bluuebunny/crossref_metadata_2025_split huggingface dataset:
C35 SUCCESSFUL PERCUTANEOUS TREATMENT OF A GIANT CORONARY ANEURYSM IN THE EMERGENCY SETTING
Authors: Quadri G , Tomassini F , Rolfo C , Franzè A , Cerrato E , Chinaglia A , Tizzani E , Minniti D , Varbella F 
Published: May 2022

Abstract
In 2008, a 60–year–old man with an anterior STEMI and cardiogenic shock underwent coronary angiography: a thrombotic occlusion in the mid–LAD, distal to a coronary aneurysm, was successfully treated with DES. (Fig. A). In 2020, the patient was readmitted with NSTE–ACS and cardiogenic shock. The coronary angiography showed severe stenosis after the proximal–LAD aneurysm and occlusion of the previously implanted stent (Fig. B, Panel B1 and B3). A very slow distal coronary flow was provided by a huge epicardial collateral branch emerging from a second giant coronary aneurysm; furthermore, a severe stenosis in the proximal–LCX was present (Fig. B. Panel B1,2). The patient was judged inoperable by the cardiac surgeon. After IABP positioning, a DES was implanted in the LCX. The LAD was then approached. TIMI 3 flow was achieved after a challenging procedure requiring both coronary and peripheral interventional tools: 3 DES (yellow dotted–lines), 8 coronary and 1 peripheral covered stents (green solid–lines) and 6 coils were used to treat the stenosis and exclude the coronary aneurysms. (Fig. B, Panel B3,4). Both DAPT and oral anticoagulation were prescribed at discharge. A 4–month coronary angiography confirmed the good procedural result. (Fig. C). This case shows the unexpected enlargement of a coronary aneurysm through the years and the presence of a new uncommon epicardial communication, necessary to overcome a chronic coronary occlusion. It highlights the importance of knowing different interventional techniques and using non–conventional tools to approach complex coronary anatomies, such as aneurysmatic disease, whose treatment is often challenging, especially in complicated clinical scenarios.
C36 ATRIAL SEPTAL DEFECT CLOSURE WITH A NEW OCCLUDER DEVICE, EXPERIENCE ON 100 PATIENTS
Authors: Castaldi B , Sirico D , Di Candia A , Cuman M , Cantinotti M , Di Salvo G , Santoro G 
Published: May 2022

Abstract

Background
This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore & Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD).

Methods
100 unselected patients with significant ASD were submitted to trans–catheter closure with GORE® Cardioform ASD Occluder at two high–volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1–month and 6–month follow–up.

Results
Patients‘age and weight were 7.8 (6.0–13.6)and 26.1 (20.0–54.0), respectively. ASD diameter was 17.4 + 4.4, resulting in QP/QS of 1.7 ± 0.7 (median 1.6). 33 patients presented an asd larger than 18mm in diameter. 58% of defects were considered complex based on the following characteristics: deficient rim(s) (except aortic rim), aneurismal/multi–fenestrated and ASD size/pt weight ratio &gt;1.2. Device placement was successfully achieved in all but two patients (98%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross–over with different devices was recorded. Median procedure and fluoroscopy times were 54 and 11 min, respectively. Major adverse events were recorded in 7 pts. Complete closure rate was 87.3% at discharge, rising to 95.5% (39/42 pts) at 1 month evaluation, and 100% at 6 months without cardiac or extra–cardiac adverse events. “Complex” procedures were more time–consuming but as effective and safe as the “simple” ones.

Conclusions
The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.
C41 AN UNUSUAL CASE OF “PULMONARY EMBOLISM”
Authors: Nannelli C , Ferraro N , Farsad M , Cemin R 
Published: May 2022

Abstract

Background
Pulmonary vein stenosis (PVS) is a complication of catheter–based radiofrequency ablation (RFA) for atrial fibrillation (AF), caused by a vascular response which leads to replacement of necrotic myocardium with collagen. Clinical presentation can mimic pulmonary embolism (PE) and usually appears some months after procedure.

