C85 IMPACT OF QUARANTINE ON CARDIOVASCULAR RISK FACTORS

Background

Pandemic–related quarantine has led to critical lifestyle changes with possible detrimental consequences on health. The effects of lockdown on cardiovascular (CV) risk factors have been investigated to define patient–tailored strategies aimed at reducing the negative impact on CV health.

Methods

We administered a closed response survey to consecutive patients coming to our cardiac outpatient centre over a period of 10 days. Questions focused on quarantine–related lifestyle changes during March and April 2020.

Results

We enrolled 150 patients (62% male, mean age 65 years). The vast majority of subjects (73%) did not work due to retirement/unemployment, 14% worked in office and 13% worked from home. 50% had hypertension and/or diabetes and/or dyslipidemia, 33% had atrial fibrillation, 17% coronary artery disease, 6% had heart failure and 4% had a pacemaker/ICD implanted. Physical activity did not change for 44%, increased in 2%, decreased in 33% and was stopped in 21%. Dietary pattern remained the same in 73% while 22% consumed more junk food and 5% more healthy food. Body weight was not monitored in 35%, remained unchanged in 32%, increased in 28% and decreased in 5%. Among active smokers (22%), 86% reported higher cigarette consumption while 14% reduced/unchanged number of cigarettes per day. Sleep disorders were present in 73%. Regarding health needs, 16% had to reschedule medical check–ups due to personal choice or hospital unavailability.

Conclusions

Quarantine appeared to have different effects on CV risk factors. During lockdown, on–site work was limited, which may partially account for the observed lifestyle changes. Physical activity was reduced/interrupted in more than half of the population, whereas dietary pattern did not change in the vast majority of subjects, with only a small proportion reporting worse dietary habits. Body weight increased in only a minority of subjects, though this may be underestimated because most participants did not monitor their weight. Cigarette consumption was higher for the majority of active smokers. Similarly, sleep disorders were present in the vast majority of subjects. To conclude, consistent with current literature, our real–world data confirm that quarantine seems to have affected lifestyle habits defining CV risk profile differently. A patient–tailored approach should be implemented to minimise possible detrimental effects of quarantine on CV health.

C86 TAKO–TSUBO SYNDROME IN PATIENTS WITH COVID–19: A SINGLE CENTRE RETROSPECTIVE CASE SERIES

Background

COVID–19 presents with a wide range of symptoms, from mild flu–like complaints to severe acute respiratory distress and cardiovascular complications. Recent literature provides some case reports of Tako–Tsubo syndrome (TTS) in COVID–19 patients. However, its prevalence, pathophysiological mechanisms and prognostic impact in this setting is unknown.

Methods

We collected data of patients hospitalized for COVID–19 in our multidisciplinary COVID–19 department who had a diagnosis of TTS during hospitalization. The criteria for hospital admission were: 1) naso–pharyngeal polymerase chain reaction diagnosis of SARS–CoV–2 infection and 2) symptoms and signs of mild–moderate COVID–19 with a paO2/FIO2 ratio > 200. The period of the study covered the second and third wave of the pandemic in Italy.

Results

Of 635 patients admitted to our centre, we had four cases, two males and two females, with TTS associated with COVID–19. No patient had any classical trigger for TTS except for COVID–19. Mean age was 72 years (67–81) and all patients had a diagnosis of SARS–CoV–2–related interstitial pneumonia confirmed by computed tomography. One patient was admitted to our centre after stabilization of a critical respiratory distress syndrome that required intubation. All patients showed typical apical ballooning with a transitory reduction of left ventricle (LV) systolic function. The mean LV ejection fraction (LVEF) at TTS onset was 42% (40–48%). ECG showed ST–segment elevation in two cases, while an evolution with negative T waves and long QTc was observed in all patients. All patients were treated in the intensive care unit (ICU), with a median ICU stay of 9 days. The long ICU stay duration was due to intercurrent superinfections. All patients recovered a normal LVEF before discharge. The mean value of the high–sensitivity troponin T peak was 1092 ng/L. Three patients underwent coronary angiography. One patient needed vasopressors in the acute phase. Two patients had a previous diagnosis of cognitive impairment. The time interval from hospital admission to TTS onset was 4 (2–6) days, and the time interval from COVID–19 symptom onset to TTS diagnosis was 10 (8–12) days. The mean hospital stay was 32 days (26–37).

Conclusion

COVID–19 may be a trigger for TTS. Possible mechanisms to explain the contribution of COVID–19 to TTS development include the activation of the inflammatory cascade, direct myocardial injury, and stress–related conditions due to COVID–19.

P111 CLINICAL PROFILE AND CORONARY ANGIOGRAPHIC FINDINGS IN A PATIENT POPULATION WITH NORMAL STRESS ECHOCARDIOGRAPHY AND ANGINAL SYMPTOMS AND/OR ELECTROCARDIOGRAM ABNORMALITIES INDUCED BY THE STRESS TEST

The aim of this study

was to report the clinical profile of these patients and the coronary angiographic findings observed in this setting.

