bluuebunny/crossref_metadata_2025_split huggingface dataset:
P210 VENTRICULAR FIBRILLATION IN AN ELDERLY WOMAN WITH APPARENTLY UNREMARKABLE PAST CARDIOLOGICAL HISTORY: AN UNEXPECTED CULPRIT
Authors: Sansonetti A , Armillotta M , Amicone S , Impellizzeri A , Fabrizio M , Angeli F , Bergamaschi L , Stefanizzi A , Magnani I , Rinaldi A , Foà A , Galiè N , Pizzi C 
Published: May 2022

Abstract
An 85–year–old woman experienced cardiac arrest while she was at the supermarket. Cardiopulmonary resuscitation was promptly performed with ROSC after DC shock on ventricular fibrillation and immediate hemodynamic and neurological recovery. The first ECG performed by the rescuers did not show acute ischemic changes and the patient was admitted to the Cardiological Intensive Care Unit. Past medical history revealed only a previous episode of acute pulmonary embolism for which she was on oral anticoagulant therapy for a limited period of time. She had not family history of sudden cardiac death or cardiomyopathies. Before admission she was completely asymptomatic and she never complained of angina pectoris, palpitation or dyspnoea. The echocardiogram at admission showed moderate left atrial enlargement and hypokinesia of left ventricle apex and mid–apical lateral wall with global EF of 50%. Pulmonary and aortic CT angiography showed no pathological findings. In order to rule out an ACS, the patient underwent a coronary angiography which documented the absence of critical coronary stenosis. Finally, a cardiac MRI with gadolinium was performed, revealing the presence of two small areas of transmural LGE affecting inferior basal and lateral mid–apical segments with no edema, consistent with ischaemic myocardial scars. In light of this findings and to rule out paradoxical coronary artery embolism we decided to perform a transcranial echocolordoppler that showed the absence of a patent foramen ovale. Furthermore, continuous ECG monitoring during the hospital stay did not document arrhythmic recurrences. In consideration of the high probability of ischemic heart disease, therapy with antiplatelet agent, beta–blocker, ace–inhibitor and statin was introduced and the patient was discharged after ICD implantation. Three months later, during her first follow–up visit, we documented short episodes of atrial fibrillation at ICD interrogation. This was in line with the hypothesis of a ventricular fibrillation and cardiac arrest in the contest of an ischemic heart disease with myocardial scars probably due to undatale coronary artery embolism. Oral anticoagulant therapy was started in addition to previous therapy.
P213 ROLE OF ANEMIA AND IRON IMPLEMENTATION ON PROGNOSIS AND MANAGEMENT OF ELDERLY STEMI PATIENTS
Authors: Mircoli L , Tonella T , Carugo S 
Published: May 2022

Abstract

Introduction
Elderly patients with S–T elevation myocardial infarction (STEMI) presented a very high risk for both in–hospital and long–term morbility and mortality. Comorbidities plays a key role in prognosis, in particular anemia (pre–existent or acquired) is a more and more emerging clinical element able to influence short– and long–term clinical outcome. Prognostic role of anemia in elderly STEMI patients in not completely clarified.

Purpose
of the present study is to evaluate the role of anemia and its therapy by iron implementation in a very–old population of STEMI patients followed for 1 year after index event.

Methods
we considered all STEMI patients admitted in our Coronary Care Unit from 2020 to 2021 and we selected only people aged &gt; 80 years–old (n = 120). Haemoglobin (Hb, g/dl) values were considered at admission (T0), at hospital discharge (T1) and after 6 month (T2). In hospital and 1 year mortality, treatment by primary PCI, major bleedings (TIMI criteria), need of transfusion, double antiplatelet therapy (DAPT) discontinuation, were considered and compared between groups of patients without and with anemia (A, Hb &lt; 13.5 for men and &lt;12 for women at T1) and without (NA group). Type of iron implementation (sucrosomial or not) and its tolerability were considered only for A group. Data were expressed as means±SD or % values.

