bluuebunny/crossref_metadata_2025_split huggingface dataset:
P97 VALIDATION OF THE ACADEMIC RESEARCH CONSORTIUM HIGH BLEEDING RISK CRITERIA IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND METANALYSIS OF 10 STUDIES AND 67,862 PATIENTS
Authors: Esposito L , Baldi C , Silverio A , Di Maio M , Cancro F , Buccheri S , De Luca G , Sarno G , Bellino M , Verdoia M , Vecchione C , Galasso G 
Published: May 2022

Abstract

Background
The Academic Research Consortium for High Bleeding Risk (ARC–HBR) has recently proposed, by consensus, twenty clinical criteria for the assessment of the bleeding risk after percutaneous coronary intervention (PCI). A major criterion was defined as any individual clinical condition conferring in isolation a risk for major bleeding ≥4% up to 1 year after PCI; instead, a minor criterion was considered to confer a bleeding risk of &lt; 4%. The aim of this meta–analysis was to assess the performance of the ARC–HBR criteria in stratifying the risk of bleeding and ischemic events after PCI.

Methods
MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC–HBR criteria in patients treated with PCI. The primary outcome measure of this meta–analysis was major bleeding.

Results
The analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non–HBR group (RR, 2.56, 95% CI 2.28–2.89). The average C–statistic was 0.64 (95% CI 0.60–0.68), indicating modest discrimination. The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all–cause death was higher in HBR vs. Non–HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88–1.16). When assessed in isolation, the mean cumulative incidence of major bleeding at 1 year exceeded the cut–off value of 4% for all the major criteria and for two out of six minor criteria, including age ≥75 years and moderate chronic kidney disease (CKD) (Figure).

Conclusion
The ARC–HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. These findings corroborate the ability of ARC–HBR major criteria in identifying PCI patients who are more likely to develop adverse events, but also suggest caution in the decision making of patients with isolated minor criteria, including age≥75 years and moderate CKD.
P109 CORONARY FLOW VELOCITY RESERVE REDUCTION IS ASSOCIATED WITH CARDIOVASCULAR, CANCER, AND NONCANCER, NONCARDIOVASCULAR MORTALITY
Authors: Tuttolomondo D , Suma S , Botti A , Gaibazzi N 
Published: May 2022

Abstract

Background
Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high–dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non–CV conditions. We aimed to assess whether CFVR is associated with all–cause death, but more specifically with CV, cancer, and non–CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables.

Methods
One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow–up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality.

Results
A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR &lt; 2 was significantly associated with each category of cause–specific mortality. A CFVR &lt; 2 or ≥ 2 separated a group of patients with 8–year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality.

Conclusions
The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.
P115 UNEXPECTED FORMS OF CARDIAC COMPRESSION AB EXTRINSIC
Authors: Faleburle A , Khoury G 
Published: May 2022

Abstract

75–year–old man with a history of atrial fibrillation and hypertension, arrived in the emergency room after car accident (car against tree) three hours after taking Rivaroxaban. After performing a chest CT scan in the emergency room (evidence of fractures of 4 ribs and the body of the sternum) he was admitted to Emergency Medicine where, two hours later, a cardiological evaluation was requested due to sudden desaturation. For the echocardiographic evidence of an image that compressed ab extrinsically the right sections of the heart with complete collapse of the right ventricle, urgent chest CT angiography was required which highlighted a gross sliding hiatal hernia with intrathoracic transposition of fat and large parts of the gastric fundus. It was decided to carry out an evaluation by colleagues in thoracic surgery to proceed with any surgical treatment of the pathology.

Discussion
A hiatal hernia consists of part of the stomach moving up into the chest through an opening in the diaphragm. It can be of three types: sliding, the most common, in which the hernia enters and exits the thoracic cavity. It is not a permanent condition, as the affected portion of the stomach is mobile above and below the diaphragm depending on the pressure exerted on the abdomen; it is more common in obese people; Paraesophageal hernia, in which the upper part of the stomach (bottom) is trapped in the chest cavity, to the side of the esophagus. Mixed hernia, simultaneous presence of sliding hernia and paraesophageal hernia, more rare. Prolapse of a small part of the stomach through the esophageal hiatus of the diaphragm is a fairly common condition. However, the herniation of a larger component is very rare and is often misleading. Rare cases have been described in the literature in which the herniation was associated with a tumor component (GIST) and cases resulting from abdominal surgery. It is often associated with typical symptoms of hiatal hernia in a more pronounced form (belching, abdominal bloating and heartburn); in addition, there have been reports of cardiac–like chest pain. However, it is of fundamental importance to make an early diagnosis in order to be initiated into an adequate therapeutic–surgical approach. As soon as the picture of the thoracic trauma stabilized, our patient was referred for corrective surgical therapy.
P119 PERI– MYOCARDITIS A RARE CASE OF ESCHERICHIA COLI INFECTION, A BACTERIUM THAT SHOULD NOT BE UNDERESTIMATED
Authors: Manes M , Rosselli F , Musacchio D , Ibello L , Ianni M , Domenico B 
Published: May 2022

