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De Filippo O, Piroli F, Bruno F, Bocchino PP, Saglietto A, Franchin L, Angelini F, Gallone G, Rizzello G, Ahmad M, Gasparini M, Chatterjee S, De Ferrari GM, D'Ascenzo F. De-escalation of dual antiplatelet therapy for patients with acute coronary syndrome after percutaneous coronary intervention: a systematic review and network meta-analysis. BMJ Evid Based Med 2024:bmjebm-2023-112476. [PMID: 38242567 DOI: 10.1136/bmjebm-2023-112476] [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] [Accepted: 12/25/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To compare dual antiplatelet therapy (DAPT) de-escalation with five alternative DAPT strategies in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). DESIGN We conducted a systematic review and network meta-analysis (NMA). Parallel-arm randomised controlled trials (RCTs) comparing DAPT strategies were included and arms of interest were compared via NMA. Partial ranking of each identified arm and for each investigated endpoint was also performed. SETTING AND PARTICIPANTS Adult patients with ACS (≥18 years) undergoing PCI with indications for DAPT. SEARCH METHODS A comprehensive search covered several databases (PubMed, Embase, Cochrane Central, MEDLINE, Conference Proceeding Citation Index-Science) from inception to 15 October 2023. Medical subject headings and keywords related to ACS, PCI and DAPT interventions were used. Reference lists of included studies were screened. Clinical trials registers were searched for ongoing or unpublished trials. INTERVENTIONS Six strategies were assessed: T1 arm: acetylsalicylic acid (ASA) and prasugrel for 12 months; T2 arm: ASA and low-dose prasugrel for 12 months; T3 arm: ASA and ticagrelor for 12 months; T4 arm: DAPT de-escalation (ASA+P2Y12 inhibitor for 1-3 months, then single antiplatelet therapy with potent P2Y12 inhibitor or DAPT with clopidogrel); T5 arm: ASA and clopidogrel for 12 months; T6 arm: ASA and clopidogrel for 3-6 months. MAIN OUTCOME MEASURES Primary outcome: Cardiovascular mortality. SECONDARY OUTCOMES bleeding events (all, major, minor), stent thrombosis (ST), stroke, myocardial infarction (MI), all-cause mortality, major adverse cardiovascular events (MACE). RESULTS 23 RCTs (75 064 patients with ACS) were included. No differences in cardiovascular mortality, all-cause death, recurrent MI or MACE were found when the six strategies were compared, although with different levels of certainty of evidence. ASA and clopidogrel for 12 or 3-6 months may result in a large increase of ST risk versus ASA plus full-dose prasugrel (OR 2.00, 95% CI 1.14 to 3.12, and OR 3.42, 95% CI 1.33 to 7.26, respectively; low certainty evidence for both comparisons). DAPT de-escalation probably results in a reduced risk of all bleedings compared with ASA plus full-dose 12-month prasugrel (OR 0.49, 95% CI 0.26 to 0.81, moderate-certainty evidence) and ASA plus 12-month ticagrelor (OR 0.52, 95% CI 0.33 to 0.75), while it may not increase the risk of ST. ASA plus 12-month clopidogrel may reduce all bleedings versus ASA plus full-dose 12-month prasugrel (OR 0.66, 95% CI 0.42 to 0.94, low certainty) and ASA plus 12-month ticagrelor (OR 0.70, 95% CI 0.52 to 0.89). CONCLUSIONS DAPT de-escalation and ASA-clopidogrel regimens may reduce bleeding events compared with 12 months ASA and potent P2Y12 inhibitors. 3-6 months or 12-month aspirin-clopidogrel may increase ST risk compared with 12-month aspirin plus potent P2Y12 inhibitors, while DAPT de-escalation probably does not.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Piroli
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Franchin
- Cardiology Department, University Hospital 'Santa Maria della Misericordia', Azienda Sanitaria Universitaria Integrata Friuli Centrale (ASUFC), Udine, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giulia Rizzello
- Dipartimento di Scienze Matematiche (DISMA), Giuseppe Luigi Lagrange, Politecnico di Torino, Torino, Italy
| | | | - Mauro Gasparini
- Dipartimento di Scienze Matematiche (DISMA), Giuseppe Luigi Lagrange, Politecnico di Torino, Torino, Italy
| | - Saurav Chatterjee
- New York Community Hospital, Maimonides Health, Brooklyn, New York, USA
- Zucker School of Medicine, Hempstead, New York, USA
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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D'Ascenzo F, DE Filippo O, Angelini F, Piroli F, DE Lio G, Bocchino PP, Baldetti L, Melillo F, Chieffo A, Saglietto A, Omedè P, Montefusco A, Conrotto F, de Ferrari GM. Duration and kind of dual antiplatelet therapy for acute coronary syndrome patients: a network meta-analysis. Minerva Cardiol Angiol 2023; 71:494-503. [PMID: 35332750 DOI: 10.23736/s2724-5683.22.06038-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION For acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI), the choice of the duration and kind of dual antiplatelet therapy (DAPT) offering the most accurate balance between ischemic and bleeding risk remains unknown. EVIDENCE ACQUISITION A network meta-analysis was performed including all Randomized Controlled Trials (RCTs) comparing different DAPT regimens and duration in ACS patients undergoing PCI. Trial-defined MACE and major bleedings were the primary endpoints. Stroke, stent thrombosis (ST), all-cause and cardiovascular death, myocardial infarction (MI) represented secondary endpoints. EVIDENCE SYNTHESIS 13 RCTs encompassing 46145 patients were included. Mean age was 62 (61-64) years old, 42% being admitted with STEMI, 33% with NSTEMI and 25% with UA. The competitive arms were: clopidogrel and aspirin for 12 months (6 arms/18183 patients), clopidogrel and aspirin for 6 months (4/3329), clopidogrel and aspirin >12 months (3/2238), ticagrelor and aspirin for 12 months (6/12942) and prasugrel and aspirin for 12 months (3/9453). Trial-defined MACE and major bleedings, stroke and death were similar among the different arms. DAPT with prasugrel and aspirin for 12 months reduced MI compared to aspirin and clopidogrel for 12 months (OR 0.71, 95% CI: 0.54.0.94) and reduced the risk of ST compared to ticagrelor (OR 0.66, 95% CI: 0.49-0.90). Both prasugrel and ticagrelor reduced ST as compared to clopidogrel and aspirin for 12 months. CONCLUSIONS Different DAPT strategies yield similar risk of MACE, major bleeding, death and stroke in ACS patients. Prasugrel and aspirin for 12 months proved to be the most effective strategy regarding ST and MI.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Ovidio DE Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy -
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giulia DE Lio
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pier P Bocchino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Francesco Melillo
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Alaide Chieffo
- Unit of Interventional Cardiology, Department of Cardiology and Cardiothoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gaetano M de Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
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Franchin L, Piroli F, Demola P, Mantovani F, Iannaccone M, Manfredi R, D’Ascenzo F, Fortuni F, Ugo F, Meucci F, Navazio A, Boccuzzi G. Efficacy and safety of left atrial appendage closure compared with oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials and propensity-matched studies. Front Cardiovasc Med 2023; 10:1212161. [PMID: 37829693 PMCID: PMC10565038 DOI: 10.3389/fcvm.2023.1212161] [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: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Backgrounds Two recent randomized controlled trials (RCTs), the PROTECT-AF and the PREVAIL, showed that in atrial fibrillation (AF) patients, left atrial appendage closure (LAAC) is comparable to oral anticoagulants (OAC) in the prevention of stroke and could also possibly reduce mortality. Nevertheless, this net clinical benefit was not confirmed in the most recent RCT comparing LAAC vs. OAC, the PRAGUE-17 trial. Aim aim of the present study was to evaluate the efficacy and safety of LAAC compared with OAC among available high-quality studies. Methods A systematic search of electronic databases (Medline, Scopus, Embase and the Cochrane Library) was performed to identify eligible RCTs and observational studies with propensity score matching (PSM) analysis. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Outcomes of interest were the occurrence of cardiovascular death (CVD), all-cause death, all-type stroke, and major bleedings. Results A total of 3 RCTs and 7 PMS studies involving 25,700 patients were identified. 12,961 patients received LAAC while 12,739 received OAC therapy. After a median follow-up of 2.6 years (IQR 2-4.4), patients who received LAAC had lower risk of CVD (RR = 0.62; 95%CI, 0.51-0.74, I2 = 0%), all-cause death (RR = 0.67; 95% CI, 0.57-0.78, I2 68%) and major bleedings (RR = 0.68; 95%CI, 0.48-0.95 I2 = 87%) compared with patients on OAC. No difference was found between the two groups regarding strokes incidence (RR = 0.94; 95% CI, 0.77-1.15, I2 = 0%). Conclusions According to this meta-analysis, LAAC has comparable efficacy in the prevention of stroke compared with OAC and a reduced risk of major bleedings, all-cause death and CVD that may be even larger with longer follow-up. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269768, identifier CRD42021269768.
