bluuebunny/crossref_metadata_2025_split huggingface dataset:
P302 ENDOTHELIALITIS AS A POSSIBLE CAUSE OF MYOCARDIAL INJURY DURING COVID–19 INFECTION
Authors: Verde M , Nkwenze Kwenze S , Cartoni D , Chin D , Cortese A , Frollano E , Grieco A , Guerrini S , Petrolati S , Taberini L , Macali L , Stolfi A , Di Biase E 
Published: May 2022

Abstract
A 53–year–old woman was admitted for chest pain for over two weeks, fever, dry cough, fatigue and myalgia. Chest pain increased in supine position and inspiration. Nasopharyngeal swab was positive for SARS–CoV–2 RT–PCR assay. Admission ECG displayed mild ST–segment elevation (0,5 mm) in inferolateral leads and echocardiogram showed normal left ventricular volume, mildly decreased left ventricular EF (52%) and no regional wall motion abnormalities. Blood tests exhibited elevated values of high–sensitivity troponin I (818 pg/mL), proBNP (19.190 pg/mL), CRP (42 mg/dL), D–Dimer test (1090 ng/mL) and WBC (13000/uL, N 89%, L 7%). IL–6 resulted slightly increased (18 ng/mL). ECG after 24 hours showed T wave inversion in inferolateral leads. Coronary CT angiography revealed normal epicardial arteries. A new echocardiogram, after five days, showed infero–basal hypokinesia, improved global EF (57%) and minimal pericardial effusion. Aspirin and fondaparinoux were started. Myopericarditis was suspected and high dose steroids were administered. After a few days, symptoms improved and ECG, echocardiographic abnormalities and troponin levels were normalized. At 6 weeks follow–up the patient was asymptomatic, ECG and echocardiogram were both normal. Instead cardiac MRI showed signs of endothelial injury: presence of interstitial oedema in the inferoapical and anteroseptal wall (STIR–T2–weighted), without late gadolinium enhancement. We measured blood levels of endothelial dysfunction markers: soluble ICAM–1, VCAM–1 and von Willebrand factor (vWF). They all resulted elevated as compared to a laboratory pool of normal serum (535 ng/ml, 265 ng/ml, and 1659 ng/ml, respectively). Our case was suggestive of myopericarditis related to Sars–Cov–2, but echocardiogram and MRI did not show signs of myocarditis permanent damage. However MRI showed interstitial oedema and hyperemia, typical signs of endothelial injury. Moreover we found high levels of soluble endothelial adhesion molecules, vWF, ICAM–1 and VCAM–1, likely expression of the microcirculatory endothelial dysfunction due to myocardial endothelialitis.
In conclusion, our case report suggests that, in COVID–19, acute myocardial injury associated with clinical and investigational signs of myocarditis can be due to myocardial endothelialitis rather than true myocarditis and that an early management with anti–inflammatory drugs (steroids) can be particularly beneficial in patients with unexplained elevated cardiac troponin.
P304 CASE OF MYOCARDITIS AFTER COVID 19 VACCINATION
Authors: Pancaldo D , Amoroso G , Armando E , Barbero U , Bassignana A , Battisti A , Bricco G , Cavallero E , Coppolino A , Correndo L , De Benedictis M , Dogliani S , Iacovino C , Moncalvo C , Pavani M , Valeri L 
Published: May 2022

