bluuebunny/crossref_metadata_2025_split huggingface dataset:
P384 APPROPRIATENESS OF PRESCRIBING DIRECT ORAL ANTICOAGULANTS IN THE REAL WORLD: THE ANMCO NATIONAL AUDIT INITIATIVES APPRO–FA EVO PROJECT
Authors: Di Fusco S , Spinelli A , Caldarola P , De Luca L , Riccio C , Gabrielli D , Oliva F , Colivicchi F 
Published: May 2023

Abstract
Although direct oral anticoagulants (DOACs) have been in use for more than 10 years, their use in clinical practice does not always comply with established indications, especially in terms of dosage. With the National APPRO– FA EVO Audit Initiatives, data were collected on the use of DOACs in Italian hospital heart centres. In the present study, we analyse DOAC use based on the indications reported in the summary of product characteristics.

Methods
Aggregated data on patients discharged with a diagnosis of non–valvular atrial fibrillation (FANV) over a 2–week observation period were collected through a digital platform. Extrapolated variables included age, sex, diagnosis at discharge, presence of comorbidities, renal function (creatinine clearance, ClCr), and prescribed antithrombotic therapy.

Results
A total of 48 heart centres contributed to data collection. During the observation period, the total number of discharged patients was 1933. Among patients with a discharge diagnosis of FANV (569), 338 (59.4%) were male, 228 (40%) were &gt;80 years old, and 228 (40%) had a ClCr between 15 and 50 ml/min). Patients with a diagnosis of FANV undergoing coronary angioplasty during hospitalization were 103 (18.1%), 112 (19.7%) with a diagnosis of acute coronary syndrome, and 232 (40.6%) of heart failure (Figure 1). There were 300 (52.7%) male patients with CHA2–DS2–VASc score ≥2 and 219 (38.5%) female patients with CHA2–DS2–VASc score ≥ 3. Among patients with FANV discharged on oral anticoagulant therapy (96,3%), 89.6% were on DOAC. The most frequently used DOAC was apixaban (35.5%), followed by rivaroxaban (25.2%), edoxaban (20.6%) and dabigatran (18.8%) (Figures 2 and 3). The use of reduced dosage met the reduction criteria in 90.2% of cases for apixaban, 90.9% for rivaroxaban, and 86.7% for edoxaban. Among patients treated with dabigatran, there was a higher prescription of the reduced dose than the full dose (10.2% vs 8.6%).

Conclusions
In accordance with international guidelines, DOACs are the anticoagulants of choice in most patients with FANV. Although the dosage used in clinical practice was found to be appropriate in about 90% of prescriptions, there is non–negligible room for the improvement of prescribing DOAC appropriateness.
P391 THE DIAGNOSTIC CHALLENGE BETWEEN CHRONIC PULMONARY EMBOLISM AND PULMONARY ARTERY SARCOMA: A CASE REPORT
Authors: Franco E , Iancu D , Cavallone E , Feneziani A , Pasquero M , Ruffini S , Astegiano M , D'Armini A , Moretti C 
Published: May 2023

Abstract
We report the case of a 63–year–old obese and hypertensive woman, admitted in hospital with worsening dyspnea for 2 weeks and syncope. A suspected chronic thromboembolism was diagnosed nine months before for a similar clinical picture; hematologic screening excluded thrombophilia and NOACs were prescribed. Two–dimensional transthoracic echocardiography showed enlargement of right chambers, the interventricular septum shifted to the left ventricle, showing “D” sign. Color Doppler flow imaging showed moderate regurgitation in tricuspid valve, with indirect pulmonary pressure estimation 90 mmHg. Left ventricle was normal for dimensions and function. ECG evidenced sinus tachycardia and no specific ST–T alterations. Blood exams evidenced anemia (Hb 9 mg/dl), negative neoplastic markers and absence of occult blood in feces, mildly elevated inflammatory markers, T–Troponin and D–dimer. Naso–pharyngeal swab for SARSCoV2 infection was negative. Chest computed tomography with contrast revealed a large filling defect within bilateral main pulmonary arteries. No lymph nodes or pulmonary pneumonia were detected. Lower extremity venous ultrasound was positive for right popliteal deep vein thrombosis. The global clinical picture suggested an acute pulmonary embolism recurrence, with a severe right ventricle impairment and a concomitant deep vein thrombosis. Some factors were not completely clear: chronic anemia, only mildly increased D–dimer, no specific increase of inflammatory markers. The patient was referred to Cardiac Surgery Unit of IRCCS Foundation Policlinico San Matteo in Pavia, for pulmonary endarterectomy. Unexpectedly the surgical finding was a bilateral pulmonary artery sarcoma, confirmed by histological exam. We thus clarified some uncertain clinical aspects, explainable in the context of a severe neoplastic picture. There were no immediate complications, and a chemotherapy was initiated after a period of cardio–pulmonary rehabilitation. Pulmonary artery intimal sarcoma is a very rare disease, its prevalence is about 0.001–0.003%, it can originate from the left and right pulmonary arteries and intimal layer of pulmonary arteries, forming a tumor growing in the nodular cavity or spreading along the intimal surface. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome.
P392 POST–THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPLEX CASE
Authors: De Laura D , Lavolpe V , Rutigliano D , Cavallari D , Basso P , Palumbo V , Musci S , Ruggero M , Tota F , Sublimi Saponetti L , Locuratolo N , Caldarola P 
Published: May 2023

