bluuebunny/crossref_metadata_2025_split huggingface dataset:
P61 VIP–AF. CORRELATION BETWEEN VOLTAGE AND IMPEDANCE MAPPING IN PATIENTS AFFECTED BY ATRIAL FIBRILLATION: A FURTHER STEP TOWARDS SUBSTRATE CHARACTERIZATION
Authors: Ragaini E , Taormina A , Grossi B , Pagani S , Ceriotti C , Poggio L , Valcher S , Stankowski K , Galimberti P , Del Monaco G , Gregusova N , Latini A , Mincione G , Condorelli G , Frontera A 
Published: May 2023

Abstract

Background
Pulmonary veins isolation (PVI) represents the main strategy for paroxysmal atrial fibrillation (AF) treatment. Due to the poor clinical outcomes of PVI in case of non–paroxysmal AF, significant efforts have been made to develop new ablative strategies to modify the atrial substrate. Up to now, in order to characterise atrial substrate, only bipolar voltage maps have been used and impedance mapping has never been evaluated.

Purpose
Our aim is to demonstrate the potential correspondence among atrial wall thickness, bipolar voltage and impedance. Atrial impedance mapping could represent an additional tool for atrial substrate characterization, providing further information on tissue conductive properties and confirming bipolar substrate analysis.

Methods
The study includes the retrospective analysis of 60 electro–anatomical (EA) maps of patients with paroxysmal (40 patients) and persistent (20 patients) AF admitted to our institution for treatment. The clinical procedures have been performed with the support of CARTO3 mapping system. Map points have been collected with Navistar RMT Thermocool ablation catheter in order to enable the evaluation of atrial impedance values. To perform the correspondence analysis between the voltage map and impedance map, the atrial endocardial surface has been divided in six sections. Before ablation, for all patients a computed tomography has been performed in order to evaluate atrial endocardial thickness. Parameters of interest that have been evaluated in this study are EGMs voltage amplitude (mV) and fractionation (&gt; five deflections per signal) and the corresponding impedance value (Ohm) at the considered acquisition point.

Results
In all PAF cases no voltages lower than 0.5 mV have been reported. The corresponding impedance values ranged from 140.6 to 169.9 Ohm, with an average value of 151.5 ± 5.4 Ohm. In PsAF cases, instead, voltage values inferior to 0.05 mV have been reported in the posterior wall, anterior wall and roof in 19/20 patients. In these low voltage areas, long duration fractionated signals have been reported and the average impedance value dropped to 129.1 ± 3.8 Ohm, ranging from 110.2 Ohm to 139.6 Ohm.

Conclusion
Our study supports the association between left atrial thickness, voltage amplitude and impedance values. This allows the correct substrate evaluation in case of uncertain bipolar values thanks to additional information provided by impedance mapping.
P78 PSYCHIATRIC PATHOLOGIES PREVALENCE OF IN TAKOTSUBO SYNDROME
Authors: Cariello F , Bencardino G , Sacra C , Romano A , Trigiani G , Ienco V , Macrì L , Gioia M , Deietti G , Ventura G 
Published: May 2023

Abstract

Background
Tako Tsubo syndrome (TTS) is characterized by transient alterations of ventricular kinetics (ATC) in the absence of obstructive epicardial coronary artery disease.

Materials
39 cases of TTS that came to our observation from 2005 to 2019 are described, the diagnosis was made on the basis of evidence of ATC, ECG alterations, increase necrosis markers in the absence of obstructive coronary disease, excluding myocarditis.

Results
39 patients (PZ) (35 females and 4 males) diagnosed with TTS had an average age of 61 ± 13.21 years and symptoms at onset were mainly angina in 28 PZs (72%), dyspnea was present in 8 (20%) and syncope in 3 (8%). ECG changes were characterized by ST depression and/or negative T waves in 30 patients (77%), in 9 (23%) the ST segment was elevated. ATV involved apical segments (SAP) in 27 PZ (69%), 4 (10%) the basal segments (SBA), 2 (5%) the middle segments (SME) and 6 (15%) had focal points abnormalities (FOC). The average Ejection Fraction (FE) on admission was 36.85%, in PZ with ATV of SAP 33.96%, when involved SBA 41%, SME 43.5% and FOC 44.83%. Haemodynamic conditions were stable in 33 pts (84%), 3 pts (8%) presented cardiogenic shock, 3 (8%) pulmonary edema. Arrhythmias were present in 1/3 of the cases. Atrial fibrillation in 38%, extrasystolic arrhythmia in 30%, one patient with sustained ventricular tachycardia, and three patients with total BAV (23%) of which one in shock. In 10% of cases (4 PZ) there was a subvalvular aortic gradient at discharge disappeared. In 8% (3 PZ) was a recurrent TTS. 92% of the PZ reported a psychophysical stress in the 24 hours preceding the event, and a psychiatric pathology was present in 90%. However, only in 60% of cases the psychiatric diagnosis was known on admission, in the remaining 40% the diagnosis was made subsequently, and among the PZ being treated only in ¼ of the cases was it judged adequate.

