bluuebunny/crossref_metadata_2025_split huggingface dataset:
P180 A STRANGE JET IN A PATIENT WITH A MECHANICAL AORTIC VALVE
Authors: Gizzi G , D‘Agostino S , Parato V 
Published: May 2022

Abstract

Clinical Case
A 68–year–old male patient with a history of ischemic heart disease in three vessel coronary artery disease who underwent surgical myocardial revascularization in 2012 by CABG (LIMA to LAD); previous aortic valve replacement with mechanical prosthesis (2012); previous PMK implant in permanent AF. The patient arrived at our observation transferred from another hospital where, due to heart failure with new–onset severe left ventricular dysfunction, he had undergone a coronary examination with evidence of occlusion of LAD in the middle tract, patency of LIMA to LAD, severe LM/LCx stenosis followed by IVUS guided PTCA–DES stenting with final TIMI 3. During his hospitalization in our care unit he repeated trans–thoracic echocardiogram examination which documented: severe left ventricular dilatation with reduced EF (40%), left atriomegaly, bileaflet mechanical aortic prosthesis in place with normal systolic opening, normal trans–prosthetic gradients, absent peri or intraprosthetic regurgitation jet, moderate mitral valve regurgitation with central jet, right–sided sections of normal size and contractility in the absence of signs of increased pulmonary pressures. Color Doppler also documented a high–speed jet starting from the prosthesis–LAM interface directed towards the left atrium of unclear interpretation. To better interpretate this finding a transesophageal echocardiogram was performed which confirmed the correct functioning of the aortic mechanical prosthesis, absence of periprosthetic leaks and confirmed a high–speed jet directed from the prosthesis–LAM interface towards the left atrium compatible with perforation of the mitro–aortic continuity tissue. The patient was therefore sent for cardiac surgery and is currently awaiting reoperation.
P192 LONG TERM PROGNOSTIC EFFECT OF LIPROTEIN(A) IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS AFTER MYOCARDIAL INFARCTION
Authors: Cancro F , Baldi C , Silverio A , Di Maio M , Esposito L , Tedeschi M , Cristiano M , Sabatino M , Romei S , Vecchione C , Galasso G 
Published: May 2022

Abstract

Aims
To describe the baseline clinical, laboratory and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoprotein(a) [Lp(a)] serum level on long–term outcome in this very high–risk population.

Methods
This was a retrospective, single–center, study including consecutive patients admitted with MI diagnosis between January 1, 2017, and December 31, 2020. The availability of data on baseline Lp(a) serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lp(a) value of 50 mg/dL was used to test the hypothesis of a different effect of Lp(a) on the clinical outcome of patients with or without DM. The primary study outcome was all–cause death at 3–year follow–up.

Results
The study population included 997 patients (mean age 63.7±13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8±12.1 vs. 62.0±13.7 years, p &lt; 0.001) and showed a significantly higher prevalence of dyslipidemia, hypertension, obesity, prior MI and prior coronary revascularization (p &lt; 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, p &lt; 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, p = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lp(a)≥50 mg/dL showed a significantly lower long–term survival compared with those with Lp(a)&lt;50 mg/dL (Log–Rank=0.004). In DM patients DM, conversely, no survival difference was found between patients with Lp(a)≥50 mg/dL vs. those with Lp(a)&lt;50 mg/dL. At multivariable Cox regression analysis, in patients without DM, Lp(a) serum level (HR: 2.68, 95% CI 1.23–5.83; p = 0.013) and age (HR: 1.06, 95% CI 1.04–1.09; p &lt; 0.001) were independent predictors of mortality at 3–year follow–up. Among DM patients, only age was independently associated with 3–year mortality (HR: 1.07, 95% CI 1.03–1.10; p &lt; 0.001) (Table).

Conclusion
In this MI population, Lp(a) was independently associated with long–term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lp(a) on clinical outcome after MI requires confirmation by larger prospective studies.
P194 AN UNUSUAL PRESENTATION OF ST–SEGMENT ELEVATION MYOCARDIAL INFARCTION: LEFT VENTRICULAR THROMBOSIS AND ISCHEMIC STROKE
Authors: Santus S , Utzeri E , Sanna N 
Published: May 2022

Abstract

Background
Patients with large anterior MI associated with a reduced systolic function are at increased risk for developing left ventricular thrombosis. Stasis of blood in the ventricular cavity and the inflammation associated with ischemic injury are the causes of left ventricular thrombosis and increased risk of stroke. It usually develops within the first week and often the first day after infarction. Embolization takes place during the first 1 to 3 months. Our patient presented a very early embolization.

