bluuebunny/crossref_metadata_2025_split huggingface dataset:
P113 HIDDEN POCKET. LEFT ATRIAL SEPTAL POUCH: VARIANT OF NORMALITY OR CARDIOEMBOLIC SOURCE?
Authors: Minardi S , Trambaiolo P , Tocci G , Renda M , De Matteis G , Mustilli M , Fina P , Romano S , Ferraiuolo G 
Published: May 2022

Abstract
During embryological period the blood flows from right to left atrium trought patent interatial septum. Embryon’s interatrial semptum consists on the apposition of Septum Secundum (SS) over Septum Primum (SP) that go to seal each other just afther birth. Sometimes this fusion doesn’t happen or partially happens, leading respectively to patent foramen ovale (PFO) or the less known eventuality of Atrial Septal Pouch (ASP).
48–year–old woman, history of chronic anemia treated with blood transfusions, underwent a routine transthoracic echocardiogram (TTE) as recommended by her transfusion center. The patients is asymptomatic, denies cardiovascular risk factors, denies any signs or symptoms suggestive of recent infectious or inflammatory disease. The TTE documented preserved left ventricular sistolic function, normal sized cardiac chembers, no valvular abnormalities, evidence of linear formation (10 x 5 mm), near foramen ovale, on the left side of interatrial septum, increased in echogenicity. It was performed a transesophageal echocardiogram (TEE) which confirmed the finding at SIA level. It was therefore recommended in depth study with cardiac magnetic resonance (CMR) which described the same mobile formation, characterized by the same signal strength as the atrial walls, both before and afther contrat administration, compatible in the first hypotesis with an embryonic residue (Left Atrial Septal Pouch, LASP).
There is still much uncertainty regarding the clinical significance of LASP, however, its large prevalence among general population suggests that its potential embolism requires other predisposing conditions in order to be of real clinical relevance. CMR represents a usefull test for cardiac structures analysis owing its better tissue characterization cormpared to other diagnostic tests. In the event of an occasional finding and in absence of any other indication for anticoagulant therapy, no therapeutic measures are currently indicated. These patients could be followed up in order to promptly identify the onset of prothrombotic conditions likely to expose them to higher risk compared with patients who do not have LASP.
P116 GIANT LEFT ATRIAL MYXOMA CAUSING ACUTE ISCHEMIC STROKE
Authors: Chiarello G , Garzya M , Donateo M , Marazia S , Cucurachi M , De Giorgi A , Colonna G 
Published: May 2022

Abstract

Aims
Primary cardiac tumours are rare; most are benign, and around half are myxomas, often located in the left atrium. Clinical presentation is variable. Ischaemic stroke is a rare, although real and potentially fatal, complications of cardiac myxomas.

Case Report
We present a case of a 51–year–old man, ex– smoker, obese, with history of hypertension and COPD, presented to our emergency department with right–sided hemiplegia and aphasia caused by ischaemic stroke. Brain CT revealed cerebral perfusion deficit. The patient was underwent intravenous thrombolytic strategy. TTE showed a large left atrial mass attached to the interatrial septum, with a friable appearance, suggestive of myxoma. The 2D and 3D TEE detected a giant space–occupying mass in the left atrium, coral–like, and the most apical portion prolapsed into the left ventricle during diastole, causing fixed obstruction to flow in the left ventricular inflow tract. In view of the risk of imminent embolization, the emergent surgical excision of the tumour was performed. Subsequent histopathological findings confirmed the diagnosis of myxoma. Symptomatic cardiac myxoma may present with one of the three classic clinical presentations of the Goodwin’s triad, which include intracardiac obstruction, constitutional symptoms, and embolism. The obstructive pattern mimics atrioventricular valve obstruction. Constitutional manifestations include fatigue, fever, weight loss. Systemic embolization from myxoma occurs in around a third of cases. Of these, the most serious is cerebrovascular embolism, which may result in cerebral stroke. The tumour size, location, and macroscopic appearance, along with mean platelet volume and platelet count, are closely associated with embolic events. Echocardiography remains the method of choice for diagnosis and morphological characterization of myxoma. Two patterns have been established by echocardiography: round, with a solid appearance and a firm surface, and polypoid, with an irregular outline and a friable surface. The incidence of systemic embolization is higher in those with an irregular and friable surface and those that prolapse into the ventricle. Once a diagnosis of myxoma is established, surgical resection is the only effective treatment and should be performed immediately, in view of the risk of embolization.

