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Benenati S, Giacobbe F, Zingarelli A, Macaya F, Biolè C, Rossi A, Pavani M, Quadri G, Barbero U, Erriquez A, Aranzulla T, Cavallino C, Buccheri D, Rolfo C, Patti G, Gonzalo N, Chinaglia A, Musumeci G, Escaned J, Varbella F, Cerrato E, Porto I. Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry. Circ Cardiovasc Interv 2023; 16:e012780. [PMID: 37259861 PMCID: PMC10810347 DOI: 10.1161/circinterventions.122.012780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The optimal management of patients with spontaneous coronary artery dissection remains debated. METHODS Patients enrolled in the DISCO (Dissezioni Spontanee Coronariche) Registry up to December 2020 were included. The primary end point was major adverse cardiovascular events, a composite of all-cause death, nonfatal myocardial infarction, and repeat percutaneous coronary intervention (PCI). Independent predictors of PCI and medical management were investigated. RESULTS Among 369 patients, 129 (35%) underwent PCI, whereas 240 (65%) were medically managed. ST-segment-elevation myocardial infarction (68% versus 35%, P<0.001), resuscitated cardiac arrest (9% versus 3%, P<0.001), proximal coronary segment involvement (32% versus 7%, P<0.001), and Thrombolysis in Myocardial Infarction flow 0 to 1 (54% versus 20%, P<0.001) were more frequent in the PCI arm. In-hospital event rates were similar. Between patients treated with PCI and medical therapy, there were no differences in terms of major adverse cardiovascular events at 2 years (13.9% versus 11.7%, P=0.467), all-cause death (0.7% versus 0.4%, P=0.652), myocardial infarction (9.3% versus 8.3%, P=0.921) and repeat PCI (12.4% versus 8.7%, P=0.229). ST-segment-elevation myocardial infarction at presentation (odds ratio [OR], 3.30 [95% CI, 1.56-7.12]; P=0.002), proximal coronary segment involvement (OR, 5.43 [95% CI, 1.98-16.45]; P=0.002), Thrombolysis in Myocardial Infarction flow grade 0 to 1 and 2 (respectively, OR, 3.22 [95% CI, 1.08-9.96]; P=0.038; and OR, 3.98 [95% CI, 1.38-11.80]; P=0.009) and luminal narrowing (OR per 5% increase, 1.13 [95% CI, 1.01-1.28]; P=0.037) were predictors of PCI, whereas the 2B-angiographic subtype predicted medical management (OR, 0.25 [95% CI, 0.07-0.83]; P=0.026). CONCLUSIONS Clinical presentation and procedural variables drive the choice of the initial therapeutic approach in spontaneous coronary artery dissection. If PCI is needed, it seems to be associated with a similar risk of short-to-mid-term adverse events compared to medical treatment. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04415762.
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Affiliation(s)
| | - Federico Giacobbe
- Cardiology Department, AOU Citta` della Salute e della Scienza di Torino, Turin, Italy (F.G.)
| | - Antonio Zingarelli
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy (A.Z., I.P.)
| | - Fernando Macaya
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Spain (F.M., N.G., J.E.)
| | - Carloalberto Biolè
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy (C.B., A.C.)
| | - Angelica Rossi
- Division of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy (A.R.)
| | - Marco Pavani
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.)
| | - Giorgio Quadri
- Division of Cardiology, Ordine Ospedale Mauriziano Umberto I, Torino (TO), Italy (G.Q., T.A.)
| | - Umberto Barbero
- Division of Cardiology Ospedale Maggiore Ss. Annunziata - Savigliano (CN), Italy (U.B.)
| | | | - Tiziana Aranzulla
- Division of Cardiology, Ordine Ospedale Mauriziano Umberto I, Torino (TO), Italy (G.Q., T.A.)
| | - Chiara Cavallino
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (C.C.)
| | - Dario Buccheri
- Interventional Cardiology Unit, Department of Cardiology, S. Antonio Abate Hospital, Trapani, Italy (D.B.)
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.)
| | - Giuseppe Patti
- University of Eastern Piedmont, Department of Thoracic and Cardiovascular Diseases, Maggiore della Carità Hospital, Novara, Italy (G.P.)
| | - Nieves Gonzalo
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Spain (F.M., N.G., J.E.)
| | - Alessandra Chinaglia
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy (C.B., A.C.)
| | - Giuseppe Musumeci
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.)
| | - Javier Escaned
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Spain (F.M., N.G., J.E.)
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.)
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Italy (M.P., C.R., G.M., F.V., E.C.)
| | - Italo Porto
- University of Genoa, Italy (S.B., I.P.)
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy (A.Z., I.P.)
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Mori R, Macaya F, Giacobbe F, Moreno V, Quadri G, Chipayo D, Bianco M, Salinas P, Rolfo C, Mejía-Rentería H, Boi A, Tirado-Conte G, Cavallino C, Nombela-Franco L, Cinconze S, Jiménez-Quevedo P, Pavani M, Fernández-Ortiz A, Chinaglia A, Fuentes-Ferrer ME, Núñez-Gil IJ, Gonzalo N, Cerrato E, Varbella F, Escaned J. Association between hormone therapy and short-term cardiovascular events in women with spontaneous coronary artery dissection. Rev Esp Cardiol (Engl Ed) 2023; 76:165-172. [PMID: 35850485 DOI: 10.1016/j.rec.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Changes in sex hormone levels are a known triggering factor for spontaneous coronary artery dissection (SCAD) in women. However, it is unknown whether exposure to exogenous hormone therapy (HT) at the time of SCAD presentation modifies the clinical course of this condition. We investigated the association between HT in female patients presenting with SCAD and short-term clinical outcomes. METHODS We enrolled consecutive patients presenting with SCAD from the DISCO-IT/SPA (dissezioni spontanee coronariche Italian-Spanish) registry. Women on HT (estrogens, progestagens, or gonadotropins) at the time of presentation were identified, and their clinical characteristics and short-term outcomes were compared with those not receiving active HT. The outcome measure was nonfatal myocardial infarction and/or unplanned percutaneous coronary intervention during the first 28 days after the index catheterization. RESULTS Of 224 women presenting with SCAD (mean age 52.0±10.0 years), 39 (17.4%) were currently using HT while 185 (82.6%) were not. No significant differences were noted in the baseline demographics, clinical presentation, angiographic features, or initial treatment received between the 2 groups. All patients on systemic HT (n=36, 92%) discontinued it at the time of diagnosis. The composite outcome occurred in 7 (17.9%) patients with prior HT compared with 14 (7.6%) without (P=.039). After multivariable adjustment, HT remained associated with the composite outcome recorded in the first 28 days of follow-up (HR, 3.53; 95%CI, 1.30-9.61; P=.013). CONCLUSIONS In women with SCAD, exposure to HT at the time of clinical presentation was associated with short-term recurrent cardiovascular events such as nonfatal myocardial infarction and/or unplanned percutaneous revascularization.
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Affiliation(s)
- Ricardo Mori
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Macaya
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Federico Giacobbe
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Víctor Moreno
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Giorgio Quadri
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - David Chipayo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Matteo Bianco
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Rolfo
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Hernán Mejía-Rentería
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Boi
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Gabriela Tirado-Conte
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Chiara Cavallino
- Dipartimento di Cardiologia, Sant'Andrea Hospital, Vercelli, Italy
| | - Luis Nombela-Franco
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Sebastian Cinconze
- Dipartimento di Cardiologia, Azienda Ospedaliera S Croce e Carle, Cuneo, Italy
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Marco Pavani
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Antonio Fernández-Ortiz
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alessandra Chinaglia
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Manuel Enrique Fuentes-Ferrer
- Departamento de Medicina Preventiva, Unidad de soporte metodológico a la investigación, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván J Núñez-Gil
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Enrico Cerrato
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Javier Escaned
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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Maltese L, Cavallino C, Ugo F, Abdirashid M, Rametta F. 991 A PATIENT WITH INFERIOR Q WAVES AND CHEST PAIN: WHEN HOOF BEATS ARE NOT HORSES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardiac masses are commonly classified as neoplastic (primary and secondary) or non-neoplastic (e.g., thrombus or vegetation). Cardiac tumors are rare, and primary tumors are even rarer, with an estimated autopsy prevalence of < 0.1%. Differentiating between these masses is of paramount importance as treatment options greatly differ.
