bluuebunny/crossref_metadata_2025_split huggingface dataset:
P212 PROGNOSTIC ROLE OF ACUTE MYOCARDIAL INFARCTION DIAGNOSTIC CRITERIA IN NON–ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Sansonetti A , Armillotta M , Amicone S , Impellizzeri A , Angeli F , Fabrizio M , Stefanizzi A , Bergamaschi L , Magnani I , Rinaldi A , Foà A , Galiè N , Pizzi C 
Published: May 2022

Abstract

Background
Although the majority of patients with NSTEMI share similar risk factors and similar pathophysiology, their outcomes differ considerably. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined acute myocardial infarction (AMI) by an acute myocardial injury together with clinical evidence of acute myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored.

Purpose
To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in NSTEMI patients.

Methods
We enrolled all consecutive patients with AMI undergoing coronary angiogram at our Centre. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high–sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST–T changes or new LBBB); development of pathological Q waves in the ECG; echocardiographic evidence of new loss of viable myocardium or new regional wall motion abnormality. Patients with STEMI and very high risk NSTEMI were excluded. A composite endpoint of all–cause mortality, re–hospitalization for heart failure, and myocardial reinfarction was collected. The predictive value of diagnostic criteria alone and their association were evaluated using Kaplan–Meier survival curves and subsequent Cox–regression analysis to find independent predictors of adverse events.

Results
2791 patients with NSTEMI were evaluate. At admission 196 had clinical criteria alone, 187 had clinic + ECG and 829 had clinic + ECG + echo. The total number of events was 689. The median follow–up was 23.3±14.5 months. We found that patients with clinical criteria alone had a better prognosis at 2 years follow–up (p &lt; 0.001). No other significant prognostic correlation was found. Multivariable Cox–regression model demonstrated that clinical criteria was the only independent predictor of better prognosis in patients with NSTEMI (HR = 0.48; CI 95% 0.31–0.74; p &lt; 0.001).

Conclusions
Our data suggest that in NSTEMI the prognosis is considerably better if clinical criteria alone is present at admission. We hypothesize that the absence of electrocardiographic and echocardiographic alterations in NSTEMI could indirectly indicate smaller infarct sizes or other causes of acute myocardial injury.
P222 BENEFITS OF IVRABRADINE IN HEART FAILURE: FROM TRIALS TO CLINICAL PRACTICE
Authors: Lamaida N , Casillo C , Micera F , Cerciello A 
Published: May 2022

Abstract

The incidence and prevalence of heart failure (HF) are constantly increasing and represent a fundamental problem for patient hospitalizations and the resulting healthcare costs. In the latest European guidelines the importance of therapeutic optimization in patients suffering from (SCC) has been emphasized to improve prognosis. This was confirmed by the results of the SHIFT trial, aimed at establishing the efficacy of Ivabradine in addition to therapy for the SC. The SHIFT study was performed in symptomatic HF patients with left ventricular systolic dysfunction. Patients were in NYHA class between II and IV and with at least one HF exacerbation hospitalization in the previous year, were randomized to receive Ivabradine at an initial dose of 5 mg twice a day. All patients were treated at the optimal dose of therapy, with ACE–I or Sartani (90%), BB (90%) and MRA (60%). The average follow–up was 24 months. Patients who received ivabradine showed a significant 20% reduction in hospitalization for heart failure exacerbation. These results were also confirmed by the improvement of the clinical picture based on the NYHA classification and the ejection fraction. Also in our clinical practice we found the same result: 6 patients of average age (70–75 years), suffering from HF with severe left ventricular systolic dysfunction (NHYA III), and arterial hypertension in standard therapy optimal for HF according to LG, reach outpatient evaluation for clinical and instrumental follow–up. On check–up, they have dilated heart disease with severe left ventricular systolic dysfunction (FE 35–38%) on the echocardiogram. Therapy with Ivabradine 5 mg x 2 / day was introduced. Upon clinical re–evaluation, after 6 months of therapy, an improvement in the functional class of SC (from NYHA III to NYHA II) and in the ejection fraction (from 38% to 45%) was noted.

