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Orzalkiewicz M, Foroni M, Chietera F, Bendandi F, Mazzapicchi A, Bruno AG, Ghetti G, Taglieri N, Marrozzini C, Galiè N, Palmerini T, Saia F. Off-Label Use of Balloon-Expandable Transcatheter Valves to Treat Pure Aortic Regurgitation. Am J Cardiol 2024:S0002-9149(24)00312-6. [PMID: 38663573 DOI: 10.1016/j.amjcard.2024.04.030] [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] [Received: 12/07/2023] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) in native pure aortic regurgitation (AR) with off-label use of balloon-expandable valves (BEV) has been reported. However, there are scant data regarding optimal oversizing and its safety, and our study assessed BEV oversizing and outcomes of TAVI. Thirteen consecutive tricuspid aortic valve patients who underwent transfemoral TAVIs for pure AR with Sapien BEV at our center between 2019 and 2023 (69.2% males, mean age 80.8 years, Society of Thoracic Surgeons 4.0%) were divided into small annulus (SA) group (≤618 mm2) where ≥20% oversizing is achievable based on published data on BEV overexpansion, and larger annulus (LA) group (>618 mm2). Overexpansion and actual oversizing were measured on postprocedural computed tomography scan. Technical success was 92.3% with 1 valve embolization in the LA group. The postprocedural computed tomography showed a mean 28.3% oversizing, significantly higher in SA (31.2%) than in LA group (19.4%), p = 0.0092. Oversizing ≥20% was achieved in 100% SA versus 33.3% LA patients (p = 0.046). In conclusion, TAVI in pure AR with oversized Sapien BEV showed good procedural and short-term outcomes when ≥20% oversizing was predictably achievable.
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Affiliation(s)
- Mateusz Orzalkiewicz
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Marco Foroni
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Alessandro Mazzapicchi
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Pasceri V, Pelliccia F, Mehran R, Dangas G, Porto I, Radico F, Biancari F, D'Ascenzo F, Saia F, Luzi G, Bedogni F, Amat Santos IJ, De Marzo V, Dimagli A, Mäkikallio T, Stabile E, Blasco-Turrión S, Testa L, Barbanti M, Tamburino C, Fabiocchi F, Chilmeran A, Conrotto F, Costa G, Stefanini G, Spaccarotella C, Macchione A, La Torre M, Bendandi F, Juvonen T, Wańha W, Wojakowski W, Benedetto U, Indolfi C, Hildick-Smith D, Zimarino M. Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e032955. [PMID: 38533944 DOI: 10.1161/jaha.123.032955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. METHODS AND RESULTS A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). CONCLUSIONS A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.
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Affiliation(s)
| | | | | | | | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
| | | | - Fausto Biancari
- Department of Medicine South Karelia Central Hospital, University of Helsinki Lappeenranta Finland
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Francesco Saia
- Department of Cardiothoracic Vascular Surgery University Hospital Bologna Italy
| | - Giampaolo Luzi
- Cardiovascular Department Azienda Ospedaliera Regionale "San Carlo" Potenza Italy
| | - Francesco Bedogni
- Department of Cardiology IRCCS Policlinico San Donato, San Donato Milanese Milan Italy
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
- Department of Cardiology ASL2 Abruzzo Chieti Italy
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Timo Mäkikallio
- Department of Medicine South Karelia Central Hospital, University of Helsinki Lappeenranta Finland
| | - Eugenio Stabile
- Cardiovascular Department Azienda Ospedaliera Regionale "San Carlo" Potenza Italy
| | - Sara Blasco-Turrión
- CIBERCV, Interventional Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Luca Testa
- Department of Cardiology IRCCS Policlinico San Donato, San Donato Milanese Milan Italy
| | | | - Corrado Tamburino
- Division of Cardiology A.O.U. Policlinico "G. Rodolico-San Marco" Catania Italy
| | - Franco Fabiocchi
- Centro Cardiologico Monzino, IRCCS Milan Italy
- Galeazzi-Sant'Ambrogio Hospital, I.R.C.C.S Milan Italy
| | - Ahmed Chilmeran
- Department of Cardiology Royal Sussex County Hospital Brighton UK
| | - Federico Conrotto
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Giuliano Costa
- Division of Cardiology A.O.U. Policlinico "G. Rodolico-San Marco" Catania Italy
| | | | | | - Andrea Macchione
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Michele La Torre
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Francesco Bendandi
- Department of Cardiothoracic Vascular Surgery University Hospital Bologna Italy
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Central Hospital University of Helsinki Finland
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland
| | - Umberto Benedetto
- Department of Cardiac Surgery University "G. d'Annunzio" Chieti Italy
| | - Ciro Indolfi
- Division of Cardiology University Magna Graecia Catanzaro Italy
| | | | - Marco Zimarino
- Department of Cardiology ASL2 Abruzzo Chieti Italy
- Department of Neuroscience, Imaging and Clinical Sciences 'G. D'Annunzio' University of Chieti-Pescara Italy
