bluuebunny/crossref_metadata_2025_split huggingface dataset:
C78 SPONTANEOUS CORONARY ARTERY DISSECTION: THE ROLE OF CORONARY CT ANGIOGRAPHY IN THE FOLLOW–UP MANAGEMENT
Authors: Savo M , Dellino C , Continisio S , Montonati C , Mattesi G , Cozza E , Amato F , Galzerano D , Tarantini G , De Conti G , Motta R , Iliceto S , Pergola V 
Published: May 2023

Abstract

Background
Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome, myocardial infarction (MI) and sudden death. Although the gold standard for diagnosis is invasive coronary angiography, Coronary Computed Tomography Angiography (CCTA) is a new useful tool for the diagnosis and follow–up (FU). Treatment could involve a conservative or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting. AIMS: 1) analyze the clinical and CCTA features at baseline of patients with SCAD; 2) evaluate the clinical and anatomic patients outcome with conservative or invasive treatment; 3) evaluate in patients treated with the conservative approach the clinical and anatomic features of those dismissed with single (SAPT) or double (DAPT) antiplatelet therapy.

Methods
Clinical and anatomic data of 57 patients with SCAD, followed up with CCTA enrolled retrospectively between 2010 ad 2022, were collected at baseline and at the FU. The clinical endpoints evaluated were: all causes mortality, hospitalization for cardiovascular cause, SCAD or PCI ex–novo and MI. The anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline.

Results
46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) under PCI. Patients treated with PCI were more smokers (45,5% vs 15,2%; p=0,042), had peripherical arteriopathy (18,2% vs 0%; p=0,034), higher troponin peak (40425,8 vs 13436; p=0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p=0,050). Moreover the PCI population had a significant involvement of more than one coronary artery (72,7% vs 6,5%; p&lt;0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p=0,001) and of the truncus communis (45,4% vs 0%; p&lt;0,001). At the FU, there were no statistical differences for clinical and anatomic endpoints between the two groups (p&gt;0,05). Among patients treated with conservative therapy, there was a more significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p=0,033).

Conclusions
Patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated. DAPT at discharge is associated with a higher rate of SCAD recurrence at FU.
P23 A STRANGE CASE OF CERVICALGIA
Authors: Carlà A , Palazzolo M , Ruggiero A 
Published: May 2023

Abstract
65–year–old patient with a history of Type 2 Diabetes Mellitus on oral hypoglycaemic therapy, hypercholesterolemia, previous diagnosis of non–secreting K–chain micronodular myeloma undergone heterologous marrow transplantation. From January 2022, he presented persistent mild–moderate neck pain and feverish episodes, therefore he started empiric antibiotic therapy at home. Since June 2022, he complained a worsening of the neck pain partially controlled by non–steroidal anti–inflammatories. Magnetic resonance imaging was therefore performed which highlighted findings consistent with spondylitis of probable infectious nature and subsequent start of empiric antibiotic. A bone marrow biopsy was also performed which showed no recurrence of myelopathy. In July 2022 new feverish episode with shaking chills lasting about 3 days. In this circumstance he underwent a blood culture which resulted positive for the presence of Str. Bovis. In addition, a transthoracic echocardiogram was performed and showed evident floating serpiginous vegetation on the anterior mitral leaflet measuring approximately 1.2 cm x 2.5 cm with a mild mitral regurgitation. Targeted antibiotic therapy was set up and abdominal ultrasound and brain MRI were performed which excluded splenic and brain embolization. A close echocardiographic follow–up showed no reduction of the vegetation. So the patient underwent cardiac surgery in thoracotomy to remove the vegetation adhered to the anterior mitral flap in A2 on the atrial side (3 cm x 1.5 cm x 0.5 cm), and also removal of millimetric lesions on the posterior flap and abrasion of the implantation areas. The post–surgery clinical course passed without any complications, the patient remained stably afebrile with a progressive reduction of the inflammation indexes. Approximately 10 days post–surgery, the patient was then discharged with indications for echocardiographic follow–up.
P35 CARDIAC MAGNETIC RESONANCE: PROMISING SOLUTION IN CLINICAL DILEMMA
Authors: Citarelli G , De Feo D , Parisi G , Lisi F , Ricci G , Ficco M , D’Aprile P , Caldarola P 
Published: May 2023

