bluuebunny/crossref_metadata_2025_split huggingface dataset:
P9 INCESSANT ARRHYTHMIC STORM, EFFECTIVELY TREATED BY VENTRICULOPLASTY
Authors: Magnano R , Testa S , Cappelli C , Pezzi L , Occhiuzzi E , Di Marco M , Forlani D , Duronio G , Verrengia E , Vitulli P , D’Alleva A , Gallina S , Paloscia L 
Published: May 2023

Abstract
Arrhythmic storm is an emergency characterized by cardiac electrical instability leading to multiple episodes of sustained ventricular arrhythmias in a short period of time. Patients have multiple comorbidities that require multidisciplinary interventions to achieve clinical stability. The genesis of arrhythmic storm involves a complex interaction between a predisposing arrhythmogenic substrate, triggering factors, autonomic nervous system, and patient comorbidities. Antiarrhythmic drug therapy plays a key role and has been shown to be associated with a significant reduction in VT recurrence. Transcatheter ablation in patients refractory to drug therapy has been shown to reduce arrhythmic recurrences, ICD shocks, and improve patients‘ cumulative survival over time. Rare cases of arrhythmic storm refractoriness treated by plastic ventricle for the purpose of excluding scar are reported in the literature. We present the case of a 62–year–old man, Caucasian race, suffering from chronic ischemic heart disease with hypokinetic–dilated evolution carrying CRT–D, diabetic, obese, dyslipidemic, undergoing multiple percutaneous revascularizations. Sent to our hospital from a peripheral hospital for arrhythmic storm refractory to maximal antiarrhythmic therapy treated with multiple internal and external DC shocks. During hospitalization, the patient underwent SEF and attempted ATC which was ineffective in the following days due to recurrence of numerous episodes of TVS. In view of the clinical picture and refractoriness to therapy, it was decided to perform coronary examination which found subocclusion of the 1st diagonal branch treated by implantation of medicated stent. On ventriculography, the presence of severe pseudoaneurysmal formation supplied at the level of the anterior wall of the left ventricle was confirmed. It was decided to transfer the patient to cardiac surgery to perform ventriculoplasty surgery. In the following days, the patient underwent surgery through exclusion of the aneurysm by patching in pericardium in CEC. Procedure was free of complications. On follow–up echocardiogram dilated left ventricle with severe left ventricular dysfunction with findings of cardiac aneurysm exclusion. In the following days, the patient presented no further arrhythmic episodes.
P38 SINGLE VERSUS DOUBLE STENTING IN NSTEMI PATIENTS WITH COMPLEX LEFT MAIN BIFURCATION DISEASE
Authors: Rigatelli G , Zuin M , Pasquetto G , Bilato C , Roncon L 
Published: May 2023

Abstract

Background
Among patients with non–ST–segment elevation myocardial infarction (NSTEMI) the presence of a bifurcation left main (LM) disease represents a particular subset graved by both clinical and technical challenges. We sought to assess the long–term outcomes of patients with NSTEMI treated either by single or double stent strategy, having an LM bifurcation culprit lesion.

Methods
We retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for NSTEMI due to complex LM bifurcation disease as the culprit lesion, treated using either single or dual stenting (provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT)) techniques between January 2008 and May 2018. Target lesion failure (TLF) was defined as the composite of cardiovascular death, target–vessel myocardial infarction (MI), and clinically driven target lesion revascularization (TLR).

Results
Four hundred and forty–five patients (54.1% males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3) were evaluated. Of these, 155 patients (34.8%) were treated using a single stent while the remaining were treated with a double stent strategy. After a mean follow–up of 37.1 months (IQR 22.1–39.3), TLF rate was 8.7% (n = 39): 5/155 (3.2%) in the crossover group; 10/53 (18.8%) in T/TAP group, 14/89 (15.7%) in the culotte group, and 10/148 (6.7%) in the NIT group of patients. Cardiovascular mortality rate was 2.9% (n = 13) while stent thrombosis was 0.89% (n = 4). On multivariate analysis dyslipidemia, Syntax score &gt; 25, triple vessel disease, additional LM ostial, or LM body lesions and the use of Rotablator, were independent predictors of TLF.

