bluuebunny/crossref_metadata_2025_split huggingface dataset:
P214 THE THERAPEUTIC IMPLICATIONS OF A FATAL COINCIDENCE
Authors: Fiorella A , D‘Alessandro G , Rodio G , Pollicino T , Abbracciavento L , Luzzi G 
Published: May 2023

Abstract

Background
Factor VII deficiency is a rare, inherited disorder secondary to a reduction or absence of factor VII (FVII) of the coagulation pathway presenting with autosomal recessive transmission and caused by different types of mutation of the F7 gene. The clinical manifestations of the syndrome are highly variable: depending on the case, it can remain asymptomatic, or it can present with episodes of bleeding secondary to trauma and surgery, or it can manifest with potentially fatal spontaneous hemorrhages. It can be treated by long–term replacement prophylaxis, which consists of periodic infusions of FVII concentrates.

Clinical case
A 75–year–old woman presented to the emergency room in a soporose state. On the electrocardiogram, ST–segment elevation in the antero–septal and in AVR and septal akinesia affecting the left ventricle was shown. On admission, she presented with syncope, marked hypotension, and tonic–clonic spasm. Blood tests showed sodium levels of 112 mEq/L, secondary to the administration of high doses of Escitalopram and associated with the genesis of epileptic seizures. During the emergency coronary angiography, severe stenosis of mid–proximal IVA was seenand subsequently treated with PTCA/DES. Right before the procedure, therapy with Acetylsalicylic acid (ASA) 250 mg, Ticagrelor 180 mg, and Heparin sodium was administered 5000 IU + 5000 IU. Immediately after, severe anemia (5.9 Hb) and INR lengthening were demonstrated, with widespread skin hematomas. In the complete study of the coagulative state, an almost complete factor VII deficiency was found, which required infusion of factor VII concentrate. The subsequent course was further complicated by pre–renal acute renal failure and paroxysmal atrial fibrillation. Following the initial suspension of antiplatelet and anticoagulant therapy (OAT), it was possible to reintroduce, without loading dose, ASA and clopidogrel, preserving OAT for later phases.

Discussion and Conclusions
FVII deficiency, a rare hemorrhagic disorder, may represent a fatal coincidence in the context of myocardial infarction, due to the therapeutic implications of the pathology, which may lead to inevitable uncontrolled bleeding. This occurrence is difficult to predict in some cases, including the present one. It would be interesting to identify indicators that could prompt, even in an emergency setting, the suspicion of such a dangerous association.
P217 SHORT–TERM EFFECTS OF DAPAGLIFLOZIN ON CARDIAC BIOMARKERS, FLUID RETENTION, RENAL AND PULMONARY FUNCTION IN HFREF PATIENTS: NOT AS GOOD AS EXPECTED
Authors: Mapelli M , Capovilla T , Marongiu A , Maranzano G , Salvioni E , Mattavelli I , Paganin C , Vignati C , Gugliandolo P , Mantegazza V , Garlaschè A , Sinagra G , Agostoni P 
Published: May 2023

Abstract

Background
Sodium–glucose co–transporter–2 inhibitors (SGLT2–i) are currently a standard therapy for patients with heart failure with reduced ejection fraction (HFrEF). Still, their potential benefits on biomarkers, respiratory function parameters and fluid retention have not been extensively studied. Bioimpedance vector analysis (BIVA) has emerged as a new tool capable of assessing congestion, providing an estimate of the total body water and hydration index (HI). BIVA is more accurate than NT–proBNP in detecting peripheral congestion in chronic heart failure and can be used to evaluate the effects of the treatment. This study aims to assess the short–term effects of Dapagliflozin on spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), cardiac biomarkers, and BIVA.

Methods
Stable HF patients (EF &lt;40%, NYHA class II or III) eligible for SGLT2–I therapy according to guidelines underwent standard spirometry, DLCO, BIVA and venous blood sampling at baseline (V0) and after 2–4 weeks of therapy (V1).

Results
Patients characteristics (N=32) at baseline are shown in Table 1. None of the patients interrupted the treatment and/or experienced adverse events. After 26±6 days, we observed worsening of renal function (eGFR from 73.1±28.5 mL/min/1.73m2 to 67.4±27.0 mL/min/1.73m2, p&lt;0.001) and potassium levels (4.36±0.36 mEq/l vs 4.58±0.57 mEq/l, p= 0.017). There were no significant changes in NT–proBNP levels (1378 [615–2542] ng/l vs 1034 [554–2552] ng/l, p= 0.538). HI, total body water, DLCO and spirometry values did not change. On the contrary, a mild reduction in hsTnI was observed (13.88 [9.24–26.8] ng/l vs 11.58 [7.7–24.2] ng/l).