Abstract
There are many clinical conditions in which symptoms and signs can overlap, resulting in a real "clinical dilemma". Differential diagnosis is essential for identifying the pathology affecting a patient and consequently making the best therapeutic decisions. Herein we report a case of a young patient, with strong smoking habit, who looked for medical attention after experiencing chest pain, associated to upper airways inflammation. EKG revealed ischemic abnormalities, echocardiography showed a preserved ejection fraction (EF: 55%) and global cardiac contractility, although akinesia of the mid–segment of the inferolateral wall, and the presence of a mild inferolateral pericardial effusion. A concomitant increase in myocardial necrosis enzymes and inflammatory markers was observed in blood tests, but the coronarography showed undamaged coronary arteries. This clinical picture characterized by the young age of the patient, by the intercurrent inflammatory event, by the presence of pericardial rubbing on physical examination, by the evidence of echocardiographic end EKG anomalies in the absence of documentable epicardial lesions and by the complete symptomatic remission after anti – inflammatory therapy with acetylsalicylic acid and Colchicine was highly suggestive of pseudoinfarct–presenting myopericarditis. To confirm such diagnosis, cardiac magnetic resonance (CMR) was requested, unexpectedly, it showed oedema on the mid–basal inferolateral T2–weighted STIR sequences, but also microvascular obstruction (MVO) on early EGE contrastographic sequences mid–basal inferolateral site, and finally evidence of transmural fibrosis in the same site to the DE sequences resulting in pathognomonic lesions for acute ischemia in absence of epicardial coronaropathy. CMR imaging, which is able to analyse cardiac structure and function and simultaneously provide tissue characterization, has been an essential investigation for the diagnosis of MINOCA, as CMR can readily pinpoint many conditions responsible for myocardial damage and allow pathological discrimination of patients. Our patient‘s final diagnosis was “STEMI, MINOCA, and concomitant pericarditis” implying a consequent therapeutic modification, introducing DAPT. Making differential diagnosis in similar clinical conditions characterized by overlapping presentations, allows the use of personalized therapeutic strategies for each patient and better final results.
P54 RIGHT SINGLE CORONARY ARTERY AS AN INCIDENTAL FINDING IN ACUTE PERICARDIAL DISEASE
Authors: Nunziata L , Terracciano F , Maresca G , Granata F , Falato S , Ambrosino S , Carbone L , Ruggiero V , Laezza A , Prisco A , Nardiello V , Miele R , Sena L , America R , Volpicelli M , Muto C , Capasso M , Caliendo L 
Published: May 2023

Abstract
An 44–year–old woman was referred to our hospital for chest pain. She had no known cardiovascular risk factors but had a history of previous acute pericarditis following pregnancy. At admission, she still had chest pain improved by leaning forward. Cardiovascular examination and her electrocardiogram showed nothing pathological. On laboratory tests, there were mild elevation of troponin T and normal C–reactive protein. A transthoracic echocardiogram revealed only a minimal pericardial effusion close to the right heart chambers. A chest X–ray was generally normal. She was admitted to the coronary care unit with a provisional diagnosis of myopericarditis. Three days later, due to the persistence of symptoms despite the appropriate pharmacological therapy, it was decided to perform coronary angiography. During the procedure, selective cannulation of the left coronary artery was not possible, and a non–selective injection disclosed no coronary artery arising from the left coronary sinus. On selective injection of the right coronary sinus, a single ostium was visualized. The right coronary artery (RCA) was a great vessel, with no stenosis. A left anterior descending artery (LAD) and left circumflex artery (LCx) were perfused from RCA collateral vessels, both without lesions. Coronary computed tomography angiography confirmed a single coronary artery with its ostium in the right sinus of Valsalva and agenesis of the left main artery (LCA). A physical stress echo ruled out inducible myocardial ischemia. Coronary artery anomalies are rare congenital disorders that are usually diagnosed incidentally. Single coronary artery (SCA) has been known since 1903. It is an anomalous condition in which the SCA originates from a single aortic orifice, either the left or the right aortic ostium, and gives rise to the entire coronary circulation. Isolated congenital SCA is a very rare condition, occurring in 0.024–0.098% of the general population. Right SCA with congenital absence of the LCA is the least common type of SCA, and is extremely rare with a reported incidence of 0.0008%. SCA has been reported in association with atherosclerotic disease, coronary artery fistulas, mitral valve prolapse, bicuspid aortic valves, tetralogy of Fallot, transposition of the great arteries, hypertrophic cardiomyopathy and Takotsubo syndrome. We report this extremely rare case because the concomitant association with pericardial diseases has never previously been reported.
P68 DILATED CARDIOMYOPATHY AND MICRODELETION SYNDROME: A CASE REPORT
Authors: Simeoli P , Rusconi D , Bursi F , Santangelo G , Guazzi M 
Published: May 2023

