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Springhetti P, Benfari G, Nistri S, Jannello EMS, Mandoli GE, Badano L, Ribichini FL, Muraru D. Diagnostic Contexts of Echocardiographic Nonapical Window. JACC Case Rep 2024; 29:102287. [PMID: 38500538 PMCID: PMC10945174 DOI: 10.1016/j.jaccas.2024.102287] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
The long-established utility of multiwindow interrogation in echocardiography (suprasternal notch, right and left sternal border, apex, and subxiphoid) is sometimes not systematically implemented in routine practice. This case series emphasizes the pivotal importance of such practice for the systematic assessment of aortic valve stenosis and in the evaluation of left ventricular outflow tract and the aorta.
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Affiliation(s)
- Paolo Springhetti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Benfari
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | | | | | | | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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2
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Fezzi S, Del Sole PA, Pighi M, Flaim M, Mammone C, Rizzetto F, Tavella D, Mcinerney A, Pesarini G, Benfari G, Scarsini R, Mylotte D, Ribichini FL. Right Ventricle Pulmonary Artery Coupling and Renal Function in Patients With Severe Aortic Stenosis Undergoing TAVR. JACC Cardiovasc Imaging 2024; 17:451-453. [PMID: 37999658 DOI: 10.1016/j.jcmg.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
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Ficial B, Benfari G, Bonafiglia E, Clemente M, Cappelleri A, Flore AI, Petoello E, Ciarcià M, Nogara S, Milocchi C, Dani C, Ribichini FL, Gottin L, Corsini I. Tissue-Tracking Mitral Annular Displacement in Neonates: A Novel Index of Left Ventricular Systolic Function. J Ultrasound Med 2024; 43:729-739. [PMID: 38140738 DOI: 10.1002/jum.16399] [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: 09/15/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To assess the feasibility, accuracy, and reproducibility of tissue-tracking mitral annular displacement (TMAD) compared with other measures of left ventricular systolic function in healthy preterm and term neonates in the transitional period. METHODS This was a prospective observational study. Two echocardiograms were performed at 24 and 48 hours of life. TMAD, shortening fraction (SF), ejection fraction (EF), s', and global longitudinal strain (GLS) were measured offline. Accuracy to detect impaired GLS was tested by ROC curve analysis. DeLong test was used to compare AUCs. Intra and interobserver reproducibility of the off-line analysis was calculated. RESULTS Mean ± SD gestational age and weight were 34.2 ± 3.8 weeks and 2162 ± 833 g, respectively. TMAD was feasible in 168/180 scans (93%). At 24 hours the AUC (95% CI) of SF, EF, s', and TMAD (%) was 0.51 (0.36-0.67), 0.68 (0.54-0.82), 0.63 (0.49-0.77), and 0.89 (0.79-0.99) respectively. At 48 hours the AUC (95% CI) of SF, EF, s', and TMAD (%) was 0.64 (0.51-0.77), 0.59 (0.37-0.80), 0.70 (0.54-0.86), and 0.96 (0.91-1.00), respectively. The AUC of TMAD was superior to the AUC of SF, EF, s', at both timepoints (P < .02). Intraclass correlation coefficients (95% CI) of intra and interobserver reproducibility of TMAD were 0.97 (0.95-0.99) and 0.94 (0.88-0.97), respectively. CONCLUSION TMAD showed improved accuracy and optimal reproducibility in neonates in the first 48 hours of life.
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Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Bonafiglia
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Alessia Cappelleri
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Carlotta Milocchi
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | | | - Leonardo Gottin
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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Scarsini R, Portolan L, Della Mora F, Fabroni M, Andreaggi S, Mainardi A, Springhetti P, Dotto A, Del Sole PA, Fezzi S, Pazzi S, Tavella D, Mammone C, Lunardi M, Pesarini G, Benfari G, Ribichini FL. Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation. Heart 2024; 110:603-612. [PMID: 38040448 DOI: 10.1136/heartjnl-2023-323461] [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: 09/12/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the prognostic value of coronary microvascular dysfunction (CMD) at long term after transcatheter aortic valve implantation (TAVI) and to explore its relationship with extravalvular cardiac damage (EVCD). Moreover, we sought to test the correlation between angiography-derived index of microcirculatory resistance (IMRangio) and invasive IMR in patients with aortic stenosis (AS). METHODS This was a retrospective analysis of the Verona Valvular Heart Disease Registry (Italy) including 250 patients (83 (80-86) years, 53% female) with severe AS who underwent TAVI between 2019 and 2021. IMRangio was calculated offline using a computational flow model applied to coronary angiography obtained during the TAVI workup. CMD was defined as IMRangio ≥30 units.The primary endpoint was the composite of cardiovascular death and rehospitalisation for heart failure (HF). Advanced EVCD was defined as pulmonary circulation impairment, severe tricuspid regurgitation or right ventricular dysfunction.The correlation between IMR and IMRangio was prospectively assessed in 31 patients undergoing TAVI. RESULTS The primary endpoint occurred in 28 (11.2%) patients at a median follow-up of 22 (IQR 12-30) months. Patients with CMD met the primary endpoint more frequently than those without CMD (22.9% vs 2.8%, p<0.0001). Patients with CMD were more frequently characterised by advanced EVCD (33 (31.4%) vs 27 (18.6%), p=0.024). CMD was an independent predictor of adverse outcomes (adjusted HR 6.672 (2.251 to 19.778), p=0.001) and provided incremental prognostic value compared with conventional clinical and imaging variables. IMRangio demonstrated fair correlation with IMR. CONCLUSIONS CMD is an independent predictor of cardiovascular mortality and HF after TAVI.
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Affiliation(s)
- Roberto Scarsini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Leonardo Portolan
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Francesco Della Mora
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Margherita Fabroni
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Stefano Andreaggi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Alberto Dotto
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | | | - Simone Fezzi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Sara Pazzi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Domenico Tavella
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Concetta Mammone
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Mattia Lunardi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Gabriele Pesarini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Benfari
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Pio Loco C, Medo K, Gregorio C, De Luca A, Graw S, Castrichini M, Cannatà A, Ribichini FL, Dal Ferro M, Taylor M, Sinagra G, Mestroni L. Role of arrhythmic phenotype in prognostic stratification and management of dilated cardiomyopathy. Eur J Heart Fail 2024. [PMID: 38404225 DOI: 10.1002/ejhf.3168] [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: 07/15/2023] [Revised: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) with arrhythmic phenotype combines phenotypical aspects of DCM and predisposition to ventricular arrhythmias, typical of arrhythmogenic cardiomyopathy. The definition of DCM with arrhythmic phenotype is not universally accepted, leading to uncertainty in the identification of high-risk patients. This study aimed to assess the prognostic impact of arrhythmic phenotype in risk stratification and the correlation of arrhythmic markers with high-risk arrhythmogenic gene variants in DCM patients. METHODS AND RESULTS In this multicentre study, DCM patients with available genetic testing were analysed. The following arrhythmic markers, present at baseline or within 1 year of enrolment, were tested: unexplained syncope, rapid non-sustained ventricular tachycardia (NSVT), ≥1000 premature ventricular contractions/24 h or ≥50 ventricular couplets/24 h. LMNA, FLNC, RBM20, and desmosomal pathogenic or likely pathogenic gene variants were considered high-risk arrhythmogenic genes. The study endpoint was a composite of sudden cardiac death and major ventricular arrhythmias (SCD/MVA). We studied 742 DCM patients (45 ± 14 years, 34% female, 410 [55%] with left ventricular ejection fraction [LVEF] <35%). During a median follow-up of 6 years (interquartile range 1.6-12.1), unexplained syncope and NSVT were the only arrhythmic markers associated with SCD/MVA, and the combination of the two markers carried a significant additive risk of SCD/MVA, incremental to LVEF and New York Heart Association class. The probability of identifying an arrhythmogenic genotype rose from 8% to 30% if both early syncope and NSVT were present. CONCLUSION In DCM patients, the combination of early detected NSVT and unexplained syncope increases the risk of life-threatening arrhythmic outcomes and can aid the identification of carriers of malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marta Gigli
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Laura Munaretto
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carola Pio Loco
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Caterina Gregorio
- Biostatistics Unit, University of Trieste, Trieste, Italy
- MOX-Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Antonio De Luca
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matteo Castrichini
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antonio Cannatà
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, King's College London, London, UK
| | | | - Matteo Dal Ferro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matthew Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Adamo M, Branca L, Pezzola E, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Gandolfo C, Fiorina C, Sammartino S, Latib A, Santos IA, Mylotte D, De Marco F, De Backer O, Franco LN, Akodad M, Ribichini FL, Bedogni F, Laterra G, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Valvo R, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello N, Hennessey B, Mon-Noboa M, Meier D, Sgroi C, Reddavid CM, Strazzieri O, Motta SC, Frittitta V, Dipietro E, Comis A, Melfa C, Cal M, Thiele H, Webb JG, Søndergaard L, Tamburino C, Metra M, Costa G, Barbanti M. Sex-Related Outcomes of Transcatheter Aortic Valve Implantation With Self-Expanding or Balloon-Expandable Valves: Insights from the OPERA-TAVI Registry. Am J Cardiol 2024; 219:60-70. [PMID: 38401656 DOI: 10.1016/j.amjcard.2024.01.028] [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: 10/11/2023] [Revised: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
Evidence regarding gender-related differences in response to transcatheter aortic valve implantation according to the valve type is lacking. This study aimed to evaluate the impact of gender on the treatment effect of Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices on clinical outcomes. The Comparative Analysis of Evolut PRO vs SAPIEN 3 Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation (OPERA-TAVI) is a multicenter, multinational registry including patients who underwent the latest-iteration PRO or ULTRA implantation. Overall, 1,174 of 1,897 patients were matched based on valve type and compared according to gender, whereas 470 men and 630 women were matched and compared according to valve type. The 30-day and 1-year outcomes were evaluated. In the PRO and ULTRA groups, men had a higher co-morbidity burden, whereas women had smaller aortic root. The 30-day (device success [DS], early safety outcome, permanent pacemaker implantation, patient-prosthesis mismatch, paravalvular regurgitation, bleedings, vascular complications, and all-cause death) and 1-year outcomes (all-cause death, stroke, and heart failure hospitalization) did not differ according to gender in both valve groups. However, the male gender decreased the likelihood of 30-day DS with ULTRA versus PRO (p for interaction = 0.047). A higher risk of 30-day permanent pacemaker implantation and 1-year stroke and a lower risk of patient-prosthesis mismatch was observed in PRO versus ULTRA, regardless of gender. In conclusion, gender did not modify the treatment effect of PRO versus ULTRA on clinical outcomes, except for 30-day DS, which was decreased in men (vs women) who received ULTRA (vs PRO).
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Luca Branca
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisa Pezzola
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Claudia Fiorina
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ignacio Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | | | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta specializzazione (ISMETT), Palermo, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Roberto Valvo
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Mariachiara Cal
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
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Pellegrini N, Bolzan B, Franchi E, Tomasi L, Ribichini FL, Mugnai G. Correction: Major issues for supraventricular tachycardia ablation in patients with persistent left superior vena cava. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01763-5. [PMID: 38308738 DOI: 10.1007/s10840-024-01763-5] [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: 02/05/2024]
Affiliation(s)
- Nicolò Pellegrini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Elena Franchi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Luca Tomasi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy.
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8
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Masè M, Rossi M, Setti M, Barbati G, Teso MV, Ribichini FL, Koni M, Stolfo D, Merlo M, Sinagra G. Applicability and performance of heart failure prognostic scores in dilated cardiomyopathy: the real-world experience of an Italian referral center for cardiomyopathies. Int J Cardiol 2024; 396:131562. [PMID: 37907097 DOI: 10.1016/j.ijcard.2023.131562] [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: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The performance of heart failure (HF) risk models is validated in the general population with HF but in specific aetiological settings, and specifically in dilated cardiomyopathy (DCM), has scarcely been explored. We tested eight of the main prognostic scores used in HF in a large real-world population of patients with DCM. METHODS We included 784 consecutive DCM patients enrolled, both inpatients and outpatients, enrolled between January 2000 and December 2017. The risk of 1 and/or 3-year all-cause mortality/heart transplantation/durable left ventricular assist device (LVAD) implantation (D/HTx/LVAD) was estimated in our cohort according to the following risk scores SHFM, 3-CHF, CHARM, MAGGIC, GISSI-HF, MECKI, Barcelona Bio-HF, Krakow score and their accuracy calculated through the receiver operator characteristic (ROC) curve analysis. RESULTS During a median follow-up of 5.8 years (Interquartile Range 3.2-7.6 years), 191 patients (20%) died or underwent HTx/LVAD (158 deaths, 30 heart transplantations, and 3 LVAD implantations). The high missing rate allowed to calculated only four prognostic models (MAGGIC, CHARM, 3-CHF and SHFM). All the scores overestimated the rate of D/HTx/LVAD. The prognostic accuracy was suboptimal for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores and only modest for 3-CHF (AUC 0.677) and SHFM (AUC 0.667). CONCLUSIONS Main prognostic scores for the risk stratification of HF are only partially applicable to real-world patients with DCM. MAGGIC and CHARM scores showed the best accuracy, despite the overestimation of risk. Our findings corroborate the need of specific risk scores for the prognostic stratification of DCM. CLINICAL PERSPECTIVE What is new? The present study is the largest analysis in literature which investigate how the main existing heart failure prognostic risk scores performed in a real-world of dilated cardiomyopathy population, both in- and outpatients. What are the clinical implications? DCM is a stand-alone model of heart failure, where the performance of multiple heart failure prognostic scores for the risk stratification is quite limited. The need for contemporary, dedicated prognostic scores in this disease is increasingly evident.
