bluuebunny/crossref_metadata_2025_split huggingface dataset:
P348 PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION: DATA FROM NIGUARDA HOSPITAL
Authors: Maloberti A , Ceruti D , Gualini E , Colombo V , Giani V , Milani M , Sun J , Alloni M , Giannattasio C 
Published: May 2022

Abstract

Background
The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive–mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non–invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention.

Methods
559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population.

Results
During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease.

Conclusions
Our study shows a relevant percentage of inappropriate prescriptions of non–invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.
P349 A REPRODUCIBLE SENSOR PATTERN TO SUSPECT COVID19 PULMONARY INFECTION WITH LATITUDETM. CASE REPORT AND LITERATURE REVIEW
Authors: Zanchi S , La Greca C , Di Nanni N , Fogliata E , Zani M , Pecora D 
Published: May 2022

Abstract
A 78 year–old patient with post–ischaemic dilated cardiomyopathy and severely reduced ejection fraction was implanted with a Boston Scientific RESONATE X4 CRT–D and followed by LATITUDETM remote monitoring platform. From the end of January to the end of March 2021 he was hospitalized for COVID19 pneumonia followed by two episodes of acute heart decompensation. We remotely followed the patient and identified a specific Heart Logic sensor pattern linked to the COVID19 pneumonia: an increase of the thoracic impedance combined with an increase of the respiratory rate (RR), S1 heart sound and the nocturnal heart rate (nHR). This pattern differed from the one linked to the subsequent episodes of heart failure, characterized by a decrease of the thoracic impedance and of S1 heart sound combined with a high RR and nHR. We eventually made a literature review on the topic and found that our observations were in line with what was published: an increase in the thoracic impedance in association with an increase in the RR and a decrease in the activity level was present in the majority of published COVID19 patients followed by LATITUDETM remote monitoring platform. Furthermore a recent comparative study found that the thoracic impedance was significantly higher in COVID–19 patients as compared with acute HF patients, suggesting an underlying pathophysiological mechanism related to pulmonary infection.
The present case and the literature review show that LATITUDETM remote monitoring algorithm may become a useful tool to remotely detect SARS–CoV–2 infection, distinguish it from HF and lead to an early hospitalisation for symptomatic patients or to a simple home monitoring.
P354 GENDER DIFFERENCES IN EPIDEMIOLOGY OF A CORONARY CARE UNIT HUB IN COVID ERA
Authors: Frascaro F , Cardelli SL , Bugani G , Sciarra F , Zagnoni S , Canovi L , Dal Passo B , De Carolis B , Zanarelli L , Piscitelli L , Colletta M , Casella G 
Published: May 2022

Abstract

Background
The attention about sex disparities in Cardiology has grown in the last few years. Women are still often under–represented in cardiovascular randomised clinical trials (RCTs) and several studies have shown later diagnosis, less aggressive treatments and poor prognosis among women, even though hospitalized in the coronary care unit (CCU).

Objective
To analyze gender–related differences and their relationships with prognosis among patients admitted to a contemporary CCU Hub.

Methods
Between 1st March 2021 and 30th November 2021, we prospectively collected the data of patients admitted to the II level CCU of Maggiore Hospital in Bologna.

Results
The clinical characteristics of 458 enrolled patients are shown in Table 1. Women represent 32% of the population, are older (p &lt; 0.001) and have been admitted to the CCU mainly for acute coronary syndrome (ACS) (43%) or bradyarrhythmias (23%); men for ACS (57.5%) or heart failure (11.3%). Among patients with ACS, 82% of women underwent coronary angioplasty – both primary and non–primary– versus 88.1% of men (p = 0.276). Females have fewer cardiovascular risk factors and comorbidities than their male counterparts. In CCU, women received similar treatments to men (except for increased use of parenteral nutrition). Similarly, the prevalence of ischemic, haemorrhagic and septic complications was the same between the sexes. The rate of women‘s mortality in CCU was 1.4%, which increases to 4.8% at 30 days, similar to men’s mortality (1.9% versus 3%, respectively).

