bluuebunny/crossref_metadata_2025_split huggingface dataset:
P345 INTERMEDIATE–TERM RESULTS OF A NEW AORTIC BIOPROSTHESIS IN PATIENTS AT INCREASED RISK OF EARLY SVD
Authors: Paduvakis I , Cerillo A , Stefano P , Petrini F , Manca A 
Published: May 2023

Abstract

Background and aim
Biological prosthesis are increasingly been used in young patients to avoid anticoagulation. The Edwards Inspiris aortic bioprosthesis is extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the haemodynamic performance and clinical outcome of the Inspiris bioprosthesis in patients aged &lt; 50 years.

Methods
Between May 2018 and May 2022, 58 patients aged 41±7.8 years underwent AVR with the Edwards Inspiris bioprosthesis. Twenty–three (39.65%) were younger than 40, and 7 (12.06%) had a BMI &gt;30 kgm2. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 25 (43.10%) patients. There were 10 redo patients (17.2%).

Results
Major complications included bleeding (4), respiratory failure (1) and BAV requiring PMK (1). Two patients died (3.45%). The mean follow up was 29.6±12.3 months (range 10–51). Late valve–related events included endocarditis (2) requiring reoperation. There were no thromboembolic events, valve thrombosis or SVD cases. At follow up, all except one patient reported a significant improvement of their symptomatic status (96.29% were in NYHA II) and quality of life. The mean interval to return to the normal activity was of 5.37±3.3 months.

Conclusion
Our study demonstrates promising results at up to 4 years in a cohort of very young patients. Further studies with longer follow–up are needed.
P346 MINIMALLY INVASIVE APPROACH FOR THE SURGICAL TREATMENT OF COMBINED MITRAL AND AORTIC VALVE DISEASE
Authors: Fiorentino M , Mikus E , Tripodi A , Sangiorgi D , Calvi S , Tenti E , Panzavolta M , Tizzano F , Savini C 
Published: May 2023

Abstract

Background
Minimally invasive approaches are more and more used for isolated aortic or mitral valve procedures. However, minimally invasive combined mitral and aortic valve surgery is still uncommon. We report our experience performing multiple valve procedures through a right–sided mini–thoracotomy.

Methods
From November 2013 to July 2022, 32 patients underwent aortic and mitral valve surgery through right anterior thoracotomy.

Results
Median (Q1–Q3) age of our population was 71 years (59,5–76) and 59% were females. Median (Q1–Q3) logistic Euroscore was 3.99 (2.52–6.76) and median (Q1–Q3) EuroSCORE II was 2.28 (1.81–5.42). Three patients (9%) were redo operations. Median cardiopulmonary bypass and cross–clamp times were 95 (83–118) minutes and 83 (71–104) minutes, respectively. No conversion to full sternotomy was necessary. In–hospital mortality was 3.1% (1 patient) who died for septic shock and consequent multi–organ failure. 62% of patients required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 8 patients (25%) and 2 patient (6%) required Pace–maker implantation due to third degree AV block. Also, 1 (3%) re–thoracotomy for bleeding was observed. Median (Q1–Q3) intensive care unit and in–hospital length of stay were 2 (2–3) days and 9 (8–11) days respectively. Median follow up period was 5.5 years (1.4–6.3) with 87.5% survival rate (incidence rate of death: 2.8 per 100 patient–years). Re–operation rate was 9.4%.

Conclusions
In our experience, a minimally invasive approach for combined aortic and mitral valve surgery is safe and feasible, with acceptable cardiopulmonary bypass and cross–clamp times and good outcomes. Therefore, it can be an attractive option for patients with double valve diseases. Further studies are needed with a bigger population and a comparison to full sternotomy results.
P395 PULMONARY HYPERTENSION OUTPATIENT CLINIC IN CUNEO: SUMMARY OF THE FIRST TWO YEARS OF ACTIVITY
Authors: Giordana F , Cinconze S , Ferraro I , Coppini L , Bongiovanni V , Perilli A , De Benedetto Fabrizi M , Baralis G , Coletta G , Rossini R 
Published: May 2023

Abstract
Backgroung: Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and may be associated with a variety of cardiovascular and respiratory diseases. PH is defined by a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg at rest,assessed by right heart catheterization (RHC).

