bluuebunny/crossref_metadata_2025_split huggingface dataset:
P154 EVOLUTION OF ECHOCARDIOGRAPHIC AND CARDIAC MRI ABNORMALITIES DURING FOLLOW–UP IN PATIENTS WITH PREVIOUS MIS–C DIAGNOSIS
Authors: Sirico D , Basso A , Sabatino J , Reffo E , Cavaliere A , Biffanti R , Cerutti A , Castaldi B , Zulian F , Da Dalt L , Di Salvo G 
Published: May 2022

Abstract

Background
Cardiovascular manifestations in the acute phase of MIS–C are frequent. However, there is lacking evidence regarding late cardiological follow–up of this cohort of patients. The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS–C, assessed by standard echocardiography (TTE), speckle tracking echocardiography (STE), and cardiac MRI (CMR).

Materials and Methods
32 consecutive patients with confirmed MIS–C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected for all patients. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis.

Results
Mean age was 8.25±4years (range 1.3–17.7). Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease–like symptoms, and 5 (15.6%) needed ICU admission. All patients showed an hyperinflammatory state. Tn–I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Median time to STE evaluation was 7 days and to CMR 18 days since fever onset. Mean LVEF at baseline was 58.8±10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (–17.4±4%). Coronary dilation was observed in 9 (28,1%) patients. On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Median time to T1 and T2 evaluation was respectively 48.5 and 207 days. Follow–up data showed statistically significant improvement in left ventricular systolic function compared to acute phase. LVEF improved rapidly at T1 (62.5 ± 7.5 vs. 58.8±10.6%, p value 0.044) with only three patients (10%) below ≤ 55% at T1 and one patient (4%) at T2. LV GLS remained impaired at T1 (–17.2 ± 2.7 vs.–17.4 ± 4, p value 0.71), and significantly improved at T2 (–19±2.6% vs. –17.4±4%, p value 0.009). LV GLS was impaired (&gt;–18%) in 53% of patients at baseline and T1, while only 13% showed LV GLS reduction at T2. CMR, performed 6 months after diagnosis, showed LGE persistence in 33.4% of cases.

Conclusions
Even though, early cardiac involvement significantly improves during follow–up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS–C patients.
P187 DRUCEBO EFFECT IN STATIN THERAPY: MORE ATTRIBUTABLE TO THE PATIENT, THE DOCTOR, OR THE MASS MEDIA?
Authors: Cosmi D , D‘Orazio S , Mariottoni B , Tarquini B , Cosmi F 
Published: May 2022

Abstract
In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient‘s expectations, the doctor‘s preferences and the interference of the mass media rather than the actual pharmacological effect . We evaluated this effect in 9,605 patients treated with statins, in primary (27%) and secondary (73%) prevention. Presumed statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. Table 1 shows the causes of the presumed intolerance and the related SMIS (Statin Myalgia Index Score). Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the dose, with reassessment after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms were also present with the second statin, the patient was advised to take the drug every other day. In patients with unlikely SMIS, the decision to resume therapy was shared with the patient, informing him of the benefits of statins on mortality and morbidity. Probable true intolerance was found in 576 patients (6% of the overall population on statin therapy: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic CPK elevation, 15 transaminase increased, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due to both the patient and the treating physician or other specialist, who are inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non–modifiable by modifying the drug or the doses. Interference from the mass media is common, and it is difficult to distinguish a greater responsibility of one or the other.In patients treated with statins, a drucebo effect is frequently found, which is partly attributable to the patient, partly to the doctor and the mass media, who tend to attribute muscle symptoms to the treatment with statins and to interrupt therapy without taking into account the benefits regarding the reduction of mortality and morbidity found in numerous studies with indisputable evidence of efficacy and safety. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms.
P260 PRELIMINARY EXPERIENCE OF REPEATED LEVOSIMENDAN INFUSIONS IN ELDERLY OUTPATIENTS WITH ADVANCED HEART FAILURE
Authors: Camartini V , Orso F , Herbst A , Virciglio S , Salucci C , Verga F , D‘Errico G , Di Bari M , Ungar A , Fattirolli F , Marchionni N , Baldasseroni S 
Published: May 2022

Abstract

Background
The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF).