Conclusions
Our study did not detect short–term effects of Dapagliflozin on spirometry values, DLCO, fluid retention and NT–proBNP. As revealed in DAPA–HF trial, a mild worsening of potassium and serum creatinine levels was observed. Taken together, these results suggest that the favourable effects of Dapagliflozin could unfold over a longer period of time. A more extended follow–up and a larger population are needed to confirm these preliminary data.
P219 EXTRINSIC COMPRESSION OF THE RIGHT VENTRICLE CAUSING ISOLATED RIGHT HEART FAILURE
Authors: Indennidate C , Massa L , Merlo M , Sinagra G 
Published: May 2023

Abstract
Isolated right heart failure (RHF) can be caused by right ventricular (RV) compression, mainly described in severe cases of pectus excavatum. Mediastinal masses can determine an extrinsic compression of the RV. A 62–year–old retired agricultural inspector from Sicily presented in our clinic with worsening signs of RHF. His medical history consisted of echinococcosis familiarity, surgically treated congenital subvalvular aortic stenosis, resulted in a residual moderate aortic insufficiency and permanent atrial fibrillation. Around January 2021 he developed isolated leg swelling. Aortic valvular dysfunction, heart failure and other cardiogenic explanations were excluded. A year later dyspnea (NYHA class II) appeared. High resolution CT demonstrated fluid collection with peripheric calcifications inside the anterior mediastinum. PET showed uptake in a limited zone of the anterior mediastinum. The patient slowly started developing ascites, hardly manageable with diuretics because of kidney failure. Transthoracic echocardiography (TTE) highlighted mild RV dysfunction (FAC 35%) and right ventricular free wall hypokinesia due to the mediastinal mass extrinsic compression. Transesophageal echocardiography showed a heterogeneous cystic aspect of the mediastinal mass, an oscillating intraventricular mass of the right aortic cuspid (6x4 mm) and a severe mitral annular calcification. In consideration of medical history, endocarditis was considered. Cardiac magnetic resonance recognized a mediastinal mass with echinococcosis features. Echinococcous serology and antibodies were negative but the Quantiferon tested positive. Laboratory tests showed an absolute eosinophilia and a high CD4/CD8 ratio. Because of the patient severely compromised hemodynamic balance the mass was surgically removed and identified as pseudocystic tuberculoma. After the excision, hemodynamic balance was improved and the TTE showed a restored RV function with persistent hypokinesia of the RV free wall and increased right atrium pressure. In this clinical case RHF was determined by an extracardiac mass which interfered with the hemodynamic balance and the function of the right heart in the absence of any signs of left heart failure. Because of the mass mechanical action on the reduction of RV ejected volumes, a surgical option was the only possible strategy to avoid a following worsening of the heart failure.
P220 PERIPARTUM CARDIOMYOPATHY: HOW TO RECOGNIZE AND TREAT IT
Authors: Terrinoni F , Liberatore I , Basso V , Imparato L , Sciarra L , Romano S 
Published: May 2023

Abstract

Introduction
Peripartum cardiomyopathy is characterized by LV systolic dysfunction in the absence of other existing cardiac disease. It presents with clinical signs of acute heart failure, with ventricular arrhythmias or cardiac arrest in the last stages of pregnancy up to 5–6 months after delivery. The LV may be non–dilated, but EF is usually &lt;45%. Initial EF &lt;30%, end–diastolic LV diameter ≥6 cm, and RV involvement are associated with adverse outcomes. Case report: 44–year–old female, denies CAD and home therapy. It occurs due to the appearance of peripheral edema, worsening dyspnea and forced orthopneic decubitus arising after cesarean delivery which occurred 3 days earlier. On auscultation: MV abolished at the right base with diffuse rales. In the laboratory increased BNP is evident. (1485 pg/mL). On ECG Sinus tachycardia, 126 bpm. New onset BBSs. PA 100/60. Respiratory acidosis at the EGA. On Echocardiogram (Fig.1) dilated LV with severe reduction of EF 25/30%, moderate–severe IM, RV within limits. Moderate IT with PAPs 40 mmHg. Vena cava dilated, hypo collapsible. Minimal pericardial detachment. At Wcm Pulmonary CT with picture of acute pulmonary edema and apical–basal right pleural effusion, cardiogenic involvement in the interstitial–alveolar phase (Fig. 2). It is treated with inotropics, high dose diuretics and CPAP ventilation with progressive improvement. She underwent Cardiac MR (Fig. 3), to exclude ischemia, myocarditis or heart disease, which described a picture of non–ischaemic dilated heart disease of the LV with severe systolic dysfunction, moderate RV dysfunction and modest MI. On discharge, therapy with B–blockers, loop diuretics, MRA, ARNI and subsequently SGLUT–2 inhibitor was introduced. In relation to age and EF she was referred for evaluation for transplant listing and CRT–D evaluation.