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Ghetti G, Bendandi F, Donati F, Ciurlanti L, Nardi E, Bruno AG, Orzalkiewicz M, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Predictors of bail-out stenting in patients with small vessel disease treated with drug-coated balloon percutaneous coronary intervention. Catheter Cardiovasc Interv 2023. [PMID: 37172212 DOI: 10.1002/ccd.30688] [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: 12/06/2022] [Revised: 03/16/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Drug-coated balloons (DCBs) have shown comparable results with drug-eluting stents in small vessel disease (SVD) percutaneous coronary intervention (PCI) in terms of target vessel revascularization and a reduced incidence of myocardial infarction. However, the relatively high rate of bail-out stenting (BOS) still represents a major drawback of DCB PCI. AIMS The aim of the study was to investigate the clinical, anatomic, and procedural features predictive of BOS after DCB PCI in SVD. METHODS We included all consecutive patients undergoing PCI at our institution between January 2020 and May 2022 who were treated with DCB PCI of a de novo lesion in a coronary vessel with a reference vessel diameter (RVD) between 2.0 and 2.5 mm. Angiographic success was defined as a residual stenosis <30% without flow-limiting dissection. Patients who did not meet these criteria underwent BOS. RESULTS A total of 168 consecutive patients and 216 coronary stenoses were included. The rate of bail-out stent was 13.9%. On multivariate analysis, DCB/RVD ratio (odds ratio [OR]: 4.39, 95% confidence interval [CI]: 1.71-11.29, p < 0.01), vessel tortuosity (OR: 7.00, 95% CI: 1.66-29.62, p < 0.01), distal vessel disease (OR: 5.66, 95% CI: 2.02-15.83, p < 0.01), and high complexity (Grade C of ACC/AHA classification) coronary stenoses (OR: 6.31, 95% CI: 1.53-26.04, p = 0.01) were independent predictors of BOS. CONCLUSIONS BOS is not an infrequent occurrence in DCB PCI of small vessels and is correlated with vessel tortuosity, distal diffuse vessel disease, higher lesion complexity, and balloon diameter oversizing.
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Affiliation(s)
- Gabriele Ghetti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Bendandi
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Donati
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Leonardo Ciurlanti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Elena Nardi
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Antonio Giulio Bruno
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Tullio Palmerini
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Saia
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Cinzia Marrozzini
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nazzareno Galié
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nevio Taglieri
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
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Ghetti G, Chietera F, Donati F, Bendandi F, Minnucci M, Bruno AG, Orzalkiewicz M, Nardi E, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Coronary ectasia in different scenarios, primarily in myocardial infarction with nonobstructive coronary artery disease. J Cardiovasc Med (Hagerstown) 2023; 24:167-171. [PMID: 36753724 DOI: 10.2459/jcm.0000000000001445] [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: 02/10/2023]
Abstract
AIMS Several causes have been reported for coronary artery ectasia (CAE), mostly atherosclerosis and tunica media abnormalities. The main aim of the present study was to investigate if CAE extension differs in distinct clinical settings. METHODS Three hundred and forty-one patients with diagnosis of CAE were identified among 9659 coronary angiographies and divided into four groups according to the patient's admission diagnosis: stable or unstable angina (S-UA), myocardial infarction (MI), aortic disease, aortic valvular disease (AVD). S-UA and MI were subgrouped according to the presence of obstructive coronary artery disease (OCAD). Multivariable logistic regression was used to investigate the relationship between clinical diagnosis and CAE extension as expressed by Markis classification and number of coronary vessels affected by CAE. RESULTS No significant differences in CAE extension were found among the four groups, in terms of vessels affected by CAE (P = 0.37) or Markis class (P = 0.33). CAE was not related to the extension of OCAD as assessed by the Gensini score, which was higher in MI and S-UA groups (P < 0.01). However, when ischemic patients were sub-divided on the basis of the presence of OCAD, MI without obstructive coronary artery disease (MINOCA) was associated with a higher extension of CAE in terms of Markis class 1 (OR 5.08, 95% CI 1.61-16.04; P < 0.01). CONCLUSION The extension of CAE is comparable in patients referred to coronary angiography for different clinical scenarios, including S-UA, MI, aortic disease, and AVD; however, patients with MINOCA were associated with a higher extension of CAE.Graphical abstract: Difference in coronary artery ectasia extension in terms of Markis class severity, respectively, stratified by clinical presentation and obstructive coronary artery disease presence, http://links.lww.com/JCM/A519.
