bluuebunny/crossref_metadata_2025_split huggingface dataset:
P364 LOW–DENSITY LIPOPROTEIN CHOLESTEROL REDUCTION IN PATIENTS AT VERY HIGH CARDIOVASCULAR RISK
Authors: Cherubini A , Tollardo M , Palcic S , Scagnetto A , Russo G , Capelletto C , Bollini M , Di Lenarda A 
Published: May 2023

Abstract

Background
Guidelines of treatment of hypercholesterolemia in patients at very high cardiovascular (CV) risk have progressively lowered the target LDL–cholesterol (LDL–C). In real life LDL–C targets are difficult to reach. Aim of this study was to evaluate the achievement of LDL–C targets and the prescription of lipid–lowering therapy (LLT) in a large cohort of outpatients at very high CV risk.

Methods
we considered 11350 patients at very high CV risk, mean age 70 years evaluated in Our Center from 2017 to 2020. The study population was divided in 3 groups according to the presence of one or more very high risk CV score components. For each group lipid–lowering therapy, LDL–C goal and prognosis were assessed.

Results
The very high CV risk population was composed maily by patients with coronary artery disease (CAD). We found an increse of LLT after the index cardiologic visit (from 50,5 to 75,8%) and high–efficacy (HE) LLT from 22% to 27,9%. Consequently we found an increase in the achievement of LDL–C target &lt;55 mg/dl (1.4 mmol/l): from 3,2% to 8,3% 6 months after the visit. In the group with more CV risk components the LLT and HE LLT were more prescribed, the LDL–C target was more reached and the mortality rate were higher (22,3% vs 8,4% in patients with only one CV risk component).

Conclusions
in the very high CV risk population the target of LDL–C is rarely reached. We identificated patients with more CV risk components with worse prognosis and need of HE LLT.
P365 MANAGEMENT OF DYSLIPIDAEMIA AND CARDIOVASCULAR RISK REDUCTION IN HIV PATIENTS
Authors: Gatto M , Cicalini S , Bellagamba R , Biava G , Antinori A 
Published: May 2023

Abstract

Background
At our dedicated cardiology outpatient clinic, patients with HIV infection are seen daily. This patient population undergoes routine haematochemical analyses including lipid assessment every six months.

Methods
Patients with HIV infection referred to the dedicated cardiology outpatient clinic in the period between March and September 2022 were retrospectively enrolled. For each of these patients, the medical history was collected and the global cardiovascular risk, lipid assessment (total cholesterol, LDL–C, HDL–C, triglycerides), hypolipidemic therapy (if any) and, in accordance with the most recent guidelines of the European Society of Cardiology, the achieved LDL target were assessed.

Results
200 patients with mean age 59±15 years with HIV infection on antiretroviral treatment since 20±11 years, 92% male, were enrolled. 58% of patients had hypertension, 46% vasculopathy, 44% smoking, 14% diabetes, 10% chronic ischaemic heart disease and 4% previous stroke/TIA. Among these patients, 30% had a very high cardiovascular risk, 42% a high cardiovascular risk, 22% a moderate cardiovascular risk and 6% a low cardiovascular risk. Only 60% was on hypolipidemic therapy (statin in 50 per cent of cases and statin+ezetimibe in 10 per cent). Patients with a very high cardiovascular risk had an average LDL–cholesterol of 119.2±45.5 mg/dl, patients with a high cardiovascular risk 122.4±43.6 and only 12% of them was found to meet the guideline LDL targets.

Conclusions
Assessment and management of cardiovascular risk is crucial in order to reduce mortality and morbidity. In some particular clinical settings such as for patients with chronic infectious diseases (e.g. HIV) more attention must be paid to the LDL–cholesterol target in relation to the individual cardiovascular risk, which is often high or very high. Correct therapeutic management of dyslipidaemia through the use of the fixed statin/ezetimibe combination and the most innovative hypolipidemic therapies such as bempedoic acid, PCSK9 inhibitors, and inclisiran is the keystone in order to achieve the target.
P366 FULMINANT MYOCARDITIS WITH SPONTANEOUS RESOLUTION AFTER COVID 19 AND ALLERGIC EPISODE: MIS–A OR ALLERGIC MYOCARDITIS?
Authors: D’ Elia S , Catapano D , Cimmino G , Pezzullo E , Alfieri R , Golino P , Loffredo F 
Published: May 2023

