bluuebunny/crossref_metadata_2025_split huggingface dataset:
C82 PROCEDURES AND DEVICES FOR CALCIUM TREATMENT IN AN INCREASINGLY COMMON SCENARIO: YOUNG ONCOLOGIC PATIENTS
Authors: Demola P , Bosi D , Musto D‘Amore S , Tarantini L , De Francesco V , Romagnoli F , Colaioiri I , Pignatelli G , Navazio A , Guiducci V 
Published: May 2022

Abstract

Background
Cardiovascular disease and cancer have a high prevalence in Western countries, sharing many risk factors: obesity, diabetes, cigarette smoking, advanced age, diet and sedentary lifestyle. There is growing evidence that patients with ischemic heart disease (CAD) have a higher risk of developing cancer and, conversely, patients with a history of cancer are exposed to a higher incidence of CAD. In particular, cancer and its related therapies may promote the process of atherosclerosis, often with high calcific burden.

Case Report
This is a case of a 58 years old gentleman with a past smoking habit. Unfortunately from 2019 he was diagnosed by a stage IV lung adenocarcinoma, actually in 3rd line therapy: Carboplatin–Alimta, Atezolizumab and Paclitaxel weekly; no metastatic localizations was found at follow up CT scan. Last July, the patient complained of breath fatigue during exertion. At a complete cardiologic examination EKG was normal, and severe aortic stenosis was detected with concentric left ventricular hypertrophy, preserved ejection fraction. At CT scan, the aortic valve was confirmed as bicuspid Sievers type 0 (Figure 1, panel A). Vmax was 5.49 cm/s, max gradient was up to 120 mmHg, and medium gradient was 67 mmHg, as shown in Figure 1, panel B. Coronary angiography showed a very severe, focal, concentric calcific lesion of the left anterior descendant branch (Figure 2, Panel A). The patient was then referred to our local Heart Team and due to his oncological condition with prognosis &gt;12 months, we decided to treat him percoutaneously. Aortic stenosis was treated Transcatheter Aortic Valve Implantation (TAVI) a few days later: predilatation, implant of a with a balloon–expandable valve Edwards Sapien 3 n°23 and post–dilatation, by femoral access (Figure 2, four steps of TAVI). Coronary lesion was uncrossable with the lowest profile balloons, so rotatripsy was perfomed: rotational atherectomy followed by 40 pulses of lithotripsy with Shockwave (Figure 2, Panel B and C). Everolimus eluting stent 3.00 x 23 mm was implanted and optimized (Figure 2, Panel D). Conclusion Recent devices and techniques in Invasive Cardiology allow percutaneous therapies for patients with time–dependent diseases, such as patients with advanced lung adenocarcinoma. Lately, oncological therapies for this type of lung cancer are very promising, allowing the combination of interventional procedures capable of further increasing the prognosis of these patients.
C85 IMPACT OF QUARANTINE ON CARDIOVASCULAR RISK FACTORS
Authors: Castello L , Di Fusco S , Leggio M , Alonzo A , Aiello A , Imperoli G , Colivicchi F 
Published: May 2022

Abstract

Background
Pandemic–related quarantine has led to critical lifestyle changes with possible detrimental consequences on health. The effects of lockdown on cardiovascular (CV) risk factors have been investigated to define patient–tailored strategies aimed at reducing the negative impact on CV health.

Methods
We administered a closed response survey to consecutive patients coming to our cardiac outpatient centre over a period of 10 days. Questions focused on quarantine–related lifestyle changes during March and April 2020.

Results
We enrolled 150 patients (62% male, mean age 65 years). The vast majority of subjects (73%) did not work due to retirement/unemployment, 14% worked in office and 13% worked from home. 50% had hypertension and/or diabetes and/or dyslipidemia, 33% had atrial fibrillation, 17% coronary artery disease, 6% had heart failure and 4% had a pacemaker/ICD implanted. Physical activity did not change for 44%, increased in 2%, decreased in 33% and was stopped in 21%. Dietary pattern remained the same in 73% while 22% consumed more junk food and 5% more healthy food. Body weight was not monitored in 35%, remained unchanged in 32%, increased in 28% and decreased in 5%. Among active smokers (22%), 86% reported higher cigarette consumption while 14% reduced/unchanged number of cigarettes per day. Sleep disorders were present in 73%. Regarding health needs, 16% had to reschedule medical check–ups due to personal choice or hospital unavailability.

