bluuebunny/crossref_metadata_2025_split huggingface dataset:
P45 OUTCOME AFTER ACUTE TYPE A AORTIC DISSECTION: THE ROLE OF AN AORTIC TEAM AND AN AORTIC REGIONAL NETWORK
Authors: Lechiancole A , Vendramin I , Piani D , Sponga S , De Manna D , Calandruccio R , Brindicci I , Bressan M , Livi U 
Published: May 2022

Abstract

Background
The outcome of acute type–A aortic dissection (A–AAD) repair is strictly related both to surgical factors and patient conditions. Improvement in surgical experience and in diagnosis and treatment protocols could significantly increase survival for patients affected by A–AAD. The aim of this study was to assess the impact on patients outcomes of a standardized integrated surgical approach and of a regional aortic hub and spokes network.

Materials and Methods
From 2004 to 2021, a total of 258 patients underwent repair of A–AAD. In 2010 in our Institution was created the Aortic Team, with cardiac surgeons dedicated on the treatment of aortic pathologies, while in 2017 was created a regional aortic network between hub and spokes in order to standardize the diagnosis and treatment algorithm. Thus, patients were distributed among three periods: 2004–2010 (Era 1, n = 90), 2011–2016 (Era 2, n = 87), and 2017–2021 (Era 3, n = 81).

Results
Baseline demographic characteristics of the groups were similar. Compared to Era1 and Era2, clinical status at time of operation was better in Era3, because of less rates of malperfusion (16% vs 11% vs 4%, p = 0.01) and hemodynamic compromise (34% vs 38% vs 22%, p = 0.07). Patients of Era 3 were less likely to Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while femoral artery was mainly cannulated in Era 1 (91%) (p &lt; 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p &lt; 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p &lt; 0.01). Frozen elephant trunk was mainly performed in Era 3. Operative mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07, p = 0.03 between Era 1 and Era3). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Patients of Era 3 received less re–exploration for bleeding (p = 0.02) and less high inotropic support (p = 0.04).

Conclusions
With increasing experience and a more aggressive approach, including total arch replacement, repair of A–AAD can be more tailored to patients conditions, being performed with low operative mortality in many patients. Moreover, patient care and treatment by a multidisciplinary regional organization allows faster diagnosis and effective clinical stabilization allowing to further improve early and late outcomes.
P67 MAGMARIS FRACTURE AND COLLAPSE DURING PCI: ACUTE TREATMENT AND FOLLOW–UP
Authors: Quadri G , Franzè A , Tomassini F , Rolfo C , Meynet I , Celentani D , Gribaudo E , Tizzani E , Cerrato E , Chinaglia A , Lococo M , Palacio S , Minniti D , Varbella F 
Published: May 2022

Abstract
Resorbable Magnesium Scaffold (RMS) Magmaris represents an attractive alternative to permanent metal stenting in young patients undergoing PCI. Despite the promising long–term results, especially in terms of scaffold thrombosis, no data on acute RMS deployment failure and subsequent treatment are available. A 44–year–old gentleman with history of effort angina was admitted to our Department to perform coronary angiography. The exam showed an intermediate stenosis in the mid–tract of Left Anterior Descending (LAD, Figure 1, Panel A1), functionally significant (Instantaneous wave–free ratio 0.85). After Optical Coherence Tomography (OCT) evaluation (Panel A2), a wire was placed in Second Diagonal Branch (DG2) and predilation with a NC 3.5mm balloon on mid–tract of LAD was performed, followed by 3.5x25mm Magmaris implantation. Multiple runs performed after removing the jailed guidewire on Dg2, showed a remarkable angiographic result (Panel B1). However, OCT showed struts fracture near the distal RMS segment resulting in scaffold collapse as confirmed by 3D–reconstruction (Panel B2, B3). Therefore, scaffold dilatation with NC 3.5mm balloon was performed, followed by Magmaris 3.5x20mm intra–scaffold implantation. Panel C1 and C2 showed good angiographic and OCT results after postdilatation with NC 3.5 and 4.0mm balloon in the distal and proximal part, respectively. A planned one–year angiography (Panel D1) revealed a small aneurismatic enlargement in the previous overlapped segment, while no residual struts were visible at OCT. (Panel D2) To our knowledge we reported the first case of Magmaris acute fracture (probably due to a forced removal of the Dg2 jailed guidewire) treated with a second intra–scaffold RMS. The present case should emphasize the importance of intracoronary imaging guidance while more data are needed to clarify the optimal treatment of acute RMS implantation failure.
P91 HEMODYNAMICS NURSES ARE EVOLVING WITH INTERVENTIONAL CARDIOLOGY
Authors: Dessi A , Lais S , Baratta S , Menconi M 
Published: May 2022