Abstract
COVID 19 has so far found the only barrier in the use of mRNA and viral vector vaccines. Among the rare adverse effects related to mRNA vaccines is myocarditis (4.8 cases per million doses) a disease already found in COVID 19 infection but not in the safety studies of the vaccines. Males not older than 30 years (40% of the total), subjected to the second dose inoculation, are most affected. During our recent clinical practice there was a case of a patient with myocarditis, attributable to vaccination for COVID 19. It was a male, twenty–year–old, non–allergic smoker, subjected to second dose of Pfizer–BioNTech vaccine (BNT162b2). On the fifth day after the inoculation, the patient, already asthenic from the previous days, complained of an episode of oppressive chest pain, which lasted about 15 minutes, which returned, more intense the following night, associated with dyspnea, lasted for hours. When the patient went to the emergency room the pain was in regression and there was good hemodynamic compensation. EKG: sinus rhythm, slight diffuse ST segment elevation, more pronounced in the inferior–lateral leads, slight lowering of the P–R segment. Blood tests: troponin, CKMB and PCR increase, negativity of the molecular test for COVID 19. Echocardiography: normal left ventricle, non–dilated right sections, normokinetic right ventricle, normal valves, pericardial hyper–refraction without effusion, normal diastolic relaxation. In the suspicion of myocarditis, the patient was admitted to our intensive cardiological care. With the high–dose anti–inflammatory and beta–blocker therapy the pain gradually disappeared; never fever; EKG showed progressive ST segment improvement and T wave negativization. Never arrhythmic events. Negativity for all infections with common viral pathogens. MRI: hyperintensity (T2 STIR sequences and late enhancement) in the infero–lateral area. Patient discharged in therapy with lysine acetylsalicylate, to be reduced, associated with pantoprazole, and metoprolol and indicated for outpatient checks. In conclusion, the case presented reflects the scientific literature in the type of patient and in the favorable evolution of the disease.
P307 POST–COVID–19 SYNDROME: CAN IT BE CAUSED BY MYOCARDIAL INVOLVEMENT?
Authors: Cariello F , Boncompagni F , Vozza M 
Published: May 2022

Abstract

Objectives
The main aim of this work is the evaluation of the myocardial activity in recovered SARS–COV–2 patients using echocardiography.

Methods
64 recovered SARS–COV–2 patients (28 men and 36 women) were checked within our premises because of persistent symptoms after the peak phase of the infection. EchocoloDoppler has been exploited for each patient to determine the following indicators of left ventricular activity: Biplane Ejection fraction; Myocardial function by means of global longitudinal strain (GLS), global radial strain (GRS) global circonferential strain (GCS), Analysis of longitudinal and circumferential tracking at the level of the three endocardial, middle and epicardial layers and radial at the basal, middle and apical level; Myocardial Work (MW): Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficency (GWE) e Global Work Waste (GWW); assessment of the mitral E/A and E/E’ diastolic function.

Outcomes
In 4 out of 64 patients (3 women and 1 man) a myocardial dysfunction of the left ventricle was highlighted. In 2 out of 64 patients an EF reduction was discovered, while a reduction of GLS GCS GWE and an increase of the GWW was detected in every patient involved in the study. We did not encountered variations of the tracking gradient concerning the layers of the layers with lower valuesat the level of the epicardial layer and higher values at the level of the endocardial one. Every patient involved in the study was affected by a diastolic dysfunction of 1° grade with E/A &lt; 1 and E/E’ &lt; 12 and they did not present significant stenosis after CT scan or angiography. Two of the 4 patients mentioned above had fibrosis areas as detected through RMN.

Conclusions
We confirm that for patients with persistent symptoms after SARS–COV–2 recovery echocardiography assessment is recommended to exclude potential damages. Assessing the functioning status by strain analysis is important to confirm damages, mainly for patients where the EF activity is not significantly varied. The identification of early or soft myocardial damages is key to start treatments and schedule follow–up analysis.
P369 BIOCIRCUIT®: A NEW SYSTEM FOR IMPROVING EXERCISE CAPACITY IN PATIENTS WITH CARDIOVASCULAR DISEASE
Authors: Lordi R , Veronese S , Beggi G , Grazzi N , Piccinini A , Sammali A , Tesini M , Cervellati D , Grazzi G , Capucci A , Pasanisi G 
Published: May 2022

Abstract

Introduction
Cardiovascular diseases is one of the most important public health problems; are among the main causes of morbidity, disability and mortality. Those who survive to an acute form become chronically ill with repercussions on the quality of life and on the economic and social costs. Secondary prevention through an intervention aimed to modify risk factors, in particular the sedentary lifestyle could be effective in the improvement of functional abilities. In this observational study carried out at the ABCardio company in Bologna (Italy), a personalized program of Physical Activity was performed through the innovative Biocircuit technology (Technogym®), on outpatients with a prevalent diagnosis of chronic ischemic heart disease.

