bluuebunny/crossref_metadata_2025_split huggingface dataset:
P240 PREOPERATIVE OPTIMISATION FOR A PATIENT WITH HEART FAILURE UNDERGOING MAJOR NON–CARDIAC SURGERY: AN EXAMPLE OF COLLABORATION BETWEEN THE MULTIMODAL PREHABILITATION CENTRE AND THE HEART FAILURE CLINIC AT CAREGGI UNIVERSITY HOSPITAL
Authors: Testa G , Livi F , Foti L , Verga F , Salucci C , D‘Errico G , Perini E , Fiorindi C , Cianchi F , Ficari F , Scaringi S , Tognozzi C , Amatucci S , Marmorale S , Ungar A , Romagnoli S , Orso F , Baldasseroni S , Baldini G 
Published: May 2023

Abstract

Introduction
Heart failure (HF) is a risk factor for postoperative mortality in major non–cardiac surgery. Collaboration between the Multimodal Preoperative Prehabilitation unit (MPP) and Heart Failure Clinic (HFC) could allow optimization of heart failure therapy and negative prognostic factors such as reduced functional capacity (FC), malnutrition, and sarcopenia to improve the prognosis of these patients. Case report: Mrs. C.M. is a 58–year–old patient who presents to the MPP unit in anticipation of total colectomy for drug–refractory ulcerative colitis. Mrs. C.M. has a past medical history significant for heart failure with reduced ejection fraction (EF 25%) of presumably valvular–arrhythmic etiology. She underwent tricuspid annuloplasty and mitral replacement surgery some years ago and is affected by atrial fibrillation. At the MPP unit, Mrs. C.M. had a reduced FC and was malnourished and sarcopenic. Blood tests showed iron deficiency anemia. Heart failure therapy (NYHA II) was not optimized according to guidelines. Therefore, the patient started multimodal prehabilitation consisting of aerobic and resistance exercise, nutritional intervention, intravenous iron infusion, and optimization of HF therapy. After the patient was evaluated at the HFC, she started empagliflozin, sacubitril/valsartan, and ranolazine; intermittent levosimendan therapy was also performed. She also underwent cardiac NMR, which showed non–ischemic fibrosis, and coronary angiography, which was negative. Finally, she underwent PM–ICD implantation. After six months of multimodal prehabilitation, there was an increase in EF (38% vs. 25%), a reduction in NT–proBNP (700 vs 4988 pg/mL), and mitigation of HF symptoms. There was also a marked improvement in FC (383 vs 269 meters at 6–minute walking test), nutritional status (stage B vs stage C at PG–SGA test), and muscle strength (handgrip strength test 14.6 vs 8.5 kg). Considering the excellent preoperative optimization response, it was decided to proceed with surgery after a collegial discussion (anesthetist, heart failure cardiologist, surgeon, and patient).

Conclusions
Multimodal preoperative prehabilitation, based on the collaboration between the Multimodal Preoperative Prehabilitation Unit and Heart Failure Clinic, can effectively improve the preoperative functional capacity of HF patients.
P248 HOW COVID–19 PANDEMIC HAS CHANGED EPIDEMIOLOGY OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST–T ELEVATION. DATA OF SINGLE CENTER
Authors: Sacco W , Campisano M , Camellini M , Bagni E 
Published: May 2023

Abstract

Background
In recent years, the COVID–19 pandemic has led to a profound change in the epidemiological framework and incidence of cardiovascular diseases, as described in numerous reports. This condition can be attributed to various factors including reduction of hospitalizations for ACS (acute coronary syndrome) already widely discussed and documented, reduction of programmed cardiological follow–up and last but not least, the unfavorable effects of the lock–down period on life style and current health status of cardiac patients and the general population. The aim of our study was to evaluate how the characteristics of patients referred to our Cardiology Unit affected by ACS without elevation of the ST–T segment have changed in the post–pandemic phase. We analyzed the data fo the year 2022 and in particular the average age of incidence, the difference between the two sexes and the variation in the incidence of cardiovascular risk factors compared to 2021. The results showed an important reduction in the mean age of ACS incidence of about 2 years, a confirmed prevalence in males compared to females, a statistically significant increase in newly diagnosed dyslipidemia, especially in young patients, and the uncorrected primary prevention management of other cardiovascular risk factors. These data can be explained considering important changes in the lifestyle of the general population in terms of increased sedentary, poor eating habits during the pandemic phase and poor control of cardiovascular risk factors, also due to the absence of ambulatorial follow–up.

