bluuebunny/crossref_metadata_2025_split huggingface dataset:
P228 WEARABLE DEFIBRILLATOR IN CLINICAL PRACTICE. MULTIANNUAL MULTI–CENTER EXPERIENCE
Authors: Solarino G , Bartoli C , Talini E , Del Meglio J , Lilli A , Baratto M , Della Tommasina V , Canale M , Arena G , Casolo G 
Published: May 2022

Abstract

Introduction
Heart failure with reduced left ventricular ejection function (LVEF) represents a life–threatening condition for patients (pts). A period of time of 40–90 days, in optimal medical therapy, is indicated to evaluate the recovery of the LVEF and the indication to ICD implantation. In this period, from 1% to 5% of pts can experience sudden death. We evaluated the usefulness of the wearable cardioverter defibrillator (WCD) as a temporary antiarrhythmic therapy in the interval from discharge to the three–month follow–up.

Methods
From December 2015 to December 2021, 174 consecutive pts (141 M (81%); mean age 62 years ± 11.6 years) were discharged with reduced FE &lt; 35% in OMT, with WCD and were re–evaluated within 3 months to establish indication for ICD implantation.

Results
110 pts (63.2%) recovered LVEF at 3 months and left the indication to ICD. 9 pts refused and/or returned the WCD due to poor compliance (5.2%); 52 pts (29.9%) did not recover LVEF and were implanted with ICD. The WCD was worn continuously by the majority of pts with good compliance for 87.4 ± 52.0 days (range 1 ÷ 303 days), for 22.08 hours / day. 23 episodes of AF were correctly recognized; 10 TVNS&gt; 10 sec; 1 episode of VF in 1 patient in which 1 shock was correctly delivered. 1 inappropriate shock was delivered on tachycardic AF. During the WCD wearing period, 3 deaths occurred (1.7%): in 2 pts due to refractory HF (one of these pts had VF correctly recognized and treated by the WCD but degenerated into pulseless activities); 1 death for terminal cancer). The use of WCD has progressively increased over the years (from 4.5 LV / yy in 2015–16 to 45 LV / yy in 2020–21).

Conclusions
The use of WCD has gradually increased in clinical practice for patients who have not yet developed clear indications for ICD implantation. In the majority of them, ventricular dysfunction is transient. Wearable cardioverter defibrillator represents additional security during this period. Continuous monitoring makes it possible to identify supraventricular and ventricular arrhythmias, improving therapeutic appropriateness and in general the patients have excellent compliance with the device. Further studies are needed to substantiate this strategy.
P235 CLINICAL AND INSTRUMENTAL CORRELATES OF LEFT AND RIGHT ATRIAL TWO–DIMENSIONAL STRAIN MEASUREMENTS IN PATIENTS WITH HEART FAILURE
Authors: Diomede N , Terazzi E , Correale M , Di Terlizzi V , Barone R , Manuppelli V , Brunetti N , Iacoviello M 
Published: May 2022

Abstract

Background
The two–dimensional strain obtained through Speckle Tracking Imaging (STI) represents an innovative, rapid and semi–automatic echocardiographic method to study systolic and diastolic function. By analyzing the deformation of cardiac segments, it provides an indirect index of myocardial contractility and relaxation of left and right ventricles, but also of both left and right atria.

Purpose of the Study
The aim of this study was to evaluate the clinical and instrumental correlates of the different measures of right and left atrial strain in a group of patients with chronic heart failure (CHF). Method. We enrolled 165 out patients with CHF (63 ± 14 years, 76% male, 39 ± 11% ejection fraction). All patients underwent a cardiological examination, ECG and echocardiogram. The echocardiographic images were analyzed using an innovative software (TomTec, Philips) able to semi–automatically analyze both the ventricular and atrial strain. For each patient, both for the left atrium (LA) and the right atrium (RA), the measures related to all atrial functional phases were calculated: reservoir (r), conduit (cd) and contraction (ct).

Results
At univariate and multivariate logistic regression models, the main determinants of atrial strain measurements were evaluated. As shown in the Table, both for the RA and LA the reservoir and conduit were more closely associated with ventricular systolic function and age. LA contraction was associated only with E/e‘ and heart rate, whereas for the RA one there was no independent statistical association with the parameters studied.