Case presentation
A 46-year-old male patient, current smoker, with family history of CAD and new onset hyperlipidemia and hypertension, underwent electrocardiogram (ECG) screening for an episode of chest pain. His ECG showed sinus rhythm with Q waves in inferior leads. The laboratory tests did not reveal any abnormality. His transthoracic echocardiogram showed normal biventricular function, and a lobular mass of 30×20 mm, that seemed in continuity with the antero-lateral (A-L) papillary muscle. For the presence of multiple cardiovascular risk factor, the patient underwent diagnostic coronary angiography which showed normal coronary arteries. Differential diagnoses were: hypertrophic cardiomyopathy with isolated hypertrophy of the A-L papillary muscle and LV mass. Cardiac magnetic resonance (CMR) was performed and demonstrated a pedunculated mobile non-enhancing 30×18mm mass within the LV anterior apex, that in the systolic phase contracts close relationships with the A-L papillary muscle which appears dislocated. This encapsulated formation determined a mild systolic obliteration of the LV cavity at the mid-apical portion. T1 imaging with and without suppression of adipose tissue, were compatible with cardiac intraventricular lipoma. The case was discussed in a multi-disciplinary heart team, and in accordance with the cardiac surgeon the patient underwent conservative management and follow up with echocardiography at 6 months and CMR at 1 year.
Discussion
Cardiac lipomas are rare benign primary cardiac tumors. They are usually indolent, asymptomatic and incidentally-discovered. Symptoms such as dyspnea, syncope or palpitations can occur if the tumor grows and causes LV obstruction, LV dysfunction or invasion of the conduction system. Sudden cardiac death has been reported, but the true incidence is unknown given its rarity. The most common location for cardiac lipomas is the inter-atrial septum, followed by endocardium of RA and LV. CMR is the imaging modality of choice when available and lipomas have a homogeneous appearance of increased signal intensity on T1-weighted imaging, with a reduction in signal intensity in fat-saturated sequences. As the prevalence of cardiac lipomas is very low, there are no randomized clinical trials or large prospective cohorts to provide guidance for optimal treatment. Embolization or infiltration of the myocardium are not common. For large lesions causing obstruction, surgical resection is usually indicated.
Conclusion
Cardiac lipoma is a rare primary tumor of the heart. The comprehensive evaluation is highly dependent on multimodality imaging methods. The best treatment strategy is still not clear and should be individualized.
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Tovar Forero MN, Sardella G, Salvi N, Cortese B, di Palma G, Werner N, Aksoy A, Escaned J, Salazar CH, Gonzalo N, Ugo F, Cavallino C, Sheth TN, Kardys I, Van Mieghem NM, Daemen J. Coronary lithotripsy for the treatment of underexpanded stents: the international & multicentre CRUNCH registry. EUROINTERVENTION 2022; 18:574-581. [PMID: 35318955 PMCID: PMC10241293 DOI: 10.4244/eij-d-21-00545] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stent underexpansion increases the risk of cardiac adverse events. At present, there are limited options to treat refractory stent underexpansion. In this context, the intravascular lithotripsy (IVL) system might be a safe and effective strategy. AIMS We aimed to evaluate the safety and efficacy of IVL in addressing resistant stent underexpansion due to heavy underlying calcification. METHODS This was an international multicentre registry including patients receiving IVL therapy to treat stent underexpansion from December 2017 to August 2020. Angiographic and intracoronary imaging data were collected. The efficacy endpoint was device success (technical success with a final percentage diameter stenosis <50%). The safety endpoint was in-hospital major adverse cardiac events (MACE). RESULTS Seventy patients were included, the mean age was 73±9.2 years and 76% were male. The median time from stent implantation to IVL therapy was 49 days (0-2,537). Adjuvant treatment with non-compliant balloon dilatations pre- and post-IVL was performed in 72.3% and 76.8% of patients, respectively, and additional stenting was performed in 22.4%. Device success was 92.3%. Minimum lumen diameter increased from 1.49±0.73 mm to 2.41±0.67 mm (p<0.001) and stent expansion increased by 124.93±138.19% (p=0.016). No IVL-related procedural complications or MACE were observed. The use of bailout IVL therapy directly after stenting and the presence of ostial underexpanded lesions negatively predicted lumen diameter gain. CONCLUSIONS Coronary lithotripsy is safe and effective in increasing lumen and stent dimensions in underexpanded stents secondary to heavily calcified lesions.
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Affiliation(s)
| | - Gennaro Sardella
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Gaetano di Palma
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Nikos Werner
- Heart Center, Trier, Germany
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlos H Salazar
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Tej N Sheth
- McMaster University, Hamilton, Ontario, Canada
| | - Isabella Kardys
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joost Daemen
- Erasmus University Medical Center, Rotterdam, the Netherlands
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Mori R, Macaya F, Giacobbe F, Moreno V, Quadri G, Chipayo D, Bianco M, Salinas P, Rolfo C, Mejía-Rentería H, Boi A, Tirado-Conte G, Cavallino C, Nombela-Franco L, Cinconze S, Jiménez-Quevedo P, Pavani M, Fernández-Ortiz A, Chinaglia A, Fuentes-Ferrer ME, Núñez-Gil IJ, Gonzalo N, Cerrato E, Varbella F, Escaned J. Asociación entre el tratamiento hormonal y los eventos clínicos tempranos en mujeres con disección coronaria espontánea. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rivera-Caravaca JM, Núñez-Gil IJ, Lip GYH, Uribarri A, Viana-Llamas MC, Gonzalez A, Castro-Mejía AF, Alonso González B, Alfonso E, García Prieto JF, Cavallino C, Cortese B, Feltes G, Fernández-Rozas I, Signes-Costa J, Huang J, García Aguado M, Pepe M, Romero R, Cerrato E, Becerra-Muñoz VM, Raposeiras Roubin S, Santoro F, Bagur R, Sposato L, El-Battrawy I, López Masjuan A, Fernandez-Ortiz A, Estrada V, Macaya C, Marín F. Chronic Oral Anticoagulation Therapy and Prognosis of Patients Admitted to Hospital for COVID-19: Insights from the HOPE COVID-19 Registry. Int J Clin Pract 2022; 2022:7325060. [PMID: 35685504 PMCID: PMC9158796 DOI: 10.1155/2022/7325060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most evidence regarding anticoagulation and COVID-19 refers to the hospitalization setting, but the role of oral anticoagulation (OAC) before hospital admission has not been well explored. We compared clinical outcomes and short-term prognosis between patients with and without prior OAC therapy who were hospitalized for COVID-19. METHODS Analysis of the whole cohort of the HOPE COVID-19 Registry which included patients discharged (deceased or alive) after hospital admission for COVID-19 in 9 countries. All-cause mortality was the primary endpoint. Study outcomes were compared after adjusting variables using propensity score matching (PSM) analyses. RESULTS 7698 patients were suitable for the present analysis (675 (8.8%) on OAC at admission: 427 (5.6%) on VKAs and 248 (3.2%) on DOACs). After PSM, 1276 patients were analyzed (638 with OAC; 638 without OAC), without significant differences regarding the risk of thromboembolic events (OR 1.11, 95% CI 0.59-2.08). The risk of clinically relevant bleeding (OR 3.04, 95% CI 1.92-4.83), as well as the risk of mortality (HR 1.22, 95% CI 1.01-1.47; log-rank p value = 0.041), was significantly increased in previous OAC users. Amongst patients on prior OAC only, there were no differences in the risk of clinically relevant bleeding, thromboembolic events, or mortality when comparing previous VKA or DOAC users, after PSM. CONCLUSION Hospitalized COVID-19 patients on prior OAC therapy had a higher risk of mortality and worse clinical outcomes compared to patients without prior OAC therapy, even after adjusting for comorbidities using a PSM. There were no differences in clinical outcomes in patients previously taking VKAs or DOACs. This trial is registered with NCT04334291/EUPAS34399.
