bluuebunny/crossref_metadata_2025_split huggingface dataset:
P243 RELEVANCE OF RENAL RESISTANCE INDEX INCREASE AFTER CORONARY ANGIOGRAPHY
Authors: Barone R , Goffredo G , Di Terlizzi V , Correale M , Casavecchia G , Ieva R , Cuculo A , Brunetti N , Iacoviello M 
Published: May 2022

Abstract

Background
Renal resistance index is a Doppler derived measure which is able to reflect the pathophysiological background of Cardiorenal Syndrome (CS). There are no data about the influence of the intravascular administration of contrast media on RRI and its relationship with worsening of renal function (WRF).

Aim of the Study
To evaluate changes in renal resistance index (RRI) after coronary angiography in patients with and without WRF. 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). Renal arterial echo–color Doppler was used to calculate RRI before and 48 hours after coronary angiography. 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
Fourteen (12%) among the enrolled patients showed WRF. As expected, a significant increase of creatinine serum levels was observed in patients with WRF (from 1.14±0.40 to 1.71±0.49, p &lt; 0.001) but not those without (from 0.89±0.27 to 0.92±0.28, p n.s.) WRF. On the other hand, RRI significantly increased both in patients with (from 72.8±4.3 to 76.4±5.2, p &lt; 0.05) and without (from 63.1±7.2 to 65.4±7.1, p &lt; 0.05). However, both at baseline and after angiography, patients with WRF showed RRI values significantly greater when compared with those without. At ROC curve analyses for WRF, the baseline and after angiography RRI sowed similar AUC (0.88 and 0.90, respectively) and for both RRI values the best cut–off was 70% (sensitivity of 79% and 93% and Specificity of 93% and 82%, respectively). As shown in the figure, the high predictive accuracy of RRI values was due to the fact that, although increased after angiography, the proportion of patients without WRF and with RRI&gt;70% remained very low.

Conclusion
After coronary angiography RRI significantly increase both in patients with and without WRF. However, a larger proportion of patients with WRF present a critically increased RRI, i.e. equal or above 70%, before and after angiography probably because reflecting the pathophysiological background underlying the progression of cardiorenal syndrome.
P248 THE SCORE TELEHFCOVID19, ONE MONTH FOLLOW UP : A TELEHEALTH APPROACH TO MANAGE ELDERLY PATIENTS WITH CHRONIC HEART FAILURE DURING COVID–19 PANDEMIC
Authors: Salucci C , Girardi E , Orso F , Herbst A , Migliorini M , Ghiara C , Virciglio S , Camartini V , Tognelli S , Fortini G , Di Bari M , Baldasseroni S , Ungar A , Marchionni N , Fattirolli F 
Published: May 2022

Abstract

Background
Due to the total lockdown during COVID–19 pandemic, clinicians were forced to organize telephone visits or tele–monitoring. We developed a standardized multiparametric questionnaire, suitable for telephone administration to older heart failure (HF) patients and/or their caregivers.

Purpose
To compare clinical characteristics of the three groups (green, yellow, red) of patients classified by baseline TeleHFCovid19–Score and evaluate its ability to predict one–month in elderly patients with chronic HF.

Methods
The TeleHFCovid–19 score was obtained from a multiparametric questionnaire administered, from April 2020, during televisits to patients (or caregivers), which were divided in progressively increasing risk groups: green (0–3), yellow (4–8) and red (≥9). The primary study outcome was a composite of death from cardiovascular causes and/or hospitalization for HF, which individually were secondary outcomes.

Results
We enrolled 146 patients. Mean age was 81±9 years, females were 40%. In all the study population there was a high prevalence of self–reported adherence to guidelines–recommended drug treatments and behavioural measures, as well as a broad intake of diuretic therapy. Patients in green group had lower use of high dose loop diuretic (p &lt; 0.001) or thiazide–like diuretic and had reported less frequently dyspnoea at rest or for basic activities, new/worsening extremities oedema or weight increase (all p &lt; 0.001). Through scheduled phone contacts we were able to improve the overall clinical status of our patients even over a short (1 month) follow–up.The primary composite outcome of CV death and/or HF hospitalisation occurred in 8.2%, with a significantly lower prevalence in the green than in the yellow and red groups, and when analysing separately, we found that death for CV causes occurred more frequently in the red group than in the other two, while HF hospitalisations were significantly less frequent in the green group than in the red or yellow. ROC analysis confirmed the high sensibility and specificity of our score (AUC=0.883, 95% CI 0.806–0.959) with a score &lt;4.5 (very close to green group cut–off) that identified lower–risk subjects (p &lt; 0.001).

