bluuebunny/crossref_metadata_2025_split huggingface dataset:
P353 THE “TIMES” IN COVID–TIME: EXPERIENCE OF A CICU “SPOKE”
Authors: Piemonte F , Carraturo A , Cudemo V , Damiano S , De Angelis A , Forte R , Leccia A , Lirato C , Molaro M , Penna G , Petitto M , Puzio E 
Published: May 2022

Abstract
We analyzed data regarding patients hospitalized in the period 03/09/2020–03/09/2021 in the ICU–Cardiology Division of the “San Giovanni di Dio Hospital” of Frattamaggiore (NA), configured as “Spoke” CICu for the AMI Network of the Campania Region, and we compared them with the same parameters of patients hospitalized during 2019. In particular, we analyzed differences in epidemiologic parameters and, in patients hospitalized for acute coronary syndromes, we evaluated the waiting times for hemodynamic procedures. The total number of hospitalized patients decreased by about 25%, while the mean age of patients and the percentage of hemodynamic procedures were comparable. In particular we noted that, while the percentages of patients hospitalized for acute myocardial infarction were similar in COVID and PRE–COVID era, during the pandemic in patients affected by acute myocardial infarction.the percentages of STEMIs were superior to those of NSTEMIs. Finally, we examined door–to–balloon times. In patients affected by STEMI we found that, even during the pandemic, primary angioplasty was performed on average within 100 minutes, meaning that ultra–fast swabs (mandatory before the procedure) did not produce delay. Moreover, in the pandemic period patients with NSTEMI, despite a stay of about 8 hours in ER to obtain the result of the antigenic swab for SARS–COV2, received coronary arteriography in a shorter time than in the pre–pandemic era (52,8 and 62,4 hours respectively). This analysis seems to show that the pandemic has not affected the access and hospitalization times of patients with acute coronary syndrome, and that, although greatest difficulties have arisen, the times of access to hemodynamics have not been affected by COVID.
P360 HYPERTENSION DURING PREGNANCY
Authors: De Maio J , Caputi A , Martelli A , Bagni E 
Published: May 2022

Abstract
Pregnancy is a physiological condition and a delicate period too; that’s why it’s essential to support the woman. It is important to contact the specialists in Gynecology and rely on other specialists to deal with any morbid conditions that arise during gestation. In this regard, heart disease is the main cause of maternal morbidity and mortality in pregnancy. The surveillance of women with cardio–vascular disease must therefore be guided by the so–called “pregnancy heart team”. In particular, arterial hypertension affects 5 to 10% of pregnant women. The cardiovascular risk is continuously increasing. What are the reasons of this? First of all, the increase of the age of the future mothers. Furthermore, the fact that women, like the general population, are increasingly obese, hypertensive and diabetic. Cardiovascular diseases do not represent an absolute contraindication to pregnancy, except in a few cases, in particular, in severe pulmonary hypertension. However, it is essential to follow the patients according to personalized protocols with close collaboration between gynecologist and cardiologist. Our hospital references for the southern area of the province of Modena; in agreement with our gynecologist we saw the opportunity to collaborate even more closely and start a way dedicated to pregnant women. In 2021, about 30 women between 20 and 40 years old were sent to our attention, with predominantly arterial hypertension or notable symptoms. Patients were referred to us and underwent evaluation. We performed 50% EKG and examination, 50% transthoracic echocardiogram, 60% blood pressure Holter, 10% 24 hour Holter EKG. Seventy percent of the patients came from African race and the remaining from Caucasian. There was also a link with the socio–cultural level of the patients, in most cases they were overweight. In the meantime, hygienic–sanitary therapy and, if not sufficient, medical therapy has always been set up. The drug we preferred was Methyldopa under close monitoring for the comforting data from the technical data sheet on its use. To date, there have been no adverse events or complications reported to us. Further studies are needed to evaluate the effectiveness of interventions to reduce both the risk of recurrence of hypertension in future pregnancies and that of long–term cardiovascular complications.
P367 EFFECTS OF BIOARGININA® C SUPPLEMENTATION IN SECONDARY PREVENTION OF POST–COVID 19 HIGH CARDIOVASCULAR RISK PATIENTS
Authors: Ratti G , Di Tommaso C , Monda C , Fulgione C , Martone O , Ratti F , Fulgione L , Tammaro P , Mallardo M 
Published: May 2022