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Affiliation(s)
- Luca Franchin
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesco Piroli
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Demola
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Roberto Manfredi
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti”, Ancona, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medicine, A.O.U Città Della Salute e Della Scienza, Turin, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Fabrizio Ugo
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Alessandro Navazio
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giacomo Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
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Vairo A, Manai R, Gaiero L, Desalvo P, Bellettini M, Zaccaro L, Rinaudo A, Franchin L, Piroli F, Bruno F, Sebastiano V, Cura Stura E, Barbero C, Marro M, Faletti R, Alunni G, De Ferrari GM, Rinaldi M, Salizzoni S. Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure. Innovations (Phila) 2023; 18:331-337. [PMID: 37534404 DOI: 10.1177/15569845231185346] [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] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Transventricular beating-heart mitral valve repair (TBMVR) with artificial chordae implantation is a technique to treat mitral valve prolapse. Two-dimensional (2D) echocardiography completed with simultaneous biplane view during surgeon finger pushing on the left ventricular (LV) wall (finger test [FT]) is currently used to localize the desired LV access, on the inferior-lateral wall, between the papillary muscles (PMs). We aimed to compare a new three-dimensional (3D) method with conventional FT in terms of safety and better localization of LV access. METHODS During TBMVR, conventional FT was completed using 3D transesophageal echocardiography by placing the sample box in the bicommissural view of the LV, including the PMs and the apex. The 3D volume was subsequently edited to visualize the LV from above (surgical view) to localize the bulge of the operator's finger pushing on the LV. We asked the first operator, the second operator, and the cardiac surgery fellow, separately, to evaluate the location of their finger pushing, both with the 2D method and the 3D method, to estimate the interoperator concordance. RESULTS From 2019 to 2021, 42 TBMVRs were performed without complications related to access using FT completed with the 3D method. Regarding the choice of the right and safe entry site, the operator's agreement was higher using 3D rendering compared with conventional FT (mean agreement 0.59 ± 0.29 for 2D vs 0.83 ± 0.20 for 3D), while full operator agreement was 10 of 42 for 2D and 23 of 42 for 3D (P = 0.004). CONCLUSIONS Three-dimensional FT is easy to perform and facilitates surgeons choosing the best access for TBMVR in term of anatomical localization and safety.
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Affiliation(s)
- Alessandro Vairo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Rossella Manai
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Lorenzo Gaiero
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Paolo Desalvo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Matteo Bellettini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Lorenzo Zaccaro
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Andrea Rinaudo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Viviana Sebastiano
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Erik Cura Stura
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Cristina Barbero
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Matteo Marro
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Riccardo Faletti
- Division of Radiology, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Gianluca Alunni
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Italy
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Angriman F, Franchin L, Piroli F, Imazio M. Machine learning to identifying patients with pulmonary hypertension: Hope or hype? Int J Cardiol 2023; 376:172-173. [PMID: 36746200 DOI: 10.1016/j.ijcard.2023.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Federico Angriman
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Franchin
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Francesco Piroli
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Imazio
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Piroli F, Boccellino A, Ingallina G, Rolando M, Melillo F, Ancona F, Stella S, Biondi F, Palmisano A, Esposito A, Denti P, Montorfano M, Maisano F, Castiglioni A, Agricola E. Feasibility and reliability of comprehensive three-dimensional transoesophageal echocardiography screening process for transcatheter mitral valve replacement. Eur Heart J Cardiovasc Imaging 2023:7043512. [PMID: 36797650 PMCID: PMC10364620 DOI: 10.1093/ehjci/jead015] [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: 12/11/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/18/2023] Open
Abstract
AIMS The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transoesophageal echocardiography (TOE) are lacking. We evaluated the feasibility and reliability of a comprehensive 3D-TOE screening in TMVR candidates. METHODS AND RESULTS We performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TOE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT), and predicted neo-LVOT acquired with CT and 3D-TOE were compared using a novel semi-automated software for post processing analysis (3 mensio Structural Heart 10.1-3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions. Among 72 patients screened, all patients had adequate image quality for 3D-TOE analysis. 3D-TOE and CT measurements for AML length (r = 0.97), MA area (r = 0.90), perimeter (r = 0.68), anteroposterior (r = 0.88), and posteromedial-anterolateral (r = 0.74) diameters were found highly correlated, as well as for native LVOT (r = 0.86) and predicted neo-LVOT areas (r = 0.96) (all P-values <0.0001). An almost perfect agreement between CT and 3DTOE was found in assessing the eligibility for TMVR implantation (Cohen kappa 0.83, P < 0.001). CONCLUSION 3D-TOE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success.
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Affiliation(s)
- Francesco Piroli
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Antonio Boccellino
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Marco Rolando
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Federico Biondi
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Anna Palmisano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Antonio Esposito
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Paolo Denti
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Matteo Montorfano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Francesco Maisano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Alessandro Castiglioni
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
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Gallone G, Islas F, Gorla R, Melillo F, Leone PP, Cimaglia P, Pastore MC, Franzone A, Landra F, Bruno F, Scudeler L, Jimenez-Quevedo P, Viva T, Piroli F, Bragato R, Trichilo M, Degiovanni A, Ilardi F, Andreis A, Nombela-Franco L, Maurizio T, Toselli M, Conrotto F, Montorfano M, Manzo R, Cameli M, Patti G, Stefanini G, Testa L, Giannini F, Agricola E, Escaned J, D'Ascenzo F, De Ferrari GM. Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR. Eur Heart J Cardiovasc Imaging 2023:7031091. [PMID: 36752044 DOI: 10.1093/ehjci/jead018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023] Open
Abstract
AIMS The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS. METHODS AND RESULTS Patients were categorized according to SVi (<35 mL/m2) and FR (<200 mL/s). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor [SVi: hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.85-1.82, FR: HR 0.78, 95% CI 0.48-1.27]. Among 731 patients undergoing early (5 days, interquartile range 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low flow. Reduced FR following TAVR was an independent predictor of mortality (HR 1.67, 95% CI 1.02-2.74), whereas SVi was not (HR 0.97, 95% CI 0.53-1.78). Three-year estimated mortality in patients with recovered FR was lower than that in patients with reduced FR (13.3 vs. 37.7% vs, P = 0.003) and similar to that in patients with normal baseline FR (P = 0.317). CONCLUSION Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Melillo
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Paolo Cimaglia
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita";, L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Federico Landra
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luca Scudeler
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tommaso Viva
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Piroli
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Renato Bragato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Michele Trichilo
- Division of Cardiology, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Italy
| | - Anna Degiovanni
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tusa Maurizio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Marco Toselli
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Matteo Montorfano
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Giuseppe Patti
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Giannini
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Eustachio Agricola
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
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8
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Kim JH, Franchin L, Hong SJ, Cha JJ, Lim S, Joo HJ, Park JH, Yu CW, Lim DS, Filippo OD, Gwon HC, Piroli F, Kim HS, Wanha W, Choi KH, Song YB, Patti G, Nam CW, Bruno F, Kang J, Bocchino PP, De Ferrari GM, Koo BK, D’Ascenzo F. Two-Year clinical outcomes after coronary bifurcation stenting in older patients from Korea and Italy. Front Cardiovasc Med 2023; 10:1106594. [PMID: 37034327 PMCID: PMC10076885 DOI: 10.3389/fcvm.2023.1106594] [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: 11/23/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Older patients who treated by percutaneous coronary intervention (PCI) are at a higher risk of adverse cardiac outcomes. We sought to investigate the clinical impact of bifurcation PCI in older patients from Korea and Italy. Methods We selected 5,537 patients who underwent bifurcation PCI from the BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion regisTries) database. The primary outcome was a composite of target vessel myocardial infarction, clinically driven target lesion revascularization, and stent thrombosis at two years. Results In patients aged ≥75 years, the mean age was 80.1 ± 4.0 years, 65.2% were men, and 33.7% had diabetes. Older patients more frequently presented with chronic kidney disease (CKD), severe coronary calcification, and left main coronary artery disease (LMCA). During a median follow-up of 2.1 years, older patients showed similar adverse clinical outcomes compared to younger patients (the primary outcome, 5.7% vs. 4.5%; p = 0.21). Advanced age was not an independent predictor of the primary outcome (p = 0.93) in overall patients. Both CKD and LMCA were independent predictors regardless of age group. Conclusions Older patients (≥75 years) showed similar clinical outcomes to those of younger patients after bifurcation PCI. Advanced age alone should not deter physicians from performing complex PCIs for bifurcation disease.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Correspondence: Soon Jun Hong
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Giuseppe Patti
- Department of Thoracic and Cardiovascular Diseases, Maggiore Della Carita Hospital, Novara, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
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9
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Boccellino A, Piroli F, Ingallina G, Rolando M, Melillo F, Francesco A, Stella S, Biondi F, Baldetti L, Palmisano A, Esposito A, Denti P, Montorfano M, Maisano F, Castiglioni A, Agricola E. 1032 FEASIBILITY AND RELIABILITY OF COMPREHENSIVE THREE DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY SCREENING PROCESS FOR TRANSCATHETER MITRAL VALVE REPLACEMENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.162] [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
The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transesophageal echocardiography (TEE) are lacking.