Purpose
To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients.

Methods
A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60‘ up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment.

Results
Since November 2020 we enrolled 17 patients with a mean age of 77 years; 12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID–19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate; in one case drug infusion was suspended (Figure 1). The main complication observed was marked non–symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease–modify treatment, according to HF guidelines (Figure 3).

Conclusions
In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines–directed medical therapy.
P296 HIDDEN PERICARDIAL CONSTRICTION IN A PATIENT WITH CHRONIC PERICARDIAL EFFUSION AND “UNEXPLAINED” DYSPNEA
Authors: Caravita S , Baratto C , Ghiso P , Torlasco C , Senni M , Sganzerla P , Perego G , Badano L , Parati G 
Published: May 2022

Abstract
Constrictive physiology leads to exertional symptoms related to restrained diastolic filling and intracardiac/intrathoracic dissociation. However, these hemodynamic abnormalities might not be evident in some patients. A 55–year–old woman was referred to our center to perform a right and left cardiac catheterization because of “unexplained” dyspnea. Three years before she was found to have a large idiopathic pericardial effusion. Anti–inflammatory therapy did not result in any improvement. Since then, the patient complained dyspnea NYHA II–III, in the absence of any clinical and imaging sign of tamponade/pericardial constriction. At rest, there was no sign of constriction, but a relative hypovolemic status characterized by low pulmonary and filling pressures and cardiac output (CO) at the lower limits of normal. After a 500 mL saline load and passive legs raising, Kussmaul’s and “M” signs appeared on the right atrial pressure curve (Figure 1), the pulmonary artery wedge pressure (PAWP) – left ventricular end–diastolic pressure (LVEDP) gradient difference between expiration and inspiration was &gt;5 mmHg (Figure 2), and ventricular systolic pressures went out of phase by 180°. Both right and left filling pressures as well as pulmonary pressures steeply increased in a concordant manner by about 10 mmHg after fluid load, in absence of a relevant increase in CO (Figure 3). Physical exercise performed thereafter showed an additional mild increase with a plateau pattern of all pressures, suggesting an upward–shift of the pressure/flow relationship (Figure 3). All these signs suggested a latent constrictive physiology. Despite this, the patient showed an optimal CO reserve coupled with a normal exercise capacity (peak oxygen consumption, VO2, 127% of predicted) that would have argued against our hypothesis. We then performed a diagnostic and evacuative pericardiocentesis. After the drainage of 130 ml of pericardial fluid, LV transmural pressure increased and CO at rest was fully normalized. Moreover, no hemodynamic sign of constriction could be observed even after a 1000 ml saline load. The patient reported disappearance of exertional breathlessness, objectivated by an increase in peakVO2 by 20% as compared with the previous test. Thus, our case underscores how subtle the hemodynamic impact of pericardial effusion can be, with the need of well–tailored diagnostic exams to explain otherwise “unexplained” patients’ symptoms, with potential therapeutic implications.
P300 ACUTE MYOCARDITIS COMPLICATED BY VENTRICULAR ARRHYTHMIAS
Authors: Utzeri E , Santus S , Licciardi M , Mandas M , Campana N , Angius S , Gioi A , Maiani S , Perra F , Marchetti M , Montisci R 
Published: May 2022

Abstract

Background
Many kinds of arrhythmias may occur in patients with myocarditis at any stage of the disease. However, as compared to the other clinical presentations, arrhythmic myocarditis has been poorly described in literature.