Conclusions
The Strain parameters that evaluate right and left atrial function have an independent association with different clinical and instrumental variables. These results support the hypothesis that the reservoir and conduit measurements express a different physiological and pathophysiological substrate than the contraction measures.
P240 SHORT–TERM EFFECT OF SGLT2I ON ECHOCARDIOGRAPHIC PARAMETERS IN HFREF PATIENTS TREATED WITH ARNI
Authors: Mazzetti S , Cannistraci R , Scifo C , Acone L , Alonge S , Foti M , Tarantini R , Lattuada G , Perseghin G , Mortara A 
Published: May 2022

Abstract

Background
Treatment with Sacubitril / Valsartan (ARNI) in patients with heart failure and reduced ejection fraction (HFrEF) promotes significant improvement of left ventricular remodeling along with positive outcomes in terms of hospitalization for heart failure, quality of life and mortality. In a previous study we demonstrated that ARNI significantly modifies myocardial longitudinal strain (GLS), one of the most reliable markers of myocardial contractility. It is still debated whether this effect remains unchanged regardless of the presence of diabetes and if it can be further increased by SGLT2 inhibitors, which in turn have been shown to reduce hospitalizations for heart failure and cardiovascular mortality.

Purpose
of this ongoing study is to measure, in HFrEF patients with or without T2DM, treated with ARNI and SGLT2i, short–term changes (6 months follow up) of the main echocardiographic parameters, including GLS Methods We enrolled 40 outpatients (32 male, age 65 + 10 years, EF 29,7 + 6,5%) on optimized medical treatment with class I medications, including ARNI at the maximum tolerated dose (starting dose 75 + 15mg, maximum titrated dose 190 + 10mg). Population was then divided into three groups: group 1 (20 pts) without T2DM; group 2 (11 pts) with T2DMI; group 3 (9 pts) with T2DM on SGLT2i treatment (4 with empaglifozin 10 mg, 5 with dapaglifozin 10 mg). No hemodynamic or metabolic complications related with therapy were observed, and no patients needed discontinuation or down–titration of therapy All patient underwent echocardiographic study at baseline and after six–month follow–up.

Conclusions
This ongoing study confirms that, in HFrEF patients, ARNI positively modifies left ventricular contraction and remodeling, and this effect is still verified regardless of the presence of T2DM. The association with SGLT2i, conversely, does not appear to provide further positive benefits on remodeling.
P241 CARDIAC INVOLVEMENT IN CREATINE DEFICIENCY SYNDROME
Authors: Del Franco A , Battini R , Kusmic C , Forini F , L‘ Abbate S , Masotti S , Musetti V , Barison A , Emdin M , Vergaro G 
Published: May 2022

Abstract

Background
Previous reports have demonstrated electrocardiographic and echocardiographic abnormalities consistent with early–stage cardiomyopathy, in patients with creatine transporter deficiency (CRT–D), but cardiac involvement has never been accurately characterized. Our aim was to widen the current knowledge of the cardiac phenotype associated with creatine deficiency in a murine transgenic model and in patients with creatine deficiency syndrome (CDS).

Methods
Wild type (n = 6) and transgenic CRT–/y mice (n = 6) were evaluated in vivo by electrocardiogram (EKG) and echocardiography for six months, and ex vivo by histological and biochemical analyses. Nine patients with CDS (4 with L–arginine:glycine amidinotransferase deficiency – AGAT–D, 5 with CRT–D) underwent blood samples, including cardiac biomarkers, EKG, Holter monitoring, echocardiography and cardiac magnetic resonance (CMR).

Results
Compared to wild–type, CRT–/y mice showed a prolongation of QT interval (p = 0.008) (Fig. 1), as well as a trend of reduction of mitochondrial function (Fig. 2). No differences were dected in the left ventricular systolic function, in terms of ejection fraction and global longitudinal strain, at different times. Aldosterone levels were also not different between the two groups. Three patients with CDS also showed a prolonged QTc interval (median QTc 515 ms), while other 3 had a borderline QTc at Holter monitoring, without tachyarrhythmias. No subject had abnormal systolic and diastolic function. At CMR, an increase of native T1 value was reported in 4 subjects (median 1076 ms), 1 with an increase of extracellular volume matching with the detection of late gadolinium enhancement. Finally, 7 subjects with CDS presented with biohumoral signs of neurohormonal activation (2 with elevated renin, 1 with increased aldosterone and 4 with increased norepinephrine levels). Familiar carriers (3 for AGAT–D and 1 for CRT–D) showed no notable cardiac functional alterations, except for QTc prolongation in 2 AGAT–D carriers.

