bluuebunny/crossref_metadata_2025_split huggingface dataset:
P252 THE TREATMENT WITH BETA–BLOCKERS AFTER MYOCARDIAL INFARCTION WITHOUT REDUCED EJECTION FRACTION (REBOOT) TRIAL, 2023 UPDATES
Authors: Bianco M , Lazzero M , Agnelli N , Staszewsky L , Pellizzoni V , Vasami‘ A , Ferraro S , Latini R , Chinaglia A 
Published: May 2023

Abstract

Introduction
The role of beta blockers (BB) post–myocardial infarction (MI) in patients without reduced ejection fraction in the era of invasive management is controversial results from observational studies have led to opposite results.

Methods
REBOOT is an independent multinational pragmatic, controlled, randomized, open–label, with blinded endpoint adjudication clinical trial. The study is testing the benefits of BB maintenance therapy in post–MI patients (either with or without ST segment elevation) discharged with LVEF &gt;40%. Patients ≥18 years old undergoing invasive management during admission and without history of heart failure (HF) are eligible to participate. At discharge, they are 1:1 randomized to either receive BB (agent and dose chosen by the treating physician) or no BB therapy. The primary endpoint is a composite of all–cause death, nonfatal re–MI, or heart failure hospitalization over a minimum follow–up period of 2.75 years (minimum 2 years, maximum 3 years). Events are adjudicated by a blinded committee. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) is the sponsor of the trial and the coordinator of Spanish Centers while Istituto di Ricerche Farmacologiche Mario Negri IRCCS coordinates the Italian participating network. Hospital admission for COVID–19 were also recorded since June 2020.

Results
The study is currently ongoing and 29 Italian centers are still actively recruiting. A sample size of 8468 pts (728 events) was estimated to provide a power of 85% to detect a RRR of 20% (incidence of primary endpoint in control 10%) and assuming 5% withdrawals. More than 75 Spanish and 35 Italian centers recruited patients. The first patients have been included in Spain in October 2018, in Italy in January 2019. On December 31st 2022, the number of enrolled patients by Italian centers was 1685. The top three Italian enrollers at the moment are: Ospedale G. da Saliceto –Piacenza (483 pts), Ospedale S. Luigi Gonzaga – Orbassano (183 pts) and A.O San’Anna and San Sebastiano – Caserta (170 pts). The patient enrollment rate was almost stable during all the study periods with a slight decrease during COVID pandemic outbreaks. The Italian REBOOT Network goal is to include 1800 patients by April 2023. The first results will become available by the end of 2025.

Conclusion
The REBOOT, with other ongoing trials, will provide robust evidence to guide the prescription of BB to patients discharged after MI without reduced LVEF.
P253 EFFECTS OF COLCHICINE TREATMENT AFTER MYOCARDIAL INFARCTION ON TOP OF STANDARD THERAPY: EVIDENCE FROM A PRECLINICAL STUDY
Authors: Aimo A , Burchielli S , Aquaro G , Barison A , Musetti V , Masotti S , Pucci A , Galvez–Monton C , Martinez–Falguera D , Passino C , Emdin M , Bayes–Genis A 
Published: May 2023

Abstract

Background
An intense inflammatory and fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Colchicine is an anti–inflammatory drug that has been reported to improve the outcome of patients with MI; its effects on LV remodeling have not been specifically investigated. We aimed to characterize the effects of the anti–inflammatory drug colchicine in an animal model of reperfused MI.

Methods
In 4–month–old pigs, MI was induced by occluding the LAD artery through an angioplasty balloon for 90 minutes. Pigs surviving MI induction were randomized in a 1:1 fashion to 2 arms: – control group (n=13): MI induction and reperfusion, standard treatment (the same therapies as in the rat study), – colchicine group (n=13): MI induction and reperfusion, standard treatment plus colchicine. The pigs underwent a first CMR scan 72 hours after MI induction, and another CMR at day 30. The pigs were then sacrificed the day after the second CMR. The primary efficacy endpoint was LGE mass (as a percentage of LV mass).