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Affiliation(s)
- José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico UniversitarioVirgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Iván J. Núñez-Gil
- Hospital Clínico San Carlos Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Aitor Uribarri
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Adelina Gonzalez
- Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Madrid, Spain
| | | | | | - Emilio Alfonso
- Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | | | | | | | | | | | - Jaime Signes-Costa
- Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Jia Huang
- The Second People's Hospital of Shenzhen, Shenzhen, China
| | | | - Martino Pepe
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | | | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Rivoli, Turin, Italy
| | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | - Francesco Santoro
- Azienda Sanitaria Locale della Provincia di Barletta-Andria-Trani, Andria, Italy
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada
| | - Luciano Sposato
- London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Robarts Research Institute, London, Ontario, Canada
| | | | | | - Antonio Fernandez-Ortiz
- Hospital Clínico San Carlos Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Vicente Estrada
- Hospital Clínico San Carlos Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico UniversitarioVirgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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Cerrato E, Giacobbe F, Quadri G, Macaya F, Bianco M, Mori R, Biolè CA, Boi A, Bettari L, Rolfo C, Ferrari F, Annibali G, Scappaticci M, Pavani M, Barbero U, Buccheri D, Cavallino C, Lombardi P, Bernelli C, D'Ascenzo F, Infantino V, Gambino A, Cinconze S, Rognoni A, Montagna L, Porto I, Musumeci G, Escaned J, Varbella F. Corrigendum to: Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J 2021; 43:87. [PMID: 34654925 DOI: 10.1093/eurheartj/ehab720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Benenati S, Giacobbe F, Zingarelli A, Alessandra TG, Lombardi P, Musumeci G, Cinconze S, Barbero U, Iannaccone M, Patti G, Rognoni A, Menunni M, Di Leo A, Infantino V, Gambino A, D’Ascenzo F, Bruno F, Pavani M, Gagnor A, Ugo F, Cavallino C, Campo GC, Bettari L, Cassano F, Perfetti M, Scappaticci M, Buccheri D, Bordoni E, Bernelli C, Boi A, Mori R, Macaya F, Escaned J, Cerrato E, Porto I. 580 Percutaneous coronary intervention or medical therapy as initial management strategy of patients with spontaneous coronary artery dissections: insight from the multicentre, international dissezioni spontanee coronariche (disco) registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes of immediate PCI patients with those undergoing an initial strategy of medical management.
Methods and results
369 patients enrolled in the multicentre international DIssezioni Spontanee COronariche (DISCO) registry between January 2009 and December 2020 were included. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI) and any PCI. 240 (65%) patients underwent initial medical management, whereas 129 (35%) had immediate PCI. PCI patients presented more frequently with ST segment-elevation myocardial infarction (STEMI) (68.2% vs. 35%, P < 0.001) and had higher frequency of proximal coronary segment SCAD (31.8% vs. 6.7%, P < 0.001), Thrombolysis in Myocardial infarction (TIMI) flow grade 0–1 (54.3% vs. 20.4%, P < 0.001) and multivessel SCAD (18.6% vs. 9.2%, P = 0.015), as well as a more severe diameter stenosis [99% (100–90) vs. 90% (99–75), P < 0.001]. At multivariate logistic regression, STEMI at presentation (vs. NSTE-ACS, OR: 3.30 95% CI: 1.56–7.12, P = 0.002), proximal coronary segment involvement (OR: 5.43, 95% CI: 1.98–16.45, P = 0.002), TIMI flow grade 0–1 and 2 (respectively, vs. grade 3: OR: 3.22 95% CI: 1.08–9.96, P = 0.038; and OR: 3.98; 95% CI: 1.38–11.80, P = 0.009) and diameter stenosis (per 5% increase, OR: 1.13; 95% CI: 1.01–1.28, P = 0.037) were predictors of immediate PCI, whereas the angiographic subtype 2B predicted a conservative approach (OR: 0.25; 95% CI: 0.07–0.83, P = 0.026). The frequency of in-hospital major adverse cardiac events did not differ between medically and PCI-treated patients. At 2-year follow-up, there were no differences with respect to the composite of MACE (11.7% vs. 13.9%, P = 0.47) and the individual components of cardiovascular death (0.4% vs. 0.7%, P = 0.65), non-fatal MI (8.3% vs. 9.3%, P = 0.92), and any PCI (8.7% vs. 12.4%, P = 0.23).
Conclusions
The choice between an immediate medical or PCI management of SCAD is mostly driven by clinical presentation and procedural aspects. In the DISCO cohort, the primary treatment approach was not associated with the risk of short-to-midterm adverse events.
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Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna (DIMI), University of Genoa, Genoa, Italy
| | - Federico Giacobbe
- Cardiology Department, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Zingarelli
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiovascular Network, Italy
| | | | - Primiano Lombardi
- Interventional Cardiology Unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | | | | | - Umberto Barbero
- Interventional Cardiology Unit, Ospedale Maggiore SS. Annunziata, Savigliano, Cuneo, Italy
| | - Mario Iannaccone
- Interventional Cardiology Unit, Ospedale Maggiore SS. Annunziata, Savigliano, Cuneo, Italy
| | - Giuseppe Patti
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Antonio Rognoni
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Marco Menunni
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Angelo Di Leo
- Division of Cardiology, Ospedale Civile di Ciriè, Turin, Italy
| | | | - Alfonso Gambino
- Interventional Cardiology Unit, Santa Croce Hospital, Moncalieri, Turin, Italy
| | - Fabrizio D’Ascenzo
- Cardiology Department, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Bruno
- Interventional Cardiology Unit, Santa Croce Hospital, Moncalieri, Turin, Italy
| | - Marco Pavani
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | | | | | | | | | - Luca Bettari
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Cassano
- SS. Annunziata Hospital, Taranto, Italy
- Ospedale di Venere, Bari, Italy
| | | | | | - Dario Buccheri
- Interventional Cardiology Unit, S. Antonio Abate Hospital, Trapani, Italy
| | | | - Chiara Bernelli
- Interventional Cardiology Unit, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | | | - Ricardo Mori
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Fernando Macaya
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Italo Porto
- Dipartimento di Medicina Interna (DIMI), University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiovascular Network, Italy
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9
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Cerrato E, Giacobbe F, Quadri G, Macaya F, Bianco M, Mori R, Biolè CA, Boi A, Bettari L, Rolfo C, Ferrari F, Annibali G, Scappaticci M, Pavani M, Barbero U, Buccheri D, Cavallino C, Lombardi P, Bernelli C, D'Ascenzo F, Infantino V, Gambino A, Cinconze S, Rognoni A, Montagna L, Porto I, Musumeci G, Escaned J, Varbella F. Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J 2021; 42:3161-3171. [PMID: 34338759 DOI: 10.1093/eurheartj/ehab372] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investigate the relationship between single (SAPT) and dual (DAPT) antiplatelet regimens and 1-year patient outcomes. METHODS AND RESULTS We investigated the 1-year outcome of patients with SCAD managed with initial conservative treatment included in the DIssezioni Spontanee COronariche (DISCO) multicentre international registry. Patients were divided into two groups according to SAPT or DAPT prescription. Primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction (MI), and any unplanned percutaneous coronary intervention (PCI). Out of 314 patients included in the DISCO registry, we investigated 199 patients in whom SCAD was managed conservatively. Most patients were female (89%), presented with acute coronary syndrome (92%) and mean age was 52.3 ± 9.3 years. Sixty-seven (33.7%) were given SAPT whereas 132 (66.3%) with DAPT. Aspirin plus either clopidogrel or ticagrelor were prescribed in 62.9% and 36.4% of DAPT patients, respectively. Overall, a 14.6% MACE rate was observed at 12 months of follow-up. Patients treated with DAPT had a significantly higher MACE rate than those with SAPT [18.9% vs. 6.0% hazard ratios (HR) 2.62; 95% confidence intervals (CI) 1.22-5.61; P = 0.013], driven by an early excess of non-fatal MI or unplanned PCI. At multiple regression analysis, type 2a SCAD (OR: 3.69; 95% CI 1.41-9.61; P = 0.007) and DAPT regimen (OR: 4.54; 95% CI 1.31-14.28; P = 0.016) resulted independently associated with a higher risk of 12-month MACE. CONCLUSIONS In this European registry, most patients with SCAD undergoing initial conservative management received DAPT. Yet, at 1-year follow-up, DAPT, as compared with SAPT, was independently associated with a higher rate of adverse cardiovascular events (ClinicalTrial.gov id: NCT04415762).
