bluuebunny/crossref_metadata_2025_split huggingface dataset:
P413 ISCHEMIC ECG CHANGES, NOT ALWAYS CORONARY ISSUES
Authors: Zanarelli L , Canovi L , Cardelli L , Dal Passo B , Frascaro F , Piscitelli L , Pallotti M , Colletta M , Casella G 
Published: May 2022

Abstract

Background
Many abdominal deseases can mimic cardiac symthoms at their presentation and they can lead to electrocardiographic (ECG) changes, acting as a confounding factor for the physichan during the diagnostic process.

Case presentation
A 77–year–old man, former smoker, with high blood pressure not being treated, came to the emergency room with mesogastric pain and vomiting, since three hours before. The ECG showed a sinus rhythm, at 55 beats per minute and a slight elevation of the ST segment in the leads DII, DIII and aVF, evolving as T waves negativization in the same leads and flattening in V5– V6. Laboratory tests showed increasing Troponin I values from 23 to 277 ng / L. Because of this pathological context, the patient was taken to our Unit to perform a coronary angiography study in the hypothesis of acute myocardial infarction. The examination showed diffuse atheromatous lesions in the coronaries without haemodynamically significant stenosis. The patient developed fever during the hospitalization, abdominal CT study with contrast was performed, with a definitive diagnosis of acute cholecystitis and the patient was finally moved to the Internal Medicine ward.

Conclusions
ECG alterations in acute cholecystitis are not specific, but some of them are recurrent: among these there are ischemic modifications affecting the ST segment or the T waves, widely described in the scientific literature. All these ECG modifications solve with the treatment of cholecystitis, whether conservative or surgical, without acting on the cardiological side in any way; on the other hand, they can lead to unnecessary diagnostic–therapeutic investigations, to a diagnosis’delay and to complications’ onset. It is important for the clinician being able to consider abdominal pathology in case of diagnostic investigations’ inconsistency. However, ST segment’s changes during cholecystitis may deserve a cardiological study, as they are specific for acute myocardial infarction, especially in patients with high cardiovascular risk. This reminds to us, once again, the importance of anamnesis, physical examination and appropriate tests, to reach the correct diagnosis.
P415 NEUROGENIC STRESS CARDIOMYOPATHY
Authors: De Sanctis G , Rizzo M , De Pascali I , Guasti S , Chianta V , Bruno N , Monzo L , Tanzilli G 
Published: May 2022

Abstract

Case Report
Caucasian 84–years–old woman was found on the floor at her house and was brought to the ED of Policlinico Umberto I with the diagnosis of cranial trauma following a syncope. A head CT showed right paramedian fracture of the occipital bone, left frontal subarachnoid hemorrhage and left frontal subdural hemorrhage. The neurosurgeon gave no indication to urgent evacuation of the hemorrhage. Then elevation of cardiac enzymes and ST–segment elevation at the EKG were found but due to the state of the patient a coronary angiography was not performed and the patient was transferred to the CCU. The patient was hemodynamically stable with right hemiplegia. The EKG showed rapid ventricular rate atrial fibrillation with ST segment elevation in inferior and lateral leads with T wave inversion in the same leads and elevated serum troponin levels. ETT showed: EF 30% with a global reduction of left ventricular systolic function with diffuse akinesis. Intravenous therapy with mannitol and corticosteroids for perilesional oedema was started. Beta blockers and a class III antiarrhythmic drug were also started, but hemodynamic conditions declined and acute kidney failure occurred with progressive hypotension followed by cardiogenic shock. The patient had an episode of nonsustained ventricular tachycardia treated with antiarrhythmic drugs and magnesium sulfate. The EKG started to show a normalization of the repolarization phase with regression of ST segment elevation and persistent T wave inversion.The patient’s neurological conditions were complicated with epileptic seizures.On the fifth day of hospitalization the TTE revealed a slight improvement of global systolic function and the presence of an apical thrombotic apposition.The patient’s clinical conditions worsened and led to exitus.

