Search Results for: Linee guida per la gestione del carcinoma basocellulare

Circulation, Volume 150, Issue Suppl_1, Page A4142376-A4142376, November 12, 2024. Limited data indicate an elevated risk of atrial fibrillation (AF) after neoadjuvant chemoradiation in esophageal cancer however the role of AF as an independent predictor of outcomes post-esophagectomy remains under-studied. We sought to the impact of AF on overall outcomes of patients undergoing neoadjuvant chemoradiation and esophagectomy, with or without adjuvant nivolumab.The global TriNetX database was used to identify patients (based on ICD-10 codes) with esophageal squamous cell carcinoma or adenocarcinoma who received neoadjuvant chemoradiation with carboplatin and paclitaxel and subsequently underwent esophagectomy between 2009 and 2024. Patients who received adjuvant nivolumab were analyzed separately. Patients who developed AF were compared with patients who did not using propensity score matching (PSM) based on age, race, BMI, and multiple comorbidities. Outcomes over a 5-year period were mortality, ischemic stroke, and use of anticoagulation. Odds ratios with 95% confidence intervals were generated with generalized linear mixed modeling and a p value of

Circulation, Volume 150, Issue Suppl_1, Page A4144604-A4144604, November 12, 2024. Introduction:Breast cancer and cardiovascular disease are significant global health concerns for women. Our study is a significant advancement in understanding cardiomyopathy risks associated with breast cancer in the U.S. population. Unlike previous studies focusing mainly on treatment-related cardiomyopathy, our research identifies risks across various cardiomyopathy subtypes in breast cancer patients. This novel approach reveals the intricate relationship between different cardiomyopathies and breast cancer, filling a crucial gap in existing medical research. Moreover, by considering racial disparities, our study offers vital insights into the differential health impacts on diverse demographic groups, enhancing our knowledge of the interplay between these medical fields.Methodology:The research was conducted as a retrospective cohort analysis using data from the National Inpatient Sample (NIS) spanning 2016 to 2019. It targeted female patients over 18 with a diagnosis of breast cancer, carcinoma in situ, or a personal history of breast cancer. Case identification relied on ICD-10 codes. A pivotal aspect of the methodology was implementing propensity score matching to ensure balanced comparison groups, considering variables like age, race, hypertension, and diabetes. Statistical analysis involved logistic regression, Chi-Square tests, and T-tests, executed using 9.4 SAS software.Results:The study compared 589,940 breast cancer patients with an equal number of controls, matched demographically. Comorbidity prevalence was similar in both groups, with slight variations in myocardial infarction and heart failure history. Breast cancer patients exhibited a higher prevalence of cardiomyopathy (4.0% vs. 3.2%), with an increased adjusted odds ratio (OR) especially for dilated, restrictive, and drug-related cardiomyopathies. Interestingly, they had lower odds of obstructive and hypertrophic cardiomyopathy. Racial disparities were evident, with Black patients facing higher risks for most cardiomyopathies, while Hispanic and Asian or Pacific Islander patients showed varied risks. Similar patterns were observed in the control group.Conclusion:The findings highlight a significant link between breast cancer and an elevated risk of cardiomyopathy, advocating for the integration of cardiovascular monitoring into breast cancer management.

Circulation, Volume 150, Issue Suppl_1, Page A4144779-A4144779, November 12, 2024. Case Presentation:A 76-year-old male, non-smoker, with history of HLD and NIDDM, presented with several weeks of dyspnea and cough, unresponsive to outpatient treatments. He was normotensive and found to have new onset atrial fibrillation at a rate of 110bpm and pulsus paradoxus with a difference of 15mmHg. CT chest showed a 2.2cm thyroid nodule along with a pericardial effusion (PE), confirmed to be tamponade on TTE (Fig.1). A TTE showed resolution of tamponade after the pericardial window (Fig.2). Pericardial fluid cytology was positive for malignant cells. Patient was discharged, had an outpatient PET CT which showed uptake in the thyroid, pericardial region&right supraclavicular lymph node (LN). The patient developed symptoms of heart failure, prompting his 2nd visit to the hospital after 3 weeks. A repeat TTE showed a small PE with effusive-constrictive physiology (Fig.3). He was started on high dose steroids and diuresed as tolerated, but his symptoms did not improve. He underwent thyroid nodule and right supraclavicular LN biopsy, which revealed high grade follicular thyroid carcinoma (FTC). His course was complicated by multiorgan failure, prompting transfer to another facility for pericardiectomy; during which he was found to have extensive tumor infiltration into the myocardium; he then went into shock and passed away shortly after.Discussion:Effusive-constrictive pericarditis (ECP) is a rare clinical condition characterized by PE with constrictive physiology1. Hancock defined ECP as a pathophysiological form of cardiac compression due to a constricted visceral pericardium and PE, with the hallmark sign of persistently elevated right atrial pressure despite removal of pericardial fluid2. ECP can rarely be caused by malignancies, attributing 5% of cases2. FTC is a well-differentiated thyroid malignancy that typically metastasizes to distant sites such as the lungs and bones, but pericardial involvement is extremely rare. To date, there has been one reported case of PE caused by FTC, but the PE did not reaccumulate, possibly due to early recognition and radiation therapy3. To our best knowledge, this case report represents the first documented case of ECP caused by FTC. Our case demonstrates the complexity of diagnosing/managing it, which underscores the need for a multidisciplinary approach and comprehensive diagnostic evaluation in patients with PE, especially when associated with malignancies that rarely metastasize to the pericardium.

