bluuebunny/crossref_metadata_2025_split huggingface dataset:
P159 AN INSIDIOUS CASE OF VENTRICULAR STRESS EXTRASYSTOLES IN A YOUNG ATHLETE
Authors: Di Naro A , Piovesana P , Carraro N , Balestriero G , Penzo M , Pagliani L , Nicolosi E , Rivaben D , Luzza G , Antonini–Canterin F 
Published: May 2022

Abstract

VEBs in young people and athletes are generally benign; however, in some cases, they can be a sign of underlying heart disease and predispose to the risk of SCD during sports.

Clinical Case
A 14–year–old boy arrives for renewal of competitive sports eligibility. He practices competitive football; always eligible according to previous checks; not familiar with heart disease or SCD; asymptomatic; with normal cardiac objectivity. Basic ECG: RS conduction and repolarisation within normal limits. ECG during exercise: 2 monomorphic VEBs, RBB type with superior axis (Fig. 3). For this reason, he performs TT Echocardiogram and ECG sec. Holter. Holter ECG: 1 SVEB 0 VEB. MB Color Doppler Echocardiogram: LV of normal size and wall thickness with a normal pump function; no alterations of the regional dynamics, undamaged valve systems, RV in the standard; suspected image due to anomaly of coronary origin (right coronary artery from the left sinus of Valsalva). Fig. 1 shows a modified PSAX. In particular, the image highlights the origin of the right coronary and left coronary from the left sinus of Valsalva. The course of the right coronary is parallel to the anterior aortic wall. The cardiac CT confirmed the anomalous origin of the right coronary from the left coronary sinus with a course between the aorta and pulmonary artery. In the proximal section, the right coronary would seem to run for about 12 mm within the adventitia of the aortic wall (Fig. 2) Hence, myocardial scintigraphy was performed on stress testing, given a possible corrective strategy.

Discussion
Anomalies involving the origin of the coronary arteries and among these, the right coronary artery originating from the left represent one of the leading causes of SCD in athletes under 35 years of age. It is a pathology challenging to diagnose. Indeed, the affected subjects, in most cases, are healthy at the sports doctor visit. Early identification is a priority in the diagnostic classification of a young athlete. In this case, the evidence of extra systolic beats on the exercise stress test and the subsequent ultrasound demonstration of the anatomical anomaly proved significant. The importance of echocardiography in recognizing coronary anomalies in young athletes, as highlighted in our report, should also suggest introducing this method as a screening test for their early identification and, consequently, the prevention of MCI.
P162 AN UNUSUAL CASE OF RIGHT VENTRICULAR DILATATION
Authors: Casolo G , Del Meglio J , Tessa C 
Published: May 2022

Abstract
We describe the case of a 58 years old man presenting to our Cardiology Clinic because of palpitations, after a complete evaluation performed elsewhere. His symptoms showed a progressive worsening althoug present since at least 15 years. No other significant information came from his clinical history. Both his physical examination and EKG did not show abnormalities. An isolated mild enlargement of the right ventricle was seen by ecocardiography. 24–hour ECG recording revealed few ventricular ectopic beats and some couplets. An ergometric stress test did not suggest an impaired coronary reserve. Cardiac MRI was performed and the report described again a mild right ventricular enlargement without any other abnormalities. Both wall motion and late enhancement were analyzed and no pathologic behavior was detected. The patient was admitted to our Clinic for a second opinion. The analysis of the patients‘ chest x–ray showed a “tongue–like” presence of pulmonary tisse between the aortic knob and the pulmonary trunk (arrow), and a less pronounced right mediastinal border (Fig 1). A careful analysis of the Cardiac MRI showed a leftward rotation of the heart, a pronounced fatty area between the heart and the anterior thoracic wall. Finally it can be appreciated the partial absence of the pericardium limited to its anterior portion. The partial absence of pericardium is a rare congenital condition often diffucult to detect. Its prevalence ranges from 0.007–0.015% in autoptic and 1–0.044% in surgical series. Usually isolated it can accompany other malformations. It may be complete or partial, and sometimes so limited in extension to determine a sort of foramen that may strangle the heart itself. While this condition is usually benign when the heart is constricted through the above mentioned pericardial orifice a sudden death may occurr. Symptoms may be absent but sometimes the absence of pericardium is associated with an atypical chest pain, often piercing, sometimes very intense. In our patient no condition at risk was detected. We excluded other potential causes for his ventricular arrhythmyas (particular attention was posed to excluding ARVC as this suspicion was the one that prompted all the exams that the patient had previously performed) . He will be followed regularly without any specific measure.
P164 VERY LONG TERM FOLLOW UP OF PRIMARY TRANSCATHETER PATENT FORAMEN OVALE CLOSURE FOR MIGRAINE CURE
Authors: Rigatelli G , Zuin M , Gianese F , Adami A , Aggio S , Roncon L 
Published: May 2022