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Affiliation(s)
- M Masè
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Rossi
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Setti
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - G Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - F L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - M Koni
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - D Stolfo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
| | - G Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
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9
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Leonardi D, Bursi F, Fanti D, Dotto A, Ciceri L, Springhetti P, Bergamini C, Tafciu E, Maffeis C, Scarsini R, Enriquez-Sarano M, Ribichini FL, Benfari G. Outpatient tricuspid regurgitation in the community: Clinical context and outcome. Int J Cardiol 2024; 396:131443. [PMID: 37844668 DOI: 10.1016/j.ijcard.2023.131443] [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: 06/10/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a geographically defined area and its outcome, in particular overall survival and hospitalization, considering different clinical contexts. METHODS We retrospectively analyzed consecutive outpatients referred between 2006 and 2013 for echocardiography and clinical evaluation. Patients with at least moderate TR were included and five different clinical settings were defined: concomitant significant left-sided valvular heart disease (LVHD-TR), heart failure (HF-TR), previous open-heart valvular surgery (postop-TR), pulmonary hypertension (PHTN-TR) and isolated TR (isolated-TR). Primary endpoint was a composite outcome of all-cause mortality or first hospitalization for HF. RESULTS Of 6797 consecutive patients with a clinical visit and echocardiograms performed in routine practice in a geographically defined community, moderate or severe TR was found in 4.8% of patients (327) . During median follow-up of 6.1 years, TR severity was a determinant of event-free survival. Analyzed for each clinical subset, eight-year event-free survival was 87 ± 7% for postop-TR subgroup, 75 ± 7% for isolated-TR, 67 ± 6% for PHTN-TR, 58 ± 6% for LHVD -TR and 52 ± 11% for HF-TR. CONCLUSION Moderate or more TR is a notable finding in the community and has impact on event-free survival in all clinical settings, with the worst outcomes when associated with relevant left-sided valvular heart disease and HF.
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Affiliation(s)
- Denis Leonardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Diego Fanti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Dotto
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Ciceri
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
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10
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Pellegrini N, Bolzan B, Franchi E, Tomasi L, Ribichini FL, Mugnai G. Major issues for supraventricular tachycardia ablation in patients with persistent left superior vena cava. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01751-9. [PMID: 38238550 DOI: 10.1007/s10840-024-01751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Nicolò Pellegrini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Elena Franchi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Luca Tomasi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy.
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11
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Fezzi S, Pighi M, Del Sole PA, Scarsini R, Mammone C, Zanforlin R, Ferrero V, Lunardi M, Tavella D, Pesarini G, Ribichini FL. Long-term intracoronary imaging and physiological measurements of bioresorbable scaffolds and untreated atherosclerotic plaques. Int J Cardiol 2024; 394:131341. [PMID: 37678431 DOI: 10.1016/j.ijcard.2023.131341] [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: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bioresorbable scaffolds (BRS) provide the prospect of restoring the anatomic and physiologic characteristics of the vascular wall. OBJECTIVE This study sought to examine the long-term outcomes of BRS-based coronary intervention in a young population with diffuse and severe coronary atherosclerotic disease (CAD) and to compare the long-term evolution of treated segments versus the natural progression of untreated non-flow limiting stenoses. METHODS Observational, single-center cohort study that prospectively included patients that underwent percutaneous coronary intervention with implantation of ABSORB BRS (Abbott Vascular). The clinical endpoint was the incidence of device-oriented composite endpoint (DoCE) up to 5 years follow-up. A subgroup of patients with baseline intracoronary imaging assessment of long lesions and/or multivessel disease underwent elective angiographic (70 patients, 129 lesions) and intracoronary imaging (55 patients, 102 lesions) follow-up. Paired intravascular ultrasound (IVUS) and quantitative flow reserve (QFR) were analyzed. RESULTS Between 2012 and 2017, 159 patients (mean age 54.0 ± 11.1) with native CAD were treated with BRS on 247 lesions. Patients were mainly at their first cardiac event, mostly acute coronary syndromes (86.5%). At the median follow-up time of 56 months [41-65], DoCE occurred in 15/159 (9.4%) patients, while non-target vessel-oriented composite endpoint occurred in 16 patients (10.4%). A significant atherosclerotic progression was detected on residual non-flow limiting plaques as per IVUS and QFR assessment, while no significant change was detected in the treated segment. CONCLUSIONS Mild-to-moderate asymptomatic CAD progressed significantly at 5-year despite OMT. BRS-treated segments had a less aggressive progression at 5-year despite more severe and symptomatic CAD at baseline.
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Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy; The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Paolo Alberto Del Sole
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Zanforlin
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
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12
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Sammartino S, Gandolfo C, Branca L, Latib A, Amat-Santos I, Mylotte D, De Marco F, De Backer O, Nombela Franco L, Akodad M, Ribichini FL, Bedogni F, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello NJ, Hennessey B, Mon-Noboa M, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Crescenzia Motta S, Frittitta V, Dipietro E, Comis A, Melfa C, Calì M, Laterra G, Thiele H, Webb JG, Sondergaard L, Tamburino C, Barbanti M. One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry. EUROINTERVENTION 2024; 20:95-103. [PMID: 37982161 PMCID: PMC10758986 DOI: 10.4244/eij-d-23-00720] [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] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ignacio Amat-Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Matias Mon-Noboa
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Abbott Vascular, Santa Clara, CA, USA
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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13
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Mugnai G, Velagic V, Malagù M, de Asmundis C, Tomasi L, Bolzan B, Chierchia GB, Ribichini FL, Ströker E, Bertini M. Zero fluoroscopy catheter ablation of premature ventricular contractions: a multicenter experience. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01723-5. [PMID: 38102499 DOI: 10.1007/s10840-023-01723-5] [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: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Catheter ablation has become an established treatment option for premature ventricular complexes (PVCs). The use of fluoroscopy exposes patients and medical staff to potentially harmful stochastic and deterministic effects of ionizing radiations. We sought to analyze procedural outcomes in terms of safety and efficacy using a "zero fluoroscopy" approach for catheter ablation of PVCs. METHODS The present retrospective, multicenter, observational study included 131 patients having undergone catheter ablation of PVCs using "zero fluoroscopy" between 2019 and 2020 in four centers compared with another group who underwent the procedure with fluoroscopy. RESULTS Median age was 51.0 ± 15.9 years old; males were 77 (58.8%). Among the study population, 26 (19.8%) had a cardiomyopathy. The most frequent PVC origin was right ventricular outflow tract (55%) followed by the left ventricle (16%), LVOT and cusps (13.7%), and aortomitral continuity (5.3%). Acute suppression of PVC was achieved in 127 patients (96.9%). At 12 months, a complete success was documented in 109 patients (83.2%), a reduction in PVC burden in 18 patients (13.7%), and a failure was recorded in four patients (3.1%). Only two minor complications occurred (femoral hematoma and arteriovenous fistula conservatively treated). CONCLUSIONS The PVC ablation with a "zero" fluoroscopy approach appears to be a safe procedure with no major complications and good rates of success and recurrence in our multicenter experience.
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Affiliation(s)
- Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
| | - Vedran Velagic
- Department of Cardiovascular Diseases, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Michele Malagù
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
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14
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Cavigli L, Ragazzoni GL, Quer L, Cangiano N, Santoro A, Ferasin V, Mandoli GE, Pastore MC, Benfari G, Ribichini FL, Focardi M, Valente S, Cameli M, D'Ascenzi F. Aortic root/left ventricular diameters golden ratio in competitive athletes. Int J Cardiol 2023; 390:131202. [PMID: 37480998 DOI: 10.1016/j.ijcard.2023.131202] [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: 05/12/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic dilatation can be considered normal in athletes is debated. This study aimed to evaluate the ratio between left ventricular (LV) size and aortic dimensions, reporting the normal values of the ratio between the aortic root diameters at the level of the sinuses of Valsalva and LV diameters (AoD/LVEDD ratio) in a wide cohort of competitive athletes. MATERIALS AND METHODS Competitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years). RESULTS Patients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m2, p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m2, p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001). CONCLUSIONS In this study, we reported the AoD/LVEDD and LVEDD/AoD ratio values in a cohort of healthy athletes, additional parameters that could help confirm the harmonic remodelling in the athlete's heart.
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Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Gian Luca Ragazzoni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Laura Quer
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Cangiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alfonso Santoro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Veronica Ferasin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
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Mugnai G, Ferrero V, Tomasi L, Bolzan B, Vassanelli F, Ribichini FL. The implementation of telemedicine in the follow-up after catheter ablation of arrhythmias: do we still need in-office consultations? J Cardiovasc Med (Hagerstown) 2023; 24:790-792. [PMID: 37773879 DOI: 10.2459/jcm.0000000000001545] [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] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University of Verona, Verona, Italy
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16
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Stabile E, Muiesan ML, Ribichini FL, Sangiorgi G, Taddei S, Versaci F, Villari B, Bacca A, Benedetto D, Fioretti V, Liccardo G, Laurenzano E, Scappaticci M, Saia F, Tarantini G, Grassi G, Esposito G. [Italian Society of Interventional Cardiology (GISE) and Italian Society of Arterial Hypertension (SIIA) Consensus document on the role of renal denervation in the management of the difficult to treat hypertension]. G Ital Cardiol (Rome) 2023; 24:53S-63S. [PMID: 37767848 DOI: 10.1714/4101.40995] [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
Arterial hypertension is the most prevalent cardiovascular risk factor worldwide. Despite the availability of many and effective antihypertensive medications, the prevalence of uncontrolled blood pressure (BP) remains high. As sympathetic hyperactivity has long been recognized as a major contributor to resistant hypertension, catheter-based renal denervation (RDN) has emerged as a new strategy to reduce BP. RDN aims to interrupt the activity of renal sympathetic nerves by applying radiofrequency (RF) energy, ultrasound (US) energy, or injection of alcohol in the perivascular space. The Symplicity HTN-3 trial, the largest sham-controlled trial using the first-generation RF-based RDN device, failed to significantly reduce BP. Since then, new devices and techniques have been developed and consequently many sham-controlled trials using second-generation RF or US-based RDN devices have demonstrated the BP lowering efficacy and safety of the procedure. A multidisciplinary team involving hypertension experts, interventionalists with expertise in renal interventions and anesthesiologists, plays a pivotal role from the selection of the patient candidate for the procedure to the post-procedural care. The aim of this consensus document is to summarize the current evidence about the use of RDN in difficult to treat hypertension and to propose a management strategy from the selection of the patient candidate for the procedure to the post-procedural care.
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Affiliation(s)
- Eugenio Stabile
- Divisione di Cardiologia, Dipartimento Cardiovascolare, Azienda Ospedaliera Regionale "San Carlo", Potenza
| | | | | | | | - Stefano Taddei
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Pisa
| | | | - Bruno Villari
- Divisione di Cardiologia, Ospedale Sacro Cuore di Gesù, Benevento
| | - Alessandra Bacca
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Pisa
| | - Daniela Benedetto
- Divisione di Cardiologia, Università degli Studi "Tor Vergata", Roma
| | - Vincenzo Fioretti
- Divisione di Cardiologia, Dipartimento Cardiovascolare, Azienda Ospedaliera Regionale "San Carlo", Potenza - Divisione di Cardiologia, Dipartimento Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Gaetano Liccardo
- Dipartimento di Scienze Biomediche, Università Humanitas, Milano
| | | | | | - Francesco Saia
- Unità di Cardiologia, Dipartimento Cardio-Toraco-Vascolare, IRCCS Università Ospedale di Bologna, Policlinico S. Orsola, Bologna
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Scuola di Medicina, Padova
| | - Guido Grassi
- Clinica Medica, Università degli Studi Milano-Bicocca, Milano
| | - Giovanni Esposito
- Divisione di Cardiologia, Dipartimento Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
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17
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Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
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18
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Scarsini R, Tebaldi M, Rubino F, Sgreva S, Vescovo G, Barbierato M, Vicerè A, Galante D, Mammone C, Lunardi M, Tavella D, Pesarini G, Campo G, Leone AM, Ribichini FL. Intracoronary physiology-guided percutaneous coronary intervention in patients with diabetes. Clin Res Cardiol 2023; 112:1331-1342. [PMID: 37338598 PMCID: PMC10449663 DOI: 10.1007/s00392-023-02243-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The risk of vessel-oriented cardiac adverse events (VOCE) in patients with diabetes mellitus (DM) undergoing intracoronary physiology-guided coronary revascularization is poorly defined. The purpose of this work is to evaluate the risk of VOCE in patients with and without DM in whom percutaneous coronary intervention (PCI) was performed or deferred based on pressure-wire functional assessment. METHODS This is a retrospective analysis of a multicenter registry of patients evaluated with fractional flow reserve (FFR) and/or non-hyperaemic pressure ratio (NHPR). Primary endpoint was a composite of VOCE including cardiac death, vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR). RESULTS A large cohort of 2828 patients with 3353 coronary lesions was analysed to assess the risk of VOCE at long-term follow-up (23 [14-36] months). Non-insulin-dependent-DM (NIDDM) was not associated with the primary endpoint in the overall cohort (adjusted Hazard Ratio [aHR] 1.18, 95% CI 0.87-1.59, P = 0.276) or in patients with coronary lesions treated with PCI (aHR = 1.30, 95% CI 0.78-2.16, P = 0.314). Conversely, insulin-dependent diabetes mellitus (IDDM) demonstrated an increased risk of VOCE in the overall cohort (aHR 1.76, 95% CI 1.07-2.91, P = 0.027), but not in coronary lesions undergoing PCI (aHR 1.26, 95% CI 0.50-3.16, P = 0.621). Importantly, in coronary lesions deferred after functional assessment IDDM (aHR 2.77, 95% CI 1.11-6.93, P = 0.029) but not NIDDM (aHR = 0.94, 95% CI 0.61-1.44, P = 0.776) was significantly associated with the risk of VOCE. IDDM caused a significant effect modification of FFR-based risk stratification (P for interaction < 0.001). CONCLUSION Overall, DM was not associated with an increased risk of VOCE in patients undergoing physiology-guided coronary revascularization. However, IDDM represents a phenotype at high risk of VOCE.