Conclusions
These data direct our future measures in the careful and punctual early correction of cardiovascular risk factors starting from outpatient visits, in primary prevention and in the optimization of therapy with aggressive correction of the pathologies encountered during the hospitalization and prevention phase secondary.
P250 CLINICAL PREDICTORS OF ONE–YEAR MORTALITY AFTER ACUTE CORONARY SYNDROME: THE APULIA PONTE ACS REGISTRY
Authors: Scicchitano P , Locuratolo N , Basile M , Sublimi L , Rutigliano D , Palumbo V , Bonfantino V , Paolillo C , Spadafina T , Lillo A , Di Martino L , Massari F , Caldarola P 
Published: May 2023

Abstract

Background
Risk stratification in patients discharged from hospital after coronary syndrome (ACS) play a central role in the management the patients during follow–up. The aim of study was to evaluate the clinical predictors of one–year mortality after ACS.

Methods
We analysed data from 2011 participants of Apulia Ponte ACS who were on one–year follow–up. The APULIA PONTE ACS (PDTA per il follow–up integrato ospedale–territorio del paziente dopo SCA e/o rivascolarizzazione miocardica) Project had been created in order to guarantee a dedicated outpatient follow–up in patients who underwent coronary revascularization and/or ACS by creating a dedicated network among Hub/Spoke centers, outpatient clinics, local cardiologists, general practitioners, and home management of the disease. The primary endpoint was all–cause mortality. We used Cox proportional hazards regression analysis to identified prognostic markers and ROC curve analysis to assess their optimal cut–offs.

Results
At 1–year follow–up, death occurred in 61 patients (3.0 %). The mortality was significantly higher in patients with non–STE–ACS asn compared to patients with STE–ACS (3.0% vs 1.9%, p&lt;0.04). Age, heat rate, systolic blood pressure and left ventricular function remained independent predictor of mortality, while ACS type was no longer associated with death. The optimal cut–offs for death occurrence were age &gt;73 years, heart rate &gt;67 bpm, systolic blood pressure &lt;120 mmHg, and left ventricular ejection fraction &lt;40%. When a score based on the number of these prognostic variables was used (range 0–4), it was significantly associated with mortality (HR 3.1, 95% CI 2.5–3.9, p&lt;0.0001, and area under the ROC curve = 0.81, p&lt;0.0001). A score &gt;1 showed a predictive positive value = 8% and predictive negative value = 99%.

Conclusions
Age, heart rate, systolic blood pressure, left ventricular function at discharge after ACS provide independent and complementary prognostic information independent from ACS type. Our results suggest that the combination of four clinical variables can provide an easy prognostic approach in patients with ASC after hospital discharge potentially useful for personalized care.
P251 EFFECTS OF PIRFENIDONE ON SCAR SIZE AND VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION: A PRECLINICAL STUDY
Authors: Aimo A , Burchielli S , Aquaro G , Barison A , Musetti V , Masotti S , Pucci A , Modena M , Passino C , Emdin M 
Published: May 2023

Abstract

Background
An intense fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Pirfenidone is a drug currently approved for the treatment of idiopathic pulmonary fibrosis, and reduces LV fibrosis in patients with heart failure and preserved ejection fraction. We aimed to characterize the different profiles or protein expression in the infarct zone in rats receiving or not receiving pirfenidone on top of standard therapy for MI.

Methods
Male Wistar rats were randomized to: sham procedure (group 1; n=13), reperfused MI induced by surgical ligation of the left anterior descending artery (LAD) for 45 minutes (group 2; n=17), reperfused MI plus standard therapy (aspirin, angiotensin–converting enzyme inhibitor, beta–blocker, and also mineralocorticoid receptor antagonist [MRA]) (group 3; n=17), reperfused MI plus pirfenidone alone (group 4; n=17), reperfused MI plus standard therapy and pirfenidone (group 5; n=17). Rats surviving LAD ligation and reperfusion underwent cardiac magnetic resonance (CMR) after 72 hours and 30 days from MI, and were sacrificed the day after the second CMR exam. The primary endpoint was the change in late gadolinium enhancement (LGE) mass as a percentage of LV mass.