Discussion
The interpretation of this patient’s history was made more difficult by the lack of witnesses of the trauma.The patient’s age, her history of hypertension and the presence of regional wall motion abnormalities at the TTE suggested the presence of CAD. On the other side the atrial fibrillation could hint a primitive cerebral event. This case report shows the potentially severe cardiac manifestations of cerebral hemorrhage and the necessity to consider cerebrovascular events as the cause of EKG changes mimicking a myocardial infarction, cardiac enzymes elevation and ventricular wall motion abnormalities, in order to avoid inappropriate or delated therapies.
P419 CARDIAC SARCOIDOSIS IN A CARRIER OF TTR GENE MUTATION
Authors: Scheggi V , Menale S , Mazzoni C 
Published: May 2022

Abstract
Abstract A 39–year–old man came to our attention after being identified as a carrier of the mutation lle68Leu in the transthyretin (TTR) gene, following his father’s diagnosis of cardiac amyloidosis. From then on, the patient underwent periodical follow–up for early detection of target organs involvement, with normal echocardiographic results of blood test and echocardiography.
At the age of 41, he was hospitalized after a transient loss of consciousness (TLS) episode while riding a bicycle. The echocardiogram showed normal systolic function with an akinetic basal septum. A coronary angiogram excluded the presence of coronary artery disease. One year later, ECG abnormalities developed, with a new–onset right bundle branch block and posterior fascicular block. The echocardiogram showed a dilated cardiomyopathy with severe left systolic function impairment (ejection fraction 30%). SPECT with bisphosphonate ruled out cardiac amyloidosis. Cardiac MRI was significant for patchy areas of late gadolinium enhancement in the left ventricle. Before the following cardiological evaluation for a possible ICD implantation the patient was again hospitalized after a resuscitated cardiac arrest.Thoracic CT, performed in the emergency department, was significant for hilar lymphadenopathies and pulmonary nodules highly suggestive for sarcoidosis. FDG–PET showed multiorgan phlogistic–infiltrative involvement, including the myocardium. A subsequent hepatic CT–guided biopsy eventually confirmed the diagnosis of sarcoidosis. In secondary prevention, the patient underwent ICD implantation but continued to experience arrhythmic events.
P422 EARLY EXERCISE PRESCRIPTION AFTER ACUTE CORONARY SINDROME. A NEW MODEL FROM BEDSIDE TO THE COMMUNITY
Authors: Lordi R , Veronese S , Mandini S , Raisi A , Piccinini A , Ferro A , Zerbini V , Piva T , Grazzi G , Biagio S , Pasanisi G 
Published: May 2022

Abstract

Purpose
Physical inactivity is a major risk factor and negative prognostic index of cardiovascular disease. It is necessary to define effective strategies to direct patients after an acute coronary syndrome (ACS) to physically active lifestyle. The aim of this study was to examin efficacy, feasibility and long term adherence of a new physical activity prescription, adapted to patients (pts) early after ACS.

Methods
34 pts, mean age 67years, hospitalized for ACS, were enrolled consecutively and randomized 2:1 in treatment (TR) group (n = 23) or in control (CT) group. All pts were evaluated before discharge from hospital (T0) through Quality of Life (QoL) SF12 questionnaire, determination of physical activity during free time, six–minute walking test (6MWT). All pts were orally advised about the importance of changing life–style as recommended by current international guidelines. At T0, pts in the TR group performed a 500m moderate and perceptually–regulated (11–13 on the 6–20 Borg scale) treadmill walking test (500–m TWT) to estimate peak oxygen uptake (VO2peak). A home–based physical activity based on walking, was provided to pts in the TR group: it was recommended to maintain the level of perceived intensity of effort as indicated during 500m–TWT. These pts also received a reinforce phone–call at 2 and 4 weeks (T1 and T2), that allowed monitoring the adherence to the programme. All pts were finally evaluated 8 weeks after enrollment (T3) through the same tests performed at T0.

Results
Pts of the TR group at T3 reported significative improvement, compared to T0, in 6MWT (+79 m, p &lt; 0.001), QoL (expressed in the items of SF12), usual physical activity during free time (+13MET/h/week, p &lt; 0.001), VO2peak (+4 mL/kg/min, p &lt; 0.001). Compliance to the programme resulted optimal since all TR group pts continued the planned physical activity for all the follow–up.

