergoing chemotherapy and radiation therapy for a stage IV lung adenocarcinoma. The clinical evaluation was normal, as was the electrocardiogram. The transthoracic echocardiographic evaluation showed the presence of a rounded formation with variable echogenicity, with an irregular surface (4 x 3 cm), adherent to the interatrial septum at the level of the fossa ovalis, which did not hinder the excursion of the mitral valve. No other significant cardiac abnormalities were detected.Transesophageal echocardiography confirmed the presence of atrial mass adhered to the oval fossa (panels A, B). of coarsely rounded shape, and variable echogenicity, in the absence of interference with the movement of the valve leaflets and of anomalies of the interatrial septum (panel C). Coronary angiography showed right–dominant coronary circulation (panel D) and mild stenosis of the mid–left anterior descending artery. Abundant arterial perfusion of the atrial mass, with several vessels originating from the circumflex artery, was also evident at the coronary angiography (panels E, F). The patient underwent cardiac surgery; the surgical exeresis of the left atrial mass was performed through right mini–thoracotomy (panels I and L). Because the neo–formation was adherent not only to the atrial septum but also to the left atrial roof, to obtain a radical excision, a large portion of the atrial wall and the septum were removed and totally reconstructed with the pericardium. The main artery supplied the mass–related vascular network was ligated. The postoperative course was uneventful, and the patient was discharged at home on day six. The pre–discharge echocardiography and the cardiac magnetic resonance ( panels G, H) showed the absence of any residual mass in the left atrium that appears anatomically reshaped, no shunt at the level of the interatrial septum, and preserved ventricular function of both ventricles. Histological analysis confirmed the diagnosis of atrial myxoma. At the six–month follow–up the patient was asymptomatic and the echocardiography was superimposable to discharge.
P201 DRUG–COATED BALLOON AND DIABETES MELLITUS: A MATTER OF SURVIVAL
Authors: Zilio F , Verdoia M , Gioscia R , Viola O , Brancati M , Fanti D , Soldà P , Bonmassari R , Rognoni A , De Luca G 
Published: May 2023

Abstract

Background
Patients with diabetes mellitus (DM) are at higher risk of restenosis and stent thrombosis after percutaneous coronary intervention and drug eluting stent (DES) positioning. Limited although interesting data are available on prognosis after revascularization with drug–coated balloon (DCB) in this group of patients. The aim of this study is to evaluate the prognostic impact of DCB use in patients affected by DM.

Methods
Patients with DM enrolled in a retrospective multicenter registry were identified and matched to a control population of diabetic patients treated with DES enrolled in another retrospective registry, according to a propensity score calculated on the independent predictors of main adverse cardiac events (MACE). The primary study endpoint was the occurrence of MACE, a composite of death, myocardial infarction, and target vessel revascularization. Secondary endpoints were the independent components of the primary endpoint, or target lesion failure (TLF).

Results
150 patients were identified in the DCB group and matched with 150 DES–treated patients. However, patients treated with DCB displayed more often a previous cardiovascular history and received a more complete pharmacological therapy. Target vessel diameter and the percentage of stenosis were lower in DCB patients, whereas binary in–stent restenosis was more common. At a median follow–up of 545.5 days, MACE occurred in 54 (19.4%) of the patients, with no difference according to the PCI strategy. Although a trend toward higher TLF was found (p=0.06), overall death was significantly reduced in diabetic patients (3.6% vs 10.9%; adjusted HR[95%CI]= 0.27[0.08–0.91], p=0.03).

Conclusion
Although limited by some differences among the groups, the present propensity–matched study shows that, among patients with DM undergoing PCI for in–stent restenosis or de novo lesions, the use of DCB is associated to a similar rate of MACE and a possible increase in TLF, but a significantly improved survival as compared to use of DES.
P205 COMPASSIONATE DRUG USE FOR PATIENTS WITH TRANSTHYRETIN AMYLOID CARDIOMYOPATHY: THE FIRST EXPERIENCE IN ITALY
Authors: Ciliberti G , Torselletti L , Barbarossa A , Principi S , Coraducci F , Belleggia S , Coretti F , Bonci A , Stronati G , Casella M , Dello Russo A , Guerra F 
Published: May 2023

