bluuebunny/crossref_metadata_2025_split huggingface dataset:
P325 CARDIAC SARCOIDOSIS…TYPICAL CLINICAL PRESENTATION
Authors: Bracco A , Ginocchio G , Patrassi L , Secco E , Marinaccio L , Marchese D 
Published: May 2022

Abstract
We report the case of a 50–year–old man without previous medical hystory who was admitted to our department for recurrent syncopes for several months. Throughout the 24 hours ECG Holter it has been underlined several advanced atrioventricular block episodes, hence the patient underwent to definitive pacemaker implant. After 3 months, due to sustained ventricular tachycardia, the patient incurred a out–of–hospital cardiac arrest; the patient was subjeced to cardio pulmonary resuscitation with the restoration of the sinus rithm following defibrillation. Unfortunatly, due to the resuscitation maneuvers, sternal fracture resulted. During the hospitalization in the Cardiology department, he underwent coronary angiography wich showed non significant lesions. Cardiac Magnetic Resonance was also performed among the tests. The examination was found to be particularly hard to understand due to the presence of the sternal injury that deformed the pectus and affected dynamics of the right ventricle, causing systolic bulging of the subtricuspid region of the right ventricular wall. During the dynamic sequences, there was a mild bi–ventricular reduction in systolic function. In post contrast imaging, extended transmural LGE of the basal interventricular septum and right ventricular wall, as well as multifocal involvement of the left ventricle were found. Examination was not of univolcal interpretation: the patient was tranferred to another Center to perform MR PET wich was found to be strongy suggestive of sarcoidosis, later confirmed by extra cardiac biopsy. For this reason an ICD upgrade was performed along side the immunosoppressive therapy. Sarcoidosis is an inflammatory disease characterized by the presence of noncaseous granulomas in one or more organs or tissues; at the cardiac level it can “mimic” different cardiomyopathies as an insidious diagnosis. The presence of a post–traumatic pectus excavatum leads to dyskinesia of the rignt venticular wall, reduction of the bi–ventricular systolic funcion combine with an extensive late enhancement could suggest arrhytmogenic dysplasia with bi–ventricular involvement. However, by focusing on the clinical presentation (in particular the onset charaterized by unexplained advanced AV block in a young and healthy subjet and subsequent ventricular arrhytmias), through a multimodal and multidisciplinary imaging approach it was posible to diagnose sarcoidosis with cardiac involvement and refer the patient to adequate therapy.
P331 IMPLANT OF THE BALLOON EXPANDABLE BIOLOGICAL PROSTHESIS FOR TAVI (EDWARDS SAPIEN 3 ULTRA) PRE–ASSEMBLED ON EXPANSION BALLOON, IN “OPEN” SITUATION WITH PATIENT IN CEC
Authors: De Remigis F , Benvenuto M , Tomassoni G , Giancola R , Tamagnini G , De Rosa M , Fabiani D , Napoletano C 
Published: May 2022