Conclusions
Ivabradine, together with optimal medical therapy for HF, reduced hospitalizations for HF, increased survival and improved patient symptoms, reducing left ventricular remodeling, as confirmed by our clinical practice. Therefore, therapy with Ivabradine, in combination with Beta–Blockers or alone, constitutes a rational and synergistic therapeutic choice for improving the prognosis and quality of life in patients with SCC.
P223 THYROTOXIC DILATED CARDIOMYOPATHY
Authors: Follesa F , Cherubini S , Castelli F , De Luca L , Gioffrè L , Ciolli A 
Published: May 2022

Abstract
Hyperthyroidism can strongly impact cardiac function. Thyrotoxicosis enhances myocardiocytes metabolism and it can be responsible for hyperdynamic circulation state leading to heart failure with preserved ejection fraction, but also left ventricle dilatation and severe contractile function impairment. It can furthermore provoke arrhythmias, mostly atrial fibrillation, but, as we are going to discuss in this case, even ventricular arrhythmias. A 40–year–old woman came to our emergency department for chest pain. ECG showed reduced R waves voltage in precordial leads and troponin I values were normal. The echocardiogram showed severe left ventricle disfunction with global hypokinesia (EF 35%) and enlarged left ventricle (LVEDD 65 mm). Blood tests revealed severe hyperthyroidism with extremely low level of TSH, FT3 13,45 pg/ml, FT4 3,4 ng/ml and thyroid echography documented multiple solid nodular formations with hypo–isoechogenic signal. She underwent a coronary angiography that showed patent coronary arteries, and a cardiac magnetic resonance confirming severe contractile impairment and hypertrabeculation of the apex and lateral wall. On the assumption of a dilated cardiomyopathy secondary to hyperthyroidism, we started treatment with methimazole, ACE inhibitors and propranolol. During hospitalization, continuous ECG monitoring recorded several episodes of non–sustained ventricular tachycardia, the longest lasting 22 seconds, so the patient was discharged with a wearable cardioverter–defibrillator. It did not record any arrhythmias and it was dismissed a month later. After almost two months of therapy, the echocardiogram showed mild left ventricular contractility improvement (EF 45%), and blood tests documented partial reduction of hyperthyroidism. A 24–hour ECG Holter did not record any arrhythmias and the patient remained asymptomatic during all the period after discharge. Even if rare, scientific literature confirms that dilated cardiomyopathy with reduced ejection fraction can occur as a complication of hyperthyroidism. After the exclusion of an ischemic cause, we underline the need for adequate initiation of treatments for thyrotoxicosis and heart failure, in order to improve chance of left ventricular function recovery. In the case discussed, after two months of therapy, EF was still not completely restored but improved from 35% to 45%, and concurrently arrhythmic risk did clearly decrease.
P247 ARTERIAL STIFFNESS, SUBENDOCARDIAL PERFUSION AND 30–DAYS READMISSION IN ELDERLY INDIVIDUALS WITH HEART FAILURE
Authors: Giani A , Franconi A , Nicolussi Paolaz S , Zampieri A , Falceri A , Gasparini L , Mattachini E , Santuz B , Zamboni M , Fantin F 
Published: May 2022

