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Galli M, Niccoli G, De Maria G, Brugaletta S, Montone RA, Vergallo R, Benenati S, Magnani G, D'Amario D, Porto I, Burzotta F, Abbate A, Angiolillo DJ, Crea F. Coronary microvascular obstruction and dysfunction in patients with acute myocardial infarction. Nat Rev Cardiol 2024; 21:283-298. [PMID: 38001231 DOI: 10.1038/s41569-023-00953-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Despite prompt epicardial recanalization in patients presenting with ST-segment elevation myocardial infarction (STEMI), coronary microvascular obstruction and dysfunction (CMVO) is still fairly common and is associated with poor prognosis. Various pharmacological and mechanical strategies to treat CMVO have been proposed, but the positive results reported in preclinical and small proof-of-concept studies have not translated into benefits in large clinical trials conducted in the modern treatment setting of patients with STEMI. Therefore, the optimal management of these patients remains a topic of debate. In this Review, we appraise the pathophysiological mechanisms of CMVO, explore the evidence and provide future perspectives on strategies to be implemented to reduce the incidence of CMVO and improve prognosis in patients with STEMI.
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Affiliation(s)
- Mattia Galli
- Department of Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Gianluigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Salvatore Brugaletta
- Institut Clinic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Stefano Benenati
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Giulia Magnani
- Department of Cardiology, University of Parma, Parma, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore Della Carita', Novara, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Sciencies, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division of Cardiology - Heart and Vascular Center, University of Virginia, Charlottesville, VA, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
| | - Filippo Crea
- Department of Cardiovascular Sciencies, Catholic University of the Sacred Heart, Rome, Italy
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Galli M, Niccoli G, De Maria G, Brugaletta S, Montone RA, Vergallo R, Benenati S, Magnani G, D'Amario D, Porto I, Burzotta F, Abbate A, Angiolillo DJ, Crea F. Author Correction: Coronary microvascular obstruction and dysfunction in patients with acute myocardial infarction. Nat Rev Cardiol 2024; 21:347. [PMID: 38052973 DOI: 10.1038/s41569-023-00974-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Mattia Galli
- Department of Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Gianluigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Salvatore Brugaletta
- Institut Clinic Cardiovascular, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Stefano Benenati
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Giulia Magnani
- Department of Cardiology, University of Parma, Parma, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore Della Carita', Novara, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Sciencies, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division of Cardiology - Heart and Vascular Center, University of Virginia, Charlottesville, VA, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
| | - Filippo Crea
- Department of Cardiovascular Sciencies, Catholic University of the Sacred Heart, Rome, Italy
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D'Amario D, Laborante R, Santangeli P. Comorbidities and cardiac resynchronization therapy: Do we talk the talk or should we walk the walk? Eur J Heart Fail 2024. [PMID: 38561983 DOI: 10.1002/ejhf.3203] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Galante D, Leone AM, Migliaro S, DI Giusto F, Anastasia G, Petrolati E, Viceré A, Zimbardo G, Cialdella P, Basile E, D'Amario D, Vergallo R, Montone RA, Buffon A, Romagnoli E, Aurigemma C, Burzotta F, Trani C, Crea F. Prognostic value of combined fractional flow reserve and pressure-bounded coronary flow reserve: outcomes in FFR and Pb-CFR assessment. Minerva Cardiol Angiol 2024; 72:152-162. [PMID: 37930018 DOI: 10.23736/s2724-5683.23.06399-8] [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] [Indexed: 11/07/2023]
Abstract
BACKGROUND Coronary flow reserve (CFR) has an emerging role to predict outcome in patients with and without flow-limiting stenoses. However, the role of its surrogate pressure bounded-CFR (Pb-CFR) is controversial. We investigated the usefulness of combined use of fractional flow reserve (FFR) and Pb-CFR to predict outcomes. METHODS This is a sub-study of the PROPHET-FFR Trial, including patients with chronic coronary syndrome and functionally tested coronary lesions. Patients were divided into four groups based on positive or negative FFR (cut-off 0.80) and preserved (lower boundary ≥2) or reduced (upper boundary <2) Pb-CFR: Group1 FFR≤0.80/ Pb-CFR <2; Group 2 FFR≤0.80/Pb-CFR≥2; Group 3 FFR >0.80/Pb-CFR<2; Group 4 FFR>0.80/Pb-CFR≥2. Lesions with positive FFR were treated with PCI. Primary endpoint was the rate of major adverse cardiac events (MACEs), defined as a composite of death from any cause, myocardial infarction, target vessel revascularization, unplanned cardiac hospitalization at 36-months. RESULTS A total of 609 patients and 816 lesions were available for the analysis. At Kaplan-Meier analysis MACEs rate was significantly different between groups (36.7% Group 1, 27.4% Group 2, 19.2% Group 3, 22.6% Group 4, P=0.019) and more prevalent in groups with FFR≤0.80 irrespective of Pb-CFR. In case of discrepancy, no difference in MACEs were observed between groups stratified by Pb-CFR. FFR≤0.80 was associated with an increased MACEs rate (30.2% vs. 21.5%, P<0.01) while Pb-CFR<2 was not (24.5% vs. 24.2% Pb-CFR≥2 P=0.67). CONCLUSIONS FFR confirms its ability to predict outcomes in patients with intermediate coronary stenoses. Pb-CFR does not add any relevant prognostic information.
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Affiliation(s)
- Domenico Galante
- Sacred Heart Catholic University, Rome, Italy
- Operative Unit of Diagnostic and Interventional Cardiology, Fatebenefratelli Gemelli Isola Tiberina Hospital, Rome, Italy
| | - Antonio M Leone
- Sacred Heart Catholic University, Rome, Italy -
- Operative Unit of Diagnostic and Interventional Cardiology, Fatebenefratelli Gemelli Isola Tiberina Hospital, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | | | | | | | | | | | | | | | - Domenico D'Amario
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonino Buffon
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Burzotta
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo Trani
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Filippo Crea
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Borovac JA, D'Amario D. Management of dyslipidemia after atherosclerotic cardiovascular event: Still a long way to go…and we know it. Int J Cardiol 2024:131967. [PMID: 38508324 DOI: 10.1016/j.ijcard.2024.131967] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Josip Andelo Borovac
- KBC Split, Cardiovascular Diseases Department, Split Clinical Hospital Centre, Soltanska 1, 210000 Split, Croatia.
| | - Domenico D'Amario
- KBC Split, Cardiovascular Diseases Department, Split Clinical Hospital Centre, Soltanska 1, 210000 Split, Croatia
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Galli M, Laborante R, Occhipinti G, Zito A, Spadafora L, Biondi-Zoccai G, Nerla R, Castriota F, D'Amario D, Capodanno D, Jeong YH, Kimura T, Mehran R, Angiolillo DJ. Impact of ethnicity on antiplatelet treatment regimens for bleeding reduction in acute coronary syndromes: a systematic review and pre-specified subgroup meta-analysis. Eur Heart J Cardiovasc Pharmacother 2024; 10:158-169. [PMID: 37960983 DOI: 10.1093/ehjcvp/pvad085] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
AIMS Randomized controlled trials (RCTs) testing bleeding reduction strategies using antiplatelet treatment regimens (BRATs) in acute coronary syndromes (ACS) have shown promising results, but the generalizability of these findings may be significantly influenced by the ethnicity of the patients enrolled, given that East Asian (EA) patients show different ischaemic-bleeding risk profile compared to non-EA patients. METHODS AND RESULTS RCTs comparing a BRAT vs. standard 12-month dual antiplatelet therapy (DAPT) in patients with ACS undergoing percutaneous coronary intervention (PCI) were selected. The primary efficacy endpoint was major adverse cardiovascular events (MACE) as defined in each trial and the primary safety endpoint was minor or major bleeding. Twenty-six RCTs testing seven different BRATs were included. The only strategy associated with a trade-off in MACE was 'upfront unguided de-escalation' in the subgroup of non-EAs (risk ratio 1.16, 95% confidence interval 1.09-1.24). All but aspirin monotherapy-based strategies (i.e. 'short and very short DAPT followed by aspirin') were associated with reduced bleeding compared with standard DAPT in both EA and non-EA patients. There were no significant differences between subgroups, but the lack of RCTs in some of the included strategies and the difference in the certainty of evidence between EA and non-EA patients revealed that the evidence in support of different BRATs in ACS undergoing PCI is influenced by ethnicity. Moreover, absolute risk reduction estimation revealed that some BRATs might be more effective than others in reducing bleeding according to ethnicity. CONCLUSION The majority of BRATs are associated with reduced bleeding without any trade-off in hard ischaemic endpoints regardless of ethnicity. However, the supporting evidence and relative safety profiles of different BRATs might be significantly affected by ethnicity, which should be taken into account in clinical practice. STUDY REGISTRATION This study is registered in PROSPERO (CRD42023416710).
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Affiliation(s)
- Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico 'G. Rodolico-San Marco', University of Catania, Catania, Italy
| | - Andea Zito
- Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Spadafora
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Nerla
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Domenico D'Amario
- Dipartimento Universitario di Medicina Traslazionale, Università Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico 'G. Rodolico-San Marco', University of Catania, Catania, Italy
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
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7
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Bianchini E, Lombardi M, Buonpane A, Ricchiuto A, Maino A, Laborante R, Anastasia G, D'Amario D, Aurigemma C, Romagnoli E, Leone AM, D'Ascenzo F, Trani C, Crea F, Porto I, Burzotta F, Vergallo R. Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials. Int J Cardiol 2024; 397:131590. [PMID: 37979785 DOI: 10.1016/j.ijcard.2023.131590] [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: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI). METHODS PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA. RESULTS A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04). CONCLUSION TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.
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Affiliation(s)
- Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Maino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianluca Anastasia
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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8
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Zito A, Restivo A, D'Amario D. Reply to "Comment on: Heart failure management guided by remote multiparameter monitoring: A meta-analysis". Int J Cardiol 2024; 397:131545. [PMID: 37866787 DOI: 10.1016/j.ijcard.2023.131545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
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Restivo A, Paglianiti DA, D'Amario D. Left atrial pressure-assisted acute heart failure management in the cardiac intensive care unit: a proof-of-concept. Eur Heart J 2023; 44:5169. [PMID: 37883701 DOI: 10.1093/eurheartj/ehad730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 1, 00168 Rome, Italy
| | - Donato Antonio Paglianiti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 1, 00168 Rome, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Corso Mazzini 18, Padiglione A, 28100 Novara, Italy
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10
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Cinti F, Leccisotti L, Sorice GP, Capece U, D'Amario D, Lorusso M, Gugliandolo S, Morciano C, Guarneri A, Guzzardi MA, Mezza T, Capotosti A, Indovina L, Ferraro PM, Iozzo P, Crea F, Giordano A, Giaccari A. Dapagliflozin treatment is associated with a reduction of epicardial adipose tissue thickness and epicardial glucose uptake in human type 2 diabetes. Cardiovasc Diabetol 2023; 22:349. [PMID: 38115004 PMCID: PMC10731727 DOI: 10.1186/s12933-023-02091-0] [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: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE We recently demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) leads to an increase in myocardial flow reserve in patients with type 2 diabetes (T2D) with stable coronary artery disease (CAD). The mechanism by which this occurs is, however, unclear. One of the risk factors for cardiovascular disease is inflammation of epicardial adipose tissue (EAT). Since the latter is often increased in type 2 diabetes patients, it could play a role in coronary microvascular dysfunction. It is also well known that SGLT-2i modify adipose tissue metabolism. We aimed to investigate the effects of the SGLT-2i dapagliflozin on metabolism and visceral and subcutaneous adipose tissue thickness in T2D patients with stable coronary artery disease and to verify whether these changes could explain observed changes in myocardial flow. METHODS We performed a single-center, prospective, randomized, double-blind, controlled clinical trial with 14 T2D patients randomized 1:1 to SGLT-2i dapagliflozin (10 mg daily) or placebo. The thickness of visceral (epicardial, mediastinal, perirenal) and subcutaneous adipose tissue and glucose uptake were assessed at baseline and 4 weeks after treatment initiation by 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography during hyperinsulinemic euglycemic clamp. RESULTS The two groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, BMI, renal and heart function). Dapagliflozin treatment significantly reduced EAT thickness by 19% (p = 0.03). There was a significant 21.6% reduction in EAT glucose uptake during euglycemic hyperinsulinemic clamp in the dapagliflozin group compared with the placebo group (p = 0.014). There were no significant effects on adipose tissue thickness/metabolism in the other depots explored. CONCLUSIONS SGLT-2 inhibition selectively reduces EAT thickness and EAT glucose uptake in T2D patients, suggesting a reduction of EAT inflammation. This could explain the observed increase in myocardial flow reserve, providing new insights into SGLT-2i cardiovascular benefits.
