P105 A MARBLE IN THE HEART: A MYSTERIOUS MITRAL MASS

A 70–year–old woman came to our observation for acute heart failure during atrial fibrillation with high ventricular response. In the medical history she presented a previous radiofrequency ablation of paroxysmal supraventricular tachycardia, a previous episode of atrial fibrillation treated with electrical cardioversion, two hospitalizations for transient ischemic attack (TIA), the last two months before hospitalization . The patient had always refused the introduction of oral anticoagulant therapy. The transthoracic echocardiogram showed a rounded formation, with regular margins, of 20x19 mm, isoechoic and poorly mobile, adhered to the atrial side of the annulus and the posterior mitral flap, confirmed by the transesophageal echocardiogram (Fig 1,2,3). The formation did not result in mitral obstruction or significant mitral regurgitation. The left atrium appeared markedly dilated, with moderate spontaneous echo inside. In the left appendage there was no thrombus, and there were no other relevant findings. Markers of inflammation and serial blood cultures taken during hospitalization were negative, so bacterial endocarditis appeared unlikely. Mixoma or fibroelastoma appeared to be the most likely diagnosis. In consideration of the high risk of embolization and to clarify the diagnosis, the patient underwent cardiac surgery with exeresis of the formation (Fig 4–5), subsequent quadrangular resection of the posterior mitral flap, sliding and mitral annuloplasty. Macroscopically, the mass appeared brownish–red, with a smooth surface, solid and compact consistency. The histological analysis showed red blood cells and platelets mixed with vessels and granulation tissue; the wall of the mass was made up of connective tissue. Based on the findings, the differential diagnosis was between a blood cyst or a native mitral valve thrombosis. Blood cysts are generally congenital and disappear spontaneously in childhood, rarely occurring in adults. They are fluid or semi–fluid formations, and ultrasonographically they appear as masses with anechoic or hypoechoic content, surrounded by a thin wall. Thrombosis on native mitral valve is also an infrequent event, but described in literature, particularly in the presence of hypercoagulative states, mitral stenosis, atrial fibrillation. Based on the characteristics of the mass, we believe that the most likely hypothesis is that of a rare case of thrombosis on a native mitral valve.

P352 HEALTH SURVEILLANCE FOR ENTRY INTO THE CARDIOLOGY DEPARTMENT IN TIMES OF SARS–COV2 PANDEMIC

Introduction

The SARS–Cov2 pandemic has made it necessary to implement drastic measures to contain the infection and at the same time start a regulated process of protection of health workers (OS) and hospitalized patients (PR).

Objective

To verify the effectiveness of the health surveillance measures for SARS–COoV2 infection put in place to protect the OS and PR in the Cardiology of the Gubbio–Gualdo Tadino Hospital (AUSL Umbria 1).

Material and methods

we conducted a retrospective analysis, in the period 1 April 2020– 30 November 2021, on OS and PR in our Cardiology–UTIC OU. The protocols used for health surveillance provided, in all phases of the pandemic, the well–known general prevention measures (PPE, hand hygiene, distancing, per–triage). In phase 1 of the pandemic, molecular swabs were also carried out every 14 days at the OS and only at the entrance to the PR, in phase 2 antigenic tests every 5 days at the OS and molecular swabs at the entrance and after 48 hours at the PR while in the current phase 3 an antigenic test every 10 days at the OS and PR a molecular swab at T0 and T2 and an antigenic test at the 5th day and subsequently every 5 days.

Results

A total of 320 subjects, a sample of PR (300, 15 patients month) and all OS (20) were analyzed. A total of 2658 swabs were carried out (1088 molecular and 1570 antigenic) and only two positive OS were found in phase 1 of the pandemic alone, while in phase 2 and 3 no OS or PR was positive.

Conclusions

The application of the general rules for the prevention of SARS–Cov2 infection and the definition of precise intra–hospital pathways, together with the application of a hospital health surveillance protocol, has made it possible to significantly limit infections within the OU. In addition, the rapid identification of positive OS allowed for rapid isolation avoiding the spread of infection to PR and other OS. Bibliography: COVID and gender resources. Johns Hopkins Bloomberg School of Public Health. https://coronavirus.jhu.edu/map.html ISS, National Survey on COVID–19 contagion in residential and social health structures, 30 March 2020; Guidelines for health activities in phase 1, phase 2 and phase 3 of the pandemic. Umbria Region.

Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial infarction

BACKGROUND

The prognostic impact of left ventricular (LV) geometry on cardiovascular risk for patients with a first, uncomplicated acute myocardial infarction (AMI), and echocardiographic ejection fraction > or =50% has not been well described.

METHODS AND RESULTS

Accordingly, 111 AMI consecutive patients (mean age 59.3+/-10 years) performed echocardiographic examination at predischarge. LV mass was calculated by means of Devereux's formula and subsequently indexed by body surface area. Fifty-three patients had LV hypertrophy and 58 patients had normal LV mass. The two groups were homogeneous for demographic, clinical and angiographic variables as well as for the incidence of residual ischemia on predischarge stress testing. During follow-up period there were 24 cardiac events (cardiac death, unstable angina and non-fatal reinfarction) in the 53 patients with LV hypertrophy and only four events in the remaining 58 patients without LV hypertrophy (RR=2.45; CI=1.76-3.41; P<0.0001). The patients with concentric LV hypertrophy showed a higher incidence of events (64%) than patients with eccentric LV hypertrophy (32%, P<0. 05) and patients with normal geometry and mass (6%, P<0.0001). Multivariate Cox regression model identified concentric geometry as the most powerful predictor of combined end-points (chi(2)=32.7, P<0. 0001).

