bluuebunny/crossref_metadata_2025_split huggingface dataset:
P303 ECMO–PROTECTED HIGH RISK PCI IN UNUSUAL CLINICAL AND ANATOMICAL SCENARIO
Authors: Rossi S , Perfetti M , Mantini C , Cicchitti V , Zimarino M 
Published: May 2023

Abstract

Background
Non–emergent complex high–risk indicated procedure (CHIP) identify complex PCI according with clinical, anatomical and procedural features and prevent intraprocedural hemodynamic compromise represents a major issue. The aortic valve bypass (AVB) has been an uncommon surgical option performed by creating a heterotopic second left ventricular output bypassing native stenotic aortic valve with flow redistribution between the native left ventricular outflow tract and the apical–aortic bypass. AVB was phased out in “TAVI–era”.

Case Report
A 78 years–old obese and hypertensive male, with pulmonary fibrosis and previous AVB for severe aortic stenosis judged at unacceptable high surgical risk 10 years before, was admitted to the emergency department for chest pain and palpitation. Patient was in Killip class I. ECG showed rapid atrial fibrillation without ST–segment elevation. Atrial tachyarrhythmia, chest pain and palpitation spontaneously simultaneously resolved. A type 2 NSTEMI–ACS was suspected according to clinical features and pathological Hs–troponin. Multimodality imaging documented normal systolic function, normally operating AVB, paradoxical low flow severe native aortic valve stenosis, a chronic type B aortic dissection from distal anastomosis of AVB retrogradely extended to left subclavian artery origin and a wide aneurysm of the abdominal aorta (Fig. 1). Coronary angiography documented severely calcific multivessel disease. Prompt and complete revascularization was considered mandatory and a surgical redo was discarded. The use of an intraprocedural hemodynamic support was advisable, but anatomical context represented substantial contraindication to IABP and Impella. Heart Team decided to perform VA–ECMO–protected–PCI. After lesion preparation double kissing crush was performed on LMCA and single stents were implanted in proximal LAD and proximal RCA (Fig. 2). Despite signs of transient hemodynamic instability the patient tolerated the procedure thanks to the ECMO support. Complete myocardial revascularization was obtained without complications and the subsequent clinical course was uneventful.

Discussion
In this CHIP patient, hemodynamic support was vital to allow a safe complete myocardial revascularization. ECMO is a demanding system, not routinely used for “protected PCI”; however, the case here reported underlines that ECMO can be a feasible option, prerequisite in uncommon cases where other standard tMCS are contraindicated.
P308 REAL–WORD MONOCENTRIC EXPERIENCE OF DRUG ELUTING BALLOON PERFORMANCE
Authors: Venturi G , Bacchion F , Mugnolo A , Zamboni A 
Published: May 2023

Abstract

Introduction
Recently, drug eluting balloon (DEB) angioplasty has gained increased interested for both in stent restenosis lesions and de novo coronary lesions.

Objectives
This study aimed to evaluate performance of DEB in a single center real world experience and to assess predictors of outcome after DEB angioplasty.

Methods
We retrospectively evaluated patients undergoing angioplasty with drug coated balloon in the Cath Lab of Mater Salutis Hospital (Legnago). Clinical and angiographic characteristics of the groups were analyzed. The primary endpoint was a composite of all–cause mortality, any coronary revascularization and acute coronary syndromes assessed as per patients analysis at last available follow–up. Secondary endpoint was evaluation of target lesion failure (TLR) in a per lesion analysis.

Results
Between January 2018 and September 2022, 99 patients received angioplasty with DEB implantation at the Mater Salutis CathLab, Legnago, accounting for a total of 103 procedures and 112 lesions. Most patients were male (83,8%) and mean age was 66,73±9,5 years. Among 112 lesions treated, 63,4% were in stent restenosis lesions while 36,6% were de novo lesions. DEB used for de novo lesions were significantly smaller than ones used for in stent restenosis (2,23±0,30 mm vs 3,01±0,52 mm; p value&lt;0.001). 19 patients were lost at follow up soon after discharge. Among the 81 patients remaining, with a median of 24 months (IQ1–3 6–37), composite endpoint occurred in 15 patients (18,5%) leading to an overall events–free survival of 81,5%. TLF occurred in 4 out of 99 lesions avalaible at clinical follow–up (4.3%), with a TLF free–survival of 95.7%. In all 4 failure cases, DEB were used for in stent restenosis. Accordingly, TLF free–survival for de novo lesions was 100%.