Conclusions
Results of this study on efficacy, feasibility and compliance of a new model of secondary prevention programme, suggest the importance of implementing programmes of tailored physical activity schedules, based on walking, that can be safetly started soon after clinical stabilization of ACS.
P424 SMALL HEART AND SINGLE CORONARY ARTERY IN A YOUNG PATIENT WITH CHRONIC FATIGUE SYNDROME: A CASE REPORT
Authors: Poleggi C , Perfetti S , Restelli D , Perna A , Donato R , Di Bella G 
Published: May 2022

Abstract

Introduction
Chronic fatigue syndrome/Myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by severe and disabling fatigue limiting normal daily activities for at least 6 months accompanied by multiple unexplained symptoms including self–reported impairments in concentration and short–term memory, sleep disturbances, and musculoskeletal pain. Although rarely considered to have cardiac dysfunction, CFS/ME patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and post–exertional malaise severity. We describe a case of a young man affected by CFS/ME and small heart with incidental findings of anomalous origin of the left main coronary artery (LMCA).

Case Presentation
A 19–year–old Caucasian male presented to our clinic complaining weakness, lack of concentration and excessive daytime sleepiness. Medical history included CFS/ME, D hypovitaminosis, inflammatory bowel disease associated with pancreatic insufficiency. Physical examination including cardiovascular auscultation was unremarkable, with normal blood pressure and heart rate. Electrocardiogram showed sinus rhythm at 75 bpm without any repolarization abnormalities. Echocardiogram revealed reduced diameters of left ventricle (LV) (end–diastolic diameter 36 mm), normal aortic root dimensions and, in a five–chamber apical view, a binary structure that seemed to cross the aorta perpendicularly to its long axis. Cardiac magnetic resonance (CMR) found significantly reduced LV stroke volume (34 ml/m2; normal values 44–68 ml/m2) and end–diastolic volume (57 ml/m2; normal values 68–103 ml/m2) together with reduced end–diastolic wall mass (51 g/m2; normal values 59–93 g/m2). Also, right ventricle (RV) volumes were reduced: stroke volume (32 ml/m2; normal values 40–72 ml/m2), end–diastolic volume (62 ml/m2; normal values 68–114 ml/m2). In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro–aortic course.

Conclusions
Not sufficient consideration was given to cardiovascular involvement in patients with CFS/ME, although many of signs and symptoms are suggestive of cardiovascular dysfunction. This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association with cardiac congenital anomalies and CFS/ME.
P426 TELEMONITORING FOR THE SAFE MANAGEMENT OF NEW THERAPIES IN PATIENTS WITH MULTIPLE SCLEROSIS: THE RITMO PROJECT
Authors: Nodari S , Fioretti F , Bollani G , Glisenti F 
Published: May 2022

Abstract

Back in 2012 AIFA authorized the use of Fingolimod in patients with multiple sclerosis; due to possible adverse effects, continuous ECGraphic monitoring is mandatory during the first 6 hours after the administration of the first dose of the drug. Health Telematic Network, in collaboration with the Department of Cardiology of the University of Brescia, has provided a remote telemonitoring system based on the TelMed Telemedicine platform accessible from the computers of the departments, currently in use in 42 hospital departments participating in the project “Nuove Reti Sanitarie” of the General Directorate of Health of the Lombardy Region for the monitoring of patients with chronic heart failure and COPD; the patients were subjected to continuous ECG monitoring through a system consisting of the central unit IntelliVue M130, monitor IntelliVue MP2 and the traces were managed through the application WEBACCESS of the central unit M3150; the monitoring allowed the continuous recording of the ECG, the detection of arrhythmias in real time and the storage of any alarm detected; the WEBACCESS application allowed the cardiologist (local and remote HTN) to view in real time the traces and any alarm detected and stored; in case of detection of arrhythmias, the cardiologist liaised with the Neurology department to discuss the specific case and the necessary measures.

Results
21258 ECGraphic monitors were analyzed, in a total of 6865 patients (2282 males – mean age 44 years, 4583 females – mean age 45 years); drug–related side effects occurred in 30% of cases as sinus bradycardia, atrioventricular conduction disturbances in 3% of cases (first degree atrioventricular block 1.6%, transient episodes of second and third degree atrioventricular block in 1.4% of cases) and. QT interval prolongation in 9.8% of cases. Adverse events, transient and reversible, were immediately recognized and treated according to the AIFA recommendations for the use of the drug, allowing treatment for all patients monitored.

