bluuebunny/crossref_metadata_2025_split huggingface dataset:
C52 THE BIG FOUR: RESPIRATORY FAILURE, RENAL INSUFFICIENCY, HAEMORRHAGE AND SEPSIS, HOW DO THEY IMPACT ON CICU PATIENT?
Authors: Canovi L , Zanarelli L , Cardelli L , Dal Passo B , Frascaro F , Piscitelli L , De Carolis B , Gibiino F , Vitagliano A , Sciarra F , Zagnoni S , Pallotti M , Colletta M , Casella G 
Published: May 2022

Abstract

Background
The current rise in life expectancy in the general population leads to changes in baseline characteristics of Cardiac Intensive Care Unit (CICU) patients, increasing the risk of non–cardiac complications during the hospitalization.

Objectives
Evaluate epidemiology and prognostic impact of major non–cardiac complications (respiratory failure, renal insufficiency, haemorrhage and sepsis) during CICU stay. Methods: Retrospective analysis of CICU patients at Ospedale Maggiore of Bologna between March and November 2021.

Results
Baseline characteristics, cardiovascular risk factors and comorbidities of the patients are reported in Table 1. During the CICU stay, 19.7% of patients suffered from acute respiratory failure, needing for ventilation; 15.0% had renal insufficiency (considered as need for haemodialysis, glomerular filtration rate according to Cockcroft–Gault &lt; 60 ml/min, serum creatinine rise &gt; 25% from baseline); 1.8% reported major haemorrhages (defined as serum haemoglobin &lt; 8 g/dl or need for blood transfusion); 1.7% developed sepsis (positive blood cultures). Mean CICU stay for complicated patients was 6 days, intra–CICU mortality was 1.7% (8 deaths) and 30–days mortality was 7.0% (32 deaths). At univariate logistic regression analysis, acute respiratory failure was the only complication associated with a statistically relevant increase in 30–days mortality (OR 2.37, CI 95%, 1.05–5.34; p = 0.038), although, also the other complications had a negative prognostic effect: haemorrhage (OR 1.58, CI 95%, 1.77–14.16; p = 0.681), renal insufficiency (OR 1.47, CI 95%, 0.56–3.87; p = 0.432) and sepsis (OR 1.25, CI 95%, 0.33–5.87, p = 0.850).

Conclusions
Epidemiology and baseline characteristics of CICU patients are changing. Older age and frailty make non–cardiac complications more likely to happen. Acute respiratory failure has the worst prognostic effect on mortality. This fact suggests that CICU Cardiologists should improve their management of these major non–cardiac complications.
C60 12–LEAD POST–ROSC ELECTROCARDIOGRAM DISCRIMINATES SURVIVAL TO HOSPITAL DISCHARGE. A SUB–ANALYSIS OF THE PEACE STUDY
Authors: Gentile F , Baldi E , Schnaubelt S , Caputo M , Clodi C , Bruno J , Compagnoni S , Benvenuti C , Domanovits H , Burkart R , Primi R , Ruzicka G , Holzer M , Auricchio A , Savastano S 
Published: May 2022

Abstract

Background
Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.

Methods
We analysed all the post–ROSC ECGs collected from January 2015 to December 2018 in three European centres (Pavia, Lugano and Vienna). For every ECG, the main features were analysed and filed in the database together with the pre–hospital data collected for every patient according to the Utstein style.

Results
We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53–70 years); 121 from Pavia (32.7%), 38 from Lugano (10.3%) and 211 from Vienna (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95% IC 1.1–2.4), p = 0.007], QRS wider than 120 msec [HR 1.87 (95% IC 1.3–2.7), p &lt; 0.001], ST elevation in more than one segment [HR 1.7(95% IC 1.2–2.5),p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95% IC 1.1–2.9), p = 0.03] and a right bundle branch block [HR 1.8 (95% IC 1.1–2.8), p = 0.01] were all associated with death before hospital discharge. In multivariable Cox regression, adjusted for the ROSC–to–ECG time, age older than 62 years [HR 1.6 (95% IC 1.1–2.3), p = 0.01], QRS wider than 120 msec [HR 1.7 (95%IC 1.2–2.5), p = 0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2–2.5), p = 0.004] were independently associated with death before hospital discharge. By considering these latter three risk factors, the rate of survival to hospital discharge was significantly influenced by their number [no risk factor: 80.8%; 1 factor: 71.2%; 2 factors: 61.9%; 3 factors: 34.4%; p &lt; 0.001, p for trend &lt;0.001]. With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1–3.5), p = 0.037 e HR 5.1(95%IC 2.6–10.1), p &lt; 0.001 respectively].