Results
18 patients (15%) presented anemia at T0 (women 66%), 4 (22%) of them showed a TIMI major in–hospital bleeding (3, 20%, required blood transfusion) whereas 5 (5%) in non anemic, in–hospital mortality was similar between anemic and non–anemic (18% vs 17%). Sixteen (14%) presented mild anemia at T1 (14%, A group), mean age were similar to NA group (years, 86±4 vs 85±5, A vs NA, ns). In A 4 (25%) died during follow–up vs 11 (13%) in NA group during 1 year follow–up. Treatment with primary PTCA (31% vs 39%, A vs NA, ns) were similar. DAPT discontinuation In A group 16 patiens were discharged with indication to long–term iron implementation therapy, 6 of them with sucrosomial. Incidence of iron discontinuation was 16% (1 pt) for sucrosomial vs 50% (5 pts) for non–sucrosomial.

Conclusions
In elderly STEMI patients, 1) anemia at hospital admission influences in hospital major bleedings and need of blood trasfusions. 2) anemia at hospital discharge seems to affect DAPT discontinuation and long–term mortality. 3) use of sucrosomial iron reduces probability of discontinuation of implementation therapy.
P216 RENAL RESISTANCE INDEX IS INDEPENDENTLY ASSOCIATED WITH THE WORSENING OF RENAL FUNCTION AFTER CORONARY ANGIOGRAPHY
Authors: Goffredo G , Barone R , Di Terlizzi V , Correale M , Casavecchia G , Ieva R , Cuculo A , Brunetti N , Iacoviello M 
Published: May 2022

Abstract

Background
The term Cardiorenal Syndrome (CS) has been recently introduced to indicate the close relationship between cardiovascular and renal diseases, which are able to reciprocally influence the each other progression. In this setting the renal resistance index (RRI) has been demonstrated to be a useful parameter able to detect patients at higher risk of CS. However, there are no data about its role in predicting worsening of renal function (WRF) mediated by the intravascular administration of contrast.

Aim of the Study
To evaluate the role of RRI in predicting WRF after coronary angiography. METHODS We enrolled 115 patients (mean age 64 years, 73% males, 84% hypertensive, 43% diabetic, 30% with acute coronary syndrome, 21% affected by chronic heart failure, CHF, with a mean left ventricular ejection fraction, LVEF, of 51±11) with suspected coronary artery disease, stable angina, or acute coronary syndromes who have been referred for coronary angiography (with or without pre–existing renal impairment). All patients underwent medical examination, electrocardiogram, echocardiographic and chemical evaluation, and renal arterial echo–color Doppler used to calculate RRI. WRF was defined as an increase of creatinine &gt;0.3 mg/dl and of at least 25% from baseline 24–48 hours after coronary angiography.

Results
After coronary angiography, 14 (12%) of the enrolled patients showed WRF. As shown in the Table, at univariate regression analysis baseline RRI was associated with WRF as well as age, peripheral artery disease, CHF, atrial fibrillation, NYHA class, LVEF, mitral regurgitation (MR), central venous pressure (CVP), tricuspid regurgitation (TR), estimated glomerular filtration rate (GFR). In a multivariate forward stepwise regression model, including all univariate predictors, history of CHF, high CVP and RRI were the only parameters significantly associated with WRF.

Conclusion
Our findings demonstrate that in patients undergoing coronary angiography, history of CHF, high CVP and RRI are independent predictors of WRF. RRI, but not GFR, is independently associated with WRF probably because providing additional relevant information about cardiorenal pathophysiological factors reflecting the hemodynamic status and kidney flow reserve.
P217 SACUBITRIL/VALSARTAN IN ADVANCED HEART FAILURE: SAFETY AND EFFECTS ON HAEMODYNAMIC PARAMETERS
Authors: Gentile P , Cantone R , Perna E , Ammirati E , Varrenti M , D‘Angelo L , Verde A , Foti G , Masciocco G , Garascia A , Frigerio M , Cipriani M 
Published: May 2022

Abstract

Aims
The angiotensin–II receptor neprilysin inhibitor (ARNI), sacubitril/valsartan has been shown to be effective in treatment of patients with heart failure (HF), but limited data is available in patients with advanced disease. This retrospective observational study assessed the effects of ARNI treatment in patients with advanced HF.

