bluuebunny/crossref_metadata_2025_split huggingface dataset:
P256 COMORBIDITY ROLE IN THE REOCCURRENCE OF HEART FAILURE EXACERBATION ON A POPULATION OF PATIENTS WHO HAVE A DEDICATED FOLLOW UP
Authors: De Masi De Luca G , Longo S , Barba F , Marzo S , Mauro R , Accogli M 
Published: May 2022

Abstract

Background
With this work we drew attention on the importance of a proper FUP dedicated to patients affected by heart failure (HF), while also underlining the importance of proper and efficient management of comorbidities.

Material and Methods
164 patients were put into the FUP program for HF at Cardiology Department in “Card. G.Panico Hospital” in Tricase (Lecce, IT) and with the same organization at “Cardiomed Centre” in Maglie (Lecce, IT) 61% of the patients had just been hospitalized, 24% came from a generic clinic, 15% from the ER. 59% presented a systolic HF, diastolic genesis for the other patients left. The average age was 69±21 year old. During the evaluation of admission to the FUP program, the patients were divided into patients at high, medium and low risk, based on their clinical situation regarding the risk of events. Each risk category had its own different FUP iter, which was both clinical and telemedical, commited to the clinical nurse. During the periodic call, the nurse set, where necessary, a stability judgment after confronting FUP parameters, and showed the report, or better to say, the alerts, to the medical staff who had the role of re–evaluating the patient in order to put in place proper therapeutic measures.

Results
In a 12 month FUP period of time 78 alerts have been highlighted. In 64% of the cases it was about weight gaining; in 54% an increase in Borg scale index; in 37% it was due to a reduced Spo2 during exercise; In the following clinical evaluations, in 91% of the cases correctional therapeutic measures have been put into place, consisting of: – diuretic therapy readjustment for os (31 cases); – start of transitory period diuretic therapy for ev (19 cases); – hospitalization (3 cases); – comorbidities correction (59 cases). This last parameter got most attention: in 23 cases it was highlighted a reduction of a % of transferrin saturation by less than 10%, then adjusted (target according to guidelines: &gt;20%); in 17 cases we noticed a clinical situation of bronchial inflammation; in 19 patients showed a worsening in kidney function index.

Conclusion
Our experience in the clinic dedicated to heart failure suggests how fundamental attention to comorbidity is, especially where instability can be considered a predicting alert of re–exacerbation of HF.
P271 DOES SENILITY AFFECT THE MANIFESTATION AND MANAGEMENT OF PULMONARY EMBOLISM? EXPERIENCE OF AN ED
Authors: Savioli G , Lapia F , Fumoso F , Brattoli M , Mugellini A , Martignoni A , Ceresa I , Muzzi A , Novelli V , Preda L , Lava M , Maggioni P , Manzoni F , Bressan M 
Published: May 2022

Abstract

Premises
Acute pulmonary embolism is a pathology characterized by high mortality. The elderly population is destined to increase, becoming, according to some authors, 30% of the population in the developed countries.

Purpose of the Study
see if and how, in the real life of an Emergency Department, age can affect the manifestation (more severe or milder forms of pulmonary embolism; typical symptoms and atypical symptoms), patient management and adherence to guidelines. We considered subjects over 75 years of age to be elderly, as per the latest indications of the guidelines.

Methods
Single–center retrospective observational study on all patients 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 diagostic / 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 the hospitalization rate, in–hospital mortality rate, the hospitalization rate in resuscitation and the length of hospitalization. We then analyzed adherence to the guidelines valid in the period under study.

Results
We enrolled 487 patients, with equal gender distribution (F = 52%). 247 were older than 75 (50.7%). Age has a positive correlation with the presence of massive pulmonary embolism, in a statistically significant way (p &lt; 0.05), and with the presence of organ damage, touching on statistical significance (p = 0.05). On the other hand there is no statistically significant difference in the prevalence of typical or atypical symptoms in the two groups. The vital parameters were instead comparable in the two groups with no statistically significant difference (p &gt; 0.05). Long–term outcomes such as mortality, need for hospitalization, ICU stay and length of stay in hospital are also comparable results without statistically significant difference (p &gt; 0.05). Adherence to international guidelines is also comparable between the two groups (p &gt; 0.05).