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Affiliation(s)
- Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy.
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Matteo Tebaldi
- Azienda Ospedali Riuniti Marche Nord, Emodinamica e Cardiologia Interventistica, Pesaro, Italy
| | - Francesca Rubino
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Sara Sgreva
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Andrea Vicerè
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (Ferrara), Italy
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Diagnostic and Interventional Unit Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola, Rome, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, Italy.
- Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
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Varriale A, Comuzzi A, Biasin M, Locatelli A, Facci G, Strazzanti M, Tavella D, Prati D, Ribichini FL, Mugnai G. Electrical Storm in COVID-19 Infection Successfully Treated With Percutaneous Left Stellate Ganglion Blockade. Can J Cardiol 2023; 39:922-924. [PMID: 37100281 PMCID: PMC10124097 DOI: 10.1016/j.cjca.2023.04.015] [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] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Alessandro Varriale
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Alberto Comuzzi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Marco Biasin
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Alessandro Locatelli
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Gabriele Facci
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Mattia Strazzanti
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Daniele Prati
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
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20
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Capocci S, Tomasi L, Zivelonghi C, Bolzan B, Berton G, Strazzanti M, Franchi E, Tomei R, Vassanelli F, Cappellari M, Ribichini FL, Mugnai G. Early atrial fibrillation detection is associated with higher arrhythmic burden in patients with loop recorder after an embolic stroke of undetermined source. Int J Cardiol Cardiovasc Risk Prev 2023; 17:200186. [PMID: 37228330 PMCID: PMC10203739 DOI: 10.1016/j.ijcrp.2023.200186] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
Background After an embolic stroke of undetermined source (ESUS), long-term monitoring is recommended to start an anticoagulation therapy in patients with documented atrial fibrillation (AF). Literature is sparse about the AF burden following an ESUS, although this might have significant implications in terms of clinical management and therapeutic strategy. Our primary aim was to evaluate a possible association between early detection of AF (within 90 days from the ILR implantation) and higher AF burden. Methods This is a retrospective single-center study of 129 consecutive patients who received implantable loop recorders (ILRs) after an ESUS for detection of subclinical AF and their AF burden. Results Mean age was 70.3 ± 10.4 years old (males: 51.9%). Atrial fibrillation was found in 40.3% of patients. Patients with AF were older, presented a higher CHAD2S2-Vasc Score and greater left atrial volume compared with patients without AF. The median AF burden was 1.2%; 59% of patients had the first AF episode within 90 days from the ILR implant while 41% experienced the first episode later than 90 days. The AF burden was significantly higher in the former group. Of note, the univariate analysis showed that only early AF detection was significantly associated with AF burden >1% (OR 20.0; 95% CI 1.68-238.6, p = 0.01). Conclusions The early AF detection was found to be significantly associated with a higher burden of AF.
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Affiliation(s)
- Sofia Capocci
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Luca Tomasi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Cecilia Zivelonghi
- Stroke Unit, Department of Neuroscience, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giampaolo Berton
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Mattia Strazzanti
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Elena Franchi
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Ruggero Tomei
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Francesca Vassanelli
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Manuel Cappellari
- Stroke Unit, Department of Neuroscience, University Hospital of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
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21
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Bolzan B, Morani G, Rizzati V, Zamboni M, Mazzali G, Franzese I, Tomasi L, Mugnai G, De Manna D, Benfari G, De Caro A, Cortinovis M, Faggian G, Luciani GB, Ribichini FL. Correlation between epicardial adipose tissue and atrial fibrillation burden in coronary artery bypass graft surgery. J Cardiovasc Med (Hagerstown) 2023; 24:253-260. [PMID: 36952389 DOI: 10.2459/jcm.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
AIMS Recent studies suggest an association between epicardial adipose tissue (EAT) and atrial fibrillation. The aim of the study is to evaluate the quantitative and qualitative characteristics of EAT in relation to atrial fibrillation burden after coronary artery bypass graft (CABG). METHODS This prospective single-centre study included patients undergoing CABG. The patients underwent transthoracic echocardiography and collection of a bioptic sample containing right appendage and EAT during CABG for histological characterization. After surgery, clinical and telemetry data were collected. RESULTS Fifty-six consecutive patients were enrolled. The mean postsurgical hospitalization was 7.9 ± 3.7 days. Twenty-two patients had at least one episode of atrial fibrillation. In the atrial fibrillation group, there was a bigger atrial volume, a higher degree of diastolic disfunction, a thicker layer of EAT and an older median age in comparison with the group that did not develop it. EAT with a cut-off of 4 mm was a predictor of atrial fibrillation with an odds ratio (OR) of 1.49 (confidence interval (CI) 1.09-2.04), 73% of sensibility and 89% of specificity. From the histological analyses, the patients with atrial fibrillation had a significantly higher percentage of fibrosis. At univariate analysis, atrial volume [OR 1.05, CI 1.01-1.09, P = 0.022], E/A rate (OR 0.04, CI 0.02-0.72 P = 0.29), the percentage of fibrosis (OR 1.12, CI 1.00-1.25, P = 0.045) and age (OR 1.17, CI 1.07-1.28, P = 0.001) were predictors of atrial fibrillation. At multivariate analysis, atrial volume (P = 0.027), fibrosis (P = 0.003) and age (P = 0.039) were independent predictors of atrial fibrillation. CONCLUSION Postcardiac surgical atrial fibrillation is frequent. EAT thickness, atrial volume, fibrosis and age are predictors of postcardiac surgical atrial fibrillation.
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Affiliation(s)
- Bruna Bolzan
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | | | - Vanni Rizzati
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Ilaria Franzese
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
| | - Luca Tomasi
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Giacomo Mugnai
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Davide De Manna
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Annamaria De Caro
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Matteo Cortinovis
- Section of Geriatric Medicine, Department of Medicine, University of Verona
| | - Giuseppe Faggian
- Cardiac Surgery Division, Department of Surgery, University of Verona Medical School, Verona, Italy
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Maffeis C, Dondi F, Ribichini FL, Giubbini R, Gimelli A. Clinical Application of Myocardial Perfusion SPECT in Patients with Suspected or Known Coronary Artery Disease. What Role in the Multimodality Imaging Era? Rev Cardiovasc Med 2023. [DOI: 10.31083/j.rcm2402048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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23
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Bonvicini E, Portolan L, Urbani G, Santino Jannello EM, Pizzini J, Ciceri L, Benini A, Benfari G, Piccoli A, Ribichini FL. 556 EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITION ON RIGHT VENTRICULAR FUNCTION IN HEART FAILURE WITH REDUCED EJECTION FRACTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Sodium-glucose-transporter (SGLT2)-inhibitors have modified heart failure's prognosis since they are able to reduce the combined risk of cardiovascular death or hospitalization for heart failure. Evidence is available about the contribute of these drugs to LV reverse remodeling. Instead, despite the right ventricular disfunction is often related to the left ventricular one, little is known about the effects of SGLT2-inhibitors on right ventricular function.
Methods
Between October 2021 and February 2022, we enrolled 43 consecutive patients affected by heart failure with reduced ejection fraction on optimal medical therapy including ARNI who initiated SGLT2i therapy. All patients referred to our Heart Failure Clinic and were included in our heart failure registry approved by the local ethical committee A transthoracic echocardiography was performed at the beginning of treatment and after 6 months, evaluating left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVi) and tricuspid annular plane systolic excursion (TAPSE). Right ventricular longitudinal strain (RVLS) was assessed in 27 patients, while 16 were excluded for poor acoustic window. Continuous variables are reported as median and interquartile range and compared with the Mann-Whitney U test as appropriate. Statistical analysis was performed with SPSS version 26 (IBM, Armonk, NY).
Results
Median age of the study population was 65,8 years [IQR 56,4-75,1]. Median LVEF was 30% [IQR 24-33]. No other medical or electrical therapies for heart failure were introduced during the study period in this population. There was a significant increase of LVEF (30 [24-33] vs 33 [26-40], p 0.001) and a trend toward decrease of LVEDVi (110 [77.5-127] vs 94.7 [67.7-114.6], p 0.084). Moreover, there were no variations of TAPSE (17.5 [16-20] vs 18 [14 to 19.7], p 0.375), while RVLS showed a significant improvement (-12.3% [-16.6 / -10.6] vs -16.9% [-20 / -11.7], p 0.007) (Figure).
Conclusions
These preliminary data, population on optimal medical therapy including ARNI confirm the role of SGLT2-i in left ventricular reverse remodeling. Of note, these medications seem to improve right ventricular function as well as the left one as demonstrated by the increase of RVLS, which seems to be more sensitive of conventional methods to assess right ventricular function. Larger studies are necessary to confirm the positive effects of SGLT2i on right ventricular function.
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Affiliation(s)
- Eleonora Bonvicini
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Leonardo Portolan
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Giulia Urbani
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | | | - Jessica Pizzini
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Luca Ciceri
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Annachiara Benini
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Giovanni Benfari
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
| | - Anna Piccoli
- Dipartimento Di Cardiologia-Azienda Ospedaliera Universitaria Integrata Di Verona
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Alberti G, Dotto A, Roccabruna A, Zagarese G, Piccolo S, Cubich M, Prati D, Pazzi S, Gambaro A, Butturini C, Scarsini R, Ferrero V, Tavella D, Ribichini FL. 609 LUPUS IN SHEEP'S CLOTHING: A CARDIAC TAMPONADE DUE TO ACUTE POLYSIEROSITIS IN A SLE PATIENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
This case describes a cardiac tamponade in systemic lupus erythematosus (SLE), an uncommon but life-threatening condition that needs prompt recognition.
A 33-year-old woman with therapy-resistant SLE presented to the Emergency Department with chest pain and fever for 3 days. She was hemodynamically stable, the ECG showed signs of pericarditis and echocardiography showed a minimal pericardial effusion. Pericarditis was diagnosed and the patient was admitted to the Cardiology Ward. Seven hours later her symptoms deteriorated, presenting hemodynamic instability with hypotension and tachycardia. The ECG showed low QRS voltage and electrical alternans, echocardiography confirmed cardiac tamponade. The patient underwent an emergency pericardiocentesis with 220 mL of serous citrine liquid removed and immediate regression of symptoms. The cytology exam revealed inflammatory cells with no evidence of malignancy, blood culture and effusion fluid's tests came back negative. A Thoraco-abdominal CT revealed also bilateral pleural effusion (not present at the admission) and ascites. Signs, symptoms and medical history suggested SLE flare-up and high-dose oral glucocorticoid therapy was started.
Our report highlights a rare presentation of life-threatening polyserositis in SLE flare-up. Although pericarditis and pericardial effusion are frequently-reported SLE's cardiovascular complications, rapid development of cardiac tamponade is far from common. Acute cardiac tamponade, like in our case, is an indication for emergency pericardial drainage to restore an adequate cardiac output.
We describe an out of ordinary case of a patient in whom an accurate and timely diagnosis of SLE–related cardiac tamponade has been live–saving.
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Affiliation(s)
- Giorgia Alberti
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Alberto Dotto
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | | | - Giorgia Zagarese
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Solange Piccolo
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Mattia Cubich
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Daniele Prati
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Sara Pazzi
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Alessia Gambaro
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Caterina Butturini
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Roberto Scarsini
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Valeria Ferrero
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Domenico Tavella
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
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Iseppi M, Niro L, Tafciu E, Maffeis C, Benfari G, Bergamini C, Rossi A, Luciano Ribichini F. 1038 RIGHT VENTRICULAR-PULMONARY ARTERIAL (UN)COUPLING ESTIMATION IN PATIENTS WITH TRICUSPID REGURGITATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
right-ventricular (RV)-pulmonary arterial (PA) uncoupling expressed by Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Artery Systolic Pressure (PAPs) ratio is associated with poor outcomes in patients with heart failure (HF). TAPSE/PAPs ratio has been poorly investigated in patients with tricuspid regurgitation (TR) with related volume overload and progressive right chambers remodeling.
Purpose
to assess the effectiveness of other estimation methods of RV-PA coupling in different TR severity groups compared to the classic TAPSE/PAPs ratio.
Material and Methods
116 stable patients with TR were enrolled at the time of echocardiography (43 men, 37%; mean age 74±13 years). TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RV function was assessed by RV Free Wall Longitudinal Strain (FWLS).
PAPs was obtained using the following formula: 4*(peak tricuspid regurgitation velocity)2 + right atrial pressure (RAP); meanPAP was estimated using TR continuous wave signal mean gradient (PAPmIT) and pulmonary artery regurgitation peak gradient (PAPmIP), adding RAP for both. RV-PA coupling was evaluated by TAPSE/PAPs ratio, TAPSE/PAPmIT and TAPSE/PAPmIP ratios.
Result
TR was quantified mild in 23 patients, moderate in 49, severe and torrential in 29 and 15 patients respectively. Mean RV-FWLS was -26.4±6.9% in mild, -21.8±7.4% in moderate, -18±7% and -18.3±4.2% in severe and torrential TR respectively (p<0.0001).