Case Report
A 70–year–old smoker man, without other cardiovascular risk factors, presented at the emergency department of our hospital with acute aphasia and right facio–brachio–crural hemiparesis. The 12–lead ECG revealed ST–elevation in V2–V5 and Q waves in V1–V3. Patient was asymptomatic for angina at the time of presentation and the days before. He performed an urgent head–CT that revealed proximal occlusion of the M2 tract of left middle cerebral artery cause of ischemic stroke (NIHSS 13). Then, he underwent per–cutaneous mechanical thrombectomy with complete re–canalization of the vessel. Immediately after he performed coronary angiography that showed the occlusion of anterior inter–ventricular artery treated by angioplasty and implant of drug eluting stent. Both procedures have been well tolerated by the patient without complications. Measurements of high–sensitivity cardiac Troponin demonstrated a peak and following fall of the values. A two–dimensional echo–cardiogram showed akinesia of anterior wall and apical segments of LV with EF &lt; 40% and ventricular thrombus. A multidisciplinary team evaluated evolution of cerebral ischemic lesion and patient’s clinical conditions and established the correct time and management of therapy with DAPT (aspirin+clopidogrel) and VKA. It has been prescribed three months DAPT+VKA therapy and later DAT (aspirin+VKA) for one year. Patient has been discharged with minor aphasia, without cardiac symptoms and good hemodynamic status.

Conclusion
Left ventricular thrombosis is a frequent complication of anterior MI. The optimal frequency of follow–up imaging and time of treatment are not known. Our patient had a very early presentation. It should be useful to have guidelines to prevent and treat left ventricular thrombosis. Despite common use of anticoagulant drugs in the treatment of left ventricular thrombosis, there aren‘t randomized clinical trials evaluating the safety and efficacy of this strategy.
P197 TAKO TSUBO SYNDROME IN MAN FOR ‘SMART WORKING’ COMPLICATED BY ACUTE HEART FAILURE AND SAM. PRESENCE OF MYOCARDIAL BRIDGE OF IVA ‘INNOCENT BYSTANDER’ OF THE CLINICAL PICTURE
Authors: Occhiuzzi E , Ranfone F , Ippoliti C , Valentini G , Balsano C 
Published: May 2022

Abstract

Male, 59 years old with no significant pathological history or cardiovascular risk factors. Access to the ER ( 12.30 AM ) with infero–lateral STEMI (Killip I, 2 hours of symptom onset; haemodynamic and electrical stability): chest pain associated with profuse sweating and transient arterial hypotension, ST elevation in V3–V6 and inferior leads on the ECG and apical hypokinesia with slight reduction of LVEF (50%) on the Trans–Thoracic Echocardiography. Urgent coronary angiography: non–obstructive coronary arteries stenosis, short intramyocardial tract of DA with moderate systolic compression with ‘milking effect‘. Blood sampling: mild elevation of cardiac troponin hs value (479 pg / ml), mild anemia and thrombocytopenia; normal value of markes of liver and kidney function. Hospitalization in Cardiac ICU with standard antithrombotic and anti–ischemic therapy. 12 hours after admission (01.00 PM) acute low–flow heart failure with pulmonary edema treated with inotropic agent and need of endotracheal intubation and ventilatory support (ineffective attempt of NIV); ECG unchanged from the previous one and appearance of LVEF 25% for akinesia of septum, apex and lateral wall. Peak of troponin 2083 pg / ml III day: effective extubation with successive cycles of NIV and weaning from noradrenaline. Progressive recovery of LVEF with appearance of SAM with LVOT dynamic obstruction (v max&gt; 4m / s at pulsed doppler) and moderate mitral regurgitation: stop inotropic agent and start beta–blocker therapy (atenolol) not tolerated for hypokinetic arrhythmias (also total BAV) and then successful replaced in the following days with low doses of bisoprolol. Post–Iintubation pneumonia treated with antibiotic therapy. X day: hemodynamic and electrical stability, disappearance of the SAM with complete recovery of the left ventricle contractile function, mild mitral regurgitation(minimal valve prolapse) Cardiac MRI: normal LVEF, absence of myocardial LGE with the exception of small areas of the papillary muscles due to traction of the mitral flaps. In the patient‘s medical history: stressful last months related to smart working and family problems; absence of a specific identifiable trigger.