Abstract

Myopericarditis is defined as inflammation of the heart muscle and pericardium, which can be caused by infectious agents, toxins, or immunological reactions. The most recognized cases are secondary to cardiotropic viral infections. Escherichia coli rarely causes myopericarditis and is secondary to the septic dissemination of bacteria or myocardial toxicity of endotoxins. We describe a case of bacterial sepsis due to Escherichia coli which caused myocardial damage with pericardial effusion. 32 year old woman without cardiovascular risk factors, suffering from congenital immunodeficiency for IG type A, B–cell NH lymphoma undergoing chemotherapy treatment, Hashimoto‘s thyroiditis. The patient arrives for dyspnoea and fever. The ECG showed mild PR depression and an over diffuse ST in all leads with low voltage QRS and increased TNI. PA 120/70 mmHg, HR 74 b / m, FR of 15 acts / m. ETT showed diffuse hypokinesia with FE40% and moderate, circumferential, corpuscular and hyperechoic pericardial effusion without signs of cardiac tamponade. CRP, ESR, Procalcitonin, Leukocytes were elevated, hypothyroidism and low gamma globulin values. The serology of pericardiotropic viruses is negative. Chest x–ray of mild bilateral pleural effusion. Urine culture was performed for pollakiuria, dysuria, fever: positive for Escherichiacoli. After gamma globulin replacement therapy, levothyroxine and targeted antibiotic therapy, the patient presents clinical and laboratory improvement and improvement in FE with persistence of pericardial effusion. Pericardiocentesis is performed with drainage of 800 ml of serous–looking liquid with coarse fibrin shoots. Cytological examination of the liquid shows a blood serum aspect with a carpet of granulocytic inflammatory elements. The patient was discharged after therapy with colchicine, prednisone, levothyroxine sodium, indomethacin, ramipril, omeprazole. The ECG showed an evolved ischemic type pattern.

Conclusion
Very rare cases of Escherichia coli cystitis complicated by myo–pericarditis have been described in the literature. Presumably hypothyroidism and congenital IgA immunodeficiency contributed to favoring and worsening the formation of the effusion. However, further studies are still needed to clarify the mechanisms of myocardial damage, although reversible during this type of bacterial infection.
P120 A STRANGE HEART MURMUR
Authors: Nunziata L , Ambrosino S , Carbone L , Ruggiero V , Laezza A , Prisco A , Nardiello V , Miele R , Terracciano F , Falato S , Granata F , Maresca G , Volpicelli M , Muto C , Capasso M , Caliendo L 
Published: May 2022

Abstract
An 38–year–old man was referred to our hospital for chest pain. He was a smoker but had no other cardiovascular risk factors and had no history of relevant diseases. On cardiovascular examination, a rough grade IV/V systolic murmur was present at the mesocardium. His electrocardiogram showed sinus tachycardia and complete right branch block. On laboratory tests, cardiac biomarkers were negative. A transthoracic echocardiogram showed left ventricle cavity–sized at the upper limits with preserved systolic function and mild concentric hypertrophy. The aortic root was ectatic with tricuspid valve and mild regurgitation. In addition, there was a great spheric cavity in the region of the right sinus of Valsalva that was communicating with the aortic lumen with turbulent flow inside. The Pulmonary Trunk was dilated and there was a strange turbulent flow within it that extended towards the aortic valve. A chest computed tomography (CT) scan was performed in emergency which ruled out an aortic dissection and revealed the presence of an aneurysm of the right sinus of Valsalva. The following day, a transesophageal echocardiogram was performed which confirmed the aneurysm of the right sinus Valsalva and the presence of systodiastolic flow between it and the right ventricular outflow compatible with a fistula. For this reason, the patient was transferred to the Cardiac Surgery Department of another hospital. He underwent cardiac surgery of resection of aneurysmatic tissue, direct suture of the fistula by the combined transaortic / transpulmonary route and reductive plastic surgery of the pulmonary trunk. Aneurysms of sinus of Valsalva are rare cardiac anomalies, which may be either acquired or congenital. A congenital lack of continuity between the aortic media and annulus fibrosis may initiate aneurysm formation. Acquired aneurysms may result from trauma, endocarditis, syphilis, Behcet, Marfan’s syndrome and senile–type dilatation. In our case, the etiology of the aneurysm is not well understood. It could be a congenital aneurysm that has fissured over time creating a fistula with the right ventricular outflow. This fistula caused a significant left–to–right shunt resulting in haemodynamic changes such as pulmonary trunk dilation. We report this case because the concomitant presence of an aneurysm of the right Valsalva sinus and a fistula between it and the right ventricular outflow represents an extremely rare and poorly described event in the literature.
P126 THE DANGEROUS LINK BETWEEN ECTOPIC ADIPOSITY AND HIGH RISK ATHEROSCLEROSIS: A PARADIGMATIC CASE OF STEMI
Authors: Di Ienno L , Cocco M , Squeri A , Conti R 
Published: May 2022