Conclusions
Either a single or double stent strategy resulted in low rates of TLF, cardiovascular death, and stent thrombosis in the long–term period in NSTEMI LM patients with contraindications or refusal of surgery. A single stent strategy appeared to have a slightly better outcome compared to a 2–stent strategy.
P42 ACUTE STENT THROMBOSIS IN CATH LAB DURING OPTIMIZED PCI: HOW TO RECOGNIZE IT AND POSSIBLE TREATMENT
Authors: Formigli D , Parente A , Pirozzi E , Cocozza S , Franco V , Moscato F , Silvestri P , Scherillo M 
Published: May 2023

Abstract
Angiographic Acute Stent Thrombosis occur in 0.5%–2% of procedures.OCT–PCI or Optimized PCI represents a new approach particularly indicated in complex high thrombotic risk lesions, in patients at high bleeding risk with need for short DAPT and in the treatment of vulnerable plaques. Post–stent OCT thrombus finding was defined in previous studies as mass with diameter ≥250μm attached to the stent struts, was present until 40% of cases and is associated with definite angiographic thrombosis. Outcome of OCT thrombus is generally favorable although in about 25% there may be a progression. Case 1: 75–y smoker female with hypertension and atrial fibrillation on NOAC therapy presented in ICU with NSTEMI. At angiography: 75% stenosis focal plaque at proximal circumflex (Fig1A). At OCT vulnerable plaque: ulcerated with intimal flap &lt; 90°, thin fibrous cap 20 µm, MLA 2.17mm² and AS 63%, intimal micro–calcifications and cholesterol crystals (Fig1C). We implanted DES with post–dilatation. Treatment was Cangrelor, heparin 100 IU/kg and ASA 250 mg ev. OCT showed acute 660 µm thrombosis of the stent body although there was perfect angiographic result (Fig1D+B). Further multiple balloon dilatation of the stent was carried out with thrombosis persistence on OCT control (Fig1E) and new appearance of multiple thromboses adhering to the intravascular side stent struts (Fig1F–G). Switch from Cangrelor to Tirofiban was done. Patient‘s clinical course was uneventful with discharge after six days on triple antithrombotic therapy with low–dose NOAC, ASA and clopidogrel.Case 2: 63–y smoker man arrived in cath lab for anterior STEMI. He had already taken ASA 300 mg ev and Ticagrelor 180 mg oral bolus about 60 minutes earlier in the ambulance. In Cath Lab was done heparin 100 IU/kg. P–PCI was performed for acute sub–occlusion (Fig2A) of the ostial DA treated by pre–dilation, DES implantation on Left Main–DA and multiple post–dilations according to the POT technique. OCT control showing extensive stent malapposition (860 µm) with evidence of multiple thromboses adhering to the stent struts on Left Main (diameter 410 µm) although there was perfect angiographic result (Fig2B–E). Procedure was optimized by adequate post–dilatation of the LM and administration of Abciximab. Patient‘s clinical course was uneventful with discharge after five days on ASA and Ticagrelor.

Conclusions
Post–stent OCT thrombus may guide the choice of use of Glicoprotein IIb/IIIA Inhibitors in Cath Lab.
P57 VOLTAGE CHARACTERIZATION OF ABNORMAL CONDUCTION ZONES IN PATIENTS AFFECTED BY ATRIAL FIBRIALLATION
Authors: Gregusova N , Grossi B , Pagani S , Taormina A , Ceriotti C , Poggio L , Galimberti P , Battaglia V , Del Monaco G , Latini A , Valcher S , Stankowski K , Mincione G , Condorelli G , Frontera A 
Published: May 2023

Abstract

Background
In case of persistent atrial fibrillation (AF), atrial substrate assumes a dominant role in sustaining the arrhythmia. Recent studies prove that low voltage areas (LVA, Voltage Amplitude &lt; 0,5 mV) represent an additional target for ablation of AF patients. Purpose. The purpose of this study is to analyse whether structural atrial conduction abnormalities (i.e., pivot sites and slow conduction corridors) may occur outside low voltage areas.