Abstract

Introduction
Patients with post–thromboembolic pulmonary hypertension (CTEPH) achieve functional recovery after pulmonary endarterectomy (PEA). 40% of them are inoperable (1,2).

Clinical case
66–year–old man admitted in 2012 to our ward for dyspnea on exertion and high echocardiographic probability of pulmonary hypertension (PI). Medical history: smoking; thalassemia trait; COPD; splenectomy at 13; diagnosis of chronic myeloproliferative syndrome. BP: 120/70 mmHg. NYHA class III. Blood tests: Hb: 9.4 g/dl; MCV: 70; HCT: 30%; PLT: 511; WBC: 14.84 (Mo 13%).NT–pro BNP:933. Autoantibodies and tests –HIV: negative. EGA in AAPaO2: 53 mmHg, PaCO2: 32 mmHg, SO2: 87%. PFR: FEV1: 68% FVC:74%, FEV1/FVC:72.DLCO:75%.6MWT:450m,Borg:0/3;Baseline SO2: 86%,final SO2 74%. On ECG: sinus r. at 64 beats/min. Echocardiogram: left sections within limits; right ventricle:DTD:30mm; RV/LV&lt; 1; right atrial area: 19cm2, PAPs: 70+5 mmHg (Vel: 4.1 m/s), AcT: 90 msec. TAPSE: 16mm. Performs pulmonary CT scan with contrast medium: negative for pulmonary embolism; some 1 cm bubbles of emphysema in the subpleural area of the right middle lobe; right heart catheterization: PAD: 13mm; PAPM: 50mm; IC: 4.1l /min/m2; RVPtot:11WU;RVP:art:5.2WU;WP:11mmHg.Haematological diagnosis of thalassemia intermedia and exclusion of myeloproliferative syndrome/P lung scintigraphy is positive for multiple bilateral perfusion defects. The possibility of PEA for peripheral lesions at the referral Centre, therapy with warfarin (TAO), riociguat and bronchodilators was started., discontinued therapy with TAO. Finding of recurrence of pulmonary micro embolism on scintigraphy. At the end of the intravitreal treatments with resumption of TAO, at control catheterization evidence of PAD:5mm PAPm19mmHg;WP:9mmHg;IC: 3.4l/min/m2; RVPart:2.9 WU;NYHA:II.

Discussion
Not all CTEPH from thalassemia intermedia can perform PEA (3). Hypercoagulability is an important pathogenetic mechanism in the genesis of PH (4) and comorbidities have a significant role in the prognosis and response to medical therapy. COPD is the comorbidity that favors hypercoagulability, worsens pulmonary ventilation and gaseous exchanges (5).

Conclusions
In thalassemia intermedia with inoperable CTEPH, hypercoagulability is the condition that most influences the prognosis and efficacy of vasodilator therapy.
P396 FIBRINOUS PERICARDITIS AND STILL’S DISEASE IN ADULTHOOD: A RARE AND INSIDIOUS COMBINATION
Authors: Paffoni P , Maffè S , Facchini E , Prenna E , Bergamasco L , Careri G , Paino A , Franchetti Pardo N , Ariotti S , Dellavesa P 
Published: May 2023