Case Report
A 20–year–old girl, without CVRF or comorbidities, presented at the ED because of palpitations and epigastric pain irradiated to left arm. 12–lead ECG evinced elevated HR and aspecific repolarization abnormalities. Blood samples showed high cTn value and normal PCR value. Echocardiography showed a preserved LVEF, without abnormalities. Patient was hospitalized with a diagnosis of suspect acute myocarditis. Following hospital stay has been complicated by recurrent episodes of chest pain with concomitant increase of cTn that finally had presented a sinusoidal trend (peak 12830ng/L). At the same time, continuous ECG monitoring has been showing frequent but short term ventricular extrasystole activity, so B–blocker therapy was optimized. On ECG monitoring, appearance of short runs of asymptomatic mono– and polymorphic NSVT and after a few days appearance of polymorphic NSVT “torsade de pointes” like, symptomatic for presyncope. New changes in kinetics appear on the echocardiogram: hypokinesia of medio–apical segments of lateral, anterior wall septum. Therapy with metoprolol and lidocaine iv was started with subsequent stabilization of the rhythm. CMR presented data suggestive of myocarditis. Patient performed several BEM at different time and centers: diagnostic signs of myocarditis were not be found. Autoimmune and infectious disease screening, abdominal echography and a PET TC total body were been performed to research a potential etiology, without positive result. Patient has been discharged with wearable defibrillator and we waited for the ICD implantation in secondary prevention. Follow–up CMR showed a resolution of inflammation and no signs of fibrosis. Blood samples did not demonstrate a rise of cTn. After discharged, she has not had news onset of ventricular arrhythmias.

Conclusion
The mechanisms underlying the occurrence of ventricular arrhythmias during myocardial inflammation are less clear. Arrhythmias usually being self–limited with no recurrences that follow the acute phase. Management of acute life–threatening arrhythmias is generally supportive and there is a lack of evidence to support the use of specific antiarrhythmic agents. Wearable life vest has been presented as a possible therapeutic option.
P312 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN SARS–COV–2 INFECTION
Authors: Bava A , Daffinà M , Cama G , Dieni D , Barreca F , Calipari N , Sculli M , Dattola V , Luppino A , Battaglia C 
Published: May 2022

Abstract
Cardiovascular complications are a frequent occurrence in Sars–CoV–2 infection. Takotsubo cardiomyopathy is a possible cause of transient ST segment elevation (1–3% of total cases) and is characterized by a reversible left ventricular dysfunction with coronary arteries free from critical stenosis. The predominant echocardiographic pattern is an akinesia of the mid–apical myocardial segments with preserved kinetics of the basal segments. The incidence of Takotsubo cardiomyopathy showed a marked increase during the COVID–19 pandemic. Three factors mainly contribute to the onset of cardiomyopathy in patients with COVID–19: cytokine storm, adrenergic hyperactivation and microvascular dysfunction. A 79–year–old woman was hospitalized in the Pneumology department of our hospital for bilateral interstitial pneumonia Sars–CoV–2 related. In remote medical history: in 2010 diagnosis of breast cancer with negative follow–up for disease recovery, arterial hypertension, hypercholesterolemia and syndrome of reduced mobility as a result of a previous ischemic stroke. Non–invasive mechanical ventilation with c–PAP was started and, for the detection of anterolateral electrocardiographic anomalies (diffuse symmetrical negative T waves) and an increase in myocardionecrosis markers, echocardiographic evaluation was performed, which revealed an akinesia of the mid–apical segments of the left ventricle with preserved kinetics of the basal segments and severely depressed global systolic function (ejection fraction: 30%). BNP (18.100 pg /mL), interleukin–6 (339 pg /mL) and CRP (136 mg /L) were elevated on blood chemistry tests. In the suspicion of Takotsubo cardiomyopathy (InterTAK Score: 67, probability: 79.8%), cardioprotective therapy with ACE inhibitor, beta–blocker, diuretics, low molecular weight heparin, double antiaggregation and statin was started, deferring coronary angiography to improved clinical conditions. In the following days, due to the respiratory and haemodynamic worsening, the patient was transferred to an intensive setting, where she was intubated and treated with levosimendan and noradrenaline. Serial echocardiograms showed a progressive improvement of the global systolic function (ejection fraction at the last checkup: 55%), with complete regression of the kinetic anomalies, confirming of the diagnostic hypothesis of stress cardiomyopathy. For a pulmonary mycotic superinfection, complicated by iatrogenic pneumothorax, in the following days the patient died.
P314 WHEN TAKO–TSUBO TRAPS… NOT ONLY OCTOPUSES
Authors: Spissu P , Contini F , Licciardi M , Leoni L , Fazzini L , Angius S , Perra F , Secchi S , Marchetti M , Montisci R 
Published: May 2022

