bluuebunny/crossref_metadata_2025_split huggingface dataset:
P270 TELL ME HOW LONG WILL YOU STAY … TELL ME HOW LONG HOW LONG … ANALYSIS OF THE DURATION OF HOSPITAL STAY (HOSPITAL LENGTH OF STAY) OF ELDERLY PATIENTS WITH EMBOLISM: EXPERIENCE OF 4 YEARS IN FIRST AID
Authors: Savioli G , Ceresa I , Amedeo M , Martignoni A , Lava M , Muzzi A , Fumoso F , Lapia F , Brattoli M , Bressan M 
Published: May 2022

Abstract

Premise
Pulmonary embolism is a disease still characterized by high mortality. It requires emergency department resources to be diagnosed promptly and can require lengthy hospital care.

Purpose
to assess which parameters, in the real life of an Emergency Department, correlate with the duration of a hospitalization for pulmonary embolism (hospital LOS).

Methods
Single–center retrospective observational study, on all geriatric patients (&gt; 75) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood chemistry and blood gas analyzes performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We also analyzed vital parameters and the various shock indexes from these derivatives. We then analyzed whether patients had massive pulmonary embolism or the presence of organ damage (right ventricular dilation, pulmonary artery dilation and presence of pulmonary infarction).

Results
We enrolled 247 patients, all in need of hospitalization for acute pulmonary embolism. The average age is 83 with female precalence (F = 63%). Regarding the length of hospital stay, the presence of massive embolism shows a good statistical correlation (p &lt; 0.01), while the presence of organ damage seems irrelevant (p &gt; 0.05). The need for resuscitation care and the high sPESI index also show no correlation (p &gt; 0.05). Age and vital signs (blood pressure, respiratory rate, heart rate) as well as derived shock indices are unrelated (rho∼0; p &gt; 0.05). A weak correlation is instead present with high D–Dimer values (rho∼0.20; p &lt; 0.005) while the other blood samples do not show correlation (rho∼0; p &gt; 0.05). No correlation for the blood gas analysis parameters taken into consideration (pH; pO2; pCO2; lactates).

Conclusions
The study suggests that the presence of massive pulmonary embolism and to a lesser extent high D–Dimer values correlates with a long hospital stay.
P273 MANAGEMENT OF ACUTE PULMONARY EMBOLISM IN GERIATRIC PATIENTS IN THE EMERGENCY ROOM: DOES ADHERENCE TO INTERNATIONAL GUIDELINES REDUCE IN ATYPICAL SYMPTOMS?
Authors: Savioli G , Lapia F , Fumoso F , Brattoli M , Mugellini A , Martignoni A , Maggioni P , Muzzi A , Novelli V , Preda L , Lava M , Manzoni F , Ceresa I , Bressan M 
Published: May 2022

Abstract

Purpose of the Study
Evaluate if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the presence of atypical symptoms. We understood dyspnoea, chest pain, signs and symptoms of deep vein thrombosis and syncope as typical symptoms. As atypical symptoms all the others (low–grade fever, vertigo …)

Methods
Single–center retrospective observational study on all geriatric patients (&gt;75 y) who entered our ED, where they received a diagnosis of acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic/therapeutic algorithm, both for the risk of PE (Wells, Geneva and YEARS), and for the presentation of the risk of mortality at 30 days (sPESI). We then analyzed adherence to the guidelines in three decision turning points: 1 Correct application of the decision scores examined, which classify the patient at low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct administration of therapy starting from ED as suggested by the guidelines; 3 Any observation in the care area of medium intensity with careful monitoring for the subpopulation of patients with evidence of right ventricular dilation or myocardial enzyme elevation (considered to be at high risk of shock and short–term mortality).

Results
We enrolled 248 patients, with a mean age of 83 years with female prevalence (F = 63%). Of these, only 17 with atypical symptoms and 231 with typical symptoms. The vital signs were comparable in the two groups with no statistically significant difference (p &gt; 0.05). Long–term outcomes such as mortality, need for hospitalization, hospitalization in intensive care and length of stay in hospital are also comparable results with no statistically significant difference (p &gt; 0.05). However, adherence to international guidelines was statistically significantly lower in patients with atypical symptoms (33%) than in patients with typical symptoms (59%) (p &lt; 0.05).