Conclusions
Stress cardiomyopathy in man patient complicated by progressive acute heart failure and SAM with rapid restitutio ad integrum. Presence of DA myocardial bridge with absence of myocardial LGE on MRI.
P199 PROCALCITONIN PREDICTS BACTERIAL INFECTION, BUT NOT LONG–TERM OCCURRENCE OF ADVERSE EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Fabbri G , Pavasini R , Marchini F , Bianchi N , Campo G , Guardigli G 
Published: May 2022

Abstract

Background
Procalcitonin (PCT) is an acute phase protein which plasma levels raise also in sterile inflammation. For this reason, its role in the acute coronary syndrome (ACS) setting would be twofold: as a marker of infection and also as a prognosticator of generic inflammation. High PCT values have been related to worse prognosis in patients with cardiogenic shock. If PCT values may predict the risk of bacterial infections and long–term outcome in patients with acute coronary syndromes has been less investigated.

Methods
Consecutive patients with a diagnosis of ACS with PCT level assessed during the first 24 hours of hospitalization were enrolled. The primary outcome was the occurrence of bacterial infection defined by the occurrence of fever and of at least one positive blood or urinary culture with clinical signs of infection. The secondary outcome was the 1–year occurrence of the composite outcome all–cause mortality, stroke and myocardial infarction.

Results
Overall 569 patients have been enrolled (mean age 69.37±14 years, 30% females): 44 (8%) of them met criteria for bacterial infection. Age, female sex, smoking habit, heart rate, systolic blood pressure (SBP), heart failure after admission, coronary angiography, hemoglobin, creatinine clearance and PCT above the cut–off value were predictors of the outcome. After multivariate analysis, PCT and SBP resulted as independent predictors of bacterial infections (OR for PCT above the cut–off 2.67, 95%CI 1.09–6.53, p = 0.032; OR for SBP 0.98, 95%CI 0.97–0.99, p = 0.043). At 1–year, the composite outcome of all–cause death, MI and stroke occurred in 104 patients (18%). PCT did not result as an independent predictor of the composite outcome.

Conclusions
In patients with ACS PCT levels at hospital admission are predictor of bacterial infection but not of the composite lomg–term outcome of all–cause mortality, stroke and myocardial infarction.
P200 ISCHEMIC HEART IN PAZIENTS UNDER 30: AN UNSOLVED CHELLENGE
Authors: Annalisa F , Trotta R , Pollicino T , Abbracciavento L , Luzzi G 
Published: May 2022

Abstract

Background
The pathogenesis of ischemic heart disease (IHD) in young patients is still unclear. Several studies have demonstrated the existence of peculiar cardiovascular risk factors (CRFs) that differ from the typical factors involved in the more common IHD of adults.Plaque rupture represents the most common etiology of myocardial infarction (MI), nonetheless, other events can play a role in young patients affected by IHD, including coronary artery plaque erosion, coronary microvascular dysfunction, spontaneous dissection of the coronary artery, and coronary artery spasm secondary to drug abuse. Due to the differences in the clinical manifestations, diagnosis, and therapeutic management, further research is needed to study the profile of MI in young patients1

Clinical Case
A 28–year–old male, occasional smoker, negative familiar anamnesis for IHD. His past medical history was significant for an acute coronary syndrome (ACS) STEMI at the age of 20 years old, treated with percutaneous transluminal coronary angioplasty (PTCA) with scaffold in the interventricular anterior artery (IVA). After 7 years he was admitted following a thrombotic occlusion of the IVA, managed with PTCA/ drug–eluting stent (DES) followed by coronary artery bypass surgery diverting the blood flow of the IVA in the left internal mammary artery (IMA). After only 11 months he presented with a new ACS NSTEMI treated with PTCA/DES of the IVA in the left IMA. No biochemical signs of coagulopathy or peripheral artery disease were disclosed, and the supra–aortic trunks resulted normal. Nevertheless, a significant increase in the blood levels of homocysteine and slightly elevated values of fibrinogen, D–dimers, and C–reactive protein. Erythrocyte sedimentation rate resulted within the physiological ranges.