Conclusions
The TeleHFCovid19–Score score was able to correctly recognize a low risk, green group. Therefore, the score could be used to identify low risk patients which could be followed remotely, reserving a tighter on–site clinical follow–up to higher events risk patients.
P254 THE ROLE OF GENDER IN CONGESTION STATUS EVALUATION IN PATIENTS WITH ACUTE HEART FAILURE
Authors: Potenza A , Scicchitano P , Basile M , Piscopo A , Landriscina R , Sasanelli P , Trotta F , Sanasi M , Paolillo C , Ciccone M , Caldarola P , Massari F 
Published: May 2022

Abstract

Background
The evaluation of congestion play a central role in the management of patients with acute heart failure (AHF).The impact of gender on congestion in patients with HF is still a matter of debate. The objective of this analysis was to evaluate the impact of gender on congestion status at admission of patients hospitalized for AHF.

Methods
We consecutively enrolled 487 patients with AHF (50% female). We assessed peripheral edema, jugular venous distention (&gt;10 cm), B–type natriuretic peptide (BNP), hydration status (by means of bioimpedance analysis), and estimated plasma volume (by means of the Duarte’s formula [D–ePVS] and Kaplan–Hakim formula [KH–ePVS]).

Results
Home medications and body mass index were not different between women and men. Women were older (79 yrs vs 77 yrs, P = 0.005), showed better left ventricular ejection fraction (mean 50% vs 38%, P &lt; 0.001), and increased plasma concentrations in blood urea nitrogen (40 mg/dL vs 25 mg/dL, P = 0.02) and serum creatinine (1.5 mg/dL vs 1.5 mg/dL, P = 0.8). At physical examination, the number of patients with peripheral edema and jugular venous distention was not significantly different between women and men (53% vs 45% and 60% vs 55%, respectively). BNP levels (median 1100 pg/mL vs 994 pg/mL) and hydration status (78% vs 79%) were similar in women and men, while ePVS was higher in women (D–ePVS 6.0 ± 1.6 dL/gr vs 5.1 ± 1.5 dL/gr, P &lt; 0.001; KH–ePVS 7.9% ± 13% vs –7.3 ±12%, P &lt; 0.001).

Conclusions
The evaluation of congestion in AHF using physical examination and multiparametric approaches was similar between women and gender. Women rather showed higher plasma volume as compared to male individuals.
P258 HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS HOSPITALIZED FOR PAROXYSMAL ATRIAL FIBRILLATION. A CAUSE OF WORSE CLINICAL OUTCOMES?
Authors: Tufano N 
Published: May 2022

Abstract

Introduction
Among patients admitted in hospital for heart failure (HF), prevalence of heart failure with preserved ejection fraction (HFpEF) increases over time . Atrial fibrillation (AF) can lead to worsening of cardiac function and symptoms of HF. Aim of this observation was to evaluate differences on clinical course and outcomes in patents hospitalized for paroxysmal AF episode and a pre–existing HFpEF rather than paroxysmal AF patients without HF.

Methods
126 patients consecutively hospitalized in our Cardiology Unit from january 2017 to december 2020 for paroxysmal AF were retrospectively evaluated. Of them, 67 presented without heart failure, 59 with a previously known HFpEF. For each patient, demographic and clinical characteristics, comorbidities, instrumental data and clinical outcomes (percentage of cardioverted arrhythmia, length of hospitalization) were collected. To examinate the relationship between characteristics of patients and clinical outcomes, test of Student or chi–square–test were performed.

Results
Patients with AF and HFpEF were significantly older (76,7 vs 72,9 y.) and presented more comorbidities (on average 4 vs 3 morbidities) rather than AF patients without HF. Hospitalization were significantly longer (on average 6 vs 5 days) for HFpEF group rather than no–HF patient group. Percentage of cardioverted AF were significantly lower in HFpEF (66,2%) rather than in patients without HF (86,6%). Age was significantly correlated with lenght of hospitalization in HFpEF patients, but not in no–HF patients. Instead comorbidity was not correlated with days of hospitalization in HFpEF patients, whereas correlated significantly in no–HF patients. Finally, percentage of cardioverted arrhythmya was not correlated with number of comorbidities, both in HFpEF and in no–HF patients.