Conclusions
Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post–ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
C61 MULTIDISCIPLINARY MANAGEMENT IN A CASE OF EOSINOPHILIC MYOCARDITIS WITH CHURG STRAUSS SYNDROME: FROM ECG TO ENDOMYOCARDIAL BIOPSY
Authors: Amelotti N , Mapelli M , Pires I , Guglielmo M , Majocchi B , Catto V , Campodonico J , Vignati C , Baggiano A , Ribatti V , Moltrasio M , Vettor G , Sicuso R , Pontone G , Basso C , Agostoni P 
Published: May 2022

Abstract

Background
Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg–Strauss, is a rare multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia (PE). Cardiac involvement may include eosinophilic myocarditis and it is a serious manifestation of EGPA.

Case Presentation
A 67–year–old woman presented to the emergency department with 2–weeks history of dyspnea, orthopnea and asthenia. She had history of asthma, PE, adjuvant radiotherapy after right mastectomy (July 2021). The patient was diagnosed with new onset atrial fibrillation in the previous month. At admission, the patient was hemodynamically stable and with signs of congestion. Complementary exams showed sinus rhythm and T–wave inversion on lateral leads; PE (2010/uL), elevated troponin and BNP values; and severe biventricular systolic dysfunction with diffuse hypokinesia and apical akinesia. The patient was admitted to the ICU and was treated with intravenous diuretics and levosimendan. Optimal HF therapy was introduced. Serial echocardiography revealed partial recovery of LVEF and blood analysis showed a decrease in troponin levels, with persistent eosinophilia (6330/uL). Computed tomography (CT) excluded significant coronary disease, and showed bilateral basal ground–glass opacities, areas of air–space consolidation and bilateral reticular–nodular pattern. Cardiac magnetic resonance revealed increased T2 values/signs of myocardial edema in anterior wall, interventricular septum and apex and no late gadolinium enhancement, compatible with myocarditis. An endomyocardial biopsy (EMB) was performed and confirmed the diagnosis of eosinophilic myocarditis. Oral corticosteroids were started. Paranasal CT scan showed signs of chronic sinusitis, without polyposis, and antineutrophil cytoplasmic antibodies were positive, making the diagnosis of EGPA, according to ACR criteria.

Discussion
In a patient presenting with new onset heart failure and with history of asthma and eosinophilia, it is important to suspect eosinophilic myocarditis, as this is a rare but reversible life–threatening condition. EMB plays an important role in the diagnosis and should be done promptly.

Conclusion
We described a multidisciplinary management of a case of a patient with eosinophilic myocarditis and EGPA, presenting with severe acute biventricular dysfunction.
C66 LONG TERM FOLLOW–UP OF PATIENTS WITH BIOPSY– PROVEN DIAGNOSIS OF MYOCARDITIS AND VENTRICULAR ARRHYTHMIAS
Authors: Lavalle C , Magnocavallo M , Mariani M , Vetta G , Della Rocca D , Alfarano M , Piro A , Natale A , Fedele F , Vizza D , Frustaci A , Chimenti C 
Published: May 2022

Abstract

Background
The diagnosis and management of patients with myocarditis with ventricular arrhythmic (VA) onset is one of the major challenging issues faced by physicians.

Objective
We aimed at evaluating the natural history of patients with an endomyocardial biopsy–proven diagnosis of myocarditis with a VA manifestation at the time of diagnosis.

Methods
From January 2013 to October 2021, 243 consecutive patients with unexplained VAs underwent a complete diagnostic work–out, including endomyocardial biopsy. All patients with a biopsy–proven diagnosis of myocarditis were included in the study.

