bluuebunny/crossref_metadata_2025_split huggingface dataset:
P78 AN ANTEGRADE RECANALIZATION OF LEFT ANTERIOR DESCENDING CHRONIC TOTAL OCCLUSION WITH ORBITAL ATHERECTOMY IN PATIENT WITH SEVER LEFT VENTRICULAR DISFUNCTION
Authors: Fulgenzi F , Forlani D , Di Marco M , D‘Alleva A , Magnano R , Pezzi L , Verrengia E , Vitulli P , Corazzini A , Paloscia L 
Published: May 2022

Abstract
We share the case of a 71–year old man, affected by hypertension, presented in Emergency Room (ER) with chest pain. No clinical evidence of heart failure. EKG showed fast atrial fibrillation with QS complex and ST elevation in precordial leads. Echocardiogram confirmed sept and apex akinesia. Troponin I peak was 72pg/ml. In ER electrical cardioversion was efficacy performed. He was referred for invasive coronary angiography, that showed a left anterior descending (LAD) chronic total occlusion (CTO), with Rentrop grade 2 collaterals providing retrograde flow from the right coronary artery (RCA), a severe stenosis of ramus intermedius (RI) and a moderate stenosis of circumflex. A stress–echocardiogram demonstrated vitality of medio–basal anterior wall. Subsequent, recanalization procedure of LAD CTO was planned. J–CTO score was 1 (tapered calcific, lesion, &lt;20mm). double radial access and ante grade approach was chosen. An EBU3.5 guiding catheter was engaged in the left coronary artery, and 8000 units of heparin administered. The iFR of Cx was 0.99, indicative of non significant myocardial ischemia. During hemodynamic evaluation of RI, a ventricular fibrillation occurred, treated by DC–SHOCK and PCI with stenting with no polymer, eluted with Biolimus A9 (3.0x24mm) with good result. The occlusion was crossed via an antegrade approach with an Asahi Gaia II wire and with microcatheter support. Gaia II was changed in favor of Asai Sion blu, and the IVUS catheter was enable of cross the lesion. Efficacy orbital atherectomy with Diamondback 260 was performed (5 ante and retro grade run at 80Krpm and a retro grade run at 120 Krpm. Ivus was able to cross the lesion. Efficacy pre–dilatation with semi and non compliant balloon (2.5–3.5mm) was performed and then stented with a 3.0 × 36 mm Bioloimu A9–eluting stent. Finally, IVUS confirmed correct stent expansion, achieving an excellent angiographic result. Patient was discharged with triple anti–thrombotic therapy, with indication to “life jacket” till the assessment at 1 month.
P83 PERCUTANEOUS INTERVENTION FOR AORTIC COARCTATION IN YOUNG ADULTS: A CASE SERIES
Authors: Virgili G , Muraca I , Carrabba N , Bruscoli F , Migliorini A , Pennesi M , Pontecorboli G , Marchionni N , Bovenzi F , Stefàno P , Valenti R 
Published: May 2022

Abstract

Introduction
Aortic coarctation is one of the most frequent misdiagnosed congenital heart diseases and the most commonly missed foetal congenital heart disease. In adulthood the treatment of this pathology is primarily percutaneous.

Case Presentation
We present a case series of two young patients. The formers was a 37–years–old male with recent onset of heart failure symptoms due to misdiagnosed congenital aortic coarctation. The latter was a 39–years–old woman with exertional dyspnoea and a previous operated bicuspid aortic valve; in this case the intervention for the aortic defect was made in a second time, in order to avoid a huge demolishing surgical procedure. The execution of a diagnostic multimodality imaging allowed to detect the aortic coarctation, which received indication to percutaneous correction of the aortic defect after the multidisciplinary “Heart Team” discussion (image 2 and 3). In the cath–lab, the use of novel digital techniques, integrating the angiographic images with previously acquired angio–CT, allowed a safe stent delivery with minimum amount of contrast injection (image 1).

