bluuebunny/crossref_metadata_2025_split huggingface dataset:
P265 RED ZONE: 22 MILES OF FIRE. ANALYSIS OF THE TIMING AND PROCESSES OF ELDERLY PATIENTS WITH ACUTE PULMONARY EMBOLISM IN THE EMERGENCY ROOM. THE REAL–LIFE EXPERIENCE OF 5 YEARS IN THE EMERGENCY ROOM
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Muzzi A , Novara E , Fumoso F , Lapia F , Brattoli M , Bressan M 
Published: May 2022

Abstract

Purpose
to describe the role of the emergency room in the diagnostic–therapeutic process of acute pulmonary embolism.

Methods
single–center retrospective observational study, on all geriatric patients (&gt; 75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes.

Results
We enrolled 247 patients, all requiring hospitalization for acute pulmonary embolism. The average age of 83 with female prevalence (63%). Median wait times for medical examination were 42 minutes. The average waiting times, however, for the large number of low priority codes (40% between 5 and 4 codes), was more than 6 hours. All patients required a chest CT with contrast, 44% first did a chest x–ray and 2% an ultrasound. All patients underwent ECG and blood tests. The time spent in the Emergency Department (LOS) was on average 18 hours. 58% of patients were managed in areas of low or medium intensity, 42% were sent to OBI for therapeutic diagnostic completion or necessary monitoring. OBI patients were on average 504 minutes. 56% face the phenomenon of boarding. 34% showed massive EP, 32% showed organ damage. 41% were considered to be at high risk of short–term mortality according to European guidelines, 8% required intensive care and in–hospital mortality was 7.7%. Under triage is 31%.

Conclusions
The population that arrives in ED due to pulmonary embolism presents an overall clinical picture with a high degree and high care and therapeutic complexity. Need for numerous investigations and second level imaging. They often require complex therapies and multi–parameter monitoring during stabilization and observation. Therefore, the time spent in the emergency room is long. The workload to treat these patients is high and requires excellent multi–professional and multidisciplinary integration, especially between the various professional figures in urgency, the laboratory and radiology.
P303 A CASE OF MYOPERICARDITIS AFTER II DOSE COVID 19 MRNA VACCINE IN YOUNG MALE
Authors: Bolognesi M , Iconomu E , Armentano C , Turchio P , Petrini M , Moderato L , Michieletti E , Aschieri D 
Published: May 2022

Abstract
COVID 19 disease caused devasting health consequences from March 2020. The development of effective vaccines against SARs COV 2 is an important weapon to defeat this virus. However rare cases of vaccines complications have been reported including myopericarditis above all in young males that we have to follow strictly and to begin right therapy as soon as possible. Data regarding specific therapy about mypericarditis after COVid 19 vaccine are scanty. We report a case of 16 years old male with no health problems, admitted in emergency department with chest pain relieved by sitting posistion and persistent fever rised 24 h after receiving his second dose of mRNA COVID 19 vaccineA 12 lead ECG showed normal sinusal rhythm without ST changes. On admission the complete blood cells count was normal, PCR was high: 5,92 mg/dl and troponin I at high sensivity was elevated: 9249 ml/L. The patient was hospitalized in our cardiology department with suspected myopericarditis. Ecocardiography TT showed normal left ventricular ejection fraction and no pericardial effusion. We began immediately non steroidal anti inflammatory therapy at high dose (ibuprofen 600 mg x 3/die and colchicine 1 mg/die) with conseguently reduction of chest painfuls symptoms. We also began ACEi therapy. On the advice of of the infectious disease specialist we added in the 5 th day methilprednisolone 25 mg/die in consideration of an excessive acute inflammatory response and we observed a clinical improvement with an indices of inflammation reduction. Cardiac magnetic resonance (CMR) performed after 3 day in T2 weighted images showed intramyocardial and subepicardial hyperintensity localized to the mid and apical lateral, basal infero lateral, distal anterior segment, as myocardial edema. Furthermore after Injection of contrast: subepicardial late gadolinium enhancement in the same segment. Minimum (4 mm) pericardial effusion. The clinical setting was attributable as symptoms, elevated troponin above upper limit of normal, in absence of other identifiable cause of symptoms and findings, to confirmed case of acute myocarditis after vaccine in according to the “CDC case definitions”. Myocarditis after mRNA COVID 19 vaccination affect above all young males with mild and multifocal forms with risks and benefits in favour of vaccines. However we need to identify them for an early therapy. In these setting of myocarditis an early use of corticosteroids can be provided.
P309 A CASE OF POST COVID VACCINE MYCARDITIS
Authors: Gentile G , Busti A , De Carlini C , Meles E , Maggiolini S , Bruni F 
Published: May 2022

