bluuebunny/crossref_metadata_2025_split huggingface dataset:
C5 IMPACT OF ATRIAL HIGH RATE EPISODES ON PROGNOSIS IN PACEMAKER PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Matteucci A , Bacà M , Cappuccio C , Pignalberi C , Magris B , Meo A , Aquilani S , Colivicchi F 
Published: May 2022

Abstract

Background
The occurrence of high atrial rate episodes (AHRE) is growing in importance due to the increasing number of patients with implantable cardiac electronic devices (CIED). As a result, clinicians need to balance the benefits of a pharmacological therapy against the risks involved. To date, there are no clear evidence on the long–term effects of AHRE, nor are there any specific recommendations to help physicians make the most appropriate treatment choice.

Methods
We enrolled 732 patients with CIED followed in the Arrhythmology department of San Filippo Neri Hospital, in Rome and with remote home monitoring. Only patients with single–chamber, dual–chamber and biventricular pacemakers (CRT–P) were included. All patients had post–implantation follow–up at 6 months and one year. The minimum follow–up duration considered was 24 months. Patients with permanent pre–implant atrial fibrillation were excluded.

Results
Among the enrolled cohort, AHRE were found in 170 (23.2%) patients. The occurrence of AHRE was significantly related to older age (p = 0.001 HR 1.02 CI 95%), lower ejection fraction (p = 0.027 HR 0.98 CI 95%) and severe mitral valvulopathy (p = 0.003 HR 1.7 CI 95%). The presence of AHRE increased the risk of cryptogenic stroke only for episodes over 24 hours (p = 0.02 HR 1.6 CI 95%) and increased mortality (HR 1.32 CI 95%), although not significantly (p = 0.132).

Conclusion
AHRE are associated with adverse events and may increase mortality in patients with CIED. Their monitoring and detection is necessary for an appropriate management of treatments. Randomised studies are needed to clarify the criteria for thromboembolic prevention in the context of AHRE.
C13 COMPARISON OF MINIMALLY INVASIVE VERSUS CONVENTIONAL THORACIC AORTIC OPERATIONS: EARLY AND MID–TERM RESULTS IN A SERIES OF 624 PATIENTS
Authors: Berretta P , Galeazzi M , Chiuselli G , Codecasa R , Alfonsi J , Braconi L , Rapisarda F , Bonacchi M , Malvindi P , Stefano P , Di Eusanio M 
Published: May 2022

Abstract

Objective
Despite minimally invasive techniques have gained wider clinical application in cardiac surgery, current evidence on mini thoracic aortic surgery is still limited. The aim of this study was to compare early and mid–term outcomes of patients undergoing proximal thoracic aortic interventions through mini–sternotomy (MS) versus full sternotomy (FS).

Methods
Data from 624 consecutive patients undergoing proximal aortic operations through MS (n = 214, 34.3%) and FS (n = 410, 65.7%) at 2 aortic centers, were analysed. Patients with prior cardiac operations and active endocarditis, and those who underwent emergency operation and combined procedures were excluded. Treatment selection bias was addressed by the use of propensity score matching (MS vs FS). After matching, 2 well–balanced groups of 202 patients each were created. Surgical procedures involved aortic valve replacement/repair and ascending aorta replacement in 190 patients (47%), aortic root replacement in 110 patients (27.2%) and isolated ascending aorta replacement in 104 patients (25.7%).

Results
The median cardiopulmonary bypass and cross clamp times were 88 and 68 minutes, respectively, with no difference between groups. Overall 30–day mortality was 0.7%, being 1% (n = 2) in patients underwent MS and 0.5% (n = 1) in those underwent FS (p = 0.6). No difference was found in the rates of stroke (MS n = 5, 2.5%; FS n = 5, 2.5%), dialysis (MS n = 1, 0.5%; FS n = 4,2%), bleeding (MS n = 7, 3.5%; FS n = 7, 3.5%), and blood transfusions (MS n = 67, 33.3%; FS n = 57, 28.4%) (Table 1). Patients receiving MS were associated with a lower incidence of respiratory insufficiency compared with those receiving FS (0% vs. 2.5%, p = 0.03). The median intensive care unit length of stay was 24 and 25 hours in MS and FS group, respectively (p = 0.3), and in–hospital stay was 7 days both in MS and FS group (p = 0.9). Three–year survival rate was 96.6% in patients receiving MS and 95.7% in those receiving FS (p = 0.9).