Conclusions
our hospitalized patients for a newly onset AF and known HFpEF presented worse clinical outcomes rather AF patients without HF. These worse outcomes seem at least in part due to differences on age and comorbidities between the two groups.
P259 INCIDENCE OF HOSPITALIZATIONS FOR HEART FAILURE DURING THE COVID–19 PANDEMIC IN PATIENTS FOLLOWED BY THE VULTURE ALTO BRADANO (VAB) HEART FAILURE OUTPATIENT CLINIC
Authors: Caivano M , Gubelli S , Manta R 
Published: May 2022

Abstract

Purpose
Patients hospitalized for heart failure (HF) often have worse prognoses than patients who avoid hospital care. It is well known that during the first wave of the COVID–19 pandemic, in all specialty branches there was a reduction in planned hospitalizations to make room for COVID–19 patients and it happened that patients often did not access care for fear of infection. The Heart Failure Outpatient Clinic of the VAB never stopped its activity during the pandemic and continued to follow patients both with telephone counseling and with scheduled visits following the government‘s anti–Covid regulations. The aim of this study is to evaluate the incidence of hospitalizations for heart failure in Basilicata and in the VAB area during the Covid 19 pandemic.

Methods and Results
Hospitalization data for HF from the Basilicata Region database and the database of patients followed by the HF outpatient clinic of the VAB were searched and compared. In 2019, hospitalizations for DRG 127 across Basilicata were 1865; in 2020, they were 1329, a reduction of approximately 27% since the start of the pandemic. In contrast, in the VAB, hospitalizations went from No. 294 in 2019, to No. 203 at the end of 2020 with a decrease of about 31%. In the same period, deaths from all causes observed among patients followed at the VAB outpatient clinic remained unchanged (N°35 in 2019, N°34 in 2020).

Conclusions
As for other Italian realities, also in Basilicata the incidence of hospitalizations for HF during the pandemic, decreased and more consistently in the area of the VAB. It is likely that this reduction is not only due to a reduction in admissions for fear of contagion, but also to the constant support that the medical and nursing staff of the dedicated outpatient clinic managed to maintain. This shows that the management of heart failure must be based on the constant monitoring of symptoms and clinical signs at the outpatient level, firstly to anticipate instabilization and improve the outcome and prognosis of patients, and secondly to help avoid the collapse of hospital facilities already particularly busy during this pandemic.
P261 DIAGNOSTIC STRATEGIES FOR PULMONARY EMBOLISM IN PATIENTS HOSPITALIZED FOR COVID–19: ROLE OF CLINICAL PREDICTION RULES
Authors: Vedovati M , Balducci F , Becattini C 
Published: May 2022

Abstract

Background
Diagnostic strategies for pulmonary embolism (PE) in patients already facing respiratory failure due to COVID–19 is challenging. The use of the conventional diagnostic algorithm and clinical prediction rules (CPR) for PE is controversial in these patents.

Methods
The aim to evaluate the accuracy of currently available CPRs to assess the risk for venous thromboembolism (VTE) in medically ill patients with COVID–19 and algorithms for the diagnosis of PE. Consecutive patients &gt;18 years hospitalized at Santa Maria della Misericordia Hospital (Perugia, Italy) from March 2th, 2020, to September 29th, 2021 were included if they had: 1) confirmed diagnosis of COVID–19 with a molecular testing; 2) chest CT angiography performed for clinical suspicion of PE during the hospital stay. The study outcome was the accuracy of currently available CPRs for PE diagnosis (Wells and Geneva) and for VTE–risk stratification in medically ill patients (IMPROVE, IMPROVEDD and Padua score) to predict the diagnosis of PE as confirmed by a contrast–enhanced CT lung scan.