Mean TAPSE/PAPs ratio was 0.6±0.23 mm/mmHg, 0.44±0.19, 0.38±0.19 and 0.37±0.12 mm/mmHg in mild, moderate, severe and torrential TR respectively, with a statistically significant difference between the 4 groups (p<0.0001).
Mean TAPSE/PAPmIP ratio was 1.08±0.5 mm/mmHg in mild TR, 0.68±0.34 in moderate, 0.67±0.5 in severe TR and 0.47±0.13 mm/mmHg in torrential TR with a statistically significant difference between distinct TR grades (p=0.004).
Mean TAPSE/PAPmIT in mild TR was 0.92±0.5 mm/mmHg, 0.63±0.29 in moderate, 0.53±0.29 and 0.51±0.16 mm/mmHg in severe and torrential TR respectively with a statistically significant difference between the groups (p<0.0001).
Finally, an analysis of covariance with RV-FWLS as potential confounder was performed: only the adjusted means of TAPSE/PAPmIP and TAPSE/PAPmIT ratios preserved a statistically significant difference between distinct TR groups (p=0.01 and p=0.019 respectively).
Conclusion
TAPSE/PAPmIP and TAPSE/PAPmIT ratios seem to preserve a stronger relation with increasing TR grade and worsening of RV disfunction, suggesting it as a more powerful index in this subset of patients. The progression of TR grade leading to a right chamber remodeling could influence the reliability of RV-PA uncoupling expressed by standard TAPSE/PAPs ratio.
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Affiliation(s)
- Manuela Iseppi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Lorenzo Niro
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Elvin Tafciu
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Caterina Maffeis
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Giovanni Benfari
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Corinna Bergamini
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Andrea Rossi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
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Dotto A, Ciceri L, Springhetti P, Urbani G, Del Sole PA, Nistri S, D´ascenzo F, Gallone G, Tafciu E, Bergamini C, Rossi A, Luciano Ribichini F, Benfari G. 146 AORTIC ACCELERATION TIME/EJECTION TIME RATIO AND BI-VENTRICULAR PERFORMANCE IN SEVERE AORTIC STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Echocardiographic evaluation of severe aortic stenosis (SAS) is is important to guide the therapeutic approach but often challenging. Recent studies have demonstrated that the ratio of acceleration time/ejection time (AT/ET) is a simple and reproducible echocardiographic parameter that integrates aortic stenosis severity evaluation and adds information on patient's prognosis.
Aim
The aim of the study is to investigate the role of the ratio of acceleration time (AT) and ejection time (ET) and its major determinants in severe aortic stenosis .
Methods
Consecutive echocardiograms of patients with severe AS referred to our center were analyzed offline using Tomtec Arena (Tomtec, Untershlei heim, Germany). AT was measured from the start of the CW Doppler aortic wave, to the peak of the aortic jet. ET was calculated from the same starting point, to the end of the CW Doppler aortic wave.
Results
A total of 135 patients with severe aortic stenosis formed the study cohort: patients with AT/ET below the median value of 0.35 (vs. higher) presented lower LVEDV (60 vs. 71 ml/mq; p 0.014), left ventricle mass index (116 vs 130 g/m2; p 0.035) and higher LVEF (58 vs 50%; p 0.001), GLS (- 14 vs - 12%; p 0.025), FAC (46 vs 41%; p 0.01), SBP (141 vs 131 mmHg; p 0.003).
At multivariable analysis the major AT/ET determinants were systolic arterial pressure and bi-ventricular performance parameters. The following nested regression were created: the first inclusive of systolic arterial pressure (PAS), fractional area change (FAC), left ventricular mass indexed (LVMI), global longitudinal strain (GLS) (R2=0.48 p<0.001), the second inclusive of PAS, FAC, LVMI, GLS, AVA (R2=0.57, p<0.001), the third inclusive of PAS, FAC, LVMI, LVEF, AVA (R2=0.64, p<0.001).
Conclusion
Our study demonstrated that AT/ET ratio relates quite well with LV performance in the context of SAS. An high ACT/ET ratio tends to be associated with a poor bi-ventricular performance and LV negative remodeling. It is possible that this simple parameter in the next future could help in staging the disease among SAS patients.
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Niro L, Iseppi M, Fanti D, Maffeis C, Bergamini C, Rossi A, Tafciu E, Benfari G, Luciano Ribichini F. 897 PEAK RIGHT ATRIAL LONGITUDINAL STRAIN: A NEW PARAMETER IN PREDICTING VENOUS CONGESTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
tricuspid regurgitation (TR) of either organic or functional etiology can lead to systemic venous congestion particularly in its more severe forms. Little is known about the role of the right atrium (RA) which acts as an intermediate player between TR and systemic veins.
Purpose
to assess the influence of right atrial size and function on venous congestion in TR patients.
Methods
101 stable patients with at least mild to moderate TR were enrolled at the time of echocardiography (age 74±13 years, 37% male). Systemic congestion was assessed by inferior vena cava (IVC) diameter and right atrial pressure (RAP) estimated according to inferior vena cava diameter and collapsibility. TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RA and right ventricular (RV) function were assessed respectively by peak atrial longitudinal strain (PALS) and free wall longitudinal strain (FWLS) while indexed RA volume (RAVi) by Simpson's disk summation method.
Results
TR was quantified mild or moderate in 52 patients and more than moderate in 49 patients (mean EROA 37±31 mm2; mean RVol 34±23 ml). Mean indexed RA volume was 58±31 ml/m2; mean RA strain was 18±11% and mean RV strain (free wall) was -21 ± 7%. Mean IVC diameter was 20±6 mm; estimated RAP was ≤5 mmHg in 32 patients, 6-10 mmHg in 26, 11-15 mmHg in 26 and greater than 15 mmHg in 17 patients. In univariate analysis both IVC diameter and RAP correlated significantly with EROA, RVol, RAVi and RA strain (p<0.0001 for all); only RAP correlated with RV strain. In linear multivariate analysis only RAVi and RA strain were independent predictors of IVC diameter (p=0.01 and <0.0001, respectively), and only RVol and RA strain were independent predictors of RAP (p=0.001 and 0.002, respectively). We found a RA strain cut-off of -15% to have a sensitivity of 82% and specificity of 70% to identify a RAP greater than 15 mmHg (area under the curve-AUC 0.842).
Conclusions
RA size and function together with the TR-related volume overload were independent predictors of venous congestion. Among these variables, only RA strain predicted both parameters of venous congestion.
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Affiliation(s)
- Lorenzo Niro
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Manuela Iseppi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Diego Fanti
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Caterina Maffeis
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Corinna Bergamini
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Andrea Rossi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Elvin Tafciu
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Giovanni Benfari
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
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Leonardi D, Iseppi M, Ciuffreda M, Cristofaletti A, Prioli MA, Rossetti L, Sandrini C, Luciano Ribichini F. 740 TREATMENT STRATEGY IN CASE OF REPAIRED TRUNCUS ARTERIOSUS AND AORTIC COARCTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Common Truncus arteriosus (TA) is a rare congenital, cyanotic heart disease with a single vessel coming out from both ventricles and related low interventricular defect, right-left shunt, low pulmonary flow and right ventricle (RV) hypertension. TA is associated with aortic coarctation (CoA) in 10-20% of cases.
Case
A 15-year-old male affected by type 2 TA and CoA undergoing first post-natal cardiac surgery with pulmonary valved conduit (PVC) implantation and CoA repair, subsequently multiple percutaneous (PC) interventions due to right pulmonary artery (RPA) stenosis and re-CoA.
He was referred to our Centre for dyspnoea on mild efforts. Echocardiography revealed RV hypertension (75% of systemic pressure) and mild disfunction. Angio-CT showed RPA re-stenosis due to peeling of previous stents, a degenerative PVC and mild residual CoA.
Results
Cardiac catheterization confirmed imaging findings, revealing the following systolic/diastolic blood pressures [mmHg]: 100/15 in RV, 33/10 in left pulmonary artery (LPA), 13/7 in RPA, 132/65 in ascending and 125/60 in descending aorta. First, extensive balloon-interrogation of stented RPA and RV outflow tract (RVOT) with semi-compliant balloon was performed followed by PC intra-stenting transluminal angioplasty of RPA with modified undersized non-compliant balloon. As RPA was very closed to CoA with risk of aortic rupture, and mostly the main pulmonary OT accounted for increased pressure gradient, RPA enlargement with re-stenting was avoided. Then, a long semi-opened-cell stent was arranged on the prosthetic RVOT and Melody valve was implanted as Valve-in-Valve (ViV), both with balloon post-dilatation. Dilated LPA with only moderate focal stenosis and mild residual CoA were excluded from intervention. Post-interventional right heart pressures were reduced: 45/4 in RVOT and 42/13 mmHg in the main PA. At 1 month dyspnoea disappeared with good effort tolerance, echocardiographic ViV mean gradient was 12 mmHg with improved RV systolic function and pressure (50% of systemic).
Conclusions
Repaired complex TA of type described may develop multiple re-stenosis of RPA. RPA optimization was not the goal of the procedure because at high risk of vessels’ injury due to the very closed anatomy with otherwise prosthetic CoA. RV pressures and dysfunction could depend on degenerative obstructive PVC. Thus, interventional approach mostly focused on the main PA aimed at working PVC could be the best effective treatment.
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Affiliation(s)
- Denis Leonardi
- University Of Verona, Department Of Medicine , Section Of Cardiology
| | - Manuela Iseppi
- University Of Verona, Department Of Medicine , Section Of Cardiology
| | - Matteo Ciuffreda
- University Of Verona, Department Of Medicine , Section Of Cardiology
| | | | | | - Lucia Rossetti
- University Of Verona, Department Of Medicine , Section Of Cardiology
| | - Camilla Sandrini
- University Of Verona, Department Of Medicine , Section Of Cardiology
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Fezzi S, Rubino F, Del Sole PA, Pesarini G, Mammone C, Scarsini R, Lunardi M, Pighi M, Tavella D, Ribichini FL. 405 A NATURAL HISTORY OF VERY LONG-TERM BIORESORBABLE ATHEROSCLEROTIC RESTORATION THERAPY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
A 49-year-old man was referred to our cath-lab in 2015 after the detection of inducible ischaemia in the infero-lateral wall on single-photon emission CT performed due to a worsening stable angina. His cardiovascular risk factors accounted for family history of ischemic disease, high blood pressure and dyslipidaemia. The echocardiography highlighted a mildly reduced left ventricular function with infero-lateral wall hypokinesia. Coronary angiography revealed a chronic total occlusion (CTO) of the left circumflex artery (LCX) and a long diffuse severe disease of the right coronary artery (RCA). The left anterior descending artery (LAD) showed a diffuse atherosclerotic involvement without critical stenoses.
Percutaneous coronary intervention (PCI) was performed after Heart Team discussion with implantation of two 3.5×28mm and 3.5×23mm Absorb bioresorbable vascular scaffold (BVS) on the RCA. Moreover, the LCX CTO was successfully treated by anterograde approach with implantation of a 3.0×28 mm Absorb BVS. Intravascular ultrasound confirmed the optimal result of both the interventions, while confirmed the long diffuse calcific involvement of the LAD with a thick cap calcific fibroatheroma at the virtual histology. The patient was discharged on dual antiplatelet therapy for twelve months.
After five uneventful years, he was readmitted to our department for recurrence of worsening stable angina. At the coronary angiography a significant progression of the proximal LAD disease was noted. The lesion was judged hemodynamic relevant with pressure derived indices (instantaneous wave-free ratio 0.86; fractional flow reserve 0.70). The IVUS and optical coherence tomography (OCT) analysis confirmed the significant progression of the disease with a long, diffuse, sub-occlusive thick cap fibroatheroma stenosis (minimal lumen area 1.9 mm2; plaque burden 91%). The OCT analysis showed the complete resorption of the devices previously implanted to the RCA and the LCX, with optimal long-term results and positive remodelling in the LCX. Therefore, an OCT-guided PCI with marker-to-marker implantation of two 3.5×25 and 3×20 mm magnesium-based Magmaris BVS was performed.
In 2022, the patient underwent an elective coronary angiography that demonstrated a complete resorption of both the Magmaris with an optimal OCT result. Conversely, the positive remodelled segment resulting from complete resorption of the poly-L-lactic-based BVS in the mid-LCX was shown to be progressed to a critical sub-occlusive fibroatheroma. A further OCT-guided PCI with deployment one 3.5×20mm Magmaris BVS was performed.
Six months later, patient was asymptomatic with a good performance status.
To the best of our knowledge, the present is the first case of multivessel repetitive imaging-based percutaneous revascularizations with the use of two different BVS technologies and a total of six devices implanted, with very long-term intracoronary imaging result. Through the paired intravascular imaging analysis, this case sought to provide insightful findings on vulnerable plaque atherosclerotic progression and on BVS biologic restoration therapy, a process that appears particularly appealing in young patients with advanced CAD, namely multivessel involvement and diffuse disease that still poses limitations to PCI.
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Affiliation(s)
- Simone Fezzi
- University Of Verona
- University Of Galway , Irland
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Minnucci I, Bergamini C, Niro L, Springhetti P, Trento L, Benfari G, Rossi A, Tafciu E, Maffeis C, Fiorio E, Luciano Ribichini F. 608 PEAK ATRIAL SYSTOLIC LONGITUDINAL STRAIN (PALS) AS AN EARLY PARAMETER OF CANCER THERAPY-RELATED CARDIAC DYSFUNCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Trastuzumab (TZ) is widely used for his key role in HER2 positive breast cancer. However, the most concerning cardiovascular complication is cardiotoxicity. Many studies have highlighted the importance of screening for subclinical myocardial dysfunction using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, there are only few studies investigating a possible atrial damage.
