bluuebunny/crossref_metadata_2025_split huggingface dataset:
P117 TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH CHRONIC THROMBOCYTOPENIA: PREVALENCE AND IN–HOSPITAL OUTCOMES
Authors: Zuin M , Bilato C , Pasquetto G , Rigatelli G 
Published: May 2023

Abstract

Background
Thrombocytopenia represents an important issue in patients undergoing Transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. We performed a systematic review and meta–analysis to establish the pooled prevalence and the in–hospital outcomes of Chronic thrombocytopenia (cTCP) in patients after TAVR.

Methods
PubMed and Scopus databases were systematically searched for articles, published in any language, from inception through September 15, 2022, reporting the prevalence of cTCP in patients who underwent TAVR and providing data on the hospital outcomes. The pooled prevalence and the outcomes were evaluated pooling the adjusted odds ratio (OR) with the related 95% confidence interval (CI) using a random– effect models. Statistical heterogeneity between groups was measured using the Higgins I2 statistic

Results
Overall, 1,402,431 patients (mean age 87.2 years, 45.1% females) where hospitalized for TAVR. Among them, cTCP was observed in 7.0% of cases (95% CI: 1.7–24.5%, p&lt;0.0001, I2:84.5%). No significant differences were observed for in–hospital mortality and stroke comparing patients with cTCP to those without (OR: 1.07, 95% CI: 0.62–1.82, p=0.802, I2: 79.6% and OR: 0.90, 95% CI: 0.67–1.21, p=0.48, I2: 0%, respectively). Conversely, cTCP subjects showed a significant higher risk of vascular complications (OR: 1.72, 95% ci 1.37–2.16, p&lt;0.0001, I2:0%), acute kidney injury (OR: 1.60, 95% CI: 1.16–2.20, p=0.004, I2:81.4%) and cardiac tamponade (OR: 3.31, 95% ci: 1.85–5.94, p&lt;0.0001, I2: 0%) (Figure 1).

Conclusions
cTCP is present in about 7% of patients underoing TAVR and was results associated with an increased risk of vascular complications and cardiac tamponade during the periprocedural period.
P118 DEGENERATION OF PROSTHETIC HEART VALVES: EXCITING CHALLENGE IN CATH LAB
Authors: Leonardi D , Del Sole P , Scarsini R , Lunardi M , Mammone C , Tavella D , Pesarini G , Ribichini F 
Published: May 2023

Abstract

Background
Prosthetic Heart Valves are always more frequent in the clinical practice. Particularly, sometimes more than one native valve is affected and needs to be surgically treated. On the other side, replaced prosthesis could also degenerate over time, leading to worsening symptomatic heart failure. There are no many cases of combined percutaneous approach to both aortic and mitral prosthetic valve deterioration: our aim is to display a case of this complex clinical setting. Case: A 76–year–old man with previous surgical mitral and aortic valve replacement, respectively through Hancock (27 mm) and Mitroflow (21 mm), was referred to our Centre for dyspnoea on mild efforts. Echocardiography revealed severe degeneration of both prosthetic valves, with moderate mitral stenosis (mean pressure gradient – MG – 6 mmHg) and severe central regurgitation, and high transaortic pressure gradients (MG 58; peak pressure gradient – PG – 103 mmHg). Pulmonary hypertension, mild right ventricle dysfunction and reverse flow in hepatic veins were evident.

Results
The first intervention was Valve–in–Valve Transcatheter Aortic Valve Implantation (ViV TAVI) with CoreValve Evolut PRO+ (23 mm), followed however by recoil determining moderate aortic stenosis (MG 25, PG 47 mmHg). Hence, as both the left prosthetic valves needed treatment, we decided to plan an elective percutaneous procedure aimed to treat both of them. Aortic ViV cracking was successfully obtained through non–compliant Atlas Gold Balloon (22 mm). Then, transseptal puncture by Brockenbrough needle and SL0 dilator sheath system was used to gain access to the left atrium. Finally, after interatrial shunt pre–dilation, Edwards Sapien 3 Ultra (26 mm) was applied as Mitral ViV during rapid ventricle pacing. Echocardiography showed relevant decrease of aortic pressure gradients (MG 11, PG 19) and downgrading of mitral regurgitation from severe to mild, despite unvaried persistent moderate mitral stenosis and signs of chronic severe pulmonary hypertension. The patient was dismissed in 3 days, after adjusting medical therapy.

