bluuebunny/crossref_metadata_2025_split huggingface dataset:
P404 MYOCARDIAL WORK EVALUATION IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: D’Arienzo D , Sperlongano S , Iannuzzi A , Renon F , Del Giudice C , Liccardo B , Pezzullo E , Bocchetti M , Totaro A , Bianchi R , Loffredo F , Cappelli Bigazzi M , Golino P 
Published: May 2023

Abstract

Background
myocardial work (MW) is a novel echocardiographic technique that enables the study of left ventricular performance. It overcomes speckle tracking echocardiography (STE) limitations, dependent on afterload, which is increased in patients with severe aortic stenosis (AS). Aims: To evaluate myocardial performance indexes obtained with MW in patients with AS and indication to percutaneous aortic valve replacement (TAVR) before and after the procedure.

Methods
patients with severe AS and preserved left ventricular systolic function (LVEF) and indication to TAVR underwent complete echocardiographic evaluation the day before and within two days after the procedure. MW indices were calculated considering noninvasive systolic blood pressure (SBP) and corrected for the mean transvalvular aortic gradient.

Results
39 patients (78±6 years, 61.5% women) were enrolled, they presented at baseline preserved LVEF (59.4±8.2%) and reduced global longitudinal strain (GLS) (–16.8±3.3%). Corrected global work index (cGWI) and corrected global constructive work (cGCW) appeared elevated before the procedure, and were significantly reduced within 2 days after TAVR (cGWI –2460.5±839.7 mmHg% vs 1844.4±521.6 mmHg%, p&lt;0.01; cGCW 3061.3 ± 796.0 vs 2277.4 ± 536.5mmHg%, p&lt;0.01). Adjusted global wasted work (cGWW) and adjusted global work efficiency (cGWE) did not change significantly after TAVR (cGWW 262.6±151.8 vs 244.2±129.2 mmHg%, p=0.236; cGWE 90.1±4.5 vs 88.5±5.2%, p=0.079) in the overall population. In the subgroup of patients who had not developed new atrioventricular or intraventricular conduction abnormalities, cGWW also significantly decreased following TAVR (275±152.6 vs 216.3 ± 99.7 mmHg%, p=0.018), with no change in cGWE (89.7±4.8 vs 89.3±5.8%, p=0.838).

Conclusions
The reduction in cGWI and cGWC values and thus myocardial oxygen consumption in the immediate post–TAVR is attributable to the reduction in afterload. Left ventricular function abnormalities do not totally regress after the procedure, although the lack of reduction in cGWW could be partly due to the development of atrioventricular or intraventricular conduction defects. Further studies are desirable to define a role of MW in prognostic stratification of patients with severe AS.
P405 IS THE IMPAIREMENT OF MITOCHONDRIAL QUALITY CONTROL MECHANISM INVOLVED IN THE ONSET AND PROGRESSION OF AORTIC VALVE STENOSIS?
Authors: Mikus E , Savini C , Tripodi A , Pinton P , Patergnani S , Fiorentino M , Morciano G 
Published: May 2023

Abstract

Background and aim
Calcific aortic valve stenosis (CAVS) is the most common valvular disease and its pathogenesis is poorly understood. Despite the standards in cardiovascular surgery have improved, the establishment of new therapies is an ambitious goal. In the last 15 years, some studies tried to shed light on the dysregulation of the cellular self–digestion process in CAVS, but the results obtained remained controversial. This work aims to definitively establish the role of autophagy in CAVS, to analyze the involvement of other determinants that impact on the mitochondrial quality control mechanisms and to explore possible paths for pharmacological interventions in the treatment of this disease.

Methods
This study has been performed on 104 patients in which biological samples (cells and serum) have been analyzed using biochemical approaches and then have been correlated to clinical data. AV cusps were obtained from 59 patients unfergoing surgical aortic valve replacement from march 2018 to July 2019. Of them, 44 suffered from aortic stenosis and 15 from aortic regurgitation (control group).

Results
The two population didn‘t differ for baseline pre operative characteristics, except for male sex that was more represented in the AR group (73% vs 43% p=0.05). In CAVS patients, we unveiled a significant deficiency in mitochondrial respiration and in ATP production coupled to increase production of lactates. Moreover, mitochondrial population in the pathologic group was older, with significant alterations in biogenesis and mitophagy pathways. We are also reporting an update about the role of autophagy accompanying the calcification process and the advanced stages of the disease. In fact, we provided evidence for a rapamycin–based therapeutic strategy to eventually revert the process and to report the calcified phenotype back to the wild type one.