Conclusions
With this case report, we stress the importance of echocardiography in new onset of neurological deficit to prevent potentially fatal outcomes.
P121 ECHOCARDIOGRAPHIC EXAMINATION ON AGONIST ATHLETES WITH RECENT PAUCISYMPTOMATIC SARS COV 2 INFECTION, FOR THE RENEWAL OF AGONIST SPORT ACTIVITY ELIGIBILITY: PLAUSIBLE ROLE AND UTILITY OF GLS ANALYSIS THROUGH SPECKLE TRACKING
Authors: De Masi De Luca G , Papadia P , Prete G , Nuccio F , De Masi De Luca G , Morciano P , De Blasi S 
Published: May 2022

Abstract

Background
The aim of this work is to highlight whether or not the methodical echocardiography done through the analysis of global and segmental longitudinal deformation (GLS–SLS) can be useful to identify subclinical myocardial lesions in paucisymptomatic young agonist athletes with recent SarsCov2 infection before they return to agonist practice.

Material and Methods
From 12/2020 to 12/2021 84 agonist athletes with previous SarsCov2 infection have been examined at “Cardiomed Center” Maglie (Lecce, IT), as part of screening for their return to sport practice; all of them under standard echocardiographic analysis associated to GLS analysis, Holter–ECG analysis with 24h on 12 derivations.

Results
The base echocardiographic examination didn’t show any myocardial cynesis anomalies in any patient. In 5 patients there was a presence of a light pericardial effusion, how it was supposed to be as an outcome of a previous inflammatory ingjury The GLS analysis, that resulted in reliability considering the optimal acoustic window, showed a slightly lower medium value compared to the values cited in the literature (19.4 ± 2.9) and particularly 4 patients show considerable deficit reductions of segmentary strain. In these patients Holter analysis showed the presence of a moderate non–complex extrasystolic arrhythmia. These elements–that are a reduced GLS with marked regional anomaly, coupled with the presence of ventricular arrhythmia even in absence of segmentary dissinergyes– led to cardiac RMN evaluation. In 2 out of 4 patients there have been flaws that were compatible to modest myocardial lesions, in one case it was observed a marked flaw in medium–apical–lateral region that was correlated to the described areas at the specle tracking.

Conclusion
Our experience at the Cardiology and Sports integrated clinic, although it relied on a meager population of patients, it still demonstrated how echocardiographic analysis through GLS evaluation and the highlighting of sectorial alterations even in absence of cynesis anomalies can be used as a parameter to suppose the presence of miocarditic lesions that might be sent to the next RMN examination for confirmation, in young athletes with recent paucisymptomatic Covid–19 infection.
P125 CORONARY REVASCULARIZATION GUIDED BY STRESS ECHOCARDIOGRAPHY WITH ULTRASOUND CONTRAST: A CASE
Authors: Gioia M , Milo M , Passero T , Rollo R , Ignone G 
Published: May 2022