Conclusions
The study suggests that age correlates with more severe forms of pulmonary embolism but does not affect either patient management or short–term outcomes.
P275 HOLDING AREA IN EMERGENCY DEPARTMENT : A STRATEGY TO IMPROVE ADHERENCE TO INTERNATIONAL GUIDELINES IN CASES OF PULMONARY EMBOLISM IN ELDERLY
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Fumoso F , Lapia F , Brattoli M , Maggioni P , Preda L , Lava M , Muzzi A , Novelli V , Manzoni F , Bressan M 
Published: May 2022

Abstract

Premises
Pulmonary embolism is a disease still characterized by high mortality. Despite a great development of the guidelines it is not clear what adherence to them is in real life, especially in the emergency room.

Purpose of the Study
See if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the area to which the patient is addressed.

Methods
Monocentric retrospective observational study, on a group of geriatric patients (&lt;75 y) that include all the people accessed to our ED, where they received acute PE dignosis. Enrolment started on 2016 and finished on 2019. We collected data from medical history, physical examination, lab tests, imaging; we calculated characteristic scores from the diagostic/therapeutic algorhitm, both regarding PE risk (Wells, Geneva and Years), and the 30–day mortality risk presentazione (sPESI). We then analized guidelines adherence in three decision–making turning–points: 1 Correct applicarion of decisional scores examined, which classify the patient in low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct therapy administration since the ED as suggested by the guidelines; 3 The eventual observation in the medium–intensity care area with close monitoring for the subpopulation of patients with finding of right ventricular dilation or myocardial enzymes impairement (considered at high risk of short–term shock and mortality).

Results
we enrolled 249 patients, with a mean age of 83 years and female prevalence (F = 62%). Of these, 69% were referred by Triage to medium–high intensity of care, the remaining 31% was directed to low intensity of care. 42.5% of the total patients were referred to OBI. The two areas of intensity of care showed similar adherence to guidelines (approximately 50%) without there being a statistically significant difference between the two areas (p &gt; 0.05) Adherence to guidelines was higher in the holding area – OBI (75 %) compared to that of those managed in theaters (50%) in a statistically significant way (p &lt; 0.001).

Conclusions
The study suggests that holding areas located in Emergency Departments can considerably increase adherence to international guidelines.
P329 SEVERE ISOLATED MITRAL STENOSIS: ARE WE FACING DIFFERENT PHENOTYPES?
Authors: Vriz O , Eltayeb A , Anwar K , Alenazy A , Galzerano D , Mohammed A 
Published: May 2022

Abstract

Introduction
The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) mitral stenosis (MS) and, within the LG group those with high (LG–HF) or low flow (LG–LF). Moreover, we wanted to evaluated if there was any difference in overall complications and atrial fibrillation (AFib) incidence.

Methods
A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database. Echocardiograms were read off line and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient &gt; 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF–LG: 68 patients) and in high flow (SVi &gt; 35 ml/m2, HF–LG: 48 patients).

Results
The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity and derived pulmonary artery systolic pressure (PASP), right ventricular fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT. The group of LG was divided according to SVi: LF–LG compare to HG–MS had higher percent of females (45% F vs 13% M, p &lt; 0.001), similar AFib (43% vs 32%, p=ns) and pre surgical complications (19% vs 16%, p=ns). LF–LG group had smaller LA volumes (LAV systole: 117±51 51 ml vs 148.6±38 ml, p &lt; 0.0001), lower LV–S` (5.3±1.4 vs 6±1.6 cm/s, p = 0.004), lower tricuspid velocity regurgitation (TVR 2.47±0.5 vs 3.24±0.7 m/s, p &lt; 0.0001), higher TAPSE/PASP (0.64±0.3 vs 0.45±0.29, p &lt; 0.001), lower RV S` (9.79±2.01m/s vs 11.25±3.1 m/s, p = 0.01), higher RVFAC (38.5±9.6% vs 30.9±9.2%, p = 0.0005). The group of LG–LF had also less severe MS (1.3±0.6 cm2 vs 1.15±0.3 cm2, p &lt; 0.01). The 3 groups of MS were similar in terms of cardiovascular risk factors.