Abstract

Background and Purpose
Results of previous trials about PFO closure as a treatment for migraine are still doubtful and inconclusive. We sought to evaluate the long–term (&gt;10 years) effectiveness of migraine treatment by means of patent foramen ovale (PFO) closure.

Method
From 2006 to 2010, 86 patients (68 female, mean age 40.0 ±3.7 years) with disabling, medication–refractory migraine and PFO were enrolled in a prospective study over a 48–month period. Criteria for transcatheter closure were all the following: presence of a permanent right–to–left shunt (RLS) having a shower/curtain pattern, presence of interatrial septal aneurysm and Eustachian valve, 3 to 4 class Migraine Disability Assessment Score (MIDAS), coagulation abnormalities, and medication–refractory migraine with or without aura.

Results
Forty patients (46.5%) (34 females, mean age 35.0±6.7 years, mean MIDAS 35.8 ± 4.7) underwent transcatheter closure. After a mean follow–up of 118.2 ±19.1 months (range 96 to 144), 37 patients continued the follow–up and experienced symptomatic improvement: aura was abolished in the totality of patients along with a durable improvement of migraine throughout the extended follow up also in patients without aura. The mean MIDAS significantly decreased in the closure group (p &lt; 0.0001). Patients with complete migraine resolution presented a shorter history of migraine, a more severe thrombophilic profile, more severe RLS and larger left atrial diameter and volume.

Conclusions
Primary transcatheter PFO closure in selected high–risk patients having disabling refractory migraine resulted in abolition of aura and in a sustained reduction in migraine in the very long–term period.
P166 “LONG QT SYNDROME:AN ENTIRE FAMILY WITH KCNQ1 MUTATION”
Authors: Di Domenico A , De Carolis B , De Raffele M , Vitali F , Balla C 
Published: May 2022

Abstract

Introduction
Congenital long QT syndrome (LQTS) is characterized by prolongation of the QT interval that can trigger life–threatening arrhythmias leading to syncope and sudden death. Mutations in genes encoding for ion channels have been identified in 75% of LQTS cases. Long QT syndrome type 1 (LQTS1) is one of three subtypes of LQTS identified based on genetic substrate. LQTS1 is linked to a “loss–of–function” mutation in the gene encoding the potassium channel KCNQ1, and arrhythmias tend to occur during childhood with prevalence in the male sex. Adrenergic triggers are the most important trigger for arrhythmic events.

Clinical Case
Extensive family with long QT syndrome with positive genetics for mutation in the KCNQ1 gene. The index case in the family appears to be a woman who at the age of approximately 30 years died suddenly after surgery. The first patient subjected to genetic analysis, with positive result, was the daughter of this woman who, at the age of about 25 years has experienced a ventricular arrhythmia during induction of anesthesia for surgery with baseline ECG finding of prolonged QTc. Set beta–blocker therapy, arrhythmias no longer occurred. Subsequently, a cardiological screening including electrocardiogram, transthoracic echocardiography and genetic analysis was undertaken in first–degree relatives and, in cases of positivity, this screening was progressively extended to second–, third– and fourth–degree relatives. All the women in the family analyzed, eight in total, including two girls aged 5 and 12 years, tested positive for genetic analysis, and one of the women had a syncopal episode at the age of 50 years. Of the men analyzed, four in total, only two (father and son) tested positive on genetic analysis. In all patients with positive genetics a QTc &gt;480 msec was detected on ECG in clinostatism and/or orthostatism, for which a diagnosis of LQTS1 (mean Schwartz–score 4) was made and beta–blocker therapy was started.