Conclusions
In our series, SAP involvement was associated with lower EF values and greater hemodynamic compromise. Involvement of SME, SBA or FOC was associated with higher EF values and less hemodynamic compromise. A psychiatric pathology was present in over 90% of the PZ even if in 40% of the cases it was not ascertained at the time of admission, and in 75% of the PZ in which the diagnosis was known, the treatment was not adequate.
P79 MITRAL VALVE ENDOCARDITIS COMPLICATED BY INFERIOR INFARCT AND MULTIPLE DISTAL EMBOLICATIONS
Authors: Ruggiero A , Benvenuto M , Lavorgna A , Palazzolo M , Romano S , Fabiani D 
Published: May 2023

Abstract
A 41–year–old woman with history of drug addiction was ammitted at emergency department (ED) with the following symptoms: hyperpyrexia, shaking chills asthenia and anorexia for about 10 days; the hematochemical tests performed in urgency showed an increasing inflammatory markers and severe anemia. On suspicion of infective endocarditis, a transthoracic echocadiogram was performed which revealed a mobile isoechoic mass adhered to the anterior mitral leaflet (LAM), compatible in the first hypothesis with endocardiac vegetation. Hemocultures were drawn and empiric antibiotic therapy was setted. Following clinical conditions’s worsening, the patient underwent contrast–free total body Computed Tomography (CT) with the detection of multiple pulmonary, splenic and renal septic emboli associated with a cerebral hemorrhagic focus. Transesophageal echocardiography (TEE) confirmed the presence of a 29 mm mobile vegetation on the atrial side of the LAM and the LAM’s perforation at the A3 level with associated severe eccentric regurgitation jet. Therefore, during hospitalization, coronary septic embolization was suspected due to the onset of a severe epigastric pain and the electrocardiographic finding of ST–elevation in the inferior leads associated with troponin’s increase. In consideration of the high bleeding risk and the septic state, conservative therapy was indicated. After a month of targeted antibiotic therapy, once clinical stabilization was obtained, a control TEE was performed and showed the disappearance of the endocardial vegetation and the persistence of the valve flap perforation and the eccentric jet. Once the regression of the septic state, a coronarographic study was performed and it showed no significant stenosis. The patient underwent mitral valve plastic surgery with the direct suture of the LAM and ring implantation in mini–thoracotomy. After a short period in intensive care, she continued her hospitalization in cardiac surgery department without complications. Careful clinical management of the acute phase and antibiotic therapy, empirical and targeted, allowed the patient to undergo cardiac surgery in the best possible conditions, reducing the risk of complications.
P107 EARLY TRANSITION FROM CANGRELOR TO ORAL P2Y12I IS NOT ASSOCIATED WITH INCREASE OF ADVERSE EVENTS
Authors: Rizzo F , Mandurino Mirizzi A , Tondo A , Fischetti D , Quarta L , Corlianò L , Mussardo M , Cafaro A , Germinal F , Picciolo A , Colonna G 
Published: May 2023

Abstract
Intro Cangrelor, an intravenous P2Y12 receptor inhibitor (P2Y12i), characterized by rapid onset and offset of antiplatelet action, is approved by guidelines for patients P2Y12i naïve undergoing percutaneous coronary intervention (PCI). Cangrelor infusion duration and time of transition to oral P2Y12i are still debated, although there is a general indication to an infusion of at least 2 hours. The aim of our study is to evaluate the efficacy and the safety of an early transition to oral P2Y12i strategy.