Conclusions
The study demonstrates that one third of the population of a CCU Hub is represented by women, older and more often hospitalized for ACS. These women receive the same treatments as men, including coronary revascularization. There were no differences about gender prognosis, despite a higher trend towards mortality in females after discharge from the CCU. Therefore, studies where women are more represented are needed, in order to obtain precise indications on how to modulate clinical management according to gender.
P355 THE HYPNOTIC COMUNICATION USE IN CARDIOLOGY SETTING
Authors: Bricco G , Boglione M , Moncalvo C , Bossa S , Coppolino A , Valeri L , Amoroso G , Dogliani S , Pancaldo D , De Benedictis M 
Published: May 2022

Abstract
Between summer 2020 and the end of 2021 the Cardiology facility of the Savigliano hospital trained 2 doctors and 2 nurses in hypnotic communication (IC). IC is a communicative approach, which involves establishing a relationship with the patient and can allow carrying out the planned procedure by bringing the patient into a modified state of consciousness that reverberates on physical and sensory perceptions up to a trans hypnotic. This particular connection with the patient can be represented by a simple communication deepening up to the real trance and allows to overcome the procedures with a reduction in the use of anesthetics and analgesics, with a control of procedural anxiety, up to complete analgesia, but also the management of some particular procedural needs such as the prolonged maintenance of the supine position on an operating room table with the patient awake. All patient has an extremely positive experience. Hypnosis can also optimize the abilities and performances of those who use it. During this period, at the Cardiology facility of the Savigliano we started using IC to perform procedures in the hemodynamics, electrophysiology and transesophageal echocardiography. In the hemodynamics and electrophysiology room, IC has increasingly become the preferred communicative approach to the patient who are going to have a procedure. A total of 123 patients booked for coronary angioplasty were managed in IC, including 5 in emergency, 24 PM implants and defibrillators, 3 electrophysiological studies and a foramen ovale closure procedure. In recent months, an outpatient operator has started performing IC on 10 transesophageal echocardiogram exams. In 70 patients the session was concluded with an anchorage, which is a moment in which the patient is allowed to reproduce the modified state of consciousness independently, to face moments of anxiety, fatigue or other procedures. In the majority of patients, the ratification of the presence of a trance state was positive, in a smaller percentage of cases (about 15%) the ratification was sometimes not evident or if it was, the patient was expelled during the procedure, but in 100% of cases the patient‘s experience was extremely positive both in terms of perceived closeness of the healthcare staff, and in terms of tolerance to the procedure and positive experience of the latter.
P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM
Authors: Palermi S , Brugin E , Compagno S , Pescatore V , Tegon G , Gerbino L , Sarto M , Marin R , Volpato R , Masato M , Panico A , Biffi A , Giada F 
Published: May 2022

Abstract

Background
Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS

Methods
39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training

Conclusions - Results
of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS
P375 RECURRENT CEREBRAL ISCHEMIC ATTACKS IN PATIENT ON DIRECT ACTING ORAL ANTICOAGULANTS FOR ATRIAL FIBRILLATION
Authors: Bresciani B , Elmi G , Romboli E , Tortorici G 
Published: May 2022