Abstract

Background
Post COVID–19 syndrome is characterized by chronic fatigue, shortness of breath, dry cough, headache, cognitive difficulties. The complexity of the clinical feature can be explained by a pre–existing endothelial dysfunction (particularly in the patient with high cardiovascular risk) exacerbated and/or linked to viral infection. In the cardiorespiratory rehabilitation program (RCR), the introduction of nutritional supports, vitamins and aminoacids, can be considered a useful approach to post–Covid syndrome. There are observations of positive results with the use of association of oral L–arginine + liposomal vitamin C (Bioarginina®C, 1.66g 2 bottles / day).

Aim of the Study
to evaluate the effects of the use of combination of oral L–arginine + liposomal vitamin C (Bioarginina®C, 1.66g 2 bottles/day) on the functional capacity measured with the six minute walking test (6MWT) of subjects during RCR post COVID 19.

Methods
50 patients with high cardiovascular risk (38 M and 12 F), with mean age 58 ± 7 years, (Group A) undergoing integration with two bottles of L arginine and liposomal vitamin C were examined above for 90 days during the RCR cycle. These had been positive to molecular COVID–19 nasopharyngeal swab test for a period ranging from 15 to 30 days. As a control population, the results obtained with standard treatment in 30 patients with high cardiovascular risk (17 M and 13 F) (mean age 61 ± 8 years) (Group B) after RCR post COVID 19 infection, were examined. The ability to perform normal daily activities was analyzed with the six minute walk test (6MWT) which measures the distance that a subject can run on a flat surface, walking as fast as possible in six minutes, including any interruptions that patient deems necessary. The statistical analysis was performed with the Student‘s T test for paired data. A value of p &lt; 0.05 was considered statistical significant.

Results
At 3 months, improvement in 6MWT values was observed in both groups in Group A: 289 ± 96 m vs 419 ± 105 m (p &lt; 0.0001) – Group B: 280 ± 88 m vs 332 ± 98 m (p &lt; 0.021). However in Group A, these was more significant.

Conclusions
Our data confirm the improvement in the physical performance of post COVID 19 patients with introduction of nutritional supports with L–arginine and liposomal vitamin C.
P387 THE PROGNOSTIC ROLE OF ST2L AND SST2 IN PATIENTS WHO UNDERWENT CAROTID PLAQUE ENDATERECTOMY: A FIVE–YEAR FOLLOW–UP STUDY
Authors: Scicchitano P , Marzullo A , Cortese F , Ciccone A , Angiletta D , Pulli R , Massari F , Caldarola P , Ciccone M 
Published: May 2022

Abstract

Background
Soluble suppressor of tumorigenity (sST)–2 plasma concentrations are related to atherosclerosis. The aim of the study was to assess the prognostic impact of sST2 and its membrane–associated form (ST2L) in patients with carotid atherosclerotic plaque who underwent endarterectomy (CEA).

Methods
82 consecutive patients (age range: 48–86 years) who underwent CEA were enrolled. Anthropometric, clinical, instrumental, and laboratory evaluations were gathered. Thirty–seven (45%) patients were symptomatic for cerebrovascular diseases. Patients underwent a five–year follow–up. Phone calls and the analysis of national and regional databases were adopted in order to evaluate the occurrence of the primary outcome (all–cause mortality). The populations was divided according to survival status.

