bluuebunny/crossref_metadata_2025_split huggingface dataset:
P371 CONFOUNDING CARDIAC MARKERS IN A CASE OF COVID–19 MYOCARDITIS
Authors: Polo G , Scarpa D , Castegnaro N , Benetti A , Mione R , Carraro P 
Published: May 2023

Abstract

Background–Aim
A man of 81 years, with previous coronary artery disease, unrecognized myocardial infarction, carrier of implanted pacemaker, presented to the cardiology department for a scheduled hospitalization to treat shortness of breath and symptoms of heart failure. There was no chest pain, ECG poorly assessable for pacemaker–induced rhythm, cardiac troponin I of 35,879 ng/L (cut–off 20). Suspecting an acute coronary syndrome (ACS), the patient undergoes immediate coronary angiography that does not showed any change compared to a previous examination. Meanwhile SARS–CoV–2 research in nasopharyngeal swab by RT–PCR was positive and after a few hours fever appears.

Methods
The authors discussed the case and extensive monitoring of cardiac markers and intensive evaluation of clinical parameters were activated. Troponin I HS, CK–MB, Myoglobin (Beckman Coulter DxI), CK, AST, LDH are determined by routine methods (Beckman Coulter AU700), Troponin T (cTnT–hs Roche Diagnostics) on (Roche Cobas 8000).

Results
All markers (except Troponin T) had the typical pattern of an ACS, in accordance with their characteristic half–life of an acute insult with development of a peak and subsequent decrease in a few days. The peaks recorded were cTnI 35,789 ng/L, CK–MB 72.6 ug/L, CK 800 U/L, AST 1,51U/L, Myoglobin 244 ng/ml, LDH 600 U/L, all at time 0. Troponin T was moderately increased at presentation (3700 ng/L, cut–off 10) followed by a peak of 3,872 after 2 hours stabilizing around 2,800 ng/L for the next days and decreasing after day 7. The final diagnosis was acute COVID–19–related myocarditis.

Conclusions
It has been described that the presentation of a SARS–CoV–2 infection can sometimes simulate a condition of ACS when there is an inflammatory involvement of the heart. In this case all the clinical data pointed towards an ischemic pathology which, however, was excluded in diagnostic imaging. A conclusive assessment with cardiac MRI was not possible due to the presence of the pacemaker, so the diagnosis was made as probable. Among the different markers, Troponin I was found to express a more intense signal and an earlier positive evolution than that of Troponin T. Our report highlights the different evolution of cardiac troponins in this disease.
P375 ACUTE PULMONARY EMBOLISM IN A STABLE PATIENT PRESENTING WITH RIGHT CARDIAC CHAMBERS THROMBOSIS: A TICKING CLOCK SCENARIO
Authors: Procopio A , Belli L , Molisana M , Cicchitti V , Ianni U , Toro A , Di Girolamo E , Zimarino M 
Published: May 2023

Abstract
A 73–year–old male presented to the emergency department with a 1–week history of asthenia and exertional dyspnoea. He reported a recent finding of a not yet characterized renal mass in a not relevant past medical history. At the admission, he was haemodynamically stable. Electrocardiogram showed sinus rhythm without relevant abnormalities. Blood results evidenced only a slight increase of hs–troponin levels and D–dimer. An early point–of–care ultrasound (POCUS) demonstrated normal chambers dimensions and biventricular function but in the right atrium an elongated and mobile mass was documented. The echo–features were very suggestive of a large thrombus and a computed tomography pulmonary angiogram revealed several emboli in the left pulmonary artery. At the admission to our cardiac intensive care unit, according to pulmonary embolism (PE) ESC guidelines1, systemic anticoagulation was started with an aPTT–guided unfractioned heparin (UFH) infusion. Intensive monitoring was set to permit early detection of haemodynamic impairment. Multidisciplinary discussion on management was instituted but, soon after, the patient had a PEA arrest. POCUS demonstrated an extremely dilated right ventricle so rescue fibrinolytic therapy (FT) was attempted during cardiopulmonary resuscitation but the patient died. The intermediate–high–risk profile of PE encompasses a very heterogeneous group of patients, in whom controversy still exists regarding the net clinical benefit of using FT compared to anticoagulation alone. In the largest PEIHTO trial, FT compared to UFH alone prevented death and hemodynamic decompensation but increased major bleedings and strokes2. Data meta–analysis confirmed that in these patients, FT was associated with a lower mortality at the cost of more bleedings3. Current guidelines endorse FT only at the moment of clinical deterioration. Nevertheless, stable patients with “thrombus in transit” represent a niche of potentially rapidly deteriorating clinical scenario with not–predictable timing. In this setting we believe that, waiting for data deriving from interventional approaches, an aggressive therapeutical strategy should be considered, offering more liberally an early FT, especially when absolute contraindications are lacking. Data from registry or trials are strongly requested. 1.Konstantinides SV et al. EHJ 2020;41:543–603. 2.Meyer G et al. NEJM 2014;370:1402–11. 3.Chatterjee et al. JAMA 2014;311:2414–21.
P381 TEAMWORK IS SUCCESSFULL (4): PROGRESSION OF CORONARY ATHEROSCLEROSIS IN A PERIPHERAL T–CELL LYMPHOMA AND PAPILLARY RENAL CELL CARCINOMA SURVIVOR
Authors: Fari R , Di Girolamo S , Masini C , Larocca M , Righini S , Muià N , Pinto C , Navazio A , Besutti G , Tarantini L 
Published: May 2023