Aims
To evaluate the feasibility and reliability of a comprehensive 3D-TEE screening in TMVR candidates.
Methods
we performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TEE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT) and predicted neo-LVOT acquired with CT and 3DTEE were compared using a novel semi-automated software for post processing analysis (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions.
Results
Among 72 patients screened, all patients had adequate image quality for 3D-TEE analysis. 3D-TEE and CT measurements for AML length (r=0.97), MA area (r=0.90), perimeter (r=0.68), anteroposterior (r=0.88) and posteromedial-anterolateral (r=0.74) diameters were found highly correlated, as well as for native LVOT (r=0.86) and predicted neo-LVOT areas (r=0.96) (all P -values <0.0001). An almost perfect agreement among CT and 3d TEE was found in assessing the eligibility for TMVR implantation (Cohen Kappa 0.83, p<0.001).
Conclusions
3D-TEE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success.
Central Illustration. Mitral annulus segmentation and neo-LVOT area measurement performed by means of the 3mensio software (Pie Medical Imaging, Bilthoven, Netherlands) in a step-by-step fashion by TEE and CT imaging. After the virtual simulation of a valve implantation, the minimal systolic neo-LVOT area is manually measured by planimetry on a plane orthogonal to the centerline.
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Affiliation(s)
- Antonio Boccellino
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Francesco Piroli
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Marco Rolando
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Ancona Francesco
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Federico Biondi
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Luca Baldetti
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Anna Palmisano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Antonio Esposito
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Paolo Denti
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Matteo Montorfano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Francesco Maisano
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Alessandro Castiglioni
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Irccs San Raffaele Scientific Institute , Milan , Italy
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10
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Patti G, D'Ascenzo F, De Filippo O, Bruno F, Leonardi S, Chieffo A, Iannaccone M, Liebetrau C, Manzano-Fernández S, Gallone G, Omedè P, Cerrato E, Kinnaird T, Conrotto F, Piroli F, Henriques JPS, Wańha W, Elia E, Dominguez-Rodriguez A, Raposeiras-Roubin S, Abu-Assi E, De Ferrari GM. Safety and efficacy of different P2Y12 inhibitors in patients with acute coronary syndromes stratified by the PRAISE risk score: a multicentre study. Eur Heart J Qual Care Clin Outcomes 2022; 8:881-891. [PMID: 35022719 DOI: 10.1093/ehjqcco/qcac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/29/2022]
Abstract
AIMS To establish the safety and efficacy of different dual antiplatelet therapy (DAPT) combinations in patients with acute coronary syndrome (ACS) according to their baseline ischaemic and bleeding risk estimated with a machine learning derived model [machine learning-based prediction of adverse events following an acute coronary syndrome (PRAISE) score]. METHODS AND RESULTS Incidences of death, re-acute myocardial infarction (re-AMI), and Bleeding Academic Research Consortium 3-5 bleeding with aspirin plus different P2Y12 inhibitors (clopidogrel or potent P2Y12 inhibitors: ticagrelor or prasugrel) were appraised among patients of the PRAISE data set grouped in four subcohorts: low-to-moderate ischaemic and bleeding risk; low-to-moderate ischaemic risk and high bleeding risk; high ischaemic risk and low-to-moderate bleeding risk; and high ischaemic and bleeding risk. Hazard ratios (HRs) for the outcome measures were derived with inverse probability of treatment weighting adjustment. Among patients with low-to-moderate bleeding risk, clopidogrel was associated with higher rates of re-AMI in those at low-to-moderate ischaemic risk [HR 1.69, 95% confidence interval (CI) 1.16-2.51; P = 0.006] and increased risk of death (HR 3.2, 1.45-4.21; P = 0.003) and re-AMI (HR 2.23, 1.45-3.41; P < 0.001) in those at high ischaemic risk compared with prasugrel or ticagrelor, without a difference in the risk of major bleeding. Among patients with high bleeding risk, clopidogrel showed comparable risk of death, re-AMI, and major bleeding vs. potent P2Y12 inhibitors, regardless of the baseline ischaemic risk. CONCLUSION Among ACS patients with non-high risk of bleeding, the use of potent P2Y12 inhibitors is associated with a lower risk of death and recurrent ischaemic events, without bleeding excess. Patients deemed at high bleeding risk may instead be safely addressed to a less intensive DAPT strategy with clopidogrel.
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Affiliation(s)
- Giuseppe Patti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Sergio Leonardi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Hospital, Milan, Italy
| | | | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | - Guglielmo Gallone
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, San Luigi Hospital, Rivoli, Italy
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - Federico Conrotto
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | | | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Edoardo Elia
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
| | | | | | - Emad Abu-Assi
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Gaetano Maria De Ferrari
- Division of Cardiology, University of Turin A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 85, 10126 Turin, Italy
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11
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Gallone G, Elia E, Bruno F, Angelini F, Franchin L, Bocchino PP, Piroli F, Annone U, Montabone A, Marengo G, Bertaina M, De Filippo O, Baldetti L, Palmisano A, Serafini A, Esposito A, Depaoli A, D’ascenzo F, Fonio P, De Ferrari GM. Impacto de los tratamientos hipolipemiantes en los resultados cardiovasculares según la puntuación de calcio coronario. Revisión sistemática y metanálisis. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.07.017] [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: 11/25/2022]
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12
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Gallone G, Elia E, Bruno F, Angelini F, Franchin L, Bocchino PP, Piroli F, Annone U, Montabone A, Marengo G, Bertaina M, De Filippo O, Baldetti L, Palmisano A, Serafini A, Esposito A, Depaoli A, D'ascenzo F, Fonio P, De Ferrari GM. Impact of lipid-lowering therapies on cardiovascular outcomes according to coronary artery calcium score. A systematic review and meta-analysis. Rev Esp Cardiol (Engl Ed) 2022; 75:506-514. [PMID: 34483065 DOI: 10.1016/j.rec.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Coronary artery calcium (CAC) score improves the accuracy of risk stratification for atherosclerotic cardiovascular disease (ASCVD) events compared with traditional cardiovascular risk factors. We evaluated the interaction of coronary atherosclerotic burden as determined by the CAC score with the prognostic benefit of lipid-lowering therapies in the primary prevention setting. METHODS We reviewed the MEDLINE, EMBASE, and Cochrane databases for studies including individuals without a previous ASCVD event who underwent CAC score assessment and for whom lipid-lowering therapy status stratified by CAC values was available. The primary outcome was ASCVD. The pooled effect of lipid-lowering therapy on outcomes stratified by CAC groups (0, 1-100,> 100) was evaluated using a random effects model. RESULTS Five studies (1 randomized, 2 prospective cohort, 2 retrospective) were included encompassing 35 640 individuals (female 38.1%) with a median age of 62.2 [range, 49.6-68.9] years, low-density lipoprotein cholesterol level of 128 (114-146) mg/dL, and follow-up of 4.3 (2.3-11.1) years. ASCVD occurrence increased steadily across growing CAC strata, both in patients with and without lipid-lowering therapy. Comparing patients with (34.9%) and without (65.1%) treatment exposure, lipid-lowering therapy was associated with reduced occurrence of ASCVD in patients with CAC> 100 (OR, 0.70; 95%CI, 0.53-0.92), but not in patients with CAC 1-100 or CAC 0. Results were consistent when only adjusted data were pooled. CONCLUSIONS Among individuals without a previous ASCVD, a CAC score> 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy.