Abstract
Echocontrastography is an echocardiography method that involves the intravenous administration of a particular contrast medium, formed by microbubbles capable of crossing the pulmonary circulation and distributing themselves in the left sections. These micro bubbles hit by ultrasound break or oscillate emitting ultrasound waves with a different frequency than the beam that hit them, generating a series of harmonic signals that can be processed to observe, for example, the opacification of the left cavities. An 82–year–old diabetic hypertensive man with a strong family history of coronary artery disease underwent routine cardiac evaluation. At the time of the visit, sporadic episodes of non–specific chest pain (localized in the right breast), of an intermittent nature, and not related to physical exertion, were reported. On the ECG, finding of sinus rhythm and q waves in V1–V3 (not present at a previous in 2019). On echocardiography (patient with poor acoustic window): Left ventricle of normal size with mild concentric parietal hypertrophy. Slight reduction in global systolic function due to alterations in district kinetics. Akinesia of the apex and middle segment of the septum and anterior wall. FE 48%. Doubtful apical iso–hyperechoicity (artifact?). Urgent hospitalization for coronary angiography was indicated in the suspicion of subacute anterior AMI. Coronary angiography revealed occlusion of anterior interventricular artery (IVA) in the proximal tract, partially re–inhabited downstream by homocoronary circulation (figure 1). Before proceeding with revascularization, given the absence of movement of the myocardiocitonecrosis indices, it was decided to perform myocardial viability tests. In consideration of the suspected apical thrombotic formation, as well as the patient‘s poor acoustic window, echo contrast was necessary (Figure 2). Once the complete opacification of the left ventricular cavity was highlighted by the contrast agent, suggestive of the absence of apex thrombi, we proceeded to ecostress with dobutamine to evaluate myocardial viability. At the explored dosages (5 – 10 and 20 ug/kg/ min) recovery of the apex kinetics was observed, but not of the mid–apical septum, which remained akinetic. We then proceeded to angioplasty on proximal IVA with a good angiographic result and the patient was discharged on the third day from revascularization in excellent clinical conditions.
P137 GEOGRAPHIC DIFFERENCES IN CANCER RISK LONG AFTER ACS. THE ABC 7–7A* STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Cordiano R , Cavuto F , Palmieri R , Mahmoud M , Sitta N , Pasquinucci M , Lorenzon E 
Published: May 2022

Abstract

Background
Increased risk of cancer and cancer death has been reported in patients with Acute Coronary Syndrome (ACS). We investigated the long–term geographic differences in those risks.

Methods
In this prospective study, we enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy. The patients were classified as residing in urban or rural areas in each province.

Results
With 3 exceptions, all patients completed the 22–year follow–up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre–existing malignancy was noted in 16 patients, whereas 106 patients developed cancer during follow–up and 99 patients died due to the malignancy. The urban/rural incidence rate of new malignancy per 1000 person–years was (9/32 in the north, 19/21 in the middle, and 18/13 in the southern province) and the urban/rural incidence rate of neoplastic death per 1000 person–years was (10/23 in the north, 16/17 in the middle, and 17/11 in the southern province). Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR = 3.0; 95%CI=1.5–6.2; p = 0.02). Also, we found a strong positive interaction between urban/rural areas and provinces with risk increasing from the urban to rural areas from southern to northern provinces (HR 2.1; 95% CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Geographic areas, additionally, showed a strong positive interaction for the risk of cancer death, with risk increasing from the urban to rural areas from southern to northern provinces (HR = 1.9; 95%CI=1.1–3.0; p = 0.01) with the unadjusted Cox regression analysis. The fully adjusted Cox regression and Fine–Gray competing risk regression models provided similar results. We did not observe an urban/rural difference or an interaction between the geographic areas in non–neoplastic death risk.

Conclusion
This analysis reveals the significant urban/rural difference in the long–term risk of cancer onset and cancer death among unselected ACS patients. These results highlight the importance of implementing a preventive policy based on area–specific knowledge.
P140 EFFICACY AND SAFETY OF CHEMOTHERAPY CONTAINING NON–PEGYLATED LIPOSOMAL DOXORUBICIN IN PATIENTS AT HIGH CARDIOVASCULAR RISK: A SINGLE–CENTER EXPERIENCE
Authors: Bisceglia I , Camilli M , Mistrulli R , Cartoni D , Matera S , Canale M , Battistini R , Rigacci L , Petrolati S 
Published: May 2022

Abstract

Anthracyclines represent the most effective chemotherapeutic agent in the treatment of non–Hodgkin‘s lymphoma (NHL), although their use is limited due to the risk of cardiac toxicity. This occurs mainly in elderly patients, those with a history of cardiovascular (CV) disease and/or multiple concomitant risk factors. Liposomal doxorubicin has been shown to reduce this toxicity. The aim of this retrospective study is to investigate the use of non–pegylated liposomal doxorubicin in high–risk patients in terms of haematological response rate and CV events. In a single centre, 15 patients undergoing R–COMP regimen (Rituximab, Prednisone, Cyclophosphamide, Vincristine, Myocet liposomal doxorubicin) were consecutively collected from January 2020 to December 2021. The mean age of patients was 73.9 years and 60% were male. The baseline mean left ventricular ejection fraction (LVEF) was 55.9%; four patients had a baseline FE of &lt; 50%, two of them had a severe reduction in LVEF. Among all patients, 86.7% had systemic hypertension, 40% diabetes mellitus, 46.7% dyslipidaemia and 20% a family history of CV disease. Moreover, 46.7% of patients had at least two concomitant risk factors and 20% at least three. 20% had a history of ischemic heart disease, 13.3% had previous exposure to anthracyclines and 20% with mediastinal radiotherapy; 26.7% had moderate to severe aortic valvulopathy. According to the joint Cardio–Oncology evaluation, 100% of patients had been considered unsuitable for conventional doxorubicin.. More than 85% of the cases were already on cardioactive therapy at baseline evaluation and 66.7% required titration or modification during chemotherapy. With R–COMP, the whole population was able to finish treatment achieved complete haematological remission. The mean LVEF at the end of treatment was 55.8% (p = 0.814).