Conclusion
Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. However LF–LG MS were older and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of Afib and similar pre surgical complications. It could be speculated that LF–LG severe MS patients could be a different fenotype of the disease.
P333 INFECTIVE ENDOCARDITIS ON TRICUSPID VALVE CAUSED BY S. AUREUS METHICILLIN RESPONSIVE: RESOLUTION AND RECURRENCE OF DISEASE
Authors: Gizzi G , D‘Agostino S , Parato V 
Published: May 2022

Abstract

Introduction
Tricuspid valve endocarditis accounts for 5–10% of endocarditis cases and is more frequent in intravenous drug abusers. Recurrence of endocarditis occurs not infrequently in patients treated with conservative therapy.

Clinical Case
In June 2021, a 32–year–old man with a history of intravenous drug abuse came to our observation. He had been presenting for about a week high fever with shaking shivering resistant to antipyretic and antibiotic therapy and laboratory tests with neutrophilic leukocytosis with increase in CRP and procalcitonin. Trans–thoracic echocardiogram was performed and it showed mild tricuspid regurgitation with the presence of filamentous mobile isoechoic formations adhering to the valve leaflets compatible with endocarditic vegetations. A trans–esophageal echocardiogram was performed that confirmed the transthoracic finding of endocarditis on the tricuspid valve with evidence of 11 mm mobile oval vegetation adhering to the posterior flap; blood cultures were positive for methicillin susceptible S. Aureus and antibiotic therapy with oxacillin was administered as a continuous infusion for 6 weeks. The cardiac surgery center was consulted and the surgeons did not indicate any intervention because of the normofunction of the tricuspid valve and the absence of embolic phenomena on total body CT. Subsequent laboratory tests showed negative inflammation indices and negative surveillance blood cultures. Control ETE was planned with the confirmation of complete resolution of endocardial lesions. In September the patient affered the emergency room for an accidental fall from a work vehicle: transthoracic and trans–esophageal echocardiograms were repeated for the concomitant finding of hyperpyrexia and cough with an increase in CRP and procalcitonin. They showed the presence of new larger endocarditic lesions on tricuspid valve with moderate regurgitation. Blood cultures were negative. Antibiotic therapy with oxacillin was reintroduced and the patient was transferred to the infectious disease clinic in prevision of cardiac surgery.
P343 VALIDATION OF ESC 2014 GUIDELINES PROTOCOL FOR CORONARY ARTERY DISEASE DETECTION IN PATIENTS CANDIDATES TO LIVER TRANSPLANTATION
Authors: Mircoli L , Carugo S 
Published: May 2022

Abstract

Introduction
Orthotopic liver transplantation (OLT) is the only effective treatment in patients with end–stage liver disease. Coronary artery disease (CAD) is associated with increased peri–operative OLT mortality. Thus, identification of CAD is crucial in pre–OLT evaluation. There is not a specific pre–OLT accepted diagnostic algorithm for CAD detection. 2014 ESC guidelines for non–cardiac surgery management consider OLT as a high–risk abdominal surgery and only patients with CAD history, suspected symptoms and low exercise capacity are invited to undergo to specific functional exams such as stress–echo.
Purpose of the present study was to compare the ESC protocol with our cardiologic pre–OLT protocol, in which tests of ischemia and coronary CT are largely administered on based on presence of risk factors. Methods. From 2014 to 2021 all OLT candidates have been evaluated by visit, electrocardiography, rest and, when possible, stress echocardiography. In subject aged &gt; 50 years with diabetes and/or two or more of the following risk factors: smoking, CAD family history, peripheral vascular disease, CT was performed. CGF was scheduled when CAD history and typical symptoms of angina. We theoretically re–analyse our database in order to consider the potential destiny of each patient in case of application of ECS 2014 protocol. We were able to calculate the differences in the number of potentially loss CAD diagnosis. Results. 367 patients (58.2%, age 57±5.7 years, males 74%) underwent OLT. Stress Echo was performed in 239 (65.1%) and positivity was found in 24 pz (6,5%). Coronary CT was performed in 95 (25,8%). CGF was performed in 75 patients (20.1%), 38 (9,2%) directly for known CAD and/or symptoms. Critical coronary lesions were found in 12 patients (3,2 %): 7 revascularized by PTCA, 1 by CABG and 4 medically managed, 25 patients had non critical lesions (7.8%), 31 patients (9.6%) referred to CGF were subsequently removed by transplant list, whereas OLT was successfully performed in PTCA patients (n = 8). During follow–up (35±20 months) 28 patients died (14.2%), 5 with symptoms of congestive heart failure, but no ischemic events were observed.