Results
The infarcted area at 72 hours (expressed as absolute mass or as a percentage of the LV mass) and the changes over 1 month did not differ significantly between pigs on colchicine plus standard therapy vs. those on standard therapy alone. When assessing the extent of fibrosis on the explanted hearts (as a percentage of the tissue sample areas) there was a trend toward a lower extent of myocardial fibrosis in pigs on colchicine plus standard therapy (p=0.091). The percent differences in LV volumes, ejection fraction and mass across the two CMR scans did not reach statistical difference.

Conclusions
The results from a pig model of reperfused MI suggest that colchicine has no additional effects to standard MI therapy on MI size and LV remodeling.
P254 "GHOST" IN RIGHT VENTRICLE: AN ECHOCARDIOGRAPHIC FINDING AFTER TRANSVENOUS LEAD EXTRACTION
Authors: Samperi S , De Matteis G , Castro A , Loricchio M , Trambaiolo P , Romano S , Granatelli A 
Published: May 2023

Abstract

Introduction
Prolonged antibiotic therapy and complete hardware removal are recommended in definite cardiac device–related infective endocarditis (CDRIE), as well as in presumably isolated pocket infection, in class I. A tubular mobile mass, known as ghost, that previously surrounded the lead can be detected by ultrasounds, in 8–14% of patients undergoing transvenous lead extraction (TLE). Case presentation: A 72–year–old man with ischemic cardiomyopathy is referred to our center due to a persistent fever. His medical history shows a previous extraction of CRT–D for infection of the left infraclavicular pocket, with a new implantation of CRT–P on the right side of the chest, in consideration of the recovery of the ejection fraction. At the entrance to the ward he has fever and inflammation‘s signs of the pocket of the generator, with positive blood cultures for Staphylococcus Aureus Methicillin resistant. A transesophageal echocardiography (TEE) excludes vegetations of valve systems and electrocatheters. Therefore, the patient begins antibiotic therapy and undergoes full extraction of the device (generator and leads). A post–operative transthoracic echocardiography shows the presence of a linear image of 2.5 cm in the right ventricle, seen as remnants of scar tissue surrounding the lead. ECG monitoring detects phases of BAV 2:1. Considering the high risk of infectious disease, a pacemaker leadless implantation is indicated. The surgery is postposted at the end of the 4 weeks of antibiotic therapy, checking blood cultures before implantation to reduce the residual infectious risk.

Discussion
The persistence of fibrous residues after TLE has been variously described in recent years, but it is unclear whether these are predictors of increased mortality. The current guidelines on the therapeutic management of patients with infectious endocarditis and pacemaker dependency do not indicated the timing of reimplantation, in a potentially infectious ghost setting. Clinical co–morbidities play a crucial role in the prognosis of patients, especially when combined with systemic infections.

Conclusion
An echocardiographic follow–up is recommended to detect ghost disappearance in patients undergoing explant due to a related device infection. In fact, a rapid fibrin dissolution process usually takes place when the thrombogenic stimulus is removed.
P255 A GOOD PERSPECTIVE NEEDS TWO POINT OF VIEW: TRANSVENOUS CRT–D LEAD EXTRACTION COMPLICATED BY INTRAOSSEUS COURSE OF THE CORONARY SINUS LEAD
Authors: Sbragi S , Parollo M , Segreti L , Del Corso A , Carluccio M , Di Cori A , Barletta V , Mazzocchetti L , Paperini L , De Lucia R , Viani S , Canu A , Grifoni G , Cellamaro T , Branchitta G , Soldati E , Zucchelli G 
Published: May 2023