Methods
We reviewed medical records of all advanced HF patients evaluated at our center for unconventional therapies from September 2016 to January 2019. We studied 44 patients who started ARNI therapy and who had a hemodynamic assessment before beginning ARNI and after 6 ± 2 months. The primary endpoint was variation in pulmonary pressures and filling pressures at 6 months after starting ARNI therapy.

Results
Mean patient age was 51.6±7.4 years; 84% were male. At 6±2 months after starting ARNI, there was significant reduction of systolic pulmonary artery pressure (PAP) (32 mmHg, IQR 27–45 vs 25 mmHg, IQR 22.3–36.5; p &lt; 0.0001) and median PAP (20 mmHg, IQR 15.3–29.8 vs 17 mmHg, IQR 13–24.8; p = 0.046). Five of 22 patients (23%) were deferred from the heart transplant (HTx) list because of improvement, while four were listed de novo. After 23 ± 9 months, 3 patients were treated with a left ventricular assist device (LVAD) implantation, while 6 patients underwent Heart transplantation (one in emergency conditions for refractory ventricular tachycardia).

Conclusions
Sacubitril/valsartan is effective in reducing filling pressures and pulmonary pressures in patients with advanced HF. The absence of adverse events during follow–up suggests that sacubitril/valsartan is safe and well–tolerated in this cohort of patients.
P220 REMOTE MONITORING IN FOLLOW–UP OF ELDERLY PATIENTS WITH HEART FAILURE
Authors: Canestrale R , Mancinelli L 
Published: May 2022

Abstract

Background
Hospitalization is the home route after discharge of elderly patients with heart failure are associated with a high mortality rate (up to 50 % in the first six months) and repeated re–hospitalizations in the first three months, with a peak within thirty days of discharge despite therapy. Telehomecare offers concrete answers to the needs of specialized assistance, usable and in real time, but, on the other hand, the telematic follow–up lends itself to a considerable degree of distrust of non–traditional organizational models.

Objectives
The primary objective of this project is to evaluate the reduction of re–hospitalizations through a telematic follow–up by creating a low–cost virtual clinic. Secondary objective to assess the quality of life in the elderly large patient and the managerial continuity between hospital–home. MATERIALS AND

Methods
An initial narrative review of the literature was conducted by consulting the major data–bases available (Pub–Med, Chinhal and Cochrane Library) and then a qualitative survey of a sample of convenience of 31 users with an average age of 80,4 aa to assess the effectiveness of virtual follow–up . To assess the quality of life (qol) will be administered the questionnaire MLIHF Minnesota living with Heart Failure. The data will then be recorded on an excel sheet and analyzed through the R–Studio software.

Results
Through telemedicine interventions and teleconsultation has been achieved to a greater awareness of the health status of the patient and an empowerment of the selfcare that helps to ensure therapeutic adherence and to contain and/or avoid the progression of NYHA class, also improving the quality of life and the disconfort of travel

Conclusions
Home telemonitoring opens up new perspectives for chronically serious patients and shows potential benefits for patients‘ quality of life and cost containment. In our experience, the monitoring of telemedicine in patients with Heart Failure of high risk age (average age 80.4 years) will lead to an increased awareness of the disease, and the complete and specific training of the caregiver will become fundamental to build a solid social network system for the success of teledisease management.
P221 DAPAGLIFLOZIN ASSOCIATED TO SACUBITRIL/VALSARTAN EXERTS ADDITIVE CARDIOPROTECTION IN HUMAN CARDIOMYOCYTES EXPOSED TO DOXORUBICIN AND TRASTUZUMAB THROUGH MYD88, NLRP3 MEDIATED PATHWAYS AND IMPROVEMENT OF MYTOGENESIS
Authors: Quagliariello V , Iovine M , Buccolo S , Maurea N 
Published: May 2022