Conclusions
Our findings showed that mini proximal aortic operations can be performed successfully without compromising the proven efficacy and safety of conventional access. In selected patients, MS was associated with very low mortality and morbidity rates. Additionally, MS demonstrated superior clinical outcomes as regards respiratory adverse events, when compared with FS.
C17 SIMPLIFIED MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH A DIRECT VISION TRANSAXILLARY APPROACH: PROCEDURAL AND 30–DAYS OUTCOMES
Authors: Malvindi P , Berretta P , Alfonsi J , Galeazzi M , Bifulco O , Capestro F , Zingaro C , Di Eusanio M 
Published: May 2022

Abstract

Background
Minimally invasive cardiac surgery through right mini–thoracotomy access is nowadays an established approach for the treatment of mitral valve pathologies. Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection and valve exposure. Aim of this study is to review our early results with a minimally invasive approach characterized by a lateral right trans–axillary (TAx) approach and direct vision.

Methods
Prospectively collected data of patients who underwent mitral valve surgery between 2018 and 2021 were reviewed. Among them, 245 patients underwent minimally invasive mitral valve surgery through TAx access. A single incision at the fourth right intercostal space on the anterior axillary line, 3–to–5 cm in length (Fig 1), allowed a 90° direct view exposure of the mitral valve (Fig 2) and the subvalvular apparatus (Fig 3). A transthoracic clamp was invariably used to achieve the cardioplegic arrest.

Results
Mean age of the patients was 63 years and the mean EuroSCORE II was 1.6. Regurgitation was the prevalent mitral valve dysfunction (91%). Mitral valve repair was performed in 87% of the cases using several techniques including a combination of annuloplasty, leaflet resection and sliding, placement of neochordae and repair of the commissures. In patients with degenerative disease, the rate of valve repair was 92%. Tricuspid annuloplasty was associated in 10% of the cases. There was no in–hospital death; the rates of postoperative stroke and TIA were 0.4% and 1.2%, respectively. Median mechanical ventilation time was 3 [0–6] hours with 40% of the patients extubated in theatre at the end of the procedure. Median ICU stay was 24 [21–46] hours. Three patients had superficial complications of the thoracic wound and in 7 cases of the groin incision. After a median time of 7 [6–8] days, all the patients were successfully discharged from the hospital. The pre–discharge echocardiogram revealed none or trace residual mitral regurgitation in up to 96% of the patients who underwent mitral valve repair with a mean gradient across the valve of 3 [2–4] mmHg.

Conclusions
The TAx approach for minimally invasive mitral valve surgery is safe and allows a quick functional recovery. A superb direct view of the mitral apparatus and the ascending aorta, facilitates the exposure and the surgical repair of the valve with no need of any endoscopic nor an endoaortic balloon occlusion system support.
C57 DUAL ANTIPLATELET THERAPY DID NOT PREDICT ALL–CAUSE BLEEDING AT LONG–TERM FOLLOW–UP AFTER ACS: A SUBANALYSIS FROM THE APULIA PONTE ACS STUDY
Authors: Citarelli G , Locuratolo N , De Martino G , Resta M , Sassara M , Ricci G , Cicala M , Piscopo A , Sanasi M , Scicchitano P , Lisi F , Spadafina T , Grande D , Caldarola P 
Published: May 2022

Abstract

Background
Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS.

Methods
This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up.

Results
We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up.

Conclusions
Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.
C63 PHENOTYPE – GENOTYPE RELATIONSHIP IN ARRHYTHMOGENIC CARDIOMYOPATHY
Authors: Gueli I , Alderotti B , Todiere G , Grigoratos C , Modena M , Botto N , Vittorini S , Vergaro G , Giannoni A , Aimo A , Passino C , Aquaro G , Emdin M , Barison A 
Published: May 2022

Abstract

Background
Arrhythmogenic cardiomyopathy (ACM) is a primary disease of the myocardium with arrhythmic manifestations and fibro–fatty replacement either of the right (RV) or the left ventricle (LV) at the cardiac magnetic resonance (CMR). Over the last decade, different mutations in cardiac genes associated with heterogeneous phenotypes have been identified.

