bluuebunny/crossref_metadata_2025_split huggingface dataset:
P56 ROLE OF CARDIAC TROPONINS IN THE EMERGENCY DEPARTMENT IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Mager R , Fontani D , Assanelli A , Morciano D , Morosato M , Ricchetti G , Agricola E , Margonato A , Slavich M 
Published: May 2023

Abstract
Atrial fibrillation (AF) is the most frequent arrhythmia among those encountered in the emergency department. It’s well known that elevated values ​​of cardiac troponin in "stable” conditions is generally indicative of myocardial cytonecrosis and is associated with a worse prognosis in various clinical conditions. The role of cardiac biomarkers in the context of an AF episode has not yet been fully understood and is a source of debate in the cardiology community. Recent studies suggest the association of elevated troponin values in the context of an AF episode with an increased incidence of major cardiovascular events. Consequently, its measurement could be extensively taken into consideration also in the Emergency Department and implemented for risk stratification. There is currently insufficient evidence to support the dosing of cardiac troponins in all AF patients for risk stratification. The aim of this study is to investigate the significance of elevated troponin values ​​during AF and whether these are related to an increased cardiovascular risk.

Methods and Results
This is a retrospective and observational study and focuses on a population of patients who arrived in the Emergency Department of San Raffaele Hospital in Milan between the 1st of January 2018 and 22nd May 2021 with atrial fibrillation. Data were collected for 625 patients of whom 232 were enrolled for statistical analysis. The population was stratified based on cardiovascular risk factors and prior AF ablation. At 12–month follow–up we found that elevated troponin values ​​during atrial fibrillation in the Emergency Department do not correlate with an increase of deaths from any cause, major cardiovascular events or hospitalizations for heart failure. The presence of elevated cardiac troponin was not associated with an increased rate of CAD at coronary CT nor coronaru angiography. A weak association was seen between non–elevated cTnT–hs and higher rate of AF ablation.

Conclusions
Our data reject the hypothesis according to which elevated levels of highly sensitive cardiac troponin measured during an atrial fibrillation episode could be correlated with an higher incidence of major adverse cardiovascular events at 1–year follow up.
P59 SPONTANEOUS RESTORATION OF STABLE SINUS RHYTHM FOLLOWING EDGE–TO–EDGE TRANSCATHETER MITRAL REPAIR PROCEDURE WITH MITRACLIP IN A PATIENT WITH CHRONIC ATRIAL FIBRILLATION
Authors: Molinari R , Falco L , Malvezzi M , Scognamiglio G , Salerno G , Russo V , Natale F , Cimmino G , Liccardo B , Golino P 
Published: May 2023

Abstract
Patients with history of atrial fibrillation (AF) undergoing mitral edge–to–edge repair procedure with Mitraclip tend to be relatively older, have more advanced valve disease, and suffer from more comorbidities than patients without AF [1;2]. Moreover, their all–cause mortality rate one year after the procedure and hospitalization rate for heart failure is higher than that of patients in sinus rhythm [3]. Therefore, managing patients with AF poses a greater challenge, and their prognosis is considerably worse. Improvement of mitral regurgitation following mitral edge–to–edge repair procedure with Mitraclip may reduce atrial volume overload positively impacting AF triggers. In this report, we present a case of spontaneous restoration of stable sinus rhythm in a patient with chronic AF undergoing mitral valve repair procedure with Mitraclip. The patient, 80 years old, underwent implantation of a clip on centro–lateral site of the mitral valve plane (A2–P2) with mild residual insufficiency and an optimal procedural result. The restoration of sinus rhythm, which occurred during the first hours after the procedure, proved to be stable at the 30th day control post–discharge. the indexed left atrial volume remained unchanged (LAVI 43–45 mL/m2). Literature on the frequency of spontaneous sinus rhythm restoration following edge–to–edge mitral repair with Mitraclip in patients with chronic AF is limited. In a sub–analysis of the COAPT study [4], in addition to the known benefits of the Mitraclip procedure, it was possible to highlight a significant reduction in the rate of stroke in patients with AF. This outcome could be attributed to the reduction of the AF burden associated with mitral valve insufficiency. More studies are although necessary to determine the procedure‘s impact in this specific clinical situation. Rreferences: [1] Velu JF, Am J Cardiol. 2017 Dec 1;120(11):2035–2040. [2] Saad AM, Catheter Cardiovasc Interv. 2021 May 1;97(6):1252–1256. [3] Shah S, Heart Fail Rev. 2021 May;26(3):531–543. [4] Gertz ZM, Circ Cardiovasc Interv. 2021 Apr;14(4):e010300.
P67 MYOCARDIAL INFARCTION IN COVID AND NON–COVID PATIENTS: DIFFERENT TWINS
Authors: Piemonte F , Carraturo A , Damiano S , De Angelis A , Forte R , Leccia A , Lirato C , Molaro M , Penna G , Petitto M , Piemonte M , Puzio E 
Published: May 2023