Abstract

Clinical case
23–year–old male. No medical history Not vaccinated for Sars–Cov2; Recent Sars–Cov2 infection (negative antigenic swab on 03/01/22); Pharyngodynia treated with ibuprofen + ciprofloxacin and amoxicillin ac clavulanic acid(suspended for purpuric lesions on hands) After 5 days from onset of symptoms, access to PS for loss of consciousness. Laboratory: ph 7.4; Lat 3.4 EKG: sinus tachycardia HR 126 bpm ECHOCARDIOGRAM: Non–dilated left ventricle, marked reduction in FE (15%) spontaneous echocontrast in ventricular cavity chest TC: hypodense tissue in anterior mediastinum; adenopathy in peribronchial site, distended gallbladder transfer to Vanvitelli Cardiac ICU Amine support with augmented DBT for hypotension and tachycardia LAB: Tni 2193; Nt proBNP 27796; PCR 26; PCT 4; crea 1,4, Lat 1 CATH DX + EMB after 24 hours EBM: …Mixed cellularity endomyocarditis, predominantly lymphocytic, presence of eosinophils… enrollment in the MYTHS study: placebo group (saline solution) after 10 day MRI:Normal biventricular systolic function. Tissue characterization images consistent with the presence of limited area of active myocardial damage and with nonischemic pattern involving the basal segment of the infero–lateral wall of the left ventricle.

Discussion
The case has been a source of considerable discussion to establish the etiology of myocarditis. Although with numerous doubts, after careful evaluation of the histologic picture, the case falls under possible MIS–A (MULTISYSTEM INFLAMMATORY SYNDROME in adult) Cardiac manifestations of MIS–A include myocarditis, pericarditis, and arrhythmias, which can rapidly lead to cardiogenic shock.
P372 PULMONARY EMBOLISM IN CARDIAC INTENSIVE CARE UNIT–REAL–WORLD EXPERIENCE OF A TERTIARY CENTER
Authors: Morosato M , Mager R , Morciano D , Ricchetti G , Eustachio A , Margonato A , Slavich M 
Published: May 2023

Abstract

Introduction
Pulmonary thromboembolism represents a therapeutic challenge for patients admitted to cardiology intensive care units, given the variety of clinical presentations and available treatment opportunities.

Methods
This retrospective, single–center study recruited patients hospitalized in cardiology intensive care units with a diagnosis of pulmonary thromboembolism between April 2010 and May 2022. For each hospitalized patient, Wells and PESI scores were calculated, the location of the PE was identified, and acute PE resolution at discharge was determined. Patients with cardiac arrest (CCA) and/or cardiogenic shock were identified, and RV longitudinal systolic function (TAPSE) and pulmonary arterial systolic pressure (PASP) were studied. Patients were then stratified based on their clinical risk of in–hospital or 30–day mortality (early mortality); acute phase and discharge treatments and patients who developed major bleeding complications were identified.

Results
A total of 148 patients were recruited, with a median age of 66 years and predominantly male (51.4%). In 6.4% of patients, in–hospital death occurred (from 0% in low–risk patients to 25% in high–risk patients), 12.2% developed cardiogenic shock and/or CCA. 25.0% of patients had an ongoing neoplasm. Systemic thrombolytic therapy and Sonos were the most effective in terms of mortality (p=0.015) and RV function at discharge in high–risk patients, although associated with a high risk of bleeding. Intermediate–low–risk patients treated with reperfusion therapy showed better RV function parameters, although the sample size did not allow for statistical significance.