Conclusions
Quarantine appeared to have different effects on CV risk factors. During lockdown, on–site work was limited, which may partially account for the observed lifestyle changes. Physical activity was reduced/interrupted in more than half of the population, whereas dietary pattern did not change in the vast majority of subjects, with only a small proportion reporting worse dietary habits. Body weight increased in only a minority of subjects, though this may be underestimated because most participants did not monitor their weight. Cigarette consumption was higher for the majority of active smokers. Similarly, sleep disorders were present in the vast majority of subjects. To conclude, consistent with current literature, our real–world data confirm that quarantine seems to have affected lifestyle habits defining CV risk profile differently. A patient–tailored approach should be implemented to minimise possible detrimental effects of quarantine on CV health.
C86 TAKO–TSUBO SYNDROME IN PATIENTS WITH COVID–19: A SINGLE CENTRE RETROSPECTIVE CASE SERIES
Authors: Alonzo A , Di Fusco S , Castello L , Spinelli A , Altamura V , Mocini D , Imperoli G , Colivicchi F 
Published: May 2022

Abstract

Background
COVID–19 presents with a wide range of symptoms, from mild flu–like complaints to severe acute respiratory distress and cardiovascular complications. Recent literature provides some case reports of Tako–Tsubo syndrome (TTS) in COVID–19 patients. However, its prevalence, pathophysiological mechanisms and prognostic impact in this setting is unknown.

Methods
We collected data of patients hospitalized for COVID–19 in our multidisciplinary COVID–19 department who had a diagnosis of TTS during hospitalization. The criteria for hospital admission were: 1) naso–pharyngeal polymerase chain reaction diagnosis of SARS–CoV–2 infection and 2) symptoms and signs of mild–moderate COVID–19 with a paO2/FIO2 ratio &gt; 200. The period of the study covered the second and third wave of the pandemic in Italy.

Results
Of 635 patients admitted to our centre, we had four cases, two males and two females, with TTS associated with COVID–19. No patient had any classical trigger for TTS except for COVID–19. Mean age was 72 years (67–81) and all patients had a diagnosis of SARS–CoV–2–related interstitial pneumonia confirmed by computed tomography. One patient was admitted to our centre after stabilization of a critical respiratory distress syndrome that required intubation. All patients showed typical apical ballooning with a transitory reduction of left ventricle (LV) systolic function. The mean LV ejection fraction (LVEF) at TTS onset was 42% (40–48%). ECG showed ST–segment elevation in two cases, while an evolution with negative T waves and long QTc was observed in all patients. All patients were treated in the intensive care unit (ICU), with a median ICU stay of 9 days. The long ICU stay duration was due to intercurrent superinfections. All patients recovered a normal LVEF before discharge. The mean value of the high–sensitivity troponin T peak was 1092 ng/L. Three patients underwent coronary angiography. One patient needed vasopressors in the acute phase. Two patients had a previous diagnosis of cognitive impairment. The time interval from hospital admission to TTS onset was 4 (2–6) days, and the time interval from COVID–19 symptom onset to TTS diagnosis was 10 (8–12) days. The mean hospital stay was 32 days (26–37).

Conclusion
COVID–19 may be a trigger for TTS. Possible mechanisms to explain the contribution of COVID–19 to TTS development include the activation of the inflammatory cascade, direct myocardial injury, and stress–related conditions due to COVID–19.
P7 HEMODYNAMIC DEVICE BASED SENSOR TO CRT OPTIMIZATION
Authors: Covino G , Ciardiello C , Covino S , Sibilio G 
Published: May 2022