Purpose
Aim of this study was to analyze the modification peak atrial systolic longitudinal strain (PALS) in patients undergoing therapy with TZ in a follow-up period of 12 months. The fluctuation of left atrial function parameters under chemotherapy was evaluated focusing the attention on those patients who developed cancer therapy–related cardiac dysfunction (CTRCD).
Methods
116 women affected by breast cancer treated with TZ were enrolled. Each patient underwent a complete echocardiography at baseline and every 3 months.
Exclusion criteria were poor quality imaging and lack of a complete follow up with consequent missing data.
CTRCD was defined as a decrease in the left ventricular ejection fraction of >10 percentage points to a value <53% at any time of follow-up. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software to analyze both atrial and left ventricular function. Trends of GLS, and PALS during 12 months-follow up periods were analyzed. Additionally, we explored if diabetes and renal impairment were associated with more prevalent atrial subclinical disfunction as demonstrated in previous studies.
Results
A total of 10 patients (9%) developed cancer therapy–related cardiac dysfunction. A significant reduction in GLS compared to the baseline was observed during the whole follow-up (p=0.05), starting in the first six months of treatment (-21 ± 2% vs -17 ± 2%, p= 0.021). Interestingly, PALS showed a similar trend with a significant decrease during the whole 12 months-follow up (p=0.012), starting in the first 3 months (45 ± 9% vs 35 ± 8%, p=0.001).
6 patients presented a diagnosis of diabetes at baseline, and presented lower PALS compared to the non-diabetic counterpart (38± 10% vs 49 ± 12% p=0.03).
2 patients presented a significant renal impairment (eGFR ≤30 ml/min). Similarly, these patients presented a lower PALS at baseline (32 ± 7% and 48 ± 7%; p=0.055).
Conclusions
In patients treated with Trastuzumab the development of left atrial impairment is frequent and PALS modifications seem to precede GLS variations in patients with CTRCD, suggesting a possible cardiotoxic effect of such therapy on both atrial and left ventricular myocardium and physiology.
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Affiliation(s)
| | | | - Lorenzo Niro
- Integrated University Hospital Of Verona , Verona , Italy
| | | | - Laura Trento
- Integrated University Hospital Of Verona , Verona , Italy
| | | | - Andrea Rossi
- Integrated University Hospital Of Verona , Verona , Italy
| | - Elvin Tafciu
- Integrated University Hospital Of Verona , Verona , Italy
| | | | - Elena Fiorio
- Integrated University Hospital Of Verona , Verona , Italy
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Piccolo S, Dotto A, Rizzetto F, Lia M, Widmann M, Pazzi S, Ferrigni F, Tomasi L, Scarsini R, Prati D, Castaldi G, Ferrero V, Tavella D, Luciano Ribichini F. 613 QTC PROLUNGATION IN TAKOTSUBO: DIFFERENT PATTERN, DIFFERENT OUTCOME? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
QT prolongation has been widely described in Takotsubo Syndrome (TTS), but the pathophysiology and prognostic implications remain unclear, and it can still hold some surprise.
We have noticed two different populations based on electrocardiogram (ECG) findings that weren't described before. The aim of the study was to investigate the difference between the two of them, with a focus on prognosis.
Methods
We retrospectively analyzed in-hospital ECG from TTS (based on revised Mayo Clinic criteria) from 2014 to August 2022. QT interval was manually measured and corrected with Bazzett formula. Patients with bundle branch blocks or QT shorter than 460 (male), 470 msec (female) were excluded.
The population was divided into two groups, based on the lead with the longest QT: V5 (group A) or V2 (group B). Our primary endpoint was overall mortality. Secondary outcome ware either ventricular or supraventricular arrhythmias detected before discharge.
Results
Our final cohort was composed of 67 patients, 42 of which had the maximum QTc interval in V5 (group A) and the other 25 having the longest QTc in V2 (group B). These two populations did not differ much in terms of age, sex, comorbidities, and echocardiographic findings at presentation. Despite this, we observed a significant prognostic difference: patients in group B experienced more in-hospital arrhythmias than the other subgroup (p=0.035), but after a median follow up of 3.6 years their all-cause mortality was significantly lower (p=0.034).
Conclusion
Although quite similar in demographic characteristics and presentations, we observed that patients with longer QTc in V5 lead (Group A) seem to have a higher mortality rate, in comparison with patients with longer QTc in V2 (Group B). It could help to identify a high-risk subgroup of patients. This is a preliminary study, further investigation is needed to make more reliable inferences.
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Affiliation(s)
- Solange Piccolo
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Alberto Dotto
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Francesca Rizzetto
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Micaela Lia
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Maddalena Widmann
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Sara Pazzi
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Francesca Ferrigni
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Luca Tomasi
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Roberto Scarsini
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Daniele Prati
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Gianluca Castaldi
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Valeria Ferrero
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
| | - Domenico Tavella
- Cardiology Division, Department Of Medicine, University Of Verona , Italy
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Capocci S, Berton G, Zivelonghi C, Portolan L, Piccolo S, Strazzanti M, Bolzan B, Mugnai G, Tomasi L, Franchi E, Tomei R, Vassanelli F, Luciano Ribichini F. 375 ATRIAL FIBRILLATION BURDEN IN PATIENTS WITH IMPLANTABLE LOOP RECORDER AFTER A CRYPTOGENIC STROKE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
After a cryptogenic stroke, long-term monitoring is recommended to start an anticoagulation therapy in patients with at least a documented paroxysm of subclinical atrial fibrillation (AF). Literature is sparse about the recurrence of AF (AF burden) after a cryptogenic stroke, but this might have significant implications in terms of therapeutic strategy.
Methods
This is a retrospective single-center study of 129 patients who received implantable loop recorders (ILRs), after a cryptogenic stroke, between March 2015 and March 2022. All patients were followed through remote monitoring for at least 6 months. The primary endpoint was AF detection; the secondary endpoints were the AF burden, the earliness (within or after 90 days from the ILR implant) of the first AF episode and if there was an association between these two variables.
Results
Mean age was 70.3 ± 10.4 years old (67 males, 51.9%); the mean value of left ventricular ejection fraction was 61% ± 5.8. Atrial fibrillation has been detected by ILR in 40.3% of patients (AF= 52 patients, NO AF= 77 patients) and each intracardiac electrogram was visually reviewed by two physicians. Median CHAD2S2-Vasc Score was 5 [4-6]; the median AF burden (assessed in 39 of the 52 patients) was 1.2% [0.1%-14.6%]; among these, 23 patients (59%) had the first episode within 90 days from the ILR implant versus 16 patients (41%) which experienced the first episode later than 90 days. AF burden was significantly higher in the first group (median 3.9% [1.2%-30.9%] vs 0.1% [0.03%-0.75%]; p=0.001). Of note the univariate analysis showed that both detection of the first AF episode within 90 days and echocardiographic findings of atrial disease (atrial dilation or diastolic dysfunction) were significantly associated with AF burden > 1% (about 7 hours for month) (respectively OR 16.5; 95% IC=3.34-81.21, p=0.001 and OR 4.5; 95% IC=1.2-17.5, p=0.03); at the multivariate analysis the significance was confirmed for the earliness of the first AF episode (OR 14.6; 95% IC=2.8-76.75, p=0.002).
Conclusion
In this small, retrospective study, AF was detected by ILR, after a cryptogenic stroke, in more than one third of patients. AF onset during the first 90 days might be a marker of a high AF burden and might highlight patients who could benefit from a rhythm control strategy of AF. Larger studies and clinical outcomes evaluation of these patients are required to confirm our results.
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Affiliation(s)
- Sofia Capocci
- Division Of Cardiology, University Of Verona , Italy
| | | | | | | | | | | | - Bruna Bolzan
- Division Of Cardiology, University Of Verona , Italy
| | | | - Luca Tomasi
- Division Of Cardiology, University Of Verona , Italy
| | - Elena Franchi
- Division Of Cardiology, University Of Verona , Italy
| | - Ruggero Tomei
- Division Of Cardiology, University Of Verona , Italy
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Niro L, Iseppi M, Tafciu E, Maffeis C, Bergamini C, Rossi A, Benfari G, Luciano Ribichini F. 1000 THE EFFECT OF RIGHT VENTRICULAR SIZE AND FUNCTION ON TRICUSPID REGURGITATION SEVERITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Tricuspid regurgitation (TR) is a relatively common echocardiographic finding and its proportional influence on prognosis and quality of life has been well described. A bidirectional relationship connects TR severity and its volume overload with right ventricular (RV) dilation and dysfunction.
Purpose
to assess the impact of RV size and function on TR severity.
Material and Methods
116 stable patients with TR were enrolled at the time of echocardiography (43 men, 37%; mean age 74±13 years). TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RV size was assessed by RV End Diastolic Area (EDA) and RV function by RV Free Wall Longitudinal Strain (FWLS).
Results
TR was quantified mild in 23 patients, moderate in 53 and severe in 40 patients, with higher predominance of functional rather than organic etiology (101 vs 15 patients); median EROA was 31 mm2 and median RVol was 30 mL. Mean RV-FWLS was -25.9±7%, -21.4±7.4% and -18.4±6.4% respectively in mild, moderate and severe TR with a statistically significant difference between the groups (p=0.001). Mean RV-EDA was 19±7.7 cm2 in mild TR, 21.7±8.5 cm2 and 26.2±7 cm2 in moderate and severe TR respectively (p=0.002).
In univariate analysis both RV-FWLS and RV-EDA were predictor of TR grade estimated by TR-EROA (p=0.012 and p<0.0001 respectively). In linear multivariable analysis only RV-EDA was an independent predictor of TR-EROA (p=0.001).
A ROC curve analysis confirmed the better ability of RV-EDA to identify severe TR (sTR) compared to RV-FWLS (AUC=0.738 vs AUC=0.669).
Conclusions
RV remodeling in terms of chamber dilation seems to better predict a higher TR severity compared to RV dysfunction.
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Affiliation(s)
- Lorenzo Niro
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Manuela Iseppi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Elvin Tafciu
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Caterina Maffeis
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Corinna Bergamini
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Andrea Rossi
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
| | - Giovanni Benfari
- University Of Verona, Department Of Medicine , Section Of Cardiology, Verona ( Italy )
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Pazzi S, Maffignoli LB, Bertani G, Bergamini C, Pegoretti M, Siviero V, Giorgio D, Maffeis C, Tafciu E, Benfari G, Rossi A, Luciano Ribichini F. 1082 LEFT VENTRICULAR FUNCTION ESTIMATION: WHEN VOLUMES MEASUREMENT IS NOT FEASIBLE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Contrast echocardiography is mainly performed for the assessment of global left ventricular (LV) function, left ventricular ejection fraction (LVEF) and stroke volume (SV) thanks to improved visualization of endocardial LV borders. Neverless in some patients estimation of ventricular volumes could be difficult also with contrast and assessment of LVEF can be really hard. The aim of the study was to find alternative methods for LV function evaluation independent from volume assessment.
Methods
Patients who underwent a contrast echocardiography between October 2015 and September 2022 were enrolled in the study. A complete transthoracic echocardiography was performed and Sonovue contrast was then injected. End-diastolic and end-systolic LV volume in apex 4 and 2 chamber views, were measured prior and after injecting contrast. Left ventricular outflow tract diameter (LVOTd) was measured and LVOT velocity time integral was traced in order to calculate LVOT VTI Stroke Volume (product of LVOT cross sectional area to the LVOT VTI). LVOT VTI SV obtained during traditional echocardiography was then compared to LV SV calculated as the difference between end-diastolic and end-systolic volume traced after contrast. After intravenous bolus injection of Sonovue pulmonary transit time (PTT) was recorded as contrast agent's transit time from right to left ventricle in apex 4 chamber view (seconds). PTT was then compared to measures of LV function: LVEF with and without Sonovue and LV SV with contrast.
Results
149 patients were enrolled in the study, 86 had history of CAD, 31 presented dilatative cardiomyopathy, 5 hypertrophic cardiomyopathy (HMC), 113 had arterial hypertension, and 37 diabetes. Medium BMI was 28. The main indications for contrast echocardiography were measurement of EF and exclusion of thrombi in LV apex. LVOT VTI SV was calculated in 126 patients. In the same patients LVEF Stroke Volume was calculated. A strong correlation (P value < 0.0001) between LVOT VTI SV and LV SV was found (Figure 1). PPT was calculated in 74 patient and in the same patients LVEF with and without contrast (Figure 2) and LV SV were calculated. A strong correlation (P-value <0.048, p-value<0.006 and p-value < 0.046 respectively) was found.
Conclusion
This study demonstrates that, besides extremely poor acoustic windows, bedside echocardiography, with and without contrast, can be used to estimate LV function using volume-independent methods like PTT and LVOT VTI SV.
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Affiliation(s)
- Sara Pazzi
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | | | - Gabriele Bertani
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Corinna Bergamini
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Monica Pegoretti
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Valentina Siviero
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Daniela Giorgio
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Caterina Maffeis
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Elvin Tafciu
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Giovanni Benfari
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
| | - Andrea Rossi
- Dipartimento Di Cardiologia , Azienda Ospedialiera Universitaria Integrata Di Verona
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Del Sole PA, Fezzi S, Mammone C, Flaim M, Lunadi M, Scarsini R, Tavella D, Pesarini G, Pighi M, Ribichini FL. 961 RIGHT VENTRICLE-PULMONARY ARTERY COUPLING RATIO AS PROGNOSTIC FACTOR FOR PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TAVI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Right Ventricle/Pulmonary Artery (RV/PA) coupling has recently emerged as a relevant prognostic factor in patients undergoing transcatheter valvular interventions. The aim of this study is to assess the interaction between RV/PA coupling ratio and the incidence of Acute Kidney Injury (AKI) following TAVI in patients with severe aortic stenosis. Furthermore we investigated the interaction between this novel ratio and adverse events at 24 months follow-up.