Conclusions
The results obtained are in line with those of the literature with regard to epidemiology, total hospital stay, correlation between acute PE and neoplasms, in–hospital death and FU death. Furthermore, Sonos represents an effective alternative to full–dose systemic thrombolysis in high–risk patients who cannot undergo the latter. Finally, in intermediate–low risk patients, there may be a role for reperfusion therapy in selected patients with very low bleeding risk.
P374 THE BAD COUSIN OF PULMONARY EMBOLISM: PRIMARY PULMONARY ARTERY SARCOMA
Authors: Tempestini F , Tinti M , Natale E , Giuliani M , Colucci F , Putini R , Cianni R , Gabrielli D 
Published: May 2023

Abstract
A young man of 29 years presented to the Emergency Room reporting worsening dyspnea for about 2 weeks. He had never had previous cardiovascular disease nor had risk factors for them. Hemodynamics were stable, but arterial blood gases showed hypocapnic hypoxia. The ECG revealed a S1Q3T3 pattern, incomplete right bundle branch block and signs of right ventricular overload. D–dimer was 4493 ng/ml. CT pulmonary angiogram (CTPA) showed massive bilateral embolism with thrombotic material in the right ventricle (RV) and almost complete obliteration of pulmonary trunk and main pulmonary arteries; moreover, there were subpleural nodularities in upper pulmonary lobes. Echocardiogram showed a dilated and hypokinetic RV, moderate tricuspid regurgitation with a sPAP of 80 mmHg, thrombotic pulmonary trunk obliteration and floating thrombi adhered to the tricuspid valve. UFH therapy was started. After ten days, there was no improvement in clinical status, echocardiography and CTPA. So, we decided to perform mechanical thrombectomy. In addition to thrombotic material, fibrous tissue was extracted and histologically analyzed. At the end of the procedure, the patient became hemodynamically unstable (BP 80/40 mmHg and HR 130 bpm) with dyspnea and tachypnea. ABG showed mixed acidosis. Right ventricular function worsened due to high afterload for the persistence of thrombotic material in the pulmonary trunk, defining a picture of obstructive shock. We started fibrinolysis (with rtPA), enoximone and norepinephrine, but asystole occurred and the patient eventually died. The histological examination revealed that the mass was a pleomorphic rhabdomyosarcoma of the pulmonary artery. Primary pulmonary artery sarcoma is an extremely rare and histologically heterogeneous disease. It develops mainly from great pulmonary arteries and then it grows up in the lumen of vessels. It may involve pulmonary valve and RV and invade pulmonary parenchyma and loco–regional lymph nodes. Diagnosis is challenging, because it simulates pulmonary embolism in clinical, echocardiographic and radiological presentation. Suspicion may arise from lack of benefit from anticoagulant therapy. Nodular pulmonary infiltrates are typical. There are two surgical approaches: pneumectomy or endarterectomy (as palliation). Prognosis is poor: mean survival of 1,5 month without therapy and 10 months with pneumectomy. In addition to the progression of the disease, death can occur for obstructive shock, as in our patient.
P378 HEART FAILURE DURING ACUTE CORONARY SYNDROME AND THE LONG–TERM RISK OF INCIDENT CANCER. THE ABC–9* STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Cordiano R , Cavuto F , Merotto D , Menegon F , Bagato F , Dal Bo A , Mahmoud M , Sitta N 
Published: May 2023

Abstract

Introduction
Recent reports have suggested a higher risk of incident cancer among patients with pre–existing Heart failure (HF) in community–based cohorts.

Methods
To investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long–term cancer risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were prospectively followed for 24 years or until death.

Results
All except for three patients completed the follow–up, representing 6440 person–years. Patients‘ mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow–up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF]. The incidence rates for cancer were 18 and 21 per 1000 person–years for patients with and without baseline HF, respectively (p = 0.62). The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62–1.47; p=0.85). Similar associations were observed among both genders and in patients younger than 75 years of age. Yet, in patients older than 75 years, the unadjusted risk was (HR: 0.30; 95% CI: 0.09–0.92; p=0.04). However, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12–1.30; p=0.13). The unadjusted HRs for incident cancer were (HR: 0.88; 95% CI: 0.45–1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48–1.71; p=0.77) for patients with HFrEF and HFpEF respectively. We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.003 –1.004; p=0.02) in the unadjusted model. Results were the same in the fully adjusted model.