Methods
Our prospective observational monocentric study enrolled consecutive patients who received Cangrelor during PCI (bolus + infusion iv starting at time of PCI). Clopidogrel and Prasugrel were administered immediately upon discontinuation of Cangrelor infusion, while Ticagrelor was started up to 30 min before Cangrelor was discontinued. Transition was defined as early when Cangrelor infusion duration was less than 2 hours. Endpoints of interest were major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), stroke and target vessel revascularization (TLR) and stent thrombosis (ST). Safety endpoints were bleeding events divided as major events (BARC 3–5) and minor events (BARC 1–2).

Results
133 patients were enrolled: mean age was 69,3±11 years, men were 97 (73%), diabetics 24 (18%). 112 (84%) presented with acute coronary syndrome (tab1). 90% of interventions were done by radial approach, 19% of patients received Clopidogrel as oral P2Y12i. In–hospital MACE were 3, in absence of fatal events; 2 cases of MI (type 4a). The only case of ST was observed with OCT performed during staged PCI of non culprit lesion, with patient totally asymptomatic, without troponin increase and on Clopidogrel as oral P2Y12i. There were 2 BARC 3 events. Patients who received early transition strategy did not presented significant differences of ischemic/bleeding events (tab2).

Conclusions
Cangrelor demonstrated efficacy and safety in patients undergoing PCI. An early transition strategy to oral P2Y12i was not associated with an increase in both efficacy and safety adverse events in this early phase of our study.
P137 STEMI IN YOUNG MAN: A "CHALLENGE" CASE OF SPONTANEOUS CORONARY DISSECTION
Authors: Centola M , De Carlini C , Saltafossi D , Mollichelli N , Moro C , Provenzale G , Loffreno A , Iacuitti G , Giulia B , Russo V , Rogagka R , Spina M , Achilli F 
Published: May 2023

Abstract
A 21–years old male patient presented to the emergency department complaining chest pain in the night. There was no family history of cardiovascular events; he did not have any known risk factors and denied drug abuse. Pathological history was positive for allergic asthma. On admission, he was paucisyntomatic. The physical examination was normal. Blood pressure was slightly elevated. The EKG showed sinus rhythm, ST segment elevation in high lateral leads and reciprocal ST depression in inferior leads. The echocardiogram showed anterolateral and mid–apical septal akinesia of the left ventricle with ejection fraction of 45%. The urgent coronary angiography showed suspected coronary artery dissection of the first diagonal branch with TIMI flow grade 2 and myocardial brigde of the middle segment of the left anterior descending artery (fig.1). An initial conservative management with beta–blockers, dual antiplatelet therapy, statin and ACE–inhibitors was adopted: the patient was asymptomatic and the EKG became normal during the coronary angiography. In addition the young age, the suspicion of Spontaneous Coronary Artery Dissection (SCAD) and TIMI flow grade 2 in the culpit vessel provided support of conservative treatment. The hospital stay was unremarkable. Troponin T peak value was 1542 pg/ml (n.v. &lt; 13 pg/ml). Thrombophilia screening showed mild hyperhomocysteinemia and homozygous MTHFR mutation. Autoimmunity screening was negative. The subsequent echocardiogram showed mid–distal hypokinesia of the anterolateral, inferolateral and anterior wall of the left ventricle with normal ejection fraction. The CT angiography of the cerebral and abdominal vessels was normal. The cardiac magnetic resonance imaging (MRI) confirmed a recent acute myocardial infarction of the mid–apical portions of the anterior and anterolateral wall and normal global contractile function of the left ventricle (fig. 2, 3). At 30 days follow up, the echocardiogram remained unchanged; the coronary AngioCT scan confirmed the dissection of the ostium and proximal section of the first diagonal branch; the cardiac MRI showed transmural fibrosis of the anterolateral wall with normal left ventricular ejection fraction. SCAD is an under–reported pathology. It can lead to acute coronary syndromes and life–threatening consequences. Diagnosis and treatment are still under debate. The presented clinical case, effectively treated with conservative therapy, represented a "challenge" in the acute phase.
P139 RETURN TO THE ORIGINS: WHEN THE THROMBOLYSIS SAVES THE ANGIOPLASTY
Authors: Palazzolo M , Carlà A 
Published: May 2023