Circulation, Volume 150, Issue Suppl_1, Page A4143305-A4143305, November 12, 2024. Introduction/Background:Improved survival following Fontan surgery has been tempered by Fontan failure. Heterogenous multi-organ complications varying over time have limited study of Fontan failure. We sought to identify complications associated with hospitalization.Methods/Approach:A retrospective cohort of 735 pediatric and adult Fontan patients were identified from two healthcare systems (median age 7yrs, IQR 14, 57.4% male, 41.0% black). The deduplicated cohort was linked to 2010-2019 encounters from both healthcare systems (one pediatric, one adult) and to death certificates to capture vital status. ICD-9-CM and ICD-10-CM codes were mapped by clinicians to capture variables of interest. Bivariate analyses were conducted to examine select covariates by the composite outcome which includes heart transplant, hepatocellular carcinoma (HCC) and death during the surveillance period; group differences were examined using chi-square, Fisher exact and independent t-tests. Negative binomial regression evaluated the association between select characteristics and hospitalization rates with adjustment.Results/Data:Of 735 Fontan patients,11.6% experienced the primary outcomes (median age 14yrs, IQR 17). Characteristics significantly associated with the composite outcome included older age, dysrhythmia, liver disease, cyanosis and heart failure (Table 1). Modeling showed increased rates of hospitalization for children with dysrhythmia (RR=1.43, 95%CI 1.13-1.80) and cyanosis (RR=2.32, 95%CI 1.78-3.03) adjusting for potential confounders (Table 2). This association remained for adults, however, after adjustment, the association of cyanosis and hospitalization rate was attenuated.Conclusion:Fontan patients with dysrhythmia, liver disease, cyanosis and heart failure are at an increased risk for heart transplant, HCC, and death, and have higher hospitalization rates. Incorporation of these factors into the definition of Fontan failure may help early identification and intervention.

Circulation, Volume 150, Issue Suppl_1, Page A4146814-A4146814, November 12, 2024. Background:The Fontan operation has been an effective treatment plan for patients with single ventricle anomalies, greatly improving survival into adulthood. Yet, Fontan patients are at increased risk of numerous cardiac and noncardiac complications, and premature mortality.Methods:A cohort of 735 patients with a prior Fontan surgery (median age 7.6yrs at first encounter, 57.4% male, 41.0% Black), with at least one healthcare encounter from a pediatric or adult healthcare system between 2010-2019, was linked to encounter data and death certificates. Heart failure (HF) was defined by ICD-9-CM and ICD-10-CM codes determined by clinicians. The primary composite outcome included heart transplant, hepatocellular carcinoma (HCC) and death. Hospitalizations were defined as an inpatient encounter spanning at least two consecutive days. Time to event was anchored at initial encounter.Results:Characteristics of those with and without HF are seen in Table 1. Median age was 17.1yrs [3.0-70.5] and 5.5yrs [3.0-56.0] for those with and without HF, respectively. The composite outcome occurred in 85 Fontan patients (11.6%) at median 3.26yrs after initial encounter. Of those with HF, 12.5% experienced a heart transplant compared to 0.9% without HF (p