Abstract
In 9/2022 we admitted a 69–year–old man with history of hypertension, in therapy with bisoprolol and edoxaban after recent diagnosis of persistent atrial fibrillation, with a minor pericardial effusion at the echocardiogram. He had dyspnea, fever, and atrial fibrillation with elevated cardiac frequency. The echocardiogram showed increased pericardial effusion, circumferential, about 2 cm, with important fibrinous organization, without signs of cardiac tamponade (fig1). Hemocultures and urocultures were repeatedly negative, with significant increase in flogosis parameters. Therapy with high–dose acetylsalicylic acid was started first and then Ibruprofene + colchicine with poor clinical response and persistence of symptoms and effusion. The presence of elevated fever, arthralgias, transient skin rush to the trunk and flogosis indices (CRP 17 mg/dl, ESR 97mm, WBC 11000/ul with 80% neutrophil, ferritin 2200 ng/ml), with negativity of antinucleus antibodies and rheumatoid factor, allowed to place diagnosis of adult Still’s disease (AOSD). High–dose steroid therapy (prednisone 1mg/kg) was initiated with fever regression, progressive normalization of inflammatory indices and spontaneous restoration of sinus rhythm. The 7–day echocardiogram showed almost complete resolution of pericardial fibrinous effusion (fig 2). At 2 months patient remained asymptomatic, no more pericardial effusion, no signs of flogosis. Differential diagnosis of pericarditis is often complex, and therapeutic attitude and prognosis are variable according to etiology. AOSD has a prevalence of about 1/100,000, affects mainly young adults, very late onset cases are rare. Transient, small, salmon–pink, not itchy rashes, usually concurrent with fever, can drive diagnosis, along with major and minor criteria of Yamaguchi. Often patients have serositic involvement with pleuritis or pericarditis, with tamponade needing drainage. Such forms respond well only to steroid treatment. However, cases of fibrinous pericarditis as marked as the one described have not been described; the so important fibrinous component would made an eventual pericardiocentesis difficult. Although infrequent, it is a differential diagnosis that the cardiologist must consider in cases of refractory pericarditis and pericardial effusion.
P402 PROSTHETIC MECHANICAL VALVE THROMBOSIS: THE EXPERIENCE OF SALAM CENTRE FOR CARDIAC SURGERY (EMERGENCY NGO)
Authors: Masini F , Lentini S , Portella G , Raafat Shadig D , Abdelwahab Abdalla S , Erba N , Giovanella E 
Published: May 2023

Abstract
Mechanical heart valve (MHV) replacement in patients with rheumatic valve disease is common in Africa. MHV requires long–life anticoagulation (OAT) and managing this can be difficult. Prosthetic valve thrombosis (VT) is a pathological entity characterized by thrombus formation on the prosthetic structures, with subsequent prosthesis dysfunction. Salam Centre for Cardiac Surgery was built in Khartoum Sudan by Emergency NGO. Since April 2007 high–quality and free–of–charge medical and cardio–surgical treatment has been offered to patients. More than 10000 cardiac surgery, 80% of which for MHV replacement, were performed. The aim of the work is to analyze the characteristics of patients with VT, the risk factors and clinical follow–up. From Aug 1, 2018 to Nov 30, 2022, 287 VT involving 237 patients were collected.The incidence is 1.36% p/y. The most relevant risk factor was the interruption of anticoagulant therapy and irregular INR control (N. 142; 49,5%). In 101 cases (35,2%) a clinical factor (infection, pregnancy, eosinophilia, heart failure) was the main cause of VT. The diagnosis, suspected with the Transthoracic Echo and confirmed with fluoroscopy, was done at the OPD visit (32,4%) in asymptomatic or at triage for symptomatic patients (67,6%). 236 patients were admitted to Salam Centre.The treatments of choice were thrombolysis, performed with 2 different protocols, fast and low dose–slow infusion (Alteplase 25 mg./6 hrs), followed by Triple Therapy (TT) (Warfarin, LMWH and Aspirin) (N.189–65,8%), TT alone (N.44– 15,3%) or Warfarin and Aspirin (N.54–18,8%). 210 events (73,2%) ended with unblocked valve,24 events ended with the death of the patient (8,3%); low dose/slow infusion regimen had less deaths. Thrombolysis was more effective (unblockage 79,9%). Warfarin and Aspirin and not admission to Salam Centre were linked to less unblokage and high mortality rate.

Conclusions
The incorrect conduct of OAT represents the most relevant risk factor for VT.Many are the underlying causes, from economic and social factors to insufficient patient awareness. MOH intervention to offer free of charge INR check, but also patient education must be improved. VT is caused also by intercurrent clinical events such as pregnancy, infection. Eosinophilia represents a chapter that deserves a detailed study.Patients with history of VT must be followed by a dedicated clinic that aims to increase patient loyalty in order to intercept risk factors as early as possible.
P406 LAUBRY–PEZZI SYNDROME: EVERYTHING IS NOT AS IT SEEMS
Authors: Polito M , Cannavaro G , D'Auria F , Bottiglieri P , Vassallo M , Ianniello G , Longobardi A , Ferrara F , Coscioni E , Malinconico M 
Published: May 2023

Abstract

Introduction
Laubry–Pezzi syndrome is a congenital heart disease characterized by the prolapse of an aortic valve cusp into a subjacent ventricular septal defect (VSD), mostly supracristal, leading to severe aortic regurgitation (AR). It has been reported nearly always in childhood, the Venturi effect is the predominant factor and onset symptoms may be variable.