Abstract

Background
Myocarditis is an inflammatory disease of the heart muscle commonly caused by viral infections. Vaccines can also cause myocarditis although the occurrence of this side effect is very rare. In the course of the Sars Cov 2 pandemic, there have been myocarditis both related to the virus and related to the anti–virus vaccine (especially related to RNA vaccines).
We present a case of myocarditis from Comirnaty. 23 year old sportsman. In anamnesis only frequent tonsillitis in school age leading him to tonsillectomy at 18 years old. June 2021 1st dose Pfizer vaccine. Next day in ER for fever, headache, nausea, dizziness, abdominal pain. Brain CT: neg; Blood tests: slight increase in Gb 14,200 (109 / L) (neutrophils 88%) which drop the next day to 9,000 and a slight increase in CRP which from 0.19 mg / dl (nv &lt; 0.5) reaches the value of 1.5. Of note a slight increase in CPKs stable in the two samples (CPK 602 U / l –&gt; 652); August 2021 2nd dose of Pfizer vaccine. From 6th to 12th day post vaccine intense headache. Chest pain on the 13th day. In ER ECG with diffuse elevated ST. Trop I 12888 (vn &lt; 50); Echocardium: normal. Trop I peak 45795 ng / l; Bisoprolol 1.25 mg started for a 6–beat TVNS. CardiacMRI: FE 67%, T2–weighted sequences: anterior and lateral intramural hyperintensity, sequences after contrast medium: large areas of late intramural enhacement in the apical and middle anterior wall and in the lateral wall, suggestive for myocarditis. In discharge recommended suspension of competitive physical activity. 3 months later inspection: pz in excellent condition. Echocardium: normal. CardiacMRI: reduction of ventricular volumes (EDV Vsx 187 ml –&gt; 136) (EDV Vdx 227 ml –&gt; 195) areas of intramural fibrosis reduced at the level of the lateral wall.

Discussion
Post vaccine myocarditis cases are rare but more frequent than reported in pivotal studies. The incidence varies according to the different registers. There seems to be an increase in incidence compared to the general population but not compared to the population affected by Sars Cov2. As confirmed by our case, this pathology is more frequent in young men and appears mainly after the 2nd dose. The pathogenetic mechanism of this reaction is still uncertain. The short–term prognosis of the disease is generally benign even if a longer follow–up is necessary in order to observe the evolution of the clinical status over time
P351 “HOLDING AREA AND SHORT STAY HOSPITAL: A NEW MODEL OF ORGANIZATION
Authors: Verde M , Taberini L , Macali L , Stolfi A , Matera S , Gabrielli D , Petrolati S 
Published: May 2022