Abstract
The case we present involves a 75 years–old woman with no cardiological past medical history, who presented to our attention complaining of sudden onset thoracic pain associated with dyspnea, dry cough, nausea and an episode of vomit. She called 911 rapidly coming to our Hospital. In the Emergency room an EKG showed ST segment depression in the inferior leads and in the blood test a remarkable increase in HS–Troponin level was evident. An echocardiogram showed mid and apical left ventricle segments hypokinesia with moderately reduced Ejection Fraction (45%); notably, right ventricle was increased in dimension with moderate tricuspid regurgitation and mild pulmonary hypertension. Because of this last find, D–dimer was checked and a pulmonary angio– CT was performed which excluded active pulmonary embolism. Next day she underwent coronary angiography which showed no coronary lesion able to explain the clinical and echocardiographic presentation; left ventriculography was also performed showing an increase in end–systolic volume with hypokinesia of the anterolateral, apical and diaphragmatic walls and an Ejection Fraction (EF) of 30%. These findings allowed us to make the diagnosis of Tako–Tsubo syndrome, also known as stress–induced cardiomyopathy. Few days later, a cardiac magnetic resonance (CMR) was performed showing whole apical and antero–lateral mid ventricular hypokinesia with compensatory hyperkinesia of basal segments; T2–weighted sequences were positive at the hypokinetic segments with no specific Late Gadolinium Enhanced (LGE) images. What’s more, an atrial septal defect type “ostium secundum” was clearly evident, causing a left–to–right shunt hemodynamically significant (Qp/Qs of about 2,8) with right atrial and right ventricle dilatation. Pulmonary artery and its main branches were dilated too. After these findings, lady underwent right heart cardiac catheterization that reported a Qp/Qs of 3,24 and a shunt flow of 8,78 L/min, with a cardiac index of 2,5 L/min/m2 and normal pulmonary vascular resistance (0,7 Wood Units). Because of these measures the patient was discharged from our Cardiology Unit and referred to the Interventional Cardiology centre of our city for the percutaneous closure of the hemodynamically significant atrial septal defect.
This case is curious because it shows how things in Cardiology can be deeply and unpredictably connected.
P395 INFECTIVE ENDOCARDITIS: A SUBTLE PRESENTATION
Authors: Corsi E , Bosso A , Venturini E 
Published: May 2022

Abstract

Background
Infective endocarditis is still a serious and deadly disease. Despite improvements in its management, the diagnosis it is not always easy and thus it is still associated with high mortality and severe complications. This is especially true for patients with prosthetic valves, that have higher risk of developing infective endocarditis and more often associated with severe complications and a higher rate of mortality.