Discussion and Conclusion
The peculiar medical history of the described patient suggests a marked tendency not only for the formation and plaque rupture but also for platelet aggregation. The only significant and persistent values that were found to be elevated were homocysteine and inflammatory markers. One–year follow–up examination revealed complete regression of the symptoms with double antiaggregating therapy and supplements of folic acid. The rarity of such cases should prompt new research to better understand IHD in this population and possible targeted treatments Acute Myocardial Infarction in Young Individuals; Rajiv Gulati; Mayo Clinic Proceedings, V 95, I. 1, P136–156, 2020.
P202 PRETREATMENT WITH ANTAGONISTS OF P2Y12 PLATELETS RECEPTORS IN ST–ELEVATION MYOCARDIAL INFARCTION: CLINICAL AND ANGIOGRAPHIC OUTCOMES
Authors: Antonucci A , Cutolo A , Gallo F , Bellin A , Cavalli G , Barbierato M , Themistoclakis S 
Published: May 2022

Abstract

Background
The use of antagonists of P2Y12 platelets receptors as antiplatelets drugs is a cornerstone in the treatment of ACS. Many efforts are made to understand the right timing of beginning this therapy with the purpose to reduce intra– and periprocedural complications (stent thrombosis, no reflow phenomenon). The rationale behind “pretreatment” (administration of antagonists of P2Y2 platelet receptor before the coronarography) is valuable but the evidences are lacking, also in the setting of ACS–STEMI.

Method and Objectives
We conduct an observational, monocentric (Ospedale dell’Angelo – Venezia Mestre), retrospective study including patients with STEMI (1st January 2016 – 9th august 2018). We compared two strategies of administration of clopidogrel, ticagrelor and prasugrel (pretreatment vs no pretreatment). Primary endpoints were bleeding BARC 3–5, acute or subacute stent thrombosis and TIMI flow grade &gt; 0 in the culprit coronary. Secondary endpoints were cardiovascular and no cardiovascular in–hospital mortality and in–hospital neurological complications.

Results
We studied 501 patients (199 in the group pretreated and 302 in the group no pretreated). The median time from first medical contact to PCI was 70,5 minutes in the pretreated group and 60 minutes in the no pretreated group (p = 0.022). No significant differences between the two groups were observed in terms of acute or subacute stent thrombosis (OR 3.72 [0.82–14.20], p = 0.09) e TIMI flow grade &gt; 0 in the culprit coronary (OR 1.11 [0.77–1.58], p = 0.58). In the multivariate analysis we observed that bleeding BARC 3–5 significantly were increased in the pretreated group (adjusted OR 2.78 [1.13–6.83, p = 0.025). In the subgroup analysis, the pretreated subjects with age &gt; 75 were at augmented risk of bleeding BARC 3–5.

Conclusions
Pretreatment in the setting of ACS–STEMI is not associated with benefits in terms of acute or subacute stent thrombosis and perfusion of culprit coronary but may cause clinically relevant bleedings, in particular in the elderly (age &gt; 75).
P204 FRACTIONAL EXCRETION OF ALBUMIN DURING ACS AS A PREDICTOR OF THE VERY LONG–TERM MORTALITY AND CAUSES OF DEATH. RESULTS FROM 22 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Cordiano R , Palmieri R , Cavuto F , Mahmoud M , Sitta N , Merotto D , Preti G , Segafedo B 
Published: May 2022

Abstract

Introduction
Several clinical risk predictors have been used to stratify risk in acute coronary syndromes (ACS) patients. Yet, few have been tested or demonstrated usefulness in the very long–term follow–up.

Purpose
To investigate the association between baseline albumin fractional excretion (AlbFE) and the long–term mortality and causes of death after ACS.

Methods
This prospective analysis included 579 patients admitted with ACS to 3 hospitals and discharged alive. Clinical and laboratory data were gathered within the first 7 days of hospitalization. Baseline AlbFE calculated as ((Serum Cr*Urine Alb) / (Serum Alb*UCr)) %, Patients were followed–up for 22 years.