Abstract
For about 2 months (from 13 January to 15 March 2022) our CICU–Cardiology department (spoke for the AMI network) of the "San Giovanni di Dio" Hospital of Frattamaggiore (Napoli) has assumed the role of Covid–CICU for ASL Napoli 2 Nord. We analyzed the data regarding patients hospitalized for acute myocardial infarction in our department from January to August, selected on the basis of the presence of SARS–COV2 infection at admission, and we noted some substantial differences between the two populations, although in the small sample examined. 15 of the 44 patients hospitalized with Covid (34%) were discharged with a diagnosis of acute myocardial infarction, while among non–Covid patients 46.4% had acute myocardial infarction. The average age and days of hospitalization were higher in Covid patients (70 vs 67 years and 8.9 vs 6 days), and Covid patients with myocardial infarction and heart failure were 50% vs 24.7% of non–Covid patients. Diabetes was present in 31.5% of Covid patients and 15.7% in non–Covid. The number of STEMIs was higher in the Covids (53.3% vs 15.7% of the non–Covids), probably because being CICU–COVID we also accepted patients with STEMI who otherwise would have been hospitalized in the CICU HUB. Despite the difficulties in managing acute coronary syndromes in Covid patients, 60% of all Covid patients hospitalized for infarction underwent a haemodynamic study (73% in non–Covid patients) and primary PTCA was guaranteed for 87.5% of Covid patients with STEMI in a reasonable time in that context (&lt; 9 hours from admission to hospital). However, in the face of this considerable organizational effort, the 6–month and intra–hospital mortality in Covid patients hospitalized for infarction was 31.5% and 12.5%, much higher than that of non–Covid patients (2.2% and 1.1% respectively ). The STEMi data from COVID patients is not comforting either: in fact, 25% of them died within 6 months and 12.5% in hospital, despite almost all of them were treated with primary PTCA, although not in the first 3 hours. But the mortality of the Covid patients in our department with a prevalent respiratory commitment is even higher than that of the Covid patients with AMI, reaching 40% at 6 months. In the light of our limited experience, we can hypothesize that the therapeutic protocols used in heart attacks, despite the inevitable delays due to Covid and although they are not as effective as in non–Covid patients, nevertheless can have impact on the prognosis.
P74 NIGHT SWEATS AND AN UNUSUAL RIGHT ATRIAL MASS
Authors: Cerrito L , Sembenini C , Varotto L , Basso C , Testolin L , Caprioglio F 
Published: May 2023

Abstract

Background
Primary cardiac tumors are infrequently, usually benign, and diagnosed incidentally. Among primary cardiac tumors, cardiac hemangiomas are exceptionally rare with only a 1–2% incidence. In most cases, histological diagnosis is made after surgical removal or at autopsy. Case presentation: A 36–year–old male patient is suffering from several months of bothering night sweats. He has no previous medical history and is not taking medication. After performing various exams, including an electrocardiogram and chest rx–ray that were unremarkable, the patient performed a chest TC scan that shows a large mass at right atrial level (Figure 1). Surprisingly, at transthoracic echocardiography the mass was not visible and moreover the exam was normal. To better visualize the mass, a transesophageal echocardiography was performed, showing a inhomogeneous, round–shape, intracavitary mass of 70x65 mm in size. The mass appear to be fixed, expansive, with no embolic–features and seem to be initially–obstructing the upper–cava blood flow (Figure 2), even the patient was hemodynamically stable. A diagnosis of lymphoma was initially suspected and an Total–body PET–TC was performed, showing that the heart mass was metabolically inactive and an intestinal metabolic active mass. Intestine mass biopsy, made by colonscopy, showed a non–malignous villous adenoma. Before undergoing heart surgery, to understand the nature of the mass, we performed a intracavitary ecocardiography (ICE)–guided percutaneous biopsy. Histologically, the heart tumor was composed of cavernous channels embedded in a loose fibrous stroma, compatible with Cavernous hemangioma. At heart surgery, the mass was localized inside the right atrium, at upper–front level, adhered to a small part of atrial myocardium, and was removed without complications. The right atrium was rebuilt with artificial patch. (Figure 3).