Abstract
A 66 year old woman with dilated cardiomyopathy, carrier of CRT–D device in secondary prevention since 2013 and a mitralic mechanical prosthesis, suffered of CIED infection, confirmed by PET imaging exam. She was scheduled in our Hospital Unit for transvenous lead extraction. The procedure was performed by the subclavian approach, and the transvenous lead extraction was staged using mechanical telescopic sheats. After the extraction of the atrial and ventricular leads, the advance of the sheats was hampered by tenacious adherences along the site of vascular subclavian access of the coronary sinus lead. Firstly the portion of the lead running inside the coronary sinus was retracted with a pigtail by femoral vein approach. The inability to pass over the tenacious adherences at the point of the subclavian vein access were overcome expanding the surgical field with the help of the Vascular Surgeon, finding out that the adherence was determined by the presence of an osteophyte embracing the lead to the clavicle. The osteophyte was then surgically removed and the lead was finally extracted by jugular vein access. In this case the CIED leads were implanted using a intrathoracic subclavian venous access, where the vein lies behind the medial region of the clavicle. This approach could rarely lead to a periosteal penetration during needle advance that can generate osteophytes between the lead and the bone. In those circumstances the transvenous lead extraction could become extremely complicated, whatever technique is used.
P274 LEFT ATRIAL STRAIN RESPONSE TO HEART RATE IN PATIENTS AFFECTED OR NOT BY CHRONIC HEART FAILURE: CLINICAL CORRELATES
Authors: Di Terlizzi V , Corbo M , Barone R , Goffredo G , Manuppelli V , Pellegrino P , Ieva R , Brunetti N , Iacoviello M 
Published: May 2023

Abstract

Background
and aim of the study. Left atrium (LA) is poorly understood in many pathological conditions and it is often considered a passive bystander of these pathophysiologic alterations. In the setting of impaired heart rate related LV response, the LA function could play a relevant role. The relevance of LA has been also recently demonstrated by studies which have evaluated its function by using new echocardiographic techniques such as two–dimensional speckle tracking evaluation (2D–STE). The aim of this study was to evaluate the relationship between changes in LV and LA function, assessed by 2D–STE, in response to the increase of heart rate (HR) in a group of patients carrying a pacemaker (PM) or an implantable cardioverter defibrillator (ICD).

Methods
We enrolled 45 patients. Among them, 38 were evaluated with LA strain. 31 patients were affected by CHF, among whom 18 with implanted cardioverter defibrillator (ICD), 13 with ICD and cardiac resynchronization therapy (ICD–CRT) and 7 without CHF who had a PM implanted. All were in clinically stable conditions for at least 30 days and in conventional medical therapy. Starting from basal values, HR was increased by 10 beats/min programming the implantable devices at higher atrial stimulation frequencies to max 90 beats/min. At each HR, echocardiography was performed and for left atrium the strain of reservoir (LAr), strain of conduit (LAcd) and contraction (LAct) were calculated (figure 1). Changes in left ventricle global longitudinal strain (LVGLS) were also calculated.

Results
The LAr shows a significant reduction from baseline at a heart rate of 90 bpm in conjunction with a significant change in the LAcd. No variation in LAct was observed at the various frequencies. Among the 38 patients, 29 showed a worsening of LVGLS and 9 no worsening with increasing heart rate. We demonstrated a close relationship between LV and LA function assessed by longitudinal strain measures (figure 2). A significant decrease in LAr was observed in patients with worsening LV–GLS that was not evident in patients with no or improvement.

Conclusions
Our study demonstrates that, in chronic HF outpatients, HR increase has different and heterogeneous effects on the LA function, assessed by STI and this response is more frequent among patients with LV systolic dysfunction. These results could be useful for guiding the optimal heart rate responsiveness of the implanted devices.
P275 COMBINED NEURO–HUMORAL MODULATION AND OUTCOME IN PATIENTS WITH CHRONIC HEART FAILURE AND MILDLY REDUCED OR PRESERVED EJECTION FRACTION
Authors: Gori M , Marini M , Gonzini L , Carigi S , De Gennaro L , Gentile P , Leonardi G , Orso F , Tinti D , Lucci D , Iacoviello M , Navazio A , Ammirati E , Municinò A , Benvenuto M , Cassaniti L , Tavazzi L , Maggioni A , De Maria R 
Published: May 2023

Abstract

Background
Drug therapy of patients with chronic heart failure (HF) with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF) remains a challenge. We aimed to assess whether escalating neuro–humoral–modulation (NHM) (renin–angiotensin system inhibitors (RASI), betablockers (BB), mineralocorticoid receptor antagonists (MRA)) was differentially associated with outcome according to phenotype and age groups.