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Federico Giacobbe
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fernando Macaya
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ricardo Mori
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlo Alberto Biolè
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | | | - Luca Bettari
- Interventional cardiology unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fabio Ferrari
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Gianmarco Annibali
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | | | - Marco Pavani
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Umberto Barbero
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Dario Buccheri
- Interventional Cardiology Unit, S. Antonio Abate Hospital, Trapani, Italy
| | | | - Primiano Lombardi
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | - Chiara Bernelli
- Interventional cardiology unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Fabrizio D'Ascenzo
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Alfonso Gambino
- Interventional cardiology unit, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Sebastian Cinconze
- Cardiology Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Andrea Rognoni
- Cardiology Department, Ospedale Maggiore della Carità, Novara, Italy
| | - Laura Montagna
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Giuseppe Musumeci
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
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10
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Demarchi A, Ugo F, Cavallino C, Rametta F. Very late stent expansion with intracoronary lithotripsy: a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204993 PMCID: PMC7649517 DOI: 10.1093/ehjcr/ytaa228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/03/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
Background Underexpanded stent in heavily calcified coronary lesion is common and persists over years. It is related to long-term failure and negative outcomes. Treatment of this situation after many years with intracoronary lithotripsy (ICL-Shockwave®) could be an option. Case summary We report a case of a man with underexpanded coronary stent implanted 11 years earlier. Optical coherence tomography highlighted the mechanism of stent underexpansion showing the presence of calcium stones under the old struts. Intracoronary lithotripsy crushed calcium under the stent struts causing its geometric change (from elliptical to round shape) and a consequent better transmission of the true radial force of the old stent. Discussion Heavily calcified coronary lesions lead to stent underexpansion which persists over years. Intracoronary lithotripsy could be a very late option to manage this unfavourable common result.
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Affiliation(s)
- Andrea Demarchi
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Fabrizio Ugo
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Chiara Cavallino
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Francesco Rametta
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
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11
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Tumminello G, Cavallino C, Demarchi A, Rametta F. Bail-out unexpanded stent implantation in acute left main dissection treated with intra coronary lithotripsy: a case report. Eur Heart J Case Rep 2019; 3:1-5. [PMID: 31911999 PMCID: PMC6939817 DOI: 10.1093/ehjcr/ytz172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/04/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
Abstract
Background The percutaneous treatment of heavily calcified coronary lesions is challenging and presents high rate of complications. Unexpandable stent is one of the most serious complication. Both of these conditions may benefit from the intracoronary lithotripsy (ICL-Shockwave®), a new coronary percutaneous technique. Case summary This case report describes a man treated with percutaneous coronary intervention (PCI) for a left main (LM) severe calcified lesion. The PCI was complicated by a huge dissection of LM in a not completely expandable lesion. A bail-out stent implantation was performed with residual unexpansion. The ICL permitted to expand acutely the stent and obtain an optimal final result. Discussion Familiarity with dedicated techniques and devices to treat calcified coronary lesions is fundamental to perform high-risk complex PCI. This case emphasizes the potential usefulness of the new ICL technique to treat calcified lesions or related complications like unexpandable stent.
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Affiliation(s)
- Gabriele Tumminello
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Chiara Cavallino
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Andrea Demarchi
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Francesco Rametta
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
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12
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Cerrato E, Quadri G, Cavallino C, Porto I, Bettari L, Franzè A, Lo Savio L, Demarchi A, Rametta F, Barbero U, Rolfo C, Pavani M, Ferrari F, Giachet AT, Campo G, Bordoni E, Di Leo A, Beqaraj F, Greco Lucchina GP, Cassano F, Tomassini F, Varbella F. TCT-469 Percutaneous Coronary Intervention Performance in Spontaneous Coronary Artery Dissection: Insight From an Italian Multicenter Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Quadri G, Cerrato E, Porto I, Cavallino C, Bettari L, Tomassini F, Franzè A, Ferrari F, Iannaccone M, Pavani M, Rametta F, Giachet AT, Lo Savio L, Campo G, Demarchi A, Rolfo C, Bordoni E, Infantino V, Bernelli C, Gambino A, Cassano F, Varbella F. TCT-470 Acute Management of Patients With Spontaneous Coronary Artery Dissection: The DISCO (DIssezioni Spontanee COronariche) Italian Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Rognoni A, Cavallino C, Mennuni MG, Barbieri L, Rosso R, Rametta F, Nardi F, Lupi A, Bongo AS. Out-of-hospital cardiac arrest: always coronary angiography? Expert Rev Cardiovasc Ther 2017; 15:847-851. [PMID: 28885062 DOI: 10.1080/14779072.2017.1376654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) remains one of the principle challenges in the setting of critical care medicine and emergency cardiology. Areas covered: Long-term survival rates even after successful resuscitation are variable but increasing in the recent years; due to the improvement of base and advanced cardiac life support techniques an increasing number of resuscitated patients are admitted to the hospital. Recent data suggested that patients surviving to hospital discharge after OHCA presented long-term outcome similar to patients with ST-elevation myocardial infarction. However, limited and incompletely clear data are available in the literature about the selection and risk stratification of patients to be subjected to coronary angiography, particularly in patients who have unfavorable clinical features in whom procedures may be futile and may affect public reporting of morality. Recently the ESC and AHA addressed appropriate treatments for ST-elevation myocardial infarction (STEMI) patients with out-of-hospital cardiac arrest. Expert commentary: Immediate coronary intervention in the setting of OHCA appears to be associated with better survival to discharge; the documentation of an occluded coronary artery in medium 25% of patients without signs of STEMI at ECG helps to explain why early angiography can improve outcomes. In the treatment of OHCA we can find some ethical issues; for example a combination of comorbidities with advanced age and prolonged ischemia indicated by severe lactic acidosis may signify a high enough chance of multiorgan failure or anoxic brain injury and where the benefit of coronary reperfusion therapy appears minimal.