Conclusion
Percutaneous treatment of aortic coarctation in young adult is safe and effective. Fusion imaging tools could be very useful to optimize procedural results and sparing contrast dye, suggesting their possible implementation in different percutaneous procedures.
P99 LONG TERM DUAL ANTIPLATELET THERAPY AFTER MYOCARDIAL INFARCTION IN CLINICAL PRACTICE: IMPACT OF NUISANCE BLEEDING ON MEDICATION ADHERENCE
Authors: Ratti G , Monda C , Di Tommaso C , Ratti F , Fulgione L , Fulgione C , Mallardo M , Tammaro P 
Published: May 2022

Abstract

Background
Long term dual antiplatelet therapy (LTDAPT) with ticagrelor 60 mg and low–dose aspirin are indicated after acute coronary syndrome (ACS) for the secondary prevention of atherothrombotic events in high–risk patients with a history of ACS of at least 1 year. LTDAPT had a well tolerability and safety profile, but the risk of TIMI major bleeding was increased. However even non significant bleeding may be important because have an effect on quality of life and therefore may lead to treatment discontinuation. Objective To understand the experiences of patients with LTDAPT and nuisance bleeding, and their impact on medication adherence.

Methods
We retrospectively reviewed 225 patients in follow up after ACS with at least one high risk condition (Fig. 1), treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The outpatient follow–up program after hospitalization provides a visits at day 30 after discharge and subsequently after 3 months, then continuing with six–monthly checks. The intensity of bleeding was assessed according to the TIMI score. Any overt bleeding event that did not meet the criteria of major and minor was defined “minimal”.

Results
they are shown in Fig. 2. Minmal bleedings were present in 49 patients (21%), but were not a cause for discontinuation of therapy. However 39 (79%) subjects had asked opinion on stop the therapy at the telephone consultation. We found that: (1) participants adhered to treatment when they believed long term DAPT was important to health outcomes; (2) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (3) participants’ and their family’s understanding of LTDAPT risks and benefits, and their ability to manage symptoms, influenced medication adherence. Factors influencing long term DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital.

Conclusions
All adverse events judged to be “not serious” in trials may have an effect on quality of life and therefore may lead to treatment discontinuation. The need to educate the patient in order to improve adherence should therefore be emphasized. The authors underline the importance of careful outpatient follow–up and constant counselling in order to check out compliance and possible adverse effect of long term DAPT risks treatment.
P101 ARRHYTHMIC MITRAL VALVE PROLAPSE: COULD ELECTROANATOMICAL MAPPING AND CARDIAC MAGNETIC RESONANCE BE GOOD FRIENDS?
Authors: Piscitelli L , Pedone C , Perugini E , Coutsoumbas G , Riva L , Dattolo G , Carinci V , Barbato G , Cardelli L , Casella G 
Published: May 2022

Abstract

Background
There is an increasing awareness of the association between mitral valve prolapse (MVP) and sudden cardiac death (SCD), but risk stratification is still challenging. Mitral annular disjunction (MAD) is a recognized risk factor for arrhythmic complications. A multimodality imaging strategy, including advanced echocardiography, magnetic resonance (CMR) and electromechanical mapping, could improve risk stratification and management by combining anatomical and functional information.

Case Review
We report a case of a 50–year–old woman without cardiovascular risk factors, complaining for worsening palpitations in the last months. Echocardiogram documented bileaflet MVP with moderate regurgitation, MAD (12 mm in inferolateral wall) and normal ventricular systolic function. 24–hour Holter monitoring revealed a high (13%) premature ventricular complexes burden with ventricular bigeminy and non–sustained ventricular tachycardia. Stress test showed a reduction of the arrhythmias during exercise. CMR confirmed MAD but no late gadolinium enhancement areas were detected. The patient underwent electrophysiological study with electroanatomic mapping (CARTO). The latter revealed multifocal fragmented and delayed low voltage potentials close to the posterior papillary muscle and the posterior anular mitral area, respectively. Both locations were the targets of endoventricular radiofrequency ablation. However, due to her high arrhythmic risk profile the patient implanted a cardioverter defibrillator.

Discussion
In arrhythmic risk stratification of MVP with MAD, CMR could have technical limitations due to diffuse fibrosis patterns or irregular cardiac rhythm that could undermine a detailed and complete evaluation. Thus, electroanatomical mapping during electrophysiological testing could offer additional and complementary information that could improve risk stratification and further management.
P103 LIBMAN–SACKS ENDOCARDITIS AND FIBROELASTOMA IN ANTYPHOSPHOLIPIDIC SYNDROME: A RARE COEXISTANCE
Authors: Piscitelli L , Pedone C , Perugini E , Coutsoumbas G , Corbo P , Martin S , Dal Passo B , Dattolo G , Casella G 
Published: May 2022

Abstract

Background
Libman–Sacks endocarditis (LSE) is the most common cardiac manifestation of the antiphospholipid antibody syndrome (APS), a systemic autoimmune disease characterized by the presence of arterial and venous thrombosis associated with the persistent presence of antiphospholipid antibodies (Sydney criteria). Cardioembolic events, mainly stroke, are important prognostic determinants of APS. Echocardiography, mostly transesophageal, is the main diagnostic tool to early identification and timely management of LSE.