Methods
The Cardiology Rare Disease Outpatient Clinic was opened in 2021 in the Cardiology Division of S. Croce and Carle Hospital, Cuneo. In this ambulatory setting, patients with suspected or confirmed PH diagnosis were screened and followed up. The outpatient evaluation included cardiological physical examination, electrocardiogram (ECG) and transthoracic echocardiogram. In case of echocardiographic PH suspicion (intermediate or high probability) a comprehensive work–up was performed with first level diagnostic tools (respiratory function tests with DLCO, high–resolution chest CT, arterial blood gases, blood tests and overnight oximetry or polysomnography). Eventually, lung scintigraphy was performed and work up was completed with RHC with vasoreactivity test with nitric oxide (NO) if indicated. Multidisciplinary team approach proved to be an essential requirement for good practice in this setting.

Results
Between January 2021 and December 2022, 95 patients were evaluated in the PH outpatient clinic; Sixty–one (63%) patients were female, mean age was 66 years. Forty–two (42%) patients were referred from Rheumatology, 9 (9%) from Pulmonologiy, 13 (14%) from Emergency Medicine or Internal Medicine, 20 (21%) from Cardiology, and the remaining 13 (14%) patients from other departments or from other hospitals. Following clinical and echocardiographic evaluation, patients were stratified into low, intermediate and high PH–risk levels. In 23 (24%) patients RHC was performed and in one case it was associated with vasoreactivity test with NO. Eight (8%) patients with chronic thromboembolic PH (CTEPH) suspicion were referred to the Hub Center in Pavia to evaluate pulmonary endarterectomy. Seven (7%) patients were treated with specific therapy for group 1 PH and 3 (3%) patients for CTEPH. Two (2%) patients died during follow–up.

Conclusions
The aim of the dedicated PH outpatient clinic is to screen patients and identify those who need a complete work–up for diagnosis and classification of PH subtypes, in order to select those patients who could benefit from specific PH therapies, and to monitor the response at FU.
P430 SCARE PROJECT: SUDDEN DEATH IN RIMINI
Authors: Saporito D , Marzaloni S , Carigi S , Baldazzi F , Spighi L , Righetti E , Fabbri F , Di Cesare A , Giuliani G , Montomoli J , Santarelli A 
Published: May 2023

Abstract
Sudden death guidelines make emphasis on the need to identify the etihiology of the arrest in survived patients or in their family members. If cardio–pulmonary resuscitation techniques are almost standardized throughout the world, the intra– and post–hospital treatment of the patient changes in the different centers and countries. The local discrepancies related to the survival rate of the patients can instead be considered as an indirect index of the good network in the management of the victims. Given the impossibility of carrying out randomized, controlled and prospective studies, registries represent the only alternative system for collecting and analyzing data in this area. The SCARe (Sudden Cardiac Arrest Registry) project – unique for being multidisciplinary – represents the most effective system for carrying out an epidemiological investigation, optimizing the treatment of patients affected by cardiac arrest, creating collaborations and integrations between hospitals and the territory, identifying diagnostic pathways for study of family members, monitoring the efficiency of the work performed. 646 interventions for "code blue" (out–of–hospital cardiac arrest) carried out in the Province of Rimini from 2019 to 2021 were analysed. There were 318 patients less than 75 yrs old, with a median age of 63 years: only 24% of the victims presented with a shockable rhythm, in 98% of them with ventricular fibrillation; autopulse was used in 20%; 217 patiente died out from hospital, 5 in the emergency room. Of the remaining 72% was hospitalized in Intensive Care, 28% in CCU or Emergency Medicine. A multi–specialist database can evaluate the adherence to the guidelines and the methods of approach of the different professional figures to the patient. Data analysis will allow to increase the survival rate of patients.
P435 THE IMPORTANCE OF CORRELATION BETWEEN HEART FAILURE AND THYROID: A CASE REPORT
Authors: Falco O , Taras S , Maninchedda P , Cambule S , Atzori M 
Published: May 2023