Abstract
The biological valve prostheses malfunctioning often leads to severe forms of heart failure, whose treatment requires surgical or percutaneous re–intervention. We report the case of a 77–year–old man with a biological aortic prosthesis since 2009 (Elan stentless–21), hospitalized for acute cardiac decompensation related to severe aortic prosthetic insufficiency (likely infective endocarditis with periprosthesis abscess involving the perivalvular fibrous lamina) and coexistence of severe mitral insufficiency. After 25 days of therapy, in stable haemodynamic conditions, surgery was scheduled to replace the aortic prosthesis and the mitral valve, in CEC. The exposure of the aortic valve plane highlighted the rupture of the prosthetic coronary cusp in the absence of prosthetic detachment and perivalvular abscess. After removal of the degenerated cusps, the preparation and implantation of the new biological prosthesis (perimount–Magna–19) was hindered by the excessive presence of calcium–fibrosis in the suture site of the valve ring which did not allow adequate sealing, with multiple peri–prosthetics leaks; the possibility of sutureless prostheses implantation was made impossible by lack of adequate anatomical conditions. In these conditions, the possibility of implanting a biological prosthesis for TAVI, pre–mounted on the expansion balloon (Ewards–Sapien3–Ultra–23mm), in an “open” situation and in CEC, was considered. The implantation of the balloon–expandable prosthesis was performed with direct vision of the aortic annulus and coronary ostia; the insertion of the prosthesis was performed on a standard “J” guide wire positioned in the ventricle; the expansion of the prosthesis was performed in two balloon inflation steps. The intraoperative ecotransophageal echo demonstrated the correct positioning of the biological aortic prosthesis with minimal periprosthetic leak. The presence of severe residual mitral insufficiency suggested a replacement of the mitral valve with biological prosthesis. On day 4 the patient was clinically stable; the transesophageal echocardiogram showed normal functioning of the prostheses. The direct implantation of the expandable biological prosthesis in the cardiac surgery room, in “open” and CEC, after excluding active endocarditic processes and infectious complications, allowed the implantation of a larger prosthesis and to avoid significant perivalvular leaks.
P332 ACUTE HEART FAILURE IN AN ELDERLY, DIABETIC, HYPERTENSIVE PATIENT. A NEVER BANAL CASE UNDERLINES THE ROLE OF EMERGENCY ECHOCARDIOGRAPHY AND AND THE RELIABILITY OF THE ANAMNESIS COLLECTED IN URGENCY
Authors: Savioli G , Fumoso F , Lapia F , Brattoli M , Raffaele B , Martignoni A , Magrini G , Giulia F , Giulia B , Deborah H , Elena S , Di Sabatino A 
Published: May 2022

Abstract
We describe the case of a 78–year old male who acceded to high intensity medicine ward for acute heart failure after some days management in the emergency room, with acuity stabilization. In his history all atherosclerosis‘ risk factors were present (diabetes mellitus type 2, arterial hypertension, dyslipidemia and kidney chronic disease) together with no active IgGk multiple myeloma, diagnosed the month before. A previous echocardiogram demonstrated aortic valve calcifications, preserved ejection fraction and mild mitral valve failure. the emergency echocardiography service was activated and the patient received echocardiography on first day. Echocardiography revealed severe aortic insufficiency secondary to erosive endocarditis of 15 mm in diameter, increased left ventricular filling pressures, and increased estimated right ventricular pressures. empirical antibiotic therapy was immediately undertaken and were carried out blood cultures.from the emergency echocardiography service the cardiology service was activated for a trans–esophageal echocardio execution which confirmed the findings Streptococcus gallolyticus was isolated. only after performing the echocardiogram did the patient remember having had fever for a few days, more than a month before the first symptoms of heart failure. In the next days, colon adenocarcinoma‘s diagnosis was made. Notably Streptococcus gallolyticus‘s infections are frequent in immunocompromised patients and its most common clinical manifestation is infective endocarditis.This kind of infection is usually connected with colon rectum cancer, mostly in patients that have already started chemotherapy. When endocarditis regards people who don‘t make use of intravenous drugs or that haven‘t congenital or acquired valves defects, the most involved one is the aortic valve. This is especially true in elderly patients.That could be explained by aortic valve damage caused by shear stress and atherosclerotic process, that always involves aortic valve‘s endothelium. This damage manifests itselves as calcium endothelium overload and aortic valve stenosis. All of these factors transform the aortic valve into the perfect target for bacteremia.The patient underwent aortic replacement surgery, because of acute massive aortic valve failure, that impaired patient‘s hemodynamic, and proper antibiotics therapy was started, with benefit. Finally, the colon cancer was treated with surgery, no chemotherapy was needed.
P335 AORTIC VALVE INFECTIVE ENDOCARDITIS COMPLICATED BY SUPERIOR MESENTERIC ARTERY ACUTE TROMBOSIS
Authors: Viele A , Cuzzola B , Porchetta N , Paolone P , Giannotti G , Trivisonno A , Pierro A , Colavita A 
Published: May 2022