Conclusions
The use of Fingolimod has provided satisfactory clinical results with a high safety profile; the use of continuous telemonitoring has allowed to extend the number of subjects treated and to manage effectively and in real time the few side effects encountered.
P428 PRESCRIPTION APPROPRIATENESS AND EFFECTIVE CLINICAL IMPACT OF EXERCISE STRESS TEST IN ROUTINE DAILY PRACTICE
Authors: Prati D , Widmann M , Castaldi G , Zucchelli F , Tavella D , Ribichini F 
Published: May 2022

Abstract

Rationale
In the clinical setting, and particularly in the cardiovascular field, an exponential increase of non–invasive diagnostic tests has been observed. Between these, the exercise stress test represents a low–sensitivity and low–specificity diagnostic approach and its use has been less and less recommended in national and international guidelines. However, in the Italian clinical common practice it continues to be extensively prescribed both for chronic coronary syndrome (CCS) follow–up and for screening of coronary artery disease (CAD) in asymptomatic patients with multiple cardiovascular risk factors.

Materials and Methods
A retrospective cohort single–center study was conducted and 968 consecutives patients undergoing ECG stress test at our Department between October 2018 and March 2019 were included. Appropriateness of prescription and impact on the following diagnostic and therapeutic pathway has been analyzed.

Results
In this series, the main indication for exercise stress test was subclinical ischemia detection in CCS follow–up (312 pts, 32.3%). 181 tests (18.2%) were undertaken for CAD detection in patients symptomatic for chest pain and 171 (17.7%) for CAD detection in asymptomatic patients with multiple cardiovascular risk factors. At last, 97 tests (10%) were prescribed for arrhythmic burden evaluation and exercise response in patients with documented hyperkinetic arrhythmias. 590 tests (61%) were considered significative for reaching heart rate significance threshold (85% of target heart rate); between these 53 (9%) were positives for symptoms or ECG modifications. Among the positive tests, 25 patients (2.6%) went to the catheterization laboratory for coronary angiography: the indications for the exercise stress testing were chest pain for 14 of these patients while 7 undertook the examination for CCS follow–up. No asymptomatic patient presented for CAD screening undertook coronary angiography. At the end of the diagnostic pathway, 9 patients (0.9% of the complete cohort) received percutaneous or surgical revascularization.

Conclusions
Routinary and extensive use of exercise stress test can lead to dispersion of resources with many inappropriate examinations. Accurate clinical evaluation and appropriate prescription, especially regarding chest pain evaluation, are the foundations for a significative impact on clinical history of patients.
SCN5A mutation is associated with severity of abnormalities detected by ECG imaging in Brugada syndrome
Authors: Pannone L , Monaco C , Sorgente A , Gauthey A , Calburean P-A , Overeinder I , Bala G , Almorad A , Stroker E , Pappaert G , Sieira J , Brugada P , La Meir M , Chierchia GB , De Asmundis C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Brugada syndrome (BrS) is caused by mutations in SCN5A gene in 15%-20% of cases. Previous studies showed a worse prognosis in SCN5A mutation carriers (SCN5A+).

Purpose
To evaluate genotype-phenotype correlation with ECG imaging (ECGI).

Methods
All consecutive patients who underwent ECGI with CardioInsight for BrS were retrospectively analyzed. ECGI parameters analyzed before and after ajmaline administration were: 1) Right ventricular outflow tract (RVOT) activation time (RVOT-AT) and 2) RVOT recovery time (RVOT-RT). Genetic analysis was performed in all patients with SeqCap EZ Human Exome Probes v3.0 for BrS. Patients were defined as SCN5A+ if they had a pathogenic/likely pathogenic mutation in SCN5A following ACMG guidelines.

Results
Thirty-six BrS patients were included and 8 patients (22%) were SCN5A+. At baseline ECGI map, mean RVOT-RT was higher in SCN5A+ [384.8 ms vs 362 ms, p=0.037], with no difference in RVOT-AT (p=0.65). After ajmaline administration SCN5A+ patients showed higher RVOT-AT [125.6 ms vs 102.4 ms, p=0.045] (Figure) and higher RVOT-RT [426.4 ms vs 400 ms, p=0.038]. At univariate logistic regression, baseline RVOT-RT was a predictor of SCN5A mutation (specificity: 0.64, sensitivity 0.88, AUC 0.75).