Abstract

Introduction
The cumulative incidence of cardiac events in breast cancer patients treated with anthracycline and trastuzumab at 1 year after the diagnosis of cancer was 16.4%, at 2 years 23.8 %, and at 3 years 28.2%. Sodium glucose co–transporter 2 inhibitors showed measurable benefits in reduction of HF hospitalization and cardiovascular mortality. LCZ696 (neprilysin inhibitor + valsartan) as able to lower the risk of cardiovascular events in chronic heart failure.

Purpose
We hypothesize that dapagliflozin associated to LCZ696 could exerts cardioprotective effects in cellular models of doxorubicin and trastuzumab–induced cardiotoxicity

Methods
Human cardiomyocytes (HL–1 cells) were exposed to subclinical concentration of doxorubicin and trastuzumab (100 nM) alone or in combination with dapagliflozin (50 nM) or LCZ696 (at 100 mM) or both in combination for 48h. Cell viability, apoptosis and necrosis were performed. Quantification of MDA– 4–HNE and Ca2+ were performed through spectrophotometric methods. Anti–inflammatory studies were also performed (expression of NLRP3, TLR4/MyD88 pathways, nuclear expression of NF–kB). Intracellular concentration of IL–1α, IL–1β, IL–2, IL–4, IL–6, IL–8, IL–10, IL–12, IL17–α, IL–18, IFN–γ, TNF–α, G–CSF, and GM–CSF were also performed.

Results
Dapagliflozin and LCZ696 increased synergistically the cell viability during exposure to doxorubicin and trastuzumab. Combination of dapagliflozin and LCZ696 reduces Ca2+ overload (–68,4% vs cells treated only to anticancer drugs; p &lt; 0,001) and MDA (mean reduction of 57–63,4 % compared to cells exposed only to anticancer drugs; p &lt; 0,05). The expression of MyD88, NLRP3 and NF–kB were strongly reduced after treatment with dapagliflozin and LCZ–696 (–52,5, –43,7 and –57,3 % vs cells exposed only to anticancer drugs, respectively; p &lt; 0.05). Notably, combination of dapagliflozin and LCZ–696 enhanced the expression of IL–10. Expression of IL–1α, IL–1β, IL–6, IL–8, IL17–α and IL–18 was reduced (p &lt; 0.05). Mitogenesis was strictly improved also as demonstrated by confocal microscope analysis

Conclusion
Dapagliflozin associated to LCZ–696 exerts additive cardioprotective and anti–inflammatory effects compared to each drug alone. Their properties are mediated by the reduction of iCa2+ content that consequently reduces peroxidation and NLRP3– MyD88 expression. These results indicating the potential use of SGLT–2 inhibitors associated to LCZ696 in preclinical models of cardiotoxicity.
P229 IMPROVED CLINICAL–INSTRUMENTAL OUTCOMES IN PATIENTS WITH CHRONIC DILATED HYPERTENSIVE / ISCHEMIC HEART DISEASE, UNDERGOING CCM, CARRIER OF CRTD WITH PERSISTENT SEVERE LEFT VENTRICULAR DYSFUNCTION
Authors: Incampo G , De Luca V , Rizzo D , Bux F , Moramarco M , Valecce R , Robles G , Pirozzi M , Candida T , Marino F , Campagna M , Fiorentino A , Bonfantino M 
Published: May 2022