Methods
We have analyzed 31 patients (M / F, 25/6) with a mean age of 61 years, and BMI of 26.4 kg / m2. Patients followed a two–month personalized physical activity program consisting in functional assessment at baseline (T0) and at the end of the program (T1) and of 2 weekly training sessions. Evaluation included: lower and upper limb isokinetic test to measure muscle strength, 500–meter moderate walking test to estimate maximum oxygen uptake (VO2max).

Results
The results obtained from the comparison between T0 and T1 in the 31 patients in study show significant improvements in the muscle strength of the lower limbs: Leg press +32.9 kg (p = 0.0003), Leg curl +11.8 kg (p &lt; 0.0001), Leg extension +15.8 kg (p = 0.0002); as well as in upper limb muscle strength: Low Row +10.5 kg (p = 0.0005), Chest press +5.7 kg (p = 0.0007), Shoulder press +6.2 kg (p = 0, 0005). Estimated VO2max was also significantly improved from 26.2 mL / kg / min (T0) to 36.3 mL / kg / min (T1), with a mean increase of 10.1 mL / kg / min (p = 0, 0001). No adverse events occurred during supervised training sessions.

Conclusions
The program, safe and well tolerated by the patients in study, has proved to be effective in increasing exercise capacity in terms of both muscle strength and aerobic capacity. This secondary prevention intervention can be considered useful in reducing residual cardiovascular risk as it induced a significant increase in VO2max.
P371 1 YEAR OUTCOME OF BICARBON AORTIC MECHANICAL VALVE IN LOW–INR REGIMEN: RESULTS FROM SURE–AVR REGISTRY
Authors: Santarpino G , De Feo M , Menicanti L , Corbi P , Nobre A , Scardone M , Luo W , Rajakaruna C , Nicoletti A , Atzeni F , Torella M 
Published: May 2022

Abstract

Background
The drawback of using mechanical valve is lifelong anticoagulation use, and close monitoring is required to prevent postoperative complications, including thromboembolism and anticoagulation–related bleeding. Moderate anticoagulation after mechanical heart valve replacement has been proposed to reduce these risks. The present study aimed to evaluate the safety and feasibility of reduced oral anticoagulation after Bicarbon aortic mechanical valve replacement.

Methods
SURE–AVR is a propsective, multinational registry of patients undergoing aortic valve replacement. Between July 2018 and October 2020, among subjects undergoing AVR with Bicarbon valve in the SURE–AVR registry, 108 were assigned at discharge to low–INr regimen (international normalized ratio 1.5–2.5). Mean INr at discharge was 1.8+/–0.5 and 2.2+/–0.4 at 1 year. in–hospital and post–discharge outcomes up to 1 years were collected. The mean age was 55.5 +/–10.6 years old (range 25–82). Concomitant procedures included coronary artery bypass grafting (14.6%), mitral valve procedure (3.7%) and myectomy (1.9%). The follow–up duration averaged 1 year (361.8 +/– 258 days).

Results
No bleeding events were reported in the late follow up. The low–INR regimen did not affect the thromboembolism rates, since no stroke or transient ischemic attack were reported post–operatively at each time point. No in–hospital or late deaths were reported among the 108 subjects analyzed. In the early period (&lt;30 days), three reinterventions occurred: two because of postoperative bleeding requiring thoracotomy and one due to pericardial effusion. In the late postoperative period two reinterventions with device explant occurred (one for non–structural valve dysfunction and one for endocarditis (1.2%).

Conclusion
The results of the SURE–AVr Registry demonstrated that the proposed Lower–INR Target is safe and feasible after Bicarbon aortic mechanical valve replacement. The low–intensity anticoagulation strategy is associated with a low risk of hemorrhagic events without any increase of thromboembolic complications.
P378 CARDIAC DEATH AND NURSING CARING: A LITERATURE REVIEW
Authors: Canestrale R , Camilloni S , Lizzadro A 
Published: May 2022

Abstract

Background
Brugada syndrome is a genetically determined disease that predisposes to the risk of malignant ventricular arrhythmias and can cause sudden death in young adults with structurally healthy hearts. Currently the main treatment consists in the implantation of the defibrillator (ICD) but new therapeutic profiles emerge from the literature.