Conclusion
it is a rare disease: 50% of patients improve with standard medical treatment; 25% develop chronic heart failure and the rest die in the course of the disease. The onset is subtle with non–specific signs and symptoms often confused with "inconveniences" related to the pregnancy itself. To limit the diagnostic delay it is necessary to pay attention to the appearance of tachycardia, third heart sound, basal crackling rales and jugular venous turgor, since they are not physiologically present in pregnancy and to carry out a control echocardiogram especially if in old age.
P222 POSTINFARCT CARDIAC FREE WALL RUPTURE DETECTED BY CARDIAC CT
Authors: Berloni M , Tonet E , Campo G , Guardigli G 
Published: May 2023

Abstract
A 57–years–old man with a history of smoke and hypertension was transferred to our unit with chest pain and dyspnoea, lasting few days. Electrocardiography revealed the presence of ST elevation in the infero–lateral leads with Q waves and Transthoracic Echocardiographic Study revealed a normal dimension left ventricle with infero–postero–lateral akinesia, moderately reduced EF (40%) in the absence of significant valve disease and an organized pericardial effusion of about one centimetre. In the meantime, the first signs of hemodynamic instability and cardiogenic shock appeared and the ETT revealed the exacerbation of the pericardial effusion. So we did an emergency coronary angiography that revealed a calcified three–vessel disease with occlusion of the middle segment of Cx. Because of the worsening of the cardiogenic shock we used the aortic balloon pump to improve the hemodynamic instability. The concomitant presence of signs of late infarction, pericardial effusion and cardiogenic shock make us suspect a myocardial rupture so we did a cardiac computed tomography (CT ) scan that was suggestive for a cardiac wall rupture within the infarcted left ventricle. The patient was urgently transported to the cardiac surgery room where the patch of inferior wall was performed and then was transferred to the Intensive Care Unit. After the surgery, a residual of pericardial effusion persisted without hemodynamic significant and the revascularization was planned one month after discharge. Heart rupture represents a mechanical complication of MI that we have to suspect every time we find signs of myocardial infarction and pericardial effusion that degenerate into cardiogenic shock. Although it occurs in a very limited number of cases, the postinfarct cardiac free wall rupture is characterized by a poor prognosis and cardiac Computed Tomography provides primary information for the diagnosis.
P223 MYOCARDIAL INJURY AFTER NONCARDIAC SURGERY (MINS): A RETROSPECTIVE ANALISYS OF OUR LAST TWO YEARS OF WORK
Authors: Tufano N 
Published: May 2023

Abstract

Introduction
Myocardial injury is defined as an elevation of troponin due to ischemic causes, with or without clinical signs. In the myocardial injury after noncardiac surgery (MINS), troponin elevation usually occurs without signs of ischemia. The etiology of this perioperative pathology, is in most cases based on a mismatch between oxigen supply and demand. Recently, expert consensus and european guidelines suggest the implementation of diagnostic tools for perioperatory screening of patients at risk of MINS. Aims: to evaluate the clinical course of patients who have experienced MINS in the last two years in our hospital, in order to identity the lacks of our diagnostic and terapeutic tools.

Methods
we retrospectively evaluated 122 consecutive patients who experienced MINS in the perioperative period from january 2021 to december 2022. For each patient, we have collected data regarding clinical, strumental and laboratoristics characteristics, such as biomarkers, risk factors and type/urgency of surgery.

Results
more than half of patients with MINS (54%) had a low patient–related risk, whereas only 17% of them had a high risk. Regarding the surgery–related risk, only a third of patients (33.6%) had high risk related to the type or urgency of surgery, whereas two thirds of them (66.3%) had low or intermediate risk related to surgery. Combining these risks, resulted that only a minority of patients (5%) had both patient related and surgery–related risk, whereas less than a half (42%) of patients had a high patient related or high surgery related risk. Instead, most of the patients (68%) had low patient–related risk or low surgery related risk. All patients had a pre–operative electrocardiogram. More than a half (54,9%) of patients had a pre–operative transthoracic echocardiography. Large majority (95,6%) of patients had a pre–operative troponin.