Abstract

Subject Matter
Hemodynamics deals with issues concerning ‘the bloodstream and the vascular system’ and the figure of nurses pursuing their activity within those settings is constantly growing and evolving. Nurses must keep on training in procedures, new techniques, different procedural approaches and required equipment. Furthermore, this training has to develop besides the fundamentals, i.e. throughout briefing and debriefing sections. In fact, patient care is complex and mechanistic and therefore documented and transversal in order to satisfy clinical needs of the on–going process. In the hemodynamics ward in Massa’s Ospedale del Cuore of the Fondazione Toscana Gabriele Monasterio, diagnostics and interventions performed on patients are consistently developing. A hemodynamic patient leads, affects and characterises the nurse who must be able of taking care of their adult patients and pediatric ones until their prematurity.

Objective
Highlighting nursing skills in hemodynamics wards and types of training and care of patients of different age groups during procedural approaches.

Methods and Materials
Shared approval among medical directors of training courses to select for the training plan; mentorship; periodical evaluation of trainee plans; on–the–job nursing training; training courses chaired by experts; simulation of intra–setting emergency; evaluation of panic ranges to detect and it is necessary to act promptly for.

Outcome
In consideration of creating a nursing team capable of facing scenarios and procedures which can include every life stage of patients, it is paramount that a nurse follows the whole process. The procedural activities include the realization of a job description for basic and specialised skills and its observation. Outcomes and steps outlined to carry out care–giving performances are overseen each year. Lastly, it is necessary to know patients in their pre– and post–procedural stage up until the outcome of care–giving treatments.

Conclusions
Hemodynamics nurses are able to face changes and clinical solutions development alongside with a cross–disciplinary team.
P94 LOWER RATE OF MAJOR BLEEDING IN HIGH–RISK PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: A PROPENSITY MATCHED COMPARISON WITH DIRECT ORAL ANTICOAGULATION
Authors: Magnocavallo M , Della Rocca D , Vetta G , Lavalle C , Mariani M , Schiavone M , Carola G , Mohanty S , Bassiouny M , Forleo G , Burkhardt D , Al–Ahmad A , Gallinghouse J , Horton R , Lakireddy D , Di Biase L , Natale A 
Published: May 2022

Abstract

Background
Stroke prophylaxis in very high risk (CHA2DS2–VASc ≥ 5) patients with atrial fibrillation (AF) is one of the major challenges faced by physicians. Specifically, initiating direct oral anticoagulants (DOACs) in these patients poses a therapeutic conundrum due to the concomitant high risk of bleeding. Left atrial appendage occlusion (LAAO) might be a potential alternative for thromboembolic (TE) prevention; however, there are no studies comparing these two strategies in very high–risk patients.

Objective
To evaluate the efficacy of LAAO versus DOACs in AF patients at very high TE risk.

Methods
Data were extracted from two prospective databases including 1053 Watchman and 1328 DOAC patients. Watchman patients with a CHA2DS2–VASc ≥ 5 accounted for 26.3% (n = 277). In order to attenuate the imbalance in covariates, a 1:1 propensity score matching technique was used (co–variates: age, sex, CHA2DS2–VASc and HAS–BLED scores). This method resulted in 554 matched patients (277 patients per group; mean age: 79±7y; 57.4% F; CHA2DS2–VASc: 5.8±0.9). The primary endpoint was a composite of cardiovascular (CV) death, TE events (Stroke/TIA/peripheral embolism) and clinically significant bleeding. The annual TE and major bleeding risks were estimated based on the CHA2DS2–VASc score and compared with the annualized observed risk.