Abstract
We present the case of an 81 year old man suffering from hypertensive heart disease with dilated evolution, dyslipidemia and previous TIAs; on one occasion documentation of cardioembolic origin of the event: AF paroxysm. CHA2DS2–VASc Score = 6. In therapy with DOAC: Dabigatran 110 mg x 2. Placed in therapy with Mysoline for inconstant tremors of the limbs and doubt of absences. Three days after the start of this therapy, the patient was hospitalized for dysarthria (2 h); NIHSS: 0 and ABCD2 score: 4; Brain CT: not acute lesions; centralization to Hub stroke not indicated and DOAC dosage not performed in the PS; at the verification of the DOAC concentration at the peak, during the infra–hospital intake, values of 123 ng / ml; no changes in blood pressure at onset, unchanged CHA2DS2 Vasc Score and HAS–BLED, unchanged blood tests, verified correct intake (CP count), kept the original packaging of the drug, there were no changes in body weight and there was no associated GE pathology; however, primidone was found to be a drug able to decreasing the plasma levels of Dabigatran as an inducer of P–gp glycoprotein. Tp confirmed with Dabigatran and Mysoline replaced with Clonazepam. Subsequent new hospitalization for dysarthria (2 h); centralized in Hub stroke; NIHSS: 1 (slight deviation of the buccal rim–outcome); pressure rise upon access to the PS; peak DOAC concentration 53 ng / ml; CT angiography of the neck and intracranial vessels with evidence of significant underlying vascular lesion load already in itself a contraindication to reperfusion tp which has been excluded; no brain CT lesions; hypothesized in the acute phase switch to another DOAC that has been performed; switch to Apixaban 5 mg 1 tablet x 2 and potentiation of antihypertensive treatment. NMR program of brain in sedation for claustrophobia. Subsequent new hospitalization for septic state and profound drowsiness; severe alteration of blood tests; subacute ischemic hypodensity in the peripheral territory of the left posterior brain; exitus of the patient. Many patients with AF remain at high residual risk of stroke despite an apparent appropriate dosage of oral anticoagulant drugs. However, a multidisciplinary and integrated investigation strategy of all known risk factors does not always give an effective answer, as in the case presented, and there is a lack of information in the literature regarding management options in such circumstances.
P382 FOLLOW–UP OF PATIENTS SUBMITTED TO TRANSVENOUS LEAD EXTRACTION FOR ENDOCARDITIS OR SEPTIC SHOCK AND THEN RE–IMPLANTED WITH LEADLESS PACEMAKER: SINGLE CENTER’S EXPERIENCE
Authors: Dentico A , Ferrieri A , Epicoco G , Troccoli R , Carretta F , D‘Agostino C , Carretta D 
Published: May 2022

Abstract

Introduction
With increasing of complications associated with pacemakers and defibrillators implants, the number of patients that undergo transvenous lead extraction following an infection increased. Often in pacemaker–dependent patients there is the problem of having to make an early re–implanting after extraction. This study aims to evaluate the incidence of reinfection in patients implanted with leadless PM following extraction.

Materials and Methods
From January 2016 to December 2021, 132 extractions have been performed in our center. Of these post–extracted patients, 21 were then implanted with a leadless. Among the remaining, in 25 were re–implanted with a traditional PM, 27 with a defibrillator, 2 with a loop recorder, 3 are protected with Life Vest waiting for re–implant; 54 are patients who, after cardiological revaluation, or have not re–implanted a new device or have been redirected to the first implant’s center waiting to complete antibiotic therapy. To evaluate the technical efficiency of leadless in post–extracted patients, a comparison was made between these and the leadless PM implanted “de novo”. To demonstrate the reduction of reinfection recurrences, the post–operative of patients re–implanted with leadless has been compared to those re–implanted with traditional PM. To test the patient‘s level of approval to the new implanted device, a questionnaire was administered to the two samples.

Results
A first analysis of the follow–up of the above classes from 2016 to today shows that in patients who have implanted a leadless PM in no case a recurrence of infection has occurred; in patients who have implanted a traditional device, we have seen how some of these had already suffered a revision of pocket, an extraction or leads’ abandonment. The statistics of electrical parameters have demonstrated the effectiveness of the leadless in both classes of patients compared. Finally, the rating index questionnaire has shown greater acceptance of the new implanted device and a better patient–device relationship in patients re–implanted with leadless.