| | - Edoardo Elia
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Umberto Annone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Andrea Montabone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Giorgio Marengo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Maurizio Bertaina
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- Department of Radiology and Experimental Imaging Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Esposito
- Department of Radiology and Experimental Imaging Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Depaoli
- Department of Radiology, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Paolo Fonio
- Department of Radiology, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
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13
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Desalvo P, Vairo A, Piroli F, Gaiero L, Fioravanti F, De Lio F, Bellettini M, Montali N, Alunni G, Giustetto C, De Ferrari G. C39 ECHOCARDIOGRAPHIC PREDICTORS OF MALIGNANT EVENTS IN ARRHYTHMIC MITRAL VALVE PROLAPSE POPULATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Bileaflet mitral valve prolapse (bMVP) has been linked to major arrhythmic events and sudden cardiac death (SCD). Solid evidence of consistent predictors of SCD in this setting is still lacking. Echocardiography is the best tool for the analysis of ventricle mechanics and for the correlation with electrical myocardial activation. The aim of this study was to find new predictors of malignant events within an arrhythmic MVP population.
Methods
We conducted a retrospective comparative analysis, selecting 22 patients with bMVP with a high arrhythmic risk profile. 6 of them had a previous major arrhythmic event (5 aborted SCD, one cardiogenic syncope) and previously received ICD implantation (ICD–MVP), while 16 presented with a high arrhythmic burden without major events (A–MVP). All patients underwent transthoracic echocardiography in the last year. Each echocardiogram followed a specific protocol focused on mitral valve anatomy and ventricular contraction using 2D imaging, 3D imaging, tissue doppler imaging and speckle tracking analysis.
Results
ICD–MVP group, compared with A–MVP group, presented a longer anterior leaflet (AML) length (28,6 mm, IQR: 24,1–31,1 mm; vs 21,4 mm, IQR: 20,4–24,0 mm; p = 0,03), larger mitral valve annulus (MVA) indexed area (6,88 cm2/m2, IQR 6,27–7,87 cm2/m2 vs 5,44 cm2/m2, IQR: 4,93–6,15 cm2/m2, p = 0,02), lower MVA anteroposterior diameter/AML length ratio (1,24, IQR: 1,21–1,41 vs 1,50, IQR 1,32–1,62; p = 0,049), higher inferolateral basal S3 velocity (26 cm/s, IQR: 20,8–29,6 cm/s vs 14,2 cm/s, IQR 10,1–21,3 cm/s; p = 0,02) and a greater mechanical dispersion (MD) of the basal and mid–ventricular segments calculated with speckle tracking (128 ms, IQR: 125–131 ms; vs 58 ms, IQR 45–106 ms; p = 0,03). Mitral regurgitation grading, instead, did not correlate with malignant events. Best predictors of malignant events were AML length and MD of basal and mid–ventricular segments. Cut–off values with highest sensibility and specificity above 80% were 26 mm for AML length and 122 ms for MD of basal and mid–ventricular segments. Logistic bivariate regression confirmed AML length as an independent predictor of malignant events (p = 0,01), while MD of basal and mid–ventricular segments showed a trend toward significancy (p = 0,07).
Conclusion
Five parameters were found to be predictors of malignant events in a high–risk MVP population. AML length and MD of the basal and mid–ventricular segments presented the best predictive value.
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Affiliation(s)
- P Desalvo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - A Vairo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - F Piroli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - L Gaiero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - F Fioravanti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - F De Lio
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - M Bellettini
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - N Montali
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - G Alunni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - C Giustetto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO
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14
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Gaiero L, Vairo A, Fioravanti F, Piroli F, Gallone G, D‘Ascenzo F, Desalvo P, Marro M, Sebastiano V, Alunni G, De Ferrari G, Rinaldi M, Salizzoni S. P102 NEW THREE–DIMENSIONAL ECHOCARDIOGRAPHIC PREDICTING PARAMETERS IN TRANS–VENTRICULAR HEART–BEATING MITRAL VALVE REPAIR WITH NEOCHORDAE: A MONOCENTRIC RETROSPECTIVE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Trans–ventricular off pump mitral valve (MV) repair with neochordae implantation (Neochord procedure) is a minimally invasive surgical technique for correction of degenerative mitral regurgitation (MR) due to prolapse or flail. The aim of this study was to evaluate mid–term results of patients undergoing this procedure and find new three–dimensional pre–operative echocardiographic parameters to predict MR recurrence at follow–up.
Methods
We performed a retrospective analysis of 72 consecutive patients with severe MR due to prolapse or flail who underwent Neochord procedure at our hospital from March 2015 to February 2021. MV pre–operative anatomical parameters were assessed using 2D TEE, 3D TEE and dedicated three–dimensional (3D) post–processing analysis with dedicated software (QLAB, Philips). TTE follow–up and clinical evaluation were performed at 3 months, 6 months, 1 year and then annually.
Results
Twenty–seven patients were female (37.5%), mean age was 77±9 years. The average preoperative EuroSCORE II was 2.2%±1.5%. Twenty–three patients (32%) had an history of paroxysmal or persistent atrial fibrillation. Procedural success at discharge was achieved in sixty–eight patients (94.5%). Mean follow–up was 30±16 months. Three years follow–up was completed by fifty patients. At three years thirteen patients (26%) presented with recurrence of severe MR or underwent new surgical operation. Prevalence of mild or trace MR at three years follow–up visit was 70%. End–systolic annulus area (12.5±2.5 cm2 vs 14.1±2.6 cm2; p = 0.038), end–systolic annulus diameter (13.2±1.2 cm vs 14±1.3 cm; p = 0.042) and indexed left atrial volume (59±17 ml/m2 vs 76±37 ml/m2; p = 0.041) were lower in patients with residual MR less than moderate (MR < 3+/4+). Three–dimensional indexes specifically focused on coaptation reserve and annular disfunction were the best predictors of MR < 3+/4+ at follow–up, in particular diastolic sum of the leaflets/end–systolic annulus area ([AUC] 0.74; p = 0.029) and systo–diastolic annulus area fractional change ([AUC] 0.743; p = 0.035). Furthermore, each of these annular parameters, calculated using dedicated 3D software, were predictive of residual MR, whereas annular 2D dimensions were not (p = 0.347).
Conclusion
In patients with degenerative MR treated with Neochord procedure, 3D analysis focused on annular measures and coaptation indexes, that included 3D annular dimensions, predicts better MR relapse than conventional 2D parameters.
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Affiliation(s)
- L Gaiero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - A Vairo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - F Fioravanti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - F Piroli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - F D‘Ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - P Desalvo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - M Marro
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - V Sebastiano
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - G Alunni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - M Rinaldi
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
| | - S Salizzoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; OSPEDALE GIOVANNI BOSCO, TORINO; CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO
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15
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Piroli F, Boccellino A, Ingallina G, Rolando M, Melillo F, Ancona F, Stella S, Biondi F, Denti P, Castiglioni A, Agricola E. 763 Feasibility and reliability of a comprehensive three-dimensional transesophageal echocardiography screening process for transcatheter mitral valve replacement. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The planning of transcatheter mitral valve replacement (TMVR) requires cardiac imaging assessment to establish patient eligibility according to mitral valve anatomy, device characteristics and risk of left ventricular outflow tract (LVOT) obstruction. In this setting, computed tomography (CT) is considered the reference method. Although recent studies demonstrated that three-dimensional transesophageal echocardiographic (3D-TEE) assessment of mitral anatomy presents a good agreement compared to CT, its potential role in the TMVR planning has never been fully evaluated. To test feasibility and reliability of a comprehensive 3D-TEE screening in candidates for TMVR.
Methods
We performed a single-centre retrospective observational study including 59 consecutive patients referred to our centre for TMVR due to high surgical risk, who performed a pre procedural CT and 3D-TEE screening. The measurements of mitral annulus (MA), native LVOT and predicted Neo-LVOT, assessed with CT and 3D-TEE were collected in order to evaluate their concordance in the assessment of TMVR eligibility. The final suitability decision was given by the valve manufacturer based on CT measurements and then compared with the screening results obtained with 3D-TEE evaluation. 3D-TEE measurements were obtained with a post processing analysis using a novel automated software platform (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands).