Conclusions
A lack of association between clinical HF at admission for ACS and the long–term cancer risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.
P380 ORAL ANTICOAGULATION THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND CANCER: A LITERATURE REVIEW
Authors: Cereda A , Franchina G , Laricchia A , Spangaro A , Rocchetti M , Minardi A , Sala E , Ponti L , Marini C , Lucreziotti S 
Published: May 2023

Abstract

Introduction
Cancer and atrial fibrillation (AF) are two very frequent conditions that share common pathophysiological and epidemiological features. Spontaneous coagulation is associated with malignant neoplasia as well as prothrombotic potential due to the overexpression of procoagulants. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult. The use of direct oral anticoagulants (DOACs) is now first line anticoagulation in common clinical practice, but no specific study addressing the use of DOACs in cancer patients has been published to date. In this review we aimed to retrieve all studies comparing the use of DOACs to warfarin.

Methods
We searched for all relevant articles published in English. Articles included RCTs sub–studies and observational trials comparing the use of DOACs therapy to warfarin in cancer patients with AF. Efficacy outcomes comprised three efficacy endpoints: ischemic stroke (IS), systemic embolism (SE) and venous thromboembolism/pulmonary embolism (VTE/PE) and five safety endpoints: cerebral bleedings (CB), minor bleedings (mB), gastrointestinal bleedings (GI–B) major bleedings (MB) and overall mortality (OM). Not all endpoints were available for all the retrieved articles.

Results
We retrieved 3 RCTs sub–studies and 7 observational studies for a total of 219952 patients. DOACs patients have lower risk of ischemic stroke; Odds Ratio (OR) 0.65 (95%IC 0.48–0.98). Both SE and VTE/PE did not significantly differ between the two groups OR 0.61 (95%IC 0.26–1.42) OR 0.49 (95%IC 0.22–1.07), respectively. All safety endpoints except for overall mortality were significantly lower in the DOACs group: CB OR 0.42 (95%IC 0.27–0.66), mB OR 0.62 (95%IC 0.45–0.87), GI–B OR 0.65 (95%IC 0.45–0.95), MB OR 0.55 (95%IC 0.45–0.95). Overall mortality did not statistically differ between the two anticoagulation strategies OR 0.75 (95%IC 0.46–1.22).

Discussion
Overall DOACs may be an effective and safe option for cancer patients suffering from atrial fibrillation.
P388 OUT OF HOSPITAL CARDIAC ARREST ( OHCA) OUTCOME : ARE THERE GENDER DIFFERENCE ?
Authors: Bolognesi M , Bricoli S , Pelizzoni V , Rossi L , Biagi A , Ferraro S , Aschieri D 
Published: May 2023

Abstract

Background
Sudden cardiac death ( SCD) from cardiac arrest ( SCA) represents 25% out of all deaths. Despite the advance in resuscitation and prevention of SCA, out of hospital arrest ( OHCA) accounts only a 10 % of survival . Coronary artery disease is the major underlying etiology . Females have lower incidence of SCD. However data regarding OHCA outcome in female are controversial.

Methods
We considered consecutively 3124 OHCA survivors resuscitated from emergency medical System or bystander In Piacenza between from January 2013 to June 2022 and we e evaluated the etiology and outcome, considering sex and gender disparities.

Results
Out of 3124 SCA occured in 10 years, 1371(43%) were females with average age 82 ±12 years and 1753 ( 57%) males with average age 75 ±14 years ( p&lt;0,0001) . The survival of our population was 10% with better results in males ( f 3,1% vs 14% m p&lt;0,0001) 1268 females and 1482 males were treated at home. 2366 ( 75%) patients,1091 ( 46%) female and 1275 ( 54%) males,developed an initial non shockable rhythm and 323( 25%), 242 (74%) females and 81 (26%) males ventricolar fibrillation ( FV) . In the group with FV as initial rhythm, the survival was 40% . Considering etiology in the group with FV as initial rhythm, females had less incidence of coronary artery disease ( 5 f vs 48 m, p=0,004) and myocardial infarction (f 1 vs 33 m, p=0, 001). The survival wasn’t different between females and males in this group.( 22 f vs 64 m, p=0,8). Female had more frequently non shockable rhythm ( 79 % f vs 72 % m, p&lt; 0,001) and were found more frequently at home ( 92% vs 85% p &lt; 0,001).