Conclusions
Our data suggest that the CAVS phenotype is featured by defects in mitochondrial quality control mechanisms and that autophagy is not activated enough to counteract cell death and sustain cell functions. Boosting autophagy and mitophagy from short– to long–term reverts quite all pathological phenotypes.
P407 MULTIDIMENSIONAL ASSESSMENT OF THE ELDERLY PATIENT WITH SEVERE AORTIC STENOSIS: THE ROLE OF FRAILTY IN THE CHOICE OF TREATMENT (TAVI/SAVR)
Authors: Curri F , Patetta L , Foti A , Gasparini F , Bortoluzzi C , Rossi A , Curreri C , Sergi G 
Published: May 2023

Abstract

Background
Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVI) are treatment options in patients with severe aortic stenosis. International guidelines suggest both traditional risk scores and a Comprehensive Geriatric Assessment (GCA) be determinants in treatment decision–making. The aim of the study is to identify the GCA parameters associated with the decision to perform TAVI instead of SAVR in elderly patients with severe aortic stenosis.

Materials and Methods
Between 2019 and 2022, 66 patients aged ≥75 years were referred to the Cardiology department of Padua Hospital for pre–operative evaluation, including CGA. The CGA consisted of functional status (Activities of Daily Living and Instrumental Activities of Daily Living Scales), cognitive impairment (Mini Mental State Examination, Montreal Cognitive Assessment), mood disorders (Geriatric Depression Scale), physical performance (Short Physical Performance Battery, 6–minute Walking Test, grip strength) and quality of life (Short–Form 36 items Health Survey).

Results
SAVR was proposed to 53% of patients and TAVI to 47%. The mean age was 78.9 ± 4.8 years and 47% were women. TAVI patients were older and had lower scores on both cognitive and motor performance tests than SAVR patients. The geriatric parameters associated with treatment decision–making between SAVR and TAVI were age (OR= 1.64, p &lt; 0.04) and gait speed (OR= 0.09, p = 0.05).

Conclusions
Therapeutic decision–making in elderly patients with severe aortic stenosis is not only influenced by age, but also by a frailty index, gait speed. This could become a simple, quick and inexpensive routine test to effectively stratify patients.
P409 MYOCARDITIS OR RHABDOMYOLYSIS WITH MYOCYTE NECROSIS?
Authors: Cherubini S , Appella M , Mattaroccia G , Castelli F , De Luca L , Gioffré L , Ciolli A 
Published: May 2023

Abstract
Rhabdomyolysis is a clinical syndrome involving skeletal muscle tissue characterized by muscle weakness, myalgias and increased creatine phosphokinase (CPK) levels, usually 5 times up the normal limit. During rhabdomyolysis troponin (TNI) may be released due to mismatch between oxygen supply and demand, cytokine and endotoxin toxicity, presence of heterophile antibodies that cause false positive results and cross–reactivity between TNI isoforms produced by skeletal muscle and TNI isoforms produced by cardiac muscle. The triggering causes are multiple and include viral infections and genetic pathologies involving skeletal muscles. Genetic mutations of filamin C can cause myofibrillar myopathies, a heterogeneous group of neuromuscular disorders characterized by myopathy involving proximal and distal muscles that often occur in adulthood and may be associated with cardiomyopathies. Genetic mutations of filamin C can also be found in healthy adults because some variants have a subclinical expression.

Case Report
A 34 years old man came to the Emergency Department (ED) with fever, diarrhoea, asthenia and anuria. His past medical history was characterized by 4 episodes of myocarditis (TNI value increased up to 21 ng/dl, reduced left ventricular ejection fraction to 40%) all occurring in conjunction with acute gastroenteritis. The genetic analysis, performed six months before, showed a heterozygous mutation of the gene coding for filamin C. Blood tests performed in ED showed an increase in CRP values (4.8mg/dl), in transaminases values and a modest increase in troponin values (0.96ng/dl) without electrocardiographic and echocardiographic abnormalities (ejection fraction was preserved). He was admitted to Emergency Cardiology Department with a diagnosis of myocarditis. The CPK value resulted to be 22.503 U/l (n.v. 60 –190 U/l). Cardiac MRI underlined no signs of acute myocarditis. The patient, treated with intravenous fluid therapy, after one week showed clinical improvement and normalization of CPK and TNI values.