Abstract
The infective endocarditis (IE) has a significant impact on mortality rate in the first year after diagnosis, despite the improvements in early diagnosis and therapy. Embolic complications cause worsening of patient’s prognosis and they occur in the 20–50% of cases, with a risk of new embolic events after the initiation of antibiotic therapy rated between 6 and 12%. Echocardiographic characterization of vegetation has an important role in the definition of the embolization risk, it is documented that vegetation with dimension more than 10 mm are at higher risk. Several characteristic of the patient (diabetes, previous embolization, atrial fibrillation) determine the increase of the embolization risk, as well as the initiation of antibiotic therapy. We describe the case of a 64 y.o. man with chronic coronary syndrome (previous PCI) and previous Bentall–De Bono intervention for ascending aorta aneurysm. Patient was under anticoagulant therapy with DOAC due to atrial fibrillation. He was admitted to the emergency department for intermittent fever during the last three months, dyspnea and fatigue. Blood test showed neutrophilic leukocytosis and increased value of inflammatory markers. Transthoracic echography revealed an hyperechoic image on the ventricular side of the aortic prosthesis. The diagnosis of infective endocarditis was confirmed with transesophageal echocardiography, and empiric antibiotic therapy was initiated. Cardiac surgeon suggested follow up and new evaluation after three weeks of therapy. Clinical course was complicated by acute abdomen. The CT exam revealed dilation of a distal tract of superior mesenteric artery (maximum axial diameter was 10 mm) associated with distal thrombosis extended for 6 mm. The transthoracic echocardiogram showed absence of the vegetation on aortic prosthesis previous documented. Therapy with intravenous infusion of unfractionated heparin was administrated for three weeks, but the control TC showed persistence of the thrombotic occlusion of superior mesenteric artery so the case was discussed with Vascular Surgery team. They decided to treat patient with embolization and aneurysmectomy surgery (cultures were negative). This clinical case demonstrates that embolic complication of infective endocarditis, even on proper antbiotic therapy and close monitorization, are unpredictable and can cause the worsening of patient’s clinical course.
P337 SPORTS CARDIOLOGY NURSE IMPORTANCE IN YOUNG SPORTSMEN SUFFERING FROM ACUTE HEART DISEASE PREVENTION AND REHABILITATION. PILOT EXPERIENCE: REMOTE MONITORING DURING THE SARSCOV–2 PANDEMIC
Authors: Follero P , Tagliamonte G , Follero D , Vassallo M , Sibilio G 
Published: May 2022

Abstract
This is because it is difficult to understand that a “well trained” heart is not necessarily a “healthy” heart, and many malignant arrhythmias are triggered by physical activity. A project on diagnosis and prevention aimed at recognizing acute cardiac pathologies in young sportsmen has been launched using professional nursing figures, who in addition to having acquired relevant skills in the critical, interventional and clinical cardiology area, have also acquired additional skills in the field of the Biomedical and Neuromotor Sciences. The “sport cardiology nurse” can represent a relevant support for athletes’ acute cardiac pathologies prevention and rehabilitation. It takes the young patient throughout the process together with the Doctor: – Outpatient activity (recognition of ECG alterations, preparation of the patient for drug tests, Tilt test, management of complications) – Interventional cardiology activities: implantation of loop recorders and implantable defibrillators. – Rehabilitation and physical, nutritional and psychological education. With the SARS–CoV–2 pandemic, our work has undergone a drastic change. We have worked with telemedicine and activated remote monitoring for implanted cardiac devices. Our experience from January 2020 to today counts the enrolment of 80 patients undergoing ICD implantation, of which 8 subcutaneous, in young athletes. With the video visiting service it was possible to follow young patients who had been diagnosed with acute heart disease, to monitor and identify the onset of symptoms and / or arrhythmias. Remote monitoring is managed by the Sports Cardiology Nurse and the Doctor in charge. Given the results obtained, the project also aims to expand its skills in the environments most attended by young people, such as schools and sports centres in association with local companies in a not too far future. This “Sport Cardiology” aims to train more nursing professionals, to plan interventions aimed at reducing mortality and to spread the basic concepts of health education in the field of prevention.
P340 PARADOXICAL DIVERGENCE BETWEEN RATE OF SURVIVAL AND QUALITY INDICATOR OF CARE IN MYOCARDIAL INFARCTION ACCORDING TO PNE–AGENAS (ITALIAN NATIONAL HEALTHCARE OUTCOMES PROGRAM)
Authors: Casolo G , Del Meglio J , Lilli A , Canale L , Christou A , De Caro F , Bertini L 
Published: May 2022

Abstract

Background
The Italian National Healthcare Outcomes Program (PNE – AGENAS) each year provides quality performance measures for our Hospitals. Some measures refer directly to hard events such as mortality, others are focused over procedures that should be related to subsequent events, including mortality. The rate of PCI performed within 48 hours (48h–PCI) in patients with acute myocardial infarction (AMI) is currently used as a performance measures. An arbitrary standard of 35–40% of 48h–PCI for patients with AMI is considered the goal for a satisfactory practice.

