bluuebunny/crossref_metadata_2025_split huggingface dataset:
285 BIVENTRICULAR TAKO-TSUBOSYNDROME ASSOCIATED WITH SYNCOPE AND UNCONSCIOUSNESS
Authors: Mallardi Adriana , Ruggieri Roberta , Cuonzo Maria , Grimaldi Nicola , De Luca Viviana , Giannoccaro Viviana , Santoro Francesco , Brunetti Natale Daniele , Bonfantino Massimo Vincenzo 
Published: December 2022

Abstract
A 58-years old woman came to the emergency department due to syncope; she had been found lying on the ground in her residence. At the admission the patient was unconscious but had preserved blood pressure 120/80 mmHg. CT brain scan was negative for hemorrhage. Admission ECG showed a 52 b/m sinus bradycardia, elevated antero-septal ST segment and prolonged QT interval. Diagnosis of antero-septal STEMI was made and a coronary angiogram performed via right femoral access showed mild atheromasia in the absence of angiographically significant lesions. Bedside echocardiogram showed severe left ventricular dysfunction (LVEF 35%) with akinesia of apical and mid-ventricular segments. The right ventricle presented a marked hypocontractility of the apical region and a preserved kinetics of the basal portion (TAPSE 22 mm). There was also a moderate mitral regurgitation and a mild tricuspid regurgitation with a sPAP of 50 mmHg (40+10).
On blood sampling, high-sensitivity troponin was slightly elevated (3950 pg/ml) and marked hyponatriemia (117 mmol/l) and slight hypokalemia (3.1 mmol/l) were noted. The echocardiogram on the third day showed an improvement in global and segmental kinetics of left ventricle with an estimated EF of 45% and persistence of a mild hypocontractility of the apex of right ventricle. During her hospital stay, her cognitive state gradually improved and she remained asymptomatic without evidence of arrhythmic events on monitoring. The ECG evolved on days with normalization of the ST-T tract, negative T wave in the anterior region and prolonged QTc interval. The pre-discharge echocardiogram showed a recovery of biventricular kinetics with an estimated EF of 50%. The presence of a transient abnormality in biventricular wall motion beyond a single epicardial coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of Tako-tsubo Syndrome defined by Mayo Clinic criteria. The electrocardiogram on the day of discharge showed a 55 b/m sinus bradycardia with a negative T wave from V1 to V4.
Tako-tsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction that improves spontaneously within days or weeks and is often preceded by emotional or physical stress.
Biventricular involvement in TTS is typically identified on imaging studies such as echocardiography and MRI. TTS with RV involvement is associated with a higher rate of in-hospital mortality and long-term adverse clinical events than isolated LV TTS.
In our clinical case, biventricular involvement was associated with a severe clinical presentation (syncope and unconsciousness). This case shows that biventricular Tako-tsubo is a clinical scenario that requires intensive care monitoring and strict cardiological evaluation.
223 THE ROLE OF SARS-COV-2 VACCINATION-INDUCED MYOCARDITIS IN UNMASKING UNDERLYING ARRHYTHMOGENIC CARDIOMYOPATHIES: A CASE SERIES LOOKING BEYOND THE TIP OF THE ICEBERG
Authors: Brusamolino Matteo , Amelotti Nicola , Mapelli Massimo , Baggiano Andrea , Campodonico Jeness , Majocchi Benedetta , Ribatti Valentina , Vettor Giulia , Teruzzi Giovanni , Trabattoni Daniela , Novelli Valeria , Catto Valentina , Basso Cristina , Pontone Gianluca , Agostoni Piergiuseppe 
Published: December 2022

Abstract

Background
Acute myocarditis (AM) is a heart inflammatory disease that may also rarely occur as a complication of COVID-19 vaccines. Inflammation is involved in arrhythmogenic cardiomyopathy (ACM) pathogenesis. Little is known regarding the COVID-19 vaccines influence on ACM relapses. We present two cases of vaccine related AM revealing a pre-existent (silent) ACM.

Cases presentation
Table shows a summary of the patients’ main clinical characteristics.