Abstract
Arterial stiffness and subendocardial perfusion impairment significantly affect cardiovascular morbidity and mortality, playing a relevant role in heart failure. The aim of the present study was to describe the trend of hemodynamical parameters, arterial stiffness indexes and subendocardial viability ratio (SEVR) in geriatric patients, hospitalized with hearth failure, and to define the main predictors of 30–days readmission. A cohort of 41 patients, admitted to the Geriatric ward of Verona University Hospital, affected by heart failure, was included in the study. Each subject underwent clinical evaluation, geriatric comprehensive assessment, routine laboratory testing, and cardiac ultrasound. At the time of admission, after achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy) and at the time of discharge, blood pressure measurement and applanation arterial tonometry (with evaluation of carotid–femoral pulse wave velocity –PWVcf– and SEVR) were also performed. SEVR was corrected for hemoglobin concentration and oxygen saturation. Through the three evaluations, a progressive decrease in PWVcf was described (17.79±4.49 m/s, 13.54±4.54 m/s, 9.94±3.73 m/s respectively, p &lt; 0.001); the trend remained significant even after adjustment for age, gender, mean arterial pressure (MAP) variation and left ventricular ejection fraction (LVEF) (p &lt; 0.001). A significant improvement was registered for both SEVR (83.48±24.43, 97.94±26.84, 113.29±38.02 respectively) and corrected SEVR (12.74±4.69, 15.71±5.30, 18.55±6.66 respectively) values (p &lt; 0.001 for both), and it was still significant when adjusted for age, gender, MAP variation and LVEF (p &lt; 0.001). After discharge, 26.8% of patients was readmitted within 30 days. In a multivariate binary logistic regression analysis, considering 30–days readmission as dependent variable, PWVcf at discharge was the only predictor of readmission (OR 2.004, CI 1.154–3.481, p = 0.014) In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with hearth failure. Furthermore, PWVcf is a valid predictor of 30–days readmission. Its feasibility and reproducibility in clinical practice, may provide an instrument to detect heart failure patients at high risk of rehospitalization.
P268 MANAGEMENT OF ACUTE PULMONARY EMBOLISM IN THE EMERGENCY ROOM IN ELDERLY: DOES ADHERENCE TO INTERNATIONAL GUIDELINES INCREASE IN THE MOST SERIOUS CASES?
Authors: Savioli G , Ceresa I , Fumoso F , Lapia F , Brattoli M , Maggioni P , Mugellini A , Martignoni A , Manzoni F , Muzzi A , Novelli V , Preda L , Lava M , Bressan M 
Published: May 2022

Abstract

Premises
Pulmonary embolism is a pathology still characterized by high mortality. Some international studies have actually shown that adherence to guidelines is generally quite low in both primary and secondary care and ranges, depending on the studies, between 40 and 60%.

Purpose of the Study
see if and how, in the real life of an Emergency Department, adherence to the Guidelines varies according to the severity of the acute pulmonary embolism. We understood this severity as the presence of organ damage or massive pulmonary embolism.

Methods
Single–center retrospective observational study, on all geriatric patients (&gt;75 y) who entered our ED, where they received a diagnosis of acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We therefore analyzed adherence to the guidelines in three decisional turning points: 1 Correct application of the decision scores examined, which classify the patient at low, intermediate or high risk of PE, calculated with Wells and simplified Geneva score; 2 Correct administration of therapy starting from ED as suggested by the guidelines; 3 Any observation in the care area of medium intensity with careful monitoring for the subpopulation of patients with finding of right ventricular dilation or myocardial enzyme elevation (considered to be at high risk of shock and short–term mortality).

Results
We enrolled 248 patients, with a mean age of 83 years with female prevalence (F = 62%). Of these, 81 (32.7%) have organ damage and 86 (34.7%) have massive pulmonary embolism. Patients with organ damage received treatment with a higher adherence to the guidelines (68%) than those who did not have organ damage (51%) in a statistically significant way (p &lt; 0.01). Patients with massive pulmonary embolism received treatment with a higher adherence to the guidelines (69 %) than those with peripheral pulmonary embolism (50%) in a statistically significant way (p &lt; 0.005).

Conclusions
The study suggests that patients with organ damage or massive pulmonary embolism are more likely to receive treatment in the emergency room with greater compliance with international guidelines.
P274 GUESS WHO‘S COMING TO REANIMATION? ANALYSIS OF THE ELDERLY PATIENT WITH EMBOLISM IN NEED OF HOSPITALIZATION IN INTENSIVE CARE: REAL LIFE IN THE EMERGENCY ROOM
Authors: Savioli G , Ceresa I , Muzzi A , Manzoni F , Fumoso F , Lapia F , Brattoli M , Bressan M 
Published: May 2022

Abstract

Premise
Pulmonary embolism is a disease still characterized by high mortality and which may require hospitalization in intensive care.

Purpose
Evaluate which parameters, in the real life of an Emergency Department, correlate with the need and the duration of hospitalization in intensive care.

Methods
Single–center retrospective observational study, on all geriatric patients (&gt; 75) who refer to our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes.