Abstract
Nowadays CCTA has become the first line diagnostic tool in the clinical management of CAD thanks to its outstanding performance in assessing both the degree of stenosis and coronary plaques features, with crucial prognostic implications. Furthermore, CTCA allows an accurate quantification of epicardial fat, which has been shown to be a metabolic active tissue that by means of inflammatory mediators influences the development of high risk plaques and atrial fibrillation. A 70–years–old man underwent primary PCI for an acute STEMI. He was a former smoker with a history of obesity, hypertension, hypercholesterolemia and type II diabetes, without previous major cardiovascular events or significant comorbidities. The coronary angiography revealed diffuse coronary artery ectasia and a thrombotic total occlusion of the proximal portion of the RCA. After intravenous antiplatelet agent administration, balloon angioplasty was performed and three drug eluting stents were implanted. Furthermore, since the coronary angiography showed a calcific contour travelling parallel to the RCA course, in order to rule out a thrombosed coronary pseudoaneurysm, a CTCA was performed. CTCA unexpectedly revealed an enormous fibro–fatty plaque surrounded by a calcific shell in the RCA ostium–proximal segment, with the stents located at one border of the plaque, well expanded inside the vessel lumen. The post–procedural hospital stay was marked by new onset Atrial Fibrillation, unresponsive to pharmacological cardioversion. In contrast with coronary invasive angiography, CT was able to detect a very high plaque burden and a salient ubiquitary epicardial fat volume. In addition, at the site of the culprit lesion, CT showed huge plaque volume with an extreme eccentrically positive vessel remodeling, large low attenuation areas and spotty calcifications, all features known to predict adverse coronary events. This case shows how the combination of metabolic syndrome and ectopic fat accumulation fosters a milieu conducive for high risk atherosclerosis and its clinical complications.
P129 IMPACT OF THE ATHEROSCLEROTIC PABULUM ON IN–HOSPITAL MORTALI–TY FOR SARS–COV–2 INFECTION. IS CALCIUM SCORE ABLE TO IDENTIFY AT RISK PATIENTS?
Authors: Continisio S , Pergola V , Dellino C , Montonati C , Cabrelle G , Previtero M , Perazzolo M , Di Michele S , De Conti G , Motta R , Iliceto S , Mele D 
Published: May 2022

Abstract

Background
Although the primary cause of death in COVID–19 infection is respiratory failure, there are evidences that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognised that COVID–19 is associated with a high incidence of thrombotic complications.

Aim of the Study
evaluate if CAC score was useful to predict in–hospital mortality and complications in patients with COVID infection

Methods
Two–hundred–eighty–four patients with proven SARS–CoV2 infection who had a non–contrast Chest CT at our facility were retrospective analysed for coronary artery calcium (CAC) score. Primary endpoint was in–h mortality. Secondary end–points were need for mechanical ventilation and Intensive Care Unit admission. Clinical and radiological data were retrieved.

Results
Patients with coronary calcium had higher inflammatory burden at admission (D–dimer, CRP, Procalcitonin) and higher high–sensitive Troponin I (HScTnI) at admission and at peak. While there was no association with presence of consolidation and ground glass opacities, patients with coronary calcium had higher incidence of bilateral infiltration and higher in–hospital mortality. The main finding of our research is that CAC alone does not completely identify all the population at risk of events in the setting of COVID 19 patients. Peak HScTnI was associated with higher mortality, intensive care unit admission and mechanical ventilation in both univariable at multivariable analysis.

Conclusions
Together with the presence of higher inflammation burden CAC may be a useful marker in identifying patients at risk of cardiovascular complications and in hospital mortality.
P130 A RARE CASE OF LARGE POST INFARCTION LEFT VENTRICULAR PSEUDOANEURYSM UNDERGOING CONSERVATIVE MANAGEMENT
Authors: Di Saverio M , Massacesi C , Rolando M , Iadanza Lanzaro B , Marrangoni A , Gregori G , Napoletano C , Marini L , Gennarelli A 
Published: May 2022

Abstract

Introduction
Left ventricular pseudoaneurysm is a rare complication of myocardial infarction and its natural history is still unclear. Non invasive imaging improves detection ability and differential diagnosis with aneurysm. We present the case of large post infarction left ventricular pseudoaneurysm undergoing conservative management.