Abstract
Cardiac resynchronization therapy (CRT) is an effective and established therapy for patients with medically refractory heart failure (HF), left ventricular (LV) ejection fraction ≤ 35%, and a wide QRS complex; CRT obtained notable results but there is a not negligible rate of patients considered clinical and/or instrumental non responder. Amongst several factors that could adversely affect response, suboptimal optimization of the atrioventricular (AV) timing is the most common and most supposed correctable variable to achieve optimal outcome from CRT. All companies have a specific algorithm to obtain an automatic optimization of AV timing, among these Microport has developed a different approach to perform this automatic optimization based on a hemodynamic sensor. The SonR sensor, embedded in the tip of an atrial pacing lead, is able to perform automatic optimization recording mechanical vibration generated by cardiac contraction. The aim of the present study has been to correlate the variability of AV interval, automatically programmed by SonR sensor, with echocardiographic response. 57 patients eligible for CRT–D implantation were included in the study, for all patients programmed follow–up were performed at 6 and 12 months. We have defined three different CRT response classes: Responder A with LVESV reduction &gt; 15%, Responder B with LVEF &gt; 40% and Responder S (Super Responder) if the patient was at the same time Responder A and B. At 12–month follow–up we recorded the following results: Responder A = 69%, Responder B = 59% and Responder S = 55%. In all patients we decided to analyse the variability of the A–V timing controlled by SonR algorithm, we used the coefficient of variation (CV) that appears to be among the most widespread and validated in the literature. The highest values of the CV index are significantly correlated to RESP S and RESP A patients compared to the relative groups of non–responders. In conclusion, the SonR is able to improve the performance of the CRT in the majority of patients by ensuring a high variability of the programmed AV interval. Furthermore, it has been shown that as the CV index increases, the probability of response to CRT increases.
P24 WEAREBLE CARDIOVERTER – DEFIBRILLATOR : UTILITY AND USER FRIENDLINESS
Authors: Bolognesi M , Rossi L , Biagi A , Coccia M , Sticozzi C , Comastri G , Aschieri D 
Published: May 2022

Abstract

Background
Worldwide, cardiovascular disease are still a major mode of death, being sudden arrhythmic death (SCD)25 % of total death. Implantable cardioverter defibrillator (ICD) is an effective weapon for SCD prevention in high risk patients with reasonable expectation of survival with good functional status for &gt;1 year. However sometimes the risk of SCD can be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered.

Methods
We considered consecutively 40 patients discharged from our cardiology department of Piacenza and Castel san Giovanni that, for potentially transient high risk of SCD, weared a WCD from August 2017 to September 2021, after a systematic education session lasting 30 – 45 minutes. They are followed through remote monitoring.

Results
Out of 40 patients, with average age 66 years old and average left ventricular ejection fraction (LVEF) 29%, 88% were males, 70 % suffered from arterial hypertension, 32% diabetes mellitus, 17,5 % peripheral vascular disease, 35 % chronic renal failure, 55% heart failure, 7,5% previous stroke. 56% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 7% after removal of an infected ICD, 9 % whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 34% after newly diagnosed cardiomyopathy.The patients were discharged in high risk mode of SCD with WCD protection.The average wearing time of WCD was 51 days and 22,98 hours daily. We received 953 trasmissions, with 21 events: 7 ventricular tachicardia, 4 Sopraventricular tachicardia and 5 T wave oversensing .Neither inappropriate shock and neither death were detected .After wearing time and after clinical evaluation, only 52% of patients were subjected to ICD implantation.

Conclusions
In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients, considering wearing time. The WCD allows saving resources with less hospitalization time.
P28 AN OMINOUS FINDING OF BRUGADA PATTERN: FROM PAROXYSMAL ATRIAL FIBRILLATION TO SEVERE TRICUSPID VALVE REGURGITATION
Authors: Di Nicola F , Barile L , Bertelli M , Bertolini D 
Published: May 2022