Conclusion
In our real–world monocentric experience, patients undergoing DEB angioplasty had good cardiovascular events free survival. Of note, DEB performance proved excellent outcome in de novo coronary artery lesions.
P315 GENETIC RESISTENCE TO CLOPIDOGREL AND COMPLEX PCI: A CASE REPORT
Authors: Ossola P , Ciampi C , Grieco N , Di Matteo I , Emanuela P , Giannattasio C , Oliva F 
Published: May 2023

Abstract
A 35–year–old man presents to the attention of the cardiology department for anterior STEMI. On history he reports hypertension, atrial fibrillation with CHA2DS2–VASc 2 on Rivaroxaban therapy, a previous PCI in the anterior interventricular artery, and a known genetic resistance to Clopidogrel (CYP2C19*2 mutation in heterozygosity) that emerged during diagnostic investigations for marked hyperhomocysteinemia (MTHFR A1298C variant in heterozygosity). Coronary angiography showed endoluminal thrombosis at the ostium of the anterior descending artery and an intrastent thrombosis. IVUS analysis, moreover, shows underexpansion and a concomitant protrusion of the stent at the ostium of the coronary. Thus, angioplasty with positioning of a drug eluting stent was performed. Antithrombotic therapy in these patients is usually triple therapy with ASA, clopidogrel and an anticoagulant. In this case the management of therapy was guided by the patient‘s genetic. Therefore, considering the low hemorrhagic risk and the high thrombotic risk, it was decided to undertake combination therapy with Dabigatran 150mg and Ticagrelor 90 BID in accordance with the Re–Dual PCI treatment trial. Thromboembolic events affect high mortality and morbidity, especially in the 30 days following the angioplastiy procedure. There is a part of the population that may have a poor response to the drugs used and most frequently to Clopidogrel. Genetic polymorphisms present in the coding regions for cytochrome CYP2C19 are involved in the altered metabolism and activation of the drug. The "genetic guided DAPT" used in the POPular Genetics study, was not inferior to Ticagrelor/Prasugrel therapy with regard to thrombotic events but showed a significant reduction in minor bleeding. Since long–term mortality post PCI is predominantly related to the occurrence of hemorrhagic rather than thrombotic events, the reduction of bleeding is very valuable in clinical practice. This case emphasizes the importance for the possible interindividual genetic variability and the most personalized approach possible in treatment choices. The feasibility in terms of cost and events saved of introducing "genetic–guided" DAPT into everyday clinical practice remains to be defined.
P323 WELLENS PATTERN, MYOCARDIAL BRIDGING, AND BIVENTRICULAR ARRHYTHMOGENIC CARDIOMYOPATHY: A SINGLE "TRIPLE" DIAGNOSIS
Authors: Ossola P , Bassi I , Pirola R , Gallone G , Occhi L , Milani M , Spanò F , Regazzetti M , Pedrotti P , Quattrocchi G , Soriano F , Giannattasio C 
Published: May 2023

Abstract
Wellens‘ syndrome describes an electrocardiographic pattern characterized by T–wave changes in the antero–septal leads that make this finding highly suggestive of a lesion of the proximal segment of the anterior interventricular artery. Case report. A 58–year–old patient from China with a silent medical history presented to the emergency department with angor, dizziness, asthenia, and blurred vision. The electrocardiogram shows a Wellens type A pattern, and blood chemistry tests collected in the emergency department show liver, kidney function and blood count within normal limits. High–sensitivity troponin T values stand at 34 ng/mL. The echocardiogram shows preserved biventricular systolic function in the absence of major regional wall motion abnormality. Given the symptoms, troponin values, and electrocardiographic pattern, the patient underwent coronary angiopgraphy, which showed lesion–free epicardial coronary arteries but with a muscular bridge in the mid–proximal section of the anterior interventricular artery, with no obvious significant systolic–diastolic caliber changes at subsequent coronary CT analysis. To better assess possible myocardial ischemic damage, the patient underwent MRI (magnetic resonance), which showed an entirely unexpected result. In fact, T1 sequences revealed biventricular adipose infiltration at the anterolateral and inferolateral walls of the left ventricle, with homosedial enhancement to nonischemic pattern on late post–contrast images: this picture was considered suggestive of biventricular arrhythmogenic cardiomyopathy. In the absence of history of syncope and documented arrhythmias on prolonged rhythm monitoring during hospitalization, no indication was made for further diagnostic and therapeutic investigations from the arrhythmological point of view. Thus, beta blocker and ace inhibitor therapy was set, and the patient was started on an outpatient cardiology follow–up course and genetic counseling for him and first–degree family members was scheduled. Selecting the correct imaging method becomes crucial for a correct diagnosis, especially in cases in which symptomatology is inconclusive.
P325 CARDIAC SARCOIDOSIS PRESENTING WITH ATRIOVENTRICULAR BLOCK AND SUBSEQUENT CARDIAC ARREST: A CASE REPORT
Authors: Caldarella Y , Foroni M , Spagnolo P , Brunello G , Migliore F , Sarais C , Perazzolo Marra M , Iliceto S , Rigato I 
Published: May 2023