Conclusions
The study suggests that patients with atypical symptoms are more likely to have reduced adherence to international guidelines, most likely due to diagnostic delay.
P280 USE OF SYSTEMIC THROMBOLYSIS IN HEMODYNAMICALLY UNSTABLE PULMONARY EMBOLISM PATIENTS WITH AND WITHOUT CARDIAC ARREST: DATA FROM THE IPER REGISTRY
Authors: Zuin M , Bilato C , Bongarzoni A , Zonzin P , Casazza F , Roncon L 
Published: May 2022

Abstract

Background
Systemic thrombolysis (ST) remains the treatment of choice in haemodynamically unstable patients with acute pulmonary embolism (PE). However, it remains frequently underused in clinical practice. The purpose of the study is to evaluate the use of ST in hemodynamically unstable PE patients with aand without acute cardiac arrest using the IPER registry.

Materials and Methods
IPER is a multicentre, national, prospective, web–based registry based on 47 Italian hospitals. In this study, the population was divided into two groups: patients with (ACC) and without (No ACC) cardio–circulatory arrest at admission.

Results
Of 1716 patients enrolled between September 2006 and August 2010, 201 (11.7%) [mean age 74 ± 14 years 127 females] were defined as high risk (i.e. haemodynamically unstable). Of these 59 (29.4%, mean age 76.4 ± 13.3 years, 40 females) were admitted with ACC while the remaining 142 (70.6, mean age 73.5 ± 13.7 years, 87 females) without. No differences were observed for venous thromboembolism risk factors, such as immobilization for more than three days, trauma, surgery within the previous 4 weeks, previous venous thromboembolism, history of heart failure, cancer and ischemic heart disease, among the two gropus. Mortality from all causes (62.7% vs 19.0, p &lt; 0.001) and for acute PE (55.9% vs 9.9%, p &lt; 0.001) was higher in ACC patients. Thrombolysis was administered in 82 (40.7%) of haemodynamically unstable patients and more frequently in ACC subjects (55.9% VSA 34.5%, p = 0.005) (Figure 1, panel A). The administration of systemic thrombolysis increased with aging in the No ACC group but showed a significant reduction in over–octogenarian patients (Figure 1, panel B). Major bleeding complications following reperfusive treatment were observed in 8 patients (3.9%); among these, intracranial hemorrhage was registered in 2.4% of cases.

Conclusions
Although systemic thrombolysis remains the first–line treatment in patients with hemodynamically unstable acute PE and is capable of improving both the mortality and morbidity, it continues to be underused in daily clinical practice, often for fear of major bleeding complications.
P286 ECHOCARDIOGRAPHIC FINDINGS IN SUBJECTS WITH AN AMYLOIDOGENIC APOLIPOPROTEIN A1 MUTATION
Authors: Aimo A , Tomasoni D , Lombardi C , Panichella G , De Angelis M , Fabiani I , Regazzoni V , Vergaro G , Nardi M , Passino C , Scolari F , Emdin M , Metra M 
Published: May 2022

Abstract

Background
The APOA1 gene encodes the precursor of apolipoprotein AI (ApoAI), whose mature form is the major component of high–density lipoproteins. APOA1 mutations may cause a form of hereditary amyloidosis (AApoAI). Only very small case series of patients with AApoAI are available.

Methods
We examined 189 consecutive subjects with the heterozygous APOA1 Leu75Pro mutation referred for cardiac screening over a 10–year timespan at the Spedali Civili of Brescia (Italy).

Results
Subjects (men 54%, median age 55 years, renal disease 39%, liver disease 31%) had a median left ventricular ejection fraction (LVEF) of 60% (55–66), did not display a prominent diastolic dysfunction (E/e’ ratio 7 [6–10]) nor LV hypertrophy (LV mass index [LVMI] 92 g/m2 [74–111]). LV global longitudinal strain (GLS) (–19% [–21 to –17]), and mass to strain ratio (MSR) (10.0 [6.8–12.1]) were within normal limits. Age correlated with several echocardiographic parameters, including interventricular septal (IVS) thickness (r = 0.484), LVMI (r = 0.459), E/e’ (r = 0.501), and right ventricular free wall thickness (r = 0.459) (all p &lt; 0.001). Some individuals displayed echocardiographic red flags of cardiac amyloidosis (CA; “granular sparkling” of the IVS, 19%; pericardial effusion, 11%; apical sparing, 10%; thickened atrioventricular valves, 8%). Thirteen out of 96 (14%) fulfilled non–invasive criteria for CA. Twenty–nine subjects died over 5.8 years (4.1–8.0), with 10 deaths for cardiovascular causes; 14 out of 182 (8%) were hospitalized because of HF, and 17 (9%) died for cardiovascular causes or were hospitalized for HF. Individuals with suspected CA had a much higher risk of all–cause death (p = 0.009), cardiovascular death (p &lt; 0.001), cardiovascular death or HF hospitalization (p &lt; 0.001), and HF hospitalization alone (p &lt; 0.001). Furthermore, subjects with either renal or liver involvement had a higher risk of events and a worse outcome.