Results
Statins were administered in 81% and 87.5% of survivors and non–survivors, respectively. sST2 levels were higher in non–survivors as compared to survivors (117.0 ± 103.9 vs 38.0 ± 30.0ng/mL, p &lt; 0.001) and in symptomatic individuals as compared to asymptomatic (80.3 ± 92.1 ng/mL vs 45.4 ± 41.4 ng/mL, p = 0.02). ROC curve analysis identified sST2 cut–off: &gt; 98.44 ng/mL as the best predictor for mortality. At one year follow–up, survival rate decreased up to 20% in patients with sST2 higher than the cut–off value. At multivariate regression analysis sST2 (HR: 1.012, 95% CI: 1.008–1.016, p &lt; 0.0001) and triglycerides plasma levels (HR: 1.008, 95% CI: 1.002–1.015, p = 0.0135) remained significantly associated to all–cause death.

Conclusions
sST2 may act as independent prognostic determinant of all–cause mortality and symptomatic cerebrovascular diseases in patients with carotid atherosclerotic plaque who underwent CEA.
P392 A MULTIMODALITY IMAGING DIAGNOSIS OF A CHALLENGING CASE OF CONCOMITANT GROUP 1 PULMONARY HYPERTENSION AND PARADOXICALLY LOW–FLOW, LOW–GRADIENT AORTIC STENOSIS
Authors: Martini M , Zupa F , Mancuso D , Baritussio A , Famoso G , Perazzolo Marra M , Iliceto S , Rigato I 
Published: May 2022

Abstract

A 76 year old woman was admitted to our hospital for self–limiting dyspnoea (NYHA class III) in oxygen dependence and frequent lipothymia following Valsalva manoeuvres. She was previously admitted to a Spoke Centre for heart failure (HF) with preserved ejection fraction (EF) and a new diagnosis of “pre–capillary pulmonary hypertension (PH)”. Despite a diagnosis of PH of unclear aetiology, she was started on macitentan without being reassessed for functional capacity due to Covid emergency; because of worsening symptoms, she was admitted to our Hub Centre. Resting ECG showed right axis deviation, right ventricle (RV) hypertrophy, first–degree atrioventricular block and right bundle branch block. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) volume with preserved EF (diastolic volume= 37 ml, EF = 88%), severe right atrial and RV dilation with flattening of the interventricular septum, estimated pulmonary artery systolic pressure (PASP) of 124 mmHg, and moderate calcific aortic stenosis (peak aortic velocity 3.3 m/s, mean gradient 25 mmHg, valve area 1.1 cm2). Right and left heart catheterization showed severe pre–capillary PH (mean pulmonary pressure 60 mmHg, mean wedge 11 mmHg, pulmonary vascular resistance 14.41 WU), a severe aortic valve stenosis (aortic valve area 0.68 cmq and peak–to–peak gradient 25 mmHg, slight reduction of cardiac index 2.04 l/min/mq) and no significant coronary artery disease. The degree of aortic stenosis was considered as moderate–severe by integrating data of transesophageal echocardiography (planimetric area 1cm2) and assessment of calcium score (1615 Agatson units). Pneumological causes, chronic thromboembolic PH, rheumatologic diseases, HIV infection, paraneoplastic origin and veno–occlusive disease were all ruled out as potential PH causes and a diagnosis of Idiopathic pulmonary arterial hypertension (IPAH) was finally made. The Heart Team established the best therapeutic option was a transcatheter aortic valve replacement (TAVI) allowing better haemodynamic tolerability of PH therapy. The patient underwent TAVI and was started on PH therapy; a complete atrio–ventricular block developed after the procedure, requiring permanent pacemaker (PM) implantation. Unfortunately, few days later, the patient died following pacemaker’s lead dislocation.