Results
Excellent correlation was found between 3D-TEE and CT measurements for MA area (r =0.85), antero-posterior diameters (r= 0.81), native LVOT (r=0.82) and Neo-LVOT areas (r=0.95) (all P-values <0.0001). Among 59 patients screened, 17 did not undergo the intervention because were found ineligible due to small predicted neo-LVOT, too small or too large MA area. Among the 42 patients with a successful screening, 32 underwent TMVR and all of them showed a correct implantation and no LVOT obstruction at post procedural echocardiographic evaluation. An almost perfect agreement among CT and 3D-TEE was found in assessing the eligibility for TMVR implantation (Cohen kappa 0.82, P<0.001). Interobserver and intraobserver agreements were found excellent for the parameters appraised with ICCs >0.80.
Conclusions
3D-TEE appraisements of MA dimensions, native LVOT and Neo-LVOT are feasible in patients candidate for TMVR, showing good correlations with CT measurements and high accuracy to predict TMVR screening success.
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Affiliation(s)
- Francesco Piroli
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
- Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
| | - Antonio Boccellino
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Giacomo Ingallina
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Marco Rolando
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Melillo
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Ancona
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Stefano Stella
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Federico Biondi
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Paolo Denti
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Alessandro Castiglioni
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Eustachio Agricola
- Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
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16
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Gallone G, Depaoli A, D'Ascenzo F, Tore D, Allois L, Bruno F, Casale M, Atzeni F, De Lio G, Bocchino PP, Piroli F, Angelini F, Angelini A, Scudeler L, De Lio F, Andreis A, Salizzoni S, La Torre M, Conrotto F, Rinaldi M, Fonio P, De Ferrari GM. Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr 2021; 16:207-214. [PMID: 34896066 DOI: 10.1016/j.jcct.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/13/2021] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools. METHODS 391 consecutive TAVI patients with pre-procedural CT scan were included (81 ± 6 years, 57.5% male, STS-PROM score 4.4 ± 3.6%) and abdominal muscle retrospectively quantified. The two definitions of radiologic sarcopenia previously adopted in TAVI studies were compared (psoas muscle area [PMA] at the L4 vertebra level: "PMA-sarcopenia"; indexed skeletal muscle area at the L3 vertebra level: "SMI-sarcopenia"). The primary endpoint was longer available-term all-cause mortality. Secondary endpoints were Valve Academic Research Consortium-2-defined in-hospital and 30-day outcomes. RESULTS SMI- and PMA-sarcopenia were present in 192 (49.1%) and 117 (29.9%) patients, respectively. After a median of 24 (12-30) months follow-up, 83 (21.2%) patients died. PMA-(adj-HR 1.81, 95%CI 1.12-2.93, p = 0.015), but not SMI-sarcopenia (adj-HR 1.23, 95%CI 0.76-2.00, p = 0.391), was associated with all-cause mortality independently of age, sex and in-study outcome predictors (atrial fibrillation, hemoglobin, history of peripheral artery disease, cancer and subcutaneous adipose tissue). PMA-defined sarcopenia provided additive prognostic value over current post-TAVI mortality risk estimators including STS-PROM (p = 0.001), Euroscore II (p = 0.025), Charlson index (p = 0.025) and TAVI2-score (p = 0.020). Device success, early safety, clinical efficacy and 30-day all-cause death were unaffected by sarcopenia status regardless of definition. CONCLUSIONS PMA-sarcopenia (but not SMI-sarcopenia) is predictive of 2 year mortality among TAVI patients. The prognostic information provided by PMA-sarcopenia is independent of the tools currently adopted to predict post-TAVI mortality in clinical practice.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Alessandro Depaoli
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Luca Allois
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio Casale
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Atzeni
- Division of Cardiac Surgery, Department of Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Giulia De Lio
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Angelini
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Scudeler
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesca De Lio
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Michele La Torre
- Division of Cardiac Surgery, Department of Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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17
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Imazio M, Andreis A, Piroli F, Casula M, Paneva E, Avondo S, De Ferrari GM. Is colchicine safe for cardiovascular indications? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1209] [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
Background
Colchicine has an emerging role in the cardiovascular field (e.g. acute and chronic coronary syndromes, pericarditis, atrial fibrillation), although, concerns for side effects, especially gastrointestinal, may limit its prescription.
Aims
We aimed at evaluating reported side effects of colchicine for cardiovascular indications.
Methods
We performed a meta-analysis of published randomized controlled trials on colchicine for the treatment of cardiovascular diseases. Random-effects meta-analysis was used to assess the risk of adverse events and drug withdrawal. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity.
Results
Among 14 188 patients, 7136 patients received colchicine while the other 7052 received placebo. The occurrence of any adverse event with colchicine was reported in 15.3 vs. 13.9% patients [relative risk (RR) 1.26, 95% confidence interval (CI) 0.96–1.64, P=0.09, see figure]. Gastrointestinal events were reported in 16.1 vs. 12.2% (RR 2.16, 95% CI 1.50–3.12, P<0.001), while diarrhoea was reported in 12.5 vs. 8.1% (RR 2.77, 95% CI 1.55–4.94, P<0.001). The risk of gastrointestinal events increased with daily dose and shorter treatment duration. Myalgias were observed in 21 vs. 18% patients (RR 1.16, 95% CI 1.02–1.32, P=0.03). Other adverse events such as myotoxicity, hepatic adverse events, hematologic adverse events, cutaneous adverse events, infection or death were not increased by colchicine treatment. Colchicine discontinuation was reported in 4.8 vs. 3.4% patients (RR 1.54, 95% CI 1.20–1.99, P<0.001).
Conclusions
Colchicine is associated with increased risk of gastrointestinal events and myalgias, but not of other adverse events. The risk of gastrointestinal events may be avoided with lower dose (0.5 mg/daily) and is inversely related to treatment duration, possibly due to early drug discontinuation or drug tolerance.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - F Piroli
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - M Casula
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - E Paneva
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - S Avondo
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - G M De Ferrari
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
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18
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Abstract
Abstract
Background
Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition.
Purpose
This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.
Results
The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.
Conclusions
In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - F Piroli
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - G Lazaros
- Hippokration General Hospital, University Cardiology, Athens, Greece
| | - M Lewinter
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, United States of America
| | - A Klein
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - A Brucato
- Fatebenefratelli Hospital, Department of Biomedical and Clinical Sciences, Milan, Italy
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19
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Franchin L, Kang J, De Filippo O, Gwon HC, Piroli F, Kim HS, Wańha W, Song YB, Patti G, Hong SJ, Bruno F, Bocchino PP, De Ferrari GM, Koo BK, D'Ascenzo F. Incidence and Predictors of Stent Thrombosis in Patients Treated with Stents for Coronary Bifurcation Narrowing (From the BIFURCAT Registry). Am J Cardiol 2021; 156:24-31. [PMID: 34294409 DOI: 10.1016/j.amjcard.2021.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022]
Abstract
Percutaneous coronary interventions performed at coronary bifurcations yield high rates of stent thrombosis (ST). The aim of the present study was to investigate the predictors of ST in contemporary coronary bifurcation percutaneous coronary interventions. We retrospectively investigated the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry on coronary bifurcations to assess the incidence and predictors of definite ST, which were the study primary endpoints. Predictors of ST among patients on dual antiplatelet therapy (DAPT) were also examined. A total of 5330 patients were included. After a mean 2-years follow-up, 64 (1.2%) patients experienced ST. 42 (65.6%) ST patients were on DAPT. At multivariable analysis, age (HR 1.02, CI 1.01 to 1.05, p = 0,027), smoking status (HR 2.57, CI 1.49 to 4.44, p = 0.001), chronic kidney disease (HR 2.26, CI 1.24 to 4.12, p = 0.007) and a 2-stent strategy (HR 2.38, CI 1.37 to 4.14, p = 0.002) were independent predictors of ST, whereas intracoronary imaging (HR 0.42, CI 0.23 to 0.78, p = 0.006) and final kissing balloon (FKB) (HR 0.48, CI 0.29 to 0.82, p = 0.007) were protective against ST. Among patients on DAPT, smoking status and a 2-stent strategy significantly increased the risk of ST, while intracoronary imaging and FKB reduced the risk. In conclusion, age, smoking status, chronic kidney disease and a 2-stent strategy were significant predictors of ST, whereas intracoronary imaging use and FKB had a protective effect. Only smoking status and a 2-stent strategy significantly predicted ST in DAPT subgroup, while intracoronary imaging and FKB had a protective role.