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Affiliation(s)
- Gabriele Ghetti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
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Bendandi F, Ciurlanti L, Chietera F, Mazzapicchi A, Foroni M. 76 INSIDE VEIN GRAFT FAILURE: A WORK FOR OCT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.292] [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
An 84-years-old woman with prior history of triple coronary artery bypass graft and subsequent percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) for right coronary artery (RCA) was admitted for non-ST-elevation myocardial infarction and newly diagnosed atrial fibrillation. Coronary angiography showed chronic occlusion of native vessels and good flow in all grafts, in absence of critical stenoses. However, SVG for RCA presented a small filling defect of non-univocal interpretation (atherothrombosis, thromboembolus, venous valve). Optical coherence tomography (OCT) was performed for better assessment of the lesion, which was found to be a red thrombus, overlying a ruptured thin-cap fibroatheroma. To reduce the risk of distal embolization, a well-known complication of SVG PCI, direct stenting with conservative stent sizing was performed: everolimus-eluting stent diameter (3,5 mm) was chosen according to mean reference lumen diameter, while length (18 mm) was determined to obtain complete plaque coverage. Repeated OCT showed proximal stent malapposition and underexpansion at the mid portion. The stent was post-dilated with 4,0×12 mm non-compliant balloon and final OCT showed correction of both malapposition and underexpansion.
The presented case offers an example of the advantages of intravascular imaging in diagnosis and treatment of SVG lesions. Venous grafts have high failure rate: up to 12% of graft are occluded before hospital discharge and up to 60% after 10 years. While in the first year graft occlusion is mainly caused by neointimal hyperplasia, after this period neoatherosclerosis is the leading cause of failure, as exemplified in the case. Intravascular imaging, and particularly OCT, may help to elucidate graft failure mechanism, with important implications for treatment strategy. Moreover, SVG interventions have higher incidence procedural complications, particularly no-reflow and periprocedural myocardial infarction, due to high plaque burden and friable atheromatous material. Proposed strategies to mitigate procedural risk include use of embolic protection devices, direct stenting and use of undersized stents. In this complex setting, intravascular imaging can guide stent sizing and optimization, thus reducing procedural complications and long-term lesion failure.
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Affiliation(s)
- Francesco Bendandi
- Azienda Ospedaliera Universitaria Policlinico S. Orsola-Malpighi
- Università Degli Studi Di Bologna
| | - Leonardo Ciurlanti
- Azienda Ospedaliera Universitaria Policlinico S. Orsola-Malpighi
- Università Degli Studi Di Bologna
| | - Francesco Chietera
- Azienda Ospedaliera Universitaria Policlinico S. Orsola-Malpighi
- Università Degli Studi Di Bologna
| | - Alessandro Mazzapicchi
- Azienda Ospedaliera Universitaria Policlinico S. Orsola-Malpighi
- Università Degli Studi Di Bologna
| | - Marco Foroni
- Azienda Ospedaliera Universitaria Policlinico S. Orsola-Malpighi
- Università Degli Studi Di Bologna
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Marcelli C, Bendandi F, Sabatino M, Potena L, Galiè N, Saia F. 177 TRANSCATHETER EDGE-TO-EDGE REPAIR OF SEVERE FUNCTIONAL MITRAL REGURGITATION TO OVERCOME ACUTE DECOMPENSATION IN A YOUNG MAN CANDIDATE TO HEART TRANSPLANTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.467] [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
Chronic severe functional mitral regurgitation (FMR) is common in patients with HF as it reflects left ventricle dysfunction and portends poor prognosis.