Results
We enrolled 247 patients, with a mean age of 83 years and female prevalence (F = 63%). Of these 12 (14 %) required hospitalization in intensive care from the emergency room. Regarding the need for hospitalization in resuscitation, age and vital parameters (arterial pressure, respiratory rate, heart rate), as well as derived shock indices are not correlated (p &gt; 0.05). Only the systolic blood pressure values and it show a trend which however does not reach statistical significance (p = 0.06). Among the blood gas analysis parameters, only low pCO2 has a slight correlation (p &lt; 0.05). The D–Dimer (p &lt; 0.01) and creatinine values (p &lt; 0.05) show correlation between the blood chemistry tests. Regarding the length of stay in resuscitation, age and vital parameters (blood pressure, respiratory rate, heart rate), as well as derived shock indices, do not show any correlation (rho∼0; p &gt; 0.05). A weak correlation is instead present with high values of D–Dimer (rho∼0.25; p &lt; 0.005) and creatinine (rho∼0.33; p &lt; 0.0005). The presence of massive pulmonary embolism shows no correlation (p &gt; 0.5). The presence of organ damage, on the other hand, correlates in a statistically significant manner (p &lt; 0.0005). Excellent correlation is shown by the sPESI index (p &lt; 0.0001). Discrete correlation showed the alteration in pH (rho∼0.61; p &lt; 0.0001). Correlation for the blood gas analysis parameters taken into consideration (pH; pO2; pCO2; lactates).

Conclusions
The study suggests a reduced significance of vital parameters and indices derived from them for the need and duration of hospitalization in resuscitation. Presence of organ damage, low pCO2 values and high D–Dimer and creatinine values are associated with both the need for hospitalization in resuscitation and duration.
P276 BLOOD GAS ANALYSIS AND D–DIMER IN CASES OF ORGAN DAMAGE FROM PULMONARY EMBOLISM IN ELDERLY: POOR CORRELATION IN REAL LIFE IN THE EMERGENCY ROOM
Authors: Savioli G , Ceresa I , Mugellini A , Martignoni A , Fumoso F , Lapia F , Brattoli M , Preda L , Bressan M 
Published: May 2022

Abstract

Premise
Pulmonary embolism is a pathology still characterized by high mortality and severe sequelae, greater in cases of organ damage. Raising suspicion and early recognition of this condition is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process.

Purpose
Evaluate which vital parameters and shock parameters derived from them, in the real life of an Emergency Department, correlate with the presence of organ damage from pulmonary embolism to see which ones may be of help in raising the suspicion of this condition early.

Methods
Single–center retrospective observational study, on all geriatric patients (&gt;75) who were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood gas analyzes performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We went to see the correlation of vital parameters and shock indexes from these derivatives with the presence of organ damage from pulmonary embolism. We considered right ventricular dilation, pulmonary artery dilation and the presence of pulmonary infarction organ damage.

Results
We enrolled 247 patients, with a mean age of 83 years and female prevalence (F = 63%). Of these, 79 (32%) have organ damage from pulmonary embolism. The lactate values do not correlate with the presence of organ damage (p &gt; 0.05). The pCO2 values correlate inversely with the presence of organ damage reaching statistical significance (P &lt; 0.05). Instead, the reduction in pO2 values and the increase in pH values do not have any correlation with the presence of organ damage (p &gt; 0.05). The D–Dimer in turn shows a fair association with the values of organ damage from pulmonary embolism (p &lt; 0.01).

Conclusions
The study suggests a reduced significance of blood gas analysis in the early identification of patients with organ damage in the event of pulmonary embolism. A fair correlation is given only by the reduction in pCO2 values and by the increase in D–Dimer values.
P279 MORTALITY RISK DUE TO ACUTE PULMONARY EMBOLISM IN COVID–19 PATIENTS: META–ANALYSIS BASED ON ITALIAN COHORTS
Authors: Zuin M , Rigatelli G , Bilato C , Navaro M , Roncon L 
Published: May 2022

Abstract

Background
Acute pulmonary embolism (PE) has been recognized as a frequent complication of COVID–19 infection influencing the clinical course and outcomes of these patients.