Methods and Results
Between 1999 and 2018 we recruited in a nationwide cardiology registry 4707 patients (HFmrEF n=2298, HFpEF n=2409) and classified them into 3 age groups: young (&lt;65 years), old (65–79 years), oldest–old (80+ years). We analysed clinical characteristics and 1–year all–cause mortality/cardiovascular hospitalization according to none/single (RASI or BB or MRA), double (RASI+BB or RASI+MRA or BB+MRA), or triple (MRA+RASI+BB) NHM. Overall, approximately half of HFmrEF and HFpEF patients had double–NHM. Among HFmrEF, 25.1% received no/single and 26.7% triple NHM. In the HFpEF group, 36.5% had no/single and 17.9% triple NHM. Older age was associated with a higher prescription of no/single NHM among HFmrEF patients (ptrend=0.001); the reverse was observed among HFpEF patients (ptrend =0.005). Prescription of triple NHM increased over time in both phenotypes (all p for trend&lt;0.0001). Compared to no/single NHM, triple, but not double, NHM was associated with better outcome in both HFmrEF (HR 0.700, 95% CI 0.505–0.969, p=0.032) and HFpEF (HR 0.700, 95% CI 0.499–0.983, p=0.039), with no interaction between NHM and age groups (p=0.58, p=0.80, respectively).

Conclusions
In a cardiology setting, among HF outpatient with EF&gt;40%, prescription rates of triple NHM increased over time and were associated with better patient outcome.
P279 IMPACT OF COVID–19 DIAGNOSIS ON HOSPITALIZATION AND MORTALITY RATES IN PATIENTS WITH ISCHEMIC STROKE ADMITTED DURING THE 2020 PANDEMIC IN ITALY
Authors: Rosato S , D’ Errigo P , Giordani B , Seccareccia F , Badoni G , Tavilla A , Mureddu G , De Luca L , Baglio G 
Published: May 2023

Abstract

Background
and purpose. We sought to evaluate the impact of the Covid–19 infection on hospitalization and mortality rates in patients with ischemic stroke admitted during the 2020 pandemic in Italy.

Methods
We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients admitted for ischemic stroke during and after the national lockdown for Covid–19 infection in 2020 and the equivalent periods of the previous 5 years in Italy. The 2020 observed rates of hospitalizations and mortality of stroke patients with and without Covid–19 infection were compared with the expected rates, according to the trend of the previous 5 years.

Results
During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant Covid–19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared to the previous years (percentage change –23.5). Based on the 5–year trend, the 2020 expected rate of 30–day and 1–year mortality was 9.8% and 23.9%, while the observed incidence of death was 12.2% and 26.7%, respectively (both p&lt;0.001). After multiple corrections, the higher rate of mortality was observed among patients admitted for stroke with a concomitant Covid–19 diagnosis.

Conclusions
During the Covid–19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, while both 30–day and 1–year mortality was increased, especially in those with a Covid–19 diagnosis, compared to the previous 5–year trend.
P284 POTENTIAL PROARRHYTHMIC SIDE EFFECT OF HIGH DOSE AND PROLONGED SODIUM NITROPRUSSIDE INFUSION THROUGH CALCIUM ION REDUCTION
Authors: Fazzini L , Gori M , Calabrese A , Giammarresi A , Iorio A , Manca P , Quarta G , Perra F , Cadeddu Dessalvi C , Senni M 
Published: May 2023

Abstract
Patient presentation. A fifty y/o male patient with a history of congenital aortic stenosis surgically corrected previously and with chronic heart failure due to severe left ventricular dysfunction presented to our emergency department complaining dyspnea. Due to acute decompensated heart failure with ongoing cardiogenic shock, he was admitted to our intensive cardiology unit. Initial work up. The blood exams showed a normal renal and liver function, normal total and free calcium, 9.4 mg/dL and 1.16 mmol/L respectively, lactates were mildly increased. The chest x–ray showed pulmonary congestion. At the echocardiography we found severe biventricular dysfunction, moderate mitral regurgitation, severe pulmonary hypertension. Since the patient was unstable, adrenaline, high–dose sodium nitroprusside (SNP), and intra–aortic balloon pump were started. The right heart catheterization revealed combined pulmonary hypertension reversible with SNP and, therefore, the patient was inserted in the heart transplant list. Diagnosis and Management. One of the side effects of SNP is the thiocyanate toxicity. A high dose of SNP was necessary for this patient (2.2 mcg/kg/min). Thus, thiocyanate levels increased up to 10 mg/100 mL (NV&lt;3). Importantly, the patient was asymptomatic despite these levels. However, the free calcium ion progressively decreased up to 0.94 mmol/L, despite normal total calcium and calcium supplementation iv and orally. Since arrhythmic burden markedly increased, we started lidocaine which was not effective. Follow–up. Since we suspected a possible causative role of thiocyanate, which might bond the double positive charged free calcium ion with its two negatively charged sulfur atoms, explaining the normal total calcium level and the low calcium ion, we carefully reduced SNP dose within days. This allowed us to reduce thiocyanate to 6 mg/100 mL, without compromising patient hemodynamics. Concomitantly, the free calcium ion tended to normalize, lowering the arrhythmic burden.