Case report
A 65–year–old man was hospitalized in March 2021 with a complaint of worsening dyspnoea on exertion, over the course of one month. He had a past medical history of persistent atrial fibrillation, because of which he underwent four pulmonary vein ablations (both RFA and crioablation), the last one in 2019. The previous echocardiogram showed a high systolic pulmonary arterial pressure (sPAP of 75 + 5 mmHg) with normal right ventricular function and dimensions. Despite D–dimer at admission was negative, a CT pulmonary angiography was performed and showed occlusion of left superior pulmonary vein and a severe stenosis of right superior pulmonary vein; ventilation–perfusion scintigraphy (V/Q scan) demonstrated widespread decreased perfusion of both superior lung lobes. The patient underwent angioplasty of right pulmonary vein and after the procedure sPAP greatly decreased (35 mmHg).

Discussion
Despite its reduction in incidence and its short–term presentation from procedure, severe symptomatic pulmonary vein stenosis must be considered among complications of ablation for atrial fibrillation. Delayed symptoms can also present years after procedure, even if in literature few similar cases are described. Ventilation–perfusion scintigraphy is a very sensible method to assess the functional significance of pulmonary vein stenosis and it also relates with symptoms’ severity. It should be performed in case of a high clinical suspicion, considering that the characteristic ventilation–perfusion mismatch of this condition can be seen in other diseases too, over all pulmonary embolism.

Conclusions
This case report emphasizes the importance of a thorough anamnesis and an exact interpretation of diagnostic imaging to correctly identify this AF ablation complication and optimize the patient’s therapeutic management. It must be considered that PV stenosis can develop late and with unusual symptoms, mimicking other diseases, like pulmonary embolism, which has the same scintigraphic imaging.
C46 A RARE CASE OF LANGERHANS CELLS HISTIOCYTOSIS CARDIO–VASCULAR INVOLVMENT
Authors: Talarico M , Renne S , Valiante G , Levato M , Chirillo P , Ceravolo R 
Published: May 2022

Abstract
A 54–year–old woman presented at our department for clinical follow–up. She was affected by hypertension, hypercholesterolemia, diabetes insipidus and autoimmune hypotiroidism in substitutive therapy. She had chronic coronary syndrome treated by medical therapy after unsuccessfull left anterior descending artery percutaneous revascularization and underwent to left common iliac artery stenting. The echo–doppler study showed a thickening of both common and internal carotid. Moreover, the patients underwent a skin biopsy of nodular, purple lesions which showed a xanthomatous infiltration suggestive of Langherans cell histiocytosis (CD1A+ e S100+). A subsequent PET–TC total body demonstrated a FDG uptake tissue around the great vessels and a focal increased uptake in the proximal thirds of the left tibia and in the distal thirds of fibula. The patient underwent to a new skin biopsy which confirmed histiocytosis (S100+, langherin+, CD1a+, BRAFV600E negative) and to a negative bone biopsy. Since the diagnosis of histiocytosis was confirmed the association of mercaptopurine and steroid therapy was started. In our department we performed a follow–up echocardiography which showed normal left and right ventricle dimensions and a good bi–ventricular function (LVEF according to Simpson 55% and FAC 50%) and surprisingly a focal right atrial wall thinckening of 3 mm. Therefore, the cardiac MRI showed no oedema in triple T2, no late gadolinium enhancement inIR–GRE T1 and at the posteriori wall of the right ventricle a focal thickening of 2.3 x 2.4 cm of increased intensity and a disomogenous enhancement after contrast agent administration (Figure 1); the same non stenotic tissue was showed along the aortic arch and the discending aorta (Figure 2). The MRI characteristic of these cardio–vascular lesions are consistent with the diagnosis of Langeran’s cells histiocytosis.
C53 DONOR–DERIVED CELL–FREE DNA (DD–CFDNA)–BASED ASSESSMENT OF CORONARY ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANTED PATIENTS
Authors: Bulfoni M , Dralov A , Ferrara V , Marcon B , D‘Aurizio F , Nalli C , Di Nora C , Sponga S , Beltrami A , Livi U , Curcio F 
Published: May 2022