Conclusions
The implant of Leadless Pacemaker in post–extracted patients, when we have eligible patients to implant this device, has proved to be an effective choice in reducing reinfection recurrences.
P399 SVILUPPO DI SINDROME DA IMMUNODEFICIENZA ACQUISITA DOPO SOMMINISTRAZIONE DI VASCCINO ANTI–SARAS–COV2
Authors: Viele A , Trivisonno A , Pierro A , Giannotti G , Paolone P , Colavita A 
Published: May 2022

Abstract
Il SARS–CoV2 è trasmesso tra gli umani attraverso particelle respiratorie e l’infezione può determinare un largo spettro di manifestazioni cliniche. Precedenti studi hanno dimostrato il ruolo centrale dell’immunità cellulo–mediata nel limitare la gravità delle infezioni da virus respiratori. I linfociti T–helper CD4+ sono coinvolti in funzioni di coordinazione e regolazione dell’immunità anti–virale: determinano lo sviluppo di anticorpi neutralizzanti ad alta affinità e la differenziazione dei centri germinali a cellule B in cellule della memoria secernenti anticorpi con lunga vita. Nessun dubbio sul ruolo cruciale della risposta a cellule T durante l’infezione da SARS–CoV2 o dopo la vaccinazione. Descriviamo il caso di un paziente di 39 anni, vaccinato con ChAdOx1–S. Dopo due settimane il paziente accusava dispnea e febbricola. Il test molecolare per SARS–CoV2 era negativo; agli esami ematici la PCR era aumentata. La TC del torace escludeva embolia polmonare e rivelava pattern a vetro smerigliato bilaterale, come da flogisi. All‘ecocardiogramma i parametri erano nella norma. L’ECG mostrava tachicardia sinusale. Il paziente veniva dimesso dal PS con terapia cortisonica. Una settimana dopo i sintomi peggiooravano. Una nuova TC torace mostrava difetti di opacizzazione di rami secondari dell’arteria polmonare ed aspetto bilaterale a vetro smerigliato. Si iniziava terapia con EBPM ed antibiotici a largo spettro. Il test molecolare e la sierologia per SARS–CoV2 erano negativi. Negativi i test per Mycoplasma, Chlamydia, Legionella e CMV DNA. L’emocromo mostrava ridotti linfociti (6,8%) con neutrofilia relativa (90,4%), ma normale valore dei bianchi. La TC–HR mostrava aspetto “crazy paving” bilaterale suggestivo per infezione virale o micotica (pattern come da infezione da Pneumocystis Jiroveci). Il test per HIV aveva esito positivo; alla tipizzazione linfocitaria ridotti i livelli di linfociti T–Helper (CD3+/CD4+) e rapporto CD3+/CD4+ 0%. Per il rapido deterioramento del quadro clinico il paziente veniva trasferito in terapia intensiva. Dopo 30 giorni dalla diagnosi di AIDS il paziente giungeva ad exitus. Il ruolo dei linfociti T nello sviluppo di anticorpi neutralizzanti e di cellule della memoria durante l’infezione da SARS–CoV2 è la chiave nella strategia di vaccinazione per ridurre il dilagare della pandemia, tuttavia nel nostro paziente questo meccanismo non ha funzionato rivelando il deficit del suo sistema immunitario da una latente infezione da HIV.
P400 CLINICAL IMPACT OF PROPHYLACTIC ANTICOAGULANT TREATMENT WITH ENOXAPARIN IN CORONAVIRUS DISEASE 2019 (COVID–19)ELDERLY PATIENTS
Authors: Feliziani F , Pilotti R , Cappelli M , Petrelli G , Infriccioli P , Giorgini P , Parato V 
Published: May 2022

Abstract

Introduction
COVID–19 patients are at increased risk of venous thromboembolism. The WHO/ISSrecommends daily prophylactic anticoagulation therapy with low–molecular weight heparins in COVID–19 patients. Our study evaluated the efficacy of a prophylactic therapy with enoxaparin on clinical outcomes in COVID–19 patients.