Case Report
A 61–years–old male was admitted to our intensive case unit for chest pain radiated to interscapular region and exertional dyspnea. Hemodynamic parameters were normal. At ECG sinus rytm with heart rate 92 bpm and non–specific repolarization abnomalities were reported. Hs troponin I was 276 ng/L, myoglobin 30.2 ng/mL and BNP 325 pg/mL. Transthoracic echocardiography showed a dilated left ventricle (LV EDV 107 mL/m2) with normal ejection fraction (55%), severe AR without aortic root dilation and a suspicious shunt left to right at level of interventricular septum. Therefore, transesophageal echocardiography was performed and confirmed severe AR by probable bicuspid valve and right cusp prolapse, in absence of calcifications and/or vegetations by endocarditis, restrictive perimembranous VSD (maximum diameter 0.6 cm) and ostium secundum ASD with shunt L–R. Right chambers were not dilated and non invasive systolic pulmonary artery pressure was 43 mmHg. Coronary angiography was performed and showed a significant stenosis of distal left anterior descending (LAD) artery and of proximal circumflex artery. Right heart catetherization excluded significant high values of pulmonary pressures (mPAP=18 mmHg), of pulmonary capillary wedge pressure (9 mmHg), with a mild increase of pulmonary vascular resistances (1.16 HRU; nv &lt; 96). Coronary artery bypass grafting (left internal mammary artery on LAD and Y–graft radial artery on obtuse marginal artery), aortic valve replacement with bioprothesis (Inspiris Resilia 23 mm), ASD closure by direct suture and VSD closure with pericardial patch were performed. No post–surgical complications were reported. Interestingly, during the replacement of aortic valve, it resulted tricuspid, confirming the suspicion of Laubry Pezzi syndrome.

Conclusions
our case was object of great debate because restrictive VSD and severe AR were not previously known, were diagnosed in middle age and until then paucisymptomatic. Laubry–Pezzi syndrome is a very rare disease that may explain controversial cases of severe AR.
P415 THE STRANGE CASE OF A LATE POCKET HEMATOMA
Authors: Massara M , Tofoni P , Stronati G , Laura C , Michela C , Federico G , Antonio D 
Published: May 2023

Abstract
Case report: male, 85 years old. Hospitalization in 2013 at the Ancona Cardiology Department due to severe left ventricular dysfunction. In the history of pulmonary lobectomy results (2005). ⦁ EKG: PR 220 msec, left bundle block ⦁ coronary angiography: ed ⦁ blood analysis: hemoglobin 15 g/dl, PLT 229/mm3, Creatinine 1.1 mg/dl, Glycemia 84 mg/dl. ⦁ Echocardiogram: severe LV dilatation (LVVT 105 ml/m2) and severe reduction of LVEF due to diffuse hypokinesia. Strain test for possible CRTD implant: no intraventricular asynchrony. A single–chamber ICD was implanted in primary prevention in the left subclavicular site ( antibiotic prophylaxis with ciprofloxacin 1 g). Chest x–ray showed correct lead placement, no pneumothorax. The patient was discharged with antibiotic therapy. Since then he has continued the cardiological follow–up on a regular basis (cardiological visit + six–monthly ICD check). It should be noted that NOAC (Rivaroxaban 20 mg) was introduced in 2020 for the detection of atrial fibrillation. In December 2021, at last ICD check: no arrhythmic events, no alterations of the electrical parameters, good condition of the PM pocket. On 09.01.22, access to the ER due to the appearance of elastic swelling of the pocket. Apiretic. The ER doctor performed ultrasound (non–trabecular subcutaneous effusion) and proceeded to aspirate 15 cc of serum–blood fluid. He discharged the patient with appointment at the PM clinics. Cardiological consultation or blood chemistry tests were not carried out. On 19.01.22 the patient presented to our clinics: voluminous elastic swelling of the soft tissues overlying the pocket, which appeared floating. No local inflammation or cutaneous ischemic suffering. No solutions of continuity in the skin. No pain. He also reported not having taken the prescribed antibiotic. He denied fever or trauma in the previous weeks. As the blood chemistry tests were not performed in the ER, the blood count (Hb? WBC?), renal function (rivaroxaban overdose?), inflammation indices were not known (CRP? PCT?), coagulation function (spontaneous INR?). Urgent hospitalization was scheduled for surgical revision, pocket decompression, swab culture and blood cultures.