Conclusions
Cavernous cardiac Hemangioma is a rare tumor that may have an atypical clinical presentation. To our knowledge, this is the first case of cardiac hemangioma diagnosed by ICE–guided endomyocardial biopsy.
P76 RARE CASE OF CARDIAC TUBERCULOSIS WITH CONCOMITANT SPONDYLODSCITIS MEDIATED BY MYCOBACTERIUM BOVIS
Authors: De Feo D , Marica F , Napoli V , Ciccone M 
Published: May 2023

Abstract
Tuberculosis (TB) is usually clinically confined to the respiratory system; however, it can affect any organ. Cardiac tuberculosis, though, is a rare as extrapulmonary manifestation of TB, generally it is clinically silent, and it shows up as sudden death due to ventricular arrhythmias. TB, and in particular cardiac TB, is a disease with complex signs and symptoms that overlap with other disorders determining a diagnostic dilemma, especially in case of a blood culture–negative infective pancarditis. Herein we report a case of a 30–year–old patient (African immigrant, HIV negative, black) who presented with chest pain and heart pounding because of paroxysmal atrial fibrillation. He suddenly developed sustained ventricular tachycardia, for which he was underwent subcutaneous ICD implantation. He was submitted to echocardiography and magnetic resonance, and a large mass involving right atrium, right ventricle and apex was observed. Cardiac tuberculosis without active pulmonary disease, with a concomitant spondylodiscitis, was diagnosed thanks to bacterial cultures of specimens drained from vertebral abscesses. After Mycobacterium Bovis was isolated, the patient received anti–tubercular therapy with wide improvement of symptoms and neat reduction of the cardiac mass observed in months at echocardiographic follow – up. Although literature describes high rate of mortality and complications due to cardiac tuberculosis a favourable outcome occurred.
P77 A “GIANT” IN THE PANDORA’S BOX OF PARACARDIAC MASS
Authors: Briani F , Dotto A , Facci G , Bagli M , Tavella D , Ribichini F 
Published: May 2023

Abstract
In this case report, we describe a giant coronary aneurysm (CAAs) of the right coronary artery occasionally found in a patient that underwent Bentall procedure 18 years earlier for acute aortic dissection. A 77–year–old man, former smoker, with type II diabetes, hypertension, dyslipidaemia, and obesity, was referred to our echo lab for echocardiography in December 2020. His medical history included anteroseptal non–Q–wave myocardial infarction (1983), type A acute aortic dissection treated with Bentall procedure and implantation of mechanical aortic valve (2002), and reparation of abdominal aortic aneurysm (2003). During the echocardiogram a paracardiac mass was incidentally found, in close contact to the right atrium and with a diameter of 60 mm in A4Ch–view, with the appearance of a cystic formation (Figure A). After a few days, a CT angiography was performed, with evidence of 61.6 mm–sized giant aneurysm located in the proximal right coronary artery, characterised by calcified walls, eccentric thrombosis, and compression of the right atrium (Figure B). The patient was subsequently evaluated by the Cardiac Surgery Division. Conservatively management with regular follow–up was performed, because of the high surgical risk of redo and the lack of symptoms. In November 2022 we performed a follow–up echocardiography with evidence of stability of the size of coronary artery aneurysm (Figure C). CAAs are defined as giant when the diameter of the vessel is greater than 20 mm. These pathological entities are extremely rare, with an incidence rate of 0.02%, and aetiologies are various. The most frequent aetiologies comprehend atherosclerosis (about 50% of cases), congenital (17%), arteritis (e.g., Kawasaki disease), connective tissue disease. Our case is characterised by the occasional diagnosis of CAA 18 years after Bentall Surgery, in absence of inflammatory vessels disease. To the best of our knowledge, It’s the largest giant CAA described in literature after Bentall cardiac surgery. Therefore, cardiologists should consider these rare entities when approaching an incidental echocardiographic finding of paracardiac mass, especially in patients with high burden of atherosclerotic disease. This case report underlines furthermore the importance of an integrated approach in the differential diagnosis of a paracardiac mass.
P81 IMPACT OF CORONAROGRAPHY AND CORONARY ANGIOPLASTY ON MORTALITY IN A COHORT OF PATIENTS WITH NEW–ONSET HEART FAILURE IN ITALY
Authors: Seccareccia F , De Luca L , D’Errigo P , Rosato S , Duranti G , Badoni G , Baglio G 
Published: May 2023