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Affiliation(s)
- Andrea Rognoni
- a Coronary Care Unit and Catheterization laboratory , A.O.U. Maggiore della Carità , Novara , Italy
| | | | - Marco Giovanni Mennuni
- a Coronary Care Unit and Catheterization laboratory , A.O.U. Maggiore della Carità , Novara , Italy
| | | | - Roberta Rosso
- a Coronary Care Unit and Catheterization laboratory , A.O.U. Maggiore della Carità , Novara , Italy
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15
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Lupi A, Schaffer A, Rognoni A, Cavallino C, Bongo AS, Cortese B, Jaffe AS, Angiolillo DJ, Porto I. Intracoronary Bivalirudin Bolus in ST-Elevation Myocardial Infarction Patients Treated with Primary Angioplasty: Theoretical Bases, Clinical Experience, and Future Applications. Am J Cardiovasc Drugs 2016; 16:391-397. [PMID: 27541144 DOI: 10.1007/s40256-016-0186-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intracoronary thrombus is a common finding in acute coronary syndromes and often correlates with adverse prognosis and complications during percutaneous coronary interventions (PCIs). Bivalirudin, a direct thrombin inhibitor, is one of the recommended antithrombotic treatments for PCI in ST-elevation myocardial infarction (STEMI). The intracoronary administration of a bivalirudin loading dose, even if off-label, offers theoretical advantages over the standard intravenous route, providing a very high drug concentration in the infarct-related artery without increasing the total dose of the drug administered. After the description in case reports of such an approach, a larger scale experience was recently reported in a large cohort of patients with STEMI treated during primary PCI with a bivalirudin intracoronary loading dose followed by the standard intravenous maintenance infusion. As a control group, a propensity score-matched cohort of patients undergoing primary PCI treated with intravenous bivalirudin in the same institution was selected. Compared with the intravenous bolus, the intracoronary administration of bivalirudin was associated with improved ST-segment resolution, lower post-procedural peak CK-MB levels, and better Thrombolysis in Myocardial Infarction (TIMI) frame count values, without difference in bleeding rates. Thus, this new promising antithrombotic strategy, based on the intracoronary administration of a bivalirudin loading dose during primary PCI, appeared safe, improved myocardial reperfusion, and mitigated enzymatic myocardial infarct size compared with the standard intravenous protocol. Randomized trials are warranted to confirm these results and evaluate the possible long-term clinical benefits.
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Affiliation(s)
- Alessandro Lupi
- Cardiologia II, AOU Maggiore della Carità, C.so Mazzini 18, 28100, Novara, Italy.
- Cardiology Division, ASL VCO, Domodossola, Italy.
| | - Alon Schaffer
- Cardiologia II, AOU Maggiore della Carità, C.so Mazzini 18, 28100, Novara, Italy
| | - Andrea Rognoni
- Cardiologia II, AOU Maggiore della Carità, C.so Mazzini 18, 28100, Novara, Italy
| | | | - Angelo S Bongo
- Cardiologia II, AOU Maggiore della Carità, C.so Mazzini 18, 28100, Novara, Italy
| | | | - Allan S Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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16
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Rognoni A, Cavallino C, Rametta F, Bongo AS. Correlations between microRNAs and their target genes in skeletal myoblasts cell therapy for myocardial infarction. Ann Transl Med 2016; 4:292. [PMID: 27568480 DOI: 10.21037/atm.2016.05.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità Hospital", Novara, Italy
| | - Chiara Cavallino
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità Hospital", Novara, Italy; ; Division of Cardiology, Sant'Andrew Hospital, Vercelli, Italy
| | | | - Angelo Sante Bongo
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità Hospital", Novara, Italy
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17
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Rognoni A, Cavallino C, Veia A, Bacchini S, Rosso R, Facchini M, Secco GG, Lupi A, Nardi F, Rametta F, Bongo AS. Pathophysiology of Atherosclerotic Plaque Development. Cardiovasc Hematol Agents Med Chem 2016; 13:10-3. [PMID: 25544119 DOI: 10.2174/1871525713666141218163425] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/03/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases and in particular coronary atherosclerotic disease are the leading cause of mortality and morbidity in the industrialized countries. Coronary atherosclerosis has been recognized for over a century and it was the subject of various studies. Pathophysiological studies have unravelled the interactions of molecular and cellular elements involved in atherogenesis; during the last decades the basic research has focused on the study of the instability of atherosclerotic plaque. Plaque rupture and resulting intracoronary thrombosis are thought to account for most acute coronary syndromes including ST - segment elevation myocardial infarction and non ST - segment elevation myocardial infarction. This is a brief review of the pathophysiology of atherosclerotic plaque development.
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Affiliation(s)
- Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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18
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Facchini E, Degiovanni A, Cavallino C, Lupi A, Rognoni A, Bongo AS. Beta-Blockers and Nitrates: Pharmacotherapy and Indications. Cardiovasc Hematol Agents Med Chem 2016; 13:25-30. [PMID: 25544116 DOI: 10.2174/1871525713666141219114708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 08/24/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
Many clinically important differences exist between beta blockers. B1-selectivity is of clinical interest because at clinically used doses, b1- selective agents block cardiac b-receptors while having minor effects on bronchial and vascular b-receptors. Beta-adrenergic blocking agents significantly decrease the frequency and duration of angina pectoris, instead the prognostic benefit of beta-blockers in stable angina has been extrapolated from studies of post myocardial infarction but has not yet been documented without left ventricular disfunction or previous myocardial infarction. Organic nitrates are among the oldest drugs, but they still remain a widely used adjuvant in the treatment of symptomatic coronary artery disease. While their efficacy in relieving angina pectoris symptoms in acute settings and in preventing angina before physical or emotional stress is undisputed, the chronic use of nitrates has been associated with potentially important side effects such as tolerance and endothelial dysfunction. B-blockers are the firstline anti-anginal therapy in stable stable angina patients without contraindications, while nitrates are the secondline anti-anginal therapy. Despite 150 years of clinical practice, they remain fascinating drugs, which in a chronic setting still deserve investigation. This review evaluated pharmacotherapy and indications of Beta-blockers and nitrates in stable angina.
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Affiliation(s)
| | | | | | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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DeVecchi F, Facchini E, Degiovanni A, Sartori C, Cavallino C, Santagostino M, Di Ruocco V, Magnani A, Occhetta E, Marino PN. Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization. Int J Cardiol Heart Vasc 2016; 11:66-73. [PMID: 28616528 PMCID: PMC5441335 DOI: 10.1016/j.ijcha.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Background It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation. Methods In 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline. Results There was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization. Conclusions Acute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.
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Key Words
- CRT, biventricular stimulation
- Congestive heart failure
- DYS, dyssynchrony
- Dyssynchrony
- EDV, end-diastolic volume
- EF, ejection fraction
- Ea, arterial elastance
- Ees, ventricular elastance
- FFR, force–frequency relation
- Force–frequency relation
- HR, hazard ratio
- LV, left ventricle
- MR, mitral regurgitation
- Resynchronization
- Speckle-tracking echocardiography
- TUS, temporal uniformity of strain
- r2, adjusted r squared
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Rognoni A, Cavallino C, Lupi A, Bacchini S, Rosso R, Rametta F, Nardi F, Bongo AS. Ticagrelor: Long-Term Therapy in Patients with Coronary Artery Disease. Rev Recent Clin Trials 2016; 11:280-283. [PMID: 27480967 DOI: 10.2174/1574887111666160729102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Atherothrombosis and coronary artery disease affect more than 13 million individuals only in the United States, about 8 millions in Europe and are the major causes of death worldwide. In particular chronic stable angina impairs patient quality of life, is associated with an important health spending and increased patient mortality; it is a prominent symptom of coronary artery disease (CAD), the latter being prevalent worldwide in patients. A key role in pathophysiology of cardiovascular acute events is played by activated platelets. Aspirin and adenosine diphosphate antagonist in addition to it is recommended for 1 year for reduction of cardiovascular events in patients with prior myocardial infarction with a weak recommendation to continue thereafter. P2Y12 receptor antagonists, in addition to aspirin, have been shown in the last years, to reduce ischemic events in patients with acute coronary syndrome but their role in secondary prevention is still new and unclear. The aim of our paper is to review the long-term effect of therapy with ticagrelor on the basis of recent evidence based data. METHODS We performed an online search on the major search engines. All the randomized controlled trials were summarized in the table. RESULTS We included in our paper six randomized controlled trials and we mentioned about ten post - hoc analysis, sub studies and registries. All studies included the type the therapy and a mid or long term clinical follow up. CONCLUSIONS The studies reported in our paper and in particular PEGASUS - TIMI 54 study showed the merit to placing attention of prevention secondary ischemic events after acute coronary syndrome in the context of treatment with dual anti - platelet therapy; it proved a clinical benefit in patients treated with ticagrelor (60 mg x 2) for 3 years. Nevertheless, the effectiveness of these results cannot be generalized to patients with higher bleeding risk or low ischemic risk. In fact prolonged therapy with ticagrelor 60 mg in combination with aspirin could be considered valuable in patients with repeated acute ischemic events or with several coronary revascularizations over time (especially in patients with lower bleeding risk).