Objective
To redefine the recommendations on early diagnosis and treatment of brs (Brugada syndrome). Provide an overview of the orientation and new clinical pathways emerging from scientific literature

Materials and Methods
A critical review of the literature was conducted, on the major MEDLINE data bases through PUB MED, CHINAL, COCHRANE LIBRARY and Google schoolar to narrow the search we used mesh terms from the thesaurus library. RCT, meta–analysis, systematic and scoping reviews in English published in the last 5 years for a total of 31 articles

Results
we estimated an average value of brs in young subjects (between 35 and 65 years) of about 9300 cases per year (∼ 17% of the total): the causes of the phenomenon vary greatly: in older subjects the pathology is more frequently associated with arrhythmic disorders. The review identified ICD implantation as a Class 1 indication in individuals who survived cardiac arrest and had ventricular tachycardia with or without syncope. The radiofrequency ablation technique, on the other hand, involves a preliminary electrophysiological study to identify the epicardial arrhythmogenic substrate. Therefore it seems that epicardial ablation will currently serve as an adjuvant rather than a real alternative to the ICD implant

Conclusions
Currently, no drug therapy can prevent sudden death in patients with brs some drugs are very effective in reducing symptoms or treating arrhythmias induced by ICD, therefore defibrillator implantation associated with different levels of therapeutic education is recommended, Early diagnosis with radiofrequency ablation technique that actually produces a realignment of the ST tract but in fact does not reduce arrhythmogenic events from the results there are no solving techniques other than the ICD impaction. Therapeutic education is an absolutely effective tool to improve the management of ICD–carrying patients with brs.
P381 A CHALLENGING PACEMAKER IMPLANTATION IN THE PRESENCE OF A GIANT RIGHT CORONARY ANEURYSM COMPRESSING THE RIGHT ATRIUM
Authors: Maffè S , Paffoni P , Bergamasco L , Facchini E , Prenna E , Careri G , Franchetti Pardo N , Paino A , Dellavesa P 
Published: May 2022

Abstract
Giant coronary artery aneurysm is an uncommon disease, treated with surgerical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential haemodynamic effects and may cause problems when we need to implant a cardiac device. We present a 85–year–old patient, with a previous myocardial infarction and double coronary artery bypass graft in 1995. In 2013 he was hospitalized for heart failure and severe mitral insufficiency, with cardiac surgery indication. Preoperative coronary angiography revealed a giant right coronary aneurysm (65x75mm). The aneurysm was partially thrombosed and in close contact with the posterior sternal wall; it was decided to treat it by coil embolization in order to avoid damage during the initial stages of cardiac surgery (sternotomy and isolation of the pericardium). Subsequently, the replacement of the mitral valve with a bioprosthesis was performed without complications. In 2019 a chest CT scan, in an asymptomatic patient, showed an enlarged coronary aneurysm (85x90mm), completely thrombosed, compressing the right atrium, for which a conservative approach was maintained. The patient was hospitalized in May 2021 following 3 syncopes, with cranial trauma. The EKG shows sinus rhythm with first degree AV block and complete left bundle branch block. Chest CT confirmed the aneurysm, unchanged from 2019 (Fig 1). Transthoracic and transesophageal echocardiography confirmed compression of the mass on the right atrium, reduced to a very small cavity (Fig 2). A stress echocardiogram with dobutamine, performed to evaluate a possible hemodynamic effect of atrial compression, showed no changes in diastolic ventricular filling, arrhythmias, pressure drops, or significant symptoms. Based on these assessments, the syncopes and EKG changes, we implanted a VVIR ventricular pacemaker. The procedure was hampered by the difficulty of passing the lead through the compressed right atrium in order to reach the tricuspid plane and then enter the right ventricle; only after numerous attempts, and with the help of simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure without complications (Fig 3). This case demonstrates the usefulness of the echocardiogram, in particular contexts, in cardiac electro–stimulation procedure
P396 OUR CERTIFIED SYNCOPE UNIT EXPERIENCE; FROM DIAGNOSTIC APPROPRIATENESS TO DEVICE IMPLANTS, FROM PATIENT EDUCATION TO THE IMPACT OF THE COVID–19 PANDEMIC. REPORT ON TWO “DIFFICULT” YEARS
Authors: Scapinelli M , Boccedi M , Guerra A , Caputi A , Merighi S , Bagni E 
Published: May 2022