Abstract

Introduction
Cardiac Allograft Vasculopathy (CAV) is a leading cause of long–term graft dysfunction and failure after Heart Transplant (HTx). Early diagnosis is crucial to tailor therapeutic strategies. Despite advancements in cardiac imaging, the standard for CAV diagnosis remains coronary angiography. Donor–derived cell free DNA (dd–cfDNA) is a novel marker of graft injury in solid organ transplants. Elevations in dd–cfDNA levels may reflect CAV development during subclinical inflammation, thus it could represent a non–invasive method of surveillance for CAV rejection in apparently stable post–transplant patients. Given these premises, we decided to evaluate the potential of dd–cfDNA as alternative diagnostic biomarker for CAV.

Materials and Methods
31 blood samples from patients who underwent heart transplant at our institution in the last 10 years, were analyzed by Next Generation Sequencing (NGS) according to CareDx Alloseq protocol. The cfDNA was extracted starting from 2mL of plasma (Qiagen). Sequencing was performed on the Illumina Miseq platform. Troponin T (hs–TnT) and NT–proBNP (Brain Natriuretic Peptide) were measured by automated immunoassay analysers. All statistics were performed by STATA software and significance was set at p &lt; 0.05.

Results
Heart transplant recipients were divided into 2 groups: 16 patients with known CAV status and 15 patients who had not (no–CAV). No significant differences between the two populations were observed, aside from time from HTx (177.28± 84.99 months in CAV vs 93.20 ± 84.39 months in no–CAV; p = 0.033). A significant difference in dd–cfDNA fraction was found between CAV and no–CAV patients (p = 0.03); with mean values of 0,41% e 0,13%, respectively. Neither NT-proBNP (p = 0.08) nor hs–TnT (p = 0.31) concentrations were significantly different between the two groups, but a positive correlation was found between the two biomarkers (r 0.6966; p = 0.0013). A trend of linear relationship emerged between cfDNA and NT-proBNP levels (r 0.4155; p = 0.08).

Conclusions
With this study, we demonstrated the feasibility of evaluating dd–cfDNA in long–term heart transplanted patients and its possible association with CAV development. Further investigations are warranted to explore a possible association between dd–cfDNA levels other circulating biomarkers and CAV progression. The definition of “homogeneous” subgroups of patients according to a “risk score” will allow to better manage their follow up and improve their prognosis.
C58 LONG–TERM SURVIVAL OF PATIENTS ADMITTED FOR A FIRST AMI EVENT AND MANAGED WITH MYOCARDIAL REVASCULARIZATION OR CONSERVATIVE APPROACH IN ITALY
Authors: De Luca L , D‘Errigo P , Mureddu G , Rosato S , Badoni G , Seccareccia F , Baglio G 
Published: May 2022

Abstract

Background
The long–term clinical benefits of myocardial revascularization in a contemporary cohort of patients with acute myocardial infarction (AMI) are unclear. We aimed to compare the overall mortality rates at 8 years of patients admitted in Italian hospitals with a first AMI managed with or without myocardial revascularization during the index event.

Methods
This is a national retrospective cohort study that enrolled patients admitted with a first AMI in 2012 in all Italian hospitals. The outcome of interest was all–cause mortality at 8 years. Time to events was analyzed using a Cox multivariate regression model.

Results
A total of 97,271 patients with AMI were admitted to an Italian hospital in 2012. Patients with a previous AMI or myocardial revascularization (n = 27,350) have been excluded from this analysis. Among the remaining 69,921 AMI events, 56.6% underwent a percutaneous coronary intervention (PCI) or a coronary artery by–pass grafting (CABG) during the index admission. The crude 8–year survival was 0.76% for patients treated with PCI or CABG in the index admission and 0.34% for patients managed with a conservative approach (Figure 1). Considering the differences in risk factors, the invasive approach showed a significantly lower risk of long–term mortality compared to the conservative management (hazard ratio=0.55; 95% confidence intervals 0.53–0.56) (Figure 2).