Abstract
A 45–year–old man was admitted to our Coronary Care Unit because of acute pulmonary edema and atrial flutter with high ventricular response. The patient was an active smoker, obese and reported a previous alcohol abuse. Blood tests showed increased NT–proBNP values. Transthoracic echocardiography showed a severely enlarged and dysfunctional left ventricle (LVEF 15%). Acute phase treatment required noninvasive ventilation, amine support, and electrical cardioversion with progressive improvement of patient’s clinical condition. At coronary angiography no significant coronary stenosis was found. (fig.2). Cardiac magnetic resonance showed no area of fibrosis or inflammation(fig.3). Furthermore, a new diagnosis of diabetes mellitus type 2 and mild cognitive impairment was also made during hospitalization. Upon clinical stabilization, therapy with bisoprolol, sacubitril/valsartan, spironolactone, furosemide, and direct anticoagulant was introduced and titrated with progressive improvement until normalization during follow–up of systolic function indices, ventricular volumes, and nt–proBNP values until normalization at approximately 6 months after discharge. Cardiopulmonary exercise test was performed and found good cardiopulmonary performance and absence of cardiogenic limitation to exercise (VO2 peak 22.9 ml/min/kg corresponding to 93% of predicted and VO/HR 18 ml/beat, VE/VCO2 slope equal to 24). Genetic test showed a missense mutation in heterozygosity of LMNA gene (1634 G&gt;A, p. Arg545His) currently coded as likely pathogenic and heterozygous deletion of 534 kb at the level of the short arm (p) of chromosome 16 at band p11.2. Dilated cardiomyopathies associated with mutations in the LMNA gene, coding for Lamina A/C (a component of the cellular basal lamina), tend to have an inauspicious prognosis as they are related to arrhythmic and extracardiac manifestations (myopathies, lipodystrophies, and neuropathies). 16p11 microdeletion syndrome is characterized by obesity and cognitive impairment, frequently associated with congenital heart disease, less often with dilated and hypertrophic cardiomyopathy pictures. The rapid introduction and titration to the maximum tolerated dose of heart failure therapy had an extremely positive effect in our patient who had an overlapping of genetically determined dilated cardiomyopathy and 16p11 microdeletion syndrome.
P70 UNEXPLAINED TRANSIENT BIVENTRICULAR DYSFUNCTION IN A PATIENT WITH DISSEMINATED TUBERCULOSIS AND SEVERE EOSINOPHILIA
Authors: Basile P , Santoro D , Bertrandino F , Mandunzio D , Falco G , Carella M , Monitillo F , Ciccone M , Guaricci A 
Published: May 2023

Abstract

Introduction
Tuberculosis (TB) is an infectious disease with significant global burden. Pericardial injury is relatively common, while myocardial involvement has only rarely been described.

Case presentation
A 29-years-old man from Gambia with disseminated TB, treated with isoniazid, rifampin, pyrazinamide and ethambutol, was admitted to our hospital. He denied history of heart disease, cardiovascular risk factors and voluptuary habits. Laboratory exams revealed severe eosinophilia without microbiological evidence of parasitic infection; a lymphocyte proliferation test ruled out allergic reaction to anti-TB therapy. Baseline echocardiographic evaluation showed normal cardiac function with negative troponin. The patient, subsequently, developed worsening dyspnoea and asthenia with progressive biventricular dysfunction. Therefore, he was admitted to our department for further investigations. Cardiac magnetic resonance (CMR) showed a 20% left ventricular ejection fraction and absence of myocardial oedema or fibrosis [Fig.1]. Coronary CT angiography (CCTA) was unremarkable. Endomyocardial biopsy (EMB) showed absence of TB lesions or eosinophilic infiltration. Cardiac troponin and electrocardiogram remained negative throughout. Optimal medical therapy (OMT) for heart failure was promptly initiated. After several months an almost complete recovery of cardiac function was documented [Fig.2].