Conclusions
This clinical case describes an entire family with LQTS with positive genetics for KCNQ1 with phenotypic manifestations different from those described in the literature, in particular with prevalence in the female sex and with onset of arrhythmias in adulthood.
P178 TYPE–A AORTIC DISSECTION IN MARFANOID HABITUS
Authors: Manca F , Cocco D , Pistis L , Serra E , Cirio E , Corda M , Pilleri A 
Published: May 2022

Abstract
Aortic dissection (AD) is the tearing of the tunica intima of the aortic wall with creation of a false lumen. Type–A AD, in which the intimal flaps originates in the aortic tract proximal to the left subclavian artery, is a surgical emergency because – if left untreated – it has mortality rates as high as 1–2% every hour, from the onset of symptoms. Certain collagenopathies, such as Marfan Syndrome, are a predisposing condition for AD. We describe the case of a 25–year–old man with Marfanoid habitus who came to the Emergency Room of our facility, with acute pulmonary oedema. He had been complaining about thoraco–abdominal pain, bloody mucus and worsening dyspnoea since the week before. Upon cardiology consultation, a transthoracic echocardiogram showed an aneurysm of the aortic root (70 mm) and the ascending aorta (90 mm), with dissection flap extended beneath the aortic valvular plane, with torrential aortic valve insufficiency and eccentric jet, a left ventricle severely dilated and a severe systolic dysfunction (EF 25%). On urgent CT angiography the dissection flap was observed to extend cranially to the right common carotid artery and caudally to the renal arteries. The patient then underwent cardiac surgery to replace the aortic valve with a mechanical prosthesis and the ascending aorta as per the Bentall procedure and to replace the aortic arch with reimplantation and debranching of the supra–aortic trunks. Four months after discharge, the patient presented again due to sustained ventricular tachycardia (SVT) which was interrupted by electric cardioversion. On this occasion, an ICD implant was indicated as a secondary prevention measure. After one month, recurrence of SVT was observed, which was successfully treated by the implanted ICD, and therefore indication was given for an electrophysiologic study and subsequent transcatheter radiofrequency ablation of the ventricular arrhythmia. The case presented is of particular interest as it highlights the crucial role of a rapid echocardiographic assessment focussed on making a diagnosis and directing treatment, despite a misleading clinical picture due to duration and atypicality of symptoms. It should also be stressed that an overall assessment of the patient, based on habitus and age, plays a major role in establishing a suspected diagnosis and guiding the patient towards the most appropriate treatment.
P196 CHANGE IN THE DAILY HOSPITALIZATION RATE FOR ACUTE MYOCARDIAL INFARCTION IN THE VENETO REGION FROM 2006 TO 2018
Authors: Zuin M , Picariello C , Anselmi M , Roncon L , Bilato C 
Published: May 2022

Abstract

Background
Acute myocardial infarction (AMI) continues to represent the leading cause of cardiovascular mortality in Italy, with important prognostic and health consequences both in the short and long term. The aim of the study is to evaluate the long–term variation in the daily hospitalization rate for AMI in the Veneto region.

Materials and Methods
Data regarding the total number of hospitalizations due to AMIbetween 2006 and 2018 were extracted from the periodic epidemiological reports of the Veneto region which can be consulted on the website www.ser–veneto.it and then re–elaborated and analyze. In particular, changes in daily hospitalization rates for AMI were calculated, then sub–classified into AMI with ST–segment elevation myocardial infacrction (STEMI) and without (NSTEMI). The trend of change in daily hospitalization rates was assessed with the Jonckheere–Terpstra test, using the SPSS statistical software version 19.0 (SPSS; SPSS Inc., USA).