Abstract
A 39–year–old African man was admitted to our department within a four days symptoms of short of breath, cough, tachycardia and lower limb edema. He also complained headache for about a month. He denied fever, chest pain and loss of consciousness. Clinical and family history were unremarkable. Blood tests showed moderate microcytic anemia ( Hb 9.6 g/dl, MCV 93.3 fL), hypoalbuminemia ( Albumin: 3.20 g/dl), elevated levels of LDH ( LDH: 246 U/L), mild C–reactive protein (CRP) and pro–Brain Natriuretic Peptide (pro–BNP) increase (CRP: 1.14 mg/dl); (PRO–BNP: 1133 pg/mL) and negative troponin. Given the clinical picture suggestive of heart failure, we immediately started diuretic therapy with benefit. Chest–x ray revealed a modest thickening of the pulmonary interstitium, electrocardiogram (ECG) a sinus rhythm and early repolarization changes. Chest CT highlighted a bilateral apical–basal pleural effusion, a bilateral hilar ectasia and interstitial markings due to stasis. He underwent an ultrasound of the abdomen that was normal. Thyroid function tests showed high levels of thyroid hormones with suppressed TSH and elevated levels of Ab anti–receptor TSH ( FT3: 8.73 pg/mL; FT4: 2.35 ng/dL; TSH&lt;0.01 mUI/ml; TRAB: 3.62 UI/L). Thyroid ultrasound showed a multinodular goiter. The patient began therapy with Tapazole. Echocardiogram didn’t show any evidence of acute heart disease and systolic function was normal. After discharge he performed a heart MRI with evidence of no alteration of global systolic function, of regional left and right ventricular kinetics or of pathological areas of delayed enhancement in relation to myocardial edema/fibrosis/necrosis. Hyperthyroid patients can show signs and symptoms of heart failure that are due to the hyperdynamic circulatory state and/or to the frequent pulmonary arterial hypertension and our case report demonstrates that this clinical status tends to improve with the restoration of euthyroidism, but if left untreated, can worsen over the time leading to heart failure.
P439 INTERPRETING CARDIOVASCULAR TRIALS WITH NEUTRAL OR NEGATIVE RESULTS TRIALS: A MULTISTEP APPROACH
Authors: Aimo A , Rapezzi C , Fabiani I , Castiglione V , Emdin M , Ferrari R , Maggioni A , Tavazzi L 
Published: May 2023

Abstract
Despite great progress in randomized controlled trial (RCT) design, several methodological issues can still be encountered when reading superiority trials published in leading journals. We propose a 10–step approach to the interpretation of neutral or negative trials to exclude important methodological issues before concluding that the treatment does not work (Figure). 1. Premature interruption Except when there is evidence of superiority at interim analysis, all premature discontinuations make the RCT underpowered. 2. Insufficient power Insufficient power may derive from lower event rates than anticipated or a smaller effect size than expected. Two other possible reasons are a high cross–over rate or a number of events “hypertrophied” by minor events or medical decisions. 3. Logistical peculiarities Logistical issues, e.g., heterogeneous patient selection and management in different geographic areas, are sometimes crucial. 4. Errors or ambiguities in endpoint adjudication Cardiovascular death and HF hospitalization are often used as endpoints. In some cases, the discrepancy between investigator–reported and centrally adjudicated events is quite prominent. Furthermore, some endpoint definitions may be open to interpretation. 5. Suboptimal choice of composite endpoints A composite endpoint should have clinical relevance and should include only elements to be impacted by the intervention. This last requirement is often not met. 6. Nosographic trap The nosographic trap occurs when the study population is heterogeneous, and the importance of the treatment target is not the same across the whole population. 7. Lack of pathophysiological prerequisites for efficacy Some RCTs may prove neutral or negative because they enrolled patients where the treatment was unlikely to be effective. 8. Algebraic cancellation Algebraic cancellation occurs when results are positive in some patients and negative in others. 9. p trap A possible instance is that p value approaches the statistical significance value, leading to uncertainties as to whether borderline significance should be interpreted. 10. The treatment does not really work When a trial is adequately powered and without major methodological flaws, but the p value for the primary endpoint is far from significance (and therefore the p trap is not an issue), the reasonable conclusion is that the treatment is not more effective than its comparator in this specific setting.
P457 ISCHEMIC STROKE AS A FIRST PRESENTATION OF ATYPICAL ENDOCARDITIS AFTER SINGLE CORONARY ARTERY BYPASS GRAFTING (CABG) AND MITRAL VALVE REPLACEMENT
Authors: Speziali N , Benzoni G , Martano S , Ravaro S , Fratianni G , Seravalle G , Parati G , Gavazzoni M , Verde F , Castelletti S , Chianca R , Crotti L 
Published: May 2023