Conclusions
In a contemporary nationwide cohort of patients at their first AMI episode, those who underwent a myocardial revascularization during the index event presented an adjusted 45% relative risk reduction in overall mortality at 8–year follow–up compared with those treated only medically.
C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS
Authors: Gentile P , Merlo M , Peretto G , Ammirati E , Sala S , Della Bella P , Aquaro G , Imazio M , Potena L , Campodonico J , Foà A , Raafs A , Hazebroek M , Brambatti M , Cercek A , Nucifora G , Shrivastava S , Huang F , Schmidt M , Muser D , Van De Heyning C , Van Craenenbroeck E , Aoki T , Sugimura K , Shimokawa H , Cannatà A , Artico J , Porcari A , Colopi M , Bussani R , Barbati G , Garascia A , Cipriani M , Agostoni P , Pereira N , Heymans S , Adler E , Camici P , Frigerio M , Sinagra G 
Published: May 2022

Abstract

Aims
The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.

Methods and Results
We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR.

Conclusions
In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
C72 THE EFFECTS OF BATRIATIC SURGERY ON CARDIO–METABOLIC PROFILE AND CARDIAC REMODELING
Authors: Ventura M , Giofrè F , Lucà S , Pelle M , Zaffina I , Forte V , Cloro C , Melina M , Miceli S , Sciacqua A , Segura Garcia C , Currò G , Arturi F 
Published: May 2022

Abstract

Background
Obesity is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure.

Objective
To evaluate the impact of bariatric surgery, and therefore of anthropometric and cardio–metabolic variations, on cardiac structure and function.

Methods
Twenty–six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The IR has been assessed by HOMA–IR. The patients were divided into two groups: the first group (8 patients) carried out a follow–up at 6 months post–surgery; the second group (18 patients) at 12 months post–surgery.

Results
As expected, an improvement in the anthropometric and metabolic profile in patients treated with bariatric surgery was observed. Echocardiographic data showed a significant increase in the Ejection Fraction (P &lt; 0.001) and the E/A Ratio (P &lt; 0.001) 6 months after bariatric surgery, a significant reduction in the Interventricular Septum thickness at 6 months (P &lt; 0.001) and at 12 months (P &lt; 0.002) post–surgery and a significant reduction in the Left Ventricular Mass at 6 months (P = 0.02) and at 12 months (P = 0.05) after bariatric surgery. A reduction no significant in the Left Ventricular posterior wall thickness has been observed.

Conclusions
Our data showed an increase of the systolic function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.
C78 PREVALENCE AND MECHANISMS OF SEVERE MITRAL AND TRICUSPID REGURGITATION IN A HEART FAILURE OUTPATIENTS POPULATION
Authors: Pugno Vanoni F , Biroli M , Cannata F , Pagliaro B , Pellegrino M , Villaschi A , Gasparini G , Ardino L , Vrinceanu E , Loiacono F , Pini D 
Published: May 2022

Abstract

Introduction
Mitral regurgitation (MR) and tricuspid regurgitation (TR) are a known cause of morbidity and mortality in heart failure (HF) patients. Maximal up–titration of guideline–directed medical therapy (GDMT) for HF may not be enough to reduce the severity of the valve’s incompetence and patients’ symptoms. The development and successful results of transcatheter therapies for mitral/tricuspid disease have opened new therapeutic opportunities when surgery is not feasible. Accurate valve regurgitation’s mechanisms evaluation is essential to choose the best treatment option. This study aims at evaluating the prevalence and underlying mechanisms of at least moderate–to–severe (≥3+/4+) MR and/or TR in a cohort of HF outpatients.

Methods
We retrospectively analyzed the medical records of 1260 outpatients evaluated by our HF unit between January 2020 and June 2021. All patients with echocardiographic evidence of ≥ 3+/4+ MR and/or TR were included (treated ones were excluded), and a thorough echocardiographic images review was conducted. A full collection of patients’ clinical, laboratory and therapy regimens details was performed as well.