Results
All except three patients completed the follow–up, and by its end 449(78%) patients were dead. Causes of death were sudden cardiac death (SCD) in 85(15%), non–sudden cardiac death (non–SCD) in 176(30%), non–cardiac death (non–CD) in 166 (29%). Baseline AlbFE median (IQR) values were: 4.1% (1.5–12.4), 1.7% (0.8–5.3), 1.3% (0.6–3.5) at 1st,3rd, and 7th hospitalization, respectively. At cox regression analysis, 3rd day AlbFE was associated to all–cause mortality: (HR = 1.4, 95%CI=1.3–1.5; p &lt; 0.0001). It was also associated to the risk of non–SCD (HR = 1.6, 95%CI=1.4–1.7; p &lt; 0.0001), SCD (HR = 1.3, 95%CI=1.2–1.5; p &lt; 0.0001), and to non–CD (HR = 1.3, 95%CI=1.1–1.4; p &lt; 0.0001). Using a cox regression model adjusted for age, gender diabetes and baseline left ventricular ejection fraction: the 3rd day AlbFE was associated to all–cause mortality (HR = 1.1, 95%CI=1.1–1.2; p &lt; 0.0001), and to non–SCD risk (HR = 1.2, 95%CI=1.1–1.4; p &lt; 0.0001) but not to the risk of SCD or non–CD (HR = 1.1, 95%CI=0.9–1.2; p = 0.45), and (HR = 1.1, 95% CI=1.0–1.2; p = 0.06), respectively. Same results were obtained with 1st an 7th day AlbFE values. Of relevance, a sub–analysis showed that the association between the 3rd day AlbFE and all–cause mortality kept true both in the 1st (1–11 years) and the 2nd (12–22 years) half of follow up period; (HR = 1.5, 95%CI=1.4–1.6; p &lt; 0.0001) and (HR = 1.2, 95%CI=1.1–1.4; p = 0.001) in the unadjusted model and (HR = 1.3, 95%CI=1.2–1.4; p &lt; 0.0001) and (HR = 1.1, 95%CI=1.0–1.3; p = 0.02) in age and gender–adjusted model for the 1st and the second half respectively.

Conclusion
The present results showed that baseline AlbFE is an independent predictor of mortality up to 22 years after ACS, chiefly for non–SCD.
P209 THE FOLLOW–UP OF PATIENTS AFTER ACUTE CORONARY SYNDROME: THE APULIAN PONTE–ACS PROJECT
Authors: Scicchitano P , Locuratolo N , Lillo A , Sublimi Saponetti L , Palumbo V , Lanzone S , Campanella C , Mancini L , Massari F , Landriscina R , Barba G , De Santis A , Caldarola P 
Published: May 2022

Abstract

Background
Patients discharged after acute coronary syndrome (ACS) deserve a tight follow–up in order to optimize long–term pharmacological treatments and prevent the occurrence of adverse events. The aim of the PONTE–ACS Project was to evaluate the impact of a dedicated cooperative program between hospital and outpatient structures on the persistance on recommended therapies and long–term outcome occurrence in patients discharged after ACS.

Materials and Methods
This was a prospective, longitudina, cohort study. We enrolled patients who were discharged after ACS and/or after coronary revascularization in the HUB centres of ASL Bari. Patients underwent cardiologic evaluation and laboratory examination at 30 days, 3–, 6–, and 12–months from the index event. The following endpoint were considered: all–cause mortality, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure, any bleeding. Adherence and persistence to therapies were evalauted as well as the percentage of patients who reached the recommended goals.

Results
We enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 yrs). After one–year follow–up, 99.5% (p &lt; 0.05) were on statin–therapy, 16.1% with ezetimibe (p &lt; 0.01) and 9.9% (p &lt; 0.01) with proprotein convertase subtilisin/kexin type 9 inhibitors. The overall mortality at one–year follow–up was 3.1%, while ACS recurrence/cardiac ischemia/angina and restenosis/intrastent thrombosis were 3% e 1.3%, respectively. Any bleeding rate was 2.2%.

Conclusions
The PONTE–ACS Project was able to improve the management of patients after ACS, to manage a structured follow–up protocol for patients discharged after ACS and/or coronary revascularization, thus improving adhesion to recommended therapies and keeping lower the incidence of major cardiovascular and bleeding events.