Case Summary
we report a case of 33–year–old man, with no cardiovascular risk factors. In the last few months, he had a myocardial infarction without obstructive coronary artery disease, a femoral venous thrombosis and a cryptogenic stroke. After clinical and laboratory workout he received diagnosis of primary APS and started an anticoagulation therapy with warfarin. 2D and 3D transesophageal echocardiogram performed after stroke showed two vegetations of the mitral valve. The first one appeared as granular mass, attached to ventricular and atrial surface of the posterior leaflet, measuring 16 x 5 mm. The second one was a smaller, mobile, pedunculated and more hyperechogenic mass apposed on the anterior leaflet. Mitral valve had mild to moderate regurgitation. The patient underwent surgical vegetation excision due to the high embolic risk. Resected specimens revealed sterile fibrinous and verrucous vegetations referable to LSE and a papillary fibroelastoma.

Discussion
In this case we demonstrated a very rare coexistence of abacterial endocarditis and papillary fibroelastoma. We can assume a predisposing role of fibroelastoma by altering the morphology and structure of the mitral leaflets in LSE development.
P107 MULTIMODALITY IMAGING IN ASCENDING AORTA PSEUDO–ANEURYSM COMPLICATED BY MOBILE TROMBUS SYMPTOMATIC FOR RECURRENT ISCHEMIC STROKE
Authors: Monari D , Mei D , Mantovani F , Guiducci V , Navazio A 
Published: May 2022

Abstract

A 80–year–old male patient was admitted to hospital with a clinical picture of Broca‘s aphasia. The patient had arterial hypertension, diabetes, chronic kidney disease and peripheral vasculopathy. In remote cardiological history he presents long standing persistent atrial fibrillation on OAC and he had a biological aortic valve prosthesis (Medtronic 23). Overall time in the therapeutic range (INR 2.0–2.5) was adequate considering the presence of atrial fibrillation. A CT scan was performed on suspicion of stroke, showing a recent ischemic lesion in the left middle temporal region complicated by same–site subarachnoid blood suffusion. During the hospital stay there was a recurrence of the aforementioned symptoms: at the CT check a new acute ischemic same–site lesion and a new ischaemic lesion at the left temporal site was highlighted. In the suspicion of a cardio–embolic origin of cerebro–vascular events, it was decided to carry out imaging for the study of the aorta and heart cavities to exclude embolic sources. Given the patient‘s comorbidities and the reported allergies (contrast medium with angioedema–like reaction at a previous CT) it was decided to perform transesophageal echocardiography (TEE) first. TEE documented the presence of a saccular aneurysm of probable pseudo–aneurysmatic nature, which extends from 20 mm from the valvular plane, characterized by pedunculated, mobile thrombotic apposition, adhered to the internal collar, projecting into the psueudo–aneurysmatic cavity (image 1). This finding was confirmed and better characterized with the help of the real time three–dimensional echocardiographic method (image 2). To confirm and better characterize the extension of the pseudo–aneurysm and plan any strategy, a CT scan with contrast medium was required. Performing contrast–enhanced CT, after careful preparation with premedication with antihistamine and cortisone, confirmed the finding of pseudo–aneurysm of the ascending aorta, but the pedunculated thrombotic apposition was less clearly evidenced compared with TEE (giving the superior temporal resolution of TEE) (image 3). The case was therefore assessed in Heart Team and the patient was scheduled for surgically exclusion of the pseudo–aneurysm.