Abstract
A 62–year–old man repeatedly subjected to PTCA + stent with severe left ventricular dysfunction and estimated FE 15%. After some hospitalizations for heart failure in 2015 he underwent an AICD implant Biventricular. Followed up in our clinics dedicated to heart failure, the patient did not present the characters of the CRT responder presenting a constant high end–systolic volume (224 ml) and none FE improvement of 15%. There was also an asthenia and tendency to inactivity and elevated NT Pro BNP levels despite optimal medical therapy even with entresto 24/26 mg x 2 / day. It has been decided to submit the patient enrolled in the cardiac transplant and / or VAD implantation lists to an implantation procedure of CCM system (cardiac contractility modulation). After two active fixation placement leads on the interventricular septum and connection to the CCM system housed in the subcutaneous pocket right contralateral to the biventricular AICD, the patient was monitored. We have noticed since the first days conditions of hemodynamic stability. Scheduled CCM therapy delivery for 10 hours a day. Following subsequently in the follow up at 3 – 6 – 12 – 18 months the patient showed an improvement of minneshota quality of life questionnaire in heart failure: MLWHFQ (44 at baseline, 17 at two months, 15 to six months, 10 to 12 months and 3 to 18 months), an increase in FE from 15 to 23 up to 26%, a reduction of the NTPROBNP from 13444 to 1178 then climbed back to 5549 and 3712 at 18 months for atrial fibrillation, without any requires re–hospitalization, an increased physical activity of the patient detected by the sensors of the two devices
P233 ASSOCIATIONS BETWEEN LEFT AND RIGHT ATRIAL BIDIMENSIONAL STRAIN AND HEART FAILURE PROGRESSION
Authors: Terazzi E , Diomede N , Correale M , Di Terlizzi V , Barone R , Manuppelli V , Brunetti N , Iacoviello M 
Published: May 2022

Abstract

Background
Two dimensional speckle tracking is an innovative echocardiographic method which analyses myocardial deformation thus allowing the evaluation of both atrial and ventricular function. Recently, new software are available to measure it by semiautomatic analyses.

Aim of the Study
To evaluate the association between left and right atrial Strain and the occurrence of clinical events related to the heart failure (HF) progression. Method. We enrolled 165 outpatients with chronic HF (76% males, NYHA 2.2 ± 0.69, ejection fraction 39±11%). All underwent a clinical and echocardiographic evaluation. An innovative software (TomTec, Philips) was used to analyse the images in order to semi–automatically calculate of atrial Strain. For each patient all the measures relative to the different phases of atrial deformation were considered both for the left atrium (LA) and the right one (RA), i.e. reservoir (r), conduit (cd) and contraction (ct). During the follow–up, we defined the HF progression as hospitalization due to HF worsening and/or heart transplantation and/or cardiovascular death.

Results
During a median follow–up of 5 months, at least one event related to HF progression occurred in 22 patients: all underwent at least one hospitalization, 7 patients died because of cardiovascular reasons and 2 underwent heart transplantation. At Cox univariate analysis, LASr (HR: 0,93; 95%CI: 0,88–0,97, p: 0.004; C–index 0,7), LAScd (HR: 1,09; 95%CI: 1,01–1,19; p: 0,023; C–index: 0,64), RASr (HR: 0,95; 95%CI: 0,90–0,99; p: 0,031; C–index: 0,68), RAScd (HR: 1,08; 95%CI: 1,01–1,15; p: 0,021; C–index: 0,67), but not LASct (HR: 1,04; 95%CI: 0,99–1,09; p 0,094; C–index 0,62) and RASct (HR: 1,02; 95%CI: 0,96–1,09; p: 0,61; C–index: 0,55), were significantly associated to HF progression. LASr and RASr showed the higher accuracy in predicting the events by the estimation of C index. At ROC curve analysis, for LASr the best cut–off was 16.1% (Sensitivity 83%, Specificity 56%) and for RASr 17.3% (Sensitivity 79%, Specificity 60%). Figure shows Kaplan–Meier curves for the considered end–point according with these cut–offs.