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Affiliation(s)
- Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100 Novara, Italy
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Rognoni A, Cavallino C, Lupi A, Secco GG, Veia A, Bacchini S, Rosso R, Brunelleschi S, Rametta F, Bongo AS. Ticagrelor: a novel drug for an old problem. ACTA ACUST UNITED AC 2015; 9:51-7. [PMID: 25174338 DOI: 10.2174/1574890109666140901150224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/31/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022]
Abstract
Cardiovascular disease and in particular, acute coronary syndromes are one of the principle causes of death in the industrialized countries. In the setting of acute coronary syndromes (both ST - segment or non ST - segment elevation myocardial infarction), platelets aggregation plays a key and central role in their development. Platelets are the mediators of hemostasis at sites of vascular injury, but they also mediate pathologic thrombosis; activated platelets stimulate thrombus formation in response to rupture of an atherosclerotic plaque or endothelial cell erosion promoting atherothrombotic disease. Recent patent relates to the methods and devices for treating atherosclerosis and to prevent in-stent restenosis or thrombosis. Because of the importance of platelets involvement in the initiation and propagation of thrombosis, antiplatelet drugs have a source of research; in the recent past, new antiplatelet drugs (such as ticagrelor) have been studied and placed in the routine therapy. The aim of this paper is to summarize the pharmacological properties and the clinical characteristics of ticagrelor.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Angelo S Bongo
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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Occhetta E, Quirino G, Baduena L, Nappo R, Cavallino C, Facchini E, Pistelli P, Magnani A, Bortnik M, Francalacci G, Dell’Era G, Plebani L, Marino P. Right ventricular septal pacing: Safety and efficacy in a long term follow up. World J Cardiol 2015; 7:490-498. [PMID: 26322189 PMCID: PMC4549783 DOI: 10.4330/wjc.v7.i8.490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/24/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing.
METHODS: We retrospectively evaluated: (1) 244 patients (74 ± 8 years; 169 men, 75 women) implanted with a single (132 pts) or dual chamber (112 pts) pacemaker (PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site (SEPTAL pacing); (2) 22 patients with permanent pacemaker and low percentage of pacing (< 20%) (NO pacing); (3) 33 patients with high percentage (> 80%) right ventricular apical pacing (RVA). All patients had a narrow spontaneous QRS (101 ± 14 ms). We evaluated New York Heart Association (NYHA) class, quality of life (QoL), 6 min walking test (6MWT) and left ventricular function (end-diastolic volume, LV-EDV; end-systolic volume, LV-ESV; ejection fraction, LV-EF) with 2D-echocardiography.
RESULTS: Pacing parameters were stable during follow up (21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, QoL score and 6MWT. While LV-EDV didn’t significantly increase (104 ± 40 mL vs 100 ± 37 mL; P = 0.35), LV-ESV slightly increased (55 ± 31 mL vs 49 ± 27 mL; P = 0.05) and LV-EF slightly decreased (49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF (from 56% ± 6% to 43% ± 9%, P < 0.0001).
CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
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Lupi A, Rognoni A, Cavallino C, Secco GG, Reale D, Cossa G, Rosso R, Bongo AS, Cortese B, Angiolillo DJ, Jaffe AS, Porto I. Intracoronary vs intravenous bivalirudin bolus in ST-elevation myocardial infarction patients treated with primary angioplasty. European Heart Journal: Acute Cardiovascular Care 2015; 5:487-96. [DOI: 10.1177/2048872615594499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/15/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Alessandro Lupi
- 2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Italy
| | - Andrea Rognoni
- 2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Italy
| | | | - Gioel G Secco
- 2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Italy
| | - Danilo Reale
- Divisione di Cardiologia, Ospedale S. Andrea, Italy
| | | | - Roberta Rosso
- 2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Italy
| | - Angelo S Bongo
- 2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Italy
| | | | | | - Allan S Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic, USA
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Rognoni A, Degiovanni A, Cavallino C, Lupi A, Rosso R, Veia A, Rametta F, Bongo AS. [Giant aneurysm of the right coronary artery: an unusual treatment]. G Ital Cardiol (Rome) 2015; 16:250-3. [PMID: 25959761 DOI: 10.1714/1848.20192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery aneurysm (CAA) is an uncommon disease observed in only 0.15-4.9% of patients undergoing coronary angiography. CAA are defined as dilated coronary artery sections exceeding by 1.5 times the diameter of normal adjacent segments or of the patient's largest coronary vessel. Occasionally, CAA enlarge enough to be called giant CAA. We report the case of a 78-year-old man, with known chronic ischemic cardiomyopathy and a history of prior coronary artery bypass surgery (with a left internal mammary artery graft to the left anterior descending coronary artery and saphenous venous graft to the obtuse marginal branch), who was referred to our cardiology department for progressive dyspnea. Echocardiography showed severe mitral regurgitation suggesting replacement; coronary angiography revealed three-vessel coronary artery disease, left internal mammary artery patency, saphenous vein graft occlusion and an aneurysm of the mid right coronary artery. Cardiac magnetic resonance confirmed this finding, showing a giant CAA (65 x 75 mm) with a large endoluminal thrombus. Treatment is not standardized and may include medical therapy, percutaneous treatment and surgical intervention; our patient underwent percutaneous coil embolization. One-month angiographic follow-up showed successful obliteration. The patient underwent surgical mitral valve replacement without any complications. At 9-month clinical follow-up, he was asymptomatic; transthoracic echocardiography showed an ejection fraction of 44% without prosthetic mitral regurgitation.
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De Vecchi F, Cavallino C, Di Ruocco V, Facchini E, Occhetta E, Magnani A, Marino P. EXTENT OF ACUTE CONTRACTILE RECOVERY DURING BIVENTRICULAR PACING IS NOT ASSOCIATED WITH LONG-TERM FOLLOW-UP IN HEART FAILURE PATIENTS WHO UNDERGO RESYNCHRONIZATION THERAPY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rognoni A, Lupi A, Rosso R, Cavallino C, Bongo AS. Giant bronchial artery aneurysm treated by coil embolization and Amplatzer placement. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 1:S66-7. [DOI: 10.2459/jcm.0b013e3283629cc2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cavallino C, Facchini M, Veia A, Bacchni S, Rosso R, Rognoni A, Rametta F, Lupi A, Bongo AS. New Anti-Anginal Drugs: Ranolazine. Cardiovasc Hematol Agents Med Chem 2015; 13:14-20. [PMID: 25544118 DOI: 10.2174/1871525713666141219112841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/10/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023]
Abstract
Chronic angina represents a condition that impairs quality of life and is associated with decreased life expectancy in the industrialized countries. Current therapies that reduce angina frequency include old drugs such as nitrates, β -blockers and calcium antagonists. Several new investigational drugs are being tested for the treatment of chronic angina. This review will focus on ranolazine, a drug approved by the US Food and Drug Administration (FDA) in 2006 for patients with chronic angina who continue to be symptomatic despite optimized therapies. The main molecular mechanism underlying ranolazine-mediated beneficial effects has been identified as inhibition of the late Na+ current during the action potential, which potentially improves oxygen consumption, diastolic dysfunction and coronary blood flow. The aim of this review is to update the evidence for ranolazine treatment in chronic angina and discuss its therapeutic perspectives based on the most recent clinical and experimental studies.