Methods
A population of 283 patients was selected from the Verona Valvular Registry (CESC n =1918). RV/PA coupling was estimated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPs) obtained through transthoracic echocardiograms. AKI was defined as an increase in serum creatinine (sCr) of at least 0.3 mg/dL up to 48 hours following TAVI. Major adverse cardiovascular events (MACEs) were defined as the composite occurrence of cardiac death, re-hospitalization for congestive heart failure and stroke.
Results
Mean age was 83.4 ± 5.36 years and 41.3% of patients were female. The median value of TAPSE/PAPs ratio was 0.5667 mm/mmHg and was used as a cut-off. A TAPSE/PASP ratio <0.5667 was found to be associated with a higher incidence of MACE at Kaplan Meyer analysis at 24 months (10.4% vs 3.5%, log p = 0.004) and higher occurrence of AKI (17.0% vs. 7.7%; p=0.027). Notably TAPSE/PAPs interquartile comparison showed higher incidence for AKI in patients in the lowest quartile compared to higher ones (24.2% vs. 8.5%; p = 0.001). Following Cox multivariate analysis, TAPSE/PAPs ratio and diabetes mellitus were found to be independent predictors of AKI.
Furthermore, risk for 24 months MACEs was higher in the population with lower TAPSE/PAPs ratio (HR 2.672; CI 95% [1.195–5.974]; p = 0.017).
Conclusion
RV/PA coupling, as characterized by TAPSE/PAPs ratio, is a promising independent predictor of AKI, also associated with higher risk of major adverse cardiac events at follow-up in subjects undergoing TAVI. These data suggest a possible role for this novel index in risk stratification, assessment of the prognosis, and decision-making in these patients.
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Affiliation(s)
| | - Simone Fezzi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Concetta Mammone
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Massimo Flaim
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Mattia Lunadi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Roberto Scarsini
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Domenico Tavella
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Gabriele Pesarini
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Michele Pighi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
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Rubino F, Fezzi S, Maisenti S, Facci G, Pesarini G, Mammone C, Lunardi M, Scarsini R, Ferrero V, Pighi M, Tavella D, Ribichini FL. 837 COMPLETE MAGNESIUM BIORESORBABLE SCAFFOLD ABSORPTION AT 1-YEAR OF INTRACORONARY IMAGING FOLLOW UP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
the development of bioresorbable scaffolds (BRSs) has been conceived as revolution in interventional cardiology for the prospective improvements in the treatment of coronary artery disease. However, metallic drug eluting stent (DES) demonstrated greater safety and efficacy than bioresorbable vascular scaffold (BVS) Absorb in dedicated trials culminating in the commercial withdrawal of Absorb device in 2017. Nevertheless, the progressive absorption of the scaffold and the restoration of physiological coronary artery characteristics attracted attention, so currently research on BRSs is in progress.
Case presentation
a 58-year-old woman was admitted in our department after an episode of typical angina at rest without significant troponin elevation. The electrocardiogram showed T wave inversion in lateral leads. Hypokinesia of distal septum and anterior wall and mildly reduced left ventricular ejection fraction (LVEF 50%) were observed on echocardiography. Her cardiovascular risk factors included obesity, arterial hypertension, dyslipidaemia, family history of ischemic heart disease and former smoking. Her past medical history was remarkable for chronic kidney disease (CKD EPI eGFR 50 ml/min) and previous connective tissue disease.
Coronary angiography highlighted a critical stenosis in the middle segment of left anterior descending artery (LAD). Optical coherence tomography (OCT) imaging showed recanalized and organized throumbus and calcific plaques. After adequate predilatation and stent sizing by OCT, a 3×25 mm Magnesium-based BVS (Magmaris, Biotronik AG, Buelach, Switzerland) was implanted. OCT confirmed good expansion and apposition of the stent after postdilatation. Patient was discharged on dual antiplatelet therapy (DAPT) for 12 months, anti-remodeling cardiac and lipid-lowering therapy. One year later, the patient underwent and elective coronary angiography and OCT control showing a complete reabsorption of the Magmaris BVS with positive remodelling and luminal enlargement of the vessel. The patient was asymptomatic throughout the year with a good performance status.
Conclusion
The present case illustrates an example of imaging-based revascularization with BVS Magmaris and optimal intracoronary imaging result at 1 year follow up in agreement with the last available evidence. The last European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommends the use of BVS only in the context of clinical controlled studies. However, encouraging results obtained and what expected from the current studies with Magmaris scaffolds, might change indications considering the potential benefit about the restoration of natural vasomotion, the reduced risk of neoatherosclerosis and the positive vascular remodelling following the scaffold absorption.
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Varriale A, Nannelli C, Springhetti P, Rossi A, Bergamini C, Tafciu E, Maffeis C, Ribichini FL, Benfari G. 218 PERSISTENT LEFT SUPERIOR VENA CAVA IN AN ADULT PATIENT WITH AN IMPLANTED PACEMAKER: A CASE REPORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly, although infrequent in the general population (prevalence estimates as 0.2-3%). It begins at the junction of the left subclavian and internal jugular veins, passes through the left side of the mediastinum adjacent to the aortic arch, and mostly drains into the right atrium via the coronary sinus (CS). For the majority of cases it is asymptomatic and it is mostly detected incidentally. More rarely it can be associated with other congenital abnormalities, such as aortic bicuspid valve, aortic coartation or atrial septal defects. Besides, in less than 10% of the cases the left superior vena cava drains in the left atrium, leading to a right-to-left shunt. Lastly, it can lead to arrhythmic problems.
Case presentation
A 85-year-old man was admitted to the emergency department for syncope. Previous medical history was unknown and there was no clinical documentation available. The electrocardiogram showed an atrial fibrillation and some pacemaker-induced beats. An echocardiogram was performed, which showed dilation and dysfunction of the right chambers and a dilated CS. Moreover, the same exam revealed the two pacemaker leads passing through the CS and ending their course into the right atrium and ventricle. The chest X-ray displayed the pacemaker leads passing to the left side of the aorta. Furthermore, a computed tomography angiography was performed in the suspicion of a pulmonary embolism. The exam showed small vascular filling defects in arteries of the right inferior lung lobe, but also the presence of two superior vena cavas, with the left one draining into the CS. The pacemaker leads passed from the left subclavian vein through the left superior vena cava reaching the right chambers. Therefore, the diagnosis of PLSVC was confirmed.
Discussion and Conclusions
Despite the benign natural history of this diagnosis, it is important to know the existence of this condition. PLSVC can be suspected when a dilated CS is detected on a transthoracic echocardiogram, with a parasternal long axis view. The best projections to visualize the dilatation of CS are also the apical four-chamber and the subcostal view. Besides, the direct detection of left superior vena cava can be obtained with a suprasternal view. The presence of the right superior vena cava should also be confirmed with a subcostal or suprasternal view. The differential diagnosis for a dilatation of the CS includes anomalous pulmonary venous return with a pulmonary vein draining in the CS, the “unroofed coronary sinus”, a tricuspid regurgitation with a jet directed towards the CS, elevated right-chamber filling pressures. The diagnosis of PLSVC can be confirmed with a saline contrast echocardiography (“bubble-test”) or with other radiological investigations (computed tomography or magnetic resonance). It should be reported in radiological reports even when it is an incidental finding because of its clinical relevance: it is essential to know its presence in advance in invasive procedures, such as pacemaker implantation, ablative procedures, cardiac surgery, because it could affect the proper approaches and could lead to complications. Moreover, in a minority of cases, it can be associated with other congenital abnormalities or with arrhythmic problems.
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Galli V, Trento L, Galuppi E, Casal M, Cecchin E, Fezzi S, Castaldi G, Widmann M, Ruzzarin A, Marin F, Gambaro A, Pesarini G, Pighi M, Scarsini R, Ferrero V, Tavella D, Luciano Ribichini F. 745 INTERDISCIPLINARY EVALUATION IN RESISTANT ARTERIAL HYPERTENSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Arterial hypertension is a complex and in most cases multifactorial pathology. Despite the numerous pharmacological treatments available, it is estimated that in Europe only 25%-39% of hypertensive patients achieve adequate blood pressure (BP) control. Renal arteries denervation (RDN) is an additional therapeutic weapon, complementary to Optimal Medical Therapy (OMT) in patients with resistant or refractory primary (or essential) arterial hypertension. In order to improve patients management and select those who are eligible for renal denervation, our Center has established the Interdisciplinary Group for the Treatment of Resistant Arterial Hypertension (G.I.T.I.A.R.), including Cardiologists, Nephrologists, Internists and Geriatricians.
Methods
From January 2018 to July 2022 the G.I.T.I.A.R. held twelve meetings evaluating 62 patients with resistant or refractory forms of arterial hypertension, contraindications or intolerance to antihypertensive drugs, suspected secondary or pseudoresistant forms (i.e. linked to poor patient compliance, drugs and/or inadequate dosages, concomitant intake of substances with hypertensive effect, incorrect measurements). For each of them, medical therapy was optimized and the need for second level diagnostic tests, multi-specialist follow-up and RDN candidacy were assessed. After three, six, twelve months and then annually following RDN, the patients underwent clinical and multi-specialist evaluation (where deemed appropriate), blood tests monitoring and 24-hour ambulatory blood pressure monitoring (ABPM).
Results
Of the 62 patients evaluated by the G.I.T.I.A.R., 64.5% (n=40) were male. The mean age at the time of evaluation was 64 years (range 18-87). After the first collegial discussion, 46.8% (n=29) have been declared eligible for RDN, while 53.2% (n=33) of the patients was initially rejected: 39.4% of these (n=13) for suspected or ascertained secondary hypertension, 12.1% (n=4) for the possibility of further optimization of medical therapy, 48.5% (n=16) for the presence of inclusion or exclusion criteria of ongoing studies design. Among the excluded patients, six presented moderate renal artery stenosis on non-invasive imaging: in two patients (33.3%) the stenosis turned out to be hemodynamically significant on angiographic and functional evaluation (Pd/Pa measurement), so renal angioplasty was performed; RDN was performed in the remaining 66.7% (n=4), in which a hemodynamic significance of the stenosis was excluded. Of the subgroup who had optimized medical therapy, one patient (25%) was subsequently referred to RDN for failure of all pharmacological strategies, while 3 of 4 (75%) achieved adequate BP control.
Conclusions
Resistant arterial hypertension is associated with an increased risk of development and progression of cardiovascular and renal diseases, with a significant impact on mortality and morbidity. Renal denervation has proved to be an effective and safe therapeutic strategy, complementary to OMT, whose selection of the ideal patient actually represents one of the greatest challenges. The integrated multidisciplinary approach improves the management of the hypertensive patient, the individualization of therapy and allows the identification of subjects who may benefit from RDN.
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Affiliation(s)
| | - Laura Trento
- Azienda Ospedaliera Universitaria Integrata Verona
| | | | - Matteo Casal
- Azienda Ospedaliera Universitaria Integrata Verona
| | | | - Simone Fezzi
- Azienda Ospedaliera Universitaria Integrata Verona
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Roccabruna A, Fanti D, Bonvicini E, D´onghia G, Sarao E, Guarracini F, Bonmassari R, Luciano Ribichini F. 692 THE USE OF ULTRASOUND ENHANCING AGENTS (UEA) IN THE EVALUATION OF LEFT ATRIAL APPENDAGE (LAA) THROMBUS IN PATIENT CANDIDATE TO PERCUTANEOUS LAA CLOSURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Left atrial appendage closure (LAAC) is an emerging option in patients with atrial fibrillation (AF) and contraindication for oral anticoagulation (OAC) therapy. Patients with left atrial thrombus are usually excluded from this strategy. Therefore, pre-procedural transesophageal echocardiography (TEE) is usually performed for LAA thrombus exclusion. The application of second-generation lipid microspheres ultrasound enhancing agents (UEA) is of growing interest. The following clinical cases reports describe the benefit from UEA implication on subsequent decision-making regarding with LAAC procedure.
Case report num.1
an 88-year-old male with history of symptomatic AF and post – traumatic cerebral bleeding was referred to LAAC because of high risk of bleeding in using OAC. Transthoracic echocardiography (TTE) documented a severely dilatated left atrium and preserved left ventricular systolic function. Pre – operative TEE revealed a “chicken wing” shaped LAA with severe spontaneous echo-contrast and sludge effect. Echo-contrast medium “SonoVue” showed an early filling defect with late but complete LAA opacification, excluding thrombus. Of note, ECG-gated cardiac CT (CCT) could not exclude filling defect with certainty. Consecutively, the patient was candidate to LAAC in a short time.
Case report num.2
a 75-year-old man with valvular permanent AF and multi-territory ischemic ictus despite being on adequate prophylactic OAC (Warfarin). At TTE a dilated left ventricle with mildly reduced ejection fraction was documented. ECG – gated CCT with delayed phases imaging showed a possible filling defect in LAA, however imaging was suboptimal due to a reverb of voluminous hiatal hernia. TEE revealed a “windstock” shaped LAA with incomplete distal opacification when echo-contrast medium “SonoVue” was used, confirming thrombus. The patient was therefore referred for LAAC procedure with concomitant use of cerebral embolic protection devices (CEPDs).