Conclusion
In our case a multimodality imaging approach was used to diagnose and confirm the presence of ascending aorta pseudo–aneurysm complicated by pedunculated thrombotic apposition inside it, symptomatic for recurrent ischaemic stroke.
P122 EXTENDED PULMONARY ADENOCARCINOMA INFILTRATING THE LEFT ATRIUM
Authors: Dell‘Uomo M , Bier N , Irene D , Nicolì L , Sordi M , Patella M , De Paolis M , Dominici M 
Published: May 2022

Abstract
Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in any part of the heart tissue, causing obstruction in the inflow or outflow tract of the valves, thromboembolism, arrhythmias and pericardial disorders. Diagnosis is made by echocardiography and, frequently, by cardiac MRI. The treatment of metastatic malignancies depends on the type and origin of the tumor; however, the prognosis is generally poor.73–year–old patient, he reaches echocardiographic control after having started, 5 months earlier, chemotherapy with weekly carboplatin–paclitaxel scheme for the diagnosis of primary left hilar pulmonary heteroplasia. In medical history: systemic arterial hypertension, iron deficiency anemia and thrombocytopenia in a patient with a history of alcohol–related liver cirrhosis and esophageal varices.On transthoracic echocardiogram (Figures 1 and 2): normal size and bi–ventricular systolic function; mild aortic and mitral insufficiency. Presence of non–mobile isoechoic oval mass adhering to the left atrium, 43 x 27 mm in size, at the outlet of the left pulmonary veins, which does not cause obstruction to the atrio–ventricular blood supply.On CT of chest without and with contrast (Figure 3): primary heteroplastic left hilar pulmonary lesion that infiltrates the left atrium and obliterates the left main bronchus before the bifurcation and the bronchus for the left upper lobe; the corresponding pulmonary vessels also appear infiltrated. The diagnosis was therefore of intracardiac tumor secondary to primary lung lesion.Secondary cardiac tumors are about 20 times more frequent than primary ones. The ability of the tumor to spread to the heart depends on the relationship between the specific biological potential of the primary tumor, the location of the latter and the contractile and draining force of the myocardium.Cardiac metastases can involve, also in combination, pericardium, epicardium, myocardium, endocardium, heart chambers or create endocavitary neoplastic thrombus. Tumors spread to the heart through four possible routes: direct extension, the blood route, the lymphatic route, intracavitary diffusion from the inferior vena cava or pulmonary veins, as in our case.The haemodynamic alterations they cause depend on the engagement of the atrioventricular orifice by the tumor mass.
P177 A SHOT TO THE HEART
Authors: Fais L , Orrù F , Garau V , Carboni G , Mascia D , Cirio E , Delogu G 
Published: May 2022

Abstract
We report the case of a 50–year–old man who, during a wild bird hunt, was accidentally fired with a shotgun loaded with pellets which hit the chest, the neck and the face of the hunter. The patient was taken to the emergency room, tachypnoic and suffering from chest pain, systolic blood pressure was 150/70 mmHg, SpO2 88%, analgesic therapy, liquids administration and O2 therapy were performed with moderate response. On physical examination there was a reduced vesicular murmur in middle field on the right, no heart murmurs; noticeable edema of face and neck soft tissues and absence of evident jugular turgor. The ECG showed sinus rhythm, HR 100/min, morphology at the limit for ST slightly rigid in the inferior site. He underwent a total body CT in which a shotgun pellet was found located at the heart base near the right atrium, with associated pericardial fluid, with a maximum thickness of about 10 mm, with blood density. A shotgun pellet was also found in the apical segment of the right upper lung lobe with associated parenchymal ground glass (the pellet site of passage) without pneumothorax and pleural effusion. CT also showed multiple hunting pellets in the soft tissues of the face and of the neck without significant lesions. The echocardiogram confirmed the presence of circumferential pericardial effusion of mild degree, but progressively worsening, mainly represented along the cardiac apex and the inferolateral wall, but without signs of cardiac tamponade (right atrium within limits, absence of significant Doppler variation in blood flow across cardiac valves). The hospital where the patient arrived was at a distance of 30 minutes from the cardiac surgery, therefore the patient was urgently transferred to the cardiac surgery room of the hub (distance of 30 minutes). Fortunately, the patient maintained hemodynamic stability and arrived in the operating room with good blood pressure, but with a pre–tamponade effusion. The man quickly underwentcardiac surgery, the pericardial effusion was drained and the responsible breach was found in at the atrio–caval junction and successfully sutured. The patient was discharged in the 6th day and currently is in good clinical condition.
P205 PROGNOSTIC VALUE OF AMYLOID–Β (1–40) IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Janjusevic M , Gagno G , Fluca A , Beltrami A , Sinagra G , Aleksova A 
Published: May 2022

Abstract

Background
Survivors of acute myocardial infarction (AMI) have an increased risk of various cardiovascular complications during follow–up; therefore, adequate risk stratification remains the main challenge in the clinical setting. Amyloid β 1–40 (Aβ (1–40)) has already emerged as a negative prognostic marker for cardiovascular mortality, both in patients with stable chronic coronary artery disease and in patients with NSTEMI–type infarction. This is probably due to the pro–inflammatory and pro–atherosclerotic role of this peptide.