Abstract
A 53–year–old male patient with no significant past medical history and no familiar history for cardiac diseases presented to the emergency department for asymptomatic bradycardia. The ECG showed complete atrioventricular block in the absence of pathological findings on the echocardiogram and no coronary lesions were found on coronary angiography. The patient underwent pacemaker (PM) implantation. A few months later the patient suffered from cardiac arrest in sustained ventricular tachycardia, effectively treated with DC shock. The echocardiogram showed mild right ventricular dilation and dysfunction with regional wall motion abnormalities, especially in the subtricuspid site. Cardiac magnetic resonance imaging (MRI) showed focal areas of delayed enhancement with a non–ischaemic pattern and distribution with a hook sign, highly suggestive of cardiac sarcoidosis. FDG PET showed cardiac, hepatic, splenic, and lymph nodal uptake. In the suspicion of systemic sarcoidosis, an hepatic biopsy was performed, being the liver the most accessible site. The histological examination showed the presence of non–caseating granulomas. Therefore, a diagnosis of Systemic Sarcoidosis (SS) with Cardiac involvement was made and the PM was upgraded to CRT–D in secondary prevention. The patient was discharged with cortisone therapy. Three months after discharge, a new total body PET–CT scan was performed and showed, in comparison to the previous one, the absence of areas of significant hypermetabolism in the cardiac, hepatic and bone fields. Cardiac sarcoidosis (CS) is a rare inflammatory granulomatous myocardial disease of unknown etiology that should be suspected in young patients with atrioventricular conduction disturbances and complex ventricular arrhythmias. The diagnostic approach is challenging: imaging techniques (MRI, PET) can be suggestive of CS but biopsy with histological demonstration of the non–caseous granuloma is mandatory. Endomyocardial biopsy (which has suboptimal sensitivity due to focal lesion) could be avoided if there is a more accessible and less invasive extracardiac site for biopsy. Early diagnosis relies on multidisciplinary collaboration and is essential for staging and long–term management of the disease and prevention of sudden cardiac death. Cortisone therapy remains the mainstay of treatment.
P333 A RARE CAUSE OF SHOCK: AORTO–PULMONARY FISTULA AS AORTIC ANEURYSM COMPLICATION
Authors: Ferraro I , Baralis I , Coletta G , Rossini R 
Published: May 2023