Abstract

Introduction
Growing evidence highlight cancer and cardiovascular diseases (CVD) share common risk factors, including genetic ones, and underlying pathogenesis. Such paradigm has significant implications for cancer survivors, an exponential growing cohort of patients (Pts), due to notable improvements in survival achieved with new oncological treatments. However, many new agents of targeted– and immuno–therapy can cause cardiac damage, mainly for vascular involvement, a pathophysiological mechanism different from classic chemotherapeutic agents. We present the case of left ventricular systolic dysfunction (LVSD) in a man with metastatic papillary renal cell carcinoma (PRCC) previously exposed to anthracyclines for former peripheral T–cell lymphoma (PTCL). He came to our attention for cardiological assessment before starting immunotherapy (Nivolumab), due to the failure of Tyrosine kinase inhibitor (TKIs) (Pazopanib) treatment.

Clinical case
A 74–year–old Pt with hypertension, severe renal dysfunction, dyslipidemia, and exertional dyspnea (NYHA II) presented at transthoracic echocardiogram (TTE) a normal size chambers with mild concentric hypertrophy and a clinically stable moderate LVSD (LVEF 35–40%) at periodic evaluation. Pt was also performing his radiological follow–up for the estimation of metastases with CT, twice a year since 2016. A retrospective review of these non–contrast and non–ECG–gated CT highlighted an extensive increase in coronary artery calcifications during the last four years, started with the beginning of TKIs therapy. In 2018 only mild LAD calcification was detectable (Figure 1), while in 2022 a severe three–vessel coronary atherosclerosis was present (Figure 3). After multi–disciplinary discussion, an aggressive correction of multiple cardiovascular risk factors (starting Rosuvastatin and adjusting Bisoprolol) was performed and immunotherapy started without any adverse event.

Conclusions
Non–ECG–gated CT routinely performed for monitoring the state of the oncological disease is a useful tool for the evaluation of coronary artery calcific burden and accelerated atherosclerosis. It provides additional information beyond the traditional evaluation of CV risk and must be integrated with clinical and laboratory data.
P383 DAPAGLIFLOZIN REDUCES SYSTEMIC PCSK9 LEVELS IN PRECLINICAL MODELS OF SHORT–TERM DOXORUBICIN CARDIOTOXICITY THROUGH NLRP3 INFLAMMASOME/IL–1Β: A FIRST EVIDENCE OF SGLT–2/PCSK9 CROSS–TALK IN CARDIONCOLOGY
Authors: Quagliariello V , Palma G , Luciano A , Bruzzese F , Paccone A , Iovine M , Maurea N 
Published: May 2023

Abstract

Background
Anthracyclines are an effective and widely used chemotherapy agent in the treatment of multiple solid organ tumors and hematologic malignancies. The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. In recent five years, it was demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9), a lipid metabolism–related protein, is a key orchestrator of immune infiltration in myocardial and cancer tissues and could regulate cardiac fibrosis and inflammation. PCSK9 is a protein with key roles in hepatic low density lipoprotein (LDL) homeostasis. PCSK9 systemic levels are associated to HOMA score and high insulin levels. Dapagliflozin exerts systemic ant–inflammatory properties and cardioprotective effects in diabetic and non–diabetic patients. Purpose: We hypothesized that Dapagliflozin, administered during doxorubicin, could reduce PCSK9 systemic levels in preclinical models.