Methods
Plasma Aβ (1–40) values were tested acutely in a large prospective cohort of patients hospitalized for AMI (both NSTEMI and STEMI). The primary end–point was defined as all–cause mortality during the period of follow–up.

Results
894 individuals were enrolled in the study (607 with STEMI and 287 with NSTEMI). The median plasma concentration of Aβ (1–40) at the time of admission was 96.59 (60.94–134.5) pg/ml. During a median follow–up of 43 months, 123 patients died (primary endpoint). Higher Aβ (1–40) concentrations were associated with an increased risk of mortality, both on univariate analysis and after correction for other confounding variables. Furthermore, we found a strong positive correlation between plasma Aβ (1–40) values and age. The prognostic value of Aβ (1–40) was maintained only in the subgroup of patients with greater than the median age of 67 years.

Conclusions
This is currently the largest single–centre study evaluating the role of plasma Aβ (1–40) concentrations in predicting outcome in a population of patients admitted for AMI, both STEMI and NSTEMI. Our data represent a strong correlation between plasma (1–40) values and the increased risk of all–cause mortality during follow–up.
P208 THE TREATMENT WITH BETA–BLOCKERS AFTER MYOCARDIAL INFARCTION WITHOUT REDUCED EJECTION FRACTION (REBOOT) TRIAL. CURRENT STATUS
Authors: Vetrano A , Vetrano D , Pariggiano I 
Published: May 2022

Abstract

Background
There is a lack of evidence regarding the benefits of maintenance β–blocker (BB) treatment in post–acute AMI patients (pts) without reduced LVEF in the era of invasive management.

Design and Trial Status
REBOOT is an independent multinational pragmatic, controlled, randomized, open–label, with blinded endpoint adjudication clinical trial testing the benefits of BB maintenance therapy in post–AMI pts (either with or without ST segment elevation) discharged with LVEF &gt;40%. Patients ≥18 years (yr) old undergoing invasive management during admission and without history of heart failure (HF) are eligible to participate. At discharge, pts are 1:1 randomized to either receive BB (agent and dose chosen by the treating physician) or no BB therapy. The primary endpoint is a composite of “all–cause death, nonfatal reAMI, or HF hospitalization” over a minimum follow–up period of 2 yr. Key secondary endpoints are: a) the incidence rate of each individual component of the composite endpoint; b) cardiovascular death; c) admission for sustained ventricular tachycardia/ventricular fibrillation; and d) admission for atrial fibrillation. Events will be adjudicated by a blinded committee. A sample size of 8468 pts (728 events) was estimated to provide a power of 85% to detect a relative risk reduction of 20% (incidence of primary endpoint in control 10%) and assuming 5% withdrawals. Statistical analyses will be conducted according to the intention–to–treat principle, although a pre–specified per–protocol analysis will also be performed. The Spanish National Center for Cardiovascular Research (CNIC) is the sponsor of the trial, which has no external funding. CNIC coordinates ≥75 Spanish centers, while Istituto di Ricerche Farmacologiche Mario Negri IRCCS coordinate 33 Cardiology Centers distributed in 10 Italian regions. The first pt was included in Spain in October 2018, in Italy in January 2019. The end of enrollment is anticipated in December 2022. At 09 December 2021, 5669 pts had been enrolled from which 1263 in Italy (Figure). Pts baseline characteristics are described in the Table. Hospital admission data for COVID–19 pre and post randomization were also recorded since June 2020.

Conclusions
The REBOOT trial (NCT03596385) will fill the existing scientific gap on the efficacy of β–BB after AMI in pts with LVEF &gt; 40% and no HF who are treated according to current standard–of–care. REBOOT trial results might have an impact on clinical practice guidelines.