Abstract
In A.O. San Camillo–Forlanini, dedicated “Holding Areas” (HA) are active. They enable a rapid allocation of patients (pts), avoiding their long stay in the Emergency Department (ER) and therefore reducing the overcrowding. Moreover they allow the optimization of diagnosis and care, thanks to the direct management of specialists and reduce improper hospitalizations. Our HA is committed to receive (except on weekends) 3 pts/day destined to hospitalization in Cardiology. Here the patients are re–examined and quickly undergo to further specific tests, aiming at identifying those who can be addressed to alternative paths (Day Hospital/Day Service) and those who need to be hospitalized. For the latter, the HA allows to select the most appropriate diagnostic/therapeutic path according to the model of the intensity of care: critical area (ICU); ordinary hospitalization; short stay (SHS). In 2020 (with a total of 206 of Cardiology HA opening days, net of the lockdown and summer closure periods) 402 patients from the ER were admitted to cardiology HA. Among those, 20% (81 pts) was assigned to the SHS (availability of 2 beds/day, except for weekends) while another 4.3% (17 pts) was allocated to outpatient care. 52% of SHS pts had ischemic pathology (NSTE–ACS at low risk, CCS – Chronic Coronary Syndrome – with positive stress test, doubtful chest pain with multiple risk factors), 33% arrhythmic pathology (66% tachyarrhythmias, 34% bradyarrhythmias) and 12.6% heart failure (Killip class I–III). The HA reduced the average hospital stay (AHS): for SCA–NSTE, for example, from 5.1 days to 3.6 and the waiting time for diagnostic procedures (for example, for coronary angiography from 1.8 to 0.3 days). The opening of the SHS has further reduced the duration of the AHS: 1.5 nights for the CCS (the need for revascularization was not indicated in 68% of cases); 1 night for tachyarrhythmias (electrical cardioversion in 89% of cases); 3.75 nights for bradyarrhythmias (PMK implantation in 55% of patients). The overall average stay in SHS was very brief (2.5 nights) allowing a rapid turnover even with more difficult procedures. While criticalities persist (limited availability of SHS beds, “short” week opening), the results obtained confirm the need for dedicated and specialized HA in order to reduce improper hospitalizations, trim hospitalization times and broaden the appropriateness of care.
P393 MULTIMODALITY IMAGING IN ACROMEGALIC CARDIOMIOPATHY: A CASE REPORT
Authors: Boccadoro A , Pompei G , Pavasini R , Passarini G , Micillo M , Campo G , Guardigli G , Tonet E 
Published: May 2022

Abstract

Background
Acromegaly is a disease caused by an excessive production of GH. Cardiac involvement, called acromegalic cardiomyopathy, is present in 90% of cases.

Clinical Presentation
A 56–year–old woman with acromegaly from pituitary adenoma, hypertension and obesity undewent angioCT showing thoracic aortic aneurysm (Figure 1). She was referred to a cardiological visit to evaluate the possible presence of acromegalic heart disease. The EKG showed signs of left ventricular hypertrophy (LVH) and so transthoracic echocardiogram (TTE) was prescribed: it showed slightly dilated, very hypertrophic left ventricle with ejection fraction of about 50% and signs of diastolic dysfunction. The exam also highlighted moderate to severe aortic valve regurgitation (Figure 2). In order to better characterize the cardiomyopathy a Cardiac magnetic resonance with contrast media (CMR) was performed: cine images confirmed severe left ventricular hypertrophy associated with mild dilatation, global biventricular hypertrophy and hypokinesia. After contrast media administration, a diffuse mild–enhancement pattern was found, a possible expression of diffuse interstitial fibrosis (Figure 3). In consideration of the dilatation of the ascending aorta and the contextual valve insufficiency, the patient was referred for cardiac surgery outpatient visit.

Discussion
The most frequent manifestations of acromegalic cardiomyopathy are bi–ventricular hypertrophy, the presence of diastolic and systolic dysfunction and the presence of valve regurgitation. Concentric hypertrophy is due to the increase in cardiomyocytes secondary to the GH stimulus and it is often bi–ventricular. Another characteristic finding is diffuse interstitial fibrosis with consequent systo–diastolic dysfunction and heart rhythm abnormalities. Aortic valve anomalies are linked to matrix abnormalities and myxoid degeneration.