Abstract
A 62 year old man arrived in PS for typical chest pain radiating to the jugular and associated with sweating for about three hours. History of arterial hypertension and untreated dyslipidemia, family history of CVD. ECG: sinus rithm at rate of 50 bpm with first degree AVB. Inferior ST elevation in inferior leads and ST depression in V2–V3. Echocardiogram: depressed systolic function (EF 48%) in relation to hypo–akinesia of the mid–basal segments of the inferior–posterior–lateral wall. Diagnosed with STEMI inferior–posterior, was sent to the cath lab to undergo to emergency coronary angiography, with findings of non–significant atheromas on IVA and Cx. Multiple unsuccessful attempts to search for the right coronary artery and failure to visualize the aortography in two complementary projections. During the procedure hemodynamic and electrical instability, worsening angor, marked hypotension and extreme bradycardia up to complete AVB with asystole phases. Inotropics and atropine were started, which proved ineffective, and it was therefore decided to proceed with the implantation of a temporary pacemaker. During the placement, the patient presented cardiac arrest from VF (likely an irritating effect from the passage of the lead through the tricuspid) treated with effective DC–shock. Given the technical difficulties in proceeding with mechanical revascularization and given the patient‘s instability, the decision was made to postpone PCI by attempting systemic thrombolysis. Early efficacy of thrombolysis with disappearance of precordial pain, improvement of echo motion and reduction &gt; 50% of the ST–segment elevation to the rare spontaneous QRS displayed at the transient shutdown of the temporary PM. Subsequent emergence of AF at rate of 116 bpm. Approximately 12 hours after thrombolysis: complete ST resolution in absence of Q waves. AngioTC of the coronaries was performed which showed regularl origin of Cdx from the right coronary sinus but higher up and lateralized to the left, with severe lesion in the first segment. So the patient underwent falicitated PCI with detection of ostio–proximal Cdx thrombotic lesion effectively treated with PTCA and drug–eluting stent placement with good final angiographic result. Control echo: preserved global left ventricular motion (FE 55%), hypokinesia of the basal segment of the inferior wall. The remaining stay decurred without any complications and the patient was discharged with indications for a close follow–up.
P143 PLATYPNOEA–ORTHODEOXIA: A CASE REPORT OF A RARE SYNDROME
Authors: Fontana A , Occhiuzzi E , Carducci P , Valentini G , Balsano C 
Published: May 2023

Abstract
A 32–year–old non–smoker Asian female was admitted to the Emergency Department San Salvatore Hospital of L‘Aquila experiencing worsening of dyspnea. Three months earlier the patient had undergone left pneumonectomy. An arterial blood gas analysis performed on air reported: pH 7.53, pCO2 23.7 mmHg, pO2 38.7 mmHg, SpO2 80%. Blood tests were within normal limits, except for a moderate increase in D–Dimer. Considering the diagnostic hypothesis of pulmonary embolism, an Angio CT–scan of the chest was performed and showed no radiological characteristics suggesting parenchymal pathology and no evidence of thromboembolic or other vascular pathology. From the accurate clinical evaluation of the patient, a condition of severe platypnoea was evident: supine decubitus was obliged. Together with the above position variations, a strong desaturation was observed, going from almost normal values (94–96% SpO2), to 80–82% SpO2 when she was sitting up in bed. Based on the data above, a right–left shunt condition was assumed, and a transesophageal contrast echocardiogram was requested. The latter demonstrated patency of the foramen ovale. The first description of a condition very similar to platypnoea–orthodeoxia syndrome following pneumonectomy dates to 1956, by Schnabel et al. A recent pubmed database–EMBASE systematic review identified 8 studies concerning ten patients, 6 male/4 female. The mean age was 62 years. All patients underwent resection of the right lung. The time–interval between the operation and the platypnoea–orthodeoxia syndrome (POS) was from 2 days to 3 years. A PFO was present in 90%. Considering the data, our patient shows at least two peculiarities; the first and most relevant is the young age: in fact, there is only one description of POS in a patient of younger age. The second peculiarity is the left localization of the previous pneumonectomy, much rarer in frequency than the contralateral in the known cases. Partial or total pulmonary resection can rarely be followed by the onset of POS. This syndrome can be severely disabling, so physicians must be prepared for its prompt recognition, maintaining a high degree of suspicion.
P152 CORONARY CT ANGIOGRAPHY A NEW PROMISING TOOL IN HEART TRANSPLANTED PATIENTS: FROM CLINICAL AND ECONOMICAL BENEFITS TO CORONARY INFLAMMATION DETECTION
Authors: Cozza E , Dellino C , Savo M , Amato F , De Conti G , Tarantini G , Motta R , Tessari C , Gerosa G , Iliceto S , Pergola V 
Published: May 2023

Abstract

Background
Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits. Purpose: 1) assess the non–inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non–immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary–fat–attenuation–index (pFAI) at CCTA in the progression of CAV.