Abstract

Clinical case
A 69–year–old man with right shoulder discomfort, malaise for one hour and hemodynamic instability was admitted to our Emergency Department (ED). The patient had a history of arterial hypertension, diabetes, renal failure on peritoneal dialysis and ischemic cardiomyopathy with preserved ejection fraction treated by angioplasty and stent implantation on right coronary. At first medical contact out of hospital the patient appeared confused with severe hypotension (BP 70/40 mmHg). ECG transmitted to our Cardiology Unit showed sinus tachycardia with repolarization abnormalities consistent with diffuse ischemia. The patient was centralized with clinical suspicion of acute coronary syndrome complicated by cardiogenic shock. In ED, BP was 65/35 mmHg. On physical examination extremities were cold and mottled, crackles in the lower lung zones and turgid jugulars were present. Pulses were weak but present. ECG was repeated and no evolutive signs were detected. Echocardiography finding were: not dilated left ventricle with global systolic function at the lower limits, moderate aortic insufficiency, right ventricle with dimensions at the upper limits and hypocontractile, moderate tricuspid regurgitation, inferior vena cava dilated with preserved inspiratory collapse. Aortic root was non dilatated but aortic arch was 55 mm with no images of dissection flap. At blood test lactates were 4,2 with metabolic acidosis, troponin was just above the upper limit, inflammation indices were negative and electrolytes were in range. Vasopressor support with norepinephrine was started. With the high suspicion of acute aortic disease, CT angiography was performed showing a voluminous aneurysm of the aortic arch of 70x56 mm rupturing into the left pulmonary artery (Figure 1,2). Concomitant bilateral iliac artery dissection was detected. Cardiac and Vascular Surgeons were promptly alerted to plan tan emergent surgical intervention whose complexity was increased by the difficult vascular cannulation for iliac dissection. However, the patient‘s hemodynamic rapidly deteriorated requiring intubation and, after subsequent episodes of cardiac arrest in pulseless electrical activity (PEA), his death was assessed.
P340 REMOTE MONITORING IN HEART FAILURE: EFFECTIVE TOOL TO REDUCE HOSPITALIZATIONS AND MORTALITY
Authors: Iulianella R , Perna S , Schirripa V , Sciahbasi A , Chialastri C , Rizzo V , Scicchitano M , Loricchio M , Granatelli A 
Published: May 2023

Abstract

Introduction
The prevalence of heart failure in the general population in the idustrialized countries is estimated to be around 2%, a prevalence that increases with age until it reaches 10% at 70 aa of age. The disease is burdened by a high mortality rate and high expense related mainly to repeated hospitalizations. Patients with low ejection fraction heart failure are often implanted with devices, which have the ability to be monitored remotely. The Ministry of Health‘s 2017 annual report on hospitalization activity shows dramatic data: 60% of patients with heart failure are re–hospitalized within one year of discharge and in 14% of cases even within one month of discharge with an annual mortality rate of 18%. The aim of our study is to investigate whether remote monitoring allows improving the outcome of patients with heart failure in terms of reduction of hospitalizations and reduction of all–cause mortality.

Materials and Methods
In the year 2021, 241 patients with heart failure and reduced ejection fraction, implanted with devices of mean age 73 yr (+/– 11 yr) were remotely monitored in our center; Other population data: see Table 1. On the occasion of transmissions presenting with alarm events, our operational flow chart provides: first telephone contact and possible subsequent outpatient follow–up within 24 h working hours.

Results
During the year 2021, all–cause mortality in our population was 10.7% (26 patients), while re–hospitalizations were 70 (28.8%). As a result of alarms reported to remote monitoring, 83 patients were contacted whose therapy was changed or device reprogrammed. The causes of alarms were in order: reduced thoracic impedance, arrhythmic events, and reduced biventricular pacing rate.

Conclusions
The use of remote monitoring in heart failure patients and device wearers allows early and timely diagnosis of clinical changes that anticipate heart failure exacerbation and active intervention by modifying the clinical course, often avoiding hospitalization, with a significant social and economic impact. Thanks to the operational organization of our center, the management of remote monitoring has allowed a low rate of hospitalization and low mortality year compared with literature data.
P353 A CASE OF FABRY DISEASE WITH ISOLATED CARDIAC INVOLVEMENT
Authors: Magnano R , Pezzi L , Verrengia E , D‘Alleva A , Fulgenzi F , Corazzini A , Vitulli P , Genovesi E , Forlani D , Di Marco M , Paloscia L 
Published: May 2023