Conclusion
PH has a diverse aetiology, and prognosis is generally poor, especially in patients with severe comorbidities.
P398 A CASE OF MIS–C: SARS–COV2 AND MYOCARDITIS IN PEDIATRIC AGE
Authors: Orrù L , Urru M , Stara R , Marini E , Congia M , Scano F , Campagnolo A , Marini A , Montis S , Masnata G , Zanda M , Binaghi G , Cossa S , Mura S , Porcu M , Corda M , Perrotta D , Tumbarello R 
Published: May 2022

Abstract
A 12–year–old patient with paucisymptomatic SARS–COV2 infection in November 2020 with negative swab after 10 days. After 3 weeks access to pediatric emergency room for fever, maculo–papular rash on the trunk, conjunctivitis, nausea and abdominal pain: evidence of thrombocytopenia, increased CPK, LDH, AST and inflammation markers. She starts antibiotic therapy for suspected sepsis. After 24 hours asthenia, general illness, hypotension and tachycardia: echocardium with diffuse hypokinesia of the left ventricle (EF 35%); worsening of thrombocytopenia, D–Dimer, BNP and CPK increase, hyponatremia, troponin positivity, ATIII reduction; negative viral markers. On the basis of the most recent literature, the diagnosis of MIS–C is made, a post–infection SARS–COV2 multisystemic inflammatory syndrome. After discussion with the 3rd level SARS–COV2 Pediatric Center, the following therapy begins: iv diuretic, iv cortisone, sc heparin, iv immunoglobulins, Anakinra. For a progressive clinical worsening by cardiogenic shock with evolution to DIC, she is transferred by military plane to the pediatric intensive care of 3rd level SARS–COV2 Center. The patient is subjected to mechanical ventilation, therapy with inotropes (adrenaline and milrinone) and CRRT ultrafiltration in order to reduce the excessive levels of inflammatory mediators responsible for rapid multiorgan failure. After 4 days, haemodynamic parameters improvement (EF 50%); sartan and low dose diuretic have been started because of the presence of diastolic dysfunction. Discharge after 1 month of hospitalization with good clinical and haemodynamic stability. After 6 months from myocarditis onset with cardiogenic shock in MIS–C, cardiac MRI with evidence of EF 57% and small area of delayed enhancement on the anterior IVS with non–ischemic pattern, no longer present by imaging after 1 year by acute event. Currently the patient reports subjective well–being by the regular follow–up without arrhythmias by Holter monitoring. SARS–COV2 post–infection multisystemic inflammatory syndrome (MIS–C) represents a serious complication with possible myocardial involvement also following a paucysymptomatic infection as in the described case. What happened shows us that SARS–COV2 infection is still a devious clinical entity that needs close follow–up in the short and long term.
P404 CAN THE BASELINE NT–PROBNP LEVEL BE USED AS A PROGNOSTIC MARKER IN PATIENTS HOSPITALIZED FOR COVID–19? A SINGLE CENTRE EXPERIENCE
Authors: Baldin G , Di Maio F , Todde N , Volpi N , Basan L , Vannucci V , Ruzittu G , Pisanu A , Seddone S , Bua A , Delogu G , Favuzzi A , Porcu M 
Published: May 2022

Abstract

Background
NT–proBNP is commonly used a reliable prognostic biomarker in heart failure. Although SARS–CoV–2 is primarily a respiratory virus, it can also cause a myocardial injury. Previous observations indicate that COVID–19 patients can show a pathological rise of NT–proBNP during the disease course.

Aim
To assess the in–hospital prognostic significance of baseline NT–proBNP levels in COVID–19 patients.

Methods
We retrospectively analysed the data of one–hundred and ninety–two consecutive patients (mean age 70±15, 54.6 % males), hospitalized in our institution for COVID–19 disease. Demographic parameters, clinical history, pharmacological treatments and laboratory data at the admission were analysed. According to the baseline NT–proBNP levels, the whole population was divided into normal (Group A) and elevated (Group B) NT–proBNP, considering ≥ 125 pg/mL level as the pathological cut off. The length–of–stay, the orotracheal intubation rate, non–invasive ventilation and in–hospital mortality were taken into account as prognostic parameters.