Discussion
We presented 2 cases of arrhythmic myocarditis-like clinical presentation in patients without previous cardiovascular history, whose timing was temporally related to a dose of vaccine against COVID-19. Subsequent diagnostic workup suggested the possible presence of an underlying silent ACM. In our case series, tissue characterization provided by CMR played a fundamental role as a diagnostic tool, showing in all cases a prominent left ventricle involvement and identifying both the underlying ACM disease and the superimposed myocardial inflammation. We hypothesize that a vaccine-induced AM could have revealed the presence of a pre-existent ACM, on which an inflammatory acute phase triggered the arrhythmic manifestation.

Conclusion
Vaccine-induced AM could reveal the presence of a pre-existent ACM. Our report suggests that a high index of suspicion and a multidisciplinary approach is required, in order to continue the diagnostic process once the acute event has been resolved, as it may have fundamental implication in the patient management. Further studies are required to verify if some of the vaccine-triggered AM represent the ACM first manifestation.
127 APPLICABILITY AND PERFORMANCE OF HEART FAILURE PROGNOSTIC SCORES IN DILATED CARDIOMYOPATHY: THE EXPERIENCE OF AN ITALIAN REFERRAL CENTER FOR CARDIOMYOPATHIES
Authors: Rossi Maddalena , Teso Maria Vittoria , Masè Marco , Barbati Giulia , Stolfo Davide , Merlo Marco , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Many prognostic risk scores have been developed for ambulatory Heart Failure (HF) patients, but none of these has been validated in Dilated Cardiomyopathy (DCM), that is a peculiar model of HF.

Aims
To evaluate and compare the applicability and performance of major HF risk models in a large real-world population of DCM patients

Methods
This was a retrospective study including 784 consecutive non ischemic DCM patients, both inpatients and outpatients, enrolled in the Heart Muscle Disease Registry (HMDR) of Trieste between January 2000 and December 2017. The following scores designed to estimate 1- to 3-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), simplified-SHFM (Seattle Heart Failure Model), 3-CHF (Cardiac and Comorbid Conditions), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico-Heart Failure), MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes), Barcelona Bio-HF, Krakow score.

Results
During the follow-up (5,83 ± 4,9 years) 191 patients (20% of the population) met the
primary composite endpoint (158 deaths, 30 heart transplantations and 3 LVAD implants). Due to the high quote of missing parameters, only four of the prognostic models (MAGGIC, CHARM, 3-CHF and simplified-SHFM) could be tested in the final statistical analysis.
The observed-to-predicted mortality ratios suggested an overestimation of mortality by all scores.
The prognostic accuracy of the scales was suboptimal in DCM patients for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores, worse for 3-CHF (AUC 0,677) and simplified-SHFM (AUC 0,667) scores, with the MAGGIC and simplified-SHFM respectively providing the best and worst performance.

Conclusions
The performance of HF prognostic risk scores is suboptimal for DCM patients. The need for new precise risk models tailored for this disease has to be considered.
258 CORONAVIRUS DISEASE 19 VACCINATION-RELATED PERICARDITIS: A SINGLE TERTIARY CENTER EXPERIENCE
Authors: Collini Valentino , Imazio Massimo , De Biasio Marzia , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
Vaccination represents a cornerstone of prevention in the COVID-19 pandemic. Rare adverse events including acute pericarditis and myopericarditis have been reported.

Material and Methods
All consecutive patients referred to our referral center for pericardial diseases following COVID-19 vaccination from 1st April 2021 to 15th April 2022 were included. Acute pericarditis and myopericarditis were diagnosed according to ESC guidelines. Patients with SARS-CoV-2 infection were excluded from the study.

Results
Twenty-four patients (79% males) aged 39.7 ± 19.8 years were referred to our center with pericarditis after receiving COVID-19 vaccination. 13 (54%) patients were diagnosed with myopericarditis. The mean time between vaccination and symptoms onset was 7.0 ± 4.9 days and the most frequent symptom was pericarditic chest pain (83%). Respectively, 50% and 33% of patients presented after the second and the third dose of the vaccine. Almost all patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine. Five patients (21%) experienced a recurrence of pericarditis. No patient died or developed constrictive pericarditis. Mean follow-up was 8.0 ± 3.2 months.