Abstract
Razionale. L’amiloidosi cardiaca da transtiretina (ATTR–CM), nella sua forma ereditaria o acquisita, è una cardiomiopatia a fenotipo ipertrofico–restrittivo che porta a un‘insufficienza cardiaca progressiva causata dalla deposizione extracellulare di transtiretina. Materiali e Metodi. Presso il nostro centro abbiamo avviato un ambulatorio dedicato alla gestione dei pazienti con amiloidosi cardiaca sin dal 2019. Poiché a quel tempo in Italia non erano disponibili terapie specifiche per questa condizione, decidemmo di creare un protocollo di uso compassionevole per il farmaco tafamidis in base ai risultati dello studio registrativo di fase 3. Risultati. Dopo l‘approvazione del nostro protocollo da parte dell’azienda produttrice e del comitato etico locale, a partire da ottobre 2019 e fino a novembre 2021, sono stati selezionati n=7 pazienti con ATTR–CM i quali erano idonei ricevere il farmaco (tabella 1).Dopo 22 mesi di follow–up, un paziente è deceduto per insufficienza cardiaca avanzata e un paziente ha manifestato insufficienza cardiaca che ha richiesto il ricovero in ospedale. Al termine del nostro protocollo di uso compassionevole non sono state osservate reazioni avverse al farmaco, tutti i pazienti sopravvissuti erano in classe NYHA II e hanno potuto effettuare con successo la transizione alla prescrizione ordinaria secondo i criteri del registro di monitoraggio AIFA (tabella 2).

Conclusion
i. Il presente rapporto descrive in dettaglio le caratteristiche della prima coorte di pazienti in Italia sottoposta a terapia farmacologica tramite uso compassionevole per il trattamento di ATTR–CM. L‘uso compassionevole è una modalità fattibile ed efficace per avviare la cura farmacologica in pazienti selezionati in attesa dell‘approvazione ufficiale da parte degli enti regolatori, il che può essere molto importante soprattutto nelle malattie ad andamento progressivo, in cui la somministrazione precoce della terapia è fondamentale per ottenere un beneficio clinico significativo.
P208 PREVALENCE OF TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN PATIENTS HOSPITALIZED FOR HEART FAILURE
Authors: Lanati G , Aschieri D , Di Dio M , Calabrò D , Mori M , Piepoli M , Rusticali G 
Published: May 2023

Abstract

Background
Bone scintigraphy with labeled diphosphonates allows for the non–invasive diagnosis of transthyretin cardiac amyloidosis, in case of high cardiac uptake of the radiotracer and concomitant absence of serum monoclonal component (Gillmore algorithm).

Objective
The aim of this study was to establish the prevalence of transthyretin cardiac amyloidosis in a population of patients hospitalized for heart failure.

Methods
In this prospective observational study, patients hospitalized for heart failure at the Cardiology Unit of Castelsangiovanni Hospital were evaluated in the period from 1 January 2021 to 31 July 2022. Twenty–five of them, who presented with echocardiographic moderate to severe left ventricular hypertrophy (i.e. maximum end–diastolic thickness of the interventricular septum ≥ 15 mm), were included in the study. All patients underwent anamnesis, physical examination, 12–lead electrocardiogram and transthoracic echocardiogram. Patients were divided into 2 groups according to the presence or absence of the following clinical, electrocardiographic and echocardiographic diagnostic red flags: history of carpal tunnel syndrome and/or rupture of the long head of the brachial biceps, low voltage QRS, granular sparkling of the ventricular myocardium, apical sparing pattern of the global longitudinal strain.

Results
Fifteen patients with heart failure, left ventricular hypertrophy and at least one diagnostic red flag were screened for cardiac amyloidosis by: a) search for a serum monoclonal component; b) bone scintigraphy with labeled diphosphonates. In thirteen patients, an high cardiac uptake of the radiotracer was found on bone scintigraphy. One patient with high cardiac uptake also presented a serum monoclonal component and was referred for tissue biopsy. In the remaining twelve patients (85% of the cases studied) a non–invasive diagnosis of transthyretin cardiac amyloidosis was made. In six patients affected by transthyretin cardiac amyloidosis, a salivary genetic test was also performed to search for mutations in the transthyretin gene, which resulted negative in all cases examined.