Abstract
A 71–year–old patient with a history of prostatic cancer, recently underwent CABG and mitral valve replacement and during cardiac rehabilitation (CR) was diagnosed with a cryptogenic stroke while on treatment with oral anticoagulant and antiaggregants. It is worth mentioning that during hospitalization he suffered several feverish episodes without major organ involvement with the only exception of the one related to the chest scar infection. He was admitted to CR department with high fever (38.5 C) and hemocultures were positive for Staphylococcus epidermidis which was also isolated from the chest scar. The transthoracic echocardiogram executed at the admission did not show any pathological alteration. After 5 days of antibiotic therapy and optimized medical therapy, he had an ischemic stroke. NIHSS score was initially 10. Acute presentation of ischemic stroke was peculiar: he had left hemiparesis with Babinski sign, but a concomitant Broca‘s aphasia, thus suggesting multiple areas of cerebral ischemia. He was evaluated with a basal computerized tomography (CT) scan which didn’t show any sign of ischemic stroke and NIHSS score completely reversed after 30 minutes to 0: this was more suggestive for a transient ischemic attack rather than ischemic stroke but despite the negative CT scan, the subsequent cerebral magnetic resonance imaging showed ischemic signs localized in different vascular territories. Supra–aortic vessels were normal. Therefore, we performed a transesophageal echocardiography (TEE) which showed a peculiar vegetation over the mitral valve, presenting more as a filament rather than typical vegetation. Despite the absence of fever, negative PCR, negative procalcitonine and white blood cells within the normal limits, we performed hemocultures and Staphylococcus haemolyticus was isolated. Antibiotic therapy was immediately started; however, after three weeks of appropriate therapy the TEE exam showed an evolution of the valve’s lesion which required surgical revision.

Conclusion
This case highlights how ischemic stroke related to multiple ischemic foci may be the only sign of an underlying endocarditis that caused septic embolization. Indeed, the patient was completely asymptomatic, did not have fever, inflammatory markers were negative and only clinical investigations to understand the nature of his stroke allowed us to make the diagnosis of endocarditis.
P462 ATRIAL FIBRILLATION CIED DETECTED; WHEN TO SCOAGULATE? OUR EXPERIENCE ON A STILL VERY CONTROVERSIAL TOPIC
Authors: Scapinelli M , Guerra A , Bagni E 
Published: May 2023

Abstract

Introduction
Atrial fibrillation (AF), which is constantly increasing in the population, is associated with an important care burden linked, in particular, to its consequences (stroke, heart failure, etc.). In patients with an implantable cardiac device (CIED) it is frequent the detection of high atrial frequency episodes (AHRE), often asymptomatic, for which an increased thromboembolic risk has been described (about 2.5 times) but lower than the clinical AF for which there is still no unanimous consensus regarding the initiation of oral anticoagulant therapy (OAT). We report below our experience in patients undergoing CIED implantation in whom AHRE was detected and OAT started, evaluating the characteristics of thromboembolic risk and the follow–up of complications.

Methods
From 01 January 2020 to 31 December 2021, 242 patients (mean age 74.8 years) underwent CIED implant. Among these, 41 patients (16.9% mean age 78.6 years – 30 males and 11 females) presented episodes of AHRE, detected by remote monitoring, lasting between a few seconds and more than 24 hours. The mean CHADsVasc score of these patients was 3.8. Seven patients were not anticoagulated due to arrhythmic episodes lasting a few minutes and CHADsVasc score equal to 1–2, while the other 34 started OAT with DOAC.

Results
No thromboembolic events or major bleeding events have been recorded to date; only minor bleedings (11 epistaxis, 4 haematuria and 5 SOF positivity) were easily treated.

Conclusions
The current guidelines indicate to prolong monitoring until the detection of clinical AF or an arrhythmic burden &gt; 24 hours before considering OAT; however, there are studies that recommend carefully correlating the duration of arrhythmic events with the determination of the thromboembolic risk. In our experience, the high thromboembolic risk of patients, sometimes not adequately represented by the CHADsVasc score, led us to start OAT even when the duration of the episodes was not particularly long and at the moment no major complications have been observed. The two ongoing trials (ARTESia and NOAH) dedicated to the evaluation of these situations will provide valuable indications on the treatment of these patients in whom the thromboembolic risk is certainly lower than that of patients with clinical AF but still not negligible.
P479 PATIENT WITH REGRESSION MULTIPLE MYELOMA AND INFILTRATIVE HYPERTROPHIC CARDIOMYOPATHY OF NDD UNDERGO CARDIAC TRANSPLANT
Authors: Savino L , Giovannico L , Parigino D , D‘errico Ramirez A , Fischetti G , Santeramo V , Silva A , Milano A , Bottio T 
Published: May 2023

Abstract

Introduction
We report the case of a 52–year–old patient with a history of multiple myeloma undergoing chemotherapy treatment according to the DaraRD scheme and currently in remission. Associated with haematological pathology, infiltrative hypertrophic cardiomyopathy of ndd is highlighted. Following haematological and instrumental screening tests, the patient underwent a heart transplant for frequent exacerbations of heart failure.