Conclusions
The preliminary results of this study have showed the association between LA and RA Strain variables and the HF progression. The prosecution of this study will be finalised to demonstrate the prognostic independent and incremental significance.
P234 A RARE CASE OF ACUTE RIGHT HEART FAILURE PRESENTED IN A CASE REPORT
Authors: Avondo S , Zaccaro L , Albani S , Pelloni E , Bonino C , Biava L , Scacciatella P 
Published: May 2022

Abstract

Case Summary
A 62–year–old male with multiple cardiovascular risk factors, presented at the ED with signs and symptoms of right heart failure, Doppler echocardiography showed a severe dilatation and dysfunction of the right ventricle and left ventricular diastolic dysfunction. After initial stabilization with diuretics and inotropes, the patient performed a coronary angiogram with evidence of severe multivessel coronary artery disease and combined pre–capillary and post–capillary pulmonary hypertension as shown by the right heart catheterization. After complete revascularization, the diastolic function of the left ventricle improved dramatically, and the right ventricle recovered completely.

Discussion
We presented a paradigmatical case of acute right heart failure secondary to left ventricular diastolic impairment in a patient affected by severe ischemic coronary artery disease. Several risk factors are associated with RVD in HFpEF: atrial fibrillation, male sex, chronic obstructive pulmonary disease. Diastolic performance of the LV is one of the main determinants of the right ventricular function, which, in turn, is proven to have prognostic implication in HFpEF. Nowadays, there is no evidence–based treatment for right heart failure secondary to decompensated HFpEF and therapy should be tailored to the individual patient’s response.
P238 CARDIAC CONTRACTILITY MODULATION THERAPY: INITIAL MONOCENTRIC EXPERIENCE
Authors: D‘Alleva A , Sacchetta D , Magnano R , Forlani D , Di Marco M , Pezzi L , Vitulli P , Fulgenzi F , Verrengia E , Paloscia L 
Published: May 2022

Abstract

Cardiac contractility modulation therapy consists in the delivery, by a device implanted in the patient at the level of the subclavicular region and connected to the heart through leads that send high intensity electrical impulses within the absolute refractory period of the potential of myocardial action. These pulses are delivered in cycles of 1 hour 7 times a day, each interspersed with pauses of 2–3 hours. CCM has been shown to be able to improve myocardial contractility through better management of intracellular calcium by the cardiomyocyte, exerting short and long–term effects, even managing to induce a positive remodulation of the gene expression of cardiac cells. The recent ESC 2021 guidelines indicate that cardiac contractility modulation therapy (CCM) was evaluated in patients with heart failure, FE 25%–45% and normal QRS duration (&lt;130 ms) considering pVO2, QoL, 6MWT. The modulation of cardiac contractility improves symptoms and exercise tolerance and reduces re–hospitalization for heart failure (HF).
The purpose of this work is to show our little experience on the use of CCM in patients suffering from heart failure.

Materials and methods
4 male patients, aged 38–75 years, with heart failure, on optimal medical therapy, NYHA class III – IV, QRS &lt;130 msec, FE 25–45%, hospitalized for implantation by CCM. NYHA, FE and BNP rated. The device was implanted in 4 patients without significant complications.

Results
In the 3 and 6 month follow–up, patients reported an improvement in symptoms, better exercise capacity and consequently a transition to a lower NYHA class (II – III). BNP values were lower than baseline. Upon checking the defibrillator, the trend of fluid accumulation using the optivol algorithm did not show significant levels of accumulation. No further hospitalizations for heart failure exacerbation.

Conclusion
The data limited to our little experience show how CCM produces similar results to those demonstrated in previous studies in subjects with 25% ≤LVEF≤45% and QRS &lt;130 ms; CCM therapy improves clinical outcomes in terms of exercise tolerance and quality of life, long–term survival and reduces hospitalizations.