Circulation, Volume 150, Issue Suppl_1, Page A4136539-A4136539, November 12, 2024. Superior vena cava (SVC) syndrome occurs when there is SVC occlusion or obstruction. SVC obstruction can cause an increase in venous return pressure up to 40 mm Hg, producing edema of the face, neck and chest wall. Blood flow can be diverted to the right atrium through collateral venous networks in cases of gradual SVC compression. The most common cause of SVC syndrome is malignancy, as seen in 70% of cases. Traditionally, treatment is with radiation therapy but advances have now allowed for an endovascular approach. We present a case of malignant SVC syndrome with a complex percutaneous treatment approach that provided palliation with near immediate symptom improvement.A 64 year-old-female with history of cerebrovascular accident on Eliquis, right upper lobe squamous cell carcinoma of the lung in remission, and a mediastinal nodule under surveillance presented with facial and bilateral upper extremity edema. CT revealed bilateral pulmonary embolism and a large SVC thrombus causing impaired venous return. Invasive angiogram confirmed a 95% thrombotic tubular stenosis for which she underwent aspiration thrombectomy with alpha VAC F-18, then angioplasty with an Armada (Abbott) 10 x 40 mm compliant balloon and stenting with the Express (Boston Scientific) 10 x 37 mm stent. There was 0% residual stenosis and immediate clinical improvement. Oncological workup confirmed the right mediastinal mass to be a recurrence of squamous cell carcinoma.SVC syndrome occurred due to mediastinal mass compression and a near occlusive SVC thrombus. Aspiration thrombectomy was effective in treating the SVC thrombosis and was performed alongside pulmonary embolism thrombectomy. The Armada balloon is intended for lesion dilation in the peripheral arteries, but was safely used here for venous dilation. The Express stent is intended for palliation of malignant biliary neoplasms but has versatility and was utilized here for malignant neoplasm surrounding the SVC. Peripheral endovascular stenting is an advantageous treatment option for malignant SVC syndrome given the challenges due to recurrence from mass effect. This provides additional support to maintain vessel patency and is a safe palliation option for improvement in quality of life.

Circulation, Volume 150, Issue Suppl_1, Page A4131838-A4131838, November 12, 2024. A 66-year-old male presented with 5 months of worsening left flank and lower back pain. Three weeks prior to this presentation, he was seen at an outside facility where he was found to have a left renal mass that was not further worked up. CT Abdomen and Pelvis showed an enhancing heterogenous lesion at the left superior renal pole, left adrenal gland lesion, and a pulmonary artery filling defect. This defect, along with concern for metastasis, led to a CT chest angiogram that reported small left upper and lower lobe pulmonary emboli. A transthoracic echocardiogram (TTE) was ordered and showed a linear highly mobile mass in the right atrium that was intermittently protruding into the right ventricle and into the main pulmonary artery through the pulmonic valve. There was no visible evidence of tumor extension of the renal mass into the inferior vena cava. Based on this, the highest differential was a clot-in-transit. After collaboration with the pulmonary embolism response team and echo team, the patient underwent aspiration thrombectomy via AngioVac system with transesophageal echocardiography (TEE) guidance. Most of the mass was removed, but there was a residual small portion adherent to the superior vena cava that was not amenable to aspiration. Grossly, the removed mass did not have the classic appearance of thrombus. The specimen was sent to pathology and returned as poorly differentiated carcinoma with spindle cell pattern positive for PAX8, CK7, CD10, pancytokeratin, and vimentin concerning for renal cell carcinoma. Post procedural transthoracic echo found to have new basal septal globular mass with vascularity seen on echo contrast imaging concerning for vascular involvement consistent with myocardial metastatic invasion. Cardiac magnetic resonance imaging could have aided in more precise tissue characterization to differentiate between clot or tumor prior to aspiration thrombectomy. This case demonstrates the significance of a detailed history and physical exam, use of multimodality imaging, and multidisciplinary collaboration to manage a rare cardiac condition.

Circulation, Volume 150, Issue Suppl_1, Page A4143915-A4143915, November 12, 2024. Case description:A 68-year-old man with history of prostate cancer, anal and scrotal squamous cell carcinoma presented to the cardiology clinic with dyspnea on exertion with exercise tolerance limited to 2 flights of stairs. Physical examination showed grade 3/6 holosystolic murmur best heard at the left lower sternal edge. A transthoracic echocardiograph (TTE) revealed an ejection fraction of 65%, prominent muscle bound right ventricular outflow tract obstruction (RVOT) consistent with double chambered right ventricle (DCRV), and a Windsock deformity of the membranous interventricular septum through which there was a VSD with left to right shunting. The maximal pressure gradient across the VSD was approximately 116mmHg. The pulmonary artery systolic pressure was 61mmHg; consistent with severe pulmonary artery hypertension.Discussion:DCRV is a rare condition accounting for 0.5 to 2% of congenital heart diseases. It is characterized by abnormal muscle bands that divide the right ventricle into two chambers; a proximal high-pressure and distal low-pressure chamber, leading to progressive right ventricular outflow tract obstruction (RVOT). This condition rarely occurs in isolation and is often ventricular septal defect (VSD), which is seen in up to 90% of DCRV cases. DCRV may go undiagnosed until adulthood. As the degree of RVOT increases, patients present with shortness of breath and decreased exercise tolerance. TTE is an invaluable tool for diagnosing and determining the severity of obstruction through pulsed and continuous wave doppler to measure the gradient across the hypertrophied muscle bundles. Current guidelines recommend surgery in asymptomatic patients with severe right ventricular obstruction with a pressure gradient greater than 40 mmHg between the proximal and distal compartments within the right ventricle. Even though our patient was mildly symptomatic, his significant pressure gradient of 116 mmHg warrants surgical evaluation.Conclusion:DCRV is a rare and often overlooked congenital heart disease. The patient, despite mild symptoms, exhibited classic features of DCRV and associated VSD, highlighting the potential for this condition to persist undiagnosed into late adulthood. The presence of severe pulmonary hypertension further emphasizes the importance of early detection and ongoing management to prevent severe complications such as heart failure and sudden cardiac death.