Methods
This is a retrospective analysis of 125 SARS–CoV–2 patients hospitalized from 16 MARCH 2020 to MAY 7th, 2021. In this phase of COVID–19 pandemic, man and woman in–patients and out–patients received enoxaparin either at prophilattics or therapeutic dosage. Based on these criteria, we examined 85 patients who received PROPHILATTICenoxaparin (group E, Enoxaparin) and 40 subjects undergone THERAPEUTIC Enoxaparin (group T, Therapeutic). Of them, 95 patients were hospitalized after Sars–Cov2 positive swab and 30 received prophilatic dosage at home.

Results
After applying a propensity score matching for age and gender, considering hospitalized patients, there were no significant differences between the two groups (E, T). During hospitalization, a significantly higher percentage of patients of E group developed ARDS (37 vs 13, p = 0.0001) and needed for non–invasive ventilation No significative difference between the two groups was found about incidence of intubation (20 in E vs. 19 in T group; p = 0.4) and pulmonary embolism (17 vs 5, p = 0.4). In–hospital death occurred in 17 E group patients and in 10 T group patients (p = 0.251). No difference on 30–days mortality was found between two groups (p = 0.287). N. 15 patients of T group experienced emorragic events and interrupted enoxaparin therapy. N. 17 of them experienced adverse events (mailny thrombocitopenia).

Conclusions
Among patients with SARS–CoV–2 infection, a therapeutic dose of enoxaparin is not associated with prognostic benefit and did not affect in–hospital and 30–days mortality. A risk–adapted approach to reduce the dose of anticoagulation agent should be considered in selected COVID–19 patients with evidence of coagulopathy. In summary, current data suggest the use of therapeutic–dose LMWH to reduce VTE, it, may increase bleeding, and should be avoided in hospitalized patients with severe COVID–19 in critical care settings.. Lastly, randomized trials in this patient population are still ongoing and novel antithrombotic strategies in critically ill COVID–19 patients are needed.
P401 REMOTE COUNSELING ROLE DURING COVID–19 PANDEMIC IN SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME
Authors: Lordi R , Veronese S , Ferro A , Piccinini A , Piva T , Zerbini V , Raisi A , Mandini S , Grazzi G , Sassone B , Pasanisi G 
Published: May 2022

Abstract

Introduction
Patients affected by acute coronary syndrome are usually referred to center–based secondary prevention programs where they are enrolled in physical activity programs and received indications about cardiovascular risk factors control. COVID–19 pandemic induced the emanation of restrictions in people’s mobility, ban on gathering and the obligation of social distancing. This made it difficult to maintain such group meetings in presence.

Methods
After hospitalization for acute coronary syndrome in Cardiology Unit of the AUSL of Ferrara, patients equipped with electronic devices were allowed to participate to remote counseling meetings on the digital platform LifesizeC. To improve participation, meetings were organized monthly (in order to gradually include new discharged patients) and involving caregivers (if patients weren’t able to access the web app). Information on regular physical activity benefits were provided. In particular, the F.I.T.T. principle (Frequency, Intensity, Type, Time) has been explained and Borg’s exertion scale was illustrated to be used in autonomy. Furthermore, there were provided recommendations about the need of a proper warm– up/cool–down, the possibility to wear a heart rate monitor and the early recognition of symptoms and warning signs. To complete health education, there were given information about correct nutrition, risk factors control and correct assumption of pharmacological therapy.

Results
All patients showed interest in the topics analyzed, asking various questions during the meetings. They also stated that they were strongly motivated to undertake regular physical activity having received convincing explanations on its usefulness and safety.

Conclusions
Remote counseling meetings obtained a high approval rating and the moments of discussion with the speakers were particularly well attended. The prescription of physical exercise in secondary prevention can follow innovative telemonitored approaches, which could be maintained even after COVID–19.