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Affiliation(s)
| | | | | | | | | | - Andrea Rognoni
- Catheterization Laboratory, Maggiore della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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Lupi A, Rognoni A, Cavallino C, Secco GG, Rosso R, Bongo AS. Ivabradine for Treatment of Coronary Artery Disease: From Last Chance Resort to Mainstem of a Reasoned Therapy. Cardiovasc Hematol Agents Med Chem 2014; 13:4-9. [PMID: 25544120 DOI: 10.2174/1871525713666141218162102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 08/27/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
Heart rate is a fundamental determinant of cardiac oxygen consumption and plays a pivotal role in the pathophysiology of chronic stable angina (CSA). Ivabradine selectively and specifically inhibits the sino-atrial If current, slowing selectively heart rate without other significant haemodynamic effects. The consequent clinical effects are a sinus rate reduction similar to that obtained with beta-blockers, but without the related haemodynamic side effects. Ivabradine clinical benefits have been demonstrated both in patients with stable coronary artery disease (CAD) with associated systolic left ventricular dysfunction or in patients with congestive heart failure (HF). In this review we focused on the pharmacology and clinical research about ivabradine in the context of anti-ischemic therapy for CAD patients. Actually most guidelines suggest ivabradine therapy as last resort antianginal drugs in patients with uncontrolled symptoms or excessive heart rate despite maximum tolerated beta-blockade. However, the peculiar pharmacologic effects of the drug suggest that most patients with CAD might benefit from adding ivabradine to their therapeutic schemata. In fact, even if the recently released main analysis of the SIGNIFY study seems not to support an employ of ivabradine in primary prevention, it is easy to imagine a future wider use of this drug in elderly patients with incomplete myocardial revascularization and in patients with total chronic coronary occlusions and failure or unacceptable risk for percutaneous or surgical coronary revascularization.
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Affiliation(s)
| | - Andrea Rognoni
- Catheterization Laboratory, Maggiore della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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Rognoni A, Cavallino C, Lupi A, Secco GG, Veia A, Bacchini S, Rosso R, Rametta F, Bongo AS. Novel biomarkers in the diagnosis of acute coronary syndromes: the role of circulating miRNAs. Expert Rev Cardiovasc Ther 2014; 12:1119-24. [DOI: 10.1586/14779072.2014.953483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Rognoni A, Cavallino C, Lupi A, Veia A, Rosso R, Rametta F, Bongo AS. Aortic counterpulsation in cardiogenic shock during acute myocardial infarction. Expert Rev Cardiovasc Ther 2014; 12:913-7. [DOI: 10.1586/14779072.2014.921116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bortnik M, Degiovanni A, Dell’Era G, Cavallino C, Occhetta E, Marino P. Prevalence of ventricular arrhythmias in patients with cardiac resynchronization therapy without back-up ICD. J Cardiovasc Med (Hagerstown) 2014; 15:301-6. [DOI: 10.2459/jcm.0b013e3283638148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rognoni A, Barbieri L, Cavallino C, Bacchini S, Veia A, Degiovanni A, Rametta F, Nardi F, Lazzero M, Lupi A, Bongo AS. Ranolazine: effects on ischemic heart. ACTA ACUST UNITED AC 2013; 8:197-203. [PMID: 23961914 DOI: 10.2174/15748901113089990023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/13/2013] [Accepted: 08/19/2013] [Indexed: 11/22/2022]
Abstract
Coronary artery disease is the major cause of mortality and morbidity in the industrialized countries; in the United States of America and in Europe, it is responsible for one of every six deaths per year. In the setting of ischemic heart disease, angina pectoris and chest pain, in particular, are the major causes of emergency department accesses. Angina pectoris is a clinical syndrome characterized by discomfort typically in the chest, neck, chin and left arm induced by physical exertion, emotional stress and cold and is relieved by rest or by taking of nitrates. The main targets of treatment of angina pectoris are to improve quality of life by reducing the frequency and the severity of symptoms, to increase functional capacity and to improve prognosis. Ranolazine is a recent antianginal drug with unique methods of action. It was approved by the US Food and Drug Administration in 2006 as add-on therapy in patients symptomatic for stable angina. With the inhibition of the late sodium current, Ranolazine protects against ion deregulation, prevents cellular calcium overload and the subsequent increase in diastolic tension without impacting heart rate and blood pressure. Short term clinical trials and patent research show that add on therapy with Ranolazine in patients with chronic stable angina significantly improves exercise duration, exercise time to angina and reduces the use of nitro glycerine. Long term clinical trials showed no significant differences in the rate of cardiovascular death and myocardial infarction in patients with non-ST segment elevation acute coronary syndromes but a reduction in terms of recurrent ischemia. Ranolazine is generally well tolerated and even if it increases the duration of QTc interval it is not associated with atrial and ventricular arrhythmias. Therefore Ranolazine represents a good therapeutic approach in patients with chronic stable angina still symptomatic, while on optimal anti-ischemic therapy, or intolerant to traditional anti-ischemic drugs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Angelo S Bongo
- Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carita" Hospital, Corso Mazzini 18, 28100 Novara, Italy.
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Cavallino C, Santagostino M, Facchini E, Di Ruocco V, Rognoni A. Low--molecular weight heparins and unfractionated heparins during primary coronary intervention. Cardiovasc Hematol Agents Med Chem 2013; 11:96-100. [PMID: 22963494 DOI: 10.2174/1871525711311020004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
Abstract
Coronary artery diseases continue to be the most common causes of mortality and morbidity in the industrialized world, especially in the setting of acute myocardial infarction. Anticoagulation during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) has traditionally been supported by anticoagulant unfractionated heparin (UFH). Recently, alternative anticoagulants such as low molecular weight heparin (LMWH) were included in the management of STEMI. The aim of the present review is to compare efficacy and safety outcomes among patients receiving low molecular weight heparins (LMWH) or unfractionated heparin (UFH) while undergoing PCI for STEMI.
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Affiliation(s)
- Chiara Cavallino
- Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy
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Lupi A, Rognoni A, Cavallino C, Secco GG, Prando MD, Santagostino M, Lazzero M, Cassetti E, Bongo AS. Pharmacological adjuvant therapies in primary coronary interventions: bivalirudin. Cardiovasc Hematol Agents Med Chem 2013; 11:106-114. [PMID: 22963495 DOI: 10.2174/1871525711311020006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/10/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
The direct thrombin inhibitor bivalirudin has gained popularity in cardiovascular medicine over the past decade because, in comparison with unfractionated heparin, it guarantees a predictable dose-related degree of anticoagulation with a low immunogenic profile and, possibly, with reduced rates of major bleeding complications. In the past bivalirudin has been frequently employed in the management of patients with heparin-induced thrombocytopenia. The REPLACE-2, ACUITY and ISAR-REACT4 studies demonstrated bivalirudin non-inferiority in comparison with unfractionated heparin in terms of ischemic end-points with a reduction of the bleeding rate also in patients acute coronary syndrome without ST elevation. Finally the results of the HORIZONS-AMI study positioned this drug as a first choice anticoagulant during percutaneous coronary interventions in patients with ST-elevation myocardial infarction. In fact the bivalirudin alone regimen, compared to unfractionated heparin plus GP2b3a inhibitors, decreased in-hospital bleeding rates and short and long term mortality. Given the body of clinical evidence, bivalirudin is likely to contend to GP2b3a inhibitors the leading place among the proposed anticoagulation strategies in the setting of acute coronary syndromes. The duration of the bivalirudin infusion after PCI and the optimal oral antiplatelet regimen associated to bivalirudin are important issues to be solved in future randomized controlled studies.