Methods
The study is based on the retrospective analysis of 31 consecutive maps of patients undergoing AF ablation (16 paroxysmal and 15 persistent cases). The clinical procedures have been performed with the support of a mapping system. Sinus rhythm activation maps and bipolar maps used for this analysis have been created with a multipolar mapping catheter. Map points were only acquired when the electrode was in contact with the endocardial tissue to avoid misleading voltage amplitude information. Slow conduction corridors and pivot sites have been analysed. At these sites, EGMs characterization included voltage amplitude (mV), signal duration (ms) and fractionation.

Results
The average value of EGMs amplitude reported at pivot sites and slow conduction zones, respectively, amounted to 2,08 ± 0,63 mV and 2,1 ± 0,66 mV in paroxysmal cases. In persistent cases, there were slight decreased values to 1,95 ± 0,93 mV and 1,89 ± 0,89 mV. Characterization at pivot sites documented a mean duration value of 45,4 ± 4,64 ms and 49,93 ± 5,51 ms in paroxysmal and persistent patients, respectively, while in slow conduction zones 41,53 ± 7,94 ms and 49,04 ± 6,41 ms have been reported. As for fractionation, more than five deflections per signal have been identified in all abnormal conduction areas.

Conclusion
Our study proves that functional electrophysiological phenomena can occur outside low voltage areas, even in persistent cases. According to this analysis, not all LVA represent the correct target for catheter ablation, encouraging the development of further methods for investigation of atrial substrate.
P62 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON–CULPRIT CORONARY PLAQUES
Authors: Sammartini E , Biccirè F , Debelak C , Budassi S , Varricchione G , La Porta Y , Romagnoli E , La Manna A , Marco V , Boi A , Fabiocchi F , Taglieri N , Calligaris G , Burzotta F , Francesco V , Arbustini E , Prati F 
Published: May 2023

Abstract

Background
Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood. Purpose. Our study aims to analyse the characteristics of non–culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery.

Methods
We included 1848 non–culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient.

Results
Overall, median age was 66 years (56–74), with 24.6% of women and 53.4% of ACS. At patient–level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion–level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season).

Conclusions
Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.
P84 RAPID OPTIMIZATION OF HEART FAILURE THERAPY: ROLE OF THE HOSPITAL – TERRITORY NETWORK
Authors: Scardovi A , Renzi M , Festinese S , Del Sindaco D , Di Giacomo T , Ricci R 
Published: May 2023

Abstract
Heart Failure (HF) Guidelines take into account the close administration of the four classes of "pillar" drugs (Beta–blockers, Sacubitril–Valsartan, SGLT2i, MRA) completing their titration in the shortest possible time. The hospital outpatient clinic for HF (HOCHF), with the collaboration of the dedicated nursing clinic (DNCA), is the ideal place to follow patients (pts) in the phase immediately following discharge (7–10 days), in order to rapidly optimize the therapy and achieve stabilization: this can only be possible if the HOCHF is inserted in a Hospital–Territory–Hospital (HTH) network capable of continuing and sharing the follow up (FU) of stabilized patients. In ASL Roma 1, a HTH has been active in districts 1–2–3 since 2017, which includes the Santo Spirito Hospital –NRM, 3 Health Centers and 7 territorial outpatient clinics where 23 cardiologists and 50 nurses operate. The hospital component of the HTH is represented by the HOCHF Santo Spirito (supported by the DNC) which, thanks to the close collaboration with the territorial cardiology (TC), manages to concentrate mainly on the pts just discharged for the optimization of the therapy, on the unstable ones or the ones requiring advanced treatment. The clinic performs an average of 25 weekly examinations supported by the DNC which performs face–to–face and telephone services. In the period January – December 2022, 1,109 cardiological examinations were performed. 123 pts (mean age 76 + 4 years, 25% women) had access to the HOCHF within 10 days of discharge. The target therapy was achieved in the first 4 weeks in 42 pts (34% of the total) with 3–4 accesses. A further 50 pts achieved the therapeutic goal at 8 weeks (40.6% of the total) with 4–6 accesses. Of the remaining 31 pts, 5 (4% ​​of the total) were re–hospitalized at 30 days, 4 died (3.2% of the total), 22 (17.8% of the total) reached the target therapy in the following months. All the stabilized pts continued the FU in the proximity TC. In conclusion, in our experience, it was possible to titrate the therapy suggested by the guidelines in 74.7% of pts discharged for HF within 8 weeks. This result was obtained by focusing the activity of the HOCHF and DNC on appropriate pts, thanks to the close collaboration with the TC.
P89 THE INTEGRATED CARDIOGENETICS CLINIC FOR CARDIOMYOPATHIES – FIRST YEAR OF ACTIVITY RESULTING FROM A NEW ORGANIZATIONAL MODEL
Authors: Bianco M , Gazzola V , Nangeroni G , Biolè C , Deaglio S , Giachino D , Chinaglia A 
Published: May 2023