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Affiliation(s)
- Francesca Cinti
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Leccisotti
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Pio Sorice
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
- Sezione di Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica - (DiMePRe-J), Università Degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Umberto Capece
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, UOC Di Cardiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
- Università del Piemonte Orientale , Dipartimento Medicina Translazionale, Novara, Italy
| | - Margherita Lorusso
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Shawn Gugliandolo
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cassandra Morciano
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Cliniche e Sperimentali, Medicina Interna - Università degli Studi di Brescia, Brescia, BS, Italy
| | - Andrea Guarneri
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Angela Guzzardi
- Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Teresa Mezza
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
- Pancreas Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Amedeo Capotosti
- UOSD Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Luca Indovina
- UOSD Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patricia Iozzo
- Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, UOC Di Cardiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Giaccari
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
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11
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D'Amario D, Borovac JA, Patti G. A machine-learning-based prediction model in patients with takotsubo syndrome: 'You can't stop change any more than you can stop the suns from setting!'. Eur J Heart Fail 2023; 25:2312-2315. [PMID: 37975147 DOI: 10.1002/ejhf.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Josip Angelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
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12
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D'Amario D, Galli M, Restivo A, Canonico F, Vergallo R, Migliaro S, Trani C, Burzotta F, Aurigemma C, Laborante R, Romagnoli E, Francese F, Ceccarelli I, Borovac JA, Angiolillo DJ, Tavazzi B, Leone AM, Crea F, Patti G, Porto I. Ticagrelor Enhances the Cardioprotective Effects of Ischemic Preconditioning in Stable Patients Undergoing Percutaneous Coronary Intervention: the TAPER-S Randomized Study. Eur Heart J Cardiovasc Pharmacother 2023:pvad092. [PMID: 38006237 DOI: 10.1093/ehjcvp/pvad092] [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] [Indexed: 11/26/2023]
Abstract
BACKGROUND Ticagrelor improves clinical outcomes in patients with acute coronary syndrome compared with clopidogrel. Ticagrelor also inhibits cell uptake of adenosine and has been associated with cardioprotective effects in animal models. We sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS This was a Prospective Randomized Open Blinded End-points (PROBE) trial enrolling stable patients with coronary artery disease (CAD) requiring fractional flow reserve (FFR)-guided PCI of intermediate epicardial coronary lesions. ST-segment elevation at intracoronary (IC)-ECG during a two-step sequential coronary balloon inflations in the reference vessel during PCI was used as an indirect marker of cardioprotection induced by ischemic preconditioning. The primary endpoint of the study was the comparison of the delta (Δ) (difference) ST-segment elevation measured by intracoronary-ECG during two-step sequential coronary balloon inflations. RESULTS Fifty-three patients were randomized to either clopidogrel or ticagrelor. The study was stopped earlier because the primary endpoint was met at a pre-specified interim analysis. ΔST-segment elevation was significantly higher in ticagrelor as compared to clopidogrel arms (p<0.0001). Ticagrelor was associated with lower angina score during coronary balloon inflations. There was no difference in coronary microvascular resistance between groups. Adenosine serum concentrations were increased in patients treated with ticagrelor as compared to those treated with clopidogrel. CONCLUSIONS Ticagrelor enhances the cardioprotective effects of ischemic preconditioning compared with clopidogrel in stable patients with CAD undergoing PCI. Further studies are warranted to fully elucidate the mechanisms through which ticagrelor may exert cardioprotective effects in humans. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique Identifier: NCT02701140.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Attilio Restivo
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Canonico
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca Francese
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ilaria Ceccarelli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine (USSM) and Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Split, Croatia
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Barbara Tavazzi
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Patti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino, Genova, Italy - Italian IRCCS Cardiovascular Network
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italy
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13
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D'Amario D, Laborante R, Bianchini E, Galli M, Ciliberti G, Mennuni M, Patti G. Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials. Int J Cardiol 2023; 391:131219. [PMID: 37527752 DOI: 10.1016/j.ijcard.2023.131219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/23/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Cardiotoxicity occurs in 5-20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines. METHODS PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed. RESULTS On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33-0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66-3.1, P < 0.01; I2 = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 - +4.79, P = 0.05; I2 = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF. CONCLUSIONS The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
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Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Mennuni
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
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14
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Laborante R, Bianchini E, Borovac JA, D'Amario D. High-Dose Statins in Preventing Microvascular Obstruction: "The Devil Lies in the Details". Am J Cardiol 2023; 206:384-387. [PMID: 37748957 DOI: 10.1016/j.amjcard.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Josip A Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department University Hospital of Split, Split, Croatia; Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
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15
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Ghizzoni G, Di Serafino L, Botti G, Galante D, D'Amario D, Benenati S, Gurgoglione FL, Laborante R, Pompei G, Porto I, Campo GC, Niccoli G, Esposito G, Leone AM, Chieffo A. [Ischemia with non-obstructive coronary artery disease: state-of-the-art review]. G Ital Cardiol (Rome) 2023; 24:5S-20S. [PMID: 37767843 DOI: 10.1714/4101.40990] [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: 09/29/2023]
Abstract
Chest pain affects more than 100 million people globally, however up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease and ischemia with non-obstructive coronary artery disease (INOCA) is often a cause of the clinical picture. The symptoms reported by INOCA patients are very heterogeneous and often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. The underlying pathophysiological mechanisms of INOCA are multiple and include coronary vasospasm and microvascular dysfunction. Most importantly, this condition must not be considered benign: compared to asymptomatic individuals, INOCA patients present an increased incidence of cardiovascular events, rehospitalizations, as well as impaired quality of life, with increasing costs for healthcare systems. The aims of this review are to describe the pathophysiological and clinical characteristics of INOCA and to provide guidance to the medical community on the diagnostic approaches and management of INOCA, also via a series of clinical case reports.
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Affiliation(s)
- Giulia Ghizzoni
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
| | - Luigi Di Serafino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Giulia Botti
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
| | - Domenico Galante
- Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Roma - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Domenico D'Amario
- Dipartimento di Cardiologia Traslazionale, Università del Piemonte Orientale, Novara
| | - Stefano Benenati
- Dipartimento di Medicina Interna, Università degli Studi, Genova - Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | | | - Renzo Laborante
- Dipartimento di Scienze Cardiovascolari e Polmonari, Università Cattolica del Sacro Cuore, Roma
| | - Graziella Pompei
- U.O. Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE)
| | - Italo Porto
- Dipartimento di Medicina Interna, Università degli Studi, Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | | | | | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Antonio Maria Leone
- Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Roma - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Alaide Chieffo
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
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16
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Zito A, Restivo A, Ciliberti G, Laborante R, Princi G, Romiti GF, Galli M, Rodolico D, Bianchini E, Cappannoli L, D'Oria M, Trani C, Burzotta F, Cesario A, Savarese G, Crea F, D'Amario D. Heart failure management guided by remote multiparameter monitoring: A meta-analysis. Int J Cardiol 2023; 388:131163. [PMID: 37429443 DOI: 10.1016/j.ijcard.2023.131163] [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: 04/06/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Several implant-based remote monitoring strategies are currently tested to optimize heart failure (HF) management by anticipating clinical decompensation and preventing hospitalization. Among these solutions, the modern implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been equipped with sensors allowing continuous monitoring of multiple preclinical markers of worsening HF, including factors of autonomic adaptation, patient activity, and intrathoracic impedance. OBJECTIVES We aimed to assess whether implant-based multiparameter remote monitoring strategy for guided HF management improves clinical outcomes when compared to standard clinical care. METHODS A systematic literature research for randomized controlled trials (RCTs) comparing multiparameter-guided HF management versus standard of care was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and HF hospitalization events, whereas secondary endpoints included the individual components of the primary outcome. RESULTS Our meta-analysis included 6 RCTs, amounting to a total of 4869 patients with an average follow-up time of 18 months. Compared with standard clinical management, the multiparameter-guided strategy reduced the risk of the primary composite outcome (IRR 0.83, 95%CI 0.71-0.99), driven by statistically significant effect on both HF hospitalization events (IRR 0.75, 95%CI 0.61-0.93) and all-cause death (IRR 0.80, 95%CI 0.66-0.96). CONCLUSION Implant-based multiparameter remote monitoring strategy for guided HF management is associated with significant benefit on clinical outcomes compared to standard clinical care, providing a benefit on both hospitalization events and all-cause death.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marika D'Oria
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Cesario
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; CEO, Gemelli Digital Medicine & Health Srl, Rome, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
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17
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Lombardi M, Chiabrando JG, Romagnoli E, D'Amario D, Leone AM, Aurigemma C, Montone RA, Ricchiuto A, Biondi-Zoccai G, Burzotta F, Jang IK, Escaned J, Trani C, Porto I, Crea F, Vergallo R. Impact of acute and persistent stent malapposition after percutaneous coronary intervention on adverse cardiovascular outcomes. Minerva Cardiol Angiol 2023; 71:525-534. [PMID: 36912166 DOI: 10.23736/s2724-5683.22.06185-3] [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] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The association of coronary stent malapposition (SM) and adverse clinical outcomes after percutaneous coronary intervention (PCI) remains unclear. We aimed to perform a systematic review and meta-analysis of randomized and observational studies to assess the association between acute and persistent SM detected using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and adverse cardiovascular outcomes. EVIDENCE ACQUISITION Available studies were identified through a systematic search of PubMed, reference lists of relevant articles, and Medline. Main efficacy outcomes of interest were: device-oriented composite endpoint (DoCE, including cardiac death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]), major safety events (MSE, including cardiac death, MI and ST), TLR, and ST. A sensitivity analysis regarding the impact of major malapposition was also performed. EVIDENCE SYNTHESIS A total of 9 studies enrolling 6497 patients were included in the meta-analysis. After a mean follow-up of 24±14 months, overall acute and/or persistent malapposition was not significantly associated with the occurrence of all the outcomes of interest, including DoCE (risk ratio [RR] 1.00, 95% confidence interval [CI, 0.79-1.26], P=0.99), MSE (RR 1.42, 95%CI [0.81-2.50], P=0.22), TLR (RR 0.84, 95%CI [0.59-1.19], P=0.33), and ST (RR 1.16, 95%CI [0.48-2.85], P=0.74). In the sensitivity analysis, we found a significant increase of MSE in patients with major malapposition (RR 2.97, 95%CI [1.51-5.87], P=0.001). CONCLUSIONS Acute and persistent SM were not overall associated with adverse cardiovascular clinical outcomes at follow-up. However, major malapposition was associated with an increased risk of major safety events, including cardiac death, MI and ST. These findings should be taken into account during stent implantation and PCI optimization.