Conclusions
In subjects with an amyloidogenic APOA1 mutation, transthoracic echocardiography showed only minor signs of cardiac disease. The correlations between age and echocardiographic findings suggested a progressive increase in wall thickness, a decline in systolic and diastolic function, and a greater uncoupling between LV mass and contractility over time. Subjects with both renal and liver disease displayed the most evident signs of biventricular involvement and had a worse outcome.
P288 PREVALENCE OF AMYLOID TRANSTHYRETIN CARDIOMYOPATHY IN ELDERLY SUBJECTS FROM THE GENERAL POPULATION: FIRST RESULTS FROM THE CATCH STUDY
Authors: Aimo A , Vergaro G , Fabiani I , Barison A , Moscardini S , Poggianti E , Spini V , Arzilli C , Castiglione V , Gentile F , Passino C , Emdin M 
Published: May 2022

Abstract

Background
Amyloid transthyretin cardiomyopathy (ATTR–CM) has become treatable. Wild–type ATTR–CM is an age–related disorder. Establishing the exact prevalence of ATTR–CM in elderly subjects from the general population may be useful for healthcare providers and policy makers.

Methods
The Characterizing the burden of Amyloid Transthyretin CardiomyopatHy in the elderly (CATCH) study is a population screening on all subjects aged ≥65 years followed by general practitioners in a part of Tuscany (Italy) where there is no cluster of variant ATTR. The study started on March 12, 2021 and is ongoing. Patients with 1) any clinical red flag of amyloidosis, 2) interventricular septal thickness ≥12 mm or other echocardiographic red flags, and/or 3) hs–troponin T &gt; 14 ng/L are referred to diphosphonate scintigraphy and search for a monoclonal protein.

Results
As of October 13, 2021, 514 subjects ≥65 years have been evaluated for possible participation. Among them, 135 (26%) could not be contacted, were reluctant to enter the study, died before being contacted, or were bedridden. Out of the other 379 subjects, 329 (87%) have already undergone the first step. Forty percent of individuals (n = 132) have been referred to the second step. Thirteen subjects have declined (10%); 69 patients have undergone diphosphonate scintigraphy and the search for a monoclonal protein (while the other 50 are awaiting these exams). Two subjects showed an intense myocardial uptake of the diphosphonate tracer (Perugini score 2–3) and no monoclonal protein, and were then diagnosed with ATTR–CM. They were both women, aged 83 and 78 years, both mildly symptomatic for dyspnea (New York Heart Association II) and with unexplained hypertrophy. The search for TTR gene mutation was negative in the first case and is still ongoing in the second. Based on these preliminary data, the prevalence of ATTR–CM in the elderly population can be calculated as 2/266=0.8%.

Conclusions
The CATCH study is expected to enroll at least 1,000 subjects and will provide the first data on the epidemiology of ATTR–CM in elderly subjects. Based on an interim analysis, almost 1 in 100 individuals ≥65 years has ATTR–CM.
P290 CARDIAC AMYLOIDOSIS, A CHALLENGING DIAGNOSTIC WORK – UP
Authors: Roccabruna A , Benini A , Piccoli A , Ribichini F 
Published: May 2022

Abstract

A 79 years–old male presented to our outpatient clinic with symptoms of an initial heart failure. He had an history of atrial fibrillation (AF), anaemia and thrombocytopaenia, which have never been deeply investigated, bilateral carpal tunnel syndrome. Electrocardiogram (EKG) showed AF with normal ventricular rate and low peripherical QRS voltages. Laboratory testing was significant for NT proBNPelevation, pancytopenia and iron overload. An echocardiogram (ECHO) was done showing a hypokinetic and dilated biventricular cardiopathy. The therapy was therefore optimized with clinical benefit. At coronary angiography a severe stenosis of left coronary artery was observed with normal myocardial perfusion imaging. Cardiovascular magnetic resonance (CMR) excluded an iron intramyocardial overload (in contrast to the hepatic and splenic parenchyma) and detected a subendocardial pattern of LGE at lateral and mid–basal septal area. Emochromatosis and Gaucher disease were excluded. As suggested by hematologists, he underwent osteomedullary biopsy (OMB) and a myelodysplastic syndrome (MDS) was diagnosed. He was still symptomatic for dyspnea on mild exertion. The following ECHO revealed normal left ventricular (LV) size with moderate concentric remodeling, mildly impaired LV systolic function and LV filling pattern suggestive of restrictive cardiomyopathy. All these data prompted suspicion for an infiltrative cardiopathy. Nuclear scintigraphy with the use of bone seeking agent was done and showed Perugini grade 2 cardiac uptake. Moreover, amyloid deposits were identified after Congo red–staining from OMB. immunoglobulin light chain (LA) amyloidosis was excluded.