Conclusion
In BrS syndrome SCN5A+ patients exhibit marked depolarization and repolarization abnormalities as assessed by ECGI.
Association between HV interval and electrocardiographic findings in individuals with syncope and left bundle branch block
Authors: Carvalho GD , Armaganijan LV , Ferreira MPN , Demarchi AV , Moreira DAR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The occurrence of syncope is associated with increased mortality in patients with left bundle branch block (LBBB). Among syncope risk scores, it is consensual that electrocardiographic (ECG) abnormalities and the presence of underlying cardiac disease are prominent factors. However, there is no further investigation directed towards this population and there is few that could add to clinical judgement in such cases, until electrophysiological study (EPS) is performed. The method’s modest sensitivity limits its practical usage in spite of current literature recommendation. Therefore, identifying those patients more prone to serious events is of clinical significance.

Objectives and methods
This was a cross-sectional study of patients with syncope and LBBB undergoing EP study in a tertiary hospital, which aimed to assess the relation between ECG parameters and prolonged HV interval on EPS.

Results
Ninety-four consecutive patients were eligible for the final analysis. Mean age was 63.1 ± 11.9 years (68.1% male). As for main comorbidities, the prevalence of smoking was 39.3%, hypertension 84%, diabetes mellitus 29.7%, coronary artery disease 28.7% and reduced left ventricle ejection fraction (LVEF) (≤ 40%) 48.9%. In the univariable analysis, LVEF ≤ 40% appeared to be somewhat important but this was not confirmed upon logistic regression. QRS duration ≥ 165 ms (OR 7.79; p = 0.0005) and PR interval ≥ 220 ms (OR 7.10; p = 0.003) were independent predictors for HV interval ≥ 70 ms. For each 10 ms increase in QRS and PR duration, the odds of HV interval ≥ 70 ms enhanced by 39.8% and 27.1%, respectively. For the subgroup presented with such outcome, mean QRS was 170.88 ± 26.81 ms, significantly larger than the patients with HV interval &lt; 70 ms. When combined, QRS ≥ 165 ms and PR interval ≥ 220 ms had an accuracy of 80% to predict an HV interval ≥ 70 ms in the EPS. Other analyzed data were not systematically associated with the evaluated outcome.

Conclusion
In patients with syncope and LBBB, prolonged QRS and PR interval were independent predictors of increased HV interval on EP study. Larger studies are needed to confirm these findings.
Electrocardiographic imaging a valid tool or an inaccurate toy?
Authors: Parreira A , Carmo P , Mesquita D , Marques L , Chambel D , Pinho J , Ferreira A , Amador P , Chmelevsky M , Machado P , Ferreira J , Nunes S , Goncalves P , Marques H , Adragao P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim
Electrocardiographic imaging (ECGI) is capable of performing an activation map with a single beat. However, previous studies using the epicardial-only system, have suggested a bad accuracy for the assessment of the epicardial breakthrough. Recent systems using endo-epicardial analysis have shown promising results. The aim of this study was to assess the accuracy and reproducibility of two endo-epicardial ECGI systems using different cardiac sources one based on the extracellular-potential, and the other on the equivalent double layer model, respectively the AMYCARD (EP Solutions SA, Switzerland) and VIVO (Catheter Precision, NJ USA) systems.

Methods
We studied 11 consecutive patients referred for ablation of frequent idiopathic premature ventricular contractions at our center that had an ECGI performed using both systems on the same day. The AMYCARD system uses a dense array of body-surface electrocardiograms with up to 224 leads and VIVO uses just the 12-leads ECG. Both systems use a patient-specific heart torso geometry obtained with a CT-scan or cardiac magnetic resonance. The localisation of the PVCs based on ECGI was done using a segmental model with 22 segments on the left ventricle, to include the classical 17 segment model plus the aortic cusps and the papillary muscles, and 12 segments on the right ventricle including 4 on the right ventricular outflow tract (RVOT): (anterior, lateral, right septum and left septum). A perfect match was defined as a predicted location within the same anatomic segment, whereas a near match as a predicted location within the same segment or a contiguous one.

Results
The median (Q1-Q3) number of leads used for the AMYCARD was 131 (118-144). Seven patients underwent ablation and in 4 ablation is pending. The predicted locations and the ablation site are depicted on the Table. We found a perfect match between both systems in 73% (Figure) and near match in 91% of cases. In patients that underwent ablation the systems localised the site of origin of the PVCs within the same segment or the contiguous segment in all patients with VIVO and in six out of seven with AMYCARD.

Conclusions
ECGI is an accurate diagnostic tool with reproducible results regardless the cardiac source used for analysis.