Conclusions
In our OHCA population, the survival was 10% in according with literature Female were older and they had less survival, because initial rhythm registered during SCA were non shockable rhythms. They were found at home,with a delay in the first aid . This can be due to a gender disparities.
P390 CARDIAC INVOLVEMENT IN A VERY RARE CASE OF CUTIS LAXA
Authors: Pezzi L , Di Marco M , Magnano R , Verrengia E , D‘Alleva A , Forlani D , Vitulli P , Fulgenzi F , Paloscia L 
Published: May 2023

Abstract
The "Cutis Laxa" is a rare pathology of the connective tissue characterized by redundant skin and diffuse manifestations are identified by other organs (mainly heart and lungs). The low elasticity of the tissue is believed to be attributable to an anomalous elastin formation. Cutis Laxa is usually a genetic disease, but acquired forms have also been described. The case we describe is that of a 34 –year –old young woman with a diagnosis of Cutis Laxa acquired from the age of 15, complicated by a serious impairment at the pulmonary level in the form of marked emphysema and severe asthmatic framework. It came to our observation following the PEA type cardiovascular arrest episode during tracheostomy procedure, promptly resolved by resuscitation maneuvers according to the Als protocol. The echocardiogram was performed by the only belowocostal window by which a 4 –chamber apical projection was viewed, highlighting an anomalous position of the cardiac Hague (lower and media). The left ventricle appeared to be normal endocavity dimensions and parietal thicknesses with preserved indexes of systo–diastolic functionality in the presence of SIV discline; The right ventricle was instead slightly dilated, hypertrophic, with reduced Chinese of the free wall (nappese 18 mm), the tricuspid regurgitation was moderate with indirect signs of increased lung pressures. The echocardiographic appearance was therefore compatible with a chronic pulmonary heart frame, secondary to progressive pulmonary enfisema, and described in literature as the most fearful complication of Cuis Laxa syndrome, associated with an inauspicious prognosis and premature death.
P400 WHEN COMMON VIRAL SYMPTOMS HIDE A PERFECT STORM: A CASE REPORT
Authors: Castaldo G , Piscione M , Bianco S , Mallus M , Grigioni F 
Published: May 2023

Abstract
A 38 years old woman without any cardiovascular risk was admitted to the Emergency Room of our Hospital symptomatic for chest pain and dyspnoea. She referred a recent holiday in Tunisia; she was excellent health until a week before when she developed flue–like symptoms, such as fever, fatigue, abdominal pain, diarrhea and myalgia, like all the family members; the night before the access to the ER, she suffered from weakness of breath. Physical examination revealed venous engorgement and sinus tachycardia with a rate of 102 bpm, blood pressure was about 85/50 mmHg, oxygen saturation in 3L nasal cannula was 92%. The EKG showed a sinus tachycardia without any ST elevation or depression and generalized low voltage. A transthoracic echocardiography revealed circumferential pericardial effusion (3,5 cm) and both right atrium and right ventricle collapse in the setting of cardiac tamponade; EF was 35% (GLS=6%). Our first clinical suspicion was viral pericarditis with pericardial effusion (early cardiac tamponade), in consideration of the anamnestic data, the holiday in Tunisia and the general symptoms. However, an urgent pericardiocentesis was performed and one liter of sero–sanguineous pericardial fluid (exudate) was drained; therefore, there was an immediate haemodynamic improvement. A pigtail was placed using the Seldinger technique. While the first sample of cytology on sero–sanguineus pericardial fluid was negative, the second sample resulted positive for malignancy. Chest CT showed bilateral pleural effusion and a mass which was compatible with a lung cancer. Lung nodule biopsy revealed a lung adenocarcinoma. Immunohistochemistry (IHC) and molecular testing for epidermal growth factor receptor (EGFR) were positive. The patient was affected by metastatic non small cell lung cancer with EGFR mutation, which was responsive to Osimertinib. Three days later, another echo was performed showing almost complete resolution of pericardial effusion and normal LV function (EF= 55%). The patient was transferred to the Oncology Department and then discharged from the Hospital. Before starting Osimertinib, she was suggested to undergo a baseline cardiovascular stratification, EKG and transthoracic echocardiogram, three–monthly echocardiography surveillance with monitoring of GLS (which guides the management of potentially cardiotoxic drugs); close monitoring of magnesium levels is also recommended to minimize the risk of QTc prolongation.