Conclusions
Dysfunction of prosthetic heart valves is challenging to be approached, particularly when involving more than one. The expertise of the Centre assumes great importance in this delicate clinical setting. More explanations are further needed to define type and timing of percutaneous intervention aimed to the treatment of multiple prosthetic valves.
P120 NEW MALIGNANT MUTATION IN HYPERTROPHIC CARDIOMYOPATHY
Authors: Moscardelli S , Santangelo G , Bursi F , Rusconi D , Guazzi M 
Published: May 2023

Abstract
A 62–year–old man diagnosed with non–obstructive hypertrophic cardiomyopathy and dual–chamber pacemaker wearer since the age of 40, for third–degree atrioventricular block, came to our attention for atrial fibrillation (AF) episodes (one complicated by cardiogenic shock and multiorgan failure) and flutter with high ventricular response. For a progressive worsening of the systolic function, and the onset of multiple episodes of sustained ventricular tachycardia, an upgrade to the defibrillator was performed, which, in the following months, intervened appropriately for recurrences of ventricular arrhythmias. The patient was admitted to our ward for exacerbation of heart failure. The echocardiography showed moderate concentric hypertrophy with mild ventricular dilatation and ejection fraction 33%, inferior and inferoseptal wall, and apex akinesia with thrombotic apposition. Due to a sudden deterioration of the clinical conditions, the patient died. After genetic counseling the patient‘s family agreed to genetic testing in the proband. This highlighted the presence of a missense mutation, i.e. the substitution of the cysteine ​​residue with a serine, in the codon 905 of the MYH7 gene, encoding the cardiac isoform of myosin heavy chain. The mutation is probably pathogenetic as it falls in the region where most of the missense variants are clustered and statistically associated with the HCM phenotype. Only in one previous case of HCM was detected a mutation of the same codon, Cys905Phe. Several studies have reported that AF tends to be more prevalent in patients carrying MYH7 mutations and is associated with a substantial risk of heart failure–related mortality, stroke, and severe functional disability. Knowledge of the entire spectrum of MYH7 mutations, especially those related to a high arrhythmic burden or SCD, combined with an accurate clinical and molecular characterization of the patient, can improve the genotype–phenotype correlation by clarifying the mechanism of HCM and allowing a better clinical and therapeutic decision–making of patients.
P122 CONTRAST–ENHANCED ECHOCARDIOGRAPHY IN BETTER STUDYING (OR EXCLUDING) HYPERTROPHIC CARDIOMYOPATHY. TWO CASES
Authors: Parato V , Gizzi G , Ianni U 
Published: May 2023

Abstract
Aim of this case–series report is to elucidate the potential role of contrast echocardiography (C–Echo) to optimize and improve the study of patients with Hypertrophic Cardiomyopathy (HCM). However, this report is also aimed to demonstrate the role of C–Echo in excluding a HCM diagnosis. Case 1. A young male patient, 27 y–o, presented to our Emergency Department (ED) because of chest pain and dyspnea. He referred a diagnosis of HCM without LVOT obstruction. Trans–Thoracic Echocardiogram (TTE) demonstrate a severe hypertrophy of interventricular septum with a maximum diastolic thickness of 25 mm. There was no a significant LVOT gradient. Contrast enhanced echocardiography, by left ventricle opacification (LVO) (Sonovue, Bracco Imaging, Milan, Italy), demonstrated: an interventricular septum thickness of 32 mm (7 mm more than TTE measurement); a clear touching of mid–ventricular walls with a max systolic gradient of 40 mmHg (figure 1). This aspect was no clearly detectable by TTE alone. Case 2. A young male patient, 31 y–o, presented to our ED because of palpitations. At 12–leads ECG he presented a sinus rhythm with frequent monomorphic premature ventricular complexes (PVC). A TTE was performed. It put a suspicion of left ventricle (LV) APICAL HCM, because of an apical diastolic thickness of 26 mm. A contrast enhanced echocardiography by LVO (Sonovue, Bracco Imaging, Milan, Italy) was planned. It allowed to excluding a HCM by demonstrating a LV apical false tendon mimicking endocardial border (figure 2). LV false tendons are fibromuscular bands that traverse LV cavity and are generally considered to be benign. Thay may also contain conduction tissue (Purkinje fibers) and have been identified as a source of ventricular arrhythmias. They are most commonly located near the LV apex.