Results
Forty–seven patients and one–hundred and forty–five patients belonged to Group A and Group B, respectively. Group A patients were significantly younger (57±13 vs 74±13 yrs, p &lt; 0.001), with a lower rate of previous cardiac disease (6.4% vs 39.3%, p &lt; 0.001) and atrial fibrillation (4.3% vs 16.7%, p &lt; 0.033) and a better eGFR (94±20 vs 71±29 ml/m’, p &lt; 0.001). No differences were noted between the two groups in the prevalence of diabetes, hypertension, ACE/ARBs treatment. The length–of–stay was similar (20±13 days in Group A vs 22±19 days in Group B, respectively, p=ns). Although patients of Group B showed a higher rate for orotracheal intubation (4.3% vs 13.8%) and non–invasive ventilation (13.8% vs 32.4%,), these differences were not significantly different. The in–hospital mortality was considerably lower in patients with normal baseline NT–proBNP level, as compared to Group B patients (2.1% vs 23.4% p &lt; 0.001). When stratified by quartiles of NT–proBNP, the subgroups showed a prognosis clearly related to the expression of the biomarker.

Conclusion
In patients hospitalized for COVID–19, normal baseline NT–proBNP level identifies a population with a short–term better outcome. This widely diffuse biomarker could be used in the initial phase of admission as a prognostic tool to characterize the in–hospital prognosis.
P407 WHEN A SUPRA–VENTRICULAR TACHYCARDIA SAVES A LIFE
Authors: Parato V , Molisana M , Parato A , Scarano M 
Published: May 2022

Abstract

The Case
A 76–year–old man came to ER because of palpitations and a worsening chest discomfort. His clinical history included hypertension, dyslipidemia, diabetes and gouth. 12–leads ECG revealed a supraventricular tachycardia with heart rate of 190 bpm. It also demonstrated: widespread deep ST depression involving V2–6, I, II, aVL ST elevation in aVR &gt; V1 (Figure 1). Adenosine (6 mg) intravenous administration led to sinus rhythm restoring with symptoms regression. 12–leads ECG after sinus rhythm restoring demonstrated a ST–T segment normalization (Figure 2). Trans–thoracic echocardiogram, acquired in sinus rhythm, showed a picture of left ventricle systolic dysfunction with ejection fraction of 35% due to a severe hypokinesis of mid–apical wall segments. A moderate mitral regurgitation with central jet was visible. An urgent coronary angiography was performed. It demonstrated a LEFT MAIN CORONARY ARTERY (LMCA) very severe (95%) proximal lesion. Patient was sent to urgent coronary artery bypass grafting (CABG).

Discussion
Widespread ST depression (with reciprocal STE in aVR) is a common finding in patients with supraventricular tachycardias such as AVNRT or atrial flutter. The significance of this finding in individual patients is unclear and may be due to: rate–related ischaemia (O2 demand higher than supply) unmasking of underlying coronary artery disease (i.e. tachycardia as a “stress test”) a pure electrical phenomenon (e.g. the young patient with SVT who is relatively asymptomatic and has normal coronary arteries). In this case, primary ECG pattern and then echocardiographic findings suggested a potentially lethal coronary artery disease which was confirmed by coronary angiography.

Conclusion
Sometime a supraventricular tachycardia may be helpful in order to bring out life–threatening disease.
P410 ROLE OF TELEMEDICINE IN PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASES
Authors: Nodari S , Fioretti F , Bollani G , Glisenti F , Gabbrielli F 
Published: May 2022