Results
After a mean follow–up of 26±7 months, total events were 55 (9.4 event rates per 100 patient–years) in LAAO group vs. 78 (14.9 event rates per 100 patient–years) in DOAC group. DOACs had a significantly higher risk of the primary endpoint (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.08 to 1.56; p = 0.03). TE events (HR: 1.15; 95% CI: 0.84 to 1.57; p = 0.63) and CV death (HR: 1.13; 95% CI: 0.84 to 1.54; p = 0.63) did not differ between groups. Major bleeding events were significantly lower in LAAO patients (HR: 0.75; 95% CI: 0.51 to 0.82; p = 0.04). The unadjusted estimated risk of TE events was 12.3% with LAAO and 12.4% with DOACs. The annualized incidence of TE was 3.2% with LAAO and 4.1% with DOACs, which led to a risk reduction of 74% and 67%, respectively.

Conclusion
In a large cohort of AF patients at very high TE risk (CHA2DS2–VASc ≥ 5), LAAO showed similar stroke prevention but a significantly lower risk of major bleeding than DOACs during a &gt; 2year follow–up.
P98 CLINICAL CASE: MECHANICAL SUPPORT IN HIGH RISK PATIENT DURING PCI. NURSING ROLE AND SKILLS
Authors: Missana M 
Published: May 2022

Abstract
High risk patient in Cath Lab are more common nowadays. Cath Lab nurse needs to have technical and relational skills to deal with patients in this kind of setting. He needs technical skills to manage complex ventricular assist devices, identifying as soon as possible dangerous situations to prevent it. He needs to deal with the patient in a delicate moment of the caring process, giving constant attention both to the person that is dealing with this experience and the device and monitoring system.
P110 ACCIDENTAL FINDING OF COR TRIATRIUM SINISTER IN AN ADULT: DIAGNOSIS MANAGMENT
Authors: Talarico M , Renne S , Colangelo M , Rizzuti G , Talarico R , Ceravolo R 
Published: May 2022

Abstract
A 45–year old woman presented at the emergency department for palpitations and fever. The EKG, thoracic x–ray and troponins were normal, only a neutrophil leucocytosis was found. The echocardiography showed a normal bi–ventricular and valvular function and a mobile, linear, mass in the left atrium. In order to exclude an infective vegetation the patient underwent to a 2D and 3D transesophageal echocardiography (Figure 1 and 2) which showed a left ventricle concentric remodelling (iLVmass 62 g/m2; RWT 0.45), preserved left and right ventricle function (LVEF according to Simpson 70%; FAC 50%) and valves function; inter–atrial septum defects were excluded, too. The mass was described as a mobile membrane in the left atrium at 2.11 cm from the mitral valve anular plane, which divided the atrium into two separate chambers with a large fenestration without trans–mitralic flow obstruction, supporting a cor triatrium sinister. We excluded endocarditis (the blood cultures were negative, too) and supra–valvular mitral ring (since the left appendage position in the antero–inferior side of the left atrium). The cardiac MRI showed (Figure 3) (SSFP–FIESTA, IR–GRE T1, STIR T2) confirmed the finding of a left atrium divided in two chamber by a iso–intense membraine from the coumadin ridge between the left upper pulmonary vein and the left appendage to the inter–atrial septum fossa ovalis, incomplete in the infero–lateral part. Venous drenaige and other congenital abnormalities were excluded. Miocarditis was excluded since no fibrosis in IR–GRE T1 and no edema in Triple T2 sequences. Since the non–obstructive cor triatrium sinister, grading IA according the Lucas classification, was confirmed, no surgical treatment was proposed and the patient was discharged without complications.
P131 LOW DOSES OF ADVANCED GLYCATION END–PRODUCTS AND FRUCTOSILATION PRODUCTS PROMOTES PREMATURE CELL DEATH OF HUMAN CARDIAC CELLS EXPOSED TO DOXORUBICIN VIA ACTIVATION OF NLRP3, MYD88 AND P53 DOWNREGULATION
Authors: Quagliariello V , Paccone A , Iovine M , Buccolo S , Maurea N 
Published: May 2022

Abstract

Introduction
Advanced glycosylation end–products (AGEs) are non–enzyme, protein glycosylation products caused by glucose–induced metabolic disorder, and play an important role in aging, cancer, metabolic syndrome and cardiovascular diseases.