Conclusion
based on the above findings, Cardiac Amyloidosis TTR–related wild type was diagnosed. The diagnosis of MDS and the identification of iron overload were incidental findings. The patient, currently in follow up at our center, is a candidate to Tafamidis.
P292 REDEFINING THE EPIDEMIOLOGY OF CARDIAC AMYLOIDOSIS. A SYSTEMATIC REVIEW OF SCREENING STUDIES
Authors: Aimo A , Merlo M , Porcari A , Pagura L , Sinagra G , Vergaro G , Emdin M , Rapezzi C 
Published: May 2022

Abstract

Background
Over the last years, an algorithm for non–invasive diagnosis of amyloid transthyretin cardiac amyloidosis (ATTR–CA) and novel disease–modifying therapies have prompted an active search of CA in different clinical settings.

Methods
We performed a systematic search of screening studies investigating CA.

Results
The average prevalence of CA in different settings were as follows: total body scintigraphy with “bone tracers” for non–cardiac reasons (n = 5 studies), 1%; heart failure (HF) with preserved ejection fraction (n = 6), 12%; HF with reduced or mildly reduced ejection fraction (n = 2), 10%, conduction disorders warranting pacemaker implantation (n = 1), 2%; surgery for carpal tunnel syndrome (CTS; n = 3), 7%; hypertrophic cardiomyopathy phenotype (n = 2), 9%; aortic stenosis (AS) undergoing surgical or transaortic valve replacement (n = 7), 10%; autopsy series of “unselected” elderly individuals (n = 4), 15%. Many of these patients had ATTR–CA, but the percentage of cases with amyloid light–chain CA was far from negligible.

Conclusions
Screening for CA in specific settings allows to identify a relatively high number of cases, in agreement with the notion that CA is not a rare disease. Many patients have ATTR–CA. Most studies focused on elderly subjects, given the clear relationship between age and the likelihood of CA. Men accounted for a high proportion of patients with CA, but women were quite represented.
P323 MYOCARDIAL INVOLVEMENT IN ANTI–PHOSPHOLIPID SYNDROME: A CASE OF A YOUNG BREASTFEEDING WOMAN
Authors: Varotto L , Leonardi D , Hoxha A , De Luca C , Siviero V , Bragantini G , Cerrito L , Caprioglio F 
Published: May 2022

Abstract

Introduction
In Antiphospholipid Syndrome (APS) myocardial tissue can be involved through immune–mediated or thrombotic mechanisms, giving chest pain and increase of myocardial cytolysis markers. This may occur without any signs of myocardial injury at the moment of echocardiography, coronarography and cardiac magnetic resonance (CMR). The aim is to increase the awareness about this life–threating condition.Case summary. We present the case of 26–year–old woman few days after childbirth, affected by APS in anticoagulant therapy with previous deep vein thrombosis and without any other cardiovascular risk factors. She was symptomatic for intermittent chest–epigastric pain, fever and skin livedo reticularis. Lab Tests: TnI 750 ng/L, C–reactive protein 9.6 mg/dL, D–dimer 1693 µg/L; anemia; Antithyroid Antibodies and ANA 1:160 (SSB/LA). Blood cultures and COVID test were negative.Results. Echocardiography showed normal left/right ventricular function, but minimal pericardial effusion was present. Pulmonary Angio–CT revealed small thromboembolic event, ground–glass lungs compatible with hemorrhagic alveolitis.After a few days, the patient presented increased epigastric pain, headache, vomiting up to presenting a comatose state. Thrombotic or hemorrhagic events with cerebral CT and MR were excluded. Total–body CT was negative, except for peri–splenic and recto–uterine pouches.For the increase of TnI up to 4741 ng/L, the patient underwent coronary angiography which demonstrated non–obstructive coronary arteries. The assembled Neuro–Cardio–Rheumatology team suspected a rapidly developing Catastrophic APS which was developing quickly with multi–organ and life–threatening involvement.The patient underwent 4 cycles of plasmapheresis, intravenous human IgG and corticosteroids, with rapid clinical improvement. CMR subsequently demonstrated a small transmural late enhancement area on lateral left ventricle wall.The patient was discharged from the hospital on Day 6 post–therapies.Conclusions. APS may involve more organs, including myocardial tissue with different mechanisms of damage and high mortality rate. The presented case poses a multidisciplinary challenge, because thrombotic multiorgan microangiopathy may be not always diagnosed. Imaging methods such as CMR could be optimized with adenosine stress–CMR. Clinical attention is required among women with APS, to reach early diagnosis of myocardial thrombotic microangiopathy and to establish the best effective treatment.
P326 SURGICAL VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWER GENERATION DEVICES IN REAL–WORLD PRACTICE: ONE–YEAR OUTCOMES FROM THE ITALIAN OBSERVANT STUDIES
Authors: Rosato S , Biancari F , D‘errigo P , Tarantini G , Costa G , Baglio G , Seccareccia F , Tamburino C 
Published: May 2022