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Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan G Chiabrando
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Enrico Romagnoli
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy -
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
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18
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Romagnoli E, Burzotta F, Cerracchio E, Russo G, Aurigemma C, Pedicino D, Locorotondo G, Graziani F, Leone AM, D'Amario D, Lombardo A, Malara S, Fulco L, Bianchini F, Sanna T, Trani C. Impact of Impella protected-percutaneous coronary intervention on left ventricle function recovery of patients with extensive coronary disease and poor left ventricular function. Int J Cardiol 2023; 387:131098. [PMID: 37290663 DOI: 10.1016/j.ijcard.2023.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/26/2023] [Revised: 04/15/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The use of Impella support is increasingly adopted to "protect" patients with severe coronary artery disease (CAD) and left ventricle (LV) dysfunction undergoing percutaneous coronary intervention (PCI). AIMS To evaluate the impact of Impella-protected (Abiomed, Danvers, Massachusetts, USA) PCIs on myocardial function recovery. METHODS Patients with significant LV dysfunction undergoing multi-vessel PCIs with pre-intervention Impella implantation were evaluated by echocardiography before PCI and at median follow up of 6 months: global and segmental LV contractile function were assessed by LV ejection fraction (LVEF) and wall motion score index (WMSI), respectively. Extent of revascularization was graded using the British Cardiovascular Intervention Society Jeopardy score (BCIS-JS). Study endpoints were LVEF and WMSI improvement, and its correlation with revascularization. RESULTS A total of 48 high surgical risk (mean EuroSCORE II 8) patients with median LVEF value of 30%, extensive wall motion abnormalities (median WMSI 2.16), and severe multi-vessel CAD (mean SYNTAX score 35) were included. PCIs brought a significant reduction of ischemic myocardium burden with BCIS-JS decrease from mean value of 12 to 4 (p < 0.001). At follow-up, WMSI reduced from 2.2 to 2.0 (p = 0.004) and LVEF increased from 30% to 35% (p = 0.016). WMSI improvement was proportional to the baseline impairment (R - 0.50, p < 0.001), and confined to revascularized segments (from 2.1 to 1.9, p < 0.001). CONCLUSIONS In patients with extensive CAD and severe LV dysfunction, multi-vessel Impella-protected PCI was associated to an appreciable contractile recovery, mainly determined by regional wall motion improvement in revascularized segments.
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Affiliation(s)
- Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Emma Cerracchio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulio Russo
- Division of Cardiology, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | - Antonella Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia Malara
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Linda Fulco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Tommaso Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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19
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D'Amario D, Rodolico D, Delvinioti A, Laborante R, Iacomini C, Masciocchi C, Restivo A, Ciliberti G, Galli M, Paglianiti AD, Iaconelli A, Zito A, Lenkowicz J, Patarnello S, Cesario A, Valentini V, Crea F. Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge. J Am Heart Assoc 2023; 12:e029071. [PMID: 37382176 PMCID: PMC10356099 DOI: 10.1161/jaha.122.029071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/02/2022] [Accepted: 05/05/2023] [Indexed: 06/30/2023]
Abstract
Background Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real-world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event. Methods and Results A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number/type of treatments prescribed at discharge. The prevalence of contraindications and cautions for HF with reduced ejection fraction treatments was systematically assessed. Logistic regression models were fitted to assess predictors of the number of treatments (≥2 versus <2 drugs) prescribed and the risk of rehospitalization. A population of 305 patients with a first episode of HF hospitalization and a diagnosis of HF with reduced ejection fraction (ejection fraction, <40%) was selected. At discharge, 49.2% received 2 current recommended drugs, β-blockers were prescribed in 93.4%, while a renin-angiotensin system inhibitor or an angiotensin receptor-neprilysin inhibitor was prescribed in 68.2%. A mineralocorticoid receptor antagonist was prescribed in 32.5%, although none of the patients showed contraindications to mineralocorticoid receptor antagonist prescription. A sodium-glucose cotransporter 2 inhibitor could be prescribed in 71.1% of patients. On the basis of current recommendations, 46.2% could receive the 4 foundational drugs at discharge. Renal dysfunction was associated with <2 foundational drugs prescribed. After adjusting for age and renal function, use of ≥2 drugs was associated with lower risk of rehospitalization during the 30 days after discharge. Conclusions A quadruple therapy could be directly implementable at discharge, potentially providing prognostic advantages. Renal dysfunction was the main prevalent condition limiting this approach.
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Affiliation(s)
- Domenico D'Amario
- Department of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Agni Delvinioti
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Chiara Iacomini
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | | | - Attilio Restivo
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
- Maria Cecilia HospitalGVM Care and ResearchCotignolaItaly
| | | | - Antonio Iaconelli
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | - Andrea Zito
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
| | | | | | - Alfredo Cesario
- Open Innovation Unit, Scientific DirectionFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Vincenzo Valentini
- Department of Bioimaging, Radiation Oncology and HematologyFondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica S. CuoreRomeItaly
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary SciencesCatholic University of the Sacred HeartRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
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20
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Iaconelli A, Pellicori P, Dolce P, Busti M, Ruggio A, Aspromonte N, D'Amario D, Galli M, Princi G, Caiazzo E, Rezig AOM, Maffia P, Pecorini G, Crea F, Cleland JGF. Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of randomized trials. Eur J Heart Fail 2023; 25:1094-1104. [PMID: 37211964 DOI: 10.1002/ejhf.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). METHODS AND RESULTS We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79-0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70-0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74-1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed. CONCLUSIONS For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.
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Affiliation(s)
- Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Matteo Busti
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Aureliano Ruggio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore della Carità', Novara, Italy
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Princi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisabetta Caiazzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Asma O M Rezig
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pasquale Maffia
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Giovanni Pecorini
- Cardiovascular Internal Medicine Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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21
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Galli M, Bernardi M, Ortega-Paz L, Nerla R, D'Amario D, Franchi F, Biondi-Zoccai G, Angiolillo DJ. Bivalirudin in acute coronary syndromes. Expert Rev Cardiovasc Ther 2023; 21:901-911. [PMID: 37919937 DOI: 10.1080/14779072.2023.2273902] [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: 09/03/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Bivalirudin, a bivalent direct thrombin inhibitor, has been developed to reduce bleeding without any trade-off in thrombotic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). AREAS COVERED Despite showing a superior safety profile compared with unfractionated heparin (UFH), bivalirudin is not considered the anticoagulant of choice in ACS patients undergoing PCI, mainly because of an increased rate of acute stent thrombosis (ST) shown by several randomized controlled trials (RCTs), in addition to limited availability in certain countries and increased costs. However, RCTs on bivalirudin have been characterized by several confounding factors hindering the interpretation of its safety and efficacy compared with UFH among the spectrum of ACS patients. Furthermore, a significant body of evidence has demonstrated that the risk of acute ST can be mitigated by a full-dose infusion regimen following PCI, without compromising the favorable safety profile compared to UFH. EXPERT OPINION In light of the increased understanding of the prognostic relevance of bleeding events and the excellent safety profile of bivalirudin, recent trial evidence may allow for this anticoagulant agent to reemerge and have a more prominent role in the management of ACS patients undergoing PCI.
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Affiliation(s)
- Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Marco Bernardi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Roberto Nerla
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Domenico D'Amario
- Dipartimento Universitario di Medicina Traslazionale, Università Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
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22
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Zito A, Galli M, Biondi-Zoccai G, Abbate A, Douglas PS, Princi G, D'Amario D, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis. Ann Intern Med 2023. [PMID: 37276592 DOI: 10.7326/m23-0231] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND There is uncertainty about which diagnostic strategy for detecting coronary artery disease (CAD) provides better outcomes. PURPOSE To compare the effect on clinical management and subsequent health effects of alternative diagnostic strategies for the initial assessment of suspected stable CAD. DATA SOURCES PubMed, Embase, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized clinical trials comparing diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD. DATA EXTRACTION Three investigators independently extracted study data. DATA SYNTHESIS The strongest available evidence was for 3 of the 6 comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) (4 trials), CCTA versus exercise electrocardiography (ECG) (2 trials), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) (5 trials). Compared with direct ICA referral, CCTA was associated with no difference in cardiovascular death and myocardial infarction (relative risk [RR], 0.84 [95% CI, 0.52 to 1.35]; low certainty) but less index ICA (RR, 0.23 [CI, 0.22 to 0.25]; high certainty) and index revascularization (RR, 0.71 [CI, 0.63 to 0.80]; moderate certainty). Moreover, CCTA was associated with a reduction in cardiovascular death and myocardial infarction compared with exercise ECG (RR, 0.66 [CI, 0.44 to 0.99]; moderate certainty) and SPECT-MPI (RR, 0.64 [CI, 0.45 to 0.90]; high certainty). However, CCTA was associated with more index revascularization (RR, 1.78 [CI, 1.33 to 2.38]; moderate certainty) but less downstream testing (RR, 0.56 [CI, 0.45 to 0.71]; very low certainty) than exercise ECG. Low-certainty evidence compared SPECT-MPI versus exercise ECG (2 trials), SPECT-MPI versus stress cardiovascular magnetic resonance imaging (1 trial), and stress echocardiography versus exercise ECG (1 trial). LIMITATION Most comparisons primarily rely on a single study, many studies were underpowered to detect potential differences in direct health outcomes, and individual patient data were lacking. CONCLUSION For the initial assessment of patients with suspected stable CAD, CCTA was associated with similar health effects to direct ICA referral, and with a health benefit compared with exercise ECG and SPECT-MPI. Further research is needed to better assess the relative performance of each diagnostic strategy. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42022329635).
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (M.G.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (G.B.)
- Mediterranea Cardiocentro, Napoli, Italy (G.B.)
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia (A.A.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (P.S.D.)
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy (D.D.)
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
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23
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Giallauria F, Baratta R, Costa F, D'Amario D, DE Gennaro L, Giubilato S, Mattina A, Provenzano M, Santoro D, Versaci F. New paradigm for the management of cardio-nephro-metabolic syndrome: multidisciplinary approach and role of telemedicine. Minerva Med 2023; 114:345-356. [PMID: 36255711 DOI: 10.23736/s0026-4806.22.08165-4] [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: 06/13/2023]
Abstract
Heart failure (HF), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) are some of the most important health problems of this century, and these three conditions often coexist, one worsening the prognosis of the other two. No disease is more important than the others in the composition of risk, which is significantly increased by their overlap. Thus, it would be more appropriate to refer to this cluster as cardio-nephro-metabolic syndrome. The aim of this review is to promote the development of an integrated multidisciplinary approach to the treatment of HF, T2DM and CKD in a perspective of paradigm shift from an individual management among different specialists to a shared one. Nowadays, this is achievable thanks to telemedicine and optimized therapy consisting in the new drugs with pleiotropic effect available today. The need is to have technological solutions, which also include telemedicine, for the management of patients affected by all three diseases to consider their fragility, sometimes due to a wrong, partial, or incomplete treatment. Multicentric, multidisciplinary trials on cardio-nephro-metabolic syndrome and new telemedicine/telemonitoring technologies could help place the chronic and fragile patient at the center of such multidimensionally integrated care.