Case report
A 42 years old man with cardiovascular risk factors (former smoker, obesity) but without previous cardiological history presented anterior ST-elevation myocardial infarction (STEMI) treated with primary PCI of the anterior descending artery. He developed severe ventricular dysfunction leading to congestive heart failure (HF) requiring early re-hospitalization for pulmonary edema. Despite optimal medical therapy patient remained symptomatic (NYHA class III, INTERMACS 6) with persistence of left ventricle ejection fraction (LVEF) depression, therefore he received an implantable cardiac defibrillator for primary prevention and was referred to our institution for further evaluation. Trans-esophageal echocardiography showed severe left ventricle dilatation and disfunction (EDD 6.9 cm, iEDV 113 ml/m2, LVEF 24%) and presence of severe FMR with EROA 37 mm2 and RV 44 ml. Right heart catheterization (RHC) revealed combined pulmonary hypertension (mean PA pressure 43 mmHg, PCWP 32 mmHg, PVR 4.6 WU) with severely reduced cardiac index obtained (CO 3.4 l/min, CI 1.9 l/min/m2). After infusion of inodilator (enoximone) a decrease of PA pressure and PVR was reported, concluding for reversible pulmonary hypertension. After screening for non-cardiac contraindications, the patient was listed for heart transplantation. Chances to get a donation with a short waiting list time were low because of patient's high BMI and blood group B. Therefore, after Heart Team evaluation, transcatheter edge-to-edge repair of the mitral valve (TEER) was performed as bridge to transplant. A single NTR clip was used, placed centrally between A2-P2 segments, reducing regurgitation from severe to mild. Patient was discharged on heart transplantation waiting list. At three months follow up he presented clinical improvement with reduction of NYHA class from III to II. RHC was repeated and showed normal filling pressures, reduction of pulmonary pressure (mPAP 20 mmHg) and increased cardiac output (CO 5.2 l/min, CI 2.5 l/min/m2). According to his preferences, the patient was suspended from the waiting list with indication to continue outpatient follow-up. At 1-year control he was stable in NYHA II class and the daily diuretic dose had been reduced, echocardiography showed severe LVEF depression (28%) with mild to moderate residual mitral regurgitation.
Conclusions
TEER recently emerged as an option for patients with FMR who are not suitable for surgery. Latest guidelines suggest its use in presence of specific criteria (LVEF 20-50%, ESD < 7 cm, sPAP <70 mmHg, hemodynamic stability, absence of right ventricle disfunction and severe TR) rarely fulfilled by patients with advanced HF requiring evaluation for transplant. On the other hand, access to surgical strategies for end stage HF is limited by scarce availability of donors and by temporary or definitive contraindications. Evidences are emerging that in this population TEER can improve hemodynamic profile and lead to reduction of pulmonary hypertension, providing temporary stability before definitive treatment or allowing candidacy. In this setting, TEER might be performed to reduce symptoms. Considering TEER as bridge strategy to transplant, candidacy or decision can expand the number of patients suitable for heart transplantation or delay urgency.
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Bendandi F, Bruno AG, Donati F, Ciurlanti L, Orzalkiewicz M, Palmerini T, Marrozzini C, Saia F, Galiè N, Martin Suarez S, Taglieri N, Ghetti G. Coronary Stent Infection and Subsequent Abscessualization Causing Dislocation in Extravascular Position. JACC Cardiovasc Interv 2022; 15:e189-e191. [DOI: 10.1016/j.jcin.2022.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
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Paradossi U, Taglieri N, Massarelli G, Palmieri C, De Caterina AR, Bruno AG, Taddei A, Nardi E, Ghetti G, Palmerini T, Trianni G, Mazzone A, Pizzi C, Donati F, Bendandi F, Marrozzini C, Ravani M, Galiè N, Saia F, Berti S. Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI. J Cardiovasc Med (Hagerstown) 2022; 23:234-241. [PMID: 35081074 DOI: 10.2459/jcm.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI). METHODS We analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used. RESULTS Among 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45-3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41-2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16-1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15-1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up. CONCLUSION As compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.
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Affiliation(s)
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Massarelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Donati
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, Massa
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9
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Abstract
Abstract
Aims
Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis.
Methods and results
A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients.
Conclusions
CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.