Case Report
A 81–years–old woman presented to emergency room complaining dyspnea and epigastric and right hemithoracic pain. Her past medical history included: chronic coronary syndrome, already undergoing CABG; recent inferior STEMI complicated with complete AVB, with ineffective RCA reperfusion attempt and bicameral pacemaker implantation; Paroxysmal AF in antithrombotic prophylaxis with DOAC. The ECG showed sinus tachycardia, HR 114 bpm, electro–induced ventricular complexes. Objectively, fine bilateral basal crackles were detected. Chest x–ray showed pulmonary congestion. The echocardiographic examination revealed: left ventricle with eccentric remodeling and severe depression of the contractile function (EF 35%), coarse neochamber in communication with the basal segment of the lower wall (D: 6.4 cm x 4.9 cm). The narrow neck, with a ratio &lt;0.5 between inlet orifice diameter / neochamber diameter, suggested pseudoaneurysm. Working diagnosis of NSTEMI–ACS was made (usTnT peak: 344 pg / mL, NV: 0–15 pg / mL) complicated by heart failure. Progressive improvement in compensation was achieved through diuretic therapy. To improve diagnostic definition, cardio–synchronized chest CT with contrast medium was performed. The examination confirmed the voluminous neochamber, consistent with pseudoaneurysm, in correspondence with the mid–basal segments of the lower and inferior septal wall, with thinned walls and mass effect on the great cardiac vein, and highlighted the patency of the bypasses. The venous graft to OM was 5 mm distant from the posterior sternal surface. The case was discussed collectively in Heart Team, due to the high operative risk, the surgical option was rejected and a decision was made for conservative therapy. It was titled beta–blocker, ranolazine was introduced, heart failure therapy was implemented, introducing ARNI. The patient was discharged at home and is in follow–up at the outpatient clinic for heart failure. One month after discharge, she is in NYHA functional class II and she is asymptomatic for angor. The pseudoaneurysmatic dimensions are unchanged on echocardiographic control.
P139 CARDIAC PARAGANGLIOMA: THE IMPORTANCE OF MULTIMODALITY IMAGING
Authors: Campisano M , Scapinelli M , Bagni E 
Published: May 2022

Abstract
Cardiac paraganglioma is a rare neuroendocrine tumour secreting norepinephrine and causing severe hypertension, palpitations, tachyarrhythmias; its precise location is very important because the compression of cardiovascular structures may result in ischaemia, arrhythmia and cardiac failure. Surgical resection represents the primary treatment modality. A 40–year–old young woman with history of hypertension, nocturnal tachycardia and sweats with elevated levels of urinary metanephrine underwent abdominal MRI angiography showing normal kidneys and adrenal glands while in the cardiac–mediastinal site a solid neoformation with contrast impregnation confirmed at subsequent chest CT scan with contrast medium and it appeared inseparable from superior vena cava and occupying the atrial chambers. Patient started therapy with an α–adrenoceptor blocker and underwent cardiac MRI documenting the intrapericardial site of the lesion infiltrating atrial septum and PET/CT scan revealing a large area of uptake of the analogue of somatostatin in the mediastinum typical for atrial paraganglioma. Subsequent angiography CT scan of the thoracic aorta and coronary CT scan showed no signs of infiltration on the great vessels and heart chambers but there was not a clear adipose cleavage plane and the mass appeared intensely vascularized by two large vessels arising from the circumflex artery and the isthmic aorta. After specialistic surgical evaluation the patient was treated with ligation of the afferent peduncle to the neoformation and biopsy of the tissue sample was performed. Post–procedure angiography CT scan showed the neoformation unchanged in size with the two unchanged afferent branches. Histological examination of the tissue sample concluded with arteriovenous hemangioma. One month after surgery elevated urinary normetanephrine levels persisted and the mass on echocardiogram was unchanged. Cardiac MRI after three months was unchanged and specialistic surgical evaluation did not suggest reoperation. Six months after surgery cardiac MRI showed mild increase in volume of the intrapericardial lesion and unchanged atrial septum infiltration. The multimodality imaging plays an important role in the diagnosis of cardiac paraganglioma. The arterial ligation, without the completely removal of the lesion, was not conclusive, the mass increased in size and the patient remained symptomatic. Surgical resection is necessary for the complete cure of the syndromes.