Conclusion
careful assessment with patient–related and surgery–related cross risk, such as adoption of common diagnostic tools did not allow us to adopt an effective peri–operative screening for patients at risk of MINS.
P226 A STRANGE CASE OF ISOLATED RIGHT VENTRICULAR DYSFUNCTION
Authors: Tadiello E , Bilato C 
Published: May 2023

Abstract

Introduction
In Europe, approximately 29% of the population aged between 15 and 64 have used illicit drugs. Italy is at the top of this ranking. Description 45–year–old female, no previous cardiology events. She enters the Emergency Department for typical chest pain following alcohol and cocaine abuse. EKG (see figure 1) detects sinus tachycardia and mild non–specific changes in ventricular repolarization. Blood tests reveal an increase in Troponin T levels (305 ng/L, NV &lt; 14 ng/L, then decreased with subsequent measurements) and D–dimer (902 mg/mL, NV &lt; 500 mg/mL). Echocardiography reveals a non–dilated right ventricle with severe systolic dysfunction (TAPSE 11 mm). No signs of pulmonary hypertension but a dilated and hypocollapsing inferior vena cava is noted. Abnormal motion of the interventricular septum with systolic d–shape is present (see figure 2). Left ventricle appears normal. Pulmonary angio–Tc was negative for embolic phenomena and coronary angiography detects no lesions on coronary arteries. At discharge, right ventricular systolic dysfunction and septal d–shape were completely regressed (see Figure 3).

Discussion
Cocaine is a strong systemic adrenergic agonist, which can cause vasospasm of small arterioles of the cardiac microcirculation with possible formation of intracoronary thrombi. Peculiarity of this case is the selective and reversible involvement of the right ventricle, an extremely rare presentation as evidenced by the almost absence of scientific literature on the subject (there is only a similar case report published on the American Journal of Emergency Medicine in 2015). Reversible damage from vasospasm and/or intracoronary thrombosis localized to the marginal branch of the right coronary artery, induced by cocaine use, is conceivable. D–shape of the interventricular septum associated with right ventricular dilatation is likely caused by acute right ventricular failure causing volume overload in the right sections. Take home message Drugs abuse is a widespread problem among the population. Cocaine intake is associated with important adverse cardiovascular effects. A rare presentation can be isolated right ventricular ischemia associated with acute right heart failure.
P227 THE UNEXPECTED CONSEQUENCES OF A 30 METERS FALL
Authors: Palazzini M , Sormani P , Ammirati E , Bossi I , Soriano F , Colombo P , Gentile P , Garascia A , Oliva F , Oreglia J 
Published: May 2023

Abstract

Introduction
Acute myocardial infarction (AMI) is a rare but often lethal consequence of a blunt cardiac trauma. Falls leading to coronary artery dissections are rare, thus underlining the lack of experience in their management. Case report description: a 55–year–old male patient with type 2 diabetes and no relevant past medical history was admitted to our hospital facility after a 30–meter fall during rock–climbing. On arrival, he was hemodynamically and neurologically stable. He underwent a full trauma evaluation: multiple facial bones fractures were diagnosed. An electrocardiogram revealed a QS morphology of the QRS and ST elevation in the precordial lead from V1 to V3 with reciprocal ST depression in the inferior leads. High sensitivity (hs) Troponin T was slightly elevated (49 ng/L, normal values &lt;14 ng/L). A cardiac ultrasound documented a left ventricular dysfunction (LVEF 40%) with akinesia of mid–apical antero–septal and anterior walls. Biomarkers further increased with Troponin reaching 199 ng/L and creatinine phosphokinase–MB 24,7 ug/L (normal value &lt;5 ug/L). Coronary angiography demonstrated proximal occlusion of the left anterior descending (LAD) coronary artery with an image consistent with traumatic coronary artery dissection, confirmed by a cardiac CT scan showing the proximal occlusion of the LAD with retrograde perfusion of its downstream portion. Considering the left ventricular dysfunction, the elevation of cardiac biomarkers (peak CK–MB 187 ug/L, peak hs troponin T 5400 ng/L) and the acceptable hemorrhagic risk in spite of the need for facial surgery, a coronary angioplasty was performed. A dual antiplatlet therapy with acetilsalicidic acid and clopidogrel began. Nine days later the patient underwent the maxillo–facial surgery: clopidogrel was stopped provisionally and a bridge strategy using tirofiban was chosen. Post–operatory was uneventful. A full recovery of cardiac function was assessed after one year (LVEF of 55%).