Conclusions
We describe for the first time a proarrhythmic side effect of prolonged SNP infusion, likely related to thiocyanate accumulation and free calcium ion binding, which, despite aggressive calcium supplementation, was normalized only after SNP down titration.
P292 “CAN MIXED REALITY IMPROVE THE RESULTS OF TAVI?”
Authors: Martorana A , Paduvakis I , Cerillo A , Stefano P 
Published: May 2023

Abstract

Background
and Aim: Although the rate of TAVI–related complications has consistently reduced during the last decade, vascular complications still occur, and can be serious. Mixed reality (MR) can be defined as a three–dimensional real world simulation allowing the user to directly interact with it. The present study was designed to explore the potential of MR in facilitating the vascular access and navigation with large–bore devices.

Methods
3D holograms were generated from the CT’s of 20 TAVI patients (age 81.2±6.8 years, STS score 5.1±2.1) and made available to 2 surgeons in training. Different layers were generated: Skin, Arterial tree, and Calcium. A needle simulator was also available. The vascular puncture was echo guided. 2 percutaneous suture system were used to secure the hemostasys.

Results
All the procedures were carried out through the planned access. In 2 patients intravascular lythoplasty was used. There were no vascular complications, and procedural success was 100%. A single puncture was necessary to obtain vascular access in 19/20 patients and in 2 cases the echo was not used, and the operator decided to switch to angio–guided puncture due to the bad quality of the echo images that were in contrast with MR.

Conclusion
MR can be used to predict the optimal puncture site for TAVI. The interactive 3D holograms can be used to identify relevant repere on the skin and to reduce the rate of vascular complications and could become a powerful tool for procedural planning, training and remote proctoring.
P295 WHEN TAVI IS THE RIGHT CHOICE
Authors: Cammardella A , Russo M , Ranocchi F , Pergolini A , Giannelli V , Pellicelli A , Musumeci F 
Published: May 2023

Abstract

Clinical case
We describe a case of a 62–y–old man, affected by hypertension, insulin–dependent diabetes mellitus, advanced liver cirrhosis. After screeing, the patient was listed for liver transplantation. On September 2022, the patient was admitted to our Emergency Room due to HF in class NYHA III. The transthoracic echocardiogram showed a severe aortic regurgitation with mobile vegetations, the largest of which is more than 10 mm on the right aortic cusp. Normal biventricular function was observed with sPAP of 45 mmHg. Thus, we concluded for post–endocarditis severe aortic regurgitation. We discussed tha case in our Department Heart Team with the concomitant presence of the Liver Team. We considered the patient at high surgical risk, mostly due to the risk of postoperative hepatic insufficiency. So, we decided for a TAVI off–label. So, we impantanted a Sapien 3 Ultra 26 mm through transfemoral access. To reduce the risk of cerebral embolization, we used Triguard 3 system, while to prevent coronary embolization we used a closed stent into the right coronary ostia, ready to be opened. The patient was discharged in the fourth postoperative day, without conduction disturbances. The postoperative echo showed normal valvular function and absence of paravalvular leakages.

Conclusions
Patients with advanced liver cirrhosis are at risk of organ failure following use of extracorporeal circulation. In selected patients, TAVI may be a valid alternative. The peculiarity of the specific case was due to the use of the TAVI in an off–label procedure of aortic insufficiency with the simultaneous presence of mobile vegetation at high embolic risk.