Results
104 patients were enrolled (mean age: 54 ± 16 years; 75% male). The presenting arrhythmic manifestation was syncope/aborted sudden death in 21 (20.2%) patients, sustained ventricular tachycardia (VT) in 16 (15.4%), nonsustained VT in 29 (27.9%) and frequent premature ventricular complexes in 38 (36.5%). Patients with severe systolic dysfunction (Ejection Fraction&lt;35%) were 63.5%. Late gadolinium enhancement (LGE) and myocardial oedema were detected at cardiac magnetic resonance (CMR) in 91.8% and 30% patients, respectively. Thirty–eight (36.5%) patients received an implantable cardioverter defibrillator (ICD) for primary (n = 14; 36.8%) or secondary (n = 24; 63.2%) prevention of sudden cardiac death (SCD). The mean follow–up was 69 ± 32 months: cardiovascular (CV) death was 15.4% while the recurrence of sustained Vas was 27.9%. Among ICD patients, 13 (34.2%) had an appropriated therapy of the device and arrhythmic storm occurred in 3 (23.1%) of them. The combined endpoint of sustained VA/ICD therapy/CV death occurred in 35.6%. The most important independent predictor of VAs was the presence of LGE [Odds Ratio: 9.100; Confidence of Interval: 1.125 – 73.609; p–value: 0.04].

Conclusion
Among patients with a diagnosis of myocarditis and VAs, 35.6% had recurrences of VA/ICD therapy/CV death during follow–up. The presence of LGE at CMR stratifies the risk of VA recurrence.
C68 RESTING HEART RATE AND ARTERIAL STIFFNESS: A LONGITUDINAL PROSPECTIVE STUDY IN A POPULATION OF HYPERTENSIVE PATIENTS
Authors: Maloberti A , Fumagalli S , Garofani I , Ghidini S , Ruzzenenti G , Bombelli M , Giannattasio C 
Published: May 2022

Abstract

Objective
The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow–up period.

Methods
We enrolled 572 hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). Anamnestic, clinical and laboratory data, BP and cfPWV (complior) were assessed at baseline and after a median follow–up time of 3.7 ± 0.5 years.

Results
At baseline the mean age was 53.9 ± 12.7 years, SBP and DBP were 141.2 ± 17.8 and 86.5 ± 10.5 mmHg, HR was 65.6 ± 10.9 bpm and PWV was 8.6 ± 2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p &lt; 0.001), during follow–up, PWV increased (ΔPWV 0.5 ± 2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82 ± 2.22 vs. 0.27 ± 2.25 m/s, p = 0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p &lt; 0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p = 0.017).

Conclusions
In hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow–up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.
C71 USE OF THE 6–MINUTE WALKING TEST (6–MWT) AS AN ALTERNATIVE TO INCREMENTAL ERGOMETRIC TESTING FOR THERAPEUTIC EXERCISE PRESCRIPTION IN CARDIOLOGICAL REHABILITATION
Authors: Rossini D , Dardi O , Bonaguidi E , Meoni L 
Published: May 2022

Abstract

According to the guide lines and statements from scientific societies, the determination of exercise intensity at the beginning of a cardiac rehabilitation (CR) program should include a cardiopulmonary test as the optimal standard and an incremental “symptom–limited” ergometric test (ET) as the minimal standard. However, the preliminary ergometric evaluation is often not done, because of patient’s (pt) inhability to perform ET, temporary contraindications to ET or difficulties related to organization. Therefore, we assessed whether it is possible to set an effective and safe work intensity for each pt, using a submaximal test such as the 6–MWT,

Methods
Thirty pts (20 M and 10 F; mean age 61 ± 10.1 yr) consecutively referred to an outpatient CR after cardiac surgery (15 pts) or acute coronary syndrome (15 pts) were enrolled. Eligible pts after assessment of balance and gait with the Tinetti scale (score ≥ 19), performed both a 6MWT and a ET on the cycle ergometer within one week of enrollment. By t–test for paired data, watts at ET peak (W peak) were compared with W peak calculated by the two formulas of Hill and that of Luxton using anthropometric data and the result of the 6–MWT (Holland AE et al. Estimating peak work rate during incremental cycle ergometry from the 6–minute walk distance: differences between reference equations. Respiration 2011;81:124–128). In addition, we tested whether the maximum heart rate (max HR) achieved at 6–MWT falls within the training frequency calculated using the Karvonen formula (THR).