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20
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De Filippo O, Di Franco A, Boretto P, Bruno F, Cusenza V, Desalvo P, Demetres M, Saglietto A, Franchin L, Piroli F, Marengo G, Elia E, Falk V, Conrotto F, Doenst T, Rinaldi M, De Ferrari GM, D'Ascenzo F, Gaudino M. Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01238-1. [PMID: 34538641 DOI: 10.1016/j.jtcvs.2021.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/10/2021] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparative data after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs distal) are scant. The aim of this meta-analysis was to investigate outcomes after PCI or CABG for ULMCA disease according to lesion site. METHODS Randomized controlled trials (RCTs) and adjusted observational studies that compared PCI versus CABG in patients with ULMCA disease and reported outcomes according to lesion site were systematically identified. Major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, stroke, and repeat revascularization) and all-cause death were the co-primary end points. Individual components of MACE were secondary end points. Sensitivity analysis including RCTs only were performed for each outcome. RESULTS Nine studies (3 RCTs, 6 adjusted observational), encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or distal ULMCA, respectively) were included. At the 5-year follow-up, there were no significant differences between CABG and PCI for MACE, death, or any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10 [95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95% CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The benefit of CABG for MACE and revascularization was confirmed in the analysis limited to RCTs, whereas the benefit for mortality was not. CONCLUSIONS Among patients with distal ULMCA disease, CABG is associated with lower incidence of MACE and revascularization compared with PCI, whereas no differences in outcomes were observed for ostial/shaft ULMCA disease.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Paolo Boretto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Vincenzo Cusenza
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Paolo Desalvo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences, Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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21
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Franchin L, Piroli F, D'Ascenzo F, Nuñez-Gil I, Wojakowski W, Imori Y, Trabattoni D, Huczek Z, Venuti G, Muscoli S, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Quadri G, Wańha W, Cortese B, De Filippo O, Ryan N, Varbella F, Sheiban I, Helft G, De Ferrari GM. Impact of stent thickness on clinical outcomes in small vessel and bifurcation lesions: a RAIN-CARDIOGROUP VII sub-study. J Cardiovasc Med (Hagerstown) 2021; 22:20-25. [PMID: 32740419 DOI: 10.2459/jcm.0000000000001037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The clinical impact of stent strut thickness in coronary bifurcation lesions in small vessels has not been assessed in a real-world population. METHODS All 506 patients enrolled in the RAIN study, undergoing PCI in a vessel with a diameter 2.5 mm or less were retrospectively evaluated and divided into two groups according to stent strut thickness: 74 μm (n = 206) versus 81 μm (n = 300); 87.1% of the lesions involved bifurcations. TLF [defined as a composite of myocardial infarction (MI) and target lesion revascularization (TLR)] was the primary endpoint, with MACE (a composite of death, MI and TLR), its components and stent thrombosis the secondary endpoint. RESULTS After 16 (14-18) months, a lower incidence of TLF (4.3 vs. 9.8%, P = 0.026) and ST (1.0 vs. 3.0%, P = 0.042) was seen in the 74 μm group, whereas MACE occurred in 60 of 506 patients, with no statistical difference between the two groups (9.7 vs. 13.3%, P = 0.070). At multivariate analysis, chronic renal failure increased the risk of TLF while thinner strut was an independent protective factor (hazard ratio 0.51, CI 0.17-0.85, P = 0.005). CONCLUSION In this real-world population, patients being treated for small vessels lesions with thinner strut stents had lower rates of TLF, MI and ST.
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Affiliation(s)
- Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Ivan Nuñez-Gil
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Cardio-thoracic-vascular Department, A.O.U. 'Vittorio Emanuele' Hospital, University of Catania, Catania
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome
| | | | - Andrea Rognoni
- Division of Cardiology, Maggiore della Carità Hospital, Novara
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Nicola Ryan
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | | | - Gerard Helft
- Sorbonne Université, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
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22
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Imazio M, Andreis A, Piroli F, Lazaros G, Gattorno M, Lewinter M, Klein AL, Brucato A. Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis. Heart 2021; 107:1240-1245. [PMID: 33737453 DOI: 10.1136/heartjnl-2020-318869] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/19/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition. This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting. METHODS We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis. RESULTS The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12-39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events. CONCLUSIONS In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.
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Affiliation(s)
- Massimo Imazio
- University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Alessandro Andreis
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Piroli
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - George Lazaros
- Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Marco Gattorno
- Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Giannina Gaslini, Genova, Liguria, Italy
| | - Martin Lewinter
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Allan L Klein
- Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, University of Milan, Milano, Italy
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23
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De Filippo O, Piroli F, Bruno F, Bocchino PP, Saglietto A, Franchin L, Angelini F, Gallone G, Alabed S, Gasparini M, Ahmad M, De Ferrari GM, D'Ascenzo F. De-escalation of dual antiplatelet therapy for patients with acute coronary syndrome after percutaneous coronary intervention: a network meta-analysis of randomised controlled trials. Hippokratia 2021. [DOI: 10.1002/14651858.cd014813] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Luca Franchin
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine; University of Turin; Turin Italy
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease; University of Sheffield; Sheffield UK
| | - Mauro Gasparini
- Dipartimento di Scienze Matematiche (DISMA); Giuseppe Luigi Lagrange, Politecnico di Torino; Torino Italy
| | - Mahmood Ahmad
- Department of Cardiology; Royal Free Hospital, Royal Free London NHS Foundation Trust; London UK
| | | | - Fabrizio D'Ascenzo
- Department of Internal Medicine; Division of Cardiology, University of Turin; Turin Italy
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24
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Bruno F, D'Ascenzo F, Marengo G, Manfredi R, Saglietto A, Gallone G, Franchin L, Piroli F, Angelini F, De Filippo O, Conrotto F, Omedè P, Montefusco A, Pennone M, Boffini M, Pocar M, Rinaldi M, De Ferrari GM. Fractional flow reserve guided versus angiographic guided surgical revascularization: A meta-analysis. Catheter Cardiovasc Interv 2021; 98:E18-E23. [PMID: 33315297 DOI: 10.1002/ccd.29427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/25/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical benefits of FFR (Fraction Flow Reserve) driven CABG (Coronary Artery Bypass Graft) remain to be established. METHODS All randomized controlled trials (RCTs) and observational studies with multivariable adjustement were included. MACE (Major Adverse Cardiac Events) was the primary end point, while its single components (death, myocardial infarction, and total vessel revascularization [TVR]) along with number of anastomoses, on pump procedures and graft occlusion at angiographic follow-up were the secondary ones. Each analysis was stratified for RCTs versus observational studies. RESULTS Four studies (two RCTs and two observational) were included, enrolling 983 patients, 542 angio-guided and 441 FFR-guided. Mean age was 68.45 years, 79% male, with a mean EuroSCORE I of 2.7. Coronary lesions were located in 37% of patients in the left anterior descending artery, 32% in the circumflex artery, and 26% in the right coronary artery. After a mean follow-up of 40 months, risk of MACE did not differ (OR 0.86 [0.63-1.18]) as that of all cause death (OR 0.86 [0.59-1.25]), MI (OR 0.57 [0.30-1.11]) and TVR (OR 1.10 [0.65-1.85]). FFR-driven CABG reduced on-pump procedures (OR 0.58 [0.35-0.93]) and number of anastomoses (-0.40 [-0.80: -0.01]) while incidence of graft occlusion at follow-up did not differ (OR 0.59 [0.30-1.15], all CI 95%). CONCLUSION Fraction flow reserve driven CABG reduced the number of anastomoses and of on-pump procedures without increasing risk of MACE and without reducing graft occlusion at angiographic follow-up. ID CRD42020211945.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Roberto Manfredi
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Massimo Boffini
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Marco Pocar
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
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25
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Imazio M, Andreis A, Agosti A, Piroli F, Avondo S, Casula M, Paneva E, Squarotti GB, Giustetto C, De Ferrari GM. Usefulness of Beta-Blockers to Control Symptoms in Patients With Pericarditis. Am J Cardiol 2021; 146:115-119. [PMID: 33539856 DOI: 10.1016/j.amjcard.2021.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/15/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 02/01/2023]
Abstract
Exercise restriction is a nonpharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR. Aim of this paper is to explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis. We analyzed consecutive cases with pericarditis referred to our center. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR>75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months. A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral etiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p<0.001). Using propensity-score matched cohorts, patients treated with beta-blockers had a lower frequency of symptoms persistence at 3 weeks (respectively 4% vs. 14%; p = 0.024) and a trend towards a reduction of recurrences at 18 months (p = 0.069). In conclusion the use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control.