Case Description
A 75–years–old woman presented to the ED for persistent low–grade fever and mild dyspnoea. She had an aortic biologic prosthetic valve implanted the year before for severe aortic stenosis. She also complained a persistent back pain, present for about three months and irresponsive to pharmacological therapy and also physiotherapy. Getting back in time, she had been hospitalized few months before for genitourinary tract infection from multi–resistant E. faecalis, treated with antibiotic therapy and then discharged after few days. She underwent a transthoracic echocardiogram in ED that showed an apparently intraprosthetic moderate aortic regurgitation, never described in the previous cardiologic controls. In the strong suspect of endocarditis complicated by systemic embolization, she also underwent transoesophageal echocardiography, that showed dehiscence of the prosthetic valve with severe paravalvular abscess and regurgitation, without rocking motion of the prosthesis. A TC scan and then a spine MRI confirmed the presence of infectious spondylodiscitis, responsible for that persistent back pain. The patient was therefore urgently sent to cardiac surgery: a Bentall procedure (aortic valve and aortic root replacement) was performed. The patient, despite the severity of the sepsis and the cardiac endocarditis, survived the surgery and after 3 weeks of intensive care hospitalization was discharged and sent back to our Department for Cardiac Rehabilitation. Entering the ward, the patient was severely deconditioned, but after about 45 days of hospitalization she was discharged fit, with good functional capacity.

Conclusion
This case shows the subtle but serious evolution that usually controlled infections can have in patients with high risk of endocarditis, as patients with prosthetic valves. This underlines on one hand the importance of antibiotic prophylaxis in this subset of patients, on the other hand the role of multimodality imaging for diagnosis and management of infective endocarditis and its complications.
P402 COVID–19 VACCINATION IN CHILDREN AGED 6–17 YEARS CARRIES A SIMILAR RISK OF FATAL OR LIFE–THREATENING MYOCARDITIS THAN BEING STRUCK BY LIGHTNING
Authors: Aimo A , Cantinotti M , Emdin M , Clerico A 
Published: May 2022

Abstract

Background
To better contrast the Covid–19 pandemics, national authorities worldwide are authorizing vaccination of children and adolescents, despite some concerns of adverse reactions due to their greater response to immune stimulation. Myocarditis is a particularly feared adverse reaction.

Methods
On December 30, 2021 we searched the CDC dataset of all Covid–19 vaccinations in the United States (US), and the VAERS dataset, which reports adverse reactions to vaccines after any Covid–19 vaccine in the US.

Results
Individuals receiving at least one dose were 243,182,423 (0.017% &lt;5 years, 2.745% 5–11 years, 6.571 12–17 years, 67.710% 18–64 years, and 22.958% ≥65 years). The number of fully vaccinated individuals was 205,638,307 (0.005% &lt;5 years, 2.016% 5–11 years, 6.559 12–17 years, 68.085% 18–64 years, and 23.335% ≥65 years). The cases of myocarditis reported in the VAERS dataset were 2,207 (22.247% 6–17 years, 64.522% 18–64 years, 5.754% ≥65 years, 7.476% unknown age); no cases &lt;5 years were reported. Cases of myocarditis classified as “serious events” were 1,590 (26.478% 6–17 years, 63.711% 18–64 years, 5.220% ≥65 years, 4.591% unknown age). The fatal or life–threatening events were 367 (17.711% 6–17 years, 66.757% 18–64 years, 10.899% ≥65 years, 4.632% unknown age). Based on these data, the estimated prevalence of myocarditis among individuals receiving ≥1 dose was 2.17*10–5 in individuals aged 6–17 years, 8.65*10–6 in those aged 18–64 years, and 2.27*10–6 ≥65 years; the prevalence of myocarditis as a serious event was 1.86*10–5 in individuals aged 6–17 years, 6.15*10–6 between 18 and 64 years, and 1.49*10–6 ≥65 years; myocarditis as a fatal or life–threatening event occurred in 2.87*10–6 between 6 and 17 years, 1.49*10–6 in the age range 18–64 years, and 7.16*10–7 ≥65 years. The prevalence data were similar among individuals receiving at least one vaccine dose (data not shown). By comparison, according to CDC data, the odds of being struck by lightning in a given year are around 1 in 500,000 (2*10–6).

Conclusions
While the incidence is slightly higher in the pediatric age than in adult or elderly individuals, it is still equal to 24 cases of “serious” myocarditis per million people aged 6–17 years, and less than 4 cases of fatal or life–threatening myocarditis were reported. The risk of fatal or life–threatening myocarditis is about the same than being struck by lightning.