Conclusions
COVID-19 vaccine-related pericarditis typically manifest with mild clinical signs, in young males, a few days after the second or third vaccine dose and are commonly characterized by a rapid complete recovery. Despite these rare side effects, the benefits of COVID-19 vaccination clearly outweigh the limited risk of pericarditis and myocarditis, and vaccination is strongly recommended to prevent COVID-19 infection, transmission and related complications.
472 PROGNOSTIC VALUE OF CPET REPETITION DURING FOLLOW-UP OF DILATED CARDIOMYOPATHY
Authors: Baracchini Nikita , Zaffalon Denise , Merlo Marco , Baschino Samantha , Barbati Giulia , Pezzuto Beatrice , Agostoni Piergiuseppe , Sinagra Gianfranco 
Published: December 2022

Abstract

Background
although cardiopulmonary exercise testing (CPET) is a recognized tool for prognostic stratification in patients with dilated cardiomyopathy (DCM), there are no data about the prognostic value of its repetition during follow-up in this setting. The aim of this study was to test the prognostic value of repeating CPET during follow-up, among a large cohort of DCM patients.

Methods
in this multicenter, retrospective study, we analyzed DCM patients who consecutively performed at least two CPET during a clinical stable phase of disease. All patients performed CPET and echocardiogram within 10 days. The study end-point was a composite of death from all causes, heart transplantation, implantation of durable left ventricular assist device, life-threatening ventricular arrhythmias or hospitalization for HF.

Results
216 DCM patients were enrolled (52±12 years, 78% male, NYHA I-II 82%, LVEF 32±9%, 94% on ACE inhibitors, 95% on beta-blockers); the duration of the disease at the time of first CPET was 68 months. The interval between the two CPETs was 15 (11;23) months. During a median follow-up of 38 months from the second CPET, 108 (47%) patients went through the end-point. Time-dependent ROC curves revealed that to repeat during a follow-up of 12 months both CPET and echocardiogram gives a more accurate prognostic stratification than basal echocardiography + basal CPET. Despite an higher AUC (0.91 vs 0.85) there were no significant different accuracies (95% CI: 83.6 - 98 vs 75.5–96.5; p-value: 0.2) between the repetition of CPET plus echocardiogram vs. the repetition of the echocardiogram alone. Among patients who experienced the study outcome, there was a substantial stability of echocardiographic values (relative variation of LVEF +2.7%, LVEDV +1.3%) but a significant worsening of functional capacity (relative variation of percentage predicted VO2 peak +6%, p-value: 0.002). Conversely, there were a significant improvement in echocardiographic values and CPET values in events-free patients (LVEF relative variation -8.6% p-value: 0.002; ppVO2 peak relative variation -6.8%, p-value: 0.002).

Conclusion
in a large population of clinically stable DCM patients, the systematic repetition of echocardiography or both CPET and echocardiography showed no significant prognostic impact, in presence of stable or worsened echocardiogram. Nevertheless, when there is a clinical variation of symptoms or a failing in the reverse remodeling process, 1-year repetition of CPET can identify higher risk patients.
1078 RECURRENT FLARES OF MYOCARDITIS: A CHALLENGING CASE
Authors: Ravera Francesco , Angelini Filippo , Gobello Giulia , Toso Elisabetta , Pidello Stefano , Dusi Veronica , Raineri Claudia , De Ferrari Gaetano Maria 
Published: December 2022