Circulation, Volume 150, Issue Suppl_1, Page A4146993-A4146993, November 12, 2024. Introduction:Anthracyclines (AC), a class of chemotherapeutic drugs, are used to treat various cancers, including breast cancer (BC). However, AC cause dose-dependent cardiac toxicity. Practice guidelines list pre-existing cardiomyopathy as a risk factor for cancer therapy-related cardiac dysfunction (CTRCD), but there is a lack of data on cardiotoxicity risk in patients with left ventricular (LV) hypertrabeculation without LV hypertrophy/dilation. We present a patient with LV hypertrabeculation who developed LV dysfunction after AC chemotherapy for BC.Description of Case:A 55-year-old woman diagnosed with multicentric invasive ductal carcinoma (IDC) of the right breast, stage IIA (cT3 cN1 cM0), grade 2, ER+/PR+/HER2-, was treated with neoadjuvant Paclitaxel for 3 months. Before AC-based chemotherapy, stress cardiac MRI due to residual post-COVID-19 dyspnea showed LV hypertrabeculation with a non-compacted/compacted ratio of 2.3, LVEF 56%, and no delayed enhancement. Transthoracic echocardiography (TTE) reported an LVEF of 52% with GLS of -17%. The patient’s electrocardiogram (ECG) showed normal sinus rhythm, and NT-pro BNP levels were

Circulation, Volume 150, Issue Suppl_1, Page A4142532-A4142532, November 12, 2024. Introduction:Vasovagal syncope occurs when an overwhelming parasympathetic tone is triggered by causes including emotion, pain, or baroreceptor stimulation. We present a rare case of vasovagal syncope mediated by locally invasive tonsillar squamous cell carcinoma (SCC).Case:A 66 year old man with untreated L tonsillar SCC presented with recurrent syncope, hypotension, sinus bradycardia and sinus arrest up to 6 seconds as observed on telemetry (figure 1, bottom). Symptoms were atropine responsive and reliably reproduced with head turning to the L or palpation. CT neck (figure 1A-B) showed extension of the tumor into the L carotid body and adjacent vagal sheath. Echocardiogram revealed no structural heart disease. Pacemaker implantation was deferred due to suspected reversible vasovagal mechanism. He received a course of steroids, targeted cancer therapy with weekly Cetuximab infusion and daily radiation to the neck mass. After treatment initiation, the patient remained hospitalized for 3 days with no recurrent syncope or bradycardia observed. He continued outpatient treatments with resolution of his neck mass (figure 1C-D) and had no syncopal episodes over the next year.Discussion:We highlight this case as an example of locally invasive tumor causing mechanical disruption of the carotid body and neural reflex stimulation via the vagal sheath. When associated with vasovagal syncope, this phenomenon has been previously named carotid body syndrome. Although vasovagal mechanism remains the most common cause of syncope, diagnosis and treatment can prove challenging, particularly due to variable demonstration of vasodepressor and cardioinhibitory reflexes amongst individual patients. Treatment of vasovagal syncope focuses on trigger avoidance and treatment for predisposing conditions. Pacemaker implantation remains controversial and may be offered to patients with predominantly cardioinhibitory reflex and high-risk recurrent syncope, with a possible role for implantable cardiac monitoring. In this case, the management strategy was guided by association of symptoms with head turning, and treatment of the culprit neoplastic process yielded resolution of vasovagal syncope with avoidance of device implantation.

Hepatocellular carcinoma (HCC) risk stratification is an urgent unmet need for cost-effective HCC screening and early detection in patients with cirrhosis to improve poor HCC prognosis.