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10
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Bendandi F, Ghetti G, Taglieri N. [Optical coherence tomography and coronary artery ectasia: the critical role of intracoronary imaging for optimal results of percutaneous coronary intervention]. G Ital Cardiol (Rome) 2021; 22:42-44. [PMID: 35343491 DOI: 10.1714/3723.37140] [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: 06/14/2023]
Abstract
Percutaneous coronary intervention (PCI) in coronary artery ectasia is technically challenging, particularly regarding appropriate stent sizing, and it is associated with a higher incidence of adverse events. In this case report, a 63-year-old male patient, heart transplant recipient, underwent elective follow-up coronary angiography in the absence of clinical symptoms. Five years previously the patient was treated with coronary angioplasty and drug-eluting stent implantation for critical lesions of the left anterior descending coronary artery. Angiographic images showed a focal in-stent haziness at the level of an ectatic segment. To elucidate this finding, optical coherence tomography (OCT) was performed. Intracoronary imaging showed severe malapposition of the proximal end of the stent, with an intraluminal signal-rich structure, suggestive of organized stent thrombosis. Stent dilation was performed to maximal recommended diameter, with significant reduction of the malapposed area, as shown by repeated OCT pullbacks. Intracoronary imaging is particularly valuable in PCI of ectatic vessels to guide appropriate stent sizing and avoid stent malapposition. OCT, thanks to its superior spatial resolution in comparison with other intravascular imaging techniques, provides advantages for stent optimization and evaluation of stent failure causes. However, its limited imaging area and possible incomplete blood clearance may limit its usefulness in severely ectatic vessels.
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Affiliation(s)
| | | | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
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11
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Orzalkiewicz M, Donati F, Santona L, Marcelli C, Chietera F, Bendandi F, Bruno AG, Ghetti G, Taglieri N, Palmerini T, Marrozzini C, Galie N, Saia F. Management strategies for acutely decompensated aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2199] [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
Uncertainty exists over the optimal treatment strategy for patients presenting with acutely decompensated severe aortic stenosis (AS). The available options include a bridging balloon aortic valvuloplasty (BAV) or a direct transcatheter aortic valve implantation (TAVI).
Purpose
Our study compares TAVI outcomes in patients treated with two different strategies in acutely decompensated severe AS: bridged TAVI vs direct TAVI.
Methods
In this observational study all patients admitted with decompensated severe AS who underwent balloon aortic balloon valvuloplasty (BAV) and/or TAVI on the index admission were included. Comparison was made between bridged TAVI group (defined as initial BAV followed by TAVI) and direct TAVI group (TAVI on the index admission without bridging BAV). For this analysis we excluded patients in cardiogenic shock. Baseline characteristics, echocardiographic and periprocedural data were recorded in hospital database. Major adverse cardiovascular events (MACE) were defined as death, major bleeding, rehospitalisation for heart failure, or stroke). The follow-up data was obtained by outpatient visits and/or telephone calls.
Results
178 patients with acutely decompensated AS were analysed: 58 bridged TAVI, 23 direct TAVI, 9 bridged SAVR and 88 destination BAV (defined as BAV non followed by a definite treatment). There was no statistically significant difference between bridged TAVI and direct TAVI group in mean age (83.6±6.6 vs 80.4±8.3 years), the prevalence major comorbidities (coronary, respiratory, neurological or peripheral vascular disease), renal function (eGFR 43.4±18.9 vs 45.2±20.9 ml/min/m2), the mean LV ejection fraction (53.4±13.8 vs 48.6±14.6%) or aortic valve gradient (39.4±13.0 vs 34.1±12.3mmHg), respectively. Direct TAVI patients had a higher mean surgical risk scores (STS 6.1±3.7 vs 9.1±7.0%, logES 18.8±11.5 vs 30.8±20.9%, p=0.01) and higher prevalence of significant aortic regurgitation (5% vs 43%, p=0.0001). The femoral TAVI access was used in 98% of bridged and 78% of direct TAVI patients (p=0.006). The estimated 1-year survival and 1-year MACE-free survival did not differ significantly between the bridged TAVI and direct TAVI groups (86.8% vs 78.3%, p=0.20 and 79.7% vs 64.2%, p=0.11, respectively).
Conclusions
A large proportion of patients admitted with acutely decompensated AS were not eligible for definite treatment. There is no difference in procedural success, 1-year all-cause mortality and 1-year major adverse cardiovascular events between the bridged TAVI or direct TAVI strategies in acute decompensated aortic stenosis allowing to personalize treatment strategy for individual patient.