Conclusion
It is possible to conclude that, by LV cavity opaciﬁcation optimization of echocardiographic planes and views, C–Echo represents a suitable tool for: 1) a more accurate LV wall thickness (WT) measurement; 2) acquiring additional informations about intraventricular gradients in patients with HCM. In addition, C–Echo allows to exclude a HCM diagnosis in presence of LV apical false tendons.
P124 A TAKOTSUBO SYNDROME MIMICKING AN APICAL HYPERTROPHIC CARDYOMYOPATHY: A CASE REPORT
Authors: Benzoni G , Castelletti S , Ravaro S , Chianca R , Speziali N , Volpi C , Gavazzoni M , Parati G , Fratianni G , Seravalle G , Crotti L 
Published: May 2023

Abstract
A 70–year–old woman was admitted to our Intensive Care Unit (ICU) with high levels Hs–TnT. Coronaries were normal and ventriculography was suggestive for Takotsubo Syndrome (TS). In the acute phase she developed a cardiogenic shock and transthoracic echocardiography (TTE) showed a dilated left ventricle (LV) with iperkinesia of basal segments and biventricular apex and mid –ventricular akinesia, with a severely reduced left ventricular ejection fraction (LVEF 20%). Seven days after admission to Cardiac Rehabilitation Unit, a TTE showed LV apical hypertrophy (max thickness 18 mm), hypokinesia of hypertrophic segments, hypercontractility of basal segments and LVEF 55%. These features could have been suggestive for a coexisting apical hypertrophic cardiomyopathy (HCM). The EKG showed T wave inversions in precordial and inferior leads, not present at admission, this observation being against the presence of a pre–existing unknown HCM. Cardiac Magnetic Resonance (CMR) showed T1 and T2 mapping imagines for oedema in LV infero–lateral, basal segments and apical region, a subepicardial stria of late gadolinium enhancement in infero–lateral basal segment. These patterns were reported as suggestive for myocarditis rather than TS. Recent infectious or autoimmune diseases were excluded. Further TTE showed reversed LV parameters, normal kinesis of all segments, LVEF 66%, with a persistence of negative T waves at EKG.

Discussion
Our patient developed a classical TS with LV apical ballooning and hyperkinesia of basal segments with uncommon right ventricular hypokinesia. A peculiar finding was the transient apical LV thickness that was seen through TTE, mimicking an apical hypertrophic cardiomyopathy. Such a finding has already been described in few case reports; however, the nature and the physiopathology of that apical thickness was never proved. Through CMR we noted that, in the same region where TTE detected apical hypertrophy, there was a consistent amount of oedema which could be the reason of pseudo–hypertrophy findings. Our experience confirms the importance of integrating CMR in the diagnostic algorithm as already supported in consensus statements. In our case CMR played a key–role in the exclusion of a coexisting apical hypertrophic cardiomyopathy.
P134 RECURRENT SCAD IN A PATIENT WITH BICUSPID AORTIC VALVE AND ANOMALOUS CORONARY ORIGIN
Authors: Schettino M , Rezzaghi M , Caretta G , Tonelli G , Arena M , Menozzi A , Porto I 
Published: May 2023

Abstract
Spontaneous coronary artery dissection (SCAD) is recently emerging as an increasingly frequent cause of myocardial infarction and among the main triggering factors we found hypertension, pregnancy, fibromuscular dysplasia and connective tissue diseases (e.g. Marfan syndrome). Recent studies also suggest that even bicuspid aortic valve may be a predisposing condition for the development of spontaneous coronary artery dissection. We report the case of a 45–year–old Caucasian man with no cardiovascular risk factors; his clinical history begins in August 2019, when he was hospitalized for acute coronary syndrome (NSTEMI). Echocardiography showed preserved left ventricular ejection fraction, bicuspid aortic valve (fusion of right and left cusps) with mild to moderate regurgitation without stenosis and mild dilatation of the aortic bulb (38 mm). The coronary angiography showed no significant stenoses and an anomalous origin of the right coronary artery from the common trunk. The patient was discharged two days later with a diagnosis of MINOCA and an indication to perform a coronary CT scan, which confirmed the anomalous origin of the right coronary artery with a retro–aortic course, and a cardiac MRI, which showed myocardial edema of the infero–lateral wall, mainly with sub–endocardial distribution and LGE in the same sites, compatible with ischemic damage. In September 2022 there was a new hospitalization for inferior–posterior–lateral STEMI with coronarographic finding of a large marginal branch collateral stenosis, with recovery of distal caliber. The angiographic pattern was consistent with type II SCAD (no intracoronary imaging has been performed because of vascular tortuosity and lesion distality). A retrospective comparative analysis of the 2019 angiography allowed to find a distal occlusion of the same branch, now healed, also compatible with SCAD. The patient was discharged on single antiplatelet therapy after one week of DAPT with acetylsalicylic acid and clopidogrel and indication to perform a genetic test for connective tissue diseases. The case described prompts the cardiologists to suspect an uncommon etiology (connective tissue disease, bicuspid aortic valve) in case of SCAD detection, especially if associated with anomalous origin of the coronary arteries.
P136 “THERE’S NO TWO WITHOUT THREE”: A STRANGE CASE OF RECURRENT CORONARY EMBOLISM
Authors: Scarpino T , Gerbasi E , Ferraro A , Ciconte V 
Published: May 2023