Abstract

Background
Although myocardial ischemia and coronary artery disease play a crucial role in the pathophysiology of new–onset heart failure (HF), the impact of coronary angiography and percutaneous coronary angioplasty (PCI) revascularization on HF mortality is not well clarified.

Objective
To evaluate the efficacy of performing coronary angiography and PCI in reducing medium–term outcomes in a cohort of patients hospitalized with new–onset HF in Italy.

Methods
Retrospective cohort study enrolling all patients aged 18–100 years hospitalized for new–onset heart failure in an Italian accredited public or private hospital in the years 2015–2019 and survived 30 days after index hospitalization. Patients with a prior diagnosis of CAD were excluded from the analysis. The enrolled patients were classified into: patients not undergoing coronary angiography (No CVG); patients undergoing coronary angiography without PCI (CORO) and patients undergoing coronary angiography and PCI (PCI). The primary outcome measure of the study was all–cause mortality 1 year after the index hospitalization. A multivariate Cox model estimated through a stepwise procedure was used to compare the study groups taking into account the different distribution of risk factors.

Results
342,090 hospitalizations for new–onset HF were recorded in Italy during the study period. Of these, 32,240 (9.42%) patients underwent coronary angiography without PCI and only 5,890 (1.72%) underwent PCI as well. Patients undergoing an invasive procedure were on average younger (mean age =80.7 in No CVG, 69.0 in CORO and 72.3 in PCI), with a lower percentage of women (58.8% in No CVG, 37.0% in CORO and 27.6% in PCI) and with fewer comorbidities than untreated. After adjusting for gender, age, and comorbidities, coronary angiography was protective versus no treatment whether performed alone (HR=0.57; p&lt;0.0001) or followed by PCI (HR=0.67; p&lt;0.0001). 0.0001).

Conclusions
In this cohort of consecutive patients with new–onset HF, coronary angiography and/or PCI was associated with a significant reduction in 1–year mortality.
P82 SAFETY AND FEASIBILITY OF ANGIONTENSIN RECEPTOR NEPRILYSIN INHIBITOR IN REAL– WORLD PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE
Authors: Rossini R , Angelini F , Giordana F , Coppini L , Ferraro I , Ruffino E , Varbella F , Tizzani E , Coletta G , Musumeci G 
Published: May 2023

Abstract

Background
To determine the safety and feasibility of in–hospital sacubitril/valsartan initiation after clinical stabilization in patients with acute decompensated heart failure (ADHF) and reduced ejection fraction (EF).

Methods
This retrospective, multicenter observational study included patients admitted for ADHF in 2 Italian centers between February 2017 and January 2022. Feasibility was evaluated by assessing the proportion of patients discharged on sacubitril/valsartan. Key safety endpoints were the incidences of adverse events during hospitalization and during follow–up planned at 1 month, 3 6 months and 12–18 months after discharge.

Results
One hundred and twenty–two patients were included. Median age was 71 (60–78) years, 78% male, 63% New York Heart Association (NYHA) class III at admission with a median left ventricular ejection fraction (EF) of 25% (20–30). During hospitalization, 94 (77%) patients were treated with intravenous diuretics, 39 (32%) with inotrope/vasopressor, 51 (42%) with continuous positive airway pressure ventilation and 7 (6%) were assisted with an intra–aortic balloon pump. Median time from hospitalization to sacubitril/valsartan initiation was 4 (2–7) days. Sacubitril/valsartan was started at a dosage of 12 mg/13 mg in 52 (43%) patients, 24 mg/26 mg in 61 (50%) patients and 49 mg/51 mg in 8 (7%) patients. Overall, 111 (91%) of patients were discharged on sacubitril/valsartan. At 12–18 months follow–up, the vast majority of patients were still on sacubitril/valsartan therapy.