Funding Acknowledgement
Type of funding sources: None. Table 1. Clinical and procedural data
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Affiliation(s)
| | - F Donati
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - L Santona
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Marcelli
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Chietera
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Bendandi
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - A G Bruno
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - G Ghetti
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - N Taglieri
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - T Palmerini
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Marrozzini
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - N Galie
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Saia
- St. Orsola-Malpighi University Hospital, Bologna, Italy
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12
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Vergallo R, Porto I, D'Amario D, Annibali G, Galli M, Benenati S, Bendandi F, Migliaro S, Fracassi F, Aurigemma C, Leone AM, Buffon A, Burzotta F, Trani C, Niccoli G, Liuzzo G, Prati F, Fuster V, Jang IK, Crea F. Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability: An In Vivo Optical Coherence Tomography Study. JAMA Cardiol 2020; 4:321-329. [PMID: 30865212 DOI: 10.1001/jamacardio.2019.0275] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 12/19/2022]
Abstract
Importance At one end of the coronary artery disease (CAD) spectrum, there are patients with multiple recurrent acute coronary syndromes (rACS), and at the other end there are those with long-standing clinical stability. Predicting the natural history of these patients is challenging because unstable plaques often heal without resulting in ACS. Objective To assess in vivo the coronary atherosclerotic phenotype as well as the prevalence and characteristics of healed coronary plaques by optical coherence tomography (OCT) imaging in patients at the extremes of the CAD spectrum. Design, Setting, and Participants This is an observational, single-center cohort study with prospective clinical follow-up. From a total of 823 consecutive patients enrolled in OCT Registry of the Fondazione Policlinico A. Gemelli-IRCCS, Rome, Italy, from March 2009 to February 2016, 105 patients were included in the following groups: (1) patients with rACS, defined as history of at least 3 acute myocardial infarctions (AMIs) or at least 4 ACS with at least 1 AMI; (2) patients with long-standing stable angina pectoris (ls-SAP), defined as a minimum 3-year history of stable angina; and (3) patients with a single unheralded AMI followed by a minimum 3-year period of clinical stability (sAMI). Data were analyzed from January to August 2018. Exposures Intracoronary OCT imaging of nonculprit coronary segments. Main Outcomes and Measures Coronary plaque features and the prevalence of healed coronary plaques in nonculprit segments as assessed by intracoronary OCT imaging. Results Of 105 patients, 85 were men (81.0%); the median (interquartile range) age was 68 (63-75) years. Median (interquartile range) time of clinical stability was 9 (5.0-15.0) years in the ls-SAP group and 8 (4.5-14.5) years in the sAMI group. Patients in the rACS and sAMI groups showed similar prevalence of lipid-rich plaque and thin-cap fibroatheroma, which was significantly higher than in those with ls-SAP (lipid-rich plaque 80.0% [n = 24 of 30] vs 76.3% [n = 29 of 38] vs 37.8% [n = 14 of 37], respectively; P < .001; thin-cap fibroatheroma 40.0% [n = 12 of 30] vs 34.2% [n = 13 of 38] vs 8.1% [n = 3 of 37], respectively; P = .006). Spotty calcifications were more frequently observed in patients with rACS than in those with ls-SAP and sAMI (70.0% [n = 21 of 30] vs 40.5% [n = 15 of 37] vs 44.7% [n = 17 of 38], respectively; P = .04). Healed coronary plaques were rarely observed in patients with rACS, whereas their prevalence was significantly higher in patients with ls-SAP and sAMI (3.3% [n = 1 of 30] vs 29.7% [n = 11 of 37] vs 28.9% [n = 11 of 38], respectively; P = .01). Conclusions and Relevance Patients with rACS have a distinct atherosclerotic phenotype compared with those with ls-SAP, including higher prevalence of thin-cap fibroatheroma and lower prevalence of healed coronary plaques, suggesting that atherosclerotic profile and plaque healing may play a role in leading the natural history of patients with CAD.
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Affiliation(s)
- Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy.,Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico, AOU San Martino IST, Università di Genova, Genova, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianmarco Annibali
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Benenati
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Bendandi
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Fracassi
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonino Buffon
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
| | - Francesco Prati
- Cardiology Department, San Giovanni Addolorata Hospital, Rome, Italy.,Centro per la Lotta Contro L'Infarto Foundation, Rome, Italy
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ik-Kyung Jang
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica Sacro Cuore, Rome, Italy
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