Conclusions
this case can be considered an example of acromegalic heart disease. Multimodality imaging plays a key role in the early diagnosis of cardiac involvement and therefore it allows an early start of therapeutic strategy. Additionally, it is useful for the risk stratification of acromegalic patient.
P394 FROM A PET THE FIRST AND UNEXPECTED DIAGNOSTIC ORIENTATION
Authors: Capoferri A , Sanvito R , Aiolfi E , Cinelli F , Pavone A , Canziani F , Rondi M 
Published: May 2022

Abstract

Introduction
Nuclear medicine plays an important role in the diagnosis and treatment of numerous pathologies. In the cardiology field it can be used to obtain a lot of information about ischemic heart disease, infiltrative heart disease and inflammatory and infectious diseases such as endocarditis. The greatest impact in the field of these latter pathologies was obtained using F–fluorodeoxyglucose (FDG) in the study of patients with implantable electronic devices and replaced valves or valve prostheses. In this regard, I report the case of a patient with results of valve tube implantation in which a PET performed to investigate an inflammatory pathology has allowed to make a diagnosis of endocarditis.

Discussion
The case concerns a 66–year–old man subjected to intervention of Bentall for type A aortic dissection (in 2015); chronic aortic dissection remains (Stanford B). Diabetic with chronic renal failure and COPD. Recovered in medicine for low back pain, dysuria and episodes of chills without pyrexia. High inflammatory indices but with urine culture and negative blood cultures performed on isolated febrile peak. CT scan of the chest negative for phlogistic localizations and for intense rachialgia in the suspicion of spondylodiscitis is subjected to total body PET that shows accumulation of radio compound in the first tract of the ascending aorta with greater anterior focality: hyper fixation is associated at the level of the lower limiter of L4 and L5. With these results therefore posed the suspicion of endocarditis for which started to perform transthoracic echocardiogram that did not identify certain pathological elements and transesophageal elements that instead showed suggestive images for endocarditic vegetation in aortic mechanical prosthesis (intravalvular mobile filiform appearance) and on the atrial side of the tricuspid valve (“soft” appearance of large dimensions). It is not associated with valvular dysfunction. After the echocardiographic finding, therapy with daptomycin in addition to piperacillin/tazobactam is initiated and the patient transferred to the infectious diseases department.

Conclusions
Bacterial endocarditis in particular in patients undergoing cardiac surgery or wearing implantable devices is often characterized by unusual clinical presentation as in this case, so it is not excessive to resort to second–level imaging such as transesophageal echocardiography and nuclear cardiology diagnostics.
P405 ALDOSTERONE AND INTERLEUKIN–6: IS IT A NEW ASSOCIATION IN COVID–19?
Authors: Campana P , Ranieri A , Basile C , Forzano I , Perillo E , Ciaramella L , Follero P , Tagliamonte G , Sibilio G 
Published: May 2022

Abstract

Introduction
Several pieces of evidence have confirmed the interleukin–6 (IL–6) activity in the cytokine storm induced by COVID–19 pneumonia. Furthermore, the correlation between serum IL–6 levels and plasma aldosterone has been widely ascertained in patients with primary aldosteronism (PA). Hence, the highest levels of aldosterone may increase IL–6 in COVID–19 patients with PA.

Case Presentation
We reported the clinical case of a 47–year–old woman with severe COVID–19 pneumonia complicated by Guillain–Barré Syndrome (GBS). At admission, the patient presented severe interstitial pneumonia complicated by hypoxemia and respiratory failure, which required mechanical ventilation. Blood tests revealed very high levels of IL–6 (serum IL–6: 402 pg / mL) and its soluble receptor (soluble IL–6 receptor&gt; 1900 pg / mL). In addition, the patient was diagnosed with PA after accidental evidence of right adrenal adenoma, resistant arterial hypertension, severe hypokalemia, and elevated serum levels of aldosterone with a high aldosterone/renin ratio. Therefore, infusion therapy with spironolactone was administered with a rapid improvement of the clinical condition. Later she was diagnosed with acute motor and sensory axonal neuropathy and with the indication of motor rehabilitation.