Results
Forty–six rats survived until the second CMR. Percent changes in LV end–diastolic and end–systolic volume (p=0.370 and 0.423, respectively), ejection fraction (p=0.236) and mass (p=0.815) did not differ significantly between rats on pirfenidone plus standard therapy compared with those receiving standard therapy alone. The decrease in LGE mass was significantly greater in rats on pirfenidone plus standard therapy vs. those on standard therapy alone: –22.0% (interquartile range, –37.1 to –5.7, range –51.1 to +37.5) vs. +1.9% (–7.7 to +12.5, range –19.8 to +56.5), p=0.029.

Conclusions
Pirfenidone had additive effects to standard therapy for MI (including an MRA) in reducing LV fibrosis in a rat model of reperfused MI, while it did not further improve LV function, volumes or mass.
P256 AN UNUSUAL CASE OF PACEMAKER MALFUNCTION WITH NON COMMON ELCTROCARDIOGRAPHIC PRESENTATION AND UNEXPECTED ECHOCARDIOGRAPHIC FINDING
Authors: Minardi A , Franchina G , Marini C , Pala M , Fiorista L , Lucreziotti S 
Published: May 2023

Abstract
This clinical case shows the diagnostic challenge and the management of a 79 y–o male with recent hospitalization for infero–lateral STEMI undergoing primary PCI of Right Coronary Artery with 2 DES and following DDDR MRI PM (pacemaker) implantation due to the development of persistent 2:1 Atrio–Ventricular Block. One month later, admission at Emergency Department for syncope. Normal parameters were found at laboratory analyses. The electro–stimulator activity evaluation showed a PM malfunction with ventricular capture failure. Thus, the increase of PM output up to electric ventricular capture (8 Volt/120 msec) was performed, but the following Electrocardiogram showed a PM–induced rhythm with RBBB–morphology. Then, the bedside Echocardiogram showed an apparent presence of a linear hyper–echogenic image into left ventricle with no inter–ventricular septal defect neither inter–ventricular shunt, inter–atrial septal hypermobility with no evident inter–atrial shunt at rest; while a chest Radiography identified the atrial and ventricular leads with no accurate individuation of their position. The patient was admitted in Intensive Cardiac Care Unit with confirmation of intermittent failure to ventricular capture and RBBB–morphology during PM–induced rhythm at telemetry monitoring. Due to Electrocardiographic and Echocardiographic findings, a strong suspect of abnormal position of the ventricular lead into left ventricle through a possible PFO has been raised. A chest Computed Tomography was performed confirming the anomalous position of the ventricular lead: it reached the left atrium through an inter–atrial defect/patent foramen ovale (PFO), then crossing the mitral valve up to left ventricle. The PM–lead repositioning was scheduled two days after. After positioning of temporary stimulator lead in right ventricle, the ventricular lead has been withdrawn from left–side chambers and positioned into septal–apical right ventricle; furthermore, the position of right atrial lead has been optimized (because of frequent spontaneous passage to the left atrium through the PFO, during manual maneuvers) thus obtaining good stability of the device. During the following days, the telemetry monitoring showed a PM–induced rhythm, without capture nor sensing failure. The chest Radiography confirmed the correct position of leads and the pre–discharge Echocardiography showed a LVEF 57% with no valvular pathology and with atrial and ventricular leads into right–side chambers.
P257 UNIQUE UNEXPECTED COURSE OF A S–ICD LEAD: DIAGNOSTIC CHALLENGES AND SAFE CLINICAL AND INTERVENTIONAL MANAGEMENT
Authors: Cataldi C , Persi A , Percoco F , Bacà M , Perna F , Pelargonio G , Micheli C , Canitano S , Kol A 
Published: May 2023