Conclusions
in the present case the acute gastrointestinal event was the trigger of rhabdomyolysis and not of an acute myocarditis as initially erroneously interpreted, in a patient carrying a genetic mutation predisposing to myopathies. Follow–up will evaluate whether and to what extent the genetic abnormality will lead to the development of myopathy and/or cardiomyopathy.
P414 AN UNLUCKY CASE OF PNEUMOTHORAX AND CARDIAC PERFORATION
Authors: Massara M , Campanelli F , Giulia S , Josephine S , Martina P , Giada R , Lanari A , Giovagnoli A , Di Noto G , Guerra F , Casella M , Dello Russo A 
Published: May 2023

Abstract

Background
pacemaker (PMK) implantation is a routinary procedure although it isn’t free from complications, some of with could be life–treathing. Case report: A female 84 years old with hypertensive cardiomiopathy and atrial fibrillation on anticoagulation theraphy with Dabigatran was subjected on a pacemaker implantation (29th Sept) for sick sinus syndrome (SSS) after syncope. The day after the implantation a chest radiography showed a left–apical pneumothorax (PNX) without necessity of surgical drain (fig. 1). Few days after (3th Oct) patient showed dyspnoea, desaturation and pain on left hemithorax so a chest CT was performed with detection of massive hydropneumothorax needed surgical drain. After 5 days a check CT was performed (9th Oct) showing resolution of the PNX but documented a circumferential 30 mm pericardial effusion “worthy of cardiological reevalutation” meanwhile the patient was hemodynamically stable. At echocardiographic look there was a pericardial effusion of 15 mm. After the re–evalutation of the CT imeges by a cardiologist, in the suspicion of myocardial perforation, patient were centralized in a cardio–surgery center. Transesophageal echocardiography evidenced a pericardial effusion of 19 mm with initial signs of haemodynamic impact and visualization of the lead in the percardual sac by 15 mm. The patient underwent (11th Oct) extraction of the ventricular lead in median sternotomy and epicardial reimplantation in a hybrid arrhythmological and cardiosurgery operating theater.

Conclusions
cardiac perforation and PNX are two serious but rare complication of PMK implantation with an incidence of 0,1% and 1%, but only anecdotally described together in the literature. The initial finding of PNX which was attributed the syntomatology was a confounding factor that delay the diagnosis of miocardial perforation. The unavailability of a programmer for interrogating the device didn’t allow early documentatio of the alteration of the electrical parameters. In the first CT of 3th Oct no pericardial effusion were reported but, from a retrospective analysis the images were alredy suggestive while they leave no doubts in the second radiological examination (fig 2,3).
P424 MEDIASTINAL ROUND CELL SARCOMA WITH PULMONARY ARTERY STENOSIS: CLINICAL USEFULNESS OF CARDIAC MRI IN CARDIO–ONCOLOGY
Authors: Canale M , Bisceglia I , Gallucci G , Turazza F , Camilli M , Russo G , Lestuzzi C , Paccone A , Fiscella D , Maurea N , Bucciarelli Ducci C , Baldi G , Casolo G , Camerini A 
Published: May 2023

Abstract
Case description: a previously healthy 26–year–old man presented with dyspnea on exertion and dry cough. CT scan revealed a large mediastinal mass with displacement of great vessels and trachea and pericardial effusion. Cardiac MRI showed the huge mediastinal mass, literally leaning on the heart with signs of compression of the pulmonary artery (Figure 1) with the typical D–shape of inter ventricular septum. Pericardial effusion did not compress the RV due to high intraventricular pressure. At baseline echo the mass simulated pulmonary artery stenosis as a consequence of pulmonary artery “ab extrinseco” compression. Surgical biopsy showed Ewing sarcoma lately redefined into undifferentiated round cell sarcoma so the patient started chemotherapy with VAI (vincristine, adriblastine, and ifosfamide) x6 followed by maintenance etoposide and ifosfamide (no anthraciclines for risk of cardiac toxicity). After induction phase MRI showed a partial response to treatment; mediastinal mass further reduced at the end of maintenance (Figure 2). Pericardial effusion disappeared and peak velocity of pulmonary artery went back to normal level at echo. Our patient underwent surgery with en–block removal of mediastinal mass with pericardium and anonymous vein and partial pulmonary upper left lobe resection with R0 resection. Pathology report confirmed an undifferentiated round cell sarcoma (possible embryonal origin, FISH analysis for EWS/FUS genes and 12p negative). Adjuvant mediastinal radiotherapy was delivered. The patient is alive without disease recurrence at one–year follow–up.