Discussion
Few cases of blunt cardiac trauma with coronary artery dissections have been reported and treated successfully, with the LAD being the most frequently involved vessel (76%). If urgent non–cardiac surgery can be postponed, a percutaneus revascularization eventually followed by tirofiban as bridge therapy can be suggested, carefully considering the risk of stent thrombosis and the hemorrhagic risk conveyed by the trauma itself.
P228 MINOCA/TYPE 2 IMA: WHEN WE HAVE TO EXIT FROM STANDARD DIAGNOSTIC FLOW–CHART
Authors: Cante L , Bassanelli G , Lenatti L , Bianchi A , Farina A 
Published: May 2023

Abstract
MINOCA is an Acute Myocardial Infarction (AMI), defined on the basis of Fouth Universal Definition, in absence of epicardial coronaries stenosis &gt;50%. This definition is very broad, including typical mechanisms of type 1 and type 2 AMI. Diagnostic flow–chart recommended by ESC and AHA includes imaging tests, coronary physiology and cardiac MRI. Here we present the case of 71–year–old man who underwent aortic bioprosthesis implantation (Trifecta n.25) and atrial septal defect (ASD) closure in 2019. In December 2022, the patient arrived in the Emergency Department (ED) with anterior STEMI, apical akinesia and angiographic evidence of distal left anterior descending (LAD) artery occlusion. Whereas angiographic feature was compatible with an embolic phenomenon, we performed in the 1st day transesophageal echocardiogram (TEE) that showed a voluminous, rounded mass (maximum diameter 1.2 cm) isoechoic, mobile, adherent to the aortic side of left coronary cusp. Despite the absence of clinical features of an acute infection (apyrexia and negative CRP/PCT) and the atypical mass localization for endocarditis, we took 3 sets of blood cultures and we required an immediate cardiac surgical consultation. In consideration of high estimated embolic risk, patient underwent urgent cardiac surgery with aortic bioprosthesis explantation, annular malacia (probable abscess) explantation and Carpentier n.23 biological prosthesis implant. Histological examination of the removed mass showed exudative material with intense acute inflammation. According to counseling of infectious disease specialist, we started an empiric antibiotic therapy with intravenous vancomycin and gentamicin. Given persistence of 3rd degree atrioventrocular block, patient underwent definitive pacemaker implantation. Cultures on blood and on explanted valve were negative and patient was discharged without further complications after 4 weeks of antibiotic therapy. In our opinion, this clinical case underlines the importance of an individualized diagnostic–therapeutic approach in patients with MINOCA, also considering rare etiologies and involving various medical specialist (clinical cardiologist, echocardiographer, surgeon).
P236 THE EARLY USE OF A PARTICULAR HEMODIALYTIC FILTER DURING SCA–STEMI COMPLICATED BY MULTIORGAN FAILURE
Authors: Dell'Aversana S , Ambrosio A , Lieto A , Golia B 
Published: May 2023

Abstract
A 66–year–old man, hypertensive, obese and avid smoker, in apparent good health until, due to the onset of typical chest pain associated with vomiting and algid sweating, he went to the PS where a diagnosis of acute coronary syndrome with ST–segment elevation was made. As per the guidelines, antithrombotic therapy was administered and transfer to the HUB center was arranged to perform urgent coronarography; thrombotic occlusion of the I M.O. branch was revealed and treated with angioplasty and drug–eluting stent implantation. On admission to the NICU, the patient presented hypotensive, tachycardic and with repeated episodes of rectorrhagia and vomiting intermingled with blood. Cardiac echocolorDoppler showed mild reduction in global kinesthesia (FE 45%) with hypo–akinesis of the inferior and lateral walls, circumferential pericardial effusion that was not hemodynamically significant, dilated and fixed inferior vena cava with mild increase in systolic pulmonary artery pressure. On suspicion of gastro–intestinal ischemic damage, supported by the clinical and laboratory findings (creatinine increase with anuria for more than 12 hours and severe signs of hepato–pancreatic insufficiency) CT scan with mdc was performed showing hepato–renal hypoperfusion. Therefore, on suspicion of multi–organ dysfunction syndrome, renal replacement therapy was started in CVVHD mode with filter for clearance of medium molecular weight molecules (cut–off 40 kDa) to reduce possible cytokine and myoglobin damage. Already from the first hours of treatment, there was a rapid and exponential improvement in clinical–laboratory parameters with resumption of diuresis. During hospitalization, two episodes of paroxysmal atrial fibrillation treated with electrical and pharmacological cardioversion were detected; given a CHA2DS2VASc score 3 and a HAS–BLED score 2, triple antithrombotic therapy was initiated. At follow–up, there was improvement in echocardiographic parameters (minimal residual pericardial dislodgement and inferior vena cava of normal caliber and respiratory collapsibility) and clinical–laboratory.