Results
During the study period, 74 COVID–19 patients who had CT angiography for PE clinical suspicion were included (mean age 68 years, male 64.9%). Thirteen patients (17.6%) had PE confirmed at CT. No significant differences were observed for comorbidities, antithrombotic treatment and mortality between the two groups. D–dimer resulted significantly higher in patients with compared to patients without PE. Poor discrimination was observed for Wells and Geneva scores (AUC 0.596, 95% CI 0.413–0.779, and AUC 0.603, 95% CI 0.439–0.767, respectively), without substantial differences adding d–dimer at conventional cut–off (Table). The IMPROVEDD score had the highest discriminative power among CPRs for VTE (AUC 0.699, 95% CI 0.539–0.860). Scores’ performance improved by increasing the D–dimer cut–off at level of 2000 ng/ml: among diagnostic scores, Wells showed the best discrimination (AUC 0.806, 95% CI 0.674–0.939, negative predictive value 97%); among CPRs for VTE the IMPROVEDD confirmed its accuracy (AUC 0.769, 95% CI 0.633–0.904, negative predictive value 94%).

Conclusions
The accuracy of the currently used diagnostic and predictive scores for PE or VTE in COVID–19 patients is poor. D–dimer improves the diagnostic accuracy of these scores; most of all, it seems to allow a diagnostic strategy with a high negative predictive value, so we can rule out a consistent part of the patients with a low risk of PE.
P264 ROLE OF BLOOD GAS ANALYSIS AND D–DIMER IN RAISING THE SUSPICION OF MASSIVE PULMONARY EMBOLISM IN GERIATRIC PEOPLE: THE EMERGENCY ROOM AS A WINDOW INTO REAL LIFE
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Fumoso F , Lapia F , Preda L , Manzoni F , Brattoli M , Maggioni P , Novelli V , Muzzi A , Lava M , Bressan M 
Published: May 2022

Abstract

Premise
Massive pulmonary embolism is burdened with high mortality. Raising suspicion and recognizing this condition early allows to avoid delays in the diagnostic and therapeutic process.

Purpose
Assess which parameters of blood gas analysis, in the real life of an Emergency Department, correlate with the presence of massive pulmonary embolism to see which ones can help to suspect it early.

Methods
single–center retrospective observational study, on all geriatric patients (&gt; 75 y) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and YEARS), and for the presentation of the risk of mortality at 30 days (sPESI). We looked at all the blood gas analyzes performed at the emergency room access. We then had all chest CTs retested by an experienced radiologist.

Results
We enrolled 247 patients, with a mean age of 83 years with prevalence of female prevalence (F = 63%). Of these, 85 (34.4%) have massive pulmonary embolism. Lactates do not correlate with the presence of massive pulmonary embolism (p &gt; 0.05). The pCO2 values correlate inversely with the presence of massive pulmonary embolism with excellent statistical strength (p &lt; 0.0001). The reduction in pO2 values also correlates with the presence of massive pulmonary embolism, with good statistical strength (p &lt; 0.005). The increase in pH values also correlates with the presence of massive pulmonary embolism, albeit with a lower statistical strength (p &lt; 0.05). The D–Dimer shows a strong association with massive pulmonary embolism values (p &lt; 0.0001).

Conclusions
The study suggests that the reduction of pCO2 values, with an increase in pH and D–Dimer show a strong correlation with the condition of massive pulmonary embolism. Similarly, the pO2 can play a role in the identification of this condition, while no role would seem to have the alteration of lactates. Taking into consideration these parameters, which are quickly available and easily performed in the various Italian situations, can help to raise the suspicion of massive pulmonary embolism early and direct the patient more quickly towards the therapeutic diagnostic process.
P269 LOCAL ULTRASOUND–FACILITATED THROMBOLYSIS IN ACUTE PULMONARY EMBOLISM: HAS A SPACE?
Authors: Camassa N , Liguori M , Pansini M , Troccoli R , Carretta D , Dachille A , Giardinelli F , Signore N , D‘agostino C 
Published: May 2022