Conclusions
Our results support the efficacy and safety of R–COMP in a population at high risk for cardiac events, otherwise excluded from anthracycline–containing therapy. Liposomal formulatio reduces doxorubicin cardiomyocyte accumulation and thus toxicity, providing the best possible treatment for the majority of the onco–haematological population.
P158 ELECTROANATOMIC MAPPING–GUIDED DEFIBRILLATOR IMPLANTATION WITH CARTO 3 IN YOUNG PATIENTS
Authors: Loira L , Fumanelli J , Elhyka A , Rotella M , Ferretto S , Di Salvo G , Iliceto S 
Published: May 2022

Abstract

Introduction
Defibrillator (ICD) implantation is generally performed under fluoroscopy guidance, allowing to place the leads in the correct positions within the heart. However, for young patients, fluoroscopy exposure should be reduced as much as possible due to their higher radiosensitivity. Three–dimensional (3D) electroanatomical mapping (EAM) is a technique extensively used in electrophysiology for the ablation of different arrythmia, reducing the fluoroscopy exposure. In this preliminary study 3D EAM was used to achieve ICD implantation in pediatric patients and in young patients with congenital heart disease targeting minimal fluoroscopy exposure. Data on procedure complications, fluoroscopy dose and time were compared to those achieved with the conventional approach without 3D EAM.

Methods
Using the EAM system CARTO 3 (Biosense Webster, Johnson & Johnson Medical, CA) ICD implantation was performed in 10 young patients: 8 had an age below 18 (mean 13 y ± 2) at the time of the implantation and 2 were adults with congenital heart disease (24 and 38 y). For comparison, 10 pediatric patients (mean 13 y ± 2) and 2 adults with congenital heart disease treated conventionally, without EAM, were considered. In the EAM group, the physician started by mapping the chambers of interest with a sensor–based catheter (Navistar Biosense Webster, Johnson & Johnson Medical, CA). Then the leads were advanced in the heart and visualized on the CARTO 3 system utilizing alligator clips attached to the distal part of each lead and connected to the EAM system. A final fluoroscopic snapshot image was taken to confirm the correct deployment of the leads.

Results
The total procedure time was similar between the two groups with a mean time of 61 min in the EAM group and 72 min in the conventional group. The mean fluoroscopic time and dose were lower in the EAM group (22 sec, 6.6 Gy·cm2) compared to the conventional group (887 sec, 39 Gy·cm2). There were no peri–procedural or follow–up complications in either group. Within the EAM group, a decreasing trend is observed in total procedure time, fluoroscopic time and dose by increased number of procedures.

Conclusion
Implantation of ICD under EAM guidance in young patients is feasible and allows for reduced fluoroscopic exposure, without compromising safety.
P171 EVALUATION OF ARRHYTHMIC RISK IN THE PSYCHOPHARMACOLOGIC–TREATED PATIENT
Authors: Acierno D , Scarfò G , Franzoni F , Miniati M , Perugi G 
Published: May 2022

Abstract

Background
Neuroleptics (NRL) and Tricyclic Antidepressants (TCA) could be related to the QT prolongation although the risk of ventricular arrhythmias and sudden death caused by these drugs was not clearly described in literature. Corrected QT (QTc), is the major marker of arrhythmic risk; Qt dispersion (QTd) is defined as the dispersion of the QT interval on 12–lead electrocardiogram (ECG) and is predictive of mortality if &gt; 58; the heart rate variability (HRV) is indicative of the sympathetic/vagal tone and of the arrhythmic risk. Aim of the study. Evaluation of the main effects of psychotropic drugs in psychiatric patients on the following parameters: QT interval, QTc using 4 formulas (Bazett, Fridericia, Framingham e Hodges), Qtd and HRV depending on time and heart rate.