Aim
To investigate the genotype–phenotype relationships in ACM patients. Firstly, the phenotypic expression was defined in definite mutation carriers. Secondly, the prognostic significance of mutations was assessed across different phenotypes.

Methods
The study population included 281 patients with suspected ACM, based on family history, clinical and electrocardiographic evaluation, echocardiographic and CMR findings (Fig.1), studied at our Institution since 2012. All patients underwent genetic evaluation using Sanger sequencing and NGS of mutations in desmosomal (desmoplakin [DSP], plakophilin–2[PKP2], plakoglobin[JUP], desmoglein–2 [DSG2], desmocollin–2 [DSC2]) or non desmosomal genes. The composite endpoint included cardiac death, sustained and non–sustained ventricular tachycardia (VT), ventricular fibrillation (VF), appropriate defibrillator shock/antitachycardia pacing (ATP).

Results
The genetic test was positive in 113 patients (40%), 82 (73%) for desmosomal genes (41 DSP, 15 DSG2, 15 PKP2, 5 JUP, 6 DSC2), and 31 (27%) for non–desmosomal genes (4 titin, 2 TMEM 43, 2 lamin A/C, 23 others). Gene–positive compared to gene–negative (n = 168, 60%) patients showed a higher prevalence of LV ejection fraction (EF)&lt;50% (14%vs.6%, p&lt;0.011), LV and RV LGE (62%vs.46%, p &lt; 0.001, 20%vs.12%, p&lt;0.02), RV dilatation (27%vs.17%, p&lt;0.041) (Table 1). DSG2 mutations were associated mainly to biventricular (7/15,46%) or RV involvement (4/15,26%), while DSP mutations to LV involvement (24/41,58%). During a median 36–month follow–up (IQ.range 12–56), 55 patients (19%) experienced the composite endpoint (35 non–sustained VT; 11 sustained VT – 3 ATP, 1 defibrillator–shock–; 9 VF, all treated by defibrillator–shock). At Kaplan–Meier analysis, DSP mutations were associated with the worst prognosis (Fig. 3). Conclusion Diverse genotypes were differently associated with LV dysfunction/LGE, RV dilatation/LGE. DSP mutations were associated with higher arrhythmic risk. Genetic screening may result in a better risk stratification, useful for clinical decision–making.
C70 HIGH–SENSITIVE CARDIAC TROPONINS ELEVATION: NOT ONLY A CARDIAC DISEASE. ROLE OF HETEROPHILE ANTIBODIES
Authors: Forzano I , Campana P , Ranieri A , Sforza A , Aversa M , Musella F , Basile C , Perillo E , Ciaramella L , Tagliamonte G , Sibilio G 
Published: May 2022

Abstract

Introduction
High–sensitive troponins I and T (hs–TnI and hs–TnT) represents the main biomarkers of Acute Coronary Syndrome diagnosis when combined with ST–T segment changes at ECG and typical clinical presentation. Elevated serum values of cardiac troponins can also be found in several cardiac diseases such as myopericarditis, pulmonary embolism and heart failure, conversely also in non–cardiac diseases. Among them, the analytical interference due to heterophile antibodies (HA) represent a rare non–cardiac cause of troponins elevation.

Case Presentation
We report a case of a 20–year–old man admitted to our Cardiology department for palpitations and dyspnea, associated with persistently high levels of TnI–HS. He presented no cardiovascular risk factors. During hospitalization the patient was asymptomatic with persistent TnI–HS elevation (1051.4 pg/mL; r.n. 0–34 pg/mL) associated with no CK–MB values changes or typical rise and fall of myocardial damage biomarkers at lab test. Cardiac magnetic resonance excluded myopericarditis or cardiomyopathies in this patient, therefore HA capture test was performed using HA blocking tube reagents. The analytical interference due to HA has been identified with a post–test hs–TnI value of 16.9 pg/mL.