Conclusion
Prolonged QT interval is observed in a murine model of CRT–D deficiency and in patients with CDS, in absence of an arrhythmic burden. No alterations in cardiac function were detected in the two setting, except for an increase of native T1 in patients with CDS suggesting an interstitial and replacement fibrosis.
P249 365 DAYS OF NOT ONLY COVID–19. DATA COHORT FROM THE HEART FAILURE OUTPATIENT’S AMBULATORY UNITE –IVREA HOSPITAL
Authors: Troiano F , Fornengo C , Almohani A , Grosso Marra W 
Published: May 2022

Abstract
The years 2020 and 2021 will always be remembered as the years of the SARS–Cov–2 pandemic, affecting and utilizing much of the world’s economic and humanitarian resources, especially in the health sector. At the start of 2020, Ivrea Hospital opened a new heart failure ambulatory unit. This unit was quickly set side to face the emerging health emergency of SARS–Cov–2. It was only in September 2020, with the reorganization of the hospital services, that the new unit could once again be used for outpatient visits. For this reason, this paper only covers the analysis of patients in our service from September 2020 to September 2021. During this time, 143 patients with heart failure have been evaluated as outpatients, most of whom were men (114 men, 29 females), with an average age of 70 years. The main reason for admission was ischemic cardiomyopathy (54%), although in 28% of cases the etiology was instead defined as idiopathic, on the basis of the diagnostic investigation performed. All patients had heart failure phenotype with reduced ejection fraction according to the latest ESC guidelines, with an average value of left ventricular ejection fraction of 38%. 24% of the patients received therapy with Sacubitril/Valsartan either introduced or optimized during outpatient’s follow–up. The remaining 44% of the patients (64) had sudden cardiac death prevention devices (ICD) implanted, 43% of whom had cardiac resynchronisation (Biventricular ICD– CRT–D). During the follow–up period, 10 patients died, of whom, one patient due to complications of Sars–Cov2 interstitial pneumonia, one patient due to early complications after LVAD implantation and the remaining patient due to progression of their heart failure condition, in which LVAD/transplantation was previously excluded. One patient underwent a successful heart transplant. The data presented reflect the reality of a medium sized center in the province of Turin and is aligned with what is reported by the scientific literature.
P257 THE IMPORTANCE OF ADMINISTERING A PHYSICAL EXERCISE PROGRAM WITH A NUTRITIONAL INFORMATION SHEET TO PATIENTS SUFFERING FROM CONGESTIVE HEART FAILURE INCLUDED IN A FOLLOW–UP PROGRAM WITHIN A DEDICATED CLINIC
Authors: De Masi De Luca G , Stefanelli S , Longo S , Barba F , Mauro R , Marzo S , Papadia P , Accogli M 
Published: May 2022

Abstract

Background
With this work we wanted to draw attention on the importance of administering a physical exercise path sheet and nutritional information sheet to patients with congestive heart failure (HF) in a FUP path. Materials and methods 164 patients were included in the FUP course dedicated to the HF at the dedicated outpatient clinic of the “Card.G. Panico” hospital in Tricase (Lecce, IT) in collaboration with the “Cardiomed Center” in Maglie (Lecce, IT). During the evaluation of insertion in the FBD, patients were divided according to the risk of events: low, medium and high. To improve adherence, both the patient and his caregiver obtained adequate and detailed information about the importance of the project and its aims. Patients with greater clinical stability, at medium and low risk (102) were divided into two groups. The FUP path was ideal for both, but only in the first (58 Group A) had a sheet with a personalized physical exercise path (PEP) and a sheet with nutritional information (SNI), identifying it as a real additional pharmacological therapy. The aim of the work was to highlight how an education and invitation to carry out physical exercise and an adequate nutritional path can bring benefit by evaluating medium–short term parameters that are weight, Borg scale, BNP, clinical alerts.