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Affiliation(s)
- Francesco Giallauria
- Unit of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Francesco Costa
- Unit of Interventional Cardiology, G. Martino University Hospital, University of Messina, Messina, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luisa DE Gennaro
- Unit of Cardiology and Coronary Care Unit, San Paolo Hospital, E. Cannizzaro Hospital, Catania, Italy
| | - Simona Giubilato
- Cardiology, Coronary Care Unit and Hemodynamics, E. Cannizzaro Hospital, Catania, Italy
| | - Alessandro Mattina
- Unit of Diabetes and Islet Transplantation, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC) Italy, Palermo, Italy
| | - Michele Provenzano
- Department of Specialized, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy -
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
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D'Amario D, Rodolico D, Savarese G. Reply to: 'What is the optimal dose of neurohormonal modulators in patients with heart failure? The higher the better?'. Eur J Heart Fail 2023; 25:770-771. [PMID: 36987878 DOI: 10.1002/ejhf.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Domenico D'Amario
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Daniele Rodolico
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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25
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D'Amario D, Meerkin D, Restivo A, Ince H, Sievert H, Wiese A, Schaefer U, Trani C, Bayes-Genis A, Leyva F, Whinnett ZI, Di Mario C, Jonas M, Manhal H, Amat-Santos IJ, Del Trigo M, Gal TB, Ben Avraham B, Hasin T, Feickert S, D'Ancona G, Altisent OAJ, Koren O, Caspi O, Abraham WT, Crea F, Anker SD, Kornowski R, Perl L. Safety, usability, and performance of a wireless left atrial pressure monitoring system in patients with heart failure: the VECTOR-HF trial. Eur J Heart Fail 2023. [PMID: 37092287 DOI: 10.1002/ejhf.2869] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023] Open
Abstract
AIMS In heart failure (HF), implantable hemodynamic monitoring devices have been shown to optimize therapy, anticipating clinical decompensation and preventing hospitalization. Direct left-sided hemodynamic sensors offer theoretical benefits beyond pulmonary artery pressure (PAP) monitoring systems. We evaluated the safety, usability, and performance of a novel left atrial pressure (LAP) monitoring system in HF patients. METHODS AND RESULTS The VECTOR-HF study(NCT03775161) was a first-in-human, prospective, multicenter, single-arm, clinical trial enrolling 30 patients with HF. The device consisted of an interatrial positioned leadless sensor, able to transmit LAP data wirelessly. After three months, a right heart catheterization (RHC) was performed to correlate mean pulmonary capillary wedge pressure (PCWP) with simultaneous mean LAP obtained from the device. Remote LAP measurements were then used to guide patient management. The miniaturized device was successfully implanted in all 30 patients, without acute Major Adverse Cardiac and Neurological Events (MACNE). At 3 months, freedom from short-term MACNE was 97%. Agreement between sensor-calculated LAP and PCWP was consistent, with a mean difference of -0.22±4.92mmHg, the correlation coefficient and the Lin's Concordance Correlation Coefficient values were equal to 0.79 (P<0.0001) and 0.776 (95%CI=0.582-0.886), respectively. Preliminary experience with VLAP-based HF management was associated with significant improvements in NYHA functional class (32% of patients reached NYHA II class at 6 months, P<0.005; 60% of patients at 12 months, P<0.005) and 6-minute walk-test distance (from 244.59±119.59m at baseline to 311.78±129.88m after 6 months, P<0.05, and 343.95±146.15m after 12 months, P<0.05). CONCLUSION The V-LAP™ monitoring system proved to be generally safe and provided a good correlation with invasive PCWP. Initial evidence also suggests possible improvement in HF clinical symptoms. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - David Meerkin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
- Department of Cardiology, Rostock University, Medical Center, Ernst-Heydemann-Straße 6, Rostock, Germany
| | | | - Andrea Wiese
- Department of Cardiology, Angiology and Intensive Care Medicine, Marienhospital, Hamburg, Germany
| | - Ulrich Schaefer
- Innovative Interventional Cardiology, Cardiovascular Center, Bad Bevensen, Germany
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Germans Trias University Hospital, 08916, Badalona, Spain
| | - Francisco Leyva
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Experimental & Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Habib Manhal
- Departments of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - Ignacio J Amat-Santos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Maria Del Trigo
- Interventional Cardiology, Hospital Puerta de Hierro Majadahonda, Spain
| | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Binyamin Ben Avraham
- Cardiology Department, Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
- Department of Cardiology, Rostock University, Medical Center, Ernst-Heydemann-Straße 6, Rostock, Germany
| | - Giuseppe D'Ancona
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
- Department of Cardiology, Rostock University, Medical Center, Ernst-Heydemann-Straße 6, Rostock, Germany
| | - Omar Abdul-Jawad Altisent
- Department of Cardiology, Germans Trias University Hospital, 08916, Badalona, Spain
- Interventional Cardiologist, ICCV Hospital Clínic de Barcelona, Spain
| | - Oran Koren
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Caspi
- Departments of Cardiology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Technion Medical School Haifa, Haifa, Israel
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK), partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
| | - Leor Perl
- Cardiology Department, Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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26
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Galli M, Vescovo GM, Andreotti F, D'Amario D, Leone AM, Benenati S, Vergallo R, Niccoli G, Trani C, Porto I. Impact of coronary stenting on top of medical therapy and of inclusion of periprocedural infarctions on hard composite endpoints in patients with chronic coronary syndromes: a meta-analysis of randomized controlled trials. Minerva Cardiol Angiol 2023; 71:221-229. [PMID: 33944534 DOI: 10.23736/s2724-5683.21.05645-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Composite endpoints are pivotal when assessing rare outcomes over relatively short follow-ups. Most randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with stent implantation to optimal medical therapy (OMT) in chronic coronary syndromes (CCS) patients included both hard and soft outcomes in their primary endpoint, with periprocedural myocardial infarctions (MIs) systematically allocated to the PCI arm. We meta-analyzed the above RCTs for composite hard endpoints, with and without periprocedural MIs. EVIDENCE ACQUISITION This study is registered in PROSPERO CRD42020166754 and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Collaboration reporting. Patients had inducible ischemia, no left main disease nor severe left ventricular dysfunction. EVIDENCE SYNTHESIS Six RCTs involving 10,751 patients followed for a mean of 4.4 years were included. PCI+OMT versus OMT alone was associated with no difference in the two co-primary composite endpoints of all-cause death/MI/stroke and cardiovascular death/MI including all-MIs (IRR 0.99; 95% CI 0.90-1.08 and IRR 0.95; 95% CI 0.83-1.08 respectively). After inclusion of spontaneous rather than all-MIs (i.e., excluding periprocedural MIs), the odds showed benefit of PCI+OMT for both co-primary endpoints (IRR 0.88; 95% CI 0.80-0.97, P<0.01 and IRR 0.81; 95% CI 0.69-0.95, P=0.01 respectively) with numbers needed to treat of 42 in both cases. CONCLUSIONS Among CCS patients with inducible myocardial ischemia without severely reduced ejection fraction or left main disease, adding PCI to OMT reduces hard composite outcomes only after exclusion of periprocedural MIs. Continued efforts to define periprocedural MIs reproducibly, to assess their prognostic relevance and to prevent them are warranted.
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Affiliation(s)
- Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Giovanni M Vescovo
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Felicita Andreotti
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Stefano Benenati
- IRCCS San Martino University Hospital, Italian Cardiovascular Network, University of Genoa, Genoa, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Italo Porto
- IRCCS San Martino University Hospital, Italian Cardiovascular Network, University of Genoa, Genoa, Italy -
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
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27
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Galli M, Laborante R, Ortega-Paz L, Franchi F, Rollini F, D'Amario D, Capodanno D, Tremoli E, Gibson CM, Mehran R, Angiolillo DJ. Factor XI Inhibitors in Early Clinical Trials: A Meta-analysis. Thromb Haemost 2023; 123:576-584. [PMID: 36841245 DOI: 10.1055/a-2043-0346] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Phase II randomized controlled trials (RCTs) on factor(F)XI inhibitors have shown promising results but they were burdened by low statistical power for clinical outcomes. METHODS We performed a systematic review and meta-analysis of RCT comparing FXI inhibitors versus other anticoagulants (enoxaparin or direct oral anticoagulants, DOACs) or versus placebo on top of antiplatelet therapy. RESULTS Eight RCTs testing FXI inhibitors (ISIS 416858, osocimab, abelacimab, milvexian, asundexian) and enrolling 9,216 patients were included. Compared with enoxaparin, FXI inhibitors were associated with reduced any-bleeding (risk ratio [RR]: 0.49, 95% confidence interval [CI]: 0.31-0.77), no difference in major bleeding (RR: 0.96, 95% CI: 0.41-2.28), and reduced trial-defined efficacy endpoint (RR: 0.62, 95% CI: 0.49-0.79), the latter driven by the high-dose regimens. Compared with DOACs, FXI inhibitors were associated with a trend toward reduced any-bleeding (RR: 0.66, 95% CI: 0.31-1.38) and no difference in major bleeding (RR: 1.03, 95% CI: 0.22-4.78) or in trial-defined efficacy endpoint (RR: 1.23, 95% CI: 0.88-1.70). Compared with placebo, FXI inhibitors were associated with increased any-bleeding (RR: 1.25, 95% CI: 1.08-1.43) and a trend toward increased major bleeding (RR: 1.21, 95% CI: 0.75-1.93), both driven by high-dose regimens, with no difference in trial-defined efficacy endpoint (RR: 1.02, 95% CI: 0.92-1.13). CONCLUSION Results of this meta-analysis on FXI inhibitors suggest increased safety and efficacy compared with enoxaparin and modest increased safety compared with DOACs. The use of FXI inhibitors in adjunct to antiplatelet therapy versus placebo appears to be associated with a dose-dependent increase in bleeding without any difference in efficacy. STUDY REGISTRATION This study is registered in PROSPERO (CRD42022367706).
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Affiliation(s)
- Mattia Galli
- Catholic University of the Sacred Heart, Rome, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Domenico D'Amario
- Dipartimento Universitario di Medicina Traslazionale, Università Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Charles Micheal Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
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28
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Vergallo R, Lombardi M, Besis G, Migliaro S, Ricchiuto A, Maino A, Buonpane A, Bianchini E, Annibali G, Galli M, D'Amario D, Montone RA, Leone AM, Aurigemma C, Romagnoli E, Buffon A, Hamilton-Craig C, Burzotta F, Porto I, Trani C, Crea F. Pre-stenting residual thrombotic volume assessed by dual quantitative coronary angiography predicts microvascular obstruction in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Minerva Cardiol Angiol 2023:S2724-5683.22.06156-7. [PMID: 36847435 DOI: 10.23736/s2724-5683.22.06156-7] [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: 03/01/2023]
Abstract
BACKGROUND Microvascular obstruction (MVO) is a frequent occurrence after primary percutaneous coronary intervention (pPCI), and is associated with adverse left ventricular remodeling and worse clinical outcome. Distal embolization of thrombotic material is one of the most important underlying mechanisms. The aim of this study was to investigate the relation between the thrombotic volume evaluated by dual quantitative coronary angiography (QCA) prior to stenting and the occurrence of MVO as assessed by cardiac magnetic resonance (CMR). METHODS Forty-eight patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI and receiving CMR within 7 days from admission were included. Pre-stenting residual thrombus volume at the site of the culprit lesion was measured by applying automated edge detection and video-assisted densitometry techniques (i.e., dual-QCA), and patients were categorized into tertiles of thrombus volume. The presence of delayed-enhancement MVO, as well as its extent (MVO mass), were assessed by CMR. RESULTS Pre-stenting dual-QCA thrombus volume was significantly greater in patients with MVO than in those without (5.85 mm3 [2.05-16.71] vs. 1.88 mm3 [1.03-6.92], P=0.009). Patients in the highest tertile showed greater MVO mass compared to those in the mid and lowest tertiles (113.3 gr [0.0-203.8] vs. 58.5 g [0.00-144.4] vs. 0.0 g [0.0-60.225], respectively; P=0.031). The best cut-off value of dual-QCA thrombus volume for prediction of MVO was 2.07 mm3 (AUC: 0.720). The addition of dual-QCA thrombus volume to the traditional angiographic indices of no-reflow enhanced the prediction of MVO by CMR (R=0.752). CONCLUSIONS Pre-stenting dual-QCA thrombus volume is associated with the presence and extent of MVO detected by CMR in patients with STEMI. This methodology may aid the identification of patients at higher risk of MVO and guide adoption of preventive strategies.