Case Report
A 52–year–old patient, suffering from multiple myeloma for about 1 year, for which he began chemotherapy treatment with DaraRD scheme and good response to therapy. The patient also presented dyspnoic symptoms and declining edema with echocardiographic finding of infiltrative hypertrophic heart disease for which he undergoes diagnostic investigations. He performs: • Serial echocardiograms which showed marked uniform hypertrophy with ground glass appearance of the left ventricle and severely reduced systolic function; • PET–CT with no hyperaccumulation of the radiopharmaceutical; • Cardiac MRI with evidence of severely hypocontractile left ventricle and wall changes which could be associated with amyloid infiltration; • myocardial scintigraphy that does not give evidence for the deposit of the amyloid substance of the ATTR type in the heart; • biopsy of umbilical fat and cardiac biopsy, both negative for deposition of substance AL with Congo Red staining; • Right cardiac catheterization with evidence of post–capillary pulmonary hypertension. The patient was subjected to several exacerbations of heart failure which required continuous infusion therapy with inotropes and, ultimately, heart transplantation. At the time of surgery, the heart appeared enlarged, extremely hypocontractile and with rigid walls, with poor compliance of the ventricular muscle wall. The patient responded well to the surgical procedure, in the absence of signs and symptoms of rejection, with improvement of general clinical condition.

Conclusions
At the end of the surgical procedure and the rehabilitation period, the patient was discharged home, without showing signs and symptoms of graft rejection or multiple myeloma exacerbations, in stable and satisfactory general clinical conditions.
P489 A VERY DIFFICULT PATIENT
Authors: Corleto A , Giolitto S , Varbella F 
Published: May 2023

Abstract
68–year–old woman, normal weight, dyslipidemic, with family history of ischemic heart disease. Hypothyroidism in treatment. Peripheral vascular disease: bilateral carotid artery disease. She reported adverse effects on muscle (pain with rise in CPK) and on liver (ALT elevation clinically relevant) during simvastatin/ezetimib 10/10 mg taking March 2020 hospitalized for myocardial infarction without ST–segment elevation. Coronary angiography revealed three–vessel disease with subocclusive stenosis of the medium tract of circumflex, medium tract of anterior descending and medium tract of right coronary artery, all treated with angioplasty and drug–eluting stents. Preserved left ventricular ejection fraction on echocardiograpy. Blood LDL 216 mg/dl so we started therapy with Evolocumab 140 mg every 15 days. After 6 months of therapy LDL was 137 mg/dl. Non–target LDL values so Evolocumab 140mg was stopped and Alirocumab 150 mg started. January 2021 hospitalized for suspected recurrence angina. Coronary angiography unchanged. LDL 194 mg/dl so ezetimib 10 mg was associated to alirocumab (statin intolerance). September 2022 cardiology visit for alirocumab PT renewal. LDL 92 mg/dl. Patient wanted to stop PCSK9 inhibitory monoclonal antibodies therapy due to intolerance to drug self–administration. For this reason, we suggested Inclisiran 300 mg administration in association with ezetimibe 10 mg. The administration took place in cardiology outpatient clinic with patient satisfaction. At one month, dosage LDL 78 mg/dl, at 3 months LDL 72 mg/dl.

Conclusions
The innovative mechanism of action, with only two administrations per year, and the healthcare professional administration, allow Inclisiran to obtain a rapid and sustained LDL reduction over time even in conditions of poorly adherent patients to lipid–lowering therapies. Inclisiran is the first siRNA that reduces LDL levels by silencing the mRNA of the PCSK9 protein, involved in the degradation of R–LDL receptors on hepatocytes. Inclisiran allows, in combination with statin and ezetimib, to reach the target levels of LDL–C with two administrations a year. We wait for LDL value in the coming months to confirm its effectiveness over time.