Results
The following differences were observed in the group of patients followed in the follow–up of Group A to whom the PEP and SNI sheets were administered compared to group B. – Alert in group A: 10 (7 diuretic therapy correction for OS, 1 access to the ER, 2 coomorbidity corrections) — Alert in group B: 18 (9 correction of diuretic therapy, 4 accesses to the ER, 1 hospitalization, 4 coomorbidity correction) P &lt; 0.05 — BNP group A Δ –122 / group B Δ –188 P n.s. — Borg scale (0/10) Group A Δ + 1.9 / Group B Δ –0.2 P &lt; 0.05 – Weight (kg) Group A –9% / Group B + 1% P &lt; 0.05

Conclusions
Our experience in the clinic dedicated to heart failure has demonstrated the improtance and usefulness of administering a personalized physical exercise sheet to an adequate nutritional path, highlighting the improvement of various parameters such as weight, the perception of effort and the reduction of clinical alerts in the medium–short term.
P301 FULMINANT COVID–19 RELATED MYOCARDITIS: A CASE REPORT
Authors: Parato V , Germana G , Pierantozzi S , Principi T 
Published: May 2022

Abstract

The case
A 58–year–old man presented to ED because of fever, non–productive cough and worsening dyspnea. The patient’s medical history was unremarkable. On examination there was a hypoxic respiratory failure and the clinical picture rapidly evolved towards a cardiogenic shock characterized by altered mental status and cool extremities. Vital parameters: peripheral blood pressure was of 60/30 mmHg, pulse rate of 126 bpm, respiratory rate of 30 breaths/min, temperature of 38 °C. Two episodes of ventricular fibrillation were resolved by electrical shocks. The nasopharyngeal swab tested positive for COVID–19 on real–time reverse transcriptase–polymerase chain reaction assay. Arterial blood gas analysis showed a severe metabolic acidosis with hyperlactacidaemia (pH 7.26, excess basis–22 mEq/L, lactates 10 mmol/dL) and hypoxaemia. Situation evolved towards an end–organ hypoperfusion associated with multisystem organ failure (MOF). High resolution chest CT demonstrated bilateral ground glass opacities consisting of COVID–19 related interstitial pneumonia. 12–leads ECG demonstrated sinus rhythm with diffuse concave ST–segment elevation. T–T echocardiogram showed: 1) severely thickened LV walls; 2) decreased LV systolic function; 3) segmental wall motion abnormalities consisting of akinesis of the LV distal segments with relatively preserved function at the base; 4) LVEF) of 25%; 5) pericardial effusion. Thickened LV walls meant myocardial inflammatory infiltration/edema and the final diagnosis was FULMINANT COVID–19 related MYOCARDITIS. Patient underwent oro–tracheal intubation+invasive ventilation. An intra–aortic balloon pump (IABP) was placed on top of adrenaline (0.07μg/kg/min), and noradrenaline (0.1μg/kg/min) was added for worsening hypotension (systolic blood pressure: 80/67/60 mmHg). Additional therapy consisted of intravenous high dose diuretics, methyprednisolone, tucilizumab, immunoglobulin, ceftriaxone, remdesivir. After 3 weeks, patient recovered a good respiratory and haemodinamic status, LV wall thicknesses decreased and EF increased to normal values. The final outcome was favorable.

Discussion
The prevalence of fulminant myocarditis among COVID–19 patients is unclear. This simultaneous presentation of fulminant myocarditis and COVID–19 pneumonia favors an alternative pathogenetic pathway with possible acute replication and direct dissemination of the virus through the blood or the lymphatic system from the respiratory tract to the myocardium.
P316 TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: A SINGLE CENTER EXPERIENCE
Authors: Gallone G , Bongiovanni F , Bruno F , Scudeler L , Landra F , Andreis A , Casoni R , Fava A , Pidello S , Raineri C , Usmiani T , Alunni G , Conrotto F , D‘ascenzo F , De Ferrari G 
Published: May 2022

Abstract

Background
Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR–CA) remains difficult in this subset.

Methods
Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR–CA based on clinical assessment underwent 99mTc–DPD cardiac scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR–CA in AS, was retrospectively calculated to rule–out ATTR–CA in the remaining patients. Patients were categorized as follow: “ATTR–CA +”: patients with confirmed ATTR–CA at 99mTc–DPD cardiac scintigraphy; “ATTR–CA –”: patients with negative 99mTc–DPD cardiac scintigraphy or a negative RAISE score; c) “ATTR–CA indeterminate”: patients not undergoing ATTR–CA assessment with a positive RAISE score. The characteristics and outcomes of ATTR–CA + and ATTR–CA – patients were compared.

Results
Of 107 included patients, ATTR–CA suspicion was posed in 13 patients and confirmed in 6. Patients were categorized as follow: 6 (5.6%) ATTR–CA +, 79 (73.8%) ATTR–CA –, 22 (20.6%) ATTR–CA indeterminate. Excluding ATTR–CA indeterminate patients, the prevalence of ATTR–CA was 7.1%. As compared to ATTR–CA – patients, ATTR–CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, bifascicular block was more common. No difference in procedural outcomes and 1–year mortality was observed between groups.