Results
There is a statistically significant difference between W peak and W peak calculated with the Hill formulas (p &lt; 0.0001). On the contrary, the difference is not significant applying the Luxton formula (p = 0.7). The maximum HR values reached at 6–MWT fell within the THR in 63% of cases (confidence intervals 0.46–0.80).

Conclusions
At the moment, we do not have reliable formulas for calculating the workload from a submaximal test in the population of cardiac patients. The Luxton formula deserves to be evaluated on a larger sample. Finally, the max HR at 6–MWT is a good and sufficiently safe parameter for programming an initial therapeutic exercise as it falls within the THR in the most cases and even when it does not, the difference is only a few beats.
C75 PHEOCHROMOCYTOMA–INDUCED CARDIOGENIC SHOCK: A MULTICENTER ANALYSIS OF CLINICAL PROFILES, MANAGEMENT AND OUTCOMES
Authors: De Angelis E , Ravera A , Ammirati E , Tedeschi A , Polito M , Pieroni M , Gentile P , Merlo M , Van De Heyning C , Bekelaarh T , Cipriani A , Camilli M , Sanna T , Sinagra G , Bonnefoy–cudraz E , Bochaton T , Hayek A , Aloia A 
Published: May 2022

Abstract

Background
Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal gland and overproduces catecholamines; it is an infrequent cause of cardiogenic shock (CS). Several case reports have investigated pheochromocytoma–induced CS, but larger studies have not yet been carried out.

Objectives
Our work aims to describe a multicenter experience in the diagnosis and management of patients with pheochromocytoma–induced CS, and to raise awareness around this rare condition. Methods: We enrolled all patients with a diagnosis of pheochromocytoma–induced CS admitted to the intensive care units of 8 European referral Hospitals.

Results
Among the 17 patients (47% males, mean age 49,5 years), we found that pulmonary congestion was the mostly represented clinical feature (82%). The most represented echocardiographic left ventricle (LV) pattern was the reverse Takotsubo (TTS) pattern with apical hyperkinesis associated with basal– to mid–ventricular hypokinesis (47%). Elevated systemic vascular resistances (SVR) were observed. Endomyocardial biopsy of the LV was performed in one patient showing contraction band necrosis, oedema and inflammatory reaction. 76% of patients were treated with dobutamine, 70% needed noradrenaline, 29% adrenaline, 23.5% were treated with levosimendan and 17% with milrinone. Mechanical circulatory support devices (MCS) were necessary for 65% of patients. All patients benefited from pheochromocytoma’s surgical excision, with 4 patients operated on while under ECLS. All patients recovered, excepted one (presenting a severe left ventricular dilatation at admission) who required cardiac transplantation.

Conclusion
Pheochromocytoma is an infrequent cause of CS, with most often a TTS–like presentation. It should be suspected in case of a CS with high initial SVR and rapid deterioration. MCS must be considered in the most severe cases. The main challenge is to stabilize the patient, mostly with MCS, since it remains a reversible cause of CS with a low mortality rate. Adrenalectomy can safely be performed even when the patient is under MCS.
C80 SUDDEN CARDIAC ARREST IN A YOUNG FOOTBALL PLAYER DUE TO DOCUMENTED SPONTANEOUS CORONARY ARTERY DISSECTION
Authors: Buccheri D , Priolo L , Inglese F , Barone G 
Published: May 2022