Abstract
In this report we present a case of subcutaneous cardioverter defibrillator (S–ICD) implantation complicated by pneumothorax (PNX), in the absence of alteration of electrical parameters nor lung parenchyma involvement. After implantation in secondary prevention (1995) of an abdominal transvenous defibrillator (TV–ICD) via the left subclavian vein, a replacement (2009) with a new contralateral TV–ICD system, and the withdrawal of the proximal edge of the right ventricular (RV) lead in the abdominal region, a 78–years–old man presented in our center for pocket erosion. The trans–esophageal echocardiography was suspect for vegetations, while PET/CT and blood cultures were negative. Transvenous extraction of the right–sided ICD system was performed (the original RV lead was left in place due to his complex course), then the patient underwent implantation of a S–ICD with the intermuscular 2–incision technique. In the end of this well tolerated procedure the electrical parameters were optimal, the defibrillation test was effective and the position of the S–ICD was judged correct on the chest X–ray. Few hours later, the patient complained for local pain and progressive respiratory failure. A chest CT showed a PNX at the lateral insertion of the lead, which reached the pleural space, along the left scissure (Fig.1). During lead repositioning, programmed with stand–by thoracic surgery, the lead was easily disconnected from the generator through the lateral incision, pulled–back through the subxiphoid one and tunneled in the correct plane without complications (Fig.2). Serial chest CT confirmed PNX resolution. The patient was discharged in 8 days. At the 1–month follow–up visit electrical parameters were stable, in absence of infective complications. In literature there are few cases of PNX, so that it’s challenging to define their risk factors. We assume that, despite a correct implantation technique, a barrel chest configuration and the aging of the fascia favored the wrong tunnelling. In conclusion, PNX is a rare and unexpected complication of S–ICD implantation and can go unnoticed when of limited dimensions, in the absence of clinical and radiological signs nor alteration of electrical parameters. Fluoroscopic and CT imaging is recommended for diagnosis. Thoracic surgery is useful during repositioning of the lead, which can also be performed by simple traction. CT imaging is of utmost importance for planning such a procedure and predicting its complexity.
P259 S–ICD OFFERS A POTENTIAL SYNERGISTIC THERAPY FOR HEART FAILURE PATIENTS WITH AN INDICATION FOR ICD IMPLANTATION AND CANDIDATES FOR CCM IMPLANTATION
Authors: Adamo F , Mahfouz K , Colaiaco C , Finamora I , Danisi N , Santini L , Ammirati F 
Published: May 2023

Abstract
CCM (cardiac contractility modulation) is a very promising therapy in heart failure patients as it allows, by increasing intracellular calcium handling, an improvement in cardiac contractility, ejection fraction, and patient quality of life. It delivers high–energy (7.5 V) and long–duration (about 20 milliseconds) pulses in absolute refractory period through the use of two leads on the right ventricular septum. It is indicated in patients with narrow QRS (&lt; 130 msec) and ejection fraction between 25 and 45%. Therefore, a large proportion of patients suitable for CCM therapy also have an indication for ICD implantation. The coexistence of an ICD (single–chamber or dual–chamber) and CCM presupposes the presence of 3 leads in the right ventricle and possibly a catheter in the right atrium if a dual–chamber ICD is used. The presence of numerous leads increases the risk of infection, mechanical complications, and damage on the leads. In view of the above, the strategy we propose in patients with concomitant indication for ICD and CCM is the use of the subcutaneous defibrillator (S–ICD) in patients with potential indication for CCM, narrow QRS, no pacing indication, and ejection fraction &lt;35%, thus limiting the number of leads and the risk of complications. In our center, we have started using this strategy with excellent clinical results and in the absence of complications. One of the cases treated with this strategy is a 60–year–old patient with nonischemic dilated myocardiopathy, ejection fraction 34%, QRS &lt; 130 msec, NYHA class III, despite therapy with beta blockers, ARNI, SGLT2–i, MRA at the maximum dose. The patient, also considering the potential future need for CCM implantation, underwent S–ICD implantation. After 3 months, NYHA class III with reduced quality of life persisted (MLHFQ 82). Therefore, the patient successfully underwent CCM implantation, with marked improvement in symptoms (MLHFQ 71) and ejection fraction (43%) 3 months later. This strategy avoided the placement of additional leads in the right ventricle while ensuring protection from potentially fatal arrhythmias and improvement in contractile function and symptoms. We suggest the use of the subcutaneous defibrillator (S–ICD) in all patients in whom there might be an indication for the use of CCM and no need for pacing, ensuring maximum efficacy and reducing the risk of infection and leads related complications.
P261 OUT–OF–HOSPITAL CARDIAC ARREST (OHCA): TWO–YEAR OBSERVATIONAL STUDY
Authors: Condello C , Gasparetto N , Cacciavillani L , Orazio S , Betta D , Menegon V , Bussola M , Ferramosca M , Zanatta P , Cernetti C , Iliceto S 
Published: May 2023

Abstract

Background
Cardiac arrest is the third cause of death in Europe. It is a medical emergency characterized by high mortality and morbidity. Myocardial infarction is the leading cause of cardiac arrest. Data collection through national and international registries is essential to advance knowledge and improve diagnostic and therapeutic practices. Purpose: we assess the epidemiological impact of OHCA within a territory of approximately 300.000 inhabitants and follow patients’ intrahospital clinical pathway with the aim to identify possible predictors of survival and neurological outcome.