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO–DAPA, n=6). After treatments, plasma levels of PCSK9, IL–1β and CRP were analyzed through selective anti–mouse ELISA methods. Myocardial and liver expression of NLRP3–inflammasome and IL–1β were analyzed through ELISA method in tissue lysates after treatments.

Results
DAPA associated to DOXO reduces significantly systemic levels of PCSK9 ( –37,5% vs DOXO group, p&lt;0,001). IL–1β and CRP levels were also reduced ( –47,3 and – 28,5 %, respectively; p&lt;0.05 for both). Myocardial and liver IL–1β and NLRP3 inflammasome expression were also reduced in DAPA/DOXO group vs DOXO and control, indicated beneficial metabolic and anti–inflammatory effects of SGLT2i.

Conclusion
DAPA has been shown to reduce systemic levels of PCSK9 in preclinical models of short–term DOXO cardiotoxicity. To the best of our knowledge, this is the first evidence of SGLT–2/PCSK9 crass–talk in cardioncology therefore the overall picture of the study open a new window on the beneficial properties of DAPA against anthracyclines side effects.
P385 CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION IN OCTOGENARIANS: A PROPENSITY–SCORE MATCHING COMPARISON WITH A COHORT OF YOUNGER PATIENTS
Authors: Cecchini F , Shuichiro K , Mugnai G , Bolzan B , Iacopino S , Placentino F , Ribichini F , Sieira J , Sorgente L , Tomasi L , De Asmundis C , Gian Battista C 
Published: May 2023

Abstract

Background
Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia in adults with a current estimated prevalence between 2–4% in the general population. AF prevalence increases with advancing age and it is estimated that nearly 10% of octogenarians may be affected by this arrhythmia. In terms of safety and efficacy, Cryoballoon ablation (CB–A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation (AF). However, CB–A data in octogenarians are still scarce and limited to single–centre experiences. The present multicenter study aimed to compare the outcomes and complications of index CB–A in patients older than 80 years old with a cohort of younger patients.

Methods and results
We retrospectively enrolled 97 consecutive patients aged ≥ 80 years who underwent PVI using the second–generation CB–A. This group was compared with a younger cohort of patients using a 1:1 Propensity score matching. After the matching, 70 patients from the elderly group were analyzed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow–up of 23 [18 – 32.5] months was 60.0% in the elderly group and 71.4% in the control group (p = 0.17). Phrenic nerve palsy (PNP) was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients for the elderly group and in 5 patients (7.1%) of the younger group (p = 0.51). Only 2 (1.4 %) major complications occurred: 1 (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage and 1 (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period (BP) and the need for electrical cardioversion (ECV) to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses.

Conclusions
The present study showed that CB–A PVI is as feasible, safe and effective among octogenarians as it is in younger patients.
P386 ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH SEVERELY DEPRESSED EJECTION FRACTION. META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Meco M , Belli G , Fouladvand F , Agosteo E 
Published: May 2023

Abstract

Introduction
Atrial fibrillation (AF) and severely depressed ejection fraction (SDEF) are two conditions that often coexist. AF increases overall mortality in these patients. The current available guidelines do not provide a clear consensus regarding the best management approach. We conducted this meta–analysis in order to determine if catheter ablation for AF is superior to medical therapy in this patients.

Methods Data collection
We applied the methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) statement. We searched Pubmed, and the Cochrane Central Register for randomized controlled trials (RCT) that evaluated AF catheter ablation in patients with SDEF (lower than 35%). Outcome: The primary outcomes were left ventricular ejection fraction (LVEF), 6–minute walk test (6MWT) distance, AF recurrence, and mortality Statistical Analysis: The analyses were performed using RevMan version 5.3. The results are presented as a mean difference for continuous outcome measures (inverse variance random effect model), and odds ratios (OR) for dichotomous outcomes (Mantel–Haenszel random effect model) with 95% confidence interval (CI).