Abstract
A 38-year-old woman with curly hair was admitted at the Emergency Department of our Hospital for typical thoracic pain associated with dyspnea and palpitations. Electrocardiogram showed sinus rhythm, 65 bpm, low voltages in the peripheral leads with fragmented QRS complex in the inferior leads and negative T-waves in anterior leads. Initial high-sensitivity cardiac troponin level was 46326 ng/L (n.v. &lt; 16 ng/L). At presentation the patient was treated with Anakinra (anti-interleukin 1) and Metoprolol 200 mg/die because of a past medical history characterized by multiple myocarditis recurrences since 2012. Various therapies had been tested (Aspirin, Ibuprofen, Colchicine, Prednisone, Azathioprine), with a good efficacy of Mycophenolic acid, recently stopped to plan a pregnancy.
Transthoracic echocardiography documented normal left ventricle (LV) ejection fraction and no alteration wall motion abnormalities; cardiac-MRI demonstrated LV late gadolinium enhancement with a non-ischemic subepicardial “ring-like” pattern. Endomyocardial biopsy was performed, and the ultrastructural analysis showed mitochondrial hyperplasia with focal swelling and marked alterations of intercalated disks. A high ventricular extrasystolic burden was registered at EKG monitoring.
Gene sequencing revealed a pathogenetic variant of the gene coding for Desmoplakin. This is involved in the anchoring of intermediate filaments to desmosomal plaques and its pathogenetic variants are associated with an inflammatory and fibrotic LV predominant cardiomyopathy with an arrhythmogenic evolution (see Padua criteria).
In the absence of approved therapies, in agreement with the limited available data and considering patient's history, Micofenolic acid was restarted. At 1-, 3- and 6-month follow-up the patient has remained asymptomatic with progressive declining in troponin levels after discharge.
307 A CARDIAC MASS IN A PATIENT WITH GORLIN-GOLTZ SYNDROME: INCIDENTAL DIAGNOSIS OR SOMETHING TO LOOK FOR?
Authors: Tarantini Roberto , Alonge Stefano , Acone Lorenzo , Foti Marco , Toscano Evelina , Poggio Daniele , Mortara Andrea 
Published: December 2022

Abstract

Aims
Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant, multisystem, tumor-predisposing disorder. The primary manifestation of NBCCS is the development of multiple basal cell carcinomas (BCCs) but is also associated with a variety of other benign and malignant tumors. Cardiac fibromas are increased in frequency in patients with NBCCS, developing in approximately 3 percent of affected individuals. They typically present in infancy. They are benign growths, and almost all develop within the ventricular myocardium. Although usually asymptomatic, they can result in impaired left ventricular function and conduction defects, necessitating resection.

Methods and results
we presented a case of a 59-years-old woman with a diagnosis of Gorlin-Goltz syndrome and no history of cardiovascular diseases who underwent a right knee arthroplasty in our hospital. After the surgery the patient was admitted to rehabilitation department. Electrocardiogram that showed sinusal rhythm with inverted T waves in lateral leads and a transthoracic echocardiography examination were performed. Echocardiography showed a large mass within the basal and middle segments of left ventricle lateral wall. Left ventricular ejection fraction was preserved. Cardiac magnetic resonance (CMR) revealed an intramyocardial mass with well-defined borders and several calcifications, hypointense on T1-weighted and T2-weighted images and delayed-contrast hyper-enhancement with hypoenhancing central cores. Based on these imaging features, the mass was suggestive of cardiac fibroma with calcifications. The patients was asymptomatic. Afterwards, a total body CT was performed to exclude other tumours in other sites. This case was discussed with cardiac surgeons and since the patient was asymptomatic with no conduction abnormalities or heart failure signs, urgent surgical intervention was excluded. The patient was discharged with a 3 months follow-up.

Conclusion
our case highlights the importance of echocardiography evaluation before surgery in patients with genetic syndrome like Gorlin-Goltz syndrome. Last guidelines published in 2021 recommend that all patients with NBCCS should be screened with a cardiac ultrasound and if cardiac symptoms occur in a patient with NBCCS, a cardiac ultrasound should be repeated to exclude a late-onset cardiac tumour. Furthermore, CMR plays an important role in characterizing cardiac masses and determining the management.
1124 THORAFLEX HYBRID AS FROZEN ELEPHANT TRUNK
Authors: Artiola Gaetano , Vincenzo Pettillo 
Published: December 2022

Abstract

Introduction
Dissection and aneurysms of the aorta are pathologies that greatly compromise the prognosis of patients. By examining these pathologies in the area under consideration, knowing that they also subject the epiacortic arterial structures to this dilation, an endovascular solution was sought that would reduce the long and risky times of surgery. A hybrid operation that is implemented is that of the Thoraflex™ implant. During cardiac surgery, the replacement of the ascending aorta, whether by dissection or aneurysm, is incorporated with the endovascular implant with this state-of-the-art prosthesis that can circumscribe the problem to the descending thoracic aorta. This device has three outlets that will play the role of the supraortic arteries.