Conclusions
In this study of patients hospitalized for decompensated heart failure, rigorous application of Gillmore‘s algorithm in suspected cases led to non–invasive diagnosis of cardiac transthyretin amyloidosis in 85% of cases, without wasting healthcare resources.
P212 EFFICACY AND SAFETY OF GENOTYPE–GUIDED AND PLATELET FUNCTION TEST–GUIDED ANTI–P2Y12 THERAPY IN PATIENTS UNDERGOING PCI: A META–ANALYSIS OF RCTS
Authors: Rocchetti M , Podda G , Birocchi S , Minardi A , Squizzato A , Cattaneo M 
Published: May 2023

Abstract
Clopidogrel is the most commonly used anti–P2Y12 drug in DAPT. Impaired pharmacological response and antithrombotic efficacy associated with cytochrome–P450 and/or ABCB1 gene mutations is observed in about 1/3 of treated patients. To circumvent this problem, guided therapy has been tested, based on either identification of predisposing gene mutations or results of platelet function tests (PFTs). Patients with with predisposing gene mutations or high platelet reactivity on clopidogrel (HPR) were treated with alternative, potentially more effective regimens: higher clopidogrel doses, prasugrel, ticagrelor, or additional cylostazol. In this meta–analysis, we tested the efficacy and safety of these two different strategies of guided therapy separately. We searched relevant articles published in English until October 1th 2022 on MEDLINE, Embase and Central. Articles included all RCTs comparing standard anti–P2Y12 therapy (ST) versus genotype–guided or PFTs–guided anti–P2Y12 therapy in patients with acute coronary syndromes (ACS) or chronic coronary artery disease (CCAD) undergoing PCI. Two reviewers independently assessed study eligibility and risk of bias, and extracted data. Hazard ratios with 95% CI were calculated based on fixed effects models. Efficacy outcomes comprised major adverse cardiovascular events (MACE) as defined in each study. Main safety outcome included major bleedings (MB) according to BARC. Different sub–analyses were also performed based on type of anti–P2Y12 drug in ST, type of alternative drug, type of PFT, patients’ ethnicity, prevalence of ACS. We retrieved 6 RCTs testing genotype–guided anti–P2Y12 therapy on 10443 patients and 14 RCTs testing PFTs–guided anti–P2Y12 therapy on 11596 patients. MACE were lower in genotype–guided therapy than in ST, RR 0.68 (95% CI, 0.49–0.94) while MB did not significantly differ between the two groups, RR 0.88 (95% CI, 0.63–1.23). MACE and MB did not significantly differ between PFTs–guided anti–P2Y12 therapy and ST: RR 0.83 (95% CI, 0.58–1.18) and 1.24 (95% CI, 1.00–1.53), respectively. Sub–analyses revealed that MACE were lower in PFTs–guided anti–P2Y12 therapy compared to ST in patients of Asian descent. In conclusion, gentotype–guided anti–P2Y12 therapy reduced the incidence of MACE without increasing MB, compared with ST, in patients with ACS or CCAD undergoing PCI; in contrast, PFTs–guided anti–P2Y12 therapy did not affect the incidence of MACE or MB in these patients.
P213 A COMPLICATED STEMI : POISED BETWEEN THROMBOSIS AND HEMORRHAGE
Authors: Di Fonzo R , Palumbo B , Cancro F , Loria F , Turino S , Galasso G , Vecchione C , Di Muro M , Soriente L 
Published: May 2023

Abstract
The introduction of more effective and powerful antithrombotic therapies has allowed the progressive reduction of ischemic events associated however with an increase in haemorrhagic events. What we are describing is an example of how iatrogenic and non–iatrogenic complications can add up, making routine therapeutic management difficult during and after hospital stay.We are talking about a 50–year–old male patient, a smoker and with a history of dyslipidemia under treatment, who arrived at our cath–lab with a diagnosis of anterior SCA–STEMI, after loading ticagrelor 180 mg from the spoke center where he had gone for chest pain. At coronary angiography, evidence of critical disease of the median anterior interventricular artery treated by primary angioplasty and for the high thrombotic load by thromboaspiration, DES and Tirofiban bolus and 18–hour continuous infusion. Approximately 15 hours after the event, the patient appeared confused and aphasic. A brain CT scan with and without contrast agent was performed which documented the presence of a hemorrhagic focus in the atypical left temporal site, in the absence of arteriovenous malformations not susceptible to surgical therapy (BARC–3). Therefore, in view of the high risk of bleeding, de–escalation therapy with cardioaspirin and clopidogrel was practiced. Five days after the event, the clinical picture was complicated again by the finding of apical thrombosis on the transthoracic ultrasound. For this reason, given the stability of the haemorrhagic lesion on CT scans and control MRIs, Enoxaparin sodium 4000 IU was introduced in therapy once, with resolution of the formation in the imaging control after one month. The patient was then discharged with indication for short–DAPT in consideration of the high PRECISE–DAPT score. The arduous task of managing this case led us to reflect on the importance of the pre– and post–PCI clinical picture of the patient in order to seek the appropriate antithrombotic treatment by dynamically balancing the ischemic and haemorrhagic risk during hospitalization through numerous standardized tools at our disposal.