Conclusions
The analytical interference due to HA is a rare and underestimated cause of false–positive results in cardiac troponin essay, however it should be excluded mostly in young patients without cardiovascular risk factors. Persistent hs–TnI and hs–TnT elevation combined with the absence of typical rise and fall of cardiac troponins and with no CK–MB alterations should help the clinician to recognize this analytical phenomenon at the emergency department.
C83 USE OF CANGRELOR IN A 63 YEARS OLD MEN SUFFERING FROM ACUTE INFERIOR ST–ELEVATION MYOCARDIAL INFARCTION AND SEVERE IDIOPATHIC THROMBOCYTOPENIC PURPURA: A CASE REPORT
Authors: Cocozza S , Formigli D , Parente A , Pirozzi E , Franco V , Moscato F , Amico V , Vallone R , Scherillo M 
Published: May 2022

Abstract
A 63–year–old man suffering from systemic arterial hypertension, thalassemic trait, recent right ureteral stent implantation, dysthyroidism and thrombocytopenia presented to the Emergency Department with acute chest pain and ST elevation in inferior leads and 2nd degree atrioventricular block. He suffered from idiopathic thrombocytopenic purpura since February 2020, with baseline platelet level (PLT) &lt;10,000/mm³ requiring treatment with deltacortene 5 mg, tranexamic acid 1000 mg x 3/day and fostamatimib 100 mg x 2/day. Upon arrival in the Cardiology Intensive Care Unit (UTIC) an echocardiogram was performed and confirmed inferior myocardial infarction. First laboratory results were significant for PLT of 9,000/mm³ and Troponin I peaked at 31,838 pg/mL. The patient received Acetylsalicylic acid (ASA) 300 mg iv then was urgently transported to the Cath–Lab. Coronary angiography revealed mid right coronary artery occlusion, subsequently underwent primary percutaneous coronary intervention with multiple pre–dilations and placement of dual 3.5x28mm and 4.0x28mm TiNO bioactive metal stent with excellent angiographic results. A temporary Pacemaker was implanted. It was started Cangrelor bolus 30 µ/kg followed by infusion at 4 µ/kg/min for 6 hours associated with unfractionated sodium heparin at a reduced dosage of 50 IU/kg during the procedure and with a subsequent switch to Clopidogrel after an oral bolus of 300 mg. After 24 hours, the patient removed the temporary PMK for resolution of the AV block. The haematologist consultant advised to increase fosfatimib to 150 mg x 2/day and recommended the use of Human Immunoglobulin iv from the second day of hospitalization for 2 days. The patient was discharged on the seventh day, asymptomatic, with dual antiplatelet therapy (DAPT) with ASA 100 mg and Clopidogrel 75 mg daily and did not experience any bleeding during hospitalization. At a one–month follow–up, the patient is symptomatic and continued to tolerate ASA and Clopidogrel with stable PLT of 11,000/mm³. In treating for STEMI, the treatment regimen consists of DAPT that increases risks for bleeding. In patients with thrombocytopenia, the risk for bleeding is multiplied and there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. The use of Cangrelor proved to be safe and effective during STEMI even in patient with severe thrombocytopenia.
C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP
Authors: Ancona R , Gaio G , Giordano M , Marzullo R , Cappelli Bigazzi M , Palladino M , Scognamiglio G , Sarubbi B , Russo M 
Published: May 2022

Abstract

Background
Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure.

Materials and Methods
We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA&gt;5 mm); Group II (one defect &gt;5 mm and more than one further fenestrations); Group III (multiple fenestrations).

Results
Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P &lt; 0.01) and need of implantations of more than one devices (P &lt; 0.01).