Conclusions
CAD detectionis remains a clinical challenge in candidates to OLT. The large number of normal stress echoes and normal CGF, even in presence of cardiovascular risk factors, demonstrates that CAD prevalence in ESLD is no higher than in general population, but a gold method to detect CAD is still unclear.
P356 PREVALENCE AND PROGNOSTIC IMPACT OF LIPID GOAL ATTAINMENT AND PATIENT ADHERENCE TO LOWERING LIPID TREATMENT: DATA FROM COMMUNITY ITALIAN SETTING
Authors: Di Lenarda A , Garavaglia A , Poli S , Peruzzi E , Scagnetto A , Cappelletto C , Barbati G 
Published: May 2022

Abstract

Aims
The aim of the study was to provide real–world data on low–density lipoprotein cholesterol (LDL–C) goal achievement at the time of current 2019 ESC/EAS Guidelines, treatment patterns and patient adherence to lowering lipid treatment (LLT).

Methods and Results
This community–based study identified patients with at least one LDL–C measurement and cardiological evaluation from 01–Jan–2016 to 31–Dec–2018. Patients risk stratification and LDL–C target achievement were assessed according to 2019 EAS/ESC guidelines. To identify the proportion of patients at LDL–C target, only patients with an available LDL–C evaluation after 1 year from baseline were considered (7317 patients, 51% of initial cohort 14317 pts). Of those, 492 pts (7%) presented LDL–C at target. Among them, 187 were at very high risk (4% of very high risk subgroup) and 47 at high risk (3% of high risk subgroup). Statin intolerance was reported in 7,5% of patients (1073 out of 14317). The adherence evaluation was performed in patients having 1–year of follow–up and at least one statin purchase. It was estimated through the Proportion of Days Covered (PDC), defining as adherent patients with a PDC value ≥ 75%. 8332 (58% of initial cohort 14317 pts) met the selection criteria for PDC calculation. Of those, 3346 (40%) patients resulted as adherent (46% and 22% in very high e high CV risk categories). In a multivariable Cox regression model, adjusted for age, sex, risk factors and comorbidities, patients adherence emerged as a protective factor (HR 0.62; 95% CI 0.43–0.89; p = 0,010).

Conclusion
In a real–world setting, the achievement of LDL–C target and patient adherence was suboptimal across different CV risk categories. In a full adjusted survival model, patient adherence was independently associated with a prognosis improvement.
P373 INCIDENCE OF EMBOLIC EVENTS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND ATRIAL ARRYTHMIAS
Authors: Buongiorno A , Aranzulla T , Mabritto B , Luceri S , Albani S , Tommasello A , Bongioanni S , Campagnuolo S , De Rosa C , Musumeci G 
Published: May 2022

Abstract

Background
Atrial arrythmias (AA) are well–known major complications in HCM patients. Nevertheless, there are only a few studies investigating clinical features of HCM patients with AA who experienced embolic events (EVs).

Methods
We retrospectively collected clinical data from patients with HCM and atrial fibrillation or flutter followed at our Cardiology Department. The aim of this study was to assess the occurrence of EVs during long–term follow up.