Abstract
A 28–years–old male presented with sudden cardiac arrest (SCA) while playing soccer. He was quickly resuscitated and transported to the closest cardiology department. He had no ECG or echocardiographic alterations. Coronary angiography (CA) showed a spontaneous coronary artery dissection (SCAD), confirmed by optical coherence tomography (OCT), in the mid portion of left anterior descending artery (LADA). In light of his young age, and the lack of evidence of stenosis on angiography confirmed by an instant wave–free ratio (iFR) analysis that confirmed the absence of myocardial ischemia (value obtained 0.97), the patient was treated conservatively with aspirin, clopidogrel, a statin and a beta–blocker. The patient refused implantation of a cardioverter–defibrillator repeatedly. A repeat CA was performed 6–months later, showing same findings and angiographic images of the known lesion involving the LADA. Therefore, the patient was indicated as unsuitable to play soccer. At 1 year from the index event, the patient had an episode of angina pectoris associated with intensive effort and, because of this, another CA with OCT analysis were performed. On angiography the LADA showed a significant stenosis in the same region where spontaneous dissection was previously documented; finding of hyperreflectivity on OCT suggested fibrosis of the vessel wall, probably caused by anomalous immunity reaction mimicking an autoimmune disease; residual intimal–tear representing the entry–site of the dissection was also detected, and a minimal lumen area of 2.21 mm2 was calculated consistent with angiographic stenosis. PCI was indicated, implanting a 3.0/18 mm drug–eluting stent in the mid portion of the LADA, obtaining good final angiographic result and OCT analysis confirming optimal device expansion, without residual dissection. At 2 month post–PCI the patient had returned to playing football without limitation of physical activities. 1 year post–PCI follow–up the patient is still asymptomatic and healthy. In summary, we present a case of SCAD causing an acute coronary syndrome presenting with SCA, which limited subsequent physical activity. In young patients, mostly women, SCAD episode should be strongly considered in the setting of an acute coronary syndrome. Several articles had reported that medical therapy should be oriented on the pathophysiology of SCAD due to the absence of the classic atherosclerotic burst, limiting interventional therapy when strictly indicated.
C81 CORRECTION OF MASSIVE TRICUSPIDAL INSUFFICIENCY WITH PERCUTANEOUS TRICLIP SYSTEM IN WOMAN WITH MARFAN‘S SYNDROME
Authors: De Remigis F , Benvenuto M , Tomassoni G , Lavorgna A , De Rosa M , Fabiani D , Napoletano C 
Published: May 2022

Abstract
The interventional–percutaneous therapy of valve pathologies has undergone, in recent years, an enormous technological development in traditional surgery. In particular, the recent introduction for the percutaneous treatment of tricusp insufficiency allows you to correct forms otherwise not surgically treatable. We report a case of a 58–year–old woman suffering from Marfan‘s Sd with massive tricuspidal insufficiency in relation to valve leaf prolapse, complicated by retrograde heart failure and recurrent episodes of atriale flutter, Anamnestic cardiovascular hystory began at the age of 38 (2000) when patient underwent to the first cardiac surgery in emergency contest, with replacement of the ascending aorta and aorto–coronary bypass for acute dissection (type A); after one year (2002) perform surgery to replace the aortic arch with reimplantation of the neck vessels; at the age of 45 (2009) she underwent aortic valve replacement surgery with mechanical prosthesis, for severe aortic valve insufficiency; finally, at the age of 48 (2012) she underwent surgery to replace the thoraco–abdominal aorta and reimplantation of the abdominal vessels for chronic dissecting aneurysm. Given the high risk of re–surgery for tricuspid valve repair/replacement, the Heart–Team has indicated the percutaneous correction of tricuspid insufficiency using the valve clip. The procedure was performed under general anesthesia, ultrasound–guided with transesophageal; three clips were placed at the level of the commissure between the anterior flap and septal flap with the final result of an 80% reduction in the degree of tricuspid insufficiency, absence of peri and post procedural complications; discharge of the patient on day 3. The follow–up was completed at six months: asymptomatic patient, significant reduction of arrhythmic episodes, absence of peripheral venous stasis, reduction of hepatomegaly; echocardiographic control showed persistence of optimal alignment of the clips in the closing rim of the anterior and septal tricuspid flap; normal volume and function of the right ventricle, absence of indirect signs of hypertension in the small circulation, to report a significant reduction in arrhythmic events (two episodes of atrial flutter treated effectively with drug therapy).