Purpose
We aimed to assess whether AGEs and fructosilation products, such as methylglyoxal (MG) and N–carboxymethyllysine (N–CML) could increase susceptibility to cell damages induced by doxorubicin Methods Human cardiomyocytes were pre–exposed for 24h with low doses (50 mmol/L) of methylglyoxal (MG) or N–carboxymethyllysine (N–CML). After, cells were exposed to subclinical concentration of doxorubicin (at 100 and 200 nM) for 48 and 72h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4–hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro–inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of peroxisome proliferator–activated receptor–α; mTORC1 Fox01/3a; transcriptional activation of p65/NF–κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6). Expression of p53 was also performed through western blot method

Results
Pre–exposure to methylglyoxal (MG) but especially to N–carboxymethyllysine (N–CML) increase cell mortality to doxorubicin of 48–53% compared to control. Pre–exposure to N–CML promotes premature death of cardiomyocytes to doxorubicin through NLRP3–driven pathways. Notably, MG and N–CML increased significantly the cardiotoxicity through NLRP3 inflammasome, Myd88 myddosome and cytochrome C–mediated apoptosis. Pre–exposure to N–CML and MG increase the secretion of interleukin–6 that increase cell apoptosis through a paracrine and autocrine mechanism. Induction of IL–6 reduces the expression of p53 resulting in the induction of the apoptotic process.

Conclusion
These observations suggest that AGEs and fructosilation producs promotes premature cardiotoxicity of human cardiac cells exposed to doxorubicin by activation of NLRP3, Myd88–related pathways and downregulation of p53.
P136 OCCASIONAL DIAGNOSIS OF B–CELL LYMPHOMA DURING A SCREENING EXAMINATION FOR HYPERTENSIVE CARDIOMYOPATHY: A CASE REPORT
Authors: Deserio M , Sanguettoli F , Pavasini R , Passarini G , Tonet E , Guardigli G , Campo G 
Published: May 2022

Abstract

Background
Echocardiography is fundamental in identifying early “red flags” of infiltrative cardiomyopathy in patients with monoclonal gammopathy and left ventricular hypertrophy. Nonetheless, definite diagnosis of cardiac amyloidosis requires multimodality imaging such as cardiac magnetic resonance, whole body bone scintigraphy and eventual biopsy in order to determine the disease phenotype.

Case Report
A 79 year–old male affected by Monoclonal Gammopathy of Undetermined Significance (IgM kappa) underwent a routinary echocardiography examination for arterial hypertension. The exam showed septal hypertrophy (diastolic septum width 13 mm) and right ventricular hypertrothy, E/e’&gt;14 and valvular thickening. Based on these red flags in MGUS, in order to exclude cardiac amyloidosis, a whole body bone scintigraphy was performed: the exam was negative for myocardial uptake. Laboratory tests showed increased free kappa light chain component (61, 9 mg/L (r.v. 3.3–19.4), with lambda resulting 5,46 mg/l (r.v. 5.71–26.3), a k/l ratio of 11.34 (r.v. 0.26–1.65) and absence of Bence Jones proteinuria Subsequent cardiac MRI was performed and two restricted areas of subendocardial LGE were documented on the lateral and apical left ventricular wall without corresponding regional motion abnormalities: the findings were consistent with pathologic accumulation. In relation to the subendocardial localization of the abnormalities, obstructive coronaropathy was excluded by performing a coronary computed tomography angiography (CCTA). Abdominal Fat Biopsy was negative for amyloid protein. Osteo–medular biopsy displayed an IgM kappa lymphoplasmacytic lymphoma. Cardiological findings were, therefore, interpreted as markers of initial myocardial infiltration from a plasmacytoma. Afterwards, patient’s therapy and clinical follow up were managed by the Hematology care.

Discussion
Myocardial infiltration from plasmacytoma is very rare in comparison to Multiple myeloma and it features a more focal, less homogeneous pattern. In this case, recognizing red flags on echocardiography allowed an early diagnosis.
P144 PEMBROLIZUMAB–INDUCED MYOCARDITIS
Authors: Roberta P , Isola U , Marchetti M , Giusti M , Manca F , Montisci R 
Published: May 2022

Abstract

Introduction
Patients treated with Immunocheckpoint Inhibitors (ICI) can develop adverse cardiovascular events, most frequently myocarditis, but also arrhythmias, conduction abnormalities, pericarditis, Takotsubo syndrome, ACS, heart failure, cardiac arrest. Myocarditis occurs early, within the first 3–4 administrations of therapy, and is fraught with a high mortality rate.