Discussion
Transesophageal echocardiography is the test of choice for the exclusion of LAA thrombus. However technical difficulty, spontaneous echo contrast (SEC) and prominent pectinate musculature within the appendage may make the exclusion of LAA thrombus not easy. ECG – gated cardiac CT may be conclusive as well. UEA use is associated with higher diagnostic power for LAA thrombus exclusion and recent study have shown its utility also in terms of LAA sizing. Thus, the most recent guidelines of American Society of Echocardiography mention echo contrast use for the delineation of LAA thrombi and differentiate between them with SEC.
Conclusion
The use of ultrasound enhancing agents is useful and increases the interpretative confidence in exclusion of LAA thrombus.
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Affiliation(s)
- Alessandra Roccabruna
- Cardiology Division, Department Of Medicine, University Of Verona
- Cardiology Division, Santa Chiara Hospital , Trento
| | - Diego Fanti
- Cardiology Division, Department Of Medicine, University Of Verona
- Cardiology Division, Santa Chiara Hospital , Trento
| | - Eleonora Bonvicini
- Cardiology Division, Department Of Medicine, University Of Verona
- Cardiology Division, Santa Chiara Hospital , Trento
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Ruzzarin A, Pighi M, Marin F, Zucchelli F, Portolan L, Mainardi A, Mora FD, Luciano Ribichini F. 386 IMPACT OF REVASCULARIZATION COMPLETENESS ON ONE-YEAR OUTCOMES OF IMPELLA-SUPPORTED PCI IN ACUTE CORONARY SYNDROME: A SINGLE-CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The use of mechanical circulatory support in high-risk percutaneous coronary intervention (HRPCI) has grown over the past decade. We aimed to evaluate the impact of coronary revascularization extent on one-year outcomes of Impella-supported HRPCI in the setting of acute coronary syndrome (ACS).
Methods
We performed a single-center retrospective study including all patients who underwent coronary angiography supported by Impella at our institution. Patients undergoing HRPCI in the setting of ACS with Impella-assistance were identified for the analysis. Revascularization extent was assessed using the British Cardiovascular Intervention Society (BCIS) jeopardy score revascularization index (RI). Patients were classified into two groups according to the completeness of revascularization in high RI (RI>0.75) and low RI (RI<0.75).
The primary study endpoint was survival free from major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke, heart failure hospitalization) at one-year follow-up.
Results
Among fifty patients enrolled in the study, forty ACS patients (mean age 69.2±9 years) were identified for the analysis.
At coronary angiography, 76.3% had multivessel disease, and the mean BCIS-JSPRE-PCI score was 10.2±2.1. After Impella-supported PCI, BCIS-JSPOST-PCI score was 2.1±2.0 (p<0.01) and RI>0.75 was reached in 89.2% of cases (mean RI 0.8±0.2).
In-hospital mortality was 20.5% without a statistical difference between high and low RI (p=0.1).
Within 12 months, time-to-MACCE was statistically higher in patients with high RI as compared to low RI (288.2 vs. 189.8 days, p<0.05) (Figure).
Conclusions
Our single-center experience suggests a more extensive revascularization, aiming for a positive impact on outcomes, when a Impella-protected strategy is performed in the setting of acute coronary syndromes.
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Affiliation(s)
- Alessandro Ruzzarin
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Michele Pighi
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Federico Marin
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Federico Zucchelli
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Leonardo Portolan
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Andrea Mainardi
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Francesco Della Mora
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
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Ciceri L, Springhetti P, Dotto A, Maffeis C, Tafciu E, Bergamini C, Rossi A, Benfari G, Luciano Ribichini F. 501 CASEOUS CALCIFICATION OF THE MITRAL ANNULUS AND THE IMPORTANCE OF ITS IDENTIFICATION IN THE CLINICAL PRACTICE: A REPRESENTATIVE CASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
1. Introduction
Caseous Calcification of the Mitral Annulus (CCMA) is a rare condition characterized by a liquefaction degeneration that usually involves posterior mitral ring and it is considered a variant of mitral annulus calcification. Its prevalence is very low, but it is possible that it is often underdiagnosed or misdiagnosed. This condition is related with increased age, female sex, chronic kidney disease and calcium metabolism disorders. The lesion can be detected using imaging techniques and its management is conservative in most cases.
2. Case Study
A 72-year-old man hospitalized for bilateral pneumonia complicated with ARDS has come to our attention. The patient had a history of stage IV renal failure, type 2 diabetes mellitus and calcific degenerative aortic valve disease. During its stay in the Intensive Care Unit a routine Transthoracic Echocardiogram showed a vegetation suspected for infective endocarditis that involved the posterior mitral leaflet. However, the clinical presentation did not support endocarditis diagnosis as no microorganisms were isolated at multiple blood cultures and other Duke Criteria were negative. Given the limited acoustic viewing of transthoracic echocardiogram it was necessary to perform a Transesophageal Echocardiogram (TEE) for a better characterization of the valve lesion. TEE showed the presence of a round lesion, about 2×2 cm in size, with smooth borders, located over the mitral annulus with extension up to the posterior mitral leaflet and with a partially mobile portion. The lesion had a corpuscular appearance inside with less echogenicity and without evidence of flow. No significant functional alterations of the mitral valve were detected (anterograde transmitral flow Mean Gradient 4-5 mmHg; Mild regurgitation). We therefore concluded for Caseous Calcification of the Mitral Annulus as the most likely diagnosis and decided for a conservative management. A new TEE was performed as a control after one week showing no significant changes on the valve lesion.
3. Conclusions
It is important for echocardiographers to be familiar with CCMA and to know how to distinguish it from other valve lesions such as infective vegetation, abscesses or tumors. An integration with other cardiac imaging techniques, patient past medical history and clinical-laboratory data can help the physician in the correct characterization of valve lesions and subsequent most appropriate therapeutic approach for the patient.
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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Loco CP, Medo K, Barbati G, Graw S, Ribichini FL, Ferro MD, Taylor M, Sinagra G, Mestroni L. 207 RE-DEFINING ARRHYTHMOGENIC CARDIOMYOPATHY: CHARACTERIZATION AND LONG-TERM PROGNOSTIC IMPLICATIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Arrhythmogenic dilated cardiomyopathy (AR-DCM) combines phenotypical aspects of dilated cardiomyopathy (DCM) and risk of sudden cardiac death (SCD), typical of the arrhythmogenic form (ACM). However, AR-DCM is often ambiguously defined leaving clinicians uncertain on how to identify these high-risk patients.
The aims of the study were to re-define AR-DCM based on outcome related arrhythmic markers and to test the usefulness of the novel AR-DCM definition in identifying arrhythmogenic genotypes (i.e., LMNA, FLNC, RBM20, and desmosomal genes).
Materials and methods
Consecutive DCM patients with genetic evaluation and Holter ECG monitoring or telemetry in two referral institution were analyzed. The arrhythmic markers tested to define AR-DCM were: SCD or major ventricular arrhythmias (MVA), unexplained syncope, rapid nonsustained ventricular tachycardia (nsTV), ≥1000 premature ventricular contractions/24 hours, or ≥50 ventricular couplets/24 hours. Patients were labeled as Early AR-DCM if criteria were met within 12 months from enrolment. The primary endpoint was a composite of SCD/MVA; the secondary endpoint was a composite of all-cause mortality/heart transplant/LVAD implantation (D/HTx/LVAD).
Results
Among the 743 DCM patients included, 290 had disease-related variants (39%), 94 (30%) of these carried arrhythmogenic genotype. Early AR-DCM was identified in 429 (58%) patients. During a median follow-up of 7.0 [2.2-13.8] years, among arrhythmic markers the occurrence of syncope and/or nsVT within 12 months from enrolment were the only arrhythmic markers independently associated with SCD/MVA (Figure), while the occurrence of early MVA and/or nsTV emerged as the strongest long-term predictors of D/ HTx/LVAD. Family history of MVA was also independently associated with primary and secondary endpoints, and together with MVA, nsTV or unexplained syncope increased the agreement between AR-DCM and arrhythmogenic genotypes in 1 out 2 patients.
Conclusions
A combination of early (i.e., within 1 year from diagnosis) MVA or nsVT or unexplained syncope might be proposed as a clinically useful new definition of AR-DCM, especially if associated to family history of MVA. This definition in fact allows clinicians to anticipates worse long-term arrhythmic and global outcomes, and to accurately identify malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Marco Merlo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Marta Gigli
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Laura Munaretto
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Alessia Paldino
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Davide Stolfo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Carola Pio Loco
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Kristen Medo
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Sharon Graw
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Matteo Dal Ferro
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Matthew Taylor
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | - Gianfranco Sinagra
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Luisa Mestroni
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
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Ruzzarin A, Bonatti M, Pernter P, Engl P, Pescoller F, Pesarini G, Ribichini FL, Donazzan L. 441 EFFECTS OF TRANSCATHETER AORTIC VALVE IMPLANTATION ON RENAL FUNCTION IN CT-DEFINED SARCOPENIC PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Sarcopaenia, the age-associated decline in skeletal muscle and function, increases the risk of procedure-related complications and mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate whether CT-determined sarcopenia impacts on in-hospital renal function and on midterm outcomes following TAVI.
Methods
This was a retrospective cohort study including patients who underwent TAVI. Sarcopaenia was CT-defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females at the level of L3 vertebra. Acute kidney injury (AKI) was defined as an increase in creatinine concentration of at least 0.3 mg/dL within 48 hours of TAVI according to Valve Academic Research Consortium-3 Criteria. Acute kidney recovery (AKR) was determined as an increase of 25% in eGFR within 48 hours following TAVI. The primary endpoint was freedom from major adverse cardiac and cerebrovascular events (MACCE; composite of any cause of death, any coronary revascularization, stroke and heart failure hospitalization) at the 1-year follow up in sarcopaenic and non-sarcopaenic patients.
Results
A total of 113 patients (mean age 82.2 ± 4.03 years, 52.2% female) were followed for a median of 1.1 year. Sarcopenia was found in the 59% of the TAVI population, more frequently among males (72.2% versus 33.8%, p<0.01). The incidence of AKI was 8.0% and AKR was 6.9% without differences between sarcopaenic and non-sarcopaenic patients (9.4% versus 6.5%, p=0.59 and 11.6% versus 2.2%, p=0.08). The freedom from MACCE at 1 year follow up was 74.5% for sarcopaenic and 70.3% for non-sarcopaenic patients (p= 0.6). In sarcopaenic patients, the incidence of AKI and AKR had no significant impact on the freedom from MACCE at 1-year (p=0.58 and p=0.87).
Conclusions
Sarcopaenic patients had similar out of hospital incidence of adverse events to non-sarcopaenic patients following TAVI confirming the safety of this procedure in sarcopaenic patients.
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Affiliation(s)
- Alessandro Ruzzarin
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Matteo Bonatti
- Division Of Radiology, San Maurizio Hospital , Bozen , Italy
| | | | - Patrick Engl
- Division Of Cardiology, San Maurizio Hospital , Bozen , Italy
| | - Felix Pescoller
- Division Of Cardiology, San Maurizio Hospital , Bozen , Italy
| | - Gabriele Pesarini
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | | | - Luca Donazzan
- Division Of Cardiology, San Maurizio Hospital , Bozen , Italy
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Scarsini R, Pighi M, Mainardi A, Portolan L, Springhetti P, Mammone C, Della Mora F, Fanti D, Tavella D, Gottin L, Bergamini C, Benfari G, Pesarini G, Ribichini FL. Proof of concept study on coronary microvascular function in low flow low gradient aortic stenosis. Heart 2022; 109:785-793. [PMID: 36598066 DOI: 10.1136/heartjnl-2022-321907] [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: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We hypothesised that low flow low gradient aortic stenosis (LFLGAS) is associated with more severe coronary microvascular dysfunction (CMD) compared with normal-flow high-gradient aortic stenosis (NFHGAS) and that CMD is related to reduced cardiac performance. METHODS Invasive CMD assessment was performed in 41 consecutive patients with isolated severe aortic stenosis with unobstructed coronary arteries undergoing transcatheter aortic valve implantation (TAVI). The index of microcirculatory resistance (IMR), resistive reserve ratio (RRR) and coronary flow reserve (CFR) were measured in the left anterior descending artery before and after TAVI. Speckle tracking echocardiography was performed to assess cardiac function at baseline and repeated at 6 months. RESULTS IMR was significantly higher in patients with LFLGAS compared with patients with NFHGAS (24.1 (14.6 to 39.1) vs 12.8 (8.6 to 19.2), p=0.002), while RRR was significantly lower (1.4 (1.1 to 2.1) vs 2.6 (1.5 to 3.3), p=0.020). No significant differences were observed in CFR between the two groups. High IMR was associated with low stroke volume index, low cardiac output and reduced peak atrial longitudinal strain (PALS). TAVI determined no significant variation in microvascular function (IMR: 16.0 (10.4 to 26.1) vs 16.6 (10.2 to 25.6), p=0.403) and in PALS (15.9 (9.9 to 26.5) vs 20.1 (12.3 to 26.7), p=0.222). Conversely, left ventricular (LV) global longitudinal strain increased after TAVI (-13.2 (8.4 to 16.6) vs -15.1 (9.4 to 17.8), p=0.047). In LFLGAS, LV systolic function recovered after TAVI in patients with preserved microvascular function but not in patients with CMD. CONCLUSIONS CMD is more severe in patients with LFLGAS compared with NFHGAS and is associated with low-flow state, left atrial dysfunction and reduced cardiac performance.