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Affiliation(s)
- Massimo Imazio
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Alessandro Andreis
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandra Agosti
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Piroli
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Avondo
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Casula
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elena Paneva
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Carla Giustetto
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Andreis A, Imazio M, Piroli F, Avondo S, Casula M, Paneva E, De Ferrari GM. Efficacy and safety of colchicine for the prevention of major cardiovascular and cerebrovascular events in patients with coronary artery disease: a systematic review and meta-analysis on 12 869 patients. Eur J Prev Cardiol 2021; 28:1916-1925. [PMID: 33779702 DOI: 10.1093/eurjpc/zwab045] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/09/2021] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022]
Abstract
AIMS The key role of inflammation in the pathogenesis of coronary artery disease (CAD) is an urgent call for innovative treatments. Several trials have proposed colchicine as a therapeutic option for secondary prevention in CAD patients but its utilization is hampered by fears about drug-related adverse events (DAEs) and conflicting evidences. The aim of this meta-analysis was to consolidate evidence on the efficacy and safety of colchicine for secondary prevention in patients with CAD. METHODS AND RESULTS A systematic search in electronic bibliographic databases of Medline, Scopus, Embase, and the Cochrane Library was performed to identify randomized controlled trials (RCTs) assessing the cardiovascular effects of colchicine in CAD patients, compared with placebo. Outcomes of interest were the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) and DAEs. Estimates were pooled using inverse-variance random-effects model. A total of 11 RCTs, including 12 869 patients, were identified as eligible. A total of 6501 patients received colchicine, while 6368 received placebo. After a median follow-up of 6 months (interquartile range, 1-16), patients receiving colchicine had a lower risk of MACCE [6% vs. 8.8%, relative risk (RR) = 0.67, 95% confidence interval (CI) 0.56-0.80, I2 = 19%], myocardial infarction (3.3% vs. 4.3%, RR = 0.76, 95% CI 0.61-0.96, I2 = 17%), coronary revascularization (2.9% vs. 4.2%, RR = 0.61, 95% CI 0.42-0.89, I2 = 40%), stroke (0.4% vs. 0.9%, RR = 0.48, 95% CI 0.30-0.77, I2 = 0%), hospitalization for cardiovascular cause (0.9% vs. 2.9%, RR = 0.32, 95% CI 0.12-0.87, I2 = 0%). Colchicine was associated with an increased risk of gastrointestinal DAEs (11% vs. 9.2%, RR = 1.67, 95% CI 1.20-2.34, I2 = 76%), myalgia (18% vs. 16%, RR = 1.16, 95% CI 1.02-1.32, I2 = 0%) and DAEs-related discontinuation (4.1% vs. 3%, RR = 1.54, 95% CI 1.02-2.32, I2 = 65%). However, gastrointestinal DAEs and discontinuation may be prevented with a lower daily dose. Colchicine did not increase the risk of cardiovascular death (0.7% vs. 1%, RR = 0.73, 95% CI 0.45-1.21, I2 = 14%), all-cause death (2% vs. 1.9%, RR = 1.01, 95% CI 0.71-1.43, I2 = 16%), or other DAEs. CONCLUSIONS The use of colchicine in patients with CAD is safe and efficacious for MACCE prevention.
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Affiliation(s)
- Alessandro Andreis
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Massimo Imazio
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Francesco Piroli
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Stefano Avondo
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Matteo Casula
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Elena Paneva
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
| | - Gaetano Maria De Ferrari
- Department of Cardiovascular and Thoracic, University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy
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Gallone G, D'Ascenzo F, Conrotto F, Costa F, Capodanno D, Muscoli S, Chieffo A, Yoichi I, Pennacchi M, Quadri G, Nuñez-Gil I, Bocchino PP, Piroli F, De Filippo O, Rolfo C, Wojakowski W, Trabattoni D, Huczek Z, Venuti G, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Boccuzzi G, Mattesini A, Cerrato E, Wańha W, Smolka G, Cortese B, Ryan N, Bo M, di Mario C, Varbella F, Burzotta F, Sheiban I, Escaned J, Helft G, De Ferrari GM. Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations. Catheter Cardiovasc Interv 2021; 97:E227-E236. [PMID: 32438488 DOI: 10.1002/ccd.28972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/01/2019] [Revised: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. METHODS The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. RESULTS After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI. CONCLUSIONS In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Imori Yoichi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mauro Pennacchi
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Piroli F, Leone AM, Calcagno S. The role of chronic obstructive pulmonary disease in acute coronary syndrome patients: a critical risk factor for lipid plaque burden? Minerva Cardiol Angiol 2021; 69:735-737. [PMID: 33427427 DOI: 10.23736/s2724-5683.20.05555-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Antonio M Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Calcagno
- Unit of Intensive Care, Hemodynamics, and Cardiology, S. Maria Goretti Hospital, Latina, Italy
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Piroli F, Leone AM, Calcagno S. The role of chronic obstructive pulmonary disease in acute coronary syndrome patients: a critical risk factor for lipid plaque burden? Minerva Cardioangiol 2021. [PMID: 33427427 DOI: 10.23736/s0026-4725.20.05555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy -
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Calcagno
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
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Andreis A, Imazio M, Avondo S, Casula M, Paneva E, Piroli F, De Ferrari GM. Adverse events of colchicine for cardiovascular diseases: a comprehensive meta-analysis of 14 188 patients from 21 randomized controlled trials. J Cardiovasc Med (Hagerstown) 2021; 22:637-644. [PMID: 33399344 DOI: 10.2459/jcm.0000000000001157] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Colchicine has an emerging role in the cardiovascular field, although, concerns for side effects, especially gastrointestinal, limit its prescription. We aimed at evaluating reported side effects of colchicine for cardiovascular indications. METHODS We performed a meta-analysis of published randomized controlled trials on colchicine for the treatment of cardiovascular diseases. Random-effects meta-analysis was used to assess the risk of adverse events and drug withdrawal. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. RESULTS Among 14 188 patients, 7136 patients received colchicine while the other 7052 received placebo. The occurrence of any adverse event with colchicine was reported in 15.3 vs. 13.9% patients [relative risk (RR) 1.26, 95% confidence interval (CI) 0.96-1.64, P = 0.09]. Gastrointestinal events were reported in 16.1 vs. 12.2% (RR 2.16, 95% CI 1.50-3.12, P < 0.001), while diarrhea was reported in 12.5 vs. 8.1% (RR 2.77, 95% CI 1.55-4.94, P < 0.001). The risk of gastrointestinal events increased with daily dose and shorter treatment duration. Myalgias were observed in 21 vs. 18% patients (RR 1.16, 95% CI 1.02-1.32, P = 0.03). Other adverse events such as myotoxicity, hepatic adverse events, hematologic adverse events, cutaneous adverse events, infection or death were not increased by colchicine treatment. Colchicine discontinuation was reported in 4.8 vs. 3.4% patients (RR 1.54, 95% CI 1.20-1.99, P < 0.001). CONCLUSION Colchicine is associated with increased risk of gastrointestinal events and myalgias, but not of other adverse events. The risk of gastrointestinal events may be avoided with lower dose (0.5 mg/daily) and is inversely related to treatment duration, possibly due to early drug discontinuation or drug tolerance.
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Affiliation(s)
- Alessandro Andreis
- Department of Medical Sciences, University of Torino, University Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Franchin L, Vaira M, Piroli F, Angelini F, Elia E, Bocchino P, Conrotto F, D'Ascenzo F, Giustetto C, De Ferrari G. Anticoagulation with or without antiplatelet therapy after transcatheter aortic valve replacement, when less is more: a meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2595] [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
Background
About 40% of patients undergoing transcatheter aortic valve replacement (TAVR) have a history of atrial fibrillation (AF) and an additional 10% develop AF after TAVR. However, there is paucity of data regarding the optimal antithrombotic regimen following TAVR in patients with a clinical indication for oral anticoagulants (OAC).
Purpose
To compare the prognostic impact of OAC plus at least one antiplatelet agent (APT) versus OAC therapy alone in patients undergoing TAVR.