Methods
179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022.

Results
CCTA and CA showed similar radiation doses (8.47 [1.46–30] versus 8.15 [1.38–87.34]; p=0.796) and rate of complications (0 (0%) vs 3 (3%); p=0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 ± 12.31 hours; p&lt;0.001), lower costs (120 euros versus 2800 euros; p&lt;0.001) and less contrast agent (60.4 ± 8.7 ml versus 95.68 ± 47.6ml; p&lt;0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p=0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p=0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47–45.81; p=0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (&gt;–70.1HU) and the progression of CAV (p=NS).

Conclusions
CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.
P154 HUMAN CORONARY INFLAMMATION AT CORONARY COMPUTED TOMOGRAPHY IN PATIENTS WITH INOCA
Authors: Tuttolomondo D , Gaibazzi N 
Published: May 2023

Abstract

Background
A new imaging metric using coronary computed tomography angiography (CCTA), addressing the peri–coronary adipose tissue (PCAT) computed tomography (CT) attenuation, has been clinically validated. This method provides information regarding coronary inflammation. It is unclear how coronary inflammation affects microvascular function. The non–invasive evaluation of coronary flowvelocity reserve is widely used in clinical practice using Doppler measurement on the left anterior descending coronary artery (CFVR–lad) during stress–echocardiography (SE).We hypothesize that coronary inflammation affects CFVR–lad and, in the absence of overt CAD, they are significantly correlated.

Methods
We evaluated the relationship between coronary inflammation (by PCAT CT attenuation) and coronary microvascular function (by CFVR–lad) in subjects with no or non–obstructive (diameter stenosis &lt;70%) coronary artery disease (CAD).

Results
Two–hundred and two subjects were enrolled in the study. The relationship between PCAT CT attenuation and CFVR–lad show a significant inverse relationship in the entire group of subjects enrolled in the study (r = −0.32, p &lt; 0.001). Correlation between PCAT CT attenuation and CFVR–lad was significant in subjects with no or mild CAD–lad, while this was not the case in subjects with intermediate CAD–lad. The R and R2 were respectively −0.40, −0.16 in subjects without CAD (p &lt; 0.001) and − 0.35 and − 0.12 in subjects with mild CAD–lad (p = 0.001).

Conclusions
The main finding of the current study is the independent relationship between coronarymicrovascular function, by Doppler CFVR–lad during SE, in subjectswithout severely obstructive CAD in the left anterior descending coronary artery, and the level of local coronary inflammation, by PCAT attenuation measurement on CCTA.
P159 A HOSPITAL ON A HUMAN SCALE: THE VIRTUAL HOSPITAL PROJECT
Authors: Benelli E 
Published: May 2023

Abstract
Person–centered care relies on collaboration between professionals, patients and their families to ensure that patients have the education and support they need to make decisions and be active participants in the diagnosis process and care. Designing healthcare around patients‘ preferences and needs can improve patient satisfaction and also prognosis. The Virtual Hospital project developed at the Fondazione Toscana Gabriele Monasterio pursues the goal of person–centered care through an innovative approach. The project also aims to use some of the same tools developed for patients to improve the psycho–physical well–being of healthcare personnel. The project involves the creation of an app for Android devices that provides access to information material relating to the care pathway, the system for making video calls, cultural content or for relaxation and information on the facility. The interface, which was designed to be easily usable even by elderly subjects, currently contains the following icons: "My heart", "My breath", "My path", "My exams", " Video calls”, “My diary”, “Music”, “Visit museums”, “My hospital”. The Virtual Hospital project also envisages the creation of contents relating to pulmonary, cardiac surgery, pediatric cardiological pathologies, the development of applications for visors (“oculus”) and the creation of a Tranquility room, a space where healthcare personnel can regenerate, reduce stress and find greater fulfillment in their work, improving the quality of care provided to the patient.