Results
During the study period, in the Veneto region 87,490 hospitalizations for AMI [48,165 (55.0%) STEMI and 32,325 (45.0%) NSTEMI], of which 75.7% were managed in Cardiology / ICU wards were registered. The overall average daily hospitalization rate for AMI over the entire period was 18.3 ± 0.6 admissions / day [range 17.5 / 19.8] with a decrease of 11.4% / year (p = 0.009). Among these, patients admitted for STEMI were hospiutalized for 10.1 ± 1.2 / day [range 8.6–12.4]; however their daily hospitalization rate decreased by 32.4% / year (p &lt; 0.001). Conversely, 8.2 ± 0.8 patients with NSTEMI / day were hospitalized in the observation period [range 7–8.9]. showing a growing hospitalization trend in the period considered (+ 20.9% / year, p &lt; 0.001) (Figure 1).

Conclusions
The daily hospitalization rate for AMI in the Veneto region has overall decreased in recent years, however, there has been a significant increase in daily hospitalizations for NSTEMI. The high number of daily hospitalizations requires close synergy between the cardiology departments of the region in order to ensure adequate care for patients with acute cardiac events in the area.
P201 PURSUING COMPLETENESS OF CORONARY REVASCULARIZATION IN ACUTE SETTING: TIMING AND STRATEGIES
Authors: Fazzini L , Ricci S , Angius S , Cadeddu M 
Published: May 2022

Abstract

Patient Presentation
A 59 y/o male with history of arterial hypertension and allergic asthma was admitted to our Coronary Care Unit because he went to a spoke emergency department after complaining oppressive and not continuous chest pain for a couple of hours travelling up to the left arm. Increase in cardiac troponin and mild ST–elevation in D3 lead were found. At the spoke cardiology department was treated with intravenous nitrates with relief and Ticagrelor loading dose was administered. He underwent two coronary angiographies, the first one aimed to treat the culprit lesion and the second one to complete revascularization before discharge Management: A heart ultrasound (US) described normal left ventricle ejection fraction (LVEF) with some of the right coronary segments akinesis. The first coronary angiography showed eccentric stenosis (80%) of distal right coronary artery (RCA) with endoluminal thrombosis; intraluminal filling defect of the left main coronary artery (LMCA) which request Optical Coherence Tomography evaluation that showed plaque rupture and red thrombus of LMCA; chronic total occlusion of left anterior descending artery (LAD) with several stenosis up to the apical segments. Glycoprotein IIb/IIIa receptor antagonist infusion was started, and we’ve been forced to treat first the LMCA with drug–eluting stent and then the culprit lesion with angioplasty and two drug–eluting stents complicated by intrastent thrombosis treated with mechanic and rheolytic thrombectomy. Seven days later rotational atherectomy was performed due to LAD artery’s severe calcifications complicated by LMCA intrastent thrombosis caused by stenting crush; cardiopulmonary arrest occurred. Impella ventricular assist device was placed. After LMCA stent optimization, one more drug–eluting stent was placed. Eight days later, heart US described LVEF 37% with apex and right coronary segments hypo–akinesis.

Discussion
According to latest NSTEMI guidelines, a single stage pursuing of completeness revascularization on multiple vessel disease would have been the best option. In this case, completeness of revascularization hasn’t been achievable due to LMCA plaque rupture. From a technical point of view, considering the complexity of the few days earlier treated LMCA lesion, proximal to LAD lesions we were going to treat, it would have been suitable waiting about four weeks to complete stent endothelization. By the way, it would have been out–guidelines approach.
P244 BRISK WALKING CAN BE A MAXIMAL EFFORT IN HEART FAILURE PATIENTS. A COMPARISON OF CARDIOPULMONARY EXERCISE AND SIX–MINUTE WALKING TEST CARDIORESPIRATORY DATA
Authors: Mapelli M , Salvioni E , Paneroni M , Gugliandolo P , Bonomi A , Scalvini S , Raimondo R , Sciomer S , Mattavelli I , La Rovere M , Agostoni P 
Published: May 2022

Abstract

Aims
Cardiopulmonary exercise test (CPET) and six–minute walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self–selected constant load test usually considered a submaximal, and therefore safer, exercise but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.