Abstract
49 years old male, without family history of sudden cardiac death, subjected in 2010 to effective electrical cardioversion for a first episode of paroxysmal atrial fibrillation. In 2013, a new episode of atrial fibrillation subjected to effective pharmacological cardioversion with flecainide and contextual finding of intermittent Brugada type I pattern, confirmed by ajmaline provocation test. Considering the asymptomaticity of the patient and the negative family history of sudden cardiac death, no indication was given to defibrillator implantation. In 2015 the patient performed an Electrophysiological Study, positive for induction of ventricular fibrillation, in the light of which an ICD was implanted. In the following years regular checks of the device were performed, in absence of activations. In 2021, at the annual checkup, rupture of the leads was documented, resulting in a complete extraction and reimplantation of the device. A few days later the patient was admitted to the Emergency Room for chest pain and worsening dyspnea, signs of initial right heart failure and increased inflammatory markers. In consideration of the anamnestic history, the presence of infective endocarditis was suspected, for which the patient was admitted to the Cardiology ward. The echocardiogram showed severe tricuspid valve regurgitation due to complete flail of the septal flap and rupture of first order tendon cord, probably iatrogenic and consequent to the extraction of the leads. FDG–PET was performed, which ruled out the presence of infective endocarditis, and surgical correction of the valvulopathy and definitive ICD explant was indicated. The surgery consisted of plastic repair of the tricuspid valve, implantation of definitive epicardial bipolar electrodes, isolation of the pulmonary veins for atrial fibrillation ablation and removal of the ICD. Brugada syndrome, starting from the 2013 consensus, can be diagnosed in patients who only feature the type 1 pattern, spontaneous or pharmacologically induced, even in the absence of malignant arrhythmias or family history of sudden death. This leads as a consequence to an increase in the number of patients undergoing invasive procedures and interventions even with low arrhythmic risk, being instead susceptible to the complications that such procedures can fatally provoke.
P29 AICD IMPLANTATION IN A PATIENT RESURRECTED FROM CARDIAC ARREST, WITH THE R / T PHENOMENON AT THE HOLTER
Authors: Incampo G , De Luca V , Rizzo D , Bux F , Moramarco M , Pirozzi M , Valecce R , Cassano F , Bonfantino M 
Published: May 2022

Abstract
A 72–year–old woman with hypertension for thirty years, resuscitated from cardiac arrest during prosthetic surgery of the right knee in January 2020, with external heart massage and orotracheal intubation. On examination Holter performed in February 2021, presence of couples and R / T phenomenon with Lown 1B–3–4A–5 class. The patient is subjected to coronary angiography which showed only mild atheroma without stenosis hemodynamically significant of the arterial districts explored. On the Echocardiogram, FE estimated at 60%. Based on the anamnestic data and the feedback from the fifth class of Lown at the Holter, it was decided to implant a dual chamber defibrillator for secondary prevention. The vulnerable point of refractory ventricular notoriously falls below 300 msec and in the clinical case in question there is a comparison to the holter of fifth class of lown with phenomenon R on T and coupling interval of 276 msec. The precocity of the ventricular ectopias is already in itself a risk factor for MI, reinforced in the case of clincio in question from a history of resuscitated cardiac arrest in a hospital setting. Not indicated to ours opinion of the electrophysiological inducibility study, given the positive clinical history and dynamic ECG according to Holter who examines the arrhythmic phenomenon in its spontaneous and natural way of presenting itself in circadian rhythm. The reproducibility in the laboratory with the SEI, of the electrical vulnerability was in fact in the recent years downsized, due to high specificity but low sensitivity, as there is in the clinical reality of patient neurovegetative and biohumoral fluxuonary factors, which favor the induction of malignant arrhythmias and that escape the predictive laboratory analysis. Making the patient safe with the implant of the bicameral AICD resulted from a clinical – diagnostic – instrumental analysis and after extensive discussion by the heart team in our Operating Unit.
P33 SUPRAVENTRICULAR TACHYARRHYTHMIAS AND RECURRENT SYNCOPES AFTER PERCUTANEOUS CLOSURE OF PFO IN A YOUNG PATIENT WITH NO HISTORY OF THROMBOEMBOLISM. IMPORTANCE OF CURRENT GUIDELINES
Authors: Scapinelli M , Campisano M , Bagni E 
Published: May 2022