Abstract
Acute pulmonary embolism (PE) has an annual incidence of 48 patients per 100,000 with a mortality rate of 10%, few hours after the onset of symptoms. The use of full dose of thrombolytic agent is currently the treatment of choice in acute PE at intermediate and high risk, although its contraindications are well known. An alternative choice is delivered, via percutaneous femoral or jugular venous access, infusion catheters in the pulmonary artery (PA), in order to perform a local thrombolysis (based on a map of thrombus distribution observed at pulmonary CT), with a lower dose of trobolytic agent (rTPA) in a limited time, with a core for emission of ultrasound waves capable of breaking the mesh of the thrombus. Data from the KNOCOUT PE registry show a reduced frequency of fatal intracranial hemorrhage (ICH 2.5%), compared with the full dose of rTPA. Since February 2021 we have treated 7 patients with PE, all with cTnI, D–dimer and high NT–ProBNP and with pulmonary CT finding of large thrombus burden with pruning of peripheral pulmonary branches compatible with the diagnosis of PE at high and intermediate risk in patients with complex comorbidities (significant PESI and simplified PESI). On admission to the ICU all patients were with BP &lt; 100 mmHg, RR &gt; 20/min, satO2 &lt; 90% and HR &gt; 100 bpm. In echocardiogram all were with impaired RV (RV/LF ratio &gt;1 and TAPSE &lt;15mm). All patients was treated with UHF, 1 in fondaparinux for thrombocytopenia. At time between 4h and 8gg from the onset of symptoms, all patients underwent placement of 1 or 2 catheters in right and/or left PA, 106 cm and 135 cm length with zone of interest between 18/32 cm. When possible, hemodynamic parameters were evaluated: PAPm, cardiac output, and stroke volume to characterize the associated hemodynamic deterioration. 12mg of rtPA per catheter was administered over 12 hours. In 3 patients an echocardiogram was performed at 6 hours. In all at 24 hours, vital and laboratory parameters were measured, and in one patient, right heart catheterization was repeated. In no patient was treatment discontinued early, nor were ICH or minor bleeding recorded. Low dose of rtPA allowed use of the technique in patients with severe comorbidities at the limit of thrombolysis use, in the presence of marked RV distress and severe hemodynamic instability. Trials are in progress to shorten the time and therefore reduce the dose of rTPA with equal effectiveness on the clinical course of acute PE.
P272 PULMONARY THROMBECTOMY WITH CATHETER FOR THE TREATMENT OF ACUTE PULMONARY EMBOLISM: A LOCAL PROTOCOL
Authors: Bongarzoni A , Femia M , Cortellaro F , Peigottu M , Mirarchi G , Tramarin M , Tassinario G , Garagiola M , Allievi L 
Published: May 2022

Abstract

In February 2021, a PDTA on Pulmonary Embolism (PE) was approved in our hospital, including a chapter describing a protocol for the treatment with catheter thrombectomy (CT) of patients with high and intermediate risk PE. The protocol took into account the recommendations of the ESC 2019 guidelines on PE, and was produced to describe a path to improve the treatment of patients with PE It included: a) thrombectomy with aspiration in patients high–risk patients, with no haemodynamic improvement after administration of systemic thrombolytic therapy (TT) or with absolute contraindication to it; b) thrombectomy with loco–regional ultrasound–assisted thrombolysis (USAT) in patients at high–intermediate risk. 20 patients were treated from February 2020 to September 2021. 55% were men, with an average age of 73 ± 13 years; all patients met the criteria for inclusion in the protocol and signed a consensus document. 2 high–risk patients were treated with thromboaspiration: one patient for absolute contraindication to TT (recent spontaneous brain haemorrhage), the other one for a syncopal episode with head trauma. 18 patients (92%) at high intermediate risk were treated with USAT. For the 90% of patients were used 2 catheters; in 72% the administered dose of rt–PA was 24 mg. The mean value of NT–proBNP was 2,896 ng/l (normal m &lt; 93, f &lt; 144) There was only one major bleeding complication in the high–intermediate risk group (macrohematuria) during hospitalization. The mean RV/LV ratio was 1.48 (± 0.14) at baseline and 0.85 (± 0.14) at 48 hours with a reduction of 43%. The 2 high–risk patients died: one 1 month after the procedure, due to the effects of cerebral haemorrhage, the other one after 10 days due to respiratory complications. The mean FU of 17 patients was 228 days (± 193); during the FU there was a recurrence of PE (6%) after the discontinuation of anticoagulant therapy; there were no haemorrhages. RV dysfunction persisted in one patient (6%) with CTEPH who subsequently underwent pulmonary endarterectomy.

Conclusion
PDTA and teamwork helped to improve the therapeutic decision making in patients with PE at a high and intermediate–high risk, despite the difficulties due to the SARS–COV–2 pandemic. Our experience was found to be in line with what has been published on the efficacy and safety of CT.