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Affiliation(s)
- Rocco Vergallo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy - .,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy -
| | - Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giorgos Besis
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Maino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ferrara, Italy
| | - Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianmarco Annibali
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ferrara, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonino Buffon
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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29
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Laborante R, Bianchini E, Restivo A, Ciliberti G, Galli M, Vergallo R, Rodolico D, Zito A, Princi G, Leone AM, Aurigemma C, Romagnoli E, Montone RA, Burzotta F, Trani C, Crea F, D'Amario D. Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother 2023; 9:173-182. [PMID: 36496163 DOI: 10.1093/ehjcvp/pvac069] [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: 10/19/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
AIMS Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary microvascular obstruction (CMVO). The aim of this study was to pool all the RCTs comparing intracoronary or intravenous adenosine versus placebo in patients with acute coronary syndrome (ACS) undergoing myocardial revascularization. METHODS AND RESULTS PubMed and Scopus electronic databases were scanned for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843 patients were included. Efficacy endpoints were major adverse cardiac events (MACE), all-cause death, non-fatal myocardial infarction, and heart failure. Atrioventricular blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left ventricular ejection fraction (LVEF), infarct size, and ST-segment resolution were also assessed. Adenosine administration was not associated with any clinical benefit in terms of MACE, all-cause death, non-fatal myocardial infarction, and heart failure. However, adenosine was associated with an increased rate of advanced atrioventricular blocks and of VF/SVT in studies with total mean ischaemic time >3 h, compared to placebo. Remarkably, among patients undergoing percutaneous coronary intervention, adenosine was associated with reduced myocardial blush grade 0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine did not show favourable effects on LVEF and infarct size. CONCLUSION Adenosine infusion, as adjunctive therapy in ACS, was associated with an increased risk of advanced atrioventricular blocks and increased rates of adenosine-triggered ventricular arrhythmias in patients with long ischaemic time, without providing any clinical benefit compared to placebo.
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Affiliation(s)
- Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Cotignola 48033, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Padiglione G, L.go Bellini, Novara, NO, 28100, Italy
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30
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D'Amario D, Galli M, Cappannoli L, Canonico F, Restivo A, Arcudi A, Scacciavillani R, Riccioni ME, Vergallo R, Montone RA, Conte A, Meleo E, Lancellotti S, Sacco M, Antonelli M, Andreotti F, DE Cristofaro R, Crea F. Oral anticoagulants in fragile patients with percutaneous endoscopic gastrostomy and atrial fibrillation: the ORIGAMI pilot investigation. Minerva Cardiol Angiol 2023; 71:109-116. [PMID: 35166091 DOI: 10.23736/s2724-5683.21.05903-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extensive data support the superior safety without any trade-off in efficacy of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation, deep venous thrombosis or pulmonary embolism. Whether DOACs may be successfully used to treat complex and fragile patients with percutaneous endoscopic gastrostomy (PEG) remains to be proven. The purpose of this pilot study was to evaluate the feasibility, anticoagulant effect, and preliminary safety/efficacy profile of edoxaban administered via PEG in patients with an indication for long-term oral anticoagulation. METHODS In this prospective, single-arm, pilot study, 12 patients with PEG and guideline-recommended indication for anticoagulation for nonvalvular atrial fibrillation were prospectively enrolled. Crushed edoxaban at approved doses was administered via PEG. Quantitative measures of edoxaban's antifactor Xa activity were performed at steady state. Thromboembolic and bleeding events were assessed at one-month follow-up. RESULTS Steady state edoxaban plasma levels were at therapeutic range in all patients; mean plasma concentration was 208.5 (±78.6) ng/mL. At one month follow-up, none had suffered a thromboembolic event; one developed minor bleeding, and one died from non-cardiovascular death, owing to sudden worsening of a pre-existing underlying severe condition. CONCLUSIONS In this pilot investigation, we report for the first time that crushed edoxaban, administered at approved doses through PEG in fragile and complex patients, is feasible, results in therapeutic edoxaban concentrations, and is apparently effective and safe.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Sacred Heart Catholic University, Rome, Italy -
| | - Mattia Galli
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | | | - Francesco Canonico
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | | | | | | | - Rocco Vergallo
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Amelia Conte
- NEMO Center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Emiliana Meleo
- NEMO Center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | | | - Massimo Antonelli
- Sacred Heart Catholic University, Rome, Italy.,NEMO Center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Emergency Sciences, Anesthesiology and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Felicita Andreotti
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Raimondo DE Cristofaro
- Sacred Heart Catholic University, Rome, Italy.,NEMO Center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Emergency Sciences, Anesthesiology and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Section of Hemorrhagic and Thrombotic Diseases, Department of Medicine and Translational Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
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31
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Galli M, Benenati S, Zito A, Capodanno D, Zoccai GB, Ortega-Paz L, Iaconelli A, D'Amario D, Porto I, Burzotta F, Trani C, De Caterina R, Gaudino M, Escaned J, Angiolillo DJ, Crea F. Revascularization strategies versus optimal medical therapy in chronic coronary syndrome: A network meta-analysis. Int J Cardiol 2023; 370:58-64. [PMID: 36265647 DOI: 10.1016/j.ijcard.2022.10.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of myocardial revascularization on outcomes and prognosis in patients with chronic coronary syndrome (CCS) without left main (LM) disease or reduced left ventricle ejection fraction (LVEF) may be influenced by the revascularization strategy adopted. METHODS We performed a network meta-analysis including 18 randomized controlled trials comparing different revascularization strategies, including angiography-guided percutaneous coronary intervention (PCI), physiology-guided PCI and coronary artery bypass graft (CABG), in patients with CCS without LM disease or reduced LVEF. RESULTS Compared with medical therapy, all revascularization strategies were associated with a reduction of the primary endpoint, as defined in each trial, the extent of which was modest with angiography-guided PCI (IRR 0.86, 95% CI 0.75-0.99) and greater with physiology-guided PCI (IRR 0.60, 95% CI 0.47-0.77) and CABG (IRR 0.58, 95% CI 0.48-0.70). Moreover, angiography-guided PCI was associated with an increase of the primary endpoint compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14-1.79) and CABG (IRR 1.49, 95% CI 1.27-1.74). CABG was the only strategy associated with reduced myocardial infarction (IRR 0.68, 95% CI 0.52-0.90), cardiovascular death (IRR 0.76, 95% CI 0.64-0.89), and all-cause death (IRR 0.87, 95% CI 0.77-0.99), but increased stroke (IRR 1.69, 95% CI 1.04-2.76). CONCLUSIONS In CCS patients without LM disease or reduced LVEF, physiology-guided PCI and CABG are associated with better outcomes than angiography-guided PCI. Compared with medical therapy, CABG is the only revascularization strategy associated with a reduction of myocardial infarction and death rates, at the cost of higher risk of stroke. STUDY REGISTRATION This study is registered in PROSPERO (CRD42022313612).
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Affiliation(s)
- Mattia Galli
- Catholic University of the Sacred Heart, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
| | - Stefano Benenati
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Antonio Iaconelli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy; Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy
| | - Francesco Burzotta
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Raffaele De Caterina
- University of Pisa and University Cardiology Division, Pisa University Hospital, Pisa, Italy; Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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32
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Galli M, Franchi F, Rollini F, Ortega-Paz L, D'Amario D, De Caterina R, Mehran R, Gibson CM, Angiolillo DJ. Dual pathway inhibition in patients with atherosclerotic disease: pharmacodynamic considerations and clinical implications. Expert Rev Clin Pharmacol 2023; 16:27-38. [PMID: 36455906 DOI: 10.1080/17512433.2023.2154651] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The persistence of elevated rates of ischemic recurrences despite the use of antiplatelet therapy among patients with atherosclerotic disease together with the understanding of the pivotal role of coagulation in the thrombo-inflammatory processes involved in the pathogenesis of atherosclerosis and its complications has fostered the development of treatments targeting both platelets and coagulation, a strategy known as dual-pathway inhibition (DPI). AREAS COVERED In this review we discuss the recent advancements in the understanding of the interplay between coagulation, platelets and inflammation involved in the pathophysiology of atherosclerosis and atherothrombosis, as the rationale for the implementation of a DPI strategy. We also discuss the available pharmacodynamic (PD) evidence and clinical implications with the use of DPI in patients with atherosclerotic disease. EXPERT OPINION The implementation of a DPI by adding the so-called 'vascular dose of rivaroxaban' (i.e. 2.5 mg bis in die), on top of antiplatelet therapy has consistently been associated with reduced levels of thrombin generation in PD studies and with reduced ischemic event rates at the cost of increased bleeding compared to antiplatelet therapy alone. Further research is warranted to best define patients in whom a DPI regimen has the best safety and efficacy profile.
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Affiliation(s)
- Mattia Galli
- Catholic University of the Sacred Heart, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Raffaele De Caterina
- University of Pisa and University Cardiology Division, Pisa University Hospital, Pisa, Italy.,Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Michael Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
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Radhoe SP, Jakus N, Veenis JF, Timmermans P, Pouleur A, Rubís P, Van Craenenbroeck EM, Gaizauskas E, Barge‐Caballero E, Paolillo S, Grundmann S, D'Amario D, Braun OÖ, Gkouziouta A, Planinc I, Macek JL, Meyns B, Droogne W, Wierzbicki K, Holcman K, Flammer AJ, Gasparovic H, Biocina B, Milicic D, Lund LH, Ruschitzka F, Brugts JJ, Cikes M. Sex‐related differences in left ventricular assist device utilization and outcomes: results from the PCHF‐VAD registry. ESC Heart Fail 2022; 10:1054-1065. [PMID: 36547014 PMCID: PMC10053365 DOI: 10.1002/ehf2.14261] [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: 06/23/2022] [Revised: 10/05/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Data on sex and left ventricular assist device (LVAD) utilization and outcomes have been conflicting and mostly confined to US studies incorporating older devices. This study aimed to investigate sex-related differences in LVAD utilization and outcomes in a contemporary European LVAD cohort. METHODS AND RESULTS This analysis is part of the multicentre PCHF-VAD registry studying continuous-flow LVAD patients. The primary outcome was all-cause mortality. Secondary outcomes included ventricular arrhythmias, right ventricular failure, bleeding, thromboembolism, and the haemocompatibility score. Multivariable Cox regression models were used to assess associations between sex and outcomes. Overall, 457 men (81%) and 105 women (19%) were analysed. At LVAD implant, women were more often in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 or 2 (55% vs. 41%, P = 0.009) and more often required temporary mechanical circulatory support (39% vs. 23%, P = 0.001). Mean age was comparable (52.1 vs. 53.4 years, P = 0.33), and median follow-up duration was 344 [range 147-823] days for women and 435 [range 190-816] days for men (P = 0.40). No significant sex-related differences were found in all-cause mortality (hazard ratio [HR] 0.79 for female vs. male sex, 95% confidence interval [CI] [0.50-1.27]). Female LVAD patients had a lower risk of ventricular arrhythmias (HR 0.56, 95% CI [0.33-0.95]) but more often experienced right ventricular failure. No significant sex-related differences were found in other outcomes. CONCLUSIONS In this contemporary European cohort of LVAD patients, far fewer women than men underwent LVAD implantation despite similar clinical outcomes. This is important as the proportion of female LVAD patients (19%) was lower than the proportion of females with advanced HF as reported in previous studies, suggesting underutilization. Also, female patients were remarkably more often in INTERMACS profile 1 or 2, suggesting later referral for LVAD therapy. Additional research in female patients is warranted.