Abstract

Introduction
Over the last year our center has empowered a specific clinic for the follow–up of patients affected by cardiomyopathies. In this context, genetic testing was offered to specific patients suspected of having genetically determined cardiomyopathies. We present here how we organized the genetic diagnostic pathway of these patients and the result of the first year of activity.

Methods
The diagnostic workup of patients with a suspect of genetically determined cardiomyopathies was implemented with the goal of time and resources optimization. After a comprehensive evaluation by clinical cardiologists the blood sample of patients who gave their informed consent are directly referred to the reference center for NGS analysis. In particular, patients are considered for NGS when they have familiarity for cardiomyopathies and/or when a clear explanation for their clinical picture is lacking. A dedicated platform is employed to require genetic testing by cardiologists and to provide meaningful information to the geneticists performing the genetic analysis. Once test results are available, all patients are offered a joint consultation with the cardiologist and medica geneticists to discuss the results.

Results
A total of 69 patients were recruited during the first year of this project. The majority of patients (60 patients) underwent NGS, whereas a minority (9 patients) underwent Sanger sequencing. The clinical suspects prompting NGS were DCM (20 patients), HCM (14 patients), ARVD (10 patients), amyloidosis (10 patients), NCM (2 patients), or others (4 patients). To date, 47 patients ha received the results of their genetic investigation, with a mean time from blood sampling to test results date of 88 days. In particular, the results of testing showed: 4 pathogenic variants (C5), 13 likely pathogenic variants (C4), 24 variants of uncertain significance (C3) and 22 negative results. The remaining 22 patients are waiting for results and subsequent genetic counseling, as they underwent test in the last 3 months.

Conclusions
Easy and time effective access to genetic testing is of paramount importance in the management of patients with cardiomyopathies. Here we presented the results of an innovative approach to optimize the diagnostic workup of these diseases, which allowed us to provide answers to the patients in a fast and effective way, optimizing our resources and avoiding the loss of patients during follow–up.
P93 NATURAL HISTORY AND CLINICAL BURDEN OF MODERATE AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META–ANALYSIS
Authors: Morelli M , Galasso M , Soriano F , Nava S , Da Pozzo C , Esposito G , Piccaluga E , Bossi I , Montalto C , Oliva F , Oreglia J , Giannattasio C 
Published: May 2023

Abstract

Objectives
The aim of this study was to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of left ventricular ejection fraction and of age with prognosis.

Background
The mortality risk of patients with moderate aortic stenosis is not well known but recent studies suggested that it might negatively affect prognosis.

Methods
A systematic research was conducted on PubMed. The inclusion criteria were: 1) inclusion of patients with moderate aortic stenosis; 2) report of the survival at 1–year follow–up (minimum). Incidence ratios related to all–cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. Meta–regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.