Results
Of the 1260 analyzed patients, 173 (13.7%) exhibited ≥3+/4+ MR and/or TR and were included in the registry. Table 1 shows the main clinical/echocardiographic characteristics. Mean age was 80±7 years, median ejection fraction was 45% (IQR=33–55). All patients were treated with maximal tolerated doses of GDMT and, if appropriate, with cardiac devices/myocardial revascularization. ≥3+/4+ MR and/or TR was observed in 92 (7.3%) and 117 (9.3%) patients, respectively. Patients with isolated significant MR were 56 (4.4%), with isolated significant TR were 81 (6.4%); the remaining 36 (2.8%) had both MR/TR. Among patients with significant MR, 50 (54%) had functional/secondary valvular defect (details in Figure 2): the majority (41,82%) presented a ventricular etiology (asymmetric tethering in 18/41) while 9 (18%) an atrial one (atriogenic tethering in 3/9).

Conclusion
Despite optimized GDMT, the prevalence of patients with hemodynamically significant valvular defects was considerably high in our HF population. This is the first registry to comprehensively detail atrioventricular valve regurgitations’ mechanisms in a wide real–life cohort of HF outpatients. Further studies are needed to identify reasons for potential undertreatment and patients who would benefit the most from percutaneous correction of their valvular defects.
C79 LONG–TERM OUTCOME IN PATIENTS UNDERGOING HIGH–RISK PERCUTANEOUS CORONARY INTERVENTION WITH THE SUPPORT OF IMPELLA CP: A SINGLE CENTER EXPERIENCE
Authors: Azzarelli S , Tomasello S , Franchina A , Milluzzo R , Scardaci F , Di Giorgio A , Argentino V , Amico F 
Published: May 2022

Abstract

Background
Nowadays use of the Impella for high–risk percutaneous coronary intervention (PCI) is increasing worldwide. The aim of this study is to evaluate in–hospital and long–term outcomes of patients treated for high–risk PCI with the use of Impella CP device.

Methods
This is a single center registry, which enrolled all consecutive patients treated at Cannizzaro Hospital for high–risk PCI with the use of Impella CP. Data were prospectively entered into a dedicated database.

Results
From January 2019 to December 2021, 16 patients were enrolled of which 75% were male. The clinical presentation at admission was an acute coronary syndrome in 87.5% of cases (myocardial infarction in 13 patients, unstable angina in 1 subject). The mean left ventricular ejection fraction at admission was 35 ± 7.6%. Ten subjects (62.5%) had diabetes treated with insulin in 90% of cases. The Syntax score was 29 ± 12.3 and the mortality STS score was 8.1 ± 10.4. Left main disease involved 8 (50%) patients, whereas a 3–vessels disease was present in 56% of cases. In most cases –14 (87.5%) patients– the Impella CP was introduced through the femoral artery with percutaneous access, whilst only in 2 (12.5%) subjects a surgical access was necessary. An anatomical complete revascularization was performed in 7 (43.8%) patients. For a total of 2 ± 1 vessels treated for patient and 3 ± 1.3 lesions undergoing PCI, 3 ± 1.8 stent were implanted with a mean total stent length of 81 ± 44.3 mm. In all cases, the Impella CP device was placed in left ventricle before PCI and removed a few minutes after the end of procedure, with a mean duration of mechanical circulatory support of 2.7 ± 0.8 hours. Only 1 (6.2%) patient died in hospital due to sepsis, whereas a clinically–evident bleeding occurred in 5 (31.3%) subjects (4 were access–site bleeding) and 4 (25%) patients underwent red blood cells transfusion; no acute limb ischaemia or aortic/left ventricle injury occurred. On a mean follow–up of 13 months from procedure date, any myocardial revascularization occurred in 2 (12.5%) patients, of whom 1 (6.2%) was a target–vessel revascularization. Four (25%) patients died but only 1 (6.2%) due to cardiac death: 2 subjects died as result of sepsis following pneumonia and 1 sepsis complicating gangrene.

Conclusion
Our study demonstrates the feasibility and efficacy of high–risk PCI protected by Impella CP, showing an acceptable long–term clinical outcome in a very high risk cohort of patients.