Conclusions
Among severe AS patients, ATTR–CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. The procedural and mid–term outcomes following TAVR seems unaffected by ATTR–CA status.
P334 RARE CASE OF PAPILLIFEROUS FIBROELASTOMA ON AORTIC VALVE
Authors: Magnano R , D’Alleva A , Di Marco M , Forlani D , Pezzi L , Vitulli P , Fulgenzi F , Verrengia E , Corazzini A , Paloscia L 
Published: May 2022

Abstract
Cardiac tumors are rare neoplastic processes that can arise from any tissue in the heart. They are divided into primitive (benign or malignant) and metastatic (always malignant). The prevalence of cardiac tumors ranges from 0.002% to 0.28%, of which most are benign. Papillary fibroelastoma is the third most common heart cancer and the most frequent heart valve cancer. We describe the case of a 50–year–old ex–smoker patient with a recent history of recurrent right popliteal – tibial femoral thrombectomy and subsequent percutaneous angioplasty. He arrived in the emergency room for ischemic ulcers and fistulization of the right lower limb, for which he was admitted to the Vascular Surgery Department. The patient came to our observation for appearance during the hospitalization of episodes of chest pain at rest with irradiation to the left upper limb and spontaneous regression. The physical examination, blood pressure, blood chemistry tests, chest X–ray and ECG were normal. Transthoracic and transesophageal echocardiography showed a left ventricle with good contractile function, a tricuspid aortic valve with cusp movement preserved with an oval mass, hypoechoic, with well–defined margins, adhering to the ventricular surface of the right coronary cusp, conditioning insufficiency of mild degree. This image was suggestive for papillary fibroelastoma. In addition, in anticipation of cardiac surgery, a coronary CT was performed which confirmed the presence of an oval, hypodense mass and the absence of significant coronary lesions. The absence of fever, increased inflammation and leukocytosis indices made it possible to exclude an endocarditic origin of the lesion, just as the echocardiographic and radiological characteristics eliminated the suspicion of thrombosis. The patient underwent cardiac surgery via longitudinal median sternotomy, in normothermic extracorporeal circulation (CEC). The mass was then excised, preserving the native aortic valve. Postoperative follow–up with transesophageal echocardiography showed no signs of aortic insufficiency. The postoperative course was uneventful. The histological examination of the lesion confirmed the diagnosis of papillary fibroelastoma. At the follow–up after about 3 years the patient was asymptomatic and without echocardiographic signs of local recurrence.
P342 REAL–WORLD ANALYSIS ON THE ECONOMIC VALUE OF REACHING LIPID TARGET IN ITALY
Authors: Degli Esposti L , Borghi C , Galvani M , Giacomini E , Manotti P , Marra A , Passaro A , Perrone V , Pieraccini F , Sangiorgi D , Navazio A 
Published: May 2022

Abstract
The study aimed to evaluate the healthcare direct costs for Italian National Health System of patients treated with lipid–lowering drugs that do not achieve the low–density lipoprotein (LDL)–cholesterol target compared to those reaching their targets, and to analyze costs according to the distance from LDL target by using real–world data.
An observational analysis was performed on administrative and laboratory data from selected Italian Healthcare Departments. Patients were included if they presented at least one laboratory LDL test between 2012 and 2019 and if they were prescribed lipid–lowering drugs during 6 months prior the last LDL detection (index date). Mean annual direct costs were evaluated in the 12 months before index date in terms of all drugs prescribed, all–cause hospitalizations and all outpatient services. Distance to LDL target was calculated as difference between the index LDL level and LDL target. Total mean annual healthcare direct cost for patients that did not reach LDL target was higher compared to total cost of patients achieving LDL target (€3,678 vs €2,906). Costs were mainly driven by hospitalization (€1,330) followed by drugs expenditure (€1,012) and outpatient services (€563). Mean total annual healthcare costs increased with the distance from LDL target, specifically from €3,004 for patients with 10% distance from LDL target up to €4,823 for those 50% or more distance from LDL target. This trend was particularly evident for the cost item related to hospitalization, that went from €1,486 to €2,819 moving from 10% to ≥ 50 distance from LDL target. Results from this real–world study highlighted the higher economic burden for patients that do not reach the therapeutic LDL target, that tend to rise along with increasing distance from the LDL target. Overall, our findings could suggest that reducing the distance from LDL target could have a positive impact also on the economic outcomes for these patients.