Conclusions
The higher aldosterone levels in PA could be associated with more severe forms of COVID–19, stimulating the production of IL–6 and its pro–inflammatory effects. Hence, the association between IL–6 and aldosterone may have a synergistic effect in the development of more severe complications such as GBS. The highest aldosterone levels and activity could be also identified in patients with COVID–19 pneumonia and secondary aldosteronism. More studies are needed to evaluate spironolactone therapy in COVID–19.
Familial clustering of unexplained heart failure - A Danish nationwide cohort study
Authors: Glinge C , Rossetti S , Bruun Oestergaard L , Stampe NK , Ravn Jacobsen M , Koeber L , Engstroem T , Torp-Pedersen C , Gislason G , Jabbari R , Tfelt-Hansen J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the European Union’s COST programme under acronym PARQ, registered under grant agreement No CA19137.

Background
Although family history of heart failure (HF) is associated with increased risk of HF, the extent to which a family history contributes to the risk of HF needs further investigation.

Purpose
To determine whether a family history of unexplained HF in first-degree relatives (children or sibling) increases the rate of unexplained HF.

Methods
Using Danish nationwide registry data (1978-2017), we identified patients (probands) diagnosed with first unexplained HF (HF without any known comorbidities) in Denmark, and their first-degree relatives. All first-degree relatives were followed from the HF date of the proband and until an event of unexplained HF, exclusion diagnosis, death, emigration, or study end, whichever occurred first. Using the general population as a reference, we calculated adjusted standardized incidence ratios (SIR) of unexplained HF in the three groups of relatives using Poisson regression models.

Results
We identified 57,845 first-degree relatives to individuals previously diagnosed with unexplained HF. Having a family history was associated with a significantly increased unexplained HF rate of 2.08 (95% CI 1.82-2.38) (Figure 1). The estimate was higher among siblings (SIR 4.82 [95% CI 3.17-7.32]). Noteworthy, the rate of HF increased for all first-degree relatives when the proband was diagnosed with HF in a young age (≤50 years, SIR of 3.60 [95% CI 2.37-5.47]) and having &gt;1 proband (SIR of 2.73 [95% CI 1.14-6.56]). The highest estimate of HF was observed if the proband was ≤40 years at diagnosis (6.12 [95% CI 3.39-11.05]) (Figure 2).

Conclusion
A family history of unexplained HF was associated with a two-fold increased rate of unexplained HF among first-degree relatives. If the proband age was ≤40 years, the risk was six-folded. These findings suggest that screening families of unexplained HF with onset below 50 years is indicated.
Genetics of idiopathic ventricular fibrillation
Authors: Pannone L , Gauthey A , Sorgente A , Monaco C , Bisignani A , Overeinder I , Bala G , Almorad A , Stroker E , Pappaert G , Sieira J , Brugada P , La Meir M , Chierchia GB , De Asmundis C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Idiopathic ventricular fibrillation (IVF) accounts for up to 44% of sudden cardiac deaths (SCD); the diagnostic yield of genetic testing in probands is reported as low as 3%.

Purpose
The aim of this study is to describe the results of genetic testing in IVF from a high-volume center.

Methods
All consecutive patients with IVF and genetic testing were retrospectively analyzed. IVF was diagnosed, following HRS/EHRA guidelines, by means of excluding other causes through clinical, imaging and genetic data. Genetic analysis was performed in all patients with SeqCap v3 for Brugada syndrome and with next generation sequencing HiSeq1500 for other inherited primary arrhythmia syndromes. Genetic variants were classified following ACMG as pathogenic (P)/likely pathogenic (LP) or variants of unknown significance (VUS).

Results
Fourteen patients with IVF were included (Table); an ICD was implanted in all patients. A genetic variant was found in 9 patients (64.3%), 5 patients with a P/LP variant (35.7%) and 4 patients (28.6%) with a VUS variant. Genes mutated with a P/LP variant included: RYR2 in 3 patients and TTN in 2 patients. Genes mutated with a VUS included: MYPN in one patient, SCN4A in one patient, DES in one patient and CACNA1C in one patient. At a mean follow-up of 76 months 5 patients (35.7%) experienced an ICD shock [2 patients (40%) with P/LP variant vs 3 patients (33%) of VUS/no variants, p=NS).

Conclusion
Genetic testing can be useful in IVF; prognosis is modest with a high rate of ICD shock at long-term follow up.