Methods
We analyzed the PNE–AGENAS performance measures for the year 2020. Overall 1652 MI have been recorded in 2020 in Tuscany. We considered those Hospitals with &gt; 100 AMI. We related the 30 day and one–year mortality with the 48h–PCI of the 20 Hospitals identified. Of these latter 13 are Hospitals with a 24h PCI service.

Results
All the hospitals hosting a catheterization laboratory largely overcame the 48h–PCI quality standard although with a wide variation among sites (70,8 – 90.4%). On the contrary all the Hospitals without a cath–lab did not even approach the standard (0–33.%). The analysis of the mortality data both at 30 day and at 1 year showed a wide variability among Hospitals without an appreciable difference. The 30–day mortality rate ranged from 2 to 15% without any relationship with the 48h–PCI. In some cases better survival rates were recorded for those Hospitals with the worse 48h–PCI.

Conclusions
Several factors makes 48h–PCI a useless and even confounding measure of performance. As a matter of fact this measure does not consider the type of MI treated (STEMI vs NSTEMI), nor the presence or not of a cath lab. Also it does not take account for the case mix of the population of AMI treated. Patients with STEMI represents about 30% of the activity of an Hospital with a 24h cath –lab. It is obviously easy for such an Hospital to satisfy the proposed standard as these patients should receive their PCI well before 24 hours. The contemporary organizations do cooperate and are organized as networks. The 48h–PCI should be only used to evaluate these networks, not the single hospitals. In conclusion our analysis by showing the divergent and paradoxical phenomena of better or similar survival in spite of longer or similar 48hPCI highlights the need to abandon this useless and even confounding measure to evaluate the Cardiology practice in the Italian Hospital.
P341 DANTE (DIAGNOSTIC ACUTE PATIENT TOOL IN EMERGENCY) & BEATRICE (BEDSIDE ECHOCARDIOGRAPHIC ASSESMENT FOR IMPROVE CLINICAL EVALUATION) FOR GERIATRIC PATIENTS
Authors: Savioli G , Lapia F , Bosoni T , Alunno G , Rigano G , Coppola L , Fusco A , Lo Bello A , Brattoli M , Fumoso F , Novelli V , Muzzi A , Mugellini A , Martignoni A , Cutti S , Di Sabatino A 
Published: May 2022

Abstract

Objectives
To determine whether comprehensive quantitative bed side echocardiogram could be used as a usual assessment tool in acute geriatric patients and to assess its effect on patient care.

Design
Retrospective. Setting: DEA di II livello IRCSS Policlinico san Matteo.

Patients
Acute ill medical, trauma and surgical patients. A doctor enrolled in the discipline of emergency medicine was assigned to perform bedside echocardiograms of acute inpatients. This work took only geriatric patients into consideration. (&gt; 65aa). Interventions: The Bedside Echocardiographic AssesmenT foR Improve Clinical Evaluetion (BEATRICE), a comprehensive transthoracic echocardiogram was performed.

Measurements and Main Results
6–month period, 369 BEATRICEs were performed. The mean patient age was 76.2 (±14.3) years. 95% were hospitalized in medical departments and 5% in surgical ward. In 97.4% of cases BEATRICE was performed in a timely manner. The ejection fraction, cardiac index and the volumetric indices of the left ventricle is reported in 97% of the reports. Estimated stroke volume, longitudinal systolic function with tissue Doppler and atrium study is reported in 99.7%, 98.6% and 98.9% of BEATRICE studies. The study of diastolic and atrium function is reported in 99.3% and 98.9% of the reports respectively. Estimated left ventricular filling pressures are reported in 98.3% of the measurements. Information on the vena cava reported for 98%. Right heart function was assessed for 91.8%. Mean or systolic right ventricular pressures, or both, were also estimated in 91.9% of the reports. The BEATRICE was judged to be useful by the consulting primary care team in over 96% of cases, BEATRICEs allow the modification of therapy or the diagnostic process in over 40% of cases (in 27% of cases they allow to significantly modify the therapy and in 16% of cases they allow to significantly modify the diagnostic therapeutic procedure) and speeding up the diagnostic process in over 30% of cases.