Abstract
The presence of a PFO (patent foramen ovale) has been associated with cryptogenic stroke in particular in the young adult, sustained by paradoxical embolism. Its percutaneous closure represents a prophylactic treatment. The procedure can involve various post–procedural complications including supraventricular tachyarrhythmias related to the mechanical action exerted by the device. The clinical case presented concerns a 49–year–old woman with a negative cardiovascular history, suffering from headache, who came to the emergency room due to the onset of relapsing episodes of symptomatic cardiopalmus due to dizziness and syncope. The ECG documented the presence of a high–frequency supraventricular tachyarrhythmia treated by external electrical cardioversion as the patient was pale and hypotensive. The laboratory tests were normal as well as the echocardiogram. The patient had undergone, three weeks earlier, percutaneous closure of PFO diagnosed following the finding of brain ischemic areas on magnetic resonance imaging (MRI) performed only to complete the diagnosis of the headache. The patient was then admitted to Cardiology where further arrhythmic relapses occurred, including a 2:1 atrial flutter treated effectively with amiodarone, a drug then introduced orally. Given the recent interventional procedure, pharmacological prophylaxis of arrhythmias was opted for, with benefit as the episodes have progressively reduced in terms of frequency and intensity. At two–months FU the patient reported only two episodes per week until complete regression, after a further 4 months. This allowed the suspension of amiodarone. Several studies and the latest guidelines indicate PFO closure in the case of stroke in patients under the age of 60 clearly correlated with paradoxical embolism; in our case, the procedure was performed after the occasional finding of ischemic micro–areas on MRI considered secondary to PFO in the absence of multidisciplinary cardiological–neurological evaluation and in a symptomatic patient only for headache. The patient had significant arrhythmic complications that had an important impact on her quality of life, also from a psychological point of view, for at least 6 months. Compared to the past, current guidelines have filled a gap that often led to “lightly” performing procedures whose complications can be really important.
P34 ASYMPTOMATIC VENTRICULAR PRE–EXCITATION WITH DISAPPEARANCE DURING EXERTION: ALWAYS AN INDEX OF BENIGNITY?
Authors: Barengo A , Parise A , Notaristefano F , Sforna S , Padoan L , Bernardini G , Notarianni G , D‘ammando M , Zingarini G , Cavallini C 
Published: May 2022

Abstract

Introduction
The disappearance of pre–excitation at high heart rates points to a low arrhythmic risk: why resort to electrophysiological studies anyway?

Clinical Case
L.S., a 12–year–old patient, performed an ECG for sports examination with evidence of ventricular pre–excitation from an asymptomatic left lateral accessory route (Fig. A). A 24 h ECG–Holter during training showed the disappearance of the pre–excitation at high frequencies (Fig. B) which is considered a low risk index. The patient underwent a transesophageal electrophysiological study (SETE) during which an effective refractory antegrade period of 228 ms of the pathway was objectified through atrial extrastimuli (*) (Fig. C: drive of atrial stimuli (*) followed by extrastimulus with conduction on an accessory route (E)). In addition, a 1: 1 conduction was observed on the atrial pathway up to at least 270 bpm (222 ms). The antegrade refractory period of the resting path was &lt;250 ms and therefore identified a high–risk condition to be treated with ablation.

Discussion
The disappearance of pre–excitation at high heart rates is usually considered indicative of an accessory pathway with a long refractory period and therefore at low risk, however it must be sudden. According to European guidelines, the execution of invasive studies in asymptomatic patients who are employed in high–risk jobs or competitive sports has a class I B indication, but in the remaining asymptomatic cases the indication is IIa B. The Holter ECG alone or the stress test, with a careless evaluation of the disappearance of the pre–excitation (sudden vs progressive with minimal residual pre–excitation) would have erroneously led to labeling this accessory pathway at low risk. In the left lateral accessory pathways, with the increase of the HR, there can be a disappearance or pseudo–disappearance of the pre–excitation for anatomical reasons (being further away from the SA node) and for an increase in the AV conduction speed, not therefore for a long refractory period of the pathway. SETE is closer to the atrial side of the left accessory pathway and allows to correctly classify the risk.

Conclusion
SETE is a low–cost and minimally invasive method that should be considered as an integral part of the study of patients with asymptomatic ventricular pre–excitation even if non–invasive stratification indicates low risk.