Abstract

Background
A 68 year–old woman with rheumatic heart disease underwent surgery replacement of aortic and mitral valves with mechanical prostheses 20 years ago, and since then has been in VKAs therapy. One year after the operation, she was hospitalized for ischemic stroke without relics. For detection of 2:1 block on the ECG Holter/24h a PM was implanted. After 4 years, she had an acute coronary syndrome (ACS) with VF (treated with DC–Shock). Coronary angiography (CA) showed no coronary stenosis. It was replaced PM to ICD. In 2017, she had a TIA and a mitral prosthesis dysfunction was detected from EET with hemidisk thrombosis. After CA, mitral valve replacement was performed but on the 2nd day after surgery she had an anterior STEMI caused by the occlusion of LAD. PTCA and stenting were performed. In October u.s. the patient was referred to the Emergency room for typical angina. An inferior–posterior STEMI was revealed to ECG. CA highlighted embolic occlusion of Cx and good result of prior LAD’s stenting. After multiple and ineffective attempts, invasive recanalization’s procedure was interrupted considering both patient’s high bleeding risk and embolic aetiology. Excluded prosthetic thrombosis and thrombophilic anomalies, patient was discharged in clinical stability with SAPT+ VKAs therapies.

Discussion
Coronary embolism (CE) represents 3% of ACS because the coronary arteries are protected from embolism thanks to their acute’s angle origin from the aorta. Embolism origin is various and it can originate from left (LAA, LVx, valvular, prosthetic structures) or right heart sections (paradoxical embolism in the case of PFO),generally during AF. In our case, prosthetic origin is the most probable embolic source as demonstrated by cerebral ischemic (TIA/stroke) and coronary events (first anterior then inferior–posterior STEMI) after valves surgery. Treatment consists of restoring antegrade flow without DES implantation, using if possible intracoronary thrombolysis or thromboaspiration. In secondary prevention, embolism sources removal and anticoagulant therapy are mandatory. In our case we recommended SAPT+VKAs with strict INR’s control (range 3.5–4).

Conclusions
Although CE is a rare and potentially fatal phenomenon it should be suspected in the absence of coronary atherosclerosis and in the presence of predisposing conditions such as those mentioned above. This case demonstrates that CE can occur in absence of prosthetic thrombosis with suboptimal INR control.
P158 REMOTE FOLLOW–UP OF ISCHEMIC HEART DISEASE AFTER MYOCARDIAL INFARCTION: PRELIMINARY RESULTS OF A TELEVISIT PROJECT IN THE CARDIOLOGY OF G.B. GRASSI HOSPITAL IN ROME
Authors: Pastena G , Bocchino M , Paraggio L , Ferranti F , Scardala R , Sorrentino C , Romano M , Ammirati F 
Published: May 2023

Abstract

Introduction
In literature there are few studies reported on follow–up of post infarction using telemedicine.

Objective and Methods
Considering recent pandemic and thanks to the development of digital also in its regulations, it was decided to organize a televisit service with a dedicated team (cardiologist, nurse, cardiology technician) for patients (pt) discharged after a myocardial infarction. The platform of Regione Lazio SISMED has been used to carry out all the necessary procedures (dematerialised recipe, booking, videoconference, digital signature reporting and sending to FSE). We selected pt with: ST elevation myocardial infarction (STEMI), myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) or Takotsubo syndrome, non ST elevation myocardial infarction (NSTEMI) with high–risk, providing a follow–up to 1 and 4 months to monitor cardiovascular events, adherence to therapy, achievement of therapeutic targets and level of satisfaction. An Access file was designed for reporting and data collection.