Methods

We analysed pharmacologic SE results of all patients who underwent this examination at our centre between 2015 and 2020. 34 (74%) patients performed pharmacological SE with dipyridamole and 11 (24%) with dobutamine. All patients with normal SE imaging and anginal symptoms and/or ECG abnormalities triggered by this examination who required further diagnostics using coronary angiography were enrolled in this study. Patient data were retrospectively collected from hospital records.

Results

1553 SEs were performed from 2015 to 2020. Forty–five patients met the inclusion criteria of our study (62% female, mean age 67 years). The majority of included patients 37 (82%) had hypertension, 22 (49%) dyslipidemia, 13 (29%) diabetes and 7 (16%) were smokers. Thirteen patients (29%) had anginal symptoms induced by SE and positive coronary angiography. Six patients (13%) had ECG abnormalities and positive coronary angiography. Only two patients (4%) had both ECG abnormalities, anginal symptoms, and positive coronary angiography. Overall, 47% of patients had positive coronary angiography, half of whom had a history of ischemic heart disease. Seventeen patients (38%) had anginal symptoms and negative CVG. Two patients (4%) had ECG abnormalities and negative CVG. Five patients (11%) had both ECG abnormalities and anginal symptoms (Table 1). Overall, 53% of patients had negative CVG.

Conclusion

In our centre, more than half of patients with normal SE imaging associated with ECG abnormalities and anginal symptoms induced by the stress test had negative coronary angiography. Hypertension was the most common risk factor in this patient population.

C10 IN–HOSPITAL MANAGEMENT AND OUTCOMES OF ELECTRICAL STORM: SINGLE CENTER RETROSPECTIVE STUDY

Background

Electrical storm (ES) is a condition characterized by the recurrence of malignant ventricular arrhythmia and is associated with significant morbidity and mortality. The aim of this study was to report the pharmacological and non–pharmacological interventions used to treat ES during hospitalization in an arrhythmia reference center.

Methods

We reviewed the medical record of patients consecutively admitted for ES in the intensive care unit of our center over a period of 6 years. Data on diagnostic tests and therapies used during hospitalization to manage these patients were retrospectively collected.

Results

Over the study period, 85 patients ((86% male, mean age 74±10 years) were admitted to the intensive care unit of our center for ES. Patient clinical, electrocardiographic, echocardiographic, and laboratory characteristics at hospitalization are reported in Table 1. Twenty–five patients had electrolytic disorders that required intravenous infusion of potassium and/or magnesium. Most patients (53%) were treated with at least one antiarrhythmic drug administered intravenously (Table 2). The most commonly used antiarrhythmic drug was amiodarone (38%). Twenty patients (24%) required more than one antiarrhythmic drug administered intravenously. Twenty–four patients (28%) underwent coronary angiography and seven patients (8%) required percutaneous coronary intervention (PCI). Twenty patients (24%) were treated with catheter ablation of the ventricular tachycardia during the index hospitalization, none of these also required PCI during the hospitalization. Six patients (7%) died during hospitalization after 9±10 days from ES onset, their mean left ventricle ejection fraction was 28% and none of them underwent ablation or PCI during the index hospitalization.

Conclusion

ES management in a reference center involves a comprehensive approach that includes multiple pharmacological and non–pharmacological interventions. Furthermore, our study confirms the severe prognosis associated with hospitalization due to ES.

High prevalence of asymptomatic hypothyroidism and hyperthyroidism in hospitalized elderly females

To investigate the prevalence of asymptomatic hypothyroidism and hyperthyroidism in hospitalized people, we performed thyroid function tests on a group of 2545 elderly patients consecutively observed in a General Hospital in Rome, during a six year period. The rate of asymptomatic hypothyroidism was as high as 0.71% in female patients and only 0.20% in male patients. In asymptomatic hyperthyroid subjects the prevalence rate was 0.58% in females and 0.20% in males. On the whole, prevalence rate of asymptomatic thyropathies resulted 0.94%, showing a clear difference in sex (women 1.29% and men 0.40%). The asymptomatic thyropathies screening of hospitalized elderly women may result in a very low cost diagnosis of many new cases of hypothyroidism and hyperthyroidism.

Does it exist also a "late" post-surgical hypoparathyroidism?

Hypoparathyroidism following neck surgery, mainly thyroidectomy, is not a rare event, well known since many years. Post-surgical hypoparathyroidism may occur in form of two clinical syndromes of different etiology and prognosis. The first disease is a transitory hypoparathyroidism that might spontaneously recover within a few weeks or months. The second disease is a permanent hypoparathyroidism needing a definitive opoterapic treatment. Anyhow in both cases, hypocalcemic symptoms begin always within a short time from surgery, usually after an asymptomatic period elapsing from days to months. Only few cases of hypoparathyroidism clinically conclamate after many years from surgery have been reported. Description of a patient with hypoparathyroidism that became clinically evident thirty years after the thyroid surgery is herewith described. Our findings and review of a few cases reported by medical literature, can suggest a third form of post-surgical hypoparathyroidism with the distinctive feature of a very late beginning, probably following a long period of a latent parathyroid insufficiency.