Discussion
In cases of ventricular dysfunction, establishing an etiological diagnosis is imperative, though sometimes challenging. When pre-test probability is low, CAD can be ruled out by CCTA. Myocarditis is a common cause of reversible cardiac dysfunction. In this case, the absence of Lake Louise criteria, negative bioptic findings, persistently negative cardiac troponin and microbiological tests argue against this diagnosis. However, the timing of investigations can affect diagnostic accuracy; furthermore, focal lesions can be missed by EMB, leading to false negative results. Alcoholic cardiomyopathy (CMP) could be an option, but it was not considered due to absence of alcohol consumption. The clinical picture was not compatible with a typical CMP phenotype. Immune-mediated reaction to anti-TB drugs was ruled out by immunological testing. Although not previously described, ethambutol and pyrazinamide direct cardiotoxicity may explain transient impairment of cardiac function. Recovery may be related to withdrawal of these drugs and introduction of guideline-directed OMT.
P73 CLINCAL AND FUNCTIONAL EFFECTS OF BETA–BLOCKER THERAPY DISCONTINUATION IN PATIENTS WITH BIVENTRICULAR HEART FAILURE
Authors: Ricchetti G , Slavich M , Demarchi B , Mager R , Morciano D , Morosato M , Cavalli G , Spoladore R , Federico F , Federico A , Agricola E , Margonato A , Fragasso G 
Published: May 2023

Abstract

Background
Nearly two–third of patients with heart failure with reduced ejection fraction (HFrEF) have right ventricular (RV) dysfunction, which has previously been identified as an independent predictor of reduced functional capacity and poor prognosis. However, RV has received little attention in the past. Beta–blocker therapy (β–BT) has been shown to improve mortality and reduce hospitalizations in patients with HFrEF, being approved as first–line therapy irrespective to RV function. Less is known about the sympathetic nervous system‘ role in RV dysfunction and the potential usefulness (or harmfulness) of β–BT in these patients is still unclear.

Objectives
Our study aimed to evaluate the medium–term effect of β–BT discontinuation on functional capacity and RV remodelling based on cardiopulmonary exercise testing (CPET), echocardiography and serum biomarkers in patients with clinically stable HFrEF and RV dysfunction.

Methods
Seventeen outpatients were prospectively enrolled using the following criteria: presence of signs and symptoms of HF while on optimal medical therapy (including β–BT); LVEF ≤40%; echocardiographic criteria of RV dysfunction. Patients were randomized 1:1, either to withdraw (group 0) or prosecute (group 1) β–BT. In group 0 optimal heart rate was obtained with digoxine or ivabradine. Echo and serum biomarkers were performed at baseline, after 3 and 6 months; CPET was performed at baseline and 6 months.

Results
After six months follow up, RV systolic function improved based on S’–DTI in group 0 (ΔS’: 1.01 vs. –0.92cm/s; P=.03). Conversely, worsening of estimated PAPs (ΔPAPs: 0.8 vs. –7.5mmHg; P =.04) and echo LV–remodelling (ΔEDVi: 19.55 vs. –0.96mL/mq P=.03) were observed. No significant improvements in term of functional capacity were obtained. The only variables significantly affected by β–BT withdrawal were LV EDV and ESV, appearing worse in group 0 (meanEDVi 115 vs. 84mL/mq; meanESVi 79 vs. 53mL/mq, P=.03).

Conclusions
β–BT discontinuation did not produced any beneficial effect. Additionally, despite maintenance of optimal heart rate control, β–BT withdraw worsened LV remodelling. Our study corroborates the hypothesis that improvement in LV function may be a major determinant for improvement in RV function, reducing pulmonary wedge pressure and RV afterload, with only a marginal action of its negative inotropic effect. In conclusion, β–BT might be beneficial also in heart failure patients with biventricular dysfunction.
P75 MULTIDISCIPLINARY MANAGEMENT OF INTRACARDIAC LEIOMYOMATOSIS: A CASE REPORT
Authors: Tognola C , Bonelli A , Guasti S , Spanó F , Santambrogio G , De Chiara B , Belli O , Musca F , Casadei F , Giannatasio C , Moreo A 
Published: May 2023