Abstract
Cardiovascular diseases have a high prevalence and incidence and are associated with a high rate of mortality and hospitalization; this is reflected in a reduction in quality of life and a high health care expenditure. The aim of our study was to evaluate the effectiveness of telemedicine in primary and secondary prevention, through the use of ECG, ABPM and Holter monitoring. Health Telematic Network, in collaboration with the University of Brescia and Federfarma, has installed in 6527 territorial pharmacies distributed in the country, a telematic network interconnected to a single Telemedicine platform, where cardiologists are available for H24 reporting and teleconsultation. The pharmacies performed 12–lead ECG in healthy subjects, with cardiovascular risk factors or ongoing symptoms referable to the cardiovascular system, ABPM in accordance with the guidelines for hypertension and Holter ECG in symptomatic patients (heart palpitations, syncope, lipothymias) or positive history for brady and tachyarrhythmias. In the period between 2016 and October 2021, we analyzed 660508 exams: 411526 ECG, 143869 cardiac Holter and 105113 ABPM. Of the 411526 ECGs, 14.5% of tracings showed abnormalities not compatible with the reported anamnestic data, therefore 59671 users were sent to the caregiver for further evaluation or diagnostic investigation; in 1.5% of cases, major abnormalities were detected, necessitating immediate referral of the patient to the emergency department. Of the 105113 ABPM, 37.2% of the examinations revealed abnormal blood pressure trends according to the SIIA classification, 39102 users were sent to the physician for the appropriate diagnostic and therapeutic measures. Of the 143869 Holters, 26326 patients (18.3%) were referred to the attending physician for major arrhythmias, 3008 patients (2.1%) were referred to the emergency department for red code arrhythmias (VT, grade 3 BAV, long QTc, high or low ventricular response AF with critical pauses). Our data show the important role of a Telemedicine network in primary and secondary cardiovascular prevention, able to provide early diagnosis and treatment of major events; the use of a national telemedicine network has also proved effective in the appropriate referral of subjects to the Emergency Department, with a positive impact in terms of health care expenditure containment.
P411 MINOCA OR NOT MINOCA? THE DECISIVE ROLE OF CARDIAC MAGNETIC RESONANCE IN THE DIFFERENTIAL DIAGNOSIS OF MYOCARDIAL DAMAGE
Authors: Dal Passo B , Cardelli L , Perugini E , Bugani G , Canovi L , Frascaro F , Zanarelli L , Piscitelli L , Colletta M , Casella G 
Published: May 2022

Abstract
Cardiac MRI can facilitate the differential diagnosis of myocardial damage in patients without coronary artery disease. Our case report is about a 50–year–old man who was admitted to the Emergency Department of the Maggiore Hospital in Bologna in October 2021 for oppressive chest pain at rest; previously he had experienced a similar episode but of minor intensity. He had not previous medical records. When the patient arrived at the emergency department chest pain had regressed, blood pressure was elevated (170/110 mmHg). The ECG showed sinus tachycardia at 100 bpm without electrocardiographic abnormalities suggestive of acute ischemia. Cardiac biomarkers were elevated (hsTnI 312 ng / L –&gt; 975 ng / L – n.v. &lt;19.8 ng / L); blood gas analysis showed pH 7.42, pO2 47 mmHg and pCO2 33 mmHg. Chest CT scan excluded pulmonary embolism and acute aortic syndrome. The patient was transferred to Cardiology Ward in the suspicion of acute coronary syndrome, where echocardiogram showed normal biventricular volumes, mild wall hypertrophy and hypokinesia of the lower middle wall (EF 52%). Coronary angiography didn’t showed any obstructive stenosis in any epicardial vessels. In consideration of the clinical presentation and instrumental evidences, the patient was discharged with a diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA), but a cardiac MRI was scheduled in the post–discharge to clarify its genesis. MRI didn’t showed any areas of signal hyperintensity, any perfusion deficits in the first pass study and any areas of late gadolinium enhancement (LGE). Those images permitted to exclude areas of necrosis or inflammation, orienting the diagnosis to myocardial damage during hypertensive crisis. Therefore, the antiplatelet therapy recommended at discharge was suspended. In this case report, cardiac magnetic resonance showed that it can improve the etiological diagnosis of MINOCA, allowing for better clinical and therapeutic management.