Conclusions
cardiac MR offer great tissue characterization (differential diagnosis between malignant and benign masses) inside/outside the heart. CMR is non–invasive/non radiation and ideal technique for surgery indication and follow–up imaging.
P432 ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK IN PATIENTS WITH NEPHROLITIASIS: A 10–YEAR PROSPECTIVE STUDY
Authors: Giani A , Macchi F , Caletti C , Comellato G , Lenzi S , Pianegonda M , Postinghel D , Castellucci F , Vecchini F , Chiarini M , Bugnola S , Zamboni M , Fantin F 
Published: May 2023

Abstract
Nephrolithiasis is frequently associated with several cardiovascular diseases, and the pathophysiological connection may rely on some common risk factors. In fact, systemic inflammation, promoting oxidative stress, may lead to arterial wall stiffening (which is considered an independent predictor of cardiovascular risk); however, the same mechanism may also play a role in Randall’s plaques deposition, which is a predisposing step to nephrolithiasis. This study aims to examine the correlation between arterial stiffness and nephrolithiasis, exploring its trend across aging. 82 patients (mean age 45±13 years, 36 males) referred to Geriatrics and Nephrology Outpatient Clinic were prospectively enrolled: at baseline and after 10 years they underwent a clinical evaluation (with particular focus on cardiovascular events and risk factors), and arterial stiffness measurement, obtaining carotid–femoral Pulse Wave Velocity (PWVcf) by arterial applanation tonometry. 66 patients were diagnosed with nephrolithiasis, whereas the remaining 16 formed the control group. At baseline, compared to the control group, patients with nephrolithiasis showed higher systolic blood pressure and PWVcf (128±18 vs 117±16 mmHg, p 0.02 and 7.78±1.53 vs 6.50±1.13 m/s, p 0.001 respectively). After 10 years, patients with nephrolithiasis (p 0.001), but not patients without (p 0.081), had a significant raise in PWVcf, as compared to the baseline evaluation (10.64±3 vs 7.78±1.55 m/s); this trend was confirmed even after adjustment for age and sex. In a backward regression model, considering PWVcf variation over the follow up years (ΔPWVcf) as dependent variable, and age, sex, follow up years, Δ mean arterial pressure, Body Mass Index, hypertension and nephrolithiasis as independent variables, nephrolithiasis was proved to be the only significant predictor of ΔPWVcf, accounting for 6.9% of the variance (p 0.027). In conclusion, the present study outlines an increased cardiovascular risk in patients affected by nephrolithiasis, which is represented by higher baseline PWVcf and wider increase in ΔPWVcf within 10 years. These findings endorse a comprehensive evaluation in subjects with nephrolithiasis, moving beyond the nephrological condition, and considering the patient’s cardiovascular risk profile, to identify, to prevent or to treat any possible organ damage.
P434 PAY ATTENTION TO PARA–AORTIC LYMPH NODES: A PITFALL IN ECHOGRAPHIC ABDOMINAL AORTIC ANEURYSM DIAGNOSIS
Authors: Natale F , Loffredo F , Molinari R , Covino S , Limatola M , De Luca L , Mollo N , Alfieri R , Pezzullo E , Cimmino G 
Published: May 2023

Abstract
A 65–year–old woman was scheduled for coronary angiography during the pre–surgery evaluation because of an abdominal aortic aneurysm (AAA) detected at ultrasound (Figure). The patient referred worsening dyspnoea and asthenia in the last few months, associated with atypical chest pain. Because of these symptoms and taking into account that AAA patients are very high cardiovascular risk, exclusion of coronary artery desease semmed appropriate. At admission, patient showed enlarged lymph nodes at cervical and inguinal region. In the suspicion of a malignant cancer, a contrast enhanced comupter tomography was scheduled, showing an increase in para–aortic, inguinal, cervical and maxillary lynph nodes size in absence of the AAA (figure). After blood tests and haematologic consultation, a final diagnosis of chornic myeloid leukaemia was made. The echo–colour doppler is the first line imaging test for diagnosis of AAA. However, in some cases it might be not sufficient. Para–aortic lymphadenopathy should be considered as a possible pitfall in the differential diagnosis of abdobinal aortic aneurysm.
P437 HEART AND RHEUMATOLOGICAL DISEASE: A PICTURE OF ACUTE HEART FAILURE
Authors: D’ Elia D , Rispoli A , Coppola F , Loria F , Di Feo F , Nigro E , Alfano A , Vecchione C , Galasso G 
Published: May 2023