Objectives
We performed a systematic review and meta–analysis to evaluate the mortality risk in COVID–19 Italian patients complicated by acute PE in the short–term period.

Methods
The study was performed in accordance with the Preferred Report Items for Systematic Reviews and Meta–analyses (PRISMA) guidelines. PubMed–MEDLINE and Scopus databases were systematically searched for articles, published in English language and enrolling Italian cohorts of COVID–19 patients from inception through October 20, 2021. Mortality risk data were pooled using the Mantel–Haenszel random effects models with odds ratio (OR) as the effect measure with 95% confidence interval (CI). Heterogeneity among studies was assessed using Higgins and Thomson I2 statistic

Results
Eight investigations enrolling 1.681 patients (mean age 64.9 years, 1.125 males) met the inclusion criteria and were considered for the analysis. A random–effect model showed that acute PE was presents in 3.1% (95% CI: 1.7 to 5.5%, I2: 80.7%) of COVID–19 Italian patients. Moreover, these subjects were at higher mortality risk compared to those without (OR: 1.76, 95% CI: 1.26–2.47, p = 0.001, I2=0%) (Figure 1), Sensitivity analysis confirmed yielded results.

Conclusions
In Italian COVID–19 patients, acute PE was present in one patient out of four and significantly associated with a higher mortality risk in the short–term period. The identification of acute PE in these patients remains critical to promptly identify vulnerable populations who would require prioritization in treatment and prevention and close monitoring.
P283 PROGRESSION OF PULMONARY ARTERIAL HYPERTENSION OR LEFT HEART DISEASE? DO EXERCISE!
Authors: Baratto C , Caravita S , Villella F , Sganzerla P , Perego G , Badano L , Parati G 
Published: May 2022

Abstract
An 80–year–old man, diagnosed with idiopathic pulmonary arterial hypertension (PAH) in 2012 and treated with sildenafil, experienced his first hospitalization for heart failure in June 2019. He had several cardiovascular risk factors (overweight, hypertension, diabetes) and comorbidities (ischemic heart disease, and mild chronic obstructive pulmonary disease), whose progression was excluded. Since this event, he complained a progressive deterioration of the exertional dyspnea (NYHA III), with overt signs of fluid overload, right chambers dilation and high NTproBNP (1366 ng/L). However, the center taking care of this patient neither decided to fully re–evaluate him nor to escalate PAH–treatment due to his clinical profile (high suspicion of left heart disease, LHD). He then came to our pulmonary hypertension (PH) center where we decided to perform a cardiac catheterization, which showed the persistence of precapillary PH with high pulmonary vascular resistance, PVR (7.6 WU), low cardiac output, CO (2.2 L/min/m2), high right atrial pressure, RAP (12 mmHg). Pulmonary artery wedge pressure (PAWP) and left ventricular end–diastolic pressure (LVEDP) were at the upper limits of normal (13 mmHg and 16 mmHg, respectively) (Figure 1). Based on these “borderline” PAWP values, with an intermediate–high pre–test probability of left heart disease, we performed an exercise test with concomitant gas–exchange analysis on a cycle ergometer in the cath lab (Figure 2). Exercise induced a steep increase in pulmonary pressure (TPR 9 WU), unrelated to an exaggerate increase in PAWP or LVEDP (whose peak values reached 20 mmHg, with a PAWP/CO slope &lt;2 mmHg/L/min), but entirely dependent on the precapillary component. Transpulmonary gradient (TPG)/CO slope was high, leading to an absent reduction in PVR (6.4 WU at peak), associated to severe increase in RAP (27 mmHg at peak, RAP/PAWP 1.4) (Figure 3). CO reserve was reduced (at peak 3.4 L/min/m2), due to both reduced increase in stroke volume and chronotropic incompetence. Accordingly, functional capacity was moderately–severely reduced (peak oxygen consumption was 8 ml/kg/min, 39% of predicted), with exercise hyperventilation. Once excluded LHD as the responsible of clinical worsening, and in consideration of the high–intermediate risk profile of this patient, we upgraded the PAH–specific therapy by adding macitentan, obtaining a subjective clinical improvement and a 3–years period of clinical stability.