Conclusions
In–hospital initiation of sacubitril/valsartan treatment in real–world ADHF patients may be a safe and feasible treatment option.
P86 WHEN THE HEMATOLOGIST HAS THE SOLUTION – A RARE CASE OF HEART FAILURE
Authors: Biolé C , Bianco M , Ulisciani S , Nangeroni G , Chinaglia A 
Published: May 2023

Abstract

Introduction
Cardiologists are confident with heart failure due to cardiac etiology, but sometimes this may be due to other organs‘ dysfunction (e.g. endocrine problems); in this case we report a very rare cause of anasarca due to hematologic disease.

Case report
A 33 year old man with a known complete left bundle branch block and without other pathologies is admitted to the ED for sickness and abdominal pain. Low platelet count, splenomegaly and an anterior mediastinal mass (53x54mm) are found. A Positron Emission Tomography (PET) reveals multiple lymphnodes captation above and under the diaphragm and at mediastinal level. Bone marrow biopsy is consistent with myelofibrosis. During the hospitalization the patient experiences an important weight gain (14 kg) with edema and worsening renal function suspected for heart failure; echocardiogram shows a globally hypokinetic left ventricle with moderately reduced ejection fraction (EF 37%), mild pericardial effusion, no relevant valve anomalies; cardiac MRI confirmed moderately depressed EF with global hypokinesia and no LGE anomalies of the myocardial wall; a clinical benefit is noted with high dose i.v. diuretics, and echocardiogram findings rapidly improve with therapy, EF 49% after decongestion; a discrepancy is noted between the severity of anasarca and echocardiographic data; ultimately, lymph node biopsy is performed, which is consistent with Castleman disease, HHV 8 negative. TAFRO (Thrombocytopenia, Anasarca, Fever, Reticulin myelofibrosis/Renal dysfunction, Organomegaly) syndrome is therefore diagnosed. Therapy with siltuximab (anti IL–6) is started with good clinical response on lymph nodes enlargement and on anasarca, and the patient is currently followed–up by the hematologists of our institution.

Discussion
TAFRO syndrome is a very rare hematologic disease that can manifest with severe anasarca; usually it presents with non–cardiac features, but cardiologists should be aware of this disease as they could be involved in the management of this condition, especially in the fist stages when the diagnosis has not yet been made.
P96 NO PATIENT SELECTION IN TOTALLY ENDOSCOPIC ISOLATED MITRAL VALVE SURGERY: OPERATIVE AND EARLY RESULTS IN DEGENERATIVE MITRAL VALVE REGURGITATION
Authors: Zoni D , Cresce G , Hinna–Danesi T , Salvador L 
Published: May 2023

Abstract

Background and aim
In high–volume centers MICS can be offered to any patient affected by degenerative mitral valve surgery (MVS). Aim of this study was to evaluate early outcomes in patients undergoing isolated MVS for degenerative mitral regurgitation (MR) using a totally endoscopic technique.

Methods
From January 2018 to December 2022, 1124 consecutive unselected patients underwent endoscopic MVS at our institution. Among them, 399 patients underwent isolated MVS for degenerative valve pathology. Concomitant surgery and different etiology were excluded. All patients were approached with peripheral cannulation, limited skin incision (peri–areolar/sub–mammary/anterior axillary line) and 5 mm 30° endoscope. Neo–chordae implantation plus annuloplasty ring was the preferred technique for mitral repair.

Results
Endoscopic MVS was achieved in all patients and no conversion to sternotomy was needed. Median Cross–Clamp and CPB Time were respectively 93 [75 – 11] and 143 minutes [115 – 171]. Overall in hospital mortality was 0.75%. Major Stroke occurred in 1.6%. Replacement for unsuccessful repair occurred in 4 patients (1%). Repeated cross–clamp for residual MR in 13 patients (3,3%). Median intubation time was 5 h [3 – 7], ICU time was 18 h [15 – 21], bleeding requiring revision occurred in 21 patients (5.3%) always through the same access. PM implantation occurred in 3%, vascular complications in 1%. We had 1 case of endocarditis, 1 case of early failure, 1.3% mitral redo.

Conclusions
In high volume centers isolated endoscopic MVS without preoperative patient selection has proven to be safe with optimal mortality, good fast–track and low incidence of complications.