Methods
We systematically searched the literature for studies evaluating the comparative efficacy and safety of OAC + APT versus OAC alone in TAVR. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. All-cause mortality and cardiovascular mortality were the efficacy outcomes. Stroke and major bleeding, defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety outcome.
Results
Overall, 398 titles and abstracts were identified through database searching. Four observational studies were selected, for a total of 1929 patients. After a median follow-up of 18.5 months (IQR 11.3–29.3), OAC + APT increased major bleeding events compared to OAC alone (OR=1.79; 95% CI 1.21–2.66; P=0.004) with no difference in stroke (OR 01.02; 95% CI 0.52–2.01; P=0.95), all-cause mortality (OR=1.07; 95% CI 0.78–1.47; P=0.66) and cardiovascular mortality (OR=1.08; 95% CI 0.79–1.47; P=0.62).
Conclusion
A combination strategy of OAC + APT provides increased risk of bleeding compared to OAC therapy alone in patients undergoing TAVR with similar outcomes in terms of stroke, all-cause mortality and cardiovascular mortality; therefore, when feasible, it should be advised not to add APT on top of OAC therapy in patients without other clinical indications for APT treatment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Franchin
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - M.P Vaira
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Piroli
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Angelini
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - E Elia
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - P.P Bocchino
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Conrotto
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F D'Ascenzo
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - C Giustetto
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - G.M De Ferrari
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
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Piroli F, Franchin L, Errigo D, De Filippo O, D'Ascenzo F, De Ferrari G. The management of Atrioventricular Blocks in Tako-Tsubo Syndrome, a therapeutic dilemma? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0698] [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
Atrioventricular blocks (AVBs) are a rare complication of Tako-Tsubo syndrome (TTS). Acute management of these patients is still a matter of debate since the long-term outcomes are difficult to predict and a complete recovery after PPM implantation may occur.
Methods
A critical review of current literature focusing on PPM implantation time in this patients' cohort was performed after a patient with TTS and AVB received a PPM in our medical center with a subsequent complete recovery in one month.
Results
Twenty-four case-reports of TTS-related AVBs were collected. A total of five patients went through a complete AV conduction recovery within few days, while of nineteen patients receiving a PPM during hospitalization, three showed a complete recovery within one to three months and one after two years. In six cases an electrophysiology (EP) study was performed to assess the functional nature of the AVB, resulting in four supra-Hisian blocks and two infra-Hisian blocks. In the supra-Hisian group there was a conduction recovery in three cases in a period from few days to one month while only one patient didn't improve at three-months. On the other hand, in the infra-Hisian group only one patient recovered AV conduction after two years.
Conclusion
Infra-Hisian and supra-Hisian blocks appear to have different outcomes with the latter more likely to develop a faster recovery. EP study could be a useful tool for clinicians during decision-making process and a wait-and-see strategy may be considered to avoid unnecessary PPM implantations.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Piroli
- University of Turin, Turin, Italy
| | | | - D Errigo
- University of Turin, Turin, Italy
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Piroli F, Franchin L, Bruno F, De Filippo O, D’Ascenzo F, Conrotto F. New advances in the prevention of transcatheter aortic valve implantation failure: current and future perspectives. Kardiol Pol 2020; 78:842-849. [DOI: 10.33963/kp.15522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Piroli F, Angelini F, D'Ascenzo F, De Ferrari GM. Does lowering p value threshold to 0.005 impact on evidence-based medicine? An analysis of current European Society of Cardiology guidelines on STEMI. Eur J Intern Med 2020; 79:147-148. [PMID: 32505545 DOI: 10.1016/j.ejim.2020.05.036] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, University of Turin, Cittàdella Salute e dellaScienza Hospital, Turin, Italy.
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, University of Turin, Cittàdella Salute e dellaScienza Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Cittàdella Salute e dellaScienza Hospital, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, Cittàdella Salute e dellaScienza Hospital, Turin, Italy
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Lodi Rizzini M, Gallo D, De Nisco G, D'Ascenzo F, Chiastra C, Bocchino PP, Piroli F, De Ferrari GM, Morbiducci U. Does the inflow velocity profile influence physiologically relevant flow patterns in computational hemodynamic models of left anterior descending coronary artery? Med Eng Phys 2020; 82:58-69. [PMID: 32709266 DOI: 10.1016/j.medengphy.2020.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Patient-specific computational fluid dynamics is a powerful tool for investigating the hemodynamic risk in coronary arteries. Proper setting of flow boundary conditions in computational hemodynamic models of coronary arteries is one of the sources of uncertainty weakening the findings of in silico experiments, in consequence of the challenging task of obtaining in vivo 3D flow measurements within the clinical framework. Accordingly, in this study we evaluated the influence of assumptions on inflow velocity profile shape on coronary artery hemodynamics. To do that, (1) ten left anterior descending coronary artery (LAD) geometries were reconstructed from clinical angiography, and (2) eleven velocity profiles with realistic 3D features such as eccentricity and differently shaped (single- and double-vortex) secondary flows were generated analytically and imposed as inflow boundary conditions. Wall shear stress and helicity-based descriptors obtained prescribing the commonly used parabolic velocity profile were compared with those obtained with the other velocity profiles. Our findings indicated that the imposition of idealized velocity profiles as inflow boundary condition is acceptable as long the results of the proximal vessel segment are not considered, in LAD coronary arteries. As a pragmatic rule of thumb, a conservative estimation of the length of influence of the shape of the inflow velocity profile on LAD local hemodynamics can be given by the theoretical entrance length for cylindrical conduits in laminar flow conditions.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Giuseppe De Nisco
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Piroli
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Conrotto F, D'Ascenzo F, Piroli F, Franzé A, de Luca L, Quadri G, Ryan N, Escaned J, Bo M, De Ferrari GM. Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Catheter Cardiovasc Interv 2020; 97:755-763. [PMID: 32478451 DOI: 10.1002/ccd.29048] [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: 03/13/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients. METHODS All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones. RESULTS Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76-1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease. DISCUSSION Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Franzé
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Leonardo de Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Turin, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mario Bo
- Division of Geriatrics, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
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Bocchino PP, De Filippo O, Piroli F, Scacciatella P, Imazio M, D'Ascenzo F, De Ferrari GM. Anticoagulant and anti-thrombotic therapy in acute type B aortic dissection: when real-life scenarios face the shadows of the evidence-based medicine. BMC Cardiovasc Disord 2020; 20:29. [PMID: 31973746 PMCID: PMC6977351 DOI: 10.1186/s12872-020-01342-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based recommendations about anticoagulation in acute type B aortic dissection (TBAD) are completely missing, but there is a diffuse conviction that it could prevent the healing process of the dissected aorta’s false lumen. However, several clinical conditions may lead to the necessity to start anticoagulant therapy among patients with acute type B aortic dissection, ranging from atrial fibrillation to more complicated clinical scenarios and the correct management in this kind of patients is still an open issue. Case presentation We are presenting a 51-years-old man with multi-infarct encephalopathy referred to us for an acute TBAD and a first diagnosis of ischemic cardiomyopathy complicated by left ventricular (LV) thrombus formation. Coronary angiography revealed a critical stenosis of left anterior descending artery (LAD) treated with drug-eluting stent deployment. The patient was addressed to triple antithrombotic therapy with acetylsalicylic acid, clopidogrel and warfarin with target INR 2.0–2.5. After 6 months, computed tomography angiography revealed the stability of the dissection flap. Cardiac magnetic resonance imaging, however, confirmed the persistence of a small thrombotic formation in LV apex, thus double antithrombotic therapy with warfarin and clopidogrel was instituted. The patient remained asymptomatic during the follow-up period but was advised to suspend his job and physical activities. Conclusion Current guidelines do not discuss anticoagulant therapy in the setting of TBAD and large randomized trials are lacking. Despite it is generally considered unsafe to administer anticoagulants in patients with TBAD, we present a case in which triple antithrombotic therapy was well tolerated and did not lead to progression of the intimal flap after 6 months.
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Affiliation(s)
- Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Paolo Scacciatella
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Massimo Imazio
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
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De Filippo O, D'Ascenzo F, Piroli F, Budano C, De Ferrari GM. Sometimes neither water nor fire are more useful than friendship-a new risk score for prediction of contrast-induced nephropathy (CIN) and long-term adverse outcomes in patients undergoing coronary angiography. J Thorac Dis 2019; 11:2675-2679. [PMID: 31463091 DOI: 10.21037/jtd.2019.06.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza di Torino, Turin, Italy
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