Conclusions
Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.
C88 EFFECT OF SARS–COV2 INFECTION ON ACUTE CORONARY SYNDROME: A RETROSPECTIVE OBSERVATIONAL STUDY
Authors: Cassani G , Vecchi A , Perletti G , Roberto D , Castiglioni B 
Published: May 2022

Abstract

Introduction
In Northern Italy, from October 2020 to April 2021, the second wave of COVID–19 pandemic recorded the highest incidence of infections ever. In this semester, the Lombardy region alone counted 43,318 positive cases and 16,710 deaths. It is well known how COVID–19 leads to a negative prognosis in acute coronary syndrome (ACS). This study aims to analyze the dramatic consequences of SARS–CoV2 infection on patients with concomitant ACS during the worst pandemic period ever recorded in Northern Italy.

Materials and Methods
The study enrolled 255 consecutive patients who have been hospitalized for ACS (STEMI or NSTEMI) from October 2020 to April 2021, both from the hub and spoke hospitals. Two subgroups are compared: the first is composed of patients who have tested positive for at least one molecular SARS–CoV2 swab (at admission or during hospitalization), the other group is composed of patients who have been tested negative to SARS–CoV2 swab. Major clinical data, risk factors (RF), comorbidities, laboratory findings, reperfusion times, drug therapy, complications and in–hospital mortality were systematically collected.

Results
Patients main characteristics are shown in Table 1. No differences have been observed in clinical history, RF and comorbidities in the subgroups. At admission, the incidence of acute pulmonary edema (APE) and respiratory symptoms was significantly higher in the SARS–CoV2 group, respectively 14% (p = 0.005) and 18% (p = 0.017). No differences in the “onset to door” and “door to needle” delays have been recorded. The incidence of the composite in–hospital complications is markedly increased in SARS–CoV2 group. Compared to negative patients, a higher mortality rates (18% Vs. 4%; p = 0.017), higher incidences of acute renal failure (ARF) (18% Vs. 5%; p = 0.037), cardiogenic shock (14% Vs. 3%; p = 0.033) and a wider prescription of inotropes (23% Vs. 10%; p = 0.009) in the SARS–CoV2 cohort.

Conclusion
The study confirms the negative prognostic impact of COVID–19 infection on ACS, recording a significantly higher rate of all major complications, both related to ischemia with multiorgan failure and interstitial pneumonia. Higher incidence of APE, cardiogenic shock and ARF has been observed in SARS–CoV2 positive subgroup, which is corroborated by a quadrupled risk of in–hospital mortality in the COVID–19 cohort.
P1 ATRIAL TACHYCARDIA IN PATIENT WITH TRANSFUSION–DEPENDENT BETA THALASSEMIA AND SEVERE HEMOCHROMATOSIS: A CASE REPORT
Authors: Marchini F , Sirugo P , Clò S , Capanni A , Malagù M , Bertini M , Guardigli G 
Published: May 2022

Abstract

Background
Beta thalassemia is the most common inherited disease and it’s characterized by the reduced synthesis of the beta–globin chains of the hemoglobin. Patients usually need long life transfusions since the disease leads to chronic hemolytic anemia. Iron chelation therapy is essential to prevent the chronic iron overload, which is responsible for heart failure, supraventricular and ventricular arrhythmias up to sudden cardiac death.

Case Report
A 31 year old female patient suffering from transfusion–dependent beta thalassemia has rarely taken iron chelation therapy during the years. Because of that, she developed a severe iron overload and heart failure. Furthermore, she started suffering from several episodes of supraventricular tachycardia and she was referred to our cardiological institution for medical help. She was initially treated with a pharmacological rhythm control strategy, which was ineffective. Then, even if the cardiac iron overload wasn’t completely resolved, we decided to perform an electrophysiological study and catheter ablation of atrial tachycardia. After the ablation, the patient had no more relapses during the follow up and she started to be more adherent with the iron chelation therapy.

Discussion
Cardiovascular complications are among the main causes of morbidity and mortality in patients suffering from beta thalassemia. Despite the wide use of iron–chelation therapy, today it’s still possible to find patients with severe iron overload. Furthermore, thalassemic patients have a high arrhythmic burden, especially for supraventricular arrhythmias. The best rhythm control treatment is represented by iron chelation therapy but there are still many doubts and open questions about the optimal pharmacological and interventional strategy. This clinical case shows how the interventional approach with catheter ablation can be an useful tool for rhythm control during the acute phase, even when the cardiac iron overload is still present.