Abstract
Syncope is a frequent medical problem with an incidence of about 6.2/1000 people/year, with important impact on the patients quality of life and often difficult to diagnose and manage; in this regard, the Syncope Units certified by the Italian Group for the study of syncope were created. The following describes our experience over the last 30 months characterized by significant difficulties due to the COVID–19 pandemic. Our Syncope Unit, included in the OU of Cardiology, includes 3 doctors, 3 cardiology technicians, 2 nurses; the activity is three times a week in terms of clinic and HUTT (Head up tilt test). In 2019, 54 HUTTs were performed on patients with an average age of 67 years 50% male, with indication of vasovagal syncope (VVS) for 78% of cases, presyncope and other indications for the remaining 21%, requested by other services. The HUTT was positive for cardioinhibitory and sinus–carotid syncope with indication for Pacemaker implantation (with closed loop stimulation algorithm – CLS) for 22% of cases. In 12% of patients, an ECG–Loop recorder (ILR) was indicated, but 42% of these refused this procedure. In 2020, 32 HUTTs were performed, the same average age, with 86% indication of VVS syncope. The indication for a pacemaker implant was 15% as well as for an ILR implant. 33 to 38% of patients were educated, providing dedicated material, on the prevention of syncope. About 4% of patients refused to undergo the HUTT after the explanation of its performing modalities. The first 6 months of 2021 showed a similar trend to that of 2019. The data show a good appropriateness of the indications to the HUTT and a subsequent PM implantation rate similar to the data available in the literature. The device with CLS has shown benefits in reducing syncopal recurrences at 6 months by over 25%; only 3% of the ILRs were followed by PM implantation. The HUTT, despite of low sensitivity and specificity, is confirmed as a valid VVS characterization tool but sometimes the patient frightened by its performing methods. The COVID–19 pandemic significantly impacted our activity, related to the outpatient in office activities stop and to the shift of operators in COVID areas. We had a 40% reduction in visits and HUTTs performed with consequent missed and/or delayed diagnoses.
P416 A NOT–SO–RARE COMPLICATION OF CONNECTIVE TISSUE DISEASE
Authors: Bonadies D , Palumbo R , La Manna M , Santopietro M , Sorvillo G , Visco V , Vigorito F , Ciccarelli M , Galasso G , Vecchione C , Soriente L 
Published: May 2022

Abstract
Pulmonary hypertension is a not–so–rare complication of connective tissue diseases and is usually related with an inauspicious prognosis.We present the case of a 67–years–old woman hospitalized for progressive dyspnea. Two–dimensional echocardiography showed numerous features related to pulmonary hypertension (PH) with moderate Mitral Regurgitation. The right cardiac catheterization confirmed mixed PH (pre and post capillary) without chest angio–TC evidence of pulmonary thromboembolism. Thanks to optimized medical therapy (B–Blocker, ACE–i and diuretics), there was a significant clinical improvement documented at discharge. After 1 year, due to recurrence of dyspnea, she was admitted to our medical unit. Her clinical examination showed some of the characteristics of a connective tissue disease. Compared to previous echocardiography, a moderate to mild reduction of MR was documented. Chest CT scan revealed interstitial lung disease likely related to patient’s underlying pathology. Immunological screening tests detected the presence of antinuclear (ANA) and anti–topoisomerase (ATA) antibodies. Right heart catheterization documented a worsening of PH with only pre–capillary component. On the basis of the above findings, a diagnosis of CREST syndrome complicated with PH was made, and the patient was started on oral combination of macitentan and riociguat. The frequency of this complication in connective tissue disease, the need for screening tests and different treatment approaches of pre and post capillary pulmonary hypertension is discussed.