Results
Four full texts met inclusion criteria. A total of 665 patients were included (324 patients randomized to catheter ablation and 341 patients randomized to medical therapy), with a mean follow–up of 15.2 months. Arrhythmia recurrence: AF catheter ablation was effective and significantly more patients were in sinus rhythm at the end of the follow–up (OR 14.51 (4.9–42) p &lt; 0.001) LVEF: compared to medical therapy, AF catheter ablation was associated with a significant increase in LVEF outcome (MD 5.17 (2.06–8.27) p 0.001) 6MWT distance in meters: The mean increase in 6MWT distance was higher in the AF catheter ablation group compared to the medical therapy group (MD 32.7 (13.2–52.3) p 0.001) All–Cause mortality: the risk of death from any cause was significantly lower in the AF ablation arm (OR…).

Conclusions
Summary evidence from the included RCTs showed that AF catheter ablation significantly increases LVEF, 6MWT distance, sinus rhythm maintenance, and overall mortality.
P393 EDOXABAN: NEW PERSPECTIVE IN A PATIENT WITH CANCER–ASSOCIATED THROMBOSIS COMPLICATED BY BRAIN METASTASES. A RARE CLINICAL CASE
Authors: Fioretti A , Leopizzi T , Pizzutilo P , La Forgia D , Oreste D , Marech I , Strippoli S , Fanizzi A , Scicchitano P , Lillo A , Aloisio A , Zito A , Massafra R , Catino A , Mannarini A , Luzzi G , Oliva S 
Published: May 2023

Abstract
Herein, we present the case of a 58 y–o Caucasian man with unremarkable cardiovascular history and a strong family history for cancer. He was diagnosed with lung adenocarcinoma IVb (pleura, pleural effusion, lymph nodes), PDL1: 2% TPS and absence of actionable driver mutations on DNA and RNA NGS (only ERBB2 mutation). Started first–line chemotherapy with cisplatin–pemetrexed regimen and immunotherapy with pembrolizumab. He developed common/superficial femoral and popliteal deep vein thrombosis (DVT) and pulmonary embolism (PE). The patient started low–molecular–weight heparin (LMWH) namely enoxaparin 1 mg/kg x 2/d (weight: 65 Kg). After 1 mo, CT showed PE resolution. Due to DVT persistence and patient’s preference for oral administration, LMWH was replaced with direct oral anticoagulant (DOAC) namely edoxaban 60 mg 1 cp/d. After 2 mo, resolution of common femoral and popliteal vein thrombosis with partial recanalization of superficial femoral DVT were detected. However, he developed brain metastases treated with WB radiotherapy. We decided for edoxaban full dose long–term anticoagulant treatment with monthly cardioncological surveillance. After 6 mo since cancer diagnosis, the patient was still adherent to DOAC therapy, although in a maintenance combined regimen pemetrexed–pembrolizumab based, without both drug–drug interactions and brain bleeding.

Conclusions
Thromboembolism is the second leading cause of death in malignancy. In this clinical case, a man with advanced lung cancer developed extended cancer–associated thrombosis (CAT). However, the appearance of brain metastases has posed a clinical dilemma: to continue or to withdraw the anticoagulant therapy and, also, which drug to choose between LMWH and DOAC. Literature is limited on the use of DOACs in cancer patients with brain metastases. Besides, current guidelines neither advocate contraindication to DOAC, nor suggest caution as requested for gastrointestinal and genitourinary sites of cancer. We decided to proceed with edoxaban therapy, despite chemotherapy combined to immunotherapy were still ongoing and the concurrent appearance of brain metastases, with good results in efficacy, patient’s adherence and, mostly, safety. In conclusion, in regard to our clinical experience, we point out DOAC as a reliable and manageable therapeutical choice in CAT, also in active cancer patients with brain metastases receiving chemo–immunotherapy.
P394 PULMONARY HYPERTENSION IN SEARCH OF GROUP
Authors: Camassa N , Graziadei M , De Tommasi E , De Michele L , Mannarini A , Xhelo A , Lucarelli N , Ceglie M , Tandoi F , Rendina M , Vella S , Sabbà C , D’Agostino C 
Published: May 2023