CONCLUSIONS

An increased LV mass and concentric geometry resulted important independent markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction and good LV function.

Usefulness of the severity and extent of wall motion abnormalities as prognostic markers of an adverse outcome after a first myocardial infarction treated with thrombolytic therapy

The prognostic value of wall motion score index (WMSI), assessed at predischarge after a first acute myocardial infarction (AMI) in the thrombolytic era, is still not well known. One-hundred forty-four consecutive patients with a first AMI treated with thrombolytic therapy underwent exercise testing and echocardiography at rest before discharge and were followed-up for a mean period of 18 months. During follow-up, there were 32 cardiac events (12 patients had cardiac deaths, 8 had unstable angina pectoris, 1 had nonfatal reinfarction, and 11 patients had congestive heart failure). The patients who experienced any cardiac event had a higher WMSI (1.67+/-0.15 vs. 1.30+/-0.16, p<0.0001), a higher end-systolic volume (75.1+/-34 vs. 59.5+/-22 ml, p<0.01), and a lower ejection fraction (47+/-16% vs. 55+/-10%, p<0.001) at predischarge than patients without events. The incidence of a positive predischarge exercise testing did not differ between patients with and without cardiac events (22% vs. 24%, p = NS). Multivariate Cox regression analysis, including clinical, exercise results, and echocardiographic parameters, showed that the most powerful predictor of a subsequent event was a resting WMSI > or =1.50 before discharge (chi-square 17.8, p<0.0001). Thus, in patients with a first AMI who underwent thrombolysis, the severity and extent of echocardiographically detected wall motion abnormalities are important independent predictors of cardiac events.

C-reactive protein as a marker for cardiac ischemic events in the year after a first, uncomplicated myocardial infarction

The prognostic role of C-reactive protein levels in patients with a first acute myocardial infarction, an uncomplicated in-hospital course, and the absence of residual ischemia on a predischarge ergometer test and with an echocardiographic ejection fraction > or = 50% has not been described. C-reactive protein was determined during hospitalization in 64 patients (55 men, mean age 64.6 +/- 10.4 years). The patients were followed up for 13 +/- 4 months and the following cardiac events were recorded: cardiac death, new-onset angina pectoris, and recurrent myocardial infarction. Patients who developed cardiac events during the follow-up period had significantly higher C-reactive protein values than patients without events (3.61 +/- 2.83 vs 1.48 +/- 2.07 mg/dl, p <0.001). The probability of cumulative end points was: 6%, 12%, 31%, and 56% (p = 0.006; RR 3.55; confidence interval 1.56 to 8.04), respectively, in patients stratified by quartiles of C-reactive protein (< 0.45, 0.45 to 0.93, 0.93 to 2.55 and > 2.55 mg/dl). In the Cox regression model, only increased C-reactive protein levels were independently related to the incidence of subsequent cardiac events (chi-square 9.8, p = 0.001). Thus, increased C-reactive protein levels are associated with a worse outcome among patients with a first acute myocardial infarction, an uncomplicated in-hospital course without residual ischemia on the ergometer test, and with normal left ventricular function.

[Computerized stabilometry in the monitoring of antiepileptic therapy in children]

Computerized stabilometry is an useful test to monitor postural effects of anticonvulsant therapy in adults. Our study was carried out on 65 epileptic children: 51 were treated with CBZ or PHT or VPA or PB in monotherapy, and 14 were not on therapy, in the aim to observe abnormalities of postural control in pediatric population. Computerized stabilometry has to be considered auxiliary monitoring to evaluate toxic effect of anticonvulsant therapy in children.

The problem of the sensorineural component in otosclerotic hearing loss: a comparison between operated and non-operated ears

The behaviour of bone conduction audiograms in the operated and non-operated ears of 200 otosclerotic patients was analysed. The majority (84%) of both operated and unoperated ears showed virtually unchanged bone conduction thresholds throughout the follow-up period (mean follow-up period = 13.4 +/- 5.3 years). Slight but statistically significant bone conduction deterioration was observed in the remaining 16% of cases, most frequently in the non-operated ears. However, this deterioration was generally within the usually accepted limits of the Carhart effect, and does not demonstrate the presence of any causative factor other than evolution of the ostosclerotic disease. Our findings do not support the hypothesis that total stapedectomy per se may be responsible for sensorineural deterioration.

[Effectiveness of and tolerance to azithromycin versus roxithromycin in the treatment of patients with acute infections of the upper respiratory tract]

A multicenter open prospective comparative study was carried out during two years enrolling 60 patients with upper respiratory infections. Thirty were treated with single daily 500 mg doses of azithromycin for three days, and 30 received two daily doses of roxithromycin of 150 mg each for seven days. Both treatments were equally well tolerated, and there was no substantial difference concerning clinical recovery. However, azithromycin treatment was more practical and of shorter duration.