Abstract
A 60–year–old woman with no cardiological history came to our attention for exertional dyspnea since few months. The electrocardiogram and chest radiograph were normal. Trans–thoracic echocardiogram revealed the presence of a floating parenchymatous formation measuring 12 x 2 cm starting from the inferior vena cava (IVC) and jutting into the right chambers, without obstruction to inflow. Chest CT and cardiac MRI described a nonvascularized inhomogeneous formation suggestive of thrombotic apposition in VCI, so the patient was treated with unfractionated heparin. Total body CT/PET scan excluded hypercaptant lesions. After two weeks of anticoagulant therapy, on echocardiogram the mass appeared unchanged in morphology and size. On reevaluation of the CT images, a probable origin of the formation at the level of the right ovarian vein was identified. In light of the positive history of bilateral hysteroannessiectomy for uterine myomas and the lack of response to anticoagulant treatment, the suspicion of intravascular and intracardiac leiomyomatosis was raised. After collegial discussion, given the high risk of an eventual thoraco–abdominal surgery, it was decided to remove only the portion of the mass adherent to the VCI jutting into the right heart chambers. The patient underwent cardiac surgery: a polypoid, capsular, hard–elastic mass, 12 x 2 cm in size, jutting into the right chambers and with the base of implantation located in the anterior wall of the VCI, was removed. The final histologic diagnosis was sclero–jalin leiomyoma. The surgery and postoperative course proceeded without complications. At follow–up at 20 months, the patient is asymptomatic and no mass is detectable on echocardiogram. Intracardiac leiomyomatosis is a rare condition characterized by benign smooth muscle tumors of extracardiac origin reaching the right heart by direct extension into the venous canal, described predominantly in women with a history of uterine myomas. Although histologically benign, intracardiac leiomyomatosis can result in sudden death if there is total obstruction to the outflow tract. In our case, the multimodality imaging approach and serial monitoring by echocardiography were essential to guide treatment choices and for the follow up.
P85 REAL WORLD EXPERIENCE ON THE USE OF SGLT2–I IN ELDERLY PATIENTS WITH HFREF
Authors: Verga F , Orso F , Salucci C , D‘Errico G , Perini E , Vatri M , Poletti E , Cagnoni C , Corti G , Di Bari M , Ungar A , Baldasseroni S 
Published: May 2023

Abstract
SGLT2–i have been shown to improve prognosis in patients with heart failure with reduced ejection fraction (HFrEF) in randomized clinical trials (RCTs). However, at the moment, we have little data on the use of these drugs in clinical practice, both in terms of safety and efficacy profile.

Objectives
To describe the characteristics of HFrEF outpatients who started SGLT2–i in clinical practice; evaluate tolerability and the effect on clinical and biohumoral parameters.

Methods
We prospectively analyzed patients who started SGLT2–i in our Heart Failure clinic. The baseline characteristics, the variations of bio–humoral and clinical parameters were recorded, as well as the onset of adverse effects leading to drug suspension after one month.

Results
We evaluated 37 patients, with a mean age of 77.7± 8.5 years (65% over 75). The baseline characteristics of the population compared to that of the treatment arms of the RCTs are shown in Fig.1. Most patients were in NYHA II (62%), with ischemic etiology (65%), with reduced EF (mean 34.7± 5.1%) and nearly half of the patients received ICD or CRT–D (43.2%). At the one month follow–up, there was a significant reduction in NYHA class (Fig. 2)and furosemide dose (36.3 vs 53.2 mg, p&lt;0.001), without a significant change in NTproBNP values ​​(2499 vs 2431 pg /mL, p=0.804). Furthermore, there was a reduction in systolic blood pressure (115 vs 120 mmHg, p=0.029) with no significant increase in the incidence of orthostatic hypotension (27% vs 21%, p=0.48). In line with the trials, there was a slight, non–significant worsening of renal function (CKD–EPI 52.9 vs 55.9 mL/min, p=0.10). At one month, no patients experienced any adverse effects leading to SGLT2–i discontinuation.

Conclusions
In this preliminary analysis, after one month of SGLT2–i therapy in elderly patients, there was a clinical and hemodynamic improvement as demonstrated by the improvement of the NYHA class and the reduction of the diuretic therapy. SGLT2–i have been shown to be relatively safe, with no adverse effects and no increased risk of orthostatic hypotension or significant worsening of renal function.