Abstract
Systemic sclerosis is a connective tissue disease characterized by endothelial dysfunction, hyper reactivity of fibroblasts and immunity abnormality in both humoral and mediated cells. Clinically, in addition to the typical skin involvement, mainly the face and fingers, is frequent involvement of lungs, heart and kidneys. Cardiac involvement, in combination with lung involvement, is considered to be the most important determinant of the prognosis of these patients. Cardiac involvement occurs in 15– 35% of cases but in autopsy surveys the incidence reaches 80%. The case we present concerns a woman of 65 years, admitted in December at the Department of Cardiology of our AOU for an episode of low–output heart failure with epigastralgia, sweating, and breathlessness. The cardiological history was almost silent; instead, it presented a history of chronic thyroiditis and a recent infection with SARS COV 2. The objective examination presented hypokinesis of basal pulmonary fields and pitting edema. The blood tests showed an increase in myocardial necrosis, BNP, creatininemia and inflammatory indices (VES, PCR, beta 2 microglobulin, ferritin, fibrinogen), normocytic normochromic anemia, hypogammaglobulinemia, hyperuricemia and proteinuria and hematuria. The echocardiogram showed severe biventricular dysfunction and moderate–grade mitral insufficiency. A coronary examination was performed that showed epicardial coronary vessels free from significant injury. The cardiac magnetic resonance showed a widespread late enhancement subendocardial of the ventricular and atrial chambers with non–vascular distribution suggestive of pathology on an autoimmune basis. Upon closer examination, multiple small telangiectasias were observed in the face, slight hyperpigmentation of the chest and back, and swelling of the hands. The antibody panel showed positivity of ANA and anti Scl70. The patient was thus addressed to a multi–specialist management in which therefore cardiologist and rheumatologist compare and support the treatment of this pathology with the goal of reducing the high mortality and morbidity that characterizes systemic scleroderma with cardiac involvement.
P438 DIABETES MELLITUS AND HEART FAILURE: A DANGEROUS ASSOCIATION
Authors: Iulianella R , Schirripa V , Perna S , Sciahbasi A , Renda M , Romano C , Castro A , Granatelli A 
Published: May 2023

Abstract

Introduction
Diabetes mellitus is a frequent co–morbidity in heart failure patients reaching a prevalence of about 35% and patients with diabetes mellitus are twice as likely as non–diabetics to develop heart failure. The presence of diabetes is associated with higher rates of cardiovascular morbidity and mortality. In recent years, the introduction of remote monitoring systems has allowed for more careful management of them, although there are no large studies demonstrating their effectiveness in terms of improving prognosis. The aim of our study was to evaluate the prognosis of patients with diabetes mellitus and heart failure undergoing remote monitoring.

Methods
All patients undergoing device implantation for heart failure in our Center were recruited into the study, and the incidence of events (new hospitalizations or hospitalizations) during the period from January 1, 2021 to December 31, 2021 was assessed. Patients were monitored, and direct telephone contact or contact with one of the family members was made for all of them. Data on clinical characteristics and drug therapy were recorded.

Results
A total of 240 patients (73±11 years, 81% male) of whom 74 were diabetic (73±11 years, 87% male) and 166 were nondiabetic (73±10 years, p=0.82, 80% male, p= 0.198) were enrolled in the study. The two groups had no statistically significant differences in terms of clinical characteristics (such as ejection fraction, NYHA class, presence of anemia, rate of wide QRS, or rate of defibrillator implantation) except for a higher incidence of coronary artery disease in diabetic patients (70%) and multivessel coronary disease (67%) than in non–diabetic patients (57% coronary artery disease p= 0.05, and 46% multivessel disease p= 0.02). There were no significant differences in terms of drugs with the exception of higher use of statins in the group of diabetic patients (84%) compared to non–diabetics (64%, p= 0.002). Diabetic patients had almost 4 times higher mortality rates than non–diabetic patients (22% and 6% respectively, p&lt; 0.0001). Differently, hospitalization rates were not significantly different among diabetic patients (24%) compared with nondiabetic patients (28%, p= 0.58).

Conclusions
The association of diabetes mellitus and heart failure represents a dangerous combination associated with an increased incidence of death. Therefore, clinical monitoring strategies and intensity of drug therapy should be particularly implemented in diabetic patients.