Results
Fifteen studies and 11,596 patients with moderate aortic stenosis were included. All–cause mortality was significantly higher among patients with moderate aortic stenosis than among controls: 10.7% (95% CI: 0.1010–0.1136) vs 4.5% (95% CI: 0.0438–0.0454) at 1–year (p &lt; 0.0001), 17.7% (95% CI: 0.1692–0.1854) vs 7.6% (95% CI: 0.0754–0.0775) at 2–year, 23.0% (95% CI: 0.2204–0.2387) vs 9.9% (95% CI: 0.0973–0.0997) at 3–year, 27.9% (95% CI: 0.2685–0.2899) vs 11.9% (95% CI: 0.1177–0.1203) at 4–year, and 32.4% (95% CI: 0.3125–0.3360) vs 14.2% (95% CI: 0.1402–0.1430) at 5–year follow–up. Left ventricular ejection fraction did not significantly impact on the prognosis of patients with moderate aortic stenosis (estimate = –0.0020; 95% CI: –0.0078–0.0038; p = 0.4584), unlike of age (estimate = 0.0067; 95% CI: 0.0007–0.0127; p = 0.0323).

Conclusions
Moderate aortic stenosis is not a benign disease. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of the aortic valve replacement. Figure 1: All–cause mortality of patients with moderate aortic stenosis (red) vs controls (black) at 1–, 2–, 3–, 4– and 5–year follow–up. Figure 2: Impact of left ventricular ejection fraction on prognosis of patients with moderate aortic stenosis. Figure 3: Impact of age on prognosis of patients with moderate aortic stenosis.
P94 LATE–ONSET POST–INFECTIVE AORTIC PSEUDO–ANEURYSM AFTER BIOPROSTETHIC AORTIC VALVE REPLACEMENT
Authors: Ianni U , Alfieri M , Molisana M , D’Agostino S , Gizzi G , Cicchitti V , Di Eusanio M , Parato V 
Published: May 2023

Abstract
A 74 year–old man was admitted three months after SAVR symptomatic for dyspnea. Past medical history: DM type 2, PAD and recent SAVR after diagnosis of severe aortic stenosis, complicated by Stafilococcus Epidermidis blood culture sternal wound dehiscence, requiring Robicsek technique treatment and long–term parenteral antibiotics. He was finally discharged to our cardiac rehab unit. Blood analysis: negative blood culture at admission with negative CPR. Late positivity (after 2 weeks) for a Staphylococcus epidermidis reinfection. EKG: normal atrio–ventricular and intra–ventricular conduction with regular repolarization. TTE: Normal left ventricular volume and ejection fraction with severe aortic regurgitation secondary to suspected partial bioprosthesis detachment. TOE: valvular detachment with a newly–formed pouch located in the mitro–aortic membrane. Bioprosthetic valvular failure (BVF) is a pathological entity arising from a variety of conditions affecting prosthetic heart valves. We present the case of a late–onset partial valvular bioprosthesis detachment associated with a newly–formed pseudoaneurysm due to late infective endocarditis occurred after cardiac surgery, initially manifested with negative cultural findings and suddenly evolved in severe aortic regurgitation. Valvular detachment is an infrequent complication of infective endocarditis. Surgery is the only option capable of restoring a proper anatomy and a correct function of the valvular apparatus. Patient underwent re–do surgery and a new SAVR was needed after confirmation of diagnosis with no residual aortic regurgitation after discharged. BVF is a fearsome and severe condition presenting with a wide spectrum of clinical presentation. Our experience highlights the need of a prompt diagnosis. Late positivity of blood cultures for Stafilococcus Epidermidis probably depend on prolonged antimicrobial therapy after sternal dehiscence treatment which have probably masked laboratoristic finding in early phase (negative CPR and blood cultures). An early intervention is mandatory in order to prevent systemic dissemination or acute decompensation secondary to severe aortic regurgitation. Surgical approach in this case guaranteed a radical treatment with no residual regurgitation or sub–acute microbial infection. 4–weeks parenteral antibiotics during cardiac–rehab efficacy–controlled relapse of CPR and blood–culture (negative before final discharge).