Methods
an electronic database is used to collect and share data across the Emergency Medical Services (EMS) and reference Cardiologists. Respectively, the EMS collects out–of–hospital patient data, whereas Cardiologists collect all information about intrahospital progress.

Results
during an observation period of two years, 100 patients with OHCA were enrolled. The majority were male and the average age was 65 years old. The first rhythm identified was shockable in 41% of the cases. Witnesses performed cardiopulmonary resuscitation and used automatic external defibrillator respectively in 57% and 10% of the cases. Only 34% of the victims obtained ROSC and were admitted into the cardiac intensive care unit and half of them died before discharge. Within this group, cardiac arrest was caused by myocardial infarction in 46% of the cases. Of these, culprit lesion was located in the left anterior descending artery in 46,2 % of the cases. It appears that a blood pH value below 7,04 – measured at the arrival in Emergency Department – is a poor prognostic predictor of ROSC, with a 79% sensitivity and 86% specificity (AUC 0,81, 95% CI 0,644 – 0,977). On the other hand, a plasma level of lactic acid expresses multiorgan damage secondary to cardiac arrest and therefore represents a predictor of survival and neurological outcomes, but not ROSC.

Conclusion
during the two years of observation, the incidence of OHCA turned out to be slightly lower compared to the data available in the literature. Mortality remains extremely high: only 12% of the population survives, of which 16% with poor neurological outcome. Blood gas analysis, if correctly interpreted, could be an optimal tool to target therapeutic choices for cardiac arrest victims. Further studies with a higher sample size will be needed to validate this data.
P263 EFFICACY AND SAFETY OF THE LIFEVEST® WEARABLE DEFIBRILLATOR IN PATIENTS WITH NEWLY DETECTED ISCHEMIC AND NONISCHEMIC HYPOKINETIC DILATED HEART DISEASE: EXPERIENCE FROM OUR CENTER
Authors: Della Volpe F , Giulia C , Biagini F , Mariani T 
Published: May 2023

Abstract

Introduction
The wearable defibrillator (WCD) is indicated in patients at risk of sudden cardiac death who do not have short term indication for implantation of a definitive device. Efficacy in the recognition and treatment of ventricular tachyarrhythmias has been demonstrated in the context of postinfarction ischemic heart disease, while little evidence is currently available in other clinical settings. The aim of the study was to evaluate the efficacy and safety of WCD in an unselected population of patients with ejection fraction (EF) &lt;35% and newly detected myocardial infarction (MI) or nonischemic dilated cardiomyopathy (NIDCM) pending optimization of medical therapy.

Methods
All patients with FE &lt;35% admitted to our department from 2017 to 2022 after MI or with newly found NIDCM and discharged with WCD (LifeVest® Zoll) were enrolled as part of a prospective registry. The indication was considered in patients with nonsustained ventricular arrhythmias during hospitalization. Clinical and medical history data were collected for each subject; follow–up was conducted until the end of device monitoring, recording any events and therapies delivered.

Results
Of the 22 subjects enrolled, 19 (86%) were male. The mean age was 57±10 years. Fifteen patients had newly encountered NIDCM (68.2%) and 7 had been discharged after MI. Ninety–five percent of patients were on beta–blockers, 68% on ACE inhibitors, 5% on Sartan, 32% on Sacubitril Valsartan, 81% on Antialdosteronics, 9% on SGLT2i. The mean duration of treatment was 68±33 days. A statistically significant increase in EF was observed at the end of treatment in the two subgroups (MI 40%±8 vs. 32%±3, p 0.03. NIDCM 39%±9 vs. 31%±6 p 0.002). No arrhythmic events or inappropriate discharges were recorded. At the end of treatment, 41% of patients had indication for definitive defibrillator implantation, with no difference in the two subgroups (MI 28% Vs NIDCM 46% p 0.115).

Conclusions
In a population of patients discharged on optimal medical therapy, a significant increase in EF at follow–up was observed with no significant differences in definitive ICD implantation between the subgroup of patients with recent MI or newly found NIDCM. WCD therapy was found to be safe in the absence of need for appropriate shocks.