Results
From 23–11–21 to 2–11–22, we followed 58 pt (average age 64±10 years, 73% males). Figure 1 represents the cardiovascular risk factors and Figure 2 the type and location of the myocardial infarction; at discharge (average stay 7±2 days), the ejection fraction of the left ventricle was 53±9%. At the televisit control at 1 month, 5 pt reported symptoms (4 dyspnea, 1 cardiopalm), all continued the antiaggregant therapy; Figure 3 shows those who have reached the target for LDL cholesterol (average 56±34 mg/dl), blood pressure (average 124±10 mmhg) and blood sugar level (average 107±19 mg/dl); 6 pt had no target LDL cholesterol (three stopped hypolipidaemic therapy). One pt showed intense pallor, asthenia and reduced hemoglobin (6 g/dl): after hospitalization, we found colon diverticulosis with bleeding (he took oral anticoagulant due to prior atrial fibrillation, suspended, with benefit). The 4–month follow–up was performed for 42 pt, with overlapping results, without reospedalizations. No pt died.

Conclusions
The televisit showed itself safe as an option in the follow–up of these pt, with a high approval rating. This was possible through the structuring of a health coordination center with a dedicated team, which also supported pt in the new path.
P169 ONE–MONTH RELAPSE OF UNDIFFERENTIATED SARCOMA IN THE LEFT ATRIUM: A CASE–REPORT AND LITERATURE REVIEW
Authors: Fumarulo I , Camilli M , Bisceglia I , Aspromonte N 
Published: May 2023

Abstract

Background
Primary cardiac tumors are extremely rare and mostly benign; among the malignant ones the most frequent are sarcomas (primary cardiac sarcomas, PCS), commonly located in the left atrium. Echocardiography usually provides initial information about tumor location and its size, although the correct diagnosis may be hindered by similarities to benign myxomas or thrombotic formations. Therefore a multimodality approach, with second level imaging techniques, is frequently needed. Case–report: We report a case of undifferentiated cardiac sarcoma in a 47–year–old woman who underwent surgical resection. One month after the operation the control transthoracic echocardiography (TTE) revealed disease recurrence, confirmed by Positron emission tomography (PET)–computed tomography (CT). The patient underwent chemotherapy and hypofractionated radiotherapy, with significant reduction of mass size after 2 months.

Conclusions
PCS is a very rare disease, predominantly affecting adults in the fifth decade of life, with a very poor prognosis. Symptoms depend on the size and location of the tumor and may be nonspecific up to the advanced stages. Diagnosis may be suspected by TTE or CT but histological diagnosis is often essential. There is no standard treatment. Surgery is potentially the best treatment option, followed by radiotherapy, chemotherapy and immunotherapy targeted to the specific histologic subtype of the tumor, but further studies are needed.
P172 A RARE CASE OF PLATINUM CARDIOTOXICITY: CASE REPORT
Authors: Maratea A , Mauriello A , Liccardo B , Desiderio A , D‘Andrea A 
Published: May 2023

Abstract

Background
The chemotherapy regime containing the Carboplatin–Gemcitabine combination is frequently used for improving outcomes in patients affected by metastatic breast cancer. Platinum compounds were included in the recent ESC Guidelines on cardio–oncology as potential agents which may lead to myocardial infarction, thrombosis and, rarely, heart failure. In this instance it is essential for a strict cardiological follow–up to be carried out during and after treatment. Case report: We present a clinical case report of a 38–year–old woman who was receiving standard oncology treatment for stage IV breast adenocarcinoma. The patient underwent chemotherapy cycles containing the Carboplatin–Gemcitabine combination, with a good response to treatment. It came to our attention for severe dyspnoea, which arose several days before, not compatible with her oncological situation. Transthoracic echocardiography showed severe left ventricular dysfunction (EF 25%; GLS – 9.2%; NT–proBNP 10000 pg/mL), which was not present during earlier tests, and circumferential pericardial effusions, mainly localised along the free wall of the right ventricle, non–haemodynamically significant. Lung ultrasound also showed the presence of pulmonary congestion and bilateral pleural effusions. In the circumstances, she was admitted to the Cardiac Intensive Care Unit for continuation of diagnostic treatment. She then received endo–venous diuretic treatment and haemodynamically supported with Noradrenaline and inotropic agents. A cycle of Levosimendan was performed with an excellent response. Once haemodynamic compensation was re–established, the patient underwent a cardiac CMR which excluded cardiomyopathies and myocarditis and a coronarography was performed which showed no significant lesions in the coronary arteries. After 18 days of hospitalisation in our department, the patient showed an improvement in EF (EF 38%, GLS –12.5%, NT–proBNP 2000 pg/mL), and then she was referred to the oncologist for immunological treatment.

Conclusions
The diagnosis of cardiotoxicity may not be straightforward due to the aspecificity of the symptoms, its silent progression or because of several comorbidities. Moreover, cardiac damage from chemotherapy is considered reversible if identified early. Treatment is based on the withdrawal of therapy and treatment of symptoms, given that these may be different and unpredictable.