Abstract
Episode of haemoptysis in a 25–year–old woman with the following medical history: surgical closure of Botallo‘s duct at the age of 5 months, coeliac disease, growth retardation, polycystic ovary, visus alterations. In the emergency room CT angiography of the chest showed the presence of subpleural parenchymal consolidation in the right lower lobe, with associated ground–glass opacities, cardiomegaly, severe pulmonary artery dilatation and hepatomegaly with intrathoracic involvement by a hernia of Morgagni on the right side. A porto–systemic shunt with an intrahepatic course was also noted in the duct at the VIII segment with an autonomic outlet in the right atrium. The patient was transferred to the Internal Medicine ward. Objective examination revealed an elf facies with hypertelorism, short stature, bradypsychism. On interview she reported dyspnoea on light exertion and frequent lipohymic episodes. Haematochemical examinations showed increased of bilirubinemia mainly indirect, Transaminases and of NTproBNP and normal ammonium levels. Blood gas analysis showed a tendency to respiratory alkalosis with oxyaemia at lower limits. Because of the suspicion of a syndromic picture, a genetic examination was performed. Cardiological evaluation showed a high ultrasound probability of pulmonary hypertension (PH). Transferred to cardiology, catheterisation confirmed pulmonary arterial hypertension (mPAP 64mmHg) precapillary (wedge 4mmHg) with high PVR (11 Wood Units) not responsive to nitric oxide. In addition, there was a superior vena cava protruding into the coronary sinus and an extrahepatic shunt with an isolated outlet in the RA without gradient. The hepatobiliary surgery consultation concluded for Abernethy syndrome, which is a rare congenital syndrome characterised by an extrahepatic portosystemic shunt in which the blood from the splanchnic and lienal circulation bypasses the portal vein and the liver, draining into the systemic circulation via an abnormal conduit. PH is a rare complication of this syndrome, maintained by hyperafflux, vasoactive mediators and the formation of microthrombi and intimal fibrosis in the pulmonary circulation. An HR–CT excluded venulo–capillary plexiform disease. Macitentan 10 mg/day was introduced, then continued at home for the benefit shown and follow–up at the Pulmonary Work Group was initiated. This PH, due to its association with an extremely rare pathology, required the collaboration of a diverse group of specialists.
P397 AN UNUSUAL SYMPTOMATIC PERICARDIAL EFFUSION AT THE 24TH GESTATIONAL WEEK
Authors: Condello C , Gasparetto N , Possamai M , Busato E , Gherlinzoni F , Zanatta P , Cernetti C 
Published: May 2023

Abstract

Background
pericardial diseases during pregnancy are rare. The most common are hydropericardium – typically in the third trimester, with spontaneous resolution – and pericarditis. Echocardiogram is the imaging method of first choice for diagnosis.

Clinical case
a 38–year–old woman, at gestational week 24, came to the Emergency Department due to anxiety, shortness of breath, cough, gastroesophageal reflux, inappetence, and sialorrhea, all of which started with the pregnancy and worsened overtime. She underwent cardiological evaluation because of troponin discovered via blood test. The evaluation highlighted mild pericardial effusion. Hence, she was admitted to the Cardiology Department, where a progressive increase of effusion – from mild to severe (in particular in front of apical and posterior segments) without hemodynamic impact – was noted. Corticosteroid therapy was started without clinical improvement and the patient displayed orthopnea, diaphoresis, and oliguria. Through an echographic re–evaluation an hypervascular mass was identified in parasternal view. After a multidisciplinary discussion, a CT scan of thorax and abdomen with contrast (MRI was impracticable due to orthopnea) was carried out with evidence of a mediastinal solid lesion (11,5 x 7 mm) compressing superior vena cava, trachea and principal bronchial branches suggestive of lymphoproliferative disease. A pericardiocentesis was perfomed with evacuation of 400 ml of bloody fluid. The worsening of blood gas test required a tracheal intubation. Therefore, an emergency Cesarean section was executed, and a surgical biopsy of mass was taken with detection of diffuse large B–cell non–Hodgkin‘s lymphoma. Hgh doses of corticosteroids and chemotherapeutic drugs were administered and the patient was extubated after two days. After four therapeutic cycles, a PET–CT scan confirmed remission of the disease.

Conclusion
pregnancy is not a predisposing condition for pericardial diseases. Although pericardial involvement is benign in most cases, the use of corticosteroid therapy after the 20th week of gestation is indicated in suspected pericarditis to avoid fetal complications from NSAIDs. If there is no response, the use of advanced imaging methods (even potentially dangerous to the fetus) should not be procrastinated.