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Affiliation(s)
- Alessandro Lupi
- 2nd Division of Cardiology, University Hospital Maggiore della Carità, Novara, Italy
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Rognoni A, Lupi A, Cavallino C, Secco GG, Rosso R, Bongo AS. Intracoronary injection of drugs to treat no--reflow phenomenon and microcirculatory dysfunction. Cardiovasc Hematol Agents Med Chem 2013; 11:84-88. [PMID: 22973862 DOI: 10.2174/1871525711311020002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
Abstract
In a variant proportion of patients presenting with chest pain and electrocardiographic changes characteristic for ST - elevation myocardial infarction, percutaneous coronary intervention achieves epicardial coronary artery reperfusion but not the myocardial reperfusion (ranging from 5% to 50%). Furthermore, prolonged myocardial ischemia often breaks down the coronary microvasculature and the flow to the infarct myocardium may seem to be markedly reduced. This condition is known as no reflow - phenomenon. The no reflow - phenomenon is associated with an increased incidence of malignant ventricular arrhythmias, heart failure and 30-days mortality. In the recent years in literature, several articles (subsequently discussed in the present review) have been published and made relevant to the study of the pathophysiology regarding no reflow - phenomenon. This knowledge has assisted in the development of new treatment strategies, such as prophylactic use of vasodilators, mechanical devices and drugs inhibiting platelet. The review has focused on the current literature about intra - coronary injection of drugs to treat no - reflow and microvascular dysfunction.
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Affiliation(s)
- Andrea Rognoni
- Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy.
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Rognoni A, Lupi A, Cavallino C, Veia A, Bacchini S, Rosso R, Secco GG, Sante Bongo A. Levosimendan Preoperative. Curr Pharm Des 2013; 19:3974-8. [DOI: 10.2174/1381612811319220005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/03/2012] [Indexed: 11/22/2022]
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Rognoni A, Lupi A, Cavallino C, Rosso R, Veia A, Bacchini S, Bongo AS. Intracoronary injection of glycoprotein IIb/IIIa, abciximab, as adjuvant therapy in primary coronary intervention. Cardiovasc Hematol Agents Med Chem 2013; 11:89-95. [PMID: 23394547 DOI: 10.2174/1871525711311020003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/09/2012] [Accepted: 01/30/2013] [Indexed: 11/22/2022]
Abstract
Acute coronary syndromes and, in paticular, ST - segment elevation myocardial infarction are the principle causes or mortality and morbidity in the industrialized countries. The manadgement of acute myocadial infarction is much debated in the literature; primary percutaneous coronary intervention is the treatment of choice. In the recent years there has been an increasing interest in the concept of adjunctive pharmacological therapy to improve outcomes in primary percutaneous coronary intervention. In the literature randomized trials of intravenous or more recently intracoronary injection of glycoprotein IIb/IIIa inhibitors have provided conflicting results with no definitive evidence for efficacy. The aim of the report is to review the evidence to our date on the role of intracoronary injection of abciximab during primary percutaneous intervention in the setting of acute myocardial infarction.
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Affiliation(s)
- Andrea Rognoni
- Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy.
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Bortnik M, Degiovanni A, Cavallino C, Marino P. Ventricular fusion mimicking acute inferior myocardial infarction in a patient with a dual-chamber pacemaker. J Cardiol Cases 2012; 6:e106-e108. [DOI: 10.1016/j.jccase.2012.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/09/2012] [Accepted: 06/14/2012] [Indexed: 11/29/2022] Open
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Secco GG, Bortnik M, Rognoni A, Lupi A, Cavallino C, De Luca G, Marino PN. Stable ventricular fibrillation in a heterotopic heart transplant recipient. Heart Lung Circ 2012; 21:747-9. [PMID: 22858206 DOI: 10.1016/j.hlc.2012.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/02/2011] [Accepted: 02/25/2012] [Indexed: 11/29/2022]
Abstract
We present an unusual case of ventricular fibrillation in a conscious patient symptomatic for chest pain and shortness of breath. Almost 20 years ago he underwent heterotopic cardiac transplantation for the treatment of severe idiopathic cardiomyopathy. In the precyclosporine era, this technique was extremely useful because of the high rate of graft rejection in which the maintenance of the native heart could prevent patient death. To date, with the improvements in immunosuppressive therapy, it is generally reserved to a specific subset of conditions. A coronary angiography and a cardiac MRI confirmed the diagnosis. Six months follow-up ECG was unchanged suggesting the persistence of a double heart rhythm in the same body.
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Affiliation(s)
- Gioel Gabrio Secco
- Department of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
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Leva L, Brambilla M, Cavallino C, Matheoud R, Occhetta E, Marino P, Inglese E. Reproducibility and variability of global and regional dyssynchrony parameters derived from phase analysis of gated myocardial perfusion SPECT. Q J Nucl Med Mol Imaging 2012; 56:209-217. [PMID: 22402788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of the study was to assess the reproducibility (R) and variability of quantitative parameters derived from Cedars-Sinai QGS software for phase analysis of G-SPECT in 39 coronary artery disease (CAD) patients with or without severe heart-failure (HF). METHODS Phase standard deviation (s) and entropy (e) are global parameters that quantify dyssynchrony. Regional measures of dyssynchrony were also computed including differences between the lateral wall versus the septal wall (DmW) and differences between the averages of midventricular lateral versus midventricular septal segments (DmS). RESULTS Global parameters e and s and regional parameters DmW and DmS exhibit excellent values of R=0.92, 0.99, 0.99 and 0.96, respectively. In regional parameters DmW and DmS there is a significant variability in individual scoring assessed by a standard error of measurement of =9.17 and 21.7, respectively. The box plots of e in patients with or without HF do not show any significant superimposition, while the box plots of s and DmW show a partial overlap mainly due to the significant variability of s and DmW within patients with HF. Conversely the box plots of DmS in patients with or without HF show a significant overlap due to the great variability of DmS within patients with HF. CONCLUSION Regional parameters derived from phase analysis of G-SPECT studies are not useful in the individual assessment of dyssynchrony in CAD patients either due to large variability in individual scoring and to a large heterogeneity in HF patients. Global parameters (e and s) exhibit both an excellent reproducibility. Nonetheless, e seems to perform better than s in individual assessment of dyssynchrony due to a better separation between HF and non HF patients. Using the QGS software approach no manual intervention is necessary to ensure a good reproducibility of global parameters.
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Affiliation(s)
- L Leva
- Department of Nuclear Medicine, University Hospital, Maggiore della Carità, Novara, Italy
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Rognoni A, Lupi A, Secco GG, Cavallino C, Sansa M, Lazzero M, Bongo AS. Update on glycoprotein IIb/IIIa: role in primary coronary intervention. Cardiovasc Hematol Agents Med Chem 2011; 9:106-12. [PMID: 21574947 DOI: 10.2174/187152511796196524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022]
Abstract
Coronary artery diseases continue to be the most common causes of mortality and morbidity in the industrialized world, especially in the setting of acute myocardial infarction. Platelets play a crucial role in thrombosis and haemostasis, which can be either beneficial or deleterious, depending on the circumstances. Platelet hyperreactivity is a multifactor process depending on genetic polymorphism, pathological state and lifestyle; it contributes to the activation of the thrombotic cascade. Under pathophysiological conditions platelets activation plays a critical role in arterial thrombosis including platelets aggregation, the basis of destabilization of coronary plaque. Despite the benefits observed in outcome when primary angioplasty is compared with thrombolysis for the treatment of acute myocardial infarction there is still some room for improvement; unfortunately the restoration of an "optimal" epicardial flow is not always related to an "optimal" myocardial reperfusion. In the recent, past several studies have shown significant benefits with the administration of glycoprotein IIb/IIIa inhibitors. Thus, the aim of the present review is to perform an update on factors associated with platelets hyperactivity and on adjunctive glycoprotein IIb - IIIa inhibitors in primary angioplasty.
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Affiliation(s)
- Andrea Rognoni
- Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy.
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Tomasoni L, Sitia S, Borghi C, Cicero A, Ceconi C, Cecaro F, Morganti A, De Gennaro Colonna V, Guazzi M, Morricone L, Malavazos A, Marino P, Cavallino C, Shoenfeld Y, Turiel M. Effects of treatment strategy on endothelial function. Autoimmun Rev 2010; 9:840-4. [DOI: 10.1016/j.autrev.2010.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2010] [Indexed: 10/19/2022]
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