Purpose
Assessment of patients for the treatment of aneurysms and chronic thrombosed dissections of the aortic arch and describe the effectiveness of this treatment.

Method
A Pubmed search related to clinical data and field experience was performed.

Results
Patients with different aortic pathology were treated and evaluated. The recovery, compared to the classic surgery, was faster due to the lower exposure to extra-body circulation and a reduced surgical time.

Conclusions
Thoraflex™ hybrid as frozen elephant trunk presents a cutting-edge option and a valid alternative for the treatment of complex aortic pathologies. It is clear how much, despite the surgery, the risks of stroke, of infections due to the procrastination of the operation are considerably reduced and above all how the mortality rate has been reduced, making the approach to a pathology that is usually treated less complex in an emergency.
11 PRINTING 3D MODELS OF THE HEART: CAN IT HELP IN UNDERSTANDING THE COMPLEX ANATOMY?
Authors: Santucci Stefano , Santucci Matteo 
Published: December 2022

Abstract
The use of 3D printing in the medical field is widespread especially in the dental clinic as a support to orthodontic / implant therapy. In the training of personnel relating to cardiological diagnostic methods, can it be useful to shorten the learning curve of human anatomy?
A light-curing liquid resin 3D printer was used to obtain anatomical models that faithfully reproduce the real anatomy of the individual patient. The starting model was obtained from CT with contrast medium performed on patients. Depending on the diagnostic question, CT may contain complete information on both the arterial circulation and the venous circulation of the heart and the epiaortic vessels. From this information a 3D surface reconstruction is obtained which, once reworked, can be used directly for printing. The model size is limited by the print volume of the printer which may vary depending on the printer model. The model to be printed obtained from CT acquisitions the 3D model will be the representation of the lumen of the vessels and cavities of the heart. The models obtained faithfully represent the anatomical reality of the patient who underwent CT with contrast medium. Actual size is affected by the print volume size of the printer model.
In my experience in university teaching, the models obtained with 3D printing have been found to be very useful for understanding the complex spatial configuration of the anatomy of the heart and great vessels
798 CARDIOVASCULAR EFFECTS OF WHOLE-BODY CRYOTHERAPY IN NON-PROFESSIONAL ATHLETES
Authors: Selleri Valentina , Zanini Giada , Coppi Francesca , Pinti Marcello , D’alisera Roberta , Latessa Pasqualino Maietta , Tripi Ferdinando , Savino Gustavo , Cossarizza Andrea , Nasi Milena , Mattioli Anna Vittoria 
Published: December 2022

Abstract
Whole-body cryotherapy (WBC) is a method of cold therapy widely applied for muscle recovery after injury to counteract the inflammatory response due to specific diseases, characterized by high levels of inflammation. WBC consists of short exposure, of about 2-3 minutes, to dry air at cryogenic temperatures (up to -190°C) in a special chamber. Our study aimed to investigate changes in respiratory rate, oxygen saturation, blood pressure, heart rate and body temperature induced by WBC sessions in athletes.
Ten volunteer middle-distance non-professional runners (age: 38±12 years) received 3 once-a-day sessions of WBC. Subjects underwent blood pressure measurements and ECG recorded before and immediately after the daily session. During WBC we recorded a single lead trace (D1) for heart rhythm control. Moreover, we monitored the 5 vital signs, such as blood pressure, heart rate, respiratory rate, oxygen saturation and body temperature, during, and after all WBC session.
We did not report significant changes in ECG main intervals (PR, QT, and QTc) and in the mean systolic blood pressure during and after WBC [baseline: 118 ± 5 mmHg, changed to 120 ± 3 mmHg during WBC, and to 121 ± 2 mmHg after session]. Mean respiratory rate did not change significantly during WBC as well as oxygen saturation (98 vs. 99%). Mean heart rate changed from 50.98 ± 4.43 bpm (before) to 56.83 ± 4.26 bpm after WBC session (p &lt; 0.05) and body temperature was slightly increased after WBC, however it remains within physiological values. In non-professional athletes WBC did not affect cardiovascular response and can be safely used. However, further studies are required to confirm these promising results of safety in elderly non-athlete subjects.