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Affiliation(s)
- Roberto Scarsini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy .,Department of Medicine, Division of Cardiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - Michele Pighi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Leonardo Portolan
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Concetta Mammone
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Francesco Della Mora
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Diego Fanti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Domenico Tavella
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Department of Intensive Care and Anesthesiology, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
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Costa G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Barbosa Ribeiro H, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, De Marco F, Tesorio T, Rheude T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Joner M, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Kargoli F, Tamburino C, Barbanti M. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e012417. [PMID: 36538579 DOI: 10.1161/circinterventions.122.012417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Ignacio J Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.C.)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Francesco Saia
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Matjaz Bunc
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Philippe Garot
- Institute cardiovasculaire Paris Sud, Massy, France (P.G., A.G.)
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | | | - Francesco Burzotta
- IRCSS Policlinico Universitario "Agostino Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy (F.B.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Federico De Marco
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Roberto Valvo
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Italo Porto
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, Siena, Italy (A.I.)
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | - Markus Mach
- Wien University Hospital, Austria (M.M., M.A.)
| | - Azeem Latib
- Montefiore Medical Center, New York (A.L., F.K.)
| | - Luigi Biasco
- Azienda sanitaria locale di Ciriè, Chivasso e Ivrea, ASLTO4, Italy (L.B.)
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland (M.T.)
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Brazil (H.B.R., S.F.C.)
| | - Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Mateusz Orzalkiewicz
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | | | | | | | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.).,Galway University Hospital, Ireland (D.M., M.L.)
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Vincenzo Cesario
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Vincenzo De Marzo
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Elisa Piredda
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | | | | | - Elena Dipietro
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | | | - Silvia Motta
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Marco Barbanti
- University Medical Centre Ljubljana, Slovenia (M.B., K.S.)
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46
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Mugnai G, Cecchini F, Stroker E, Paparella G, Iacopino S, Sieira J, De Greef Y, Tomasi L, Bolzan B, Bala G, Overeinder I, Almorad A, Gauthey A, Sorgente A, Ribichini FL, de Asmundis C, Chierchia GB. Pulmonary vein size is associated with reconnection following cryoballoon ablation of atrial fibrillation. J Interv Card Electrophysiol 2022; 65:717-724. [PMID: 35930128 DOI: 10.1007/s10840-022-01330-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/11/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The second-generation cryoballoon (CB) has proven to be a highly effective ablative strategy in patients with symptomatic atrial fibrillation (AF). This study sought to investigate the anatomical characteristics of pulmonary veins (PVs) and the relationship between their size, ovality, and late reconnections in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias. METHODS AND RESULTS A total of 152 consecutive patients (98 males, 64.5%; mean age 64.9 ± 9.6 years) underwent a repeat ablation for recurrent atrial tachyarrhythmias after a median time of 6.5 months [IQR 11] from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 593 PVs, 134 (22.6%) showed a late PV reconnection in 95 patients (0.88 per patient), at the time of repeat ablation procedure. There was a significant difference in ovality between left- and right-sided PVs (p < 0.001). Greater diameters of left superior PV, left inferior PV, and right inferior PV ostia (both maximum and minimum) and higher index ovality were significantly associated with late PV reconnection. CONCLUSIONS The rate of late PV reconnection after CB ablation was low (0.88 PVs/patient). Left-sided PVs were more oval than septal PVs. Larger PV dimensions and higher ovality index were significantly associated with reconnections in all PVs except for RSPV.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium. .,Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy.
| | - Federico Cecchini
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.,Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Erwin Stroker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Anais Gauthey
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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47
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Mugnai G, Donazzan L, Tomasi L, Piccoli A, Cavedon S, Manfrin M, Bolzan B, Perrone C, Lavio S, Rauhe WG, Oberhollenzer R, Bilato C, Ribichini FL. Electrocardiographic predictors of echocardiographic response in cardiac resynchronization therapy: Update of an old story. J Electrocardiol 2022; 75:36-43. [PMID: 36274327 DOI: 10.1016/j.jelectrocard.2022.10.001] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/18/2022] [Accepted: 10/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A better selection of patients with left bundle branch block (LBBB) might increase the response to cardiac resynchronization therapy (CRT). The aim of the study was to investigate the association between the Strauss criteria, absence of S wave in V5-V6, the Selvester score and response to CRT. METHODS AND RESULTS The retrospective analysis included all consecutive patients having undergone implantation of biventricular defibrillators in primary prevention between 2018 and 2020. The final analysis included 236 patients (mean age 69.7 ± 9.9; 77.5% of males). The Strauss criteria were significantly associated with CRT response (p < 0.01) with a sensitivity of 71.3% and specificity of 64.1%. The Strauss criteria along with the absence of S wave in V5 and V6 showed a sensitivity of 56.7%, a specificity of 82.6% and a positive predictive value of 90.5%. The Selvester score was significantly and inversely associated with CRT response (OR 0.818, 95% CI 0.75-0.89; p < 0.001). The multivariable model showed that left ventricular ejection fraction (LVEF) and QRS duration (≥140 ms in males and ≥ 130 ms in females) were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, p = 0.01 and OR 3.70, CI 95% 1.12-12.21, p = 0.03). CONCLUSIONS Strauss criteria, especially in association with absence of S wave in V5 and V6, were able to increase specificity and positive predictive value for predicting CRT response. The Selvester score was inversely associated with CRT response. Finally, LVEF and QRS duration were independently associated with echocardiographic response to CRT.
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Affiliation(s)
- Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
| | - Luca Donazzan
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Anna Piccoli
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Stefano Cavedon
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Cosimo Perrone
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | | | - Werner Günther Rauhe
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Rainer Oberhollenzer
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Claudio Bilato
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
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48
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Urbani G, Springhetti P, Quer L, Dotto A, Ciceri L, Fanti D, Maffeis C, Tafciu E, Bergamini C, Nistri S, Inciardi RM, Ribichini FL, Benfari G. Left atrial function may mitigate the effect of mitral regurgitation on right chambers in patients with severe aortic valve stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1545] [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
Introduction
Left atrial (LA) function has been associated to right chambers hemodynamics in the context of mitral valve regurgitation (MR). However, this physiological interplay between left atrial function, mitral regurgitation and right ventricular (RV) parameters has not yet been clarified in patients with aortic valve stenosis (AS).
Aim of the study
To assess the combination of LA function and different MR grades with right chambers performance and pulmonary non-invasive hemodynamics status in patients with severe AS using an advanced automated echocardiographic approach.
Methods
Consecutive patients with severe AS referred to our institution were analyzed. Mitral regurgitation was classified according to integrative guideline-based criteria. 2D advanced speckle tracking echocardiography analysis was conducted to measure the LA peak atrial longitudinal strain (PALS) and right ventricular free wall strain, (RVFWS) using Tomtec Arena, version TTA2 41.00, with dedicated LV/LA/RV analysis option (Tomtec, Unterschlei heim, Germany). All conventional right chambers performance indexes were also measured: TAPSE, S'- TDI, fractional area change, systolic pulmonary artery pressure (sPAP). We featured 3 patients groups based on MR grade and LA function: (a) no/mild MR and preserved PALS (above the median); (c) >mild MR and reduced PALS; (b) the remaining patients with >mild MR and low PALS or >mild MR and high PALS.
Results
A total of 102 patients with severe aortic stenosis formed the study cohort: age was 82±9, 47% were female, mean left-ventricular-ejection-fraction 56%±12, more than mild MR was present in 24% of patients, mean PALS was 19±10%, sPAP 38±12 mmHg, RVFW strain 21±6%, and RVFW/sPAP 0.62±0.25. The 3 subgroups presented similar age and sex distribution. Right ventricular function significantly worsened moving from group (a) to (c); RVFW strain decreased from 25±5 (a) to 19±7 (b) and 17±5% (c), p<0.001; sPAP increased from 34±9 (a) to 39±12 (b) and 47±13 mmhg (c), p<0.001; and RVFW/sPAP decreased from 0.76±0.21 (a) to 0.54±0.23 (b) and 0.39±0.11 (c), p<0.001. Patients in the group (c) were more symptomatic (NYHA class III/IV increase from 40% in group a and 63% in group (b) to 80% in group c, p=0.006). When added to MR grade, in a logistic regression analysis, PALS provided incremental prediction of all right ventricular parameters (p<0.01).
Conclusion
This study highlights that the combination of MR and reduced LA function is associated with symptoms and RV impairment in patients with severe AS. These preliminary results suggest that preserved LA function may modulate the adverse effects of the AS-MR combination by preventing/delaying the development of pulmonary hypertension and right ventricular dysfunction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Urbani
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - P Springhetti
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - L Quer
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - A Dotto
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - L Ciceri
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - D Fanti
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - C Maffeis
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - E Tafciu
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - C Bergamini
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - S Nistri
- CMSR Veneto Medica, Division of Cardiology , Altavilla Vicentina , Italy
| | - R M Inciardi
- University of Brescia, Division of Cardiology , Brescia , Italy
| | - F L Ribichini
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - G Benfari
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
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49
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Scarsini R, Pighi M, Mainardi A, Portolan L, Mammone C, Benfari G, Springhetti P, Fanti D, Bergamini C, Tavella D, Pesarini G, Ribichini FL. Coronary microvascular dysfunction is associated with reduced cardiac performance in low flow low gradient aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1622] [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
Little is known about coronary microvascular function of patients with low-flow low-gradient aortic stenosis (LFLGAS). We hypothesized that LFLGAS is associated with more severe coronary microvascular dysfunction (CMD) compared with normal-flow high-gradient aortic stenosis (NFHGAS) and that CMD is related to reduced cardiac efficiency.
Purpose
To perform a prospective invasive assessment of CMD in patients with LFLGAS undergoing TAVI and to compare it with patients with NFHGAS. Moreover, we aimed to assess the possible acute impact of TAVI on coronary microvascular function and the interactions between CMD and of cardiac performance at speckle tracking echocardiography (STE).
Methods
Invasive thermodilution-based assessment was systematically performed in 41 consecutive patients with isolated severe AS with angiographic unobstructed coronary arteries undergoing TAVI. The index of microcirculatory resistance (IMR), resistive reserve ratio (RRR) and coronary flow reserve (CFR) were derived to assess coronary microcirculatory function before and after TAVI. Advanced echocardiographic imaging, including STE, was performed to assess cardiac function.
Results
IMR was significantly higher in patients with LFLGAS compared with patients with NFHGAS (24.1 [14.6–39.1] vs 12.8 [8.6–19.2] p=0.002). Similarly, RRR was significantly lower in LFLGAS compared with NFHGAS (1.4 [1.1–2.1] vs 2.6 [1.5–3.3] p=0.020). No significant differences were observed in CFR between the two groups.
High IMR was associated with low stroke volume index (rho=−0.427, p=0.005), low cardiac output (rho=−0.517, p=0.001), reduced peak atrial longitudinal strain (PALS) (rho=−0.610, p≤0.001) and presence of atrial fibrillation (54.6% vs 21.1%, p=0.036). Conversely, IMR was only modestly associated with the mean pressure aortic valve gradient (rho=−0.304, p=0.054). Notably, the mean gradient was significantly associated with IMR in the NFHGAS group (rho=0.632, p=0.003) but not in the LFLGAS (rho=−0.222, p=0.333). Similarly, high IMR was associated with the AVA in the NFHGAS group (rho=−0.50, p=0.025) but not in patients with LFLGAS (rho=0.157, p=0.497).
Paradoxical LFLGAS emerged as a phenotype associated with CMD, poor left ventricular longitudinal systolic function and left atrial dysfunction. TAVI determined no significant variation in microvascular function (IMR: 16.0 [10.4–26.1] vs 16.6 [10.2–25.6], p=0.403) and in PALS (15.9 [9.9–26.5] vs 20.1 [12.3–26.7], p=0.222). Conversely, left ventricular global longitudinal strain increased overall after TAVI (−13.2 [8.4–16.6] vs −15.1 [9.4–17.8], p=0.047).
Conclusions
LFLGAS is associated with impaired coronary microvascular function compared with NFHGAS. Combined invasive assessment of microvascular function and advanced non-invasive imaging contributed to define different AS phenotypes. CMD was associated with low-flow state, left atrial dysfunction and reduced cardiac efficiency in patients with AS.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular
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Affiliation(s)
- R Scarsini
- Integrated University Hospital of Verona , Verona , Italy
| | - M Pighi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - A Mainardi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - L Portolan
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Mammone
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Benfari
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - P Springhetti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Fanti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Bergamini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Tavella
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Pesarini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - F L Ribichini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
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50
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Castaldi G, Fezzi S, Widmann M, Lia M, Rizzetto F, Mammone C, Galli V, Piccolo S, Pazzi S, Pighi M, Pesarini G, Prati D, Scarsini R, Tavella D, Ribichini FL. Angiography derived index of microvascular resistance (IMR) in Takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1133] [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 and purpose
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation.
Methods
Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed.
Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035).
Conclusion
CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Fezzi
- University of Verona , Verona , Italy
| | - M Widmann
- University of Verona , Verona , Italy
| | - M Lia
- University of Verona , Verona , Italy
| | | | - C Mammone
- University of Verona , Verona , Italy
| | - V Galli
- University of Verona , Verona , Italy
| | - S Piccolo
- University of Verona , Verona , Italy
| | - S Pazzi
- University of Verona , Verona , Italy
| | - M Pighi
- University of Verona , Verona , Italy
| | | | - D Prati
- University of Verona , Verona , Italy
| | | | - D Tavella
- University of Verona , Verona , Italy
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