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Affiliation(s)
- Sumant P. Radhoe
- Department of Cardiology, Thorax Center Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nina Jakus
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jesse F. Veenis
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | | | - Anne‐Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc Brussels Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain Louvain Belgium
| | - Pawel Rubís
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Edvinas Gaizauskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine Vilnius University Vilnius Lithuania
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | - Sebastian Grundmann
- Faculty of Medicine Heart Center Freiburg University, University of Freiburg Freiburg Germany
| | - Domenico D'Amario
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Oscar Ö. Braun
- Department of Cardiology, Clinical Sciences Lund University and Skåne University Hospital Lund Sweden
| | | | - Ivo Planinc
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jana Ljubas Macek
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bart Meyns
- Department of Cardiac Surgery University Hospital Leuven Leuven Belgium
| | - Walter Droogne
- Department of Cardiology University Hospital Leuven Leuven Belgium
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Hrvoje Gasparovic
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Lars H. Lund
- Department of Medicine Karolinska Institute Stockholm Sweden
| | - Frank Ruschitzka
- Clinic for Cardiology University Hospital Zurich Zurich Switzerland
| | - Jasper J. Brugts
- Department of Cardiology, Thorax Center Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Maja Cikes
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
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34
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Radhoe SP, Veenis JF, Jakus N, Timmermans P, Pouleur A, Rubís P, Van Craenenbroeck EM, Gaizauskas E, Barge‐Caballero E, Paolillo S, Grundmann S, D'Amario D, Braun OÖ, Gkouziouta A, Planinc I, Samardzic J, Meyns B, Droogne W, Wierzbicki K, Holcman K, Flammer AJ, Gasparovic H, Biocina B, Lund LH, Milicic D, Ruschitzka F, Cikes M, Brugts JJ. How does age affect outcomes after left ventricular assist device implantation: results from the PCHF‐VAD registry. ESC Heart Fail 2022; 10:884-894. [PMID: 36460627 PMCID: PMC10053271 DOI: 10.1002/ehf2.14247] [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: 06/23/2022] [Revised: 10/05/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Use of left ventricular assist devices (LVADs) in older patients has increased, and assessing outcomes in older LVAD recipients is important. Therefore, this study aimed to investigate associations between age and outcomes after continuous-flow LVAD (cf-LVAD) implantation. METHODS AND RESULTS Cf-LVAD patients from the multicentre European PCHF-VAD registry were included and categorized into those <50, 50-64, and ≥65 years old. The primary endpoint was all-cause mortality. Among secondary outcomes were heart failure (HF) hospitalizations, right ventricular (RV) failure, haemocompatibility score, bleeding events, non-fatal thromboembolic events, and device-related infections. Of 562 patients, 184 (32.7%) were <50, 305 (54.3%) were aged 50-64, whereas 73 (13.0%) were ≥65 years old. Median follow-up was 1.1 years. Patients in the oldest age group were significantly more often designated as destination therapy (DT) candidates (61%). A 10 year increase in age was associated with a significantly higher risk of mortality (hazard ratio [HR] 1.34, 95% confidence interval [CI] [1.15-1.57]), intracranial bleeding (HR 1.49, 95% CI [1.10-2.02]), and non-intracranial bleeding (HR 1.30, 95% CI [1.09-1.56]), which was confirmed by a higher mean haemocompatibility score (1.37 vs. 0.77, oldest vs. youngest groups, respectively, P = 0.033). Older patients suffered from less device-related infections requiring systemic antibiotics. No age-related differences were observed in HF-related hospitalizations, ventricular arrhythmias, pump thrombosis, non-fatal thromboembolic events, or RV failure. CONCLUSIONS In the PCHF-VAD registry, higher age was associated with increased risk of mortality, and especially with increased risk of major bleeding, which is particularly relevant for the DT population. The risks of HF hospitalizations, pump thrombosis, ventricular arrhythmia, or RV failure were comparable. Strikingly, older patients had less device-related infections.
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Affiliation(s)
- Sumant P. Radhoe
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Jesse F. Veenis
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nina Jakus
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | | | - Anne‐Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc Brussels Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain Louvain Belgium
| | - Pawel Rubís
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Edvinas Gaizauskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine Vilnius University Vilnius Lithuania
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | - Sebastian Grundmann
- Faculty of Medicine, Heart Center Freiburg University University of Freiburg Freiburg Germany
| | - Domenico D'Amario
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Oscar Ö. Braun
- Department of Cardiology, Clinical Sciences Lund University and Skåne University Hospital Lund Sweden
| | | | - Ivo Planinc
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jure Samardzic
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bart Meyns
- Department of Cardiac Surgery University Hospital Leuven Leuven Belgium
| | - Walter Droogne
- Department of Cardiology University Hospital Leuven Leuven Belgium
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Hrvoje Gasparovic
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Lars H. Lund
- Department of Medicine Karolinska Institute Stockholm Sweden
| | - Davor Milicic
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Frank Ruschitzka
- Clinic for Cardiology University Hospital Zurich Zurich Switzerland
| | - Maja Cikes
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jasper J. Brugts
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
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Zito A, Princi G, Romiti GF, Galli M, Basili S, Liuzzo G, Sanna T, Restivo A, Ciliberti G, Trani C, Burzotta F, Cesario A, Savarese G, Crea F, D'Amario D. Device-based remote monitoring strategies for congestion-guided management of patients with heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2022; 24:2333-2341. [PMID: 36054801 PMCID: PMC10086988 DOI: 10.1002/ejhf.2655] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 03/21/2022] [Revised: 08/02/2022] [Accepted: 08/13/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Pre-clinical congestion markers of worsening heart failure (HF) can be monitored by devices and may support the management of patients with HF. We aimed to assess whether congestion-guided HF management according to device-based remote monitoring strategies is more effective than standard therapy. METHODS AND RESULTS A comprehensive literature research for randomized controlled trials (RCTs) comparing device-based remote monitoring strategies for congestion-guided HF management versus standard therapy was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and HF hospitalizations. Secondary endpoints included the individual components of the primary outcome. A total of 4347 patients from eight RCTs were included. Findings varied according to the type of parameters monitored. Compared with standard therapy, haemodynamic-guided strategy (4 trials, 2224 patients, 12-month follow-up) reduced the risk of the primary composite outcome (IRR 0.79, 95% CI 0.70-0.89) and HF hospitalizations (IRR 0.76, 95% CI 0.67-0.86), without a significant impact on all-cause death (IRR 0.93, 95% CI 0.72-1.21). In contrast, impedance-guided strategy (4 trials, 2123 patients, 19-month follow-up) did not provide significant benefits. CONCLUSION Haemodynamic-guided HF management is associated with better clinical outcomes as compared to standard clinical care.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Cesario
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Innovation Sprint Sprl, Brussels, Belgium
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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36
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Galli M, Migliaro S, Rodolico D, DI Stefano G, Piccinni C, Restivo A, Andreotti F, Vergallo R, Montone RA, Besis G, Buffon A, Romagnoli E, Aurigemma C, Leone AM, Burzotta F, Niccoli G, Trani C, Crea F, D'Amario D. Intracoronary bolus of glycoprotein IIb/IIIa inhibitor as bridging or adjunctive strategy to oral P2Y12 inhibitor load in the modern setting of ST-elevation myocardial infarction. Minerva Cardiol Angiol 2022; 70:697-705. [PMID: 33823577 DOI: 10.23736/s2724-5683.21.05669-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the acute management of ST-elevation myocardial infarction (STEMI), glycoprotein IIb/IIIa inhibitors (GPIs) bolus not followed by intravenous infusion is potentially advantageous given their fast onset and offset of action, but clinical evidence in a contemporary setting is limited. METHODS We collected data from consecutive STEMI patients admitted to the cardiac catheterization laboratory of the IRCCS A. Gemelli University Polyclinic Foundation from October 2017 to September 2019. RESULTS Out of 423 consecutive STEMI patients, 297 met the inclusion and exclusion criteria and were included in the study. Of them, 107/297 (36%) received an intracoronary GPI bolus-only during primary percutaneous coronary intervention (PPCI) not followed by intravenous infusion and 190/297 (64%) received standard antithrombotic therapy. Of the 107 GPI-treated, 22/107 (21%) had P2Y<inf>12</inf> inhibitor pretreatment (adjunctive strategy) and 85/107 (79%) did not (bridging strategy). During hospital staying, there was no difference in the primary safety endpoint of TIMI major+minor bleeding (P=0.283), TIMI major (P=0.267) or TIMI minor (P=0.685) bleeding between groups. No stroke event occurred in the GPI group. Despite patients receiving GPI having a significantly higher intraprocedural ischemic burden, no significant differences were found in the efficacy outcomes between groups. Consistent findings were observed for patients receiving GPIs bolus before (bridging strategy) or after (adjunctive strategy) P2Y<inf>12</inf> inhibitors, compared to those receiving standard therapy. Multivariate logistic regression analyses did not find any independent predictors significantly associated to the primary and secondary composite endpoints. CONCLUSIONS In a contemporary real-world population of STEMI patients undergoing PPCI, the use of intracoronary GPIs bolus-only in selected patients at high ischemic risk is safe and could represent a useful antithrombotic strategy both in those pretreated and in those naïve to P2Y<inf>12</inf> inhibitors.
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Affiliation(s)
- Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Sacred Heart Catholic University, Rome, Italy -
| | - Stefano Migliaro
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gaetano DI Stefano
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo Piccinni
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Felicita Andreotti
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - George Besis
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonino Buffon
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Cappannoli L, Galli M, Zito A, Restivo A, Princi G, Laborante R, Vergallo R, Romagnoli E, Leone AM, Aurigemma C, Massetti M, Sanna T, Trani C, Burzotta F, Savarese G, Crea F, D'Amario D. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with vs without left ventricular unloading by Impella: a systematic review and meta-analysis. European Heart Journal - Quality of Care and Clinical Outcomes 2022:6825448. [DOI: 10.1093/ehjqcco/qcac076] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background and aims
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the treatment of cardiogenic shock (CS) may result in left ventricle overload and distension. Percutaneous microaxial flow pump Impella in addition to VA-ECMO (ECPELLA) is an emerging option to overcome these collateral effects. Aim of this study is to assess whether the addition of Impella to VA-ECMO is an effective and safe unloading strategy.
Methods
We performed a systematic literature review of studies comparing ECPELLA versus ECMO alone in patients with CS. The primary endpoint was early mortality (in-hospital or 30-day mortality). The secondary endpoints were bleeding, need for kidney replacement therapy, hemolysis, infections, and limb ischemia.