Conclusions
The hypotheses are hematoma during NOAC, pocket infection or cystic hygroma. After surgery evidence of organized hematoma of tissue adjacent to the pocket with negative blood cultures.
P418 WHEN THE GAME IS HARD…. IT‘S BETTER TO COOPERATE! THE INTEGRATED MANAGEMENT OF THE ELECTROPHYSIOLOGIST AND HEMODYNAMIST WHO RESOLVES THE COMPLICATION
Authors: Perniciaro V , Caccavo V , Di Monaco A , Katsouras G , Quadrini F , Sgarra L , Troisi F , Langialonga T , Grimaldi M 
Published: May 2023

Abstract
A 66–year–old woman came to our attention to undergo ablation of monomorphic, frequent and repetitive premature ventricular complex, symptomatic and refractory antiarrhythmic therapy. Mapping of the arrhythmia showed precocity both on the anterolateral segment of the coronary sinus and on the anterolateral mitral annulus (corresponding to the point first identified in the coronary sinus). However, earliness on the anterolateral segment of the coronary sinus was better; radiofrequency was then applied there (maximum power of 30 Watts for 120 seconds). After a few minutes, blood pressure drop and echocardiogram showed tamponade pericardial effusion. Pericardiocentesis was performed and part of the drained blood recovered by connecting an 8F long introducer (inserted in the pericardium) to the introducer in the right femoral vein, thus stabilizing the patient‘s hemodynamics. The coronary sinus was selectively cannulated with an Agilis deflectable long introducer (advanced to the vessel ostium using a deflectable decapular electrocatheter as a guide) thus visualizing the lesion on the vessel wall site of ablation. A guiding catheter for the right coronary artery was inserted into the coronary sinus and a guidewire was advanced to the distal part of the vessel. The lesion was effectively treated by placing a 5 mm by 21 mm covered stent. After approximately one hour of monitoring, the pericardial drainage was removed. There were no recurrences of arrhythmia or pericardial effusion during observation in the ICU or at follow–up. In this complex case, the integrated management of the electrophysiologist and the hemodynamist successfully resolved the complication without resorting to cardiac surgery.
P431 "TELECUORE": EXPERIMENTAL PILOT PROJECT FOR THE INTEGRATED MANAGEMENT OF 250 PATIENTS WITH CHRONIC HEART FAILURE THROUGH THE USE OF TELEMEDICINE IN PIACENZA AUSL
Authors: Matrone B , Sticozzi C , Comastri G , Lisè G , Novara P , Andena A , Aschieri D 
Published: May 2023

Abstract

Background
Heart failure (HF) has an high social–health impact that requires frequent checks and urgent hospital visits. The management of chronicity through telemedicine, integration of hospital–territory care and multidisciplinarity represents a goal of the italian PNRR.

Objectives
The project tests the feasibility of an organizational model of integrated management of heart–failure patients based on multidisciplinary integration and the use of telemedicine.

Materials and Methods
250 heart failure patients will be selected by the Heart Failure Outpatient Department of AUSL Piacenza, with the following characteristics: positive technological anamnesis, NYHA functional class II–III, clinical instability (hospital access for heart failure/need to boost diuretics in the previous 12 months) and management complexity. We will use Aditech devices, which through mobile–app will send the following parameters to the platform on a daily basis: blood pressure, weight, ECG (single track) and saturation. A QoL Assessment Questionnaire (KCCQ) will be administered. 10 GPs will be selected to view the data on the platform and be able to carry out a cardiological Teleconsultation. The Case manager (CM) and a cardiovascular technician (TFCPC) will explain the functioning of the device to groups of 2–3 patients and, in collaboration with the nursing staff, the baseline control of the parameters and blood tests will be carried out. Pre–set alerts will be activated based on the changes in the detected parameters, which will be evaluated by the TFCPC/CM and managed with the Cardiologist for therapy optimization and patient empowerment. Through televisit, the CM will evaluate the case, based on pre–established protocols, will program the necessary diagnostic services (EGC, chest echo/fast echo, performed by the TFCPC using wireless echo probes at community homes) and will plan ways to improve lifestyle. The intervention of the GP or cardiologist will be scheduled after a multidisciplinary briefing based on the clinical case.

Conclusions
The project experiments an integrated hospital–territory service model for the heart failure patient, through the use of telemedicine. The home management of the instrumental parameters and their daily sending should help to quickly manage any problems. Televisit integrated with telemonitoring and teleconsultation should reduce the number of hospital admissions.