Case Presentation
80–year–old patient with renal pelvic carcinoma who underwent nephroureterectomy and subsequent adrenalectomy. Twenty days after the first cycle of Pembrolizumab, the patient is admitted to cardiology for syncope and ECG finding of Left Posterior Fascicular Block (LPFB) and right bundle branch block (RBBB) with significant increase in troponin without any alterations in regional kinetics and normal ventricular function (EF). The patient also complains of widespread muscle pain and severe hyponatremia on blood tests. On ECG monitoring, alternation of RBBB with associated LPFB and Left Posterior Fascicular Block, left bundle branch block, first and second degree atrio–ventricular block (AV block) and on day II appearance of complete paroxysmal AV block controlled with temporary pacemaker implantation. On the 4th day, we documented changes in the segmental motion of the left ventricle (LV) and progressive gradual worsening of the EF. During the hospitalization the patient manifested episodes of general malaise with profuse sweating and marked hypotension with possible SIADH picture. In suspicion of acute myocarditis, peripheral myositis and possible Pembrolizumab SIADH, the patient was treated with high dose methylprednisolone (1000 mg / day) with little benefit. On the 6th day the patient was found in critical condition, severely suffering, hypotensive and oliguric, resigned herself.

Conclusions
Our case highlights how even a single dose of Pembrolizumab can trigger an acute inflammatory pattern affecting the myocardium with prevalent involvement of the conduction tissue even before the appearance of alterations in the kinetics and ventricular dysfunction. During ICI therapy cycles it is therefore important to monitor the ECG and troponin levels in order to be able to diagnose myocardial involvement early. In fact, although this complication is rare, it is burdened by a high mortality rate. The only treatment currently available involves the suspension of immunotherapy and the administration of high–dose methylprednisolone.
P145 A DUAL CARDIAC COMPLICATION FOR … COMBINATION CHEMOTHERAPY FOR KIDNEY CANCER
Authors: Parodi A , Brunacci M , Pestelli S , Merello M , Lupi G 
Published: May 2022

Abstract
We present the case of a 66–year–old patient suffering from metastatic kidney cancer who came to the emergency room complaining of dyspnea. 10 days prior to the event, the patient had received the last administration of chemotherapy which consisted of the combination of pembrolizumab (a monoclonal antibody) and axitinib (a tyrosine kinase inhibitor). The cardiological checks carried out up to that moment had not shown changes in the heart. In the emergency room ECG showed the presence of a sinus rhythm with a complete block of the right branch and no signs of ischemia were evident; blood chemistry tests showed an increase in troponin and BNP values. Echocardiography showed moderate left ventricular dysfunction. Therapy with diuretics, beta–blockers and Ras inhibitors was initiated which allowed for rapid resolution of symptoms. At a follow–up five days later the patient presented asymptomatic but with diffuse inversion of the T waves, a new elevation of troponin and more surprisingly the echo showed, in the presence of moderate left ventricular dysfunction, a mobile formation at the level of the apex of the left ventricle. Unfractionated heparin therapy was initiated since, on the basis of echocardiographic characteristics, the diagnosis appeared to be that of thrombosis and chemotherapy was suspended. In the following days the echo did not reveal any modification of the neoformation therefore in consideration of the characteristics (size and high degree of mobility) and of the oncological prognosis of more than one year we decided to initiate the patient to cardiac surgery for the removal operation. The histological analysis of the neoformation confirmed the thrombotic nature. Repeated echocardiography 15 days after surgery showed an almost complete recovery of the ejection fraction. To our knowledge, tyrosine kinase inhibitors can cause ventricular dysfunction (apoptosis) but, in general, it is not an acute event. Pembrolizumab has caused cases of acute myocarditis requiring discontinuation of therapy. As for the origin of the thrombosis the causes are not clear, it could be an effect of left ventricular dysfunction for myocarditis but it cannot be excluded that it is secondary to the use of one or both chemotherapy drugs.