Results
Among 702 HCM patients, 126 had AA: 79% AF (56% paroxysmal, 23% chronic), 6% AFL, 15 % both AF and AFL. Among those, 21 (16.7%) patients experienced at least one ischemic episode since HCM diagnosis and overall 29 ischemic events occurred (17 strokes, 11 TIAs, 1 lower limb embolism). 5 ischemic events occurred in 3 patients for whom no certain correlation with AA could be detected as the events occurred before the AA–diagnosis was performed. Therefore, they were excluded from the analysis. In the remaining 18 patients, age at first embolic event was 72 ± 5 years old. The mean CHA2DS2VASc score was 1.82 ± 1.16. We registered 24 EVs (15 strokes, 8 TIAs, 1 lower limb embolism) at a follow–up of 6.8 ± 5 years: in 5 (all &gt;70 years old) the diagnosis of AA was done at the moment of the first EV, in 13 the embolism occurred at a mean time of 6.3 ± 4.5 years after the diagnosis of AA. Among the patients with previously diagnosed AA, in 8 the embolism happened despite proper anticoagulation (2 NOACs, 6 VKA), 2 were not in therapeutic range, 1 had temporary NOAC withdrawal for surgery and 2 started anticoagulation only after the embolic event occurred. 5 out of 18 patients (28%) had permanent neurological impairment and 1 patient died of stroke. The independent predictors of the first embolic event in patients with a previous diagnosis of AA were female sex (p = 0.017) and inappropriate anticoagulation (p = 0.002). CHA2DS2VASc score (1.85 ± 1.19 in EVs vs 1.81 ± 1.16 in no EVs) was not a predictor of embolism (p = 0.167).

Conclusions
In our cohort of HCM patients with AA, embolic events are frequent regardless of CHA2DS2VASc score. Therefore, anticoagulation should be started immediately after the first arrhythmic episode as recommended by most recent guidelines.
P388 CORONARY PLAQUE CHARACTERISTICS ASSOCIATED WITH MAJOR ADVERSE CARDIOVASCULAR EVENTS AMONG ATHEROSCLEROTIC PATIENTS AND LESIONS: A SYSTEMATIC REVIEW AND META–ANALYSIS
Authors: Gallone G , Bellettini M , Gatti M , Bruno F , Scudeler L , Cusenza V , Lanfranchi A , Angelini A , De Filippo O , Iannaccone M , Prati F , Porto I , Pontone G , Depaoli A , Usmiani T , D‘ascenzo F , De Ferrari G , Forni J 
Published: May 2022

Abstract

Background
The clinical value of coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non–flow–limiting lesion remains uncertain. We performed a systematic review and meta–analysis to study the prognostic impact of CPCs comprehensively assessed with invasive and non–invasive imaging technologies on patient–level and lesion–level major cardiovascular adverse events (MACE).

Methods
We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for studies evaluating the association of CPC with patient–level and lesion–level (MACE). CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low attenuation plaque, spotty calcification, napkin ring sign or positive remodelling.

Results
Thirty studies (21 retrospective, 9 prospective) with 30.369 patients were included. CPCs were evaluated by invasive intravascular techniques in 9 studies (optical coherence tomography=4, intravascular ultrasound imaging=3, near–infrared spectroscopy intravascular ultrasound imaging=2) and by coronary computed tomography angiography (CCTA) in 21 studies. CPCs were significantly predictive of patient–level and lesion–level MACE, also when only adjusted data where considered. For each CPC, the odds appeared higher for lesion–level (HR range 3.2–16.8) as compared to patient–level MACE (HR range 1.8–4.1). Accuracy was modest to moderate for most CPCs at the patient–level (AUC for MACE ranging between 0.53 and 0.84) and moderate to good for most CPCs at the lesion–level (AUC for MACE ranging between 0.71 and 0.83). Plaques with more than one CPC had the highest accuracy for lesion–level MACE (AUC 0.87, 95%CI 0.84–0.90). CPC pooled sensitivities for lesion–level MACE ranged between 40% and 63% and specificities between 73% and 98%. As the pooled prevalence of CPCs among plaques was low (3% to 28%), the estimated positive predictive values for lesion–level MACE were modest (range 33% to 45%).

Conclusion
CCTA and intravascular imaging characterization of CPCs provides independent prognostic value among atherosclerotic patients and lesions. However, the modest sensitivity and positive predictive value observed across all CPCs seem to suggest modest clinical value, especially to predict lesion–level events (PROSPERO identifier: CRD42021251810).