Results
A total of 3469 potentially relevant articles were screened and 8 retrospective studies including 11.137 patients were selected. There was no significant difference in early mortality (Risk Ratio, RR 0.90, 95% CI 0.78–1.03) between ECPELLA and ECMO. Nevertheless, there was a borderline significant reduction in early mortality with ECPELLA (RR 0.74, 95% CI 0.55–1.00) at sensitivity analysis selectively including studies reporting propensity matched analysis. ECPELLA was associated with increased bleeding (RR 1.45, 95% CI 1.20–1.75), need for kidney replacement therapy (RR 1.54, 95% CI 1.19–1.99), hemolysis (RR 1.71, 95% CI 1.41–2.07) and limb ischemia (RR 1.43, 95% CI 1.17–1.75) and with a non-significant increase in severe infections (RR 1.26, 95% CI 0.84–1.89), compared with ECMO alone.
Conclusions
Among patients with cardiogenic shock, ECPELLA is associated with increased complications compared with ECMO. Whether reducing ventricular overload with Impella among patients treated with ECMO reduces early mortality needs to be confirmed by further investigations.
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Affiliation(s)
| | - Mattia Galli
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Maria Cecilia Hospital, GVM Care & Research , Cotignola , Italy
| | - Andrea Zito
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
| | | | | | | | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Massimo Massetti
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Tommaso Sanna
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Carlo Trani
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Francesco Burzotta
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Filippo Crea
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Domenico D'Amario
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
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38
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D'Amario D, Leccisotti L, Cinti F, Sorice GP, Lorusso M, Guzzardi MA, Mezza T, Cocchi C, Capece U, Indovina L, Ferraro PM, Iozzo P, Giordano A, Giaccari A, Crea F. Dapagliflozin improves Myocardial Flow Reserve in patients with Type 2 Diabetes: the DAPAHEART Trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2662] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Cardiovascular (CV) outcome trials have shown that in patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduces CV mortality and admission rates for heart failure (HF). However, the mechanisms behind these benefits are not fully understood. This study was performed to investigate the effects of the SGLT-2i dapagliflozin on whole body insulin sensitivity, myocardial perfusion, and metabolism in patients with T2D without HF.
Research design and methods
This was a single-center, prospective, randomized, double-blind controlled clinical trial including 16 patients with T2D randomized to SGLT-2i dapagliflozin (10 mg) or placebo. Whole body glucose uptake (WBGU) and myocardial glucose uptake (MGU) were measured with PET/CT with FDG during euglycemic hyperinsulinemic clamp. Stress (i.v. adenosine infusion) and resting myocardial blood flow (MBF) and myocardial flow reserve (MFR) were calculated by PET/CT with 13N-ammonia.
Results
16 patients were randomized (8 dapagliflozin; 8 placebo). The groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, renal and heart function). Dapagliflozin significantly improved MFR (2.56±0.26 vs 3.59±0.35) compared with placebo group (2.34±0.21 vs 2.38±0.24; p for interaction =0.001) and was associated to a reduction of resting MBF corrected for cardiac workload (p=0.045). A trend toward an increase in stress MBF was also detected (p=0.058). Moreover, in dapagliflozin group we observed an increase of WBGU of borderline statistical significance (p=0.06) and no effects on MGU (p=0.41).
Conclusions
At the best of our knowledge, our study, for the first time, demonstrated that SGLT-2 inhibition increases MFR in T2D patients. The data presented provide a new potential explanation of cardiovascular benefits with SGLT-2i as they make patients more tolerant to the detrimental impact of obstructive coronary atherosclerosis on MFR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D D'Amario
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - L Leccisotti
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Cinti
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - G P Sorice
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - M Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - M A Guzzardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - T Mezza
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - C Cocchi
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - U Capece
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - L Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - P M Ferraro
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - P Iozzo
- CNR – National Research Council , Pisa , Italy
| | - A Giordano
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Crea
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
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Cappannoli L, Galli M, Zito A, Restivo A, Princi G, Leone AM, Vergallo R, Aurigemma C, Romagnoli E, Aspromonte N, Burzotta F, Trani C, Sanna T, Crea F, D'Amario D. Clinical outcomes of left ventricular unloading with microaxial flow pump Impella during venoarterial extracorporeal membrane oxygenation (VA-ECMO): a systematic review and updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Whether the addition of percutaneous microaxial flow pump Impella to venoarterial extracorporeal membrane oxygenation (VA-ECMO) as left ventricle unloading strategy is effective in improving outcomes compared to VA-ECMO alone is still to be proved.
Purpose
Aim of this systematic review and meta-analysis was to assess whether patients with refractory cardiogenic shock treated with IMPELLA in addition to VA-ECMO (ECMELLA) versus ECMO alone may benefit a reduction in early mortality and to assess whether this strategy may result in an increased rate of complications.
Methods
For this systematic review and meta-analysis, from Dec 2021 to Jan 2022, we searched Scopus, MEDLINE (with PubMed interface) and the Cochrane Central Register of Controlled Trials for randomised controlled trials and observational studies published in any language comparing the use of ECMELLA versus ECMO alone in patients with acute refractory CS (with or without cardiac arrest). Two independent investigators screened titles and abstracts for eligibility, extracted the data, and assessed risk of bias. Risk ratios (RRs) and 95% CIs were calculated with random-effects or fixed-effect models according to the estimated heterogeneity among studies assessed by the I2 index. Primary efficacy endpoint was trial-defined early mortality (in hospital or 30-day mortality). Safety endpoints were major bleeding, the need for renal replacement therapy, hemolysis, severe infections/sepsis and limb ischemia. This study is registered with PROSPERO (CRD42022292517).
Results
2061 potentially relevant articles were screened. Our analysis included six retrospective studies with data for 1457 patients. Compared with ECMO alone, ECMELLA was associated with a non-significant reduction in early mortality (RR 0.87, 95% CI 0.72–1.06, p=0.17; Figure 1) and in a significant increase of major bleeding (RR 1.45, 95% CI 1.10–1.91, p=0.009), need for renal replacement therapy (RR 1.70, 95% CI 1.16–2.48, p=0.0008), hemolysis (RR 2.22, 95% CI 1.39–3.56, p=0.005) and limb ischemia (RR 1.61, 95% CI 1.20–2.16, p=0.001). No significant differences were observed in the incidence of severe infections/sepsis between the two groups (RR 1.23, 95% CI 0.97–1.58, p=0.09). (Figure 2)
Conclusions
The results of this meta-analysis showed that ECMELLA compared to ECMO alone did not significantly reduce early mortality and that, conversely, it resulted in a significantly increased risk of several complication (major bleeding, hemolysis, limb ischemia and renal replacement therapy). This study highlights that, if the benefit of left ventricle unloading with Impella during ECMO in CS shock is uncertain and probably limited to only selected patients, it surely increases the risk of some complications, therefore caution is needed in choosing such a strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Cappannoli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - M Galli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A Zito
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A Restivo
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - G Princi
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A M Leone
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - R Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - C Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - E Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - N Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - C Trani
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - T Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Crea
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - D D'Amario
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
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Iaconelli A, Rovere G, D'Amario D, Galli M, Sanna T. Aetiologic diagnosis of coronary artery aneurysm in a patient with pancreatitis, dacryoadenitis, and sialadenitis. Eur Heart J 2022; 44:535. [PMID: 36181468 PMCID: PMC9902151 DOI: 10.1093/eurheartj/ehac536] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1–00168 Rome, Italy
| | - Domenico D'Amario
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1–00168 Rome, Italy,Department of Cardiovascular Sciences, Catholic University of the Sacred Heart (UCSC), Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart (UCSC), Rome, Italy,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
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41
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Perl L, Feickert S, D'Amario D. Editorial: Advances and challenges in remote monitoring of patients with heart failure. Front Cardiovasc Med 2022; 9:1021296. [PMID: 36172588 PMCID: PMC9511161 DOI: 10.3389/fcvm.2022.1021296] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Leor Perl
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Leor Perl ;
| | - Sebastian Feickert
- Department of Cardiology, Vivantes Klinikum Am Urban, Berlin and Rostock University Medical Center, Rostock, Germany
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Domenico D'Amario
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42
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Leccisotti L, Cinti F, Sorice GP, D'Amario D, Lorusso M, Guzzardi MA, Mezza T, Gugliandolo S, Cocchi C, Capece U, Indovina L, Ferraro PM, Iozzo P, Crea F, Giordano A, Giaccari A. Dapagliflozin improves myocardial flow reserve in patients with type 2 diabetes: the DAPAHEART Trial: a preliminary report. Cardiovasc Diabetol 2022; 21:173. [PMID: 36057768 PMCID: PMC9440459 DOI: 10.1186/s12933-022-01607-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Cardiovascular (CV) outcome trials have shown that in patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) reduces CV mortality and hospital admission rates for heart failure (HF). However, the mechanisms behind these benefits are not fully understood. This study was performed to investigate the effects of the SGLT-2i dapagliflozin on myocardial perfusion and glucose metabolism in patients with T2D and stable coronary artery disease (coronary stenosis ≥ 30% and < 80%), with or without previous percutaneous coronary intervention (> 6 months) but no HF. Methods This was a single-center, prospective, randomized, double-blind, controlled clinical trial including 16 patients with T2D randomized to SGLT-2i dapagliflozin (10 mg daily) or placebo. The primary outcome was to detect changes in myocardial glucose uptake (MGU) from baseline to 4 weeks after treatment initiation by [(18)F]2-deoxy-2-fluoro-D-glucose (FDG) PET/CT during hyperinsulinemic euglycemic clamp. The main secondary outcome was to assess whether the hypothetical changes in MGU were associated with changes in myocardial blood flow (MBF) and myocardial flow reserve (MFR) measured by 13N-ammonia PET/CT. The study was registered at eudract.ema.europa.eu (EudraCT No. 2016-003614-27) and ClinicalTrials.gov (NCT 03313752). Results 16 patients were randomized to dapagliflozin (n = 8) or placebo (n = 8). The groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, renal and heart function). There was no significant change in MGU during euglycemic hyperinsulinemic clamp in the dapagliflozin group (2.22 ± 0.59 vs 1.92 ± 0.42 μmol/100 g/min, p = 0.41) compared with the placebo group (2.00 ± 0.55 vs 1.60 ± 0.45 μmol/100 g/min, p = 0.5). Dapagliflozin significantly improved MFR (2.56 ± 0.26 vs 3.59 ± 0.35 p = 0.006 compared with the placebo group 2.34 ± 0.21 vs 2.38 ± 0.24 p = 0.81; pint = 0.001) associated with a reduction in resting MBF corrected for cardiac workload (p = 0.005; pint = 0.045). A trend toward an increase in stress MBF was also detected (p = 0.054). Conclusions SGLT-2 inhibition increases MFR in T2D patients. We provide new insight into SGLT-2i CV benefits, as our data show that patients on SGLT-2i are more resistant to the detrimental effects of obstructive coronary atherosclerosis due to increased MFR, probably caused by an improvement in coronary microvascular dysfunction. Trial registration EudraCT No. 2016-003614-27; ClinicalTrials.gov Identifier: NCT03313752 Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01607-4.
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Affiliation(s)
- Lucia Leccisotti
- UOC Di Medicina Nucleare, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Francesca Cinti
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Gian Pio Sorice
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia.,Sezione Di Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, Dipartimento Dell'Emergenza E Dei Trapianti Di Organi (D.E.T.O.), Università Degli Studi Di Bari "Aldo Moro", Bari, Italia
| | - Domenico D'Amario
- UOC Di Cardiologia, Dipartimento Di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Margherita Lorusso
- UOC Di Medicina Nucleare, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Maria Angela Guzzardi
- Istituto Di Fisiologia Clinica, Consiglio Nazionale Delle Ricerche (CNR), Pisa, Italia
| | - Teresa Mezza
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Shawn Gugliandolo
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Camilla Cocchi
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Umberto Capece
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Luca Indovina
- UOSD Fisica Medica E Radioprotezione, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italia
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patricia Iozzo
- Istituto Di Fisiologia Clinica, Consiglio Nazionale Delle Ricerche (CNR), Pisa, Italia
| | - Filippo Crea
- UOC Di Cardiologia, Dipartimento Di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italia
| | - Alessandro Giordano
- UOC Di Medicina Nucleare, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia.
| | - Andrea Giaccari
- Centro Malattie Endocrine E Metaboliche, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italia.