Methods and Results
Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath–by–breath measurement of cardiorespiratory parameters. HF Patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One–hundred and fifty–five subjects were enrolled, of whom 40 were healthy (59±8 years; male 67%) and 115 were HF patients (69±10 years; male 80%; left ventricular ejection fraction 34.6±12.0%). CPET peakV̇O2 was 13.5±3.5 ml/kg/min in HF patients and 28.1±7.4 ml/kg/min in healthy (p &lt; 0.001). 6MWT–V̇O2 was 98±20% of the CPET peakV̇O2 values in HF patients, while 72±20% in healthy subjects (p &lt; 0.001). 6MWT–V̇O2 was &gt;110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2&lt;12ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as absolute value, progressively increased as exercise limitation did.

Conclusions
6MWT must be perceived as a maximal or even supra–maximal exercise activity at least in patients with severe exercise limitation from HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
P245 A RARE CAUSE OF OVERESTIMATION OF PULMONARY PRESSURE BY ECHOCARDIOGRAPHY: WHEN HEMODYNAMICS RELIEVES ECHOCARDIOGRAPHY AND ECHOCARDIOGRAPHY EXPLAINS HEMODYNAMICS
Authors: Caravita S , Baratto C , Curti E , Villella F , Sganzerla P , Perego G , Badano L , Muraru D , Parati G 
Published: May 2022

Abstract
Echocardiography is the gatekeeper of the diagnostic workflow of pulmonary hypertension (PH). However, it lacks precision, and right heart catheterization (RHC) may be needed in selected cases. A morbidly obese 47–year–old woman (BMI= 58 Kg/m2) with dyspnea NYHA II was referred to our Center after a high probability of PH was found at echocardiography, this latter performed as a routine assessment before bariatric surgery. Despite a suboptimal acoustic window, the tricuspid regurgitant jet profile was well–defined, with an estimated systolic pulmonary artery pressure (PAP) of 100 mmHg. There were no overt echocardiographic signs of left heart disease. During RHC, mean PAP was just above normal values, with filling pressures at the upper limit of normal (Figure 1), high cardiac index (3.6 L/min/m2) and normal pulmonary vascular resistance (1.4 WU). The echocardiographic estimate of high systolic PAP was explained by an intraventricular RV pressure gradient of about 100 mmHg (Figure 2). Oximetry ruled out a significant intracardiac shunt. Since resting hemodynamics did not explain the patient’s symptoms, the patient pre–test probability of having heart failure with preserved ejection fraction (HFpEF) was intermediate–high, and PAWP was in a grey–zone. Accordingly, we performed an exercise RHC. The test eventually unmasked HFpEF, as witnessed by an abnormal increase of PAWP and LV end–diastolic pressure (Figure 1 panel C and D). Exercise capacity was mildly reduced (71% of predicted) due to peripheral limitation with normal cardiac and respiratory reserves. Transesophageal echocardiography was then performed. It showed a muscular obstruction below the infundibulum dividing the RV into a high–pressure apical portion and a low–pressure infundibulum (Figure 3). This rare congenital anomaly was also associated with a restrictive perimembranous ventricular septal defect. Double–chambered RV has been reported to present rarely in adults, but it might be a cause of false Doppler echocardiographic estimate of PAP. Based on a meticulous invasive hemodynamic characterization at rest and during exercise, integrated with cardiovascular imaging, we could perform such a diagnosis. This congenital anomaly did not fully explain the patient’s symptoms, which may better be attributed to cardiovascular complication of obesity (HFpEF). Accordingly, we referred the patient for bariatric surgery first, postponing the indication to cardiac surgery during the follow–up.