Abstract
A 64–year–old patient,hypertensive,ex–smoker,no family history of CAD or MCI,with electrocardiographic abnormalities during checkups for sports activity at age 40,came to our observation for reported brief episodes of heart palpitation.On ecg sinus rhythm,PR 200 msec,elevated QRS voltages,negative T waves from V3–V6 and infero–laterally,isolated BEV. Echocardiogram showed asymmetric left ventricular hypertrophy with involvement of septum and mid–apical segments,absence of obstruction,grade II diastolic dysfunction,enlarged left atrium,ectasia of aortic bulb,ascending aorta and arch with mild valvular insufficiency. Cardiac MRI showed asymmetric hypertrophy with prevalent involvement of the SIV and apex,normal systolic function.Right ventricle within limits.LAM elongated,biatrial dilatation.Areas of enhancement with intramural extension to the inferior SIV and extensive subendocardial area to the infero–lateral wall,picture suggestive of Fabry disease. Holter ecg was performed:RS at mean fc 61 bpm,numerous isolated BEVs and pairs,1 run of TVNS of 11 beats,for which dual–chamber ICD implantation was performed in primary prevention.Genetic examination showed absence of alpha galactosidase enzyme activity and mutation in exon 5 of GLA gene(p.N215S). The patient had no other systemic symptoms typical of Fabry‘s disease such as CRI,acroparesthesias,angiokeratomas,cornea verticillata,gastrointestinal disturbances nor central neurological involvement.In addition,he was starting enzyme replacement therapy with alpha galactosidase on a home regimen.Hypertrophic cardiomyopathy is a frequent finding in clinical practice.In MF, the age of cardiac involvement is usually later than in other forms of cardiomyopathy. Cardiac MRI is the most appropriate technique to place a correct differential diagnosis;numerous studies have demonstrated preferential localization of areas of "delayed enhancement" at the infero–lateral and posterolateral basal wall,present even in the absence of frank ventricular hypertrophy. Systemic involvement, may help in the differential diagnosis because of the presence of characteristic symptoms.In the reported clinical case,however,the diagnosis is even more insidious since in late forms or cardiac variants of MF,as with the p.N215S gene variant,cardiomyopathy may be the only significant clinical manifestation.
P356 MARCHE REGIONAL NETWORK FOR CARDIAC AMYLOIDOSIS AND HYPERTOPHIC CARDIOMYOPATHY: INSIGHTS FROM 3–YEAR COLLABORATIVE EXPERIENCE
Authors: Vagnarelli F , Lofiego C , Terzi F , Romandini A , Contadini D , Olivieri R , Falchetti E , Lanari A , Caffarelli F , Scipione P , Viozzi V , D‘Agostino S , Tullio M , Matarrese A , Flori M , Capodaglio I , Patani F , Tofoni P , Lombardi G , Pietrucci F , Giorgetti R , Onofri V , Tortora C , Sgattoni C , Dello Russo A , Tarsi G , Perna G 
Published: May 2023

Abstract

Background and Methods
The management of patients with Cardiac Amyloidosis (CA) and Hypertrophic Cardiomyopathy (HCM) is complex and requires specific skills. Collaboration between centres remains essential because not all centres can perform complex diagnostic techniques (such as endomyocardial biopsy and mass spectrometry) or prescribe disease–modifying therapies, Therefore, in 2019 we created a collaborative network for diagnosis and treatment of CA (TTR and AL) and HCM (sarcomeric and phenocopies) with the aim of enhancing disease awareness among physicians and favoring appropriate access to innovative diagnostic tools/therapies. The network includes all 14 Cardiology Departments and outpatient clinics from 5 Local Health Units. At Referral Centre of the Regional University Hospital, all diagnostic and therapeutic tools necessary for a comprehensive management of CM patients including genetic testing, endomyocardial biopsy, ablation of complex ventricular arrhythmias, and septal myectomy for HOCM, are currently available and at disposal for the entire network.

Results
Thanks to this network, from December 2019 to December 2022, 283 patients were referred to our Center (fig. 1). Of these, 136 (48%) had CA, 122 (43%) were diagnosed with HCM (68 with obstructive form and 54 with non–obstructive form), 12 (4%) with Anderson Fabry Disease (AFD) and 13 (5%) with other forms of cardiomyopathy (miscellanea: arrhythmogenic, LVNC, etc). As for temporal trends in diagnosis of CM patients, in the first 2 years the diagnosis of HCM was more frequent than that of CA, while the number of CA patients has steadily grown, overtaking that of HCM patients in the last year (fig.2). The number of AFD diagnoses was consistently low over the 3 years, despite the spread use of genetic testing in all HCM patients. All patients with CA (136) were managed according to current algorythm with need of EMB in uncertain cases (8). Of the 136 patients with AC, 122 had TTR while 14 had AL (Fig.3). All patients with ATTR (122) underwent genetic testing: in 14 cases the presence of mutations in the TTR gene was documented (8 Ile68Leu; 4 Val30Met; 2 Val122Ile). 51 ATTR patients were treated with tafamidis, while 3 patients with variant–TTR and neuropathy received patisiran iv.

Conclusions
Implementing specific clinical network provided excellent results, allowing a precise phenotype/genotype characterization and favoring appropriate access to specific disease–modifying drugs.