Abstract

Objective
To compare the early and 1–year outcomes after transcatheter aortic valve replacement (TAVR) with new–generation devices over surgical replacement (SAVR) among patients with severe aortic stenosis (AS).

Background
TAVR is gaining acceptance for the treatment of lower risk patients with AS after several randomized and observational studies confirmed comparable early results to SAVR. On the other hand, clinical studies have shown that SAVR is still widely used in intermediate and high risk patients. There is need of data from large clinical registries to demonstrate the efficacy and safety of TAVR in the real–world setting, particularly after the introduction of new TAVR technology.

Methods
A total of 5706 AS patients who underwent SAVR and 2989 AS patients who underwent TAVR enrolled in the national, prospective OBSERVANT and OBSERVANT II studies, respectively in 2010–2012 and 2016–2018, were analyzed. Outcomes were adjusted using the propensity score matching. The primary outcomes of interest were all–cause mortality, major adverse cardiac and cerebrovascular events (MACCEs) and hospital readmission due to heart failure at 1–year. Secondary outcomes were major adverse events occurring during the index hospitalization.

Results
Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30–day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), acute kidney injury (0.6 vs. 8.2%, p &lt; 0.001), infectious complications (3.8 vs. 6.5%, p = 0.006) and cardiogenic shock (1.4 vs. 5.1%, p &lt; 0.001) compared to SAVR. Moderate–to–severe paravalvular regurgitation (5.9 vs. 2.0%, p &lt; 0.001), major vascular complications requiring invasive treatment (2.2 vs. 0.1%, p &lt; 0.001) and permanent pacemaker implantation (during the index hospitalization, 13.8 vs. 3.3%, p &lt; 0.001) were more frequent after TAVR. At 1–year, TAVR was associated with lower risk of all–cause death (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p &lt; 0.001) and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR.

Conclusions
In a real–world setting, patients with intermediate operative risk treated with newer generation TAVR devices had a low risk of major adverse events during the index–hospitalization and at 1–year follow–up. TAVR could become the treatment of choice for AS in the elderly provided that its durability is proved by long–term follow–up studies.
P345 HEALTH LITERACY AS A MEASURE OF NURSING COMPLEXITY OF CARE IN A DEPARTMENT OF CARDIOVASCULAR MEDICINE
Authors: De Rinaldis M , Cristofori E , Iula A , Conte M , Cocchieri A 
Published: May 2022

Abstract

Background
HL plays a fundamental role in patients’ healthcare. According to the American Medical Association, HL can be viewed as a stronger predictor of a person’s health status than age, education level, and race. HL concept has many implications for nursing; they are responsible for identifying the patient’s barriers to their health information’s comprehension and providing specific nursing interventions in minimizing barriers. Moreover, HL assessment is necessary to plan tailored interventions, improve their efficacy through patient–centered communication. As a part of the nursing process, the nursing diagnosis (ND) classifies patients according to their level of nursing dependency and can be predictive for the nursing workload. No studies have been conducted on the relationship between NDs and HL. We aimed to describe the prevalence and distribution of NDs on admission in patients with CDs and to analyze the relationship between HL and NDs.

Method
A retrospective design was used to randomly select 134 patients with CDs in eight cardiovascular and internal medicine units of an Italian hospital from 10 January to 10 May 2021. NDs were collected using a nursing information system (NIS). Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on NIS.

Results
A mean of 3.5 ± 2.3 nursing diagnosis per patient was identified. A statistically significant linear association (Spearman’s correlation coefficient) was observed between HL score and the number of NDs.

Conclusion
HL was associated with the number of NDs.