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Vergallo R, Burzotta F, Aurigemma C, Romagnoli E, D'Amario D, Trani C, Crea F. The fingerprints of plaque rupture healing as detected by serial optical coherence tomography imaging. EUROINTERVENTION 2022; 18:e405-e406. [PMID: 35652282 PMCID: PMC10259239 DOI: 10.4244/eij-d-22-00007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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44
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Pozzi G, D'Amario D, Princi G, Ciliberti G, Irano A, Simone MV, Crea F, Galiuto L. Pre-existing Psychiatric Morbidity Is Strongly Associated to Takotsubo Syndrome: A Case-Control Study. Front Cardiovasc Med 2022; 9:925459. [PMID: 35903670 PMCID: PMC9314861 DOI: 10.3389/fcvm.2022.925459] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Takotsubo syndrome (TTS) is an emerging disease characterized by an acute and reversible myocardial dysfunction which may have an influence on clinical status and prognosis. Despite extensive research, its pathophysiology has not been completely elucidated; among other hypothesis, a heart-brain interaction has been proposed. Methods The aim of this study was to assess the impact of psychiatric disorders and of some personality types on the pathogenesis of TTS. We conducted a retrospective observational case-control study. We enrolled a total of 50 patients, 25 with a previous diagnosis of TTS and 25 patients with a history of acute coronary syndrome (ACS), that underwent a comprehensive lifetime psychiatric assessment. Results We found no significant difference between TTS and ACS patients in cardiovascular risk profile. The frequency of lifetime psychiatric disorders was significantly greater in TTS. In particular, in the univariate analysis, TTS group showed a higher prevalence of mood disorders (Major Depressive Disorder, Bipolar Disorder, Dysthymia; 16 vs. 2, P < 0.001) and anxiety disorder (Generalized Anxiety Disorder, Panic Disorder, Agoraphobia; 20 vs. 8, P = 0.001) compared with ACS group. There was also a significant tendency in TTS patients to psychotropic medication use, substance abuse, and psychologist or psychiatrist consulting. However, there was no difference between the groups in previous stressful events and Type D personality. Moreover, the multivariate analysis showed that mood disorders were independently associated with TTS (OR 16.9, 95% CI, 2.2–127). Conclusion Our study demonstrated that pre-existing anxiety disorders and mostly mood disorders were significantly higher in TTS patients than in ACS group, suggesting the role of psychiatric disorders as possible pathophysiological substrate of TTS.
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Affiliation(s)
- Gino Pozzi
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Domenico D'Amario
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giuseppe Princi
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giuseppe Ciliberti
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Antonella Irano
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Velia Simone
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Leonarda Galiuto
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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45
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Musto C, Scappaticci M, Biondi‐Zoccai G, De Felice F, D'Amario D, Nazzaro MS, Stio RE, Del Prete A, Chin D, Pennacchi M, Paolucci L, Versaci F, Gabrielli D. Instantaneous wave‐free ratio‐guided revascularization of nonculprit lesions in STEMI patients with multivessel coronary disease: The WAVE registry. Catheter Cardiovasc Interv 2022; 100:351-359. [PMID: 35870173 DOI: 10.1002/ccd.30342] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/07/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Carmine Musto
- Interventional Cardiology Unit San Camillo Hospital Rome Italy
| | | | | | | | - Domenico D'Amario
- Interventional Cardiology Unit Policlinico Agostino Gemelli Rome Italy
| | | | - Rocco E. Stio
- Interventional Cardiology Unit San Camillo Hospital Rome Italy
| | - Armando Del Prete
- Interventional Cardiology Unit Santa Maria Goretti Hospital Latina Italy
| | - Diana Chin
- Interventional Cardiology Unit San Camillo Hospital Rome Italy
| | - Mauro Pennacchi
- Interventional Cardiology Unit San Camillo Hospital Rome Italy
| | - Luca Paolucci
- Interventional Cardiology Unit San Camillo Hospital Rome Italy
| | - Francesco Versaci
- Interventional Cardiology Unit Santa Maria Goretti Hospital Latina Italy
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46
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Quarti AG, Egidy Assenza G, Mangerini VF, Petridis FD, D'Amario D, Careddu L, Angeli E, Gargiulo GD. Bentall Endocarditis by C. Lusitaniae After COVID-19: The Finger Covers The Moon. World J Pediatr Congenit Heart Surg 2022; 13:523-525. [PMID: 35296172 PMCID: PMC8935133 DOI: 10.1177/21501351221083991] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report a case of endocarditis months after a Bentall procedure. This was caused by Candida Lusitaniae, in an immunocompetent patient with a recent SARS-CoV-2 infection. The patient underwent a new Bentall procedure. SARS-CoV-2 has been associated with co-infection by Candida species since the beginning of the pandemic, nevertheless, Candida Lusitaniae remains a very uncommon causative agent of prosthetic endocarditis. We suggest a possible role of the SARS-CoV-2, which may have delayed the diagnosis of endocarditis and the appropriate therapy.
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Affiliation(s)
- Andrea Giulio Quarti
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Program, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Valeria Francesca Mangerini
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Francesco Dimitri Petridis
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucio Careddu
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Emanuela Angeli
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric and Adult Congenital Cardiac Surgery, University Hospital Policlinico di Sant'Orsola IRCCS, Bologna, Italy
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47
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Gasparovic H, Jakus N, Brugts JJ, Pouleur AC, Timmermans P, Rubiś P, Gaizauskas E, Van Craenenbroeck EM, Barge-Caballero E, Grundmann S, Paolillo S, D'Amario D, Braun OÖ, Meyns B, Droogne W, Wierzbicki K, Holcman K, Planinc I, Lovric D, Flammer AJ, Petricevic M, Biocina B, Lund LH, Milicic D, Ruschitzka F, Cikes M. Impact of progressive aortic regurgitation on outcomes after left ventricular assist device implantation. Heart Vessels 2022; 37:1985-1994. [PMID: 35737119 DOI: 10.1007/s00380-022-02111-1] [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: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
Aortic regurgitation (AR) following continuous flow left ventricular assist device implantation (cf-LVAD) may adversely impact outcomes. We aimed to assess the incidence and impact of progressive AR after cf-LVAD on prognosis, biomarkers, functional capacity and echocardiographic findings. In an analysis of the PCHF-VAD database encompassing 12 European heart failure centers, patients were dichotomized according to the progression of AR following LVAD implantation. Patients with de-novo AR or AR progression (AR_1) were compared to patients without worsening AR (AR_0). Among 396 patients (mean age 53 ± 12 years, 82% male), 153 (39%) experienced progression of AR over a median of 1.4 years on LVAD support. Before LVAD implantation, AR_1 patients were less frequently diabetic, had lower body mass indices and higher baseline NT-proBNP values. Progressive AR did not adversely impact mortality (26% in both groups, HR 0.91 [95% CI 0.61-1.36]; P = 0.65). No intergroup variability was observed in NT-proBNP values and 6-minute walk test results at index hospitalization discharge and at 6-month follow-up. However, AR_1 patients were more likely to remain in NYHA class III and had worse right ventricular function at 6-month follow-up. Lack of aortic valve opening was related to de-novo or worsening AR (P < 0.001), irrespective of systolic blood pressure (P = 0.67). Patients commonly experience de-novo or worsening AR when exposed to continuous flow of contemporary LVADs. While reducing effective forward flow, worsening AR did not influence survival. However, less complete functional recovery and worse RV performance among AR_1 patients were observed. Lack of aortic valve opening was associated with progressive AR.
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Affiliation(s)
- Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Nina Jakus
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jasper J Brugts
- Division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Louvain, Belgium
| | | | - Pawel Rubiś
- Department of Cardiac and Vascular Diseases Krakow, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Edvinas Gaizauskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Sebastian Grundmann
- Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Oscar Ö Braun
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium
| | - Walter Droogne
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases Krakow, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Ivo Planinc
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Daniel Lovric
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Andreas J Flammer
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mate Petricevic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Lars H Lund
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Davor Milicic
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Maja Cikes
- Department of Cardiology, University Hospital Center Zagreb, Zagreb, Croatia
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48
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Aurigemma C, Burzotta F, Vergallo R, Farina P, Romagnoli E, Cangemi S, Bianchini F, Nesta M, Bruno P, D'Amario D, Leone AM, Trani C. Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges. Front Cardiovasc Med 2022; 9:895477. [PMID: 35711347 PMCID: PMC9194080 DOI: 10.3389/fcvm.2022.895477] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.
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Affiliation(s)
- Cristina Aurigemma
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Farina
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Cangemi
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Maria Leone
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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49
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Arcudi A, Di Francesco M, Rodolico D, D'Amario D. Angiotensin receptor-neprilysin inhibitor in symptomatic patients with Duchenne dilated cardiomyopathy: A primetime. ESC Heart Fail 2022; 9:3639-3642. [PMID: 35712811 DOI: 10.1002/ehf2.13963] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Duchenne muscular dystrophy (DMD) is an X-linked recessive neuromuscular disorder, characterized by significant long-term cardiac involvement. Dilated cardiomyopathy (DCM) is the main cause of death in DMD, and angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers (BB) are first-line treatments in DCM. It is unknown whether angiotensin receptor-neprilysin inhibitor (ARNi) could provide greater benefits in this setting. Our aim is to assess whether ARNi use may prevent deterioration in ejection fraction (EF) or is associated with EF improvement compared with ACEi in DMD patients with heart failure and to report the tolerability of ARNi in this group of patients. METHODS AND RESULTS We followed 22 DMD patients, 6 of them with an EF < 40% and 16 with an EF > 40%. The first group received ARNi on top of BB, while the control group started or continued first-line therapy with ACEi ± BB. From December 2016 to December 2021, we recorded EF values at baseline and at follow-up, comparing EF changes. Median follow-up was 7 months (interquartile range 4.7-9.1). At baseline, the mean of EF (%) in the ARNi group was 31 ± 2%, while it was 59 ± 9% in the control group. At follow-up, we recorded an EF improvement in the ARNi group (38 ± 6%, P-value < 0.05). Among controls, EF at follow-up was substantially unchanged from baseline. CONCLUSIONS Our data suggest that the use of ARNi in DMD patients with DCM and an EF < 40% might be associated with an EF improvement and a safe tolerability profile.
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Affiliation(s)
- Alessandra Arcudi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Di Francesco
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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50
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D'Amario D, Montone RA, Borovac JA. Editorial: MINOCA: Pathogenesis, Diagnosis, Clinical Management and Evolution Towards Precision Medicine. Front Cardiovasc Med 2022; 9:928515. [PMID: 35774368 PMCID: PMC9237816 DOI: 10.3389/fcvm.2022.928515] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome, Italy
| | - Rocco A. Montone
- Department of Cardiovascular and Thoracic Sciences, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico A. Gemelli, Universita Cattolica Sacro Cuore, Rome, Italy
| | - Josip A. Borovac
- Clinic for Heart and Vascular Diseases, University Hospital of Split, Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
- *Correspondence: Josip A. Borovac
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