Materials and Methods
Data from 167 patients treated with typical and atypical NRL, TCA, and mood stabilizers have been collected. The observational study consisted in these phases: 1) chart review of 84 patients admitted in day hospital to detect sex, age, diagnosis, therapy and Qtc; 2) evaluation of the same parameters in 83 of them, to whom an ECG was performed at the discharge; 3) ECG Holter in a subgroup of 17 patients who have given consent to the exam, to highlith the incidence of arrhythmias and to investigate the HRV.

Results
No significant QTc alterations related to therapy were detected at the admission or at the discharge. Moreover, no statistically significant differences emerged among NRL classes nor an increased arrhythmic risk in polypharmacy. The use of different formulas has confirmed an overestimation of the QTc according to the Bazett formula. QTd was altered in 67 patients ( QTd ≥50 in 51 subjects; QTd&gt;60 in 12 subjects)and the HRV was lower compared to the general population regardless of the therapies.

Conclusions
The psychopharmacological therapy in a “real world setting” didn’t show a signiticative influence on the evaluated parameters of arrhythmic risk. The arrhythmic risk is low in absence of other risk factors or comorbidities. QT correction using FRI or HOD, the QTd if QTc &gt;450–470 ms and the HRV in patients with arrhythmic risk factors, should be considered as parameters to evaluate in the clinic routine of follow–up of psychopharmacologic–treated patient.
P172 AN ACCESSORY PATHWAY WITHOUT REENTRANT TACHYCARDIA
Authors: Bricco G , Coppolino A , Valeri L , Amoroso G , Cavallero E , Iacovino C , Barbero U , Battisti A , Scaglione M , Correndo L , Bessignana A , De Benedictis M 
Published: May 2022

Abstract
A 65–year–old patient, hypertensive, dyslipidemic, strong smoker. He has heart disease with hypokinetic evolution EF 47%, mild MI. Negative Dipyridamole–stress echocardiography dated January 2008. Recently atrial fibrillation (AF) is found and anticoagulant therapy was started. Dyspnea and weight loss occurred in past two months. Detected keratinizing squamous pulmonary Ca with negative markers. This injury was judged to be inoperable, and the patient get indications for chemotherapy and radiotherapy. The patient also starts complaining of dyspnea and chest pain on exertion: Not serological modification, not ischemic ECG. Echocardiogram LVEF 47–50% highlights diffuse hypokinesia, regular valves. Ergometric test was not evaluable for ischemia. Coronary angiography shows stenosis of proximal and middle anterior interventricular coronary and non–critical lesions of circumflex and right coronary. Ecodobutamine test was positive for ischemia and arrhythmias (AF and wide QRS tachycardias in recovery phase), but negative for angor. The patient was treated with CT and IVA I – II. angioplasty Monitoring shows AF with high penetrance, wide QRS tachycardia runs and very short TVNS. ECG 1: During atrial tachycardia, show broad QRS conduction to BBSX alternating with narrow QRS with the same RR interval. ECG 2. show fusion between the wavefront conducted with narrow QRS and that with wide QRS. These are supraventricular arrhythmias that run along the atrioventricular nodal pathway (NAV) in the narrow QRS tracts and take an accessory pathway in the wide QRS run.
The Mahaim fibers have decremental conductivities like the AV node, therefore high ventricular frequencies does not occur AF appeared during ecodobutamine, but some beats were conducted by an anomalous path in a discontinuous way); they are generally directed from the atrium or the NAV, towards another part of the right ventricular conduction system, with atrium wave or NAV – RB, therefore the early activation of the RB generates a widened QRS, with a LBB morphology. ECG 3 Re–entry on Mahaim pathway, ventricular activation widened through Mahaim fiber, which generate LBB morphology with retrograde atrial depolarization. In this case there is no reentry, but we have an atrial tachycardia conducted alternately on an accessory pathway and across the NAV. Given the patient‘s clinical problems and the total absence of symptoms, the patient remains asymptomatic during therapy with amiodarone and beta–blocker.