Conclusions
The BEATRICE is feasible and alters care in the intensive care unit by providing clinical data not otherwise available at the bedside. Further studies are warranted to assess the impact of comprehensive echocardiogram–directed resuscitation on patient outcomes.
P344 LEANHEALTHCARE: CLINICAL DOCUMENTATION AS AN EFFECTIVE INSTRUMENT FOR IMPROVING CARE
Authors: Natali B , Baratta S , Vaselli M , Baroni M , Gwynne S , Nardini F 
Published: May 2022

Abstract

Introduction
Lean Thinking is configured as a management methodology aimed at creating value for the patient and at the systematic reduction of inefficiencies (waste). dictates of leanthinking can result in a new proactive approach supporting the clinic.For these aspects, the Lean approach seemed to us to be an excellent tool to tackle such a complex path as that of creating a computerized folder within the Intensive Care Cardiac surgery.

Objective
The aim of the project was to ensure that the lean tools applied to the development of a computerized medical record could give value to the patient, streamline and speed up the work of operators in terms of response times, delivery and fast consultation of diagnostic reports, ensuring speed and completeness in retrieving information, but also in sharing them among professionals. MATERIALS AND

Methods
Always with a view to continuous improvement of care, before starting with the drafting of the computerized medical record, a multisciplinary work group was set up with the use of typical project management and lean tools, ‘‘ analyzed the path, defined the critical issues and proposed solutions. In the section dedicated to the proposed Countermeasures we opted for a step–by–step IT implementation of both the clinical and health parts with adequate equipment that would implement the existing tools.

Results
The results of our work derive from the implementation of Lean Thinking. What we have been able to create is a folder model aligned with the healthcare processes and which supports the clinician‘s decisions, that is, the IT system has been adapted to the healthcare processes and not simply “computerized” the paper record.

Conclusions
At the end of this process, we realized how to analyze the paths and connections between the various operating units according to lean dictates, leading to highlighting those critical issues that slow down the process by not respecting criteria of efficiency and effectiveness. intensive care has been able to respect standards of support, planning and evaluation of care.
P346 HEALTH LITERACY ASSESSMENT AND HOSPITAL LENGTH OF STAY: A RETROSPECTIVE STUDY
Authors: Cristofori E , De Rinaldis M , Iula A , Conte M , Cocchieri A 
Published: May 2022

Abstract

Background
Cardiovascular diseases (CDs) were the leading cause of death worldwide in 2020. The risk of increasing CD is related to low Health Literacy (HL). HL can be defined as the individual’s ability to understand and process health information. Low HL has a risk ratio of 1.90 on mortality and 1.35 on readmission. A low level of HL was related to poorer use of health care services. Several inconsistencies were found about the relationship between HL and Length of stay (LOS). Although CDs are increasing because of the aging population, HL is often underestimated in the hospital setting. For this reason, HL assessment is important to identify patients at risk of poor HL. Therefore, this study aimed to describe the HL level in inpatients with CDs and to analyze the relationship between HL and LOS

Method
A retrospective design was used to randomly select 134 patients with CDs in eight cardiovascular and internal medicine units of an Italian hospital from 10 January to 10 May 2021. Clinical data were collected using a nursing information system (NIS) and the hospital discharge register. Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on NIS.

Results
The mean age of the sample was 71.28 (SD 13.19); 59% were male. HL‘s mean score was 2.43 (SD 1.2). A statistically significant linear association (Spearman’s correlation coefficient) was observed between the HL score and LOS. Patients with inadequate HL were 50.7% and had a longer LOS than patients with adequate HL (mean 9.1 ± 7.1 Vs 7.2 ± 5.9 days respectively, p = 0.05).

Conclusion
HL is poor and has been shown to be associated with LOS. These results should be confirmed after considering